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“Health in All Policies” in Practice: Guidance and Tools to Quantifying the Health Effects of Cycling and Walking

Sonja Kahlmeier, Francesca Racioppi, Nick Cavill, Harry Rutter, and Pekka Oja

Background:

There is growing interest in “Health in All Policies” approaches, aiming at promoting health through policies which are under the control of nonhealth sectors. While economic appraisal is an established practice in transport planning, health effects are rarely taken into account. An international project was carried out to develop guidance and tools for practitioners for quantifying the health effects of cycling and walking, supporting their full appraisal.

Development Process:

A systematic review of existing approaches was carried out. Then, the products were developed with an international expert panel through an extensive consensus finding process.

Products and Applications:

Methodological guidance was developed which addresses the main challenges practitioners encounter in the quantification of health effects from cycling and walking. A “Health Economic Assessment Tool (HEAT) for cycling” was developed which is being used in several countries.

Conclusions:

There is a need for a more consistent approach to the quantification of health benefits from cycling and walking. This project is providing guidance and an illustrative tool for cycling for practical application. Results show that substantial savings can be expected. Such tools illustrate the importance of considering health in transport policy and infrastructure planning, putting “Health in All Policies” into practice.

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A Conceptual Primer on the Potential of Adaptive Policies to Reduce Physical Inactivity

Karen Milton, Harry Rutter, Harriet Koorts, and Leandro Garcia

Background: Despite the existence of physical activity policies across many countries, insufficient physical activity remains a major global public health problem. Physical inactivity is an emergent feature of complex systems; it results from a wide range of factors at multiple levels that interact to influence behavior. Traditional approaches to public policy often fail within complex systems, largely due to unpredictability in how the system will respond. Adaptive policies, which are designed to allow for uncertainty about future system behavior and to change over time, may offer a promising solution. In this paper, we introduce the concept of adaptive policies and illustrate how this innovative approach to policy making may be beneficial for reducing physical inactivity. Design: Drawing on existing literature and guiding principles for policy making, we provide 3 examples to illustrate how the concept of adaptive policies can be applied to address physical inactivity. Discussion: The examples illustrate how changes to the way policies and interventions are developed, implemented, and evaluated could help to overcome some of the limitations in existing practices. A key challenge will be engaging policymakers to take a broader perspective of the physical activity system, develop policies that are designed to be adaptable across a range of different future scenarios, and embrace uncertainty and long-term adaptability. Conclusion: Adaptive policies may support decision makers globally to achieve the widespread and sustained changes necessary to increase population levels of physical activity.

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Toward Whole-of-System Action to Promote Physical Activity: A Cross-Sectoral Analysis of Physical Activity Policy in Australia

Tracy Nau, Karen Lee, Ben J. Smith, William Bellew, Lindsey Reece, Peter Gelius, Harry Rutter, and Adrian Bauman

Background: The value of a systems thinking approach to tackling population physical inactivity is increasingly recognized. This study used conceptual systems thinking to develop a cognitive map for physical activity (PA) influences and intervention points, which informed a standardized approach to the coding and notation of PA-related policies in Australia. Methods: Policies were identified through desktop searches and input from 33 nominated government representatives attending 2 national PA policy workshops. Documents were audited using predefined criteria spanning policy development, strategic approaches to PA, implementation processes, and evaluation. Data were analyzed using descriptive statistics. Results: The audit included 110 policies, mainly led by the health or planning/infrastructure sectors (n = 54, 49%). Most policies purporting to promote PA did so as a cobenefit of another objective that was not focused on PA (n = 63, 57%). An intention to monitor progress was indicated in most (n = 94, 85%); however, fewer than half (n = 52, 47%) contained evaluable goals/actions relevant to PA. Descriptions of resourcing/funding arrangements were generally absent or lacked specific commitment (n = 67, 61%). Conclusions: This study describes current PA-relevant policy in Australia and identifies opportunities for improving coordination, implementation, and evaluation to strengthen a whole-of-system and cross-agency approach to increasing population PA.

Open access

Promoting Physical Activity Policy: The Development of the MOVING Framework

Kate Oldridge-Turner, Margarita Kokkorou, Fiona Sing, Knut-Inge Klepp, Harry Rutter, Arnfinn Helleve, Bryony Sinclair, Louise Meincke, Giota Mitrou, Martin Wiseman, and Kate Allen

Background: Considering the large health burden of physical inactivity, effective physical activity promotion is a “best buy” for noncommunicable disease and obesity prevention. The MOVING policy framework was developed to promote and monitor government policy actions to increase physical activity as part of the EU Horizon 2020 project “Confronting Obesity: Co-creating policy with youth (CO-CREATE).” Method: A scanning exercise, documentary review of key international policy documents, and thematic analysis of main recommendations were conducted. Themes were reviewed as part of a consultation with physical activity experts. Results: There were 6 overarching policy framework areas: M—make opportunities and initiatives that promote physical activity in schools, the community, and sport and recreation; O—offer physical activity opportunities in the workplace and training in physical activity promotion across multiple professions; V—visualize and enact structures and surroundings that promote physical activity; I—implement transport infrastructure and opportunities that support active societies; N—normalize and increase physical activity through public communication that motivates and builds behavior change skills; and G—give physical activity training, assessment, and counseling in health care settings. Conclusions: The MOVING framework can identify policy actions needed, tailor options suitable for populations, and assess whether approaches are sufficiently comprehensive.