Physical Activity and Health Outcomes

– in the House of Commons at 7:00 pm on 15th March 2022.

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Motion made, and Question proposed, That this House do now adjourn.—(Gareth Johnson.)

Photo of Andrew Selous Andrew Selous The Second Church Estates Commissioner, The Second Church Estates Commissioner 7:03 pm, 15th March 2022

I am very grateful to Mr Speaker for granting me this debate.

For many years, I have championed the issue of supporting as many people as possible to achieve a healthy weight, an important issue in health prevention which matters today more than it ever has. It is also so important to remember that even if achieving a healthy weight is a real challenge and our body mass index is not yet as we would want it, the more physical activity we can do the better. Tonight, I want to issue a call to arms on the related issue of being sufficiently physically active to help us all lead healthy lives.

I start by paying tribute to Peter Walker, a parliamentary correspondent who works in this building, for his outstanding book “The Miracle Pill”. It was published last year and it should be required reading for everyone working in health and social care, everyone who cares about the NHS, and leaders across central Government and local government, as well as in business.

Let us look at the health benefits of regular physical activity. If we could achieve those outcomes with a pill, it would indeed be the miracle pill. Regular physical activity reduces the risk of breast cancer by 20%, the risk of dementia, depression and colon cancer by 30%, the risk of cardiovascular disease by 35% and the risk of type 2 diabetes by up to 40%. Hip fractures, which are so often catastrophic in their consequences for the frail and elderly, are reduced by up to a whopping 68% by regular physical activity. Those are all NHS figures.

I am grateful for the good work of the Faculty of Sport and Exercise Medicine UK on its Moving Medicine programme, which is designed to promote a person-centred approach to physical activity in health, and its Active Hospitals programme, which focuses on delivering physical activity through secondary care. Both programmes have won awards from the Royal College of Physicians and have now been adopted in Australasia and the United States. Active Conversations is also an excellent training course to increase physical activity for all health and social care professionals, social prescribers and the fitness industry.

It is good to see that the Office for Health Improvement and Disparities, a very important new part of the Department of Health and Social Care, has a number of important online resources on physical activity and health, including on the treatment of long-term conditions. As a leading academic in the area, Ralph Paffenbarger, said, “Anything that gets worse as you grow older gets better when you exercise.” As another public health expert put it, slightly more bluntly,

“being active throughout your life is about being able to get to the loo on time in your old age”.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I am not someone who has to get to the toilet early, but I congratulate the hon. Gentleman on securing the debate; I spoke to him beforehand.

I make a plug for children to take action early against physical and health conditions. In Northern Ireland, 20% of children are classed as overweight and 6% are classed as obese, and I understand that those figures are reflected on the mainland. The need to change our way of doing things is very clear. Targeted funding for children in schools, which has fallen by the wayside as a result of covid, must be re-established, as I think the hon. Gentleman will agree. The importance of daily mile walks must be promoted in every region of the UK. Start it early—and at a later stage, Madam Deputy Speaker, you will not have to run to the toilet.

Photo of Andrew Selous Andrew Selous The Second Church Estates Commissioner, The Second Church Estates Commissioner

The hon. Gentleman is absolutely right about the daily mile. I thank him for championing it in Northern Ireland. It will absolutely make a difference; I hope he will encourage all schools in Northern Ireland to take part.

How are we doing as a nation in achieving the necessary levels of physical activity? The answer, I am afraid, is not very well at all. According to a briefing that I have received from the Royal College of General Practitioners, 34% of men and 42% of women in the UK are not active enough for good health, and physical inactivity is responsible for one in every six UK deaths—the same proportion as is caused by smoking. Some 27% of the population are classified as inactive, meaning that they do less than 30 minutes of moderate physical activity, such as walking, each week.

It is getting worse. By 2030, we are on track to be 35% less active than we were in 1960. Most shockingly of all, a third of children do less than half the recommended physical activity for their age. The findings of the 2015 NHS health survey for children are even worse: they show that fewer than a quarter of children reach the required minimum of one hour’s moderate to vigorous physical activity every day on average. It is worth pausing to consider what to do about that. The curriculum is very full and the Department for Education is reluctant to mandate physical activity, while the Department of Health and Social Care’s remit does not extend to ordering the school day. Do we need the Cabinet Office to start taking a serious cross-Government interest in the issue for children, and indeed throughout later life?

What will happen if we continue on current trends? Justin Varney, who was formerly the head of adult wellbeing for Public Health England and is now in charge of public health in Birmingham, says that

“the whole concept of an NHS and welfare state, in whatever form we have it, is completely unsustainable if a third or more of the population remain physically inactive.”

It is not as if we have only just realised the importance of sufficient physical activity to our health. Back in 1948, Dr Jerry Morris was appointed the first director of the Social Medicine Unit, a Government body tasked with examining the way in which health issues interacted with people’s circumstances. His major initial research involved looking into why the drivers of London’s double-decker buses had significantly higher rates of heart attacks than their conductor colleagues. His conclusion was that the only real difference between the groups, who were from identical backgrounds, was that the former spent their days sitting down, while the latter were constantly on their feet going up and down flights of stairs. The hard facts are that for many of us, the way in which we work and the way in which we travel are taking years off what should be our healthy life expectancy. This is a big issue, but it is not remotely getting the attention that it deserves.

What can we do about it? The answer is a very great deal, if we have the political will and really value our NHS rather than just paying lip service to it, and if we follow the academic research and learn from existing best practice around the world. Making active travel possible is the single biggest health intervention that the Government could make. Walking and cycling are the easiest ways to integrate physical activity into our daily lives. Two thirds of journeys in the UK are under 5 miles and could be cycled in half an hour by those who are capable, but only 2% are cycled. E-bikes, of course, help the elderly and those in less good health, and make cycling much more inclusive. Staggeringly, 1.5 billion journeys of less than a mile are made in cars every year, so there is an enormous potential to do better. Active travel can meet 23% of the moderate-to-vigorous physical activity needs on school days for primary-age children and 36% for secondary-age children. People who cycle to work take fewer days off sick than their car-driving colleagues, so cycling is good for the economy.

Those who are not so far tempted to consider a daily commute by bicycle should read a 2017 British Medical Journal article by Carlos Celis-Morales, which used UK Biobank data to follow 250,000 people over five years. It showed that people who commuted by bicycle had a 40% lower chance of dying during the study period. I am among those who want cycling to be for the many not the brave, and we need our roads to be safe, but the statistical reality is that for many of us, it is far safer in health terms to be on a bicycle than in a car or on the sofa.

I support the work that the Department for Transport is doing to deliver the Prime Minister‘s vision in which half all journeys in towns and cities will be cycled or walked by 2030. This plan is backed by a £2 billion package of funding for active travel over five years under the inspirational leadership of Chris Boardman, the interim active travel commissioner for Active Travel England. The plan includes delivering safe routes for cycling and walking, cycle training for all children and adults who want it, and creating active travel social prescribing pilots. Employers who care about the wellbeing of their staff as well as the productivity of their businesses should be right behind that. I also look forward to the publication of the second four-year statutory cycling and walking investment strategy this spring to reflect the new policies in “Gear Change” and the multi-year funding settlement from the spending review.

This is not a pipe dream. It is happening now in Copenhagen, where 40% of commuting trips are made by bike, and I suspect that the rate is not much lower in Amsterdam. That did not happen by chance in either of those cities; it happened because of visionary leaders who cared about the wellbeing of their residents and pursued this policy over decades.

We can do more in the workplace as well. The Googleplex offices in Mountain View, California, are designed to encourage as much physical movement by staff as possible. That includes using nature between buildings as well as what happens in them. Most of the workspace is on the second storey, and all the meeting rooms and cafés, and every single toilet apart from the accessible ones, are on the ground level, connected by courtyard-style staircases.

So, what are UK businesses doing to build some mobility into what has become an excessively sedentary culture? Sitting still for too long is not good for us. I have come across one Defence Minister, one female general, one House of Commons Clerk and one Hansard recorder who conduct meetings standing up or who have a standing desk. It is the exception rather than the rule, and when I had the pleasure of discussing Peter Walker’s excellent book with him recently, I made sure we did so while walking around St James’s Park. I wonder whether the Department of Health and Social Care and the House of Commons Commission have looked at the BeUpstanding programme, a free world-leading project that improves the health and wellbeing of desk-based workers ? If not, why not?

I mentioned earlier that only between a quarter and a third of UK schoolchildren were undertaking the recommended amount of physical activity. I am a huge fan of the daily mile initiative, which Jim Shannon referred to, where children run or walk a mile at the start of each day. There are 7,289 schools in England and 1,191 in Scotland doing this, which is commendable. I would like to see that number grow substantially, including in Wales and Northern Ireland.

There is another country in Europe, however, that is doing even better. The global report card shows that of the 49 countries covered, Slovenia has the best results for activity levels in children, with more than 80% of those aged six to 19 meeting the one-hour-a-day threshold for activity. Frankly, that puts the United Kingdom to shame, notwithstanding the tremendous daily mile initiative. Again, this did not happen by chance. It was a conscious decision that equipped every school with two gyms and an outdoor play area as well as track and field facilities, and with five sports days per year and another week off for outdoor activities.

I wonder whether we fully use the fantastic expertise of our diplomatic network to really understand the best practice in public health around the world. If the Department of Health and Social Care is unaware of the level of commuting in Copenhagen or the outstanding physical activity achievements of Slovenian children, I would urge the Minister to speak to her colleagues in the Foreign, Commonwealth and Development Office to ensure that the relevant briefings are provided to her and her officials so that we can copy what is working well elsewhere.

It is really important to emphasise that even if we cannot do our 10,000 steps every day or, as adults, 150 minutes of moderate exercise or 75 minutes of intense exercise a week, every little helps. It is also really important to understand the difference between formal activity and incidental activity. Sport is brilliant and I want to see as many people as possible of both sexes and all ages participating, but the evidence suggests that the biggest gains will be from the minor adjustments we make in our everyday lives, such as using the stairs rather than the lift, getting off the bus one stop early, finding a parking space some way away from our office or meeting, or taking up a hobby we enjoy such as dancing. One of the best things that the Whips Office has ever done for me is to put me on the fifth floor of Portcullis House, giving me the opportunity to climb the 137 steps to my office on a regular basis throughout the day. I am not sure it was meant as a favour, but I am genuinely grateful.

I implore the whole of central and local government to wake up to the importance of this issue and all of us to play our part in keeping as active as possible in every way that is open to us. With good policies and the political will, we can make the right thing to do the easy and affordable thing to do for more and more people.

Photo of Gillian Keegan Gillian Keegan Minister of State (Department of Health and Social Care) 7:17 pm, 15th March 2022

I congratulate my hon. Friend Andrew Selous on bringing forward today’s debate on this important topic. In his excellent speech, he has outlined the many benefits of physical activity, and I am grateful for his challenge on what more the Government need to do to address the critical health issues of inactivity, poor diet and obesity. I would like to put on record my thanks to all those who work in our local authorities, in the NHS, in our schools, in voluntary and community organisations and in the fitness and leisure sector for their efforts in supporting people of all ages and abilities to stay active, particularly during the pandemic, which as we know, was very challenging.

As my hon. Friend so eloquently outlined, physical activity can contribute to reducing the risk of many chronic health diseases, including some cancers, heart disease and type 2 diabetes. Being physically active can also help to improve our mental health and wellbeing and help to keep people, friends and communities connected. Before the pandemic there were disparities in physical activity levels, but we were seeing some improvements. Those gains have diminished. The people most impacted by the pandemic were those we most need to support, including older adults, those in more deprived areas, those with a disability, those with long-term health conditions, those who were asked to shield and those from black, Asian and minority ethnic groups. We need to do more to achieve a level playing field and to create local places where everybody, no matter their age or circumstances, can find safe, accessible ways to be active every day and to stay fit and strong. Indeed, active travel is an important part of that.

I will shortly reflect on some of what the Government are doing to help, but first I stress that scientific evidence underpins what we and the NHS are doing to support and promote a more active nation, and advice from the UK chief medical officers is at the heart of our physical activity policies. The guidelines published in 2019 set out the types and levels of activity that are most likely to provide physical and mental health benefits for children, young people, adults, older adults, disabled adults, disabled children, disabled young people, and women during pregnancy and after birth.

As my hon. Friend knows, the Government are supporting primary schools with £320 million a year through the physical education and sport premium. We have also funded the school games network. This enables schools, through the school sport and activity action plan, to deliver a whole-school approach to physical activity, and many of us have seen the successful daily mile programme in our schools on our Friday constituency visits.

The plan, first published in 2019, is a joined-up approach by the Department for Education, the Department of Health and Social Care and the Department for Digital, Culture, Media and Sport, and it has provided the blueprint for cross-Government working on physical activity. This plan has enabled a range of non-competitive opportunities to engage the least active groups. To tackle gender disparities, the plan has enabled nearly 9,000 girls to take part in competitive sport.

Our work to promote physical activity does not stop at the school gates. Through the world-beating “Better Health” social-marketing campaign, we will continue to provide digital resources, such as the popular Couch to 5k and Active 10 applications, and to signpost people to local opportunities to get active. Our commitment to exploring new ways to help people get active is demonstrated through the health incentives pilot, which will take place in Wolverhampton with the support of the local authority, the NHS and the local community.

Birmingham will host the Commonwealth games in summer 2022. Such sporting events provide moments of inspiration, and the Government, Birmingham City Council and others are investing in providing local communities with opportunities to participate in sporting activities.

My hon. Friend rightly mentioned the contribution that an active, fitter nation could make to helping to protect the NHS and social care. The Department, through the work of the Office for Health Improvement and Disparities and in partnership with Sport England, has been working across the NHS to deliver the moving healthcare professionals programme. This work enables healthcare professionals to increase their awareness, knowledge and skills in promoting physical activity to patients, managing ill health and reducing inactivity.

The Government’s health promotion taskforce is bringing Departments together to develop actions that will deliver on our ambition to get the nation more active and provide equitable opportunities to those who will benefit most. The Government are absolutely committed to ensuring that everybody can lead more active lives, and my hon. Friend mentioned the work of my colleagues in the Department for Transport and their vision for active travel. There is unequivocal evidence that physical activity has a role to play in enabling people to live healthier, longer lives. As the Minister responsible for dementia and the dementia strategy, I know how critical physical activity is to diseases that people might not imagine have a link to it. It really is the answer to almost any health question.

As I mentioned, we remain committed to introducing actions that will help current and future generations to access, participate in and enjoy all forms of activity, play and sport and, as my hon. Friend said, to integrate them into their daily life. We understand there is still a lot of work to do to create equal access for everybody and to address disparities. We will need the help of every single local authority, school and community and a truly collaborative cross-Government and NHS approach. I genuinely believe that, by working together, we can make a huge difference to the health of our nation.

Once again, I thank my hon. Friend for securing this debate on such a vital issue.

Question put and agreed to.

House adjourned.