Routes to roots

At Intelligent Health, we believe that a healthy society is one with active citizens.

Our social nature is core to us as a species and sport and physical activity can enable us to connect and thrive. When this socialisation is removed, our resilience to stress events is impacted and it affects our health. For an individual to prosper, they must feel that they are safe, that they are valued and that they belong. Only when these three conditions apply will individuals build resilience. Whilst this resilience builds, stress is reduced and people feel empowered to adopt and maintain new health behaviours and thus, this leads to improvement in health outcomes. This can be measured through markers such as increased physical activity, social cohesion, wellbeing and nature connectedness.

We recognise the power that physical activity has in improving both mental and physical health. Physical inactivity is cited as fourth leading cause of reduced mortality, being accounted as one of five major risk-factors for developing non-communicable diseases such as Cardiovascular diseases, Chronic respiratory diseases, Type II Diabetes and some types of Cancer. All of which can be improved, and in some cases can be completely reversed, through a physically active lifestyle (amongst other health-benefitting factors). Physical activity improves mental health by reducing Chronic Inflammation and increasing the hormone BDNF that repairs synapses in the brain so helping to prevent depression, anxiety and dementia.

Whilst traditional sport can be a wonderful, life-affirming activity for some, it does not work for all. The sport and physical activity sector has made strides to make activity more accessible, but the highest success in increasing activity and impacting health is made by small changes to daily behaviour. We need to nurture both to support all needs. We know that walking (for leisure and active travel) makes up the majority of daily physical activity for most people. That is why we believe creating places and spaces where people are encouraged to walk, wheel or cycle for most short journeys, will go some way in tackling the nation's deep inactivity crisis. This includes being able to move more through active travel choices and for leisure, using parks, green spaces and waterways to connect and move. At the same time, it connects us to our place and each other, good for our health and that of our planet.

A study from Scotland showed that for a target group of older women the greatest contribution of type of activity to move from inactive to active is through walking, 38%, with Sport, Exercise and Cycling contributing to 18%, 14% and 1% respectively.

Consistent high levels of physical inactivity are recorded annually in Sport England's Active Lives survey in areas of high deprivation, Black and South Asian communities, those living with life-limiting conditions and women. These trends start in childhood, creating a worrying pattern of inactivity throughout the life course. These very communities, experiencing the most inequalities, are exactly who we should be actively engaging with to provide them opportunities to take ownership of their place and their health.

This is why we need to work collaboratively to empower communities to feel that they have the agency to create better places to live for themselves and to also build connections with each other and their surroundings. These empowered, connected communities are the key to a healthy place.

Where a person feels that they are not safe, in both a physical or mental capacity, their brain tells them to stay in a heightened mode of 'fight or flight.' Safety not only applies to the safety of oneself, but also the safety of one's environment.

Making a place safer can contribute to making a place healthier. We know that high deprivation negatively impacts on healthy life expectancy, and we also know that areas of high deprivation are also more likely to have higher incidences of crime. For children and women, walking around where they live may not always be a safe thing to do, whether this be related to a risk of injury or crime. Making a place more walkable can relate to a plethora of solutions, mostly related to infrastructure improvements such as better lighting along pavements, dedicated cycle lanes and properly designed and maintained footpaths and roads. Placing onus on local government to ensure that a place is more 'walkable,' must be a priority.

Infrastructure is vital, but we must also consider how we then look at changing behaviours. We are all aware that communities are not always listened to by decision makers. The reality is that interventions are often put into a place without consultation, decided by someone removed from the local nexus. We believe that active communities not only relate to physical activity, but also to an individual's civic connection and engagement with a place.

To truly build connection to a place, local communities must have a voice and some decisions decentralised. Therefore, we propose that Citizen's Assemblies should be created and public voice heard to determine what a healthy place looks like to them, ideate how to remedy local issues, identify a baseline from which needs to be built upon and finally to own, measure and report on progress. The Assemblies should include children as they are an indicator species for our places, if they thrive then we all can.

Alongside this, we advocate for the implementation of an Asset-Based Community Development (ABCD) approach to sustainably improve physical activity and health outcomes. ABCD builds on the skills of local people, the power of local associations, and the supportive functions of local institutions, drawing upon existing community strengths to build stronger, more sustainable communities for the future.

ABCD can be used to underpin community work to drive up physical activity levels. This focusses on what is working well already in a place and enables local people to grow these strengths, as opposed to a traditional deficit-based model which instead looks at what is missing.

Loneliness is equitable to smoking 15 cigarettes daily. Worldwide, trends are showing a steady decline in the number of people who smoke, yet we are witnessing a growing epidemic of social isolation as our communities become more disconnected from each other and their local environment. At the same time, the health of our people and of our planet is in freefall.

In the West, people are living longer but with modern advancements in medicine, many are now spending much more of their lives in ill health and it's projected to be getting worse. We are also being gripped by climate change, with the global average temperature increasing and being accelerated by human action. We believe at the heart of this change is community involvement. Social contact is the antidote to tackling loneliness. Policymakers must enable environments that encourage cohesion, build on existing networks and create new communities.

Across policymaking, siloed working is touted as a barrier to accelerating progress. A joined-up approach is the only way forward to truly bring communities together to tackle health inequalities and we believe that physical activity, namely by encouraging walking, can be a means to achieve this. We need an ambitious forward-thinking modern approach with multiple sectors working together with a common purpose, which is to improve health and resilience. To deliver more walking will create a healthier and more resilient community. We believe that a local resilience steering group could bring together the necessary partners to deliver this change with walking both an input and output of greater resilience.

We have named our considered steps towards an active society: 'Routes to Roots.' Both Routes and Roots are treated as having a dual meaning here. Routes refers to creating pathways towards a better future, but also improving physical routes (dedicated pathways and pavements) to enable people to be active. Roots here means the familiar roots that are built within a community, enabling strong foundations to embed healthy behaviours and finally, the regreening benefits by designating more green spaces in places that are notably bereft of nature and biodiversity.

With these ideas in mind, we propose the following asks of the relevant government departments:

Department for Culture, Media and Sport

• Champion Asset-Based Community Development as a means to grow sustainable physical activity in a place
• Commit to the longevity of the Physical Activity Taskforce, to ensure physical activity for health remains a cross-departmental priority and enable the aims of Get Active to be delivered.
• Launch an awareness month where facilities are opened and provide taster sessions to encourage everyone into a new physical activity or sport. Run a social marketing campaign that promotes small tangible changes, particularly walking, to encourage behaviour change.

Department for Levelling Up, Housing and Communities

• Recommend the creation of Citizen's Assemblies to determine what a healthy place looks like in their local area
• Ensure participants are demographically representative, including the voice of children and young people.
• Ensure community researchers are working in places to better understand these communities from their own perspectives.
• Work with local authorities to implement a policy that considers 'Playstreets' within the planning process. Making it a simpler process for communities to close streets off to encourage play, community and physical activity.
• Follow the National Forest planning policy that requires any new build, either housebuilding or infrastructure to dedicate 20 - 30% of land to safe, equitable and accessible green space.

Department for Transport

• Change the funding model for highways. Dedicate 5% of spend on every new road dedicated to supporting active travel, creating safer walking and cycling routes including better lighting and surfacing, particularly repairing potholes that affect all road users.
• Blanket adoption of '20 is plenty' on all school streets and change the Highway Code to fully ban pavement parking, reducing air pollution and making the streets outside schools a safer place to walk.

Department for Food, Environment and Rural Affairs

• Create new urban green spaces by reclaiming disused land into community ownership. Encourage urban allotments and use a volunteer system to educate local people on the benefits of connecting to nature.
• Increase the biodiversity of active travel routes to create wildlife corridors, through planting wildflowers and trees, encouraging users to be active amongst nature.

Department of Health and Social Care

• Create and issue a national annual census that measures children and adults' wellbeing. This could form part of existing data sets, such as the Local Health survey under OHID or the English Housing Survey that sits within DLUHC.
• Place focus on the role of community in resilience building and preventative health. Deliver a social marketing campaign that empowers the public to understand that they don't always need to rely on the NHS, educating them on their own agency to take action to help their health.
• Ensure that Integrated Care Boards ringfence a set percentage of budgets to go towards community-based preventative health programmes operated outside the public sector.

Department for Education

• Require OFSTED to measure wellbeing of children and staff as a standard for reports. Similarly, to how student satisfaction is measured in Higher Education.
• Advise schools to permit a uniform policy that encourages the use of footwear that enables daily activity through walking and cycling and moving actively through the day, i.e. allowing pupils to wear trainers for lesson (Active Soles).

This is not by any means a one-size fits all approach. We hope that with prominence placed on community decision-making through Citizen's Assemblies and moving away from a deficit-based approach, ownership will blossom into the creation of a healthy, active place. Once this place is formed, activity (both physical and civic) will only flourish further.