Australia: the healthiest country by 2020
National Preventative Health Strategy – the roadmap for action
Key action area 1: Drive environmental changes throughout the community that increase levels of physical activity and reduce sedentary behaviour
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‘The environmental quality of cities, towns and suburbs will be of critical importance to the health and wellbeing of their communities over the next twelve years to 2020 and beyond’ (Quote from submission)
It is well established that the physical environment, which incorporates the built and natural environments, impacts on our health and wellbeing – both at the individual level and at the community level. The design of our local environments and neighbourhoods influences walking, cycling and public transport use, as well as recreational physical activity.
Prolonged sitting and insufficient physical activity have become a part of daily life for many people – changes in transport, the nature of work, labour saving devices and less active leisure activities have all had negative effects on daily energy expenditure. In general, more physically active societies are healthier and have less obesity.
In 2007–08, more than 70% of Australians (aged 15 years and over) reported being sedentary or having low levels of physical exercise – a proportion virtually unchanged since 1995. The Active Australia Surveys, conducted between 1997 and 2000, also found no change or a slight increase in physical inactivity levels for some age groups.
An example of the gradual environmental and behavioural changes that have affected participation in physical activity is seen in a recent analysis of household travel surveys in New South Wales. This study found that the percentage of children aged 5–9 that walked to school was 57.7%, 44.5%, 35.3% and 25.5% in 1971, 1981, 1991 and 1999–2003, respectively, whereas the percentage of children aged 5–9 that were driven to school by car in the four surveys was 22.8%, 37.3%, 53.9% and 66.6%, respectively. This suggests that a complete reversal of the proportion walking versus driving occurred over a period of 30 years.
In 2005–06, almost one in three of the population aged 15 years and over participated in sports and physical activity twice per week (32% of females and 27% males). However, approximately 5.5 million people (34%), reported that they did not participate in any such activity in the 12 months before being interviewed.
The 2003 Victorian Neighbourhood Lifestyle Environment (VicLANES) study conducted across Melbourne found that people living in more disadvantaged areas, who were more likely to be overweight or obese, were less able to exercise due to health conditions and childcare responsibilities. The more disadvantaged areas had better street connectivity, a predictor of walking and cycling for transport, but traffic conditions were worse and there were fewer bicycle lanes.
There is already a range of measures to encourage sporting and recreation activities. Additionally, through the Australian Government’s Health portfolio, grants are provided for 98 community projects that provide a range of sporting and recreational opportunities to Australian families ($46.8 million over three years), including support for the 2009 World Masters Games in Sydney and in 2007–08 providing funding for the Football Federation of Australia to promote participation in and support for football in Australia. The Taskforce welcomes these initiatives and recommends further development of a coordinated national effort to enhance sport and recreation opportunities across Australia.
Sport plays a major role in Australia. It helps define our national identity, and provides avenues for participation, physical activity, learning of individual and team skills, and social connection, as well as being a significant employer and major leisure and entertainment industry. The Taskforce sees great synergies between the Preventative Health Strategy and the work of the Independent Sport Panel’s review to build our national capacity in junior sport, community participative sport, informal active recreation and elite sport. The Taskforce also believes there is a need to strengthen and encourage partnerships between preventative health agencies and sporting groups, and suggests that greater collaboration between the NPA, the Australian Sports Commission and national sporting bodies would deliver benefits in terms of encouraging healthy lifestyles.
A greater focus on active transport to and from work can increase opportunities for physical activity among working populations, as illustrated by the UK Healthy Weight Healthy Lives Walking into Health initiative.[32, 33] Results from the pilot of a UK program, Sustainable Travel Towns, indicate that walking has increased by around 20% and cycling by almost 50% in two years, accompanied by reductions in car and public transport use.
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There is evidence that well-designed and sustained initiatives which influence attitudinal, behavioural and environmental factors can lead to significant improvements in population rates of physical activity, through increases in both incidental (for example, walking to catch public transport) and organised (for example, participating in active recreation or sporting activities) activities. They include:
- Good urban design and land use at a street level (improved lighting, ease and safety of street crossings, pathway continuity, presence of traffic calming structures, aesthetic enhancements) increase physical activity levels by 35%.
- Each kilometre walked reduces the odds of being obese by 4.8%, whereas every additional 60 minutes per day spent in a car increases the odds of being obese by 6%.
- Having access to places for physical activity (trails, facilities, parks, safety, affordability) increases physical activity by 48.4%.
- Each quartile increase in land use mix (combining residential with other uses such as retail, workplaces etc) is associated with 12.2% reduced odds of being obese.
Increasingly, however, many of our built environments are reinforcing sedentary behaviour and contributing to inactive lifestyles, particularly by encouraging car dependence.
State and local governments play a critical role in influencing the shape and design of the built environment and, ultimately, the health of their communities. There is strong support from consumers for communities that support healthy, sustainable living and which understand the connections between the environment, climate change and our economy. Creating built environments that help individuals to be more active and to eat healthier food will benefit the whole population.
There are a number of opportunities to build on current initiatives at the state, territory, local government and non-government level, some of which are described below.
Australian initiatives illustrating the importance of long-term planning, policy and infrastructure measures to address the urban obesity-promoting environment:
The Healthy Spaces and Places project
This project is funded ($700,000 in 2008–09) through the Australian Government to develop a national guide for local planners. A partnership has been established between the Australian Local Government Association, the National Heart Foundation of Australia and the Planning Institute of Australia.
An evidence-based national planning guide has now been developed to assist practitioners and decision makers at all levels of government, industry, private sector and community groups to understand the connections between planning and health. Due for release in mid-2009, the guide showcases existing initiatives and draws on current practices that apply to and are consistent with the proposed framework and principles. In particular, it demonstrates effective policy development and implementation that encourages and requires integrated outcomes for wellbeing.
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Designing Places for Active Living
The NSW Premier’s Council for Active Living (PCAL) has developed a comprehensive web-based resource with six design areas of focus: cities, towns and neighbourhoods; walking and cycling routes; public transport; streets; open space; and retail areas. The resource includes a design objective, important design considerations and links to key references. Additional resources for detailed design guidelines and specifications are provided for each focus area.
The Liveable Neighbourhoods project
The project comprises principles and guidelines for health-promoting urban planning. Liveable Neighbourhoods applies to structure planning and subdivision for ‘green field’ sites and for the redevelopment of large ‘brown field’ and urban infill sites. This development demonstrates an increasing acceptance of good design principles over time, and of regulation as an acceptable means of achieving more active, liveable communities. Mandatory requirements establish consistency, a level playing field for developers, and more equitable access to good urban design for residents.
The guidelines have been adopted by the Western Australian Planning Commission as operational policy, and are required in all design and approval of urban development.
Healthy by Design
The National Heart Foundation’s Healthy by Design is a guide for professionals such as planners, developers and urban designers. The guide presents considerations, evidence, tools and case studies to facilitate the design of environments for active living.
The Taskforce recognises the importance of building on initiatives such as those described above. For example, the development of a resource for transport planners similar to Healthy Spaces and Places (that is, a national guide to assist transport planners to design transportation systems that foster health and wellbeing) would be a useful initiative that could be commenced immediately. Similarly, to enhance infrastructure development, linking funding allocation for built environment programs to specific criteria and to the introduction of health impact statements would strengthen the focus on identifying the health impacts (in particular, the likely impact on physical activity and sedentary behaviour) at an early stage in the process.
Transport systems are a key component of the built environment, as they shape the ways in which people carry out the diverse activities of daily life. Car-reliant cities encourage sedentary transport choices and contribute to obesity as well as additional health, environmental, transport and social harms.
Transport systems in Australia are often designed to move cars rather than people, and have resulted in urban environments that limit opportunities for walking, cycling and using public transport resulting in low rates of active travel.
When countries adopt more balanced transport systems, citizens have a greater choice of travel mode, car use declines (though not necessarily car ownership), and walking and cycling increases. Obesity levels are also lower.[40, 41]
There are also social benefits associated with increased active living. For example, reducing car dependency would reduce traffic congestion, improve air quality and community liveability, lower car space requirements and costs, reduce energy and fossil fuel use, and reduce greenhouse gas emissions.[27, 36]
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Traffic safety concerns are a major barrier to active transport in Australia.[42-44] Improved cycling and walking infrastructure is often the focus of attention to address these concerns, but supportive ‘invisible infrastructure’ is also a key feature of transport policies in countries with high rates of active travel.
It is acknowledged that solutions to address the obesity-promoting environment, such as changes in public policy, transport infrastructure and urban design, can be difficult and expensive; however, these environmental strategies are likely to impact on a large proportion of the population and are fundamental to improving the health of Australians.
It is well documented that public policies across a range of government portfolios impact on obesity levels and health more broadly. Health is an outcome of a wide range of factors – such as changes to the natural and built environments, and to social and work environments – many of which lie outside the activities of the health sector and require a shared responsibility and an integrated and sustained policy response across government. Accordingly, government policies can have positive or negative impacts on the determinants of health. Such impacts are reflected in the health status of the population today, and in the health prospects of future generations.
Case study: Health in All Policies – South Australian Government
Health in All Policies
is an innovative strategy adopted by the South Australian Government, which recognises that public policies across all government portfolios have an impact on health. It aims to address health challenges through an integrated policy response across portfolio boundaries, introducing population health outcomes and ‘Closing the Gap’ as shared goals across government. By incorporating a concern with health impacts into the policy development process of all sectors and agencies, it allows government to address the key determinants of health in a more systematic manner. It also takes into account the benefit of improved population health for the goals of other sectors. Fundamental to the successful implementation of this approach has been high-level commitment from both the central government agency (Department of Premier and Cabinet) and the Health Department.
In November 2007 the South Australian Government convened the Health in All Policies
conference. A significant outcome was the development of a set of core principles articulating the values that underpin the Health in All Policies
The South Australian Government is now considering how best to support the continued application of a Health in All Policies approach as part of the implementation of their Strategic Plan. This includes developing effective ongoing governance mechanisms, building the capacity of all sectors to consider the health impacts of their policies, and expanding the technical skills of the health sector to support agencies to use Health in All Policies
tools and processes. Other potential actions include experimenting in the application of this methodology to other portfolios such as Education, considering issues such as gender and the health gap, and further expanding this process to include other actors, in particular local government.
Adapted from an editorial, Health Promotion International Vol 23 No 1 by Kickbusch, McCann and Sherbon.
The Taskforce believes that consideration should be given to the introduction of health impact assessments across priority government policy areas (including urban planning, school education and transport) to ensure that health impacts associated with new policies are explicitly identified and considered in a systematic way early in the policy development process. Governments and policy makers can then determine the need for any policy changes or additional supporting strategies that may need to be implemented at the same time as the policy.
The Taskforce is convinced by the evidence that there are social and environmental benefits associated with active living. As people walk and cycle more, and make greater use of public transport, the accompanying reductions in car use can help reduce traffic congestion, improve air quality, enhance community liveability, lower car space requirements and costs, reduce energy and fossil fuel use, and reduce greenhouse gas emissions.
There is now an opportunity to draw together many of these current, but diverse activities – such as Travel Smart, Healthy Spaces and Places
, recent infrastructure programs and investment, the Review of Sport in Australia – into a comprehensive, sustained, national approach to support ‘getting Australians moving’. This idea was strongly supported in submissions to the Taskforce.
The Taskforce therefore proposes the establishment of a Prime Minister’s Council for Active Living
to provide high-level leadership on this issue, and drive the development of a comprehensive National Framework for Active Living that addresses the built environment, transport and social engagement.
The National Framework for Active Living will also inform the development of a business case for consideration by COAG to deliver a new funding partnership agreement between governments. The partnership agreement would leverage future infrastructure funding for the built environment, transport and social engagement against agreed active living outcomes.
A National Framework for Active Living would identify key impediments and enablers of physical activity in relation to the built environment, transport and social engagement. This will include reviewing:
- Built environment – relevant Australian and state government legislation, including building codes; and planning guidelines, including examples of good practice that incorporate healthy living (for example, Healthy Spaces and Places, Healthy by Design).
- Transport – relevant transport policy and guidelines, including examples of good practice in active transport (for example, TravelSmart, national cycling strategy).
- Social engagement – strategies and initiatives to promote social engagement in active living and sport, which may include consideration of the recommendations of the forthcoming Independent Sport Panel Review, social marketing and community engagement programs.
The development of an Active Living Business Case for COAG consideration would provide governments with options to increase active living through the built environment, active transport and social engagement, with objective measures and outcomes to monitor the impact of various options, and ultimately lead to a new funding partnership agreement between governments.
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Establish a Prime Minister’s Council for Active Living and develop and implement a National Framework for Active Living encompassing local government, urban planning, building industry and developers, designers, health, transport, sport and active recreation.
Develop a business case for a new COAG National Partnership Agreement on Active Living.
Australian and state governments to consider the introduction of health impact assessments in all policy development (including urban planning, school education and transport), using partnership models such as the Health in All Policies (HiAP) approach in South Australia.
Driving change through economic and taxation policy
Currently there are few Australian Government tax breaks, subsidies or incentives for active transport, particularly walking and cycling. Within the policy/regulatory environment, a range of government transport policies encourage inactivity
by effectively promoting private motor vehicle use and discouraging walking, cycling and public transport.
- Funding for road infrastructure but not public transport or bicycle facilities
- Reduction in fuel excise to offset the price of carbon emissions
- Financial support for car manufacturers
- Taxation incentives through fringe benefits tax (FBT) for private motor vehicle use but not for forms of transport such as public transport or walking and cycling to work
Under the current FBT system in Australia, private transport is encouraged, as cars of higher-income workers are subsidised. As the taxable value of the car and therefore the FBT payable is reduced with the number of kilometres travelled each year, there is incentive for people using the scheme to maximise car use during the FBT year in order to qualify for the greatest FBT benefit. Numerous groups and several parliamentary inquiries have called for this tax concession to be repealed.
An important first step will be to undertake a review and conduct research on economic barriers and enablers, policies and tax incentives to inform a national active living framework and actions. This review would also inform the development of the National Strategy on Active Living and the development of the business case for COAG on Active Living.
There are no comparable financial incentives for people to use active transport modes such as public transport, walking and cycling. The introduction of similar tax advantages would encourage and support increased physical activity among Australian workers, and is likely to have a subsequent beneficial environmental impact through a reduction in greenhouse gas emissions and urban traffic congestion.
Many workplaces currently provide subsidies that promote private and company motor vehicle use, such as subsidised car parking and novated leases. Inducements that encourage employees to walk, cycle or take public transport to work could be promoted in place of such subsidies. These might include fare rebates, shower and safe bicycle parking facilities, bicycle maintenance vouchers and bonuses for use of alternative forms of transport.
Taxation relief and financial subsidies could also make it easier to participate in physical activity, helping to make active choices a cheaper and easier alternative for individuals, families and business.
- Employer contributions towards activities such as cycling to work or subsidised corporate gym membership
- Tax deductibility for physical activity participation (such as club memberships, sporting equipment, bicycles and clothing) in a range of settings
- Subsidised sporting club fees for children, especially in families that experience financial hardship
- Taxation deductions for families for children’s registration and tuition in organised sport (as occurs in Canada and has been suggested for Australia)[50, 51]
Some of the suggestions from the fitness industry in submissions to the Taskforce called for the provision of tax incentives or rebates for gym memberships in order to remove an initial barrier to participation. However, the rebate or subsidy would not be given until evidence of actual use of the membership was provided, such as gym attendance records. Under such a scheme, setting minimum participation levels for eligibility for an additional activity rebate would encourage at least minimum levels of activity.
The Canadian Government has implemented programs providing healthy living tax credits. The United Kingdom is also currently piloting several initiatives that link economic incentives with physical activity. These initiatives may provide a useful model for further consideration by Australian governments.
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Case study 1: The UK’s Free Swimming Program
The Free Swimming Program is a partnership between the national government, local councils, Sport England and the Amateur Swimming Association. The program has been developed to support Change4Life, a national movement that aims to prevent people from becoming overweight through the promotion of healthier eating and physical activity.
Local councils apply for funds to help meet the cost of providing free access to pools during standard swimming sessions, including improving existing facilities or building new ones.
At launch, the scheme involved more than 1000 pools run by almost 300 local councils. The program also includes a national network of swimming experts recruited to work with participating councils and 100,000 free lessons offered to non-swimmers.
Incentives in the form of extra funding are offered to participating councils with the best record in developing the scheme and making an impact in their communities.
It is hoped the scheme will be extended to the whole population by 2012.
Case study 2: Healthy Living Tax Credit
Since 2005, the government in Nova Scotia, Canada, has provided a Healthy Living Tax Credit to help with the cost of registering children and youth in eligible sport or recreation activities that offer health benefits. Initially based on a maximum annual spending of $150 per child, it is estimated that the tax credit costs the Nova Scotia Government $2.2 million annually.
In 2006 the Children’s Fitness Tax Credit was announced, which allowed parents to claim a non-refundable tax credit of up to $500 in fees for the enrolment of a child under the age of 16 in an eligible program of physical activity. An evaluation is currently being completed.
Commission a review of economic policies and taxation systems, and develop methods for using taxation, grants, pricing, incentives and/or subsidies to promote active living and greater levels of physical activity and decrease sedentary behaviour.
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