future opportunities for making good policy: we're in this together

BrunelSport,HealthandWellbeingresearchgroup

B•SHaW BrunelSport,HealthandWellbeingresearchgroup

Future opportunities for making good policy:

we’re all in this together

Tess KayProfessor of Sport and Social SciencesBrunel Sport, Health and Wellbeing Research Group (B-SHaW)Brunel University London

[email protected]



Threequestions

1. CouldPApolicyforolderagegroupsbebetterinformed?

2. Whatadditionalknowledgecouldbeuseful?

3. HowdowewidentheevidencebaseforPA?



….but not their social world

• In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. (World Health Organisation, 2008)

• In the UK, being inactive is twice as common in low income areas as high income areas

• Living in difficult circumstances undermines individuals’ capacity to exert agency

• Collective, community interventions provide mechanisms of support

Addressing individuals’ health behaviour….

1.1 The conceptual underpinnings of policy:inactivity as individual health behaviour



1.2Knowledgeaboutolderadultsbeingactive:theStartActive,StayActiveillustrations

Jim(70)isamarriedmanwhoretiredat51.Hetakespartinmanyactivities.Hisburningpassionisbasketballrefereeing,whichhe’sdonefor56years.Agameinvolvestwohours’continuousactivity,muchofwhichisrunning;hehasfoundasummerleaguetokeepuphisactivitylevelsallyear.InsummerhealsoDuringthesummer,heoccupiesmuchofhistimedoingdoespart-timegardenmaintenanceworkforneighboursandhelpsathisdaughter’sallotment.Hehostsacoupleofholidaytoursayear,eitherwalkingorleadingvisitstogardens,andhiswifealsoensuresthattheygetoutforregularwalkstovisittheirfriends.

Shirley(81)isawidowwholivesaloneanddoesn’tdrive.Shekeptworkinguntiltheageof76andhaskeptbusyandindependenteversince.Shehasstrongfriendshipsandlocalsupportnetworks:shehasastringofneighboursvisitingher,tochatandhavecoffeeorlunch.Shetakesthebuswithafriendtotheshops,andpopsoutonfoottotopuplocally.Shealwayschoosestotakethestairsinsteadofthelift.Whenalocalexerciseclassclosed,shesoughtoutaledwalkandhasprogressedfromthe‘slow’tothe‘fast’stream.Inherownwords:‘Isaytakeadvantage,becauseImightnotbelikethatnextyear!’



1.3 Analternative,evidence-basedportrayaloflifeintheUKat65+

• Fourmillion,or40%,ofolderpeople(aged65+)intheUKhavealongstandinglimitingillness.

• Oneinthreewilldiewithaformofdementia• Nearly1millionhavetocutbackonfoodshoppingtocoverthecostofutilitybills.

• Overathirdofolderpeopleliveinoneroomtoreducetheirheating bill.

• Everyyear,28,000dieofthecold.• InDecember2014,2.9millionolderpeopleinGBfelttheyhadnoonetoturntoforhelpandsupport.

Source:AgeUK,LaterLifeintheUnitedKingdom,September20155



Threequestions






Social ecological models of health (1987+….)

2.1 Reconceptualisinginactivity:recognisingsocialinfluences



2.2 WhatcountsasevidencefornationalPAguidance:theStartActive,StayActivereport

8

StartActive,StayActive (2011)- theUK guidanceonPAKeysourceswere:

• USAPhysicalActivityGuidelines(2008)

• scientificreviewsundertakentoinformtheCanadianPhysicalActivityGuidelines

• reviewpapersfromtheBritishAssociationofSportandExerciseSciences(BASES)

• selectedadditionalrelevanthighqualityrevieworstudypapers

• 2DayScientificMeetinginOctober2009,convenedtoallowforwiderinputfrom

thescientificcommunityandtocommunicatemorewidelytheprocessthatwas

underway.

• national web-basedconsultation.


B•SHaW BrunelSport,HealthandWellbeingresearchgroup9

communitygroups

localpublichealthandhealthsector

thepublic

housingassociations/organisations

local,regionalandnationalgovernment

thirdsectorandotherdeliveryorganisations

2.3 Whatcountsasevidenceonhealthinequalities:informingtheMarmotReview,2010

FairSociety,healthylives -theMarmotReview(UK)(2010)



Threequestions






3.1 Diversifyingscientificknowledge:socialscienceresearchcontributions

• Socialstatisticalprofilingofthe‘older’population

Profilepopulationcharacteristics

• Socialscience-ledstudiesoftheexperiencesofageing

Contextrepresentingeverydaylife

• Socialscience-ledstudiesofolderadults’relationshiptobeingphysicallyactive

Specificunderstandingofbeingphysicallyactiveinolder

age

11



3.2 Recognisingexpertknowledge

12

McDonaldsisthehealthyendofthemarketinTowerHamlets.Wehave42chickenshopspersecondaryschool.

DrSamEverington OBE,GPandChairofTowerHamletsCCG



Focus groups in HASE project planning phase:

• My dreadful memory is of school sports day where I always came last or fell over

Female HASE participant, 60+

• I worried about looking out of place, arthritis, confidence, body-conscious and age. My husband died ..I was depressed..

Female HASE participant, 60+

Source: Dr Louise Mansfield (PI), B-SHaW, Health and Sport Engagement (HASE) Project – a Sport England Get healthy, get active programme

3.3 Capturing lay knowledge: understanding narratives of inactivity(Mansfield, forthcoming)

The Health and Sport Engagement (HASE) project A complex community sport intervention for improving physical activity, health and wellbeing.

Vol. 1: Evaluation of the design and delivery of HASE

Dr Louise Mansfield & Professor Tess Kay Brunel Sport, Health and Wellbeing research group (B-SHaW)

Dr Nana Anokye & Professor Julia Fox-Rushby Health Economics Research Group (HERG) Institute for Environment, Health and Societies and College of Health and Life Sciences Brunel University London September 2016





3.4 IncorporatingknowledgeinPApolicy:breakingdownknowledgesilos

14

ProducingStartActive,StayActive - theUK guidanceonPA

Winter2008-09

UK-widereviewofPAguidancecommissioned

June2009

May2010

4sub-groupsreviewevidenceforeachagegroupandreport

Sept2010 Writingofguidelinesbegins

Summer2011

StartActive,StayActivepublished

Jun-Aug2009:StakeholderconsultationondraftMarmot(healthinequalities)Review

February2010:PublicationofMarmot(healthinequalities)Review



1.5 MaintainingmomentumtomoreinformedPApolicy

Strategiesforsocialsciencecontributors

Strategiesfor(more) informedPApolicy

• Acknowledgeresistance

• Addressresearchquality

• Getintheroom:initiatecollaboration

• Makeresearchaccessible:fromgrandtheorytousefulandusable

Reconceptualising theproblem:Movingbeyondthefocusonindividual behaviour,requiring…..Diversifyingexpertcommunities:academic integration acrossawiderdisciplinerange,with substantialsocialsciencecontent,including….

Deepeningtheknowledgebase:cross-sectoral integrationwith local,layandpractitionerexpertise



B-SHaW study of Physical Activity and Health Inequalities

• The Brunel Sport Health and Wellbeing (B-SHaW) research group are launching a scoping study to investigate the challenges of raising physically activity levels among people who are constrained by difficult circumstances

• The project aims to collate professionals’ expert knowledge and experience of the constraints to physical activity for disadvantaged and marginalised groups

• The project will consider the implications for policy and practice, including whether focus on health behaviour change might be combined with a strategy to address the social determinants of health

• If you would like to participate in the study and/or discuss whether your work might feature in the associated book being planned with Routledge, do please get in touch with the project lead Professor Tess Kay - [email protected]

INVITATIONtoshareexpertknowledgeonphysicalactivity

andhealthinequalities

future opportunities for making good policy: we're in this together

Health & Medicine