This time last year, we published a blog by Trevor Shilton & Laurent Huber calling for much greater attention to physical activity as a risk factor for NCDs. 12 months later, we celebrate progress, advocacy momentum, and political leadership and interest, and explore the stepping stones ahead as the development of a Global Action Plan on Physical Activity gets underway. 

Physical inactivity is… “pandemic with far-reaching health, economic, environmental and Social consequences.” (Lancet, 2012)             

A Movement for Movement

Increasingly, we are hearing coverage in the media and mention from policy makers about everyone needing to move more. Exercise is a well evidenced and low cost method for reducing the impact of heart disease, cancers, diabetes type 2, obesity, mental illness, dementia and a raft of other conditions and risk factors. It’s a win-win policy option, with active communities also delivering economic, environmental and social policy benefits and potentially contributing to at least eight of the sixteen Sustainable Development Goals (SDGs).

Despite the abundant benefits, many governments seem stumped when it comes to taking affirmative action to invest in physically activity. Advocacy in the past twelve months has focused on making the case for action and making the decision to invest easier by providing evidence and examples of the best investments. This includes:

• Highlighting investments that show the best health, social and economic returns in the short and long-term;
• Outlining interventions that are effective for different populations and country contexts;
• Encouraging and informing conversations and collaboration between government departments such as health and education, who are juggling conflicting curriculum timetables, or transport who know that they need to support more people to take up active transport but need to adjust infrastructure priorities to facilitate it.
• Emphasising that every sector can and should have a role in promoting physical activity; and
• Promoting leadership and tools that will make it easier for everyone to see how they can get more people moving more, more often.   

WHO – Walking the Talk

From a World Health Organization (WHO) perspective, wheels are in motion to lift physical inactivity as a key NCD priority and opportunity for governments. In May, 2016 there was a side event at WHO’s 69th World Health Assembly which was a pivotal moment for the global physical activity movement. The event, convened by WHO and the Thai Government with assistance from ISPAH and others, was well attended and the most interactive – and active - of the Assembly.

During the event, Director General Margaret Chan and others indicated that physical activity was moving up the priority list at WHO. And since then, it has.

• A Technical Package and Toolkit outlining a diverse and extensive range of possible interventions to promote physical activity has been drafted and should soon be available as a comprehensive menu of options for policy makers across numerous sectors. 
• Updated Appendix 3 of the WHO Global Action Plan on NCDs, listing proven effective interventions for addressing NCDs has been strengthened for physical activity, now separated from healthy diets as an intervention area, and with greater specificity and with additional interventions nominated as cost-effective for increasing physical activity and reducing the burden of NCDs.
• Primary care and non-health sectors have been named as key partners for the successful implementation of the policy options, as well as healthy schools and community environments. This further emphasises the case for engaging non-health stakeholders more.
• The WHO Commission on Ending Childhood Obesity (ECHO) provided additional impetus for a global focus on physical activity, identifying the provision of adequate facilities, guidance for parents, teachers and caregivers on physical activity and screen time.  

“We need to promote physical activity, but we can't wait to 2025, we need to do it now!”- WHO DG, Dr Margaret Chan #WHA69 #NCDs

Activating the development of a new Action Plan

Most recently, at the January 2017 WHO Executive Board, the green light was given for WHO to develop a Global Action Plan on Physical Activity by January 2018, for consideration at WHO’s 71^st WHA in May 2018.

2018 will be an important year for physical activity. The development of the Global Action Plan for Physical Activity will coincide with preparations for the 2018 United Nations High Level Meeting on NCDs, positioning physical activity as a central consideration for countries to make greater progress in achieving voluntary NCD targets and reducing physical inactivity by 10% by 2025. The 7th ISPAH Congress in London in late 2018 promises to be an ideal opportunity to celebrate progress and achievements, and turn attention to ensuring commitments relating to the NCD and Physical Activity Global Action Plans are implemented.

Leadership & Collaboration

None of this could have been achieved, and so rapidly, without the leadership of certain people and countries. Thailand, both its Public Health and Health Promotion agencies and Prime Minister, have set an example in highlighting the importance of physical activity to health. 

Leading the charge with the adoption of a South East Asian Region regional resolution on physical activity, Thailand and their colleagues were determined to ensure that the resolution to prioritise physical activity did not stop in the countries of South East Asia. Rather, Thailand drove the putting forward of the proposal for a global action plan on physical activity to the Global WHO in order to escalate physical inactivity as a global concern requiring multilateral support and commitment. Building on all of this, Thailand and WHO are walking the talk themselves, with activation moments speaking louder than words during regional meetings, the Executive Board and WHO’s own ‘Healthy Workplace Initiative’. 

Civil society continues to make a vital contribution to global momentum and advocacy for physical activity. ISPAH has a central mission to see a healthy active world where the opportunities for physical activity and active living are available to all. ISPAH and NCDA have forged a vital civil society collaboration with complementary and coordinated voices.

The Bangkok Declaration - the electric shock physical activity needs?

Concurrently in 2016, ISPAH collaborated with ThaiHealth and the Thai Ministry of Public Health in developing the Bangkok Declaration on Physical Activity for Health and Sustainable development.  The Bangkok Declaration was launched at the 6^th International Congress on Physical Activity and Health (#ISPAH2016) in Bangkok, Thailand in November, 2016.

The Bangkok Declaration is a consensus statement on the importance of physical activity, identifying how population-based actions on physical activity will contribute to reducing NCDs and achieving at least eight of the SDGs. It calls upon governments, policy makers, donors and stakeholders, including the WHO, the United Nations and all national governments, to renew their commitment and invest at scale in implementation of global and national physical activity plans.  

Policy makers and advocates can use the Bangkok Declaration in conjunction with ISPAH’s The Toronto Charter for Physical Activity: A Global Call to Action and 7 Investments that work for physical activity documents, as templates to contribute to physical activity policy frameworks. The Bangkok Declaration is gaining traction, and is currently being translated into 22 languages. These and related advocacy materials will be available on the ISPAH website.

The NCD community has been criticised for being too quiet, too polite and too pedestrian. These are the words of Richard Horton, editor of the Lancet. He went on to say “the NCD community needs an electric shock to its semi-comatosed soul”.

 

I believe this Declaration is the electric shock for the physical activity community. It encapsulates the extensive evidence from this field, and condenses it into a compelling case and recommendations for action."

 

Katie Dain, NCD Alliance Executive Director, on the launch of the Bangkok Declaration

What next? Making the GAP worthwhile

The time is right now, the evidence of the importance of physical activity is well outlined, and the evidence and consensus around areas for urgent investment is also clear. What is now needed is global and national physical activity plans with robust funding and technical support for implementation.   

The Bangkok Declaration, Global Action Plan on NCDs, its updated Appendix 3, the Technical Package, 7 investments that work, and Toronto Charter, all represent a developed global consensus on the suite of intervention options for promoting PA and getting more people moving more often.

As a minimum, the Global Action Plan on Physical Activity should commit to:

• Healthy urban planning and city design for active lives
• Healthy active transport options with a focus on walking, cycling and public transport   
• ‘Whole of school’ physical activity programs
• Healthy active workplaces
• Active health care
• Public education and mass media, and
• Whole of community initiatives.

In addition, sustainable implementation will require 

• Sufficient resources allocation
• Cross-sector engagement and coordination platforms
• Investment in technical capacity and workforce capabilities, and
• Strengthened monitoring, surveillance, research and policy evaluation.

These should form the key elements of a stand-alone Global Action Plan on Physical Activity and equivalent national plans.

Active People, Healthy People – How World Day for Physical Activity can energise the movement

World Day for Physical Activity is Thursday 6^th April, with the 2017 theme: ‘Active People, Healthy People'. We encourage you to get out and move more for your own health every day. However, World Day for Physical Activity is a great day to do what you can to help other people move more, whether it be in your family, workplace, or community.

Consider how you can help make physical activity and its benefits more visible and more accessible, and help more people to be more active.

Finally, keep an eye on our newsletters and when the call for comment on the draft Global Action Plan on Physical Activity is published by WHO, please engage either via ISPAH and the NCD Alliance, or directly yourselves.

"Healthy environments underpin healthy populations" – @WHO DG, Dr Margaret Chan #ISPAH2016

About the Authors:

Trevor Shilton is Director of Cardiovascular Health at the National Heart Foundation of Australia (WA) and the Foundation’s National Lead for Physical Activity. Trevor is Chairman of Global Advocacy for Physical Activity (GAPA), the advocacy council of ISPAH (@ISPAH) and manages that organisation’s information network GlobalPANet. In 2016 Trevor was co-chair of the ISPAH 2016 World Congress on Physical Activity and Public Health. Trevor holds adjunct appointments at Curtin University and the University of Western Australia.  He has had an extensive career in health promotion practice, research, policy and advocacy. His principal interests are in NCD prevention, policy and programs relating to physical activity and obesity, workforce development, Aboriginal health and social marketing. His first passion is advocacy. 

Lucy Westerman (@lewest) is NCD Alliance's Communications and Policy Officer. Lucy leads NCDA's social media presence and engagement, and in addition to broader communications contributions, is curator of the NCD Alliance blog. She holds a Master of Public Health, as well as degrees in health promotion, nutrition and sociology. While committed to all aspects of reducing the burden of NCDs on people and society, her policy passion is NCD prevention, evident in her focus on physical activity, alcohol and collaboration across risk factors within NCDA's advocacy work on NCD risk factors.