This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
Part 2 describes an organising framework for efforts to influence physical settings across Australia. This is comprised of a chapter on each setting, and a review of the evidence that promoting activity can be influenced effectively in that setting. This first chapter sets the scene for interventions, by providing a health promotion framework for physical activity programs, consistent with, and derived from the World Health Organization's 'Active Living' program.
In view of the evidence for the health benefits of physical activity, the public health gain that may be possible from encouraging Australians to become more active is substantial (see chapters 1.1 and 1.4). Working towards increasing levels of physical activity in the Australian community is now a public health priority. However, major challenges remain in determining the most appropriate settings and methodologies for increasing population levels of physical activity in Australia.
There is growing recognition that while interventions in some settings may prove independently effective in raising community levels of physical activity, a combination of strategies is optimal to increase physical activity levels at the population level (Donovan and Owen 1994, King 1991). The World Health Organization (WHO) has acknowledged that comprehensive approaches to health development are the most effective (WHO 1997).
A comprehensive approach, targeting the range of settings and population groups outlined in this report, with a combination of strategies can help ensure that:
Part two describes best practice in defined settings for promoting physical activity, including general practice, schools, worksites and community settings. In addition, approaches through environmental changes and policy interventions are included as a setting. WHO acknowledges that settings offer practical opportunities for the implementation of comprehensive health promotion strategies. These are described in chapters 2.2 to 2.7.
Part three of this document takes a physical activity perspective on special population groups, including a lifespan approach to promoting physical activity. This includes an equity focus on disadvantaged groups, and on groups least likely to be physically active or to be able to afford or access programs or facilities that encourage active participation.
Approaches to increasing population levels of physical activity in Australia can be described using a health promotion framework.
Comprehensive approaches are consistent with WHO policy (WHO 1986, WHO 1997) and give due priority to strategies that:
In addition to the public health benefits that may accrue from a physically active community, it is important to acknowledge the many benefits that physical activity can deliver that relate to the core business of transport, local government, education, planning, environment and sport and recreation. Physical activity is indeed a whole-of-community concern. An implication of this is the necessary priority that must be afforded to building partnership in the development of approaches to increasing physical activity levels in the community.
There is potential for physical activity to make an important contribution to social capital in neighbourhoods and communities (Putnam 1993). Physical activity can contribute to a sense of community, provide connectedness and freedom from isolation. This is linked to growing evidence about the importance of underlying social and economic determinants of health. Achieving sustainable increases in levels of community physical activity, and changes in the physical and social environment that will support physical activity choices, will require the forging of new partnerships and collaborations with sectors outside health (Harris et al. 1995; WHO 1997; USDHHS 1996).
Successful partnerships between sectors require hard work and good will, as well as commitment to action, a considerable investment in building relationships, an agreed plan of action and planning to sustain outcomes (Harris et al. 1995). In addition, partnerships need to be constructed in such way that agreements are transparent and accountable and there is mutual understanding and respect among the players (WHO 1997, National Public Health Partnership). Partnership among agencies can result in efficiencies through combined resources and programs (NSW Taskforce 1996). A critical element of any intersectoral partnership is the recognition of the interdependence among the partners to achieve a common end. It may be the means to an end that organisations share. For example, while health, transport and the environment seek quite different ends (improved health, decongested roads, clearer air respectively), the means to these ends (walking, cycling, public transport) may be the area where common ground can be found and built upon.
The partnership between research and practice is critical. When interventions are being planned, implemented and evaluated, major gains can be made by bringing together the complementary skills of researchers and practitioners (Holman 1996).
The next dimension of a health promotion framework is the provision of information, through community education and campaigns, to promote awareness of the benefits of being active. WHO contends that access to education and information is essential to achieving effective participation and the empowerment of people and communities (WHO 1997). Specific cognitive behavioural skills have been found to be more prevalent among active members of the community (Corti and Bull 1998). The ability to plan exercise into a daily routine, set specific goals, and the presence of social support are all potentially important social-cognitive contributors to physical activity participation. Therefore, education that focuses on cognitive training in these skills, may assist individuals to translate their good intentions into action (Corti and Bull 1998).
Another important dimension is the notion of a supportive environment. Physical activity can be made convenient, easier, safer and more enjoyable through initiatives designed to influence the physical environment. This includes aspects of the physical environment, such as walking trails, park redevelopment, and provision of recreational facilities. Aspects of the social environment, including social support for activity and the provision of childcare, are also important.
It is clear that education is more effective when it takes account of social and cultural factors as well as those relating to health. Inactive people are more likely to be older, less well-educated and on lower incomes. (Stephens et al 1985; see also chapter 1.3) This has important implications for the development of targeted educational strategies. For example, consideration of social and cultural factors for parents (particularly women) who may lack time and opportunity for exercise, potentially leads to an intervention that makes physical activity more convenient through community based and neighbourhood programs or community facilities where child care is provided.
Another aspect of education is increasing skills in the professional workforces concerned with physical activity. This includes health professionals, local Government planners, sport and recreation professionals, general practitioners and allied health professionals.
Capacity building has been defined as 'An approach to the development of sustainable skills, organisational structures, resources and commitment to health improvement in health and other sectors, to multiply health gains many times over' (Hawe et al. 1999). The framework and indicators have much to offer in terms of assessing program sustainability, the strength of coalitions and the quality of program planning.
Finally, a health promotion perspective endorses an equity framework, identifying the people who are least active in the community, and developing specific interventions to address disparities among groups in physical activity behaviour or in their access to physical activity promoting environments or services. Physical activity interventions should consider the needs of people of different cultures or ages, and people with disabilities. The implications of geography, climate and remoteness on participation in physical activity should also be considered in the design of interventions.
References
Corti B, Bull F. (1998). Increasing participation in physical activity - a review of published interventions. Report for the Commonwealth Department of Health and Aged care. Canberra: CDHAC.
Department of the Arts, Sport, the Environment and Territories. (1992). Pilot survey of the fitness of Australians. Canberra: AGPS.
Department of Health and Aged Care (DHAC), Australian Institute of Health and Welfare (AIHW). (1999). National health priority areas report. Cardiovascular health 1998. Canberra: AIHW.
Department of Health and Aged Care (DHAC). (1999). National Physical Activity Guidelines for Australians. Canberra.
Donovan RJ, Owen N. (1994). Social marketing and population interventions. In Dishman RK (Ed.), Advances in exercise adherence. Champaign, Illinois: Human Kinetics. pp 249-90.
Harris E, Wise M, Hawe P, et al. (1995). Working together: intersectoral action for health. Canberra: AGPS.
Hawe P, King L, Noort M, et al. (1999). Indicators to help with capacity building in health promotion. Sydney: NSW Health Department.
Holman CDJ. (1996). Creating partnerships, building systems: Improving interactions between research and practice. Health Promotion Journal of Australia 6(2):21-5.
King A. (1991). Community interventions for promotion of physical activity and fitness. Exercise and Sport Sciences Review 19:211-59.
National Public Health Partnership URL: http://www.nphp.gov.au
NSW Premier’s Taskforce on Physical Activity (NSW Taskforce). (1996). Simply active every day. Sydney: NSW Health Department.
Putnam RD. (1993). Making democracy work. Princeton, New Jersey: Princeton University Press.
Stephens T, Jacobs DR, White CC. (1985). A descriptive epidemiology of leisure-time physical activity. Public Health Reports 100:147-58.
United States Department of Health and Human Services (USDHHS). (1996). Physical activity and health: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, pp 3-8, 85-151.
World Health Organization. (1986). The Ottawa Charter for Health Promotion. Geneva: WHO.
World Health Organization. (1997a). The Jakarta Declaration on leading health promotion into the 21st century. Geneva: WHO.
World Health Organization. (1997b). Active Living policy (Net address http://www.who.int/hpr/active/index.html no longer appears to be regularly functional, possibly due to restructuring of divisions in WHO - similar information available through the Non Communicable Disease Branch, Physical Activity Programme).
Next: Part 2 (cont.) - 2.2 Promoting physical activity through general practice
Previous: Part 1 - 1.4. Towards best practice: evidence and policy implications
This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
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