Strategies to modernise the National Health Service (NHS) in England have brought about the development of local organisations called Health and Wellbeing (H&WB) boards through the Health and Social Care Act 2012. These boards were intended to become a forum where key leaders and stakeholders from health and care systems work together to improve the health and well-being of their local population and reduce health inequalities. Throughout England these boards have been drafting their strategies, largely ignoring the importance of physical activity in health and well-being. In the county of Hertfordshire, the initial draft priorities were released in 2012 and physical activity promotion was not included. Using a BJSM blog, BJSM online poll, Twitter and email, an attempt was made to generate as much interest and formal feedback as possible to the draft strategy, in order to ensure the inclusion of physical activity as a priority in the revised strategy.
- Health Promotion Through Physical Activity
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“If you always do what you've always done, you'll always get what you've always got.” Henry Ford (1863–1947)
Although there is a need to build global capacity based on the present foundations, a system approach that focuses on populations and the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach focusing on individuals, is the way forward to increase physical activity worldwide.1
Research continues to unravel the complexity of physical inactivity and physical activity promotion. This is not easy when interactions between everchanging physical and non-physical environments are considered on an individual and population level. Physical activity is determined by psychological (cognitive and behavioural), social, economic, healthcare access, employment, commercial pressures, transportation options, accessibility to physical activity and built environments, which all affect our active and passive movement decisions every moment of every day.2 This presents a significant challenge to the public health and policy makers, when they attempt to increase the physical activity levels in different populations to benefit our health, wellbeing and inequalities. However, there seems to be consensus among international experts that coordinated interventions must target the ‘total physical activity’ and this requires agencies and sectors, working and planning together to tackle the physical inactivity pandemically.3 ,4 Without change, our health systems are threatened and our modern largely inactive societies will continue to suffer the ill effects of inactivity related disease and societal problems.4 ,5
The problem and potential solution: health and well-being boards
Strategies to modernise the National Health Service (NHS) in England have brought about the development of local organisations called Health and Wellbeing (H&WB) boards through the Health and Social Care Act 2012. These boards are intended to become a forum where key leaders and stakeholders from the health and care systems work together to improve the health and well-being of their local population and reduce health inequalities.6
Across the country these boards have been formed around the 158 local authorities and they will assume statutory functions from April 2013. These ‘shadow’ boards (‘shadow’ until April 2013) have been considered for drafting public health priorities and strategies on behalf of their local population for future years. These priorities will inevitably lead to further strategies that form the basis for the development of future services and project funding.
The Hertfordshire story
For readers not familiar with UK geography, Hertfordshire is a fairly leafy county just north of London with a population of approximately 1.1 million.7
The Hertfordshire H&WB has representatives from the NHS, County Council, District Councils and the Hertfordshire Local Involvement Network (LINk) (LINk has been set up ‘across England to help local people influence the way that their local healthcare and social services are planned and delivered’). Health and well-being priorities were chosen as areas where ‘health service and local government can make a real difference by working together’. Last year an evaluation process was used to analyse numerous key local health and social issues and these were scored against local needs, impact and importance.
A draft strategy was developed, which included eight proposed local priorities for 2013–2016. Physical inactivity and physical activity promotion were not included in this draft list.
Physical activity was not even evaluated to see whether it warranted being included in future strategy, despite overwhelming evidence of the importance of increasing physical activity for improved health, well-being8 and with numerous other positive social effects. Ironically, evidence supports increasing physical activity would positively affect nearly all the eight initial draft priorities.
The proposed eight priority areas were:
Managing long-term conditions—to reduce the use of emergency care
Supporting family carers
Promoting good mental health—including helping people to live well with dementia
Helping families facing multiple problems to thrive
Reduce harm caused by drugs and alcohol
Fulfilling lives for people with learning disabilities
The draft priorities were made public and there was an open consultation period enabling feedback.
The social media solution
The H&WB provided a unique opportunity to develop strategies across silos, agencies and sectors and so we decided to attempt a small evidence-based translation and implementation experiment. The plan was to use social media and electronic mail to try and change the draft priorities by seeking as much feedback as possible to the open consultation in support of including a physical activity priority. Our goal was to inform and interest as many people as possible about the perceived problem by using ‘viral marketing’ techniques in the hope that they would be guided to leave feedback to the open consultation.
We drafted a BJSM blog explaining the Hertfordshire problem, asking concerned readers to respond to the consultation and to help spread the discussion by forwarding the BJSM blog to interested contacts via email, discussing the draft strategy on Twitter and retweeting this Twitter debate.9
BJSM helped to develop an online poll, accompanying the blog, to enable readers to leave direct feedback. While appreciating BJSM blog readers may be better informed than most on physical activity science and exercise medicine, a convincing 98.4% of BJSM online poll voters (n=126) felt that Hertfordshire should tackle the problem of physical inactivity as a top priority for health and well-being.
Furthermore, the Engagement Response report (October 2012) to the consultation speaks for itself:
3373 responses were received (we believe that this may have demonstrated an unprecedented level of interest)
180 responses received from groups or organisations
2880 responses from a written survey and 433 from an online survey
2582 response were received from individuals
The report suggests that ‘the majority of responses felt that there should be a greater reference to healthy lifestyle. In particular, many recommended that physical activity to be included as a priority on its own’.
ENGAGEMENT RESPONSE REPORT FEEEDBACK INCLUDES
“Promoting physical activity for all ages should be a priority.”
East and North Hertfordshire NHS Trust
“Increasing levels of physical activity has many benefits, and can contribute to several of the proposed priorities…District and Borough Councils have a major role in providing and promoting physical activities, and could make a big contribution to delivery of a priority centred on this issue.”
Broxbourne Borough Councils
In addition, to the written consultation there was also considerable debate on Twitter about the Hertfordshire's draft Health and Well-being strategy.
We were invited to present a case for a physical activity priority to members of the St. Albans (one of the district councils in Hertfordshire) Health and Wellbeing Partnership; the audience included the chair of the countywide shadow H&WB Board, which was opportune.
Hertfordshire's new Health and Wellbeing Strategy for 2013-16 was launched on Monday 11 February, 2013 and now includes the following priority in the revised strategy (http://www.hertsdirect.org/docs/pdf/h/hwbstrategy.pdf): “Increasing physical activity and promoting a healthy weight.”
Despite the evidence supporting public health focus on increased physical activity (and hence fitness) over weightloss,10 ,11 we think this local priority inclusion demonstrates evidence-based public health progress in recognition of the importance of physical activity in health and well-being.
This apparently successful small-scale experiment, demonstrates that social media and modern forms of communication provide powerful information dissemination tools and discussion forums that may help enable strategic change and public health rethinks. Hopefully, this story will motivate others to attempt public health change in favour of evidence based physical activity promotion and education, perhaps using social media and modern forms of communication, but with greater sophistication. Furthermore, this also demonstrates that social marketing lessons learnt in sports medicine and sports injury prevention11 may also be relevant to exercise medicine and physical activity promotion.
We would like to thank the BJSM blog for their assistance in preparing the online poll and blog links and BJSM blog readers for their motivation and ‘viral’ help. We also thank Fiona Deans for her help in drafting the blogs. We would also like to thank Emmanuel Stamatakis and members of the University College London Population Health Domain Physical Activity Research Group for their support for the blog and Mike Evans, Andrew Murray, Ann Gates and Wilby Williamson for providing the ‘somewhat luddite’ authors with social media inspiration to attempt this small experiment.
Contributors RW and CN conceived the idea. RW drafted this manuscript. RW and Fiona Deans drafted the two BJSM blogs. All were critically revised by CN.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
▸ References to this paper are available online at http://bjsm.bmj.com
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