Place and health

The Active Partnership network authors this chapter, drawing on evidence, evaluation, insights, and practical knowledge from diverse local systems and communities in every part of England.

As Active Partnerships our work engages us in very many, if not all, of the areas covered in other chapters (referenced) in this document. Many of the chapter recommendations much align with our wider policy considerations such as a new Wellbeing Minister to maximise cross-departmental working, embedding environmental issues in all we do, using Active Design in every planning submission, strengthening statutory requirements and coordinated investment across education, children and youth services to benefit physical activity, supporting the 'pivot' of leisure to wellbeing. We welcome wider consideration of these as part of an overall transformed policy approach to tackle inactivity.

Health and place policy recommendations

1. Each ICS and/or Devolved Authority to publish annual spend on prevention as a proportion of total spend, to a consistent definition / description of prevention.

This is a low/no cost measure and will enable benchmarking and tracking so resources can be focussed where they are needed most. Longer term, once consistent and meaningful data is captured, a target % spend on prevention could be helpful if aligned to a social, expansive model, rather than a narrow, reductive approach.

2. Physical activity integrated within measurement frameworks such as the health inequalities framework, Quality Outcomes Frames (QOF) and/or local incentive frameworks across the health and care system.

Integrating physical inactivity into the healthcare inequalities and other outcomes frameworks is supported by evidence indicating that tackling inactivity is crucial for achieving their goals. This integration will lead to increased prioritisation, action, and data collection regarding inactivity, thus reducing the need to incentivise primary care to address it. There is particular interest in understanding the effectiveness of initiatives such as local incentive frameworks in driving action compared to QOF.

3. Patient Lifestyle Data Related to movement and physical activity (alongside smoking, alcohol and weight) to be explored as part of every health and care conversation, with data captured at scale and made public at LA/ICS/Devolution Authority Level.

This is a low-cost measure, which is vital to make the change from a medicalised model of healthcare and to link directly the benefits of movement and the reduction on healthcare costs. This change would transcend mere individual choices; we would be embracing physical activity as a collective societal value. We would see and hear evidence of big shifts in our existing mindsets, systems, and structures, harnessing community assets and building on strengths.

4. Wellbeing to be a mandatory consideration for, and included in, Devolution Deals.

No cost and an opportunity to ensure local places can identify and prioritise their resources.

5. A Wellbeing Impact Assessment in decision making and policy.

This is a zero-cost measure, as with equality impact assessments this will lead to a culture where health and wellbeing is always considered in every policy and decision-making.

Embedding the importance of place and key services such as health and how they directly impact on wider wellbeing, re-enforce the reasons why place is so fundamental.

These policy changes can be implemented without significant additional financial resources but require commitment, coordination, and adjustments in resource allocation. By focusing on specific timelines and delivery mechanisms, these policies can have a tangible and positive impact on reducing inactivity and health inequality and enhancing sustainable economic development in communities across the country.

1. What is the current situation?

When we move, we are stronger. As individuals, families, communities and as a nation. The evidence is overwhelming—physical activity has the power to transform lives from birth to the end of life. It yields substantial benefits to our healthcare systems, society, and economy as well as to the lives of individuals, families, and communities.

• Inactivity has been highlighted as a key modifiable preventative risk factor for all six major condition groups outlined in the forthcoming Major Conditions Strategy.
• Reducing inactivity plays an important role in addressing other significant risk factors: e.g., hypertension, blood glucose levels, and helping maintain a healthy weight.
• England has some of the highest levels of inactivity in Western Europe.
• Disabled people and people with a long-term health condition are twice as likely to be physically inactive than those without a disability or health condition.

The UK has the 3rd highest direct healthcare costs of non-communicable diseases and mental health (NCDs) attributable to physical inactivity* per capita.

On average, physical inactivity costs the UK £20.53 per capita in attributable direct healthcare costs.

The most active nation, Finland, has a per capita direct healthcare cost attributable to physical inactivity of £5.11. This is £15.42 less than the UK.

The average cost across these 15 nations is £13.31 per capita, highlighting how much greater the per capita spend is in the UK.

2. What do we want to achieve?

We can tackle inactivity and inequality across England, through a whole system, place-based approach, enabled by national policy and legislation. National-level decisions can create optimal conditions for active lives for all; working with and building on the strengths of people and communities. This is complex. If one thing changes, everything changes in response and changes at government level can create a decisive ripple effect across the whole country.

Our aim is to make movement a cultural norm in every community; designing activity back into life and ingraining this understanding of its importance across systems and sectors. This vision hinges on a fundamental shift in how society perceives movement, with a greater recognition of intervention and investment into prevention and early intervention.

Effecting change at the national level to achieve this mission necessitates shifts in mindset, policy, legislation, and strategies to enable local level action and change. This integration extends to the health and care system, transport, planning, education, environment, community safety, sport and physical activity sector and beyond.

All these things interact in place and set the conditions to design moving back into life - for everyone. By aligning intention, capacity, resource, and investment, it becomes possible to make significant strides towards a future characterised by health, sustainability, and equity.

This ambitious and collective mission is backed by DCMS' Get Active and Sport England's Uniting the Movement strategies, and in each of our local strategies. It is not just about improving individual well-being in the short term; it's about safeguarding the health and wellbeing of current and future generations of people and planet. This mission is also vital to our economy: to support a healthy, active, working population.

Both 'Get Active' and 'Uniting the Movement' recognise that two of the most significant interventions are a focus on Place to maximise impact and integrating activity and movement into health and care systems, pathways, and settings.

3. What are the barriers you have identified to achieving the goal of an inclusive active nation?

Evidence, evaluation, data, and insights from across England point to a repeating pattern of barriers as policy makers, practitioners, and clinicians seek to integrate physical activity and health.

• Physical activity is everybody's problem and so it can be nobody's'. Because of the complex number and range of barriers to activity it requires multiple agencies to coordinate effort and measure improvement, a minister with a direct leadership role and overall accountability for addressing inactivity, inequalities and improving wellbeing would help to address this barrier.
• There is a broad understanding and belief in the benefit of movement to individuals but the ability to link that movement to 'simple cause and effect' reductions in demand on other services and wider benefits to societal priorities is not possible.
• Globally, there is only emergent understanding of how to implement whole systems, place-based approaches and effective ways to understand their impact.
• Measuring activity and its outcomes is complex, particularly in a social model of health, where the work is beyond discrete services, interventions, or programmes and includes the full range of influences on inactivity and inequality in a place. There is a need for new methodologies to measure and track activity levels more regularly/in real time, and evidence the direct and causal relationship between increased activity to reductions in cost or improvements for wider societal issues.
• Disjointed, often short-term investment in programme delivery, especially for children and young people. Turning the tide on youth inactivity, excess weight, and addressing the growing mental health crisis, will require long-term, coordinated, cross departmental ambition, with a particular focus on closing the 'activity gap' for children experiencing the greatest inequalities.
• There is a lack of understanding and recognition of how the VCSE sector supports healthy, well-connected communities and has a bigger part to play.
• There is a need to invest in and develop a cross-sector workforce which has different skills, behaviours, capabilities and approaches to lead and deliver the change required.

4. What would good look like?

Together, through the approach described in section 1 and 2 above, we will add years to life, and good life to years at a population level and support social wellbeing through stronger, more resilient communities. We will drive significant reduction in risk, and healthcare costs related to inactivity for the nation. We will support health equity and a population that experiences greater life satisfaction, productivity and can contribute to our nation being a great place to live. This requires clearly understood levels of expenditure on primary, secondary, and tertiary prevention and the relationship of that to healthcare costs, with meaningful data collection that helps to embed physical activity into health and care.

Specifically, what is needed in place and health?

• Cross-government leadership and accountability that enables collective whole system leadership in place: One significant barrier is the absence of cohesive leadership across government. To address this, there is a pressing need for a unified approach that transcends departmental responsibilities and political cycles, with a long-term approach that supports the wellbeing of people and planet.
• A health and care system no longer prioritising medicalised interventions: Moving away from a predominantly medicalised approach to a social model of health is vital. An integrated, cross-sector health and care workforce can play a pivotal role in supporting physical activity as a preventative and therapeutic measure, and health and care systems can support the role of people and communities in health creation. In a social model of health such as that shown below from Greater Manchester, it is possible to release the energy of all sectors and society to support active lives; creating meaningful change at Place level from those supporting strong communities, education, skills and good work, support to carers, good homes, sustainability, active travel and much more. It is vital to rebalance the focus towards proactive, targeted prevention opportunities alongside our work on medical or clinical interventions.
• A fundamental shift to reducing the likelihood of illness and creating structural and environmental conditions at Place level.