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Development in the behavioural anti-obesity effort

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(14) 2009
Author(s): 
Adam Oliver
Health Policy Issues: 
Public Health
Reform formerly reported in: 
Developments in libertarian paternalism
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

These are the dying days of a (probably) dying government, and thus some of the newly initiated policies are perhaps inevitably somewhat 'desperate'. This report details some recent updates on the government's "Change4Life" initiative, a policy direction that aims to encourage people, particularly children, become more active, with the intention that this may serve to reduce levels of obesity in the population, both now and in the future.

Recent developments

In April 2009, the government cited some new statistics to try to emphasise how incredibly inactive children in England, in general, are. For instance, from a national survey of children's diet and activity levels that comprised about 260,000 responses from families in England (from a survey sent to 11 million people!), it was reported that 72% of children do not engage in sixty minutes of daily activity outside of school, which, according to the Minister of Public Health, Dawn Primarolo, is the minimum amount of daily activity required among children if obesity levels are to be cut (I'm not sure how she reached this conclusion and therefore I'm not sure how accurate it is - that said, she also made the startlingly original statement that "By eating better and moving more, we can all live longer and healthier lives" - presumably if we don't move under a bus). The survey also reported that only 22% of children engaged in some kind of physical activity after their evening meal.

In response, the government has, over the course of this year, implemented a number of initiatives to try to increase activity in children. For example, families who sign up for the Change4Life programme (detailed in round 13 of the Health Policy Monitor reports) have been sent a 'tailor made' advice pack that gives hints to each family on how they can make small changes to their daily lives to improve their general lifestyle behaviours. Moreover, in April 2004, the government launched a new Change4Life media advertisement that appears to draw on social marketing methods, which features an animated family who suddenly realise that their inactiviy can lead to fat build up, and consequent illnesses including cancer, diabetes and heart disease. The family is then shown to improve their activity rates by deciding to do fun things, such as playing in the park and walking to school (although, personally, I rarely found walking to school much fun).

Also in April 2009, the government introduced their imaginatively titled "Swim4Life" initiative, whereby children under the age of 16 and adults over the age of sixty can swim for free (I'm never quite sure why services are made universally free for people over the age of sixty - in any country, people within this particular demographic group comprise of many of the wealthiest people in society). As part of the Swim4Life initiative, the government has launched a national competition for children to invent a new swimming stroke (i.e. an alternative to the breast stroke, back stroke, butterfly etc. - in the event, the winning entry was for a 'dolphinella' stroke). The government anticipates that the competition will inspire children to swim more regularly, which will, it is hoped, be a means to get more children to undertake the aforementioned required sixty minutes of activity per day.  

Incidentally, the prize for the winner of the swimming stroke competition is not large - it is essentially a two day stay for a family of four at a British theme park. The emphasis on the government's recent initiatives under the Change4Life programme is therefore on making 'exercise' fun. The perfectly logical intention is that if people can find fun ways of exercising, obesity levels will fall due to a side effect of people's chosen leisure activities. I suppose the key will be whether a sufficient number of inactive people do indeed gain enjoyment from these activities, or, perhaps more importantly, whether the fun involved in being active exceeds the enjoyment experienced from being inactive. It does, after all, often require a considerable degree of effort to even begin to engage in an activity, even if you later find that you are enjoying that activity, and it may be the case that the initial effort will, for many, serve as an often unsummountable obstacle.  

 

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low high very high
Transferability strongly system-dependent rather system-neutral system-neutral
current current   previous previous

It is probably a reasonable idea for the government to use any tools at their disposal to try to improve activity levels in people in general, and in children in particular (so as to try to form good lifetime behavoural patterns). However, as noted throughout this report, the absence of a good evaluative framework to sit alongside these initiatives is problematic (and, unfortunately, is not unusual, at both the national and local levels). I suspect that these types of marketing methods are unlikely to lead to a sustained effect on individual behaviour, although some short term changes might well be observed. The free swimming policy may even have the unintended consequence of increasing the amount of children who go to the swimming pool to mess about rather than to swim (particularly duing the school holidays), which, one could argue, is at least an activity of sorts, but may have unfortunate negative externalities, the effects of which are felt by fee paying individuals who go to the pool to swim.  

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Initiators of idea/main actors

  • Government
  • Opinion Leaders

Stakeholder positions

These latest initiatives are simply part of the government's Change4Life programme. The government is not forcing anyone to do anything - as noted in round 13, these initiatives fall under the libertarian paternalism rubric (i.e. the government is using advertising, social marketing and other means to try to change the 'choice architecture', so as to encourage people to engage in more activities under their own steam). The government of course supports its own policy proposals, and can thus implement these initiatives quite freely. I have not detected strong opposition to these initiatives, partly I suspect because they are viewed as fairly harmless, although some academics are a little dismayed that the government has yet again introduced initiatives (that are after all not costless) without an adequate evaluative framework in place to assess whether these things work. However, for governments, it is the 'being seen to be doing something' that is often more important than whether that thing has an effect. The general public, I suspect, are broadly supportive of free swimming for the young and then elderly (which is perhaps seen as a form of social capital building), although I am unsure of the extent to which 'additional' individuals take advantage of these free facilities.

Actors and positions

Description of actors and their positions
Government
National governmentvery supportivevery supportive strongly opposed
Opinion Leaders
Swimming expertsvery supportivevery supportive strongly opposed
current current   previous previous

Influences in policy making and legislation

Not applicable.

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
National governmentvery strongneutral none
Opinion Leaders
Swimming expertsvery strongweak none
current current   previous previous
Swimming expertsNational government

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

All of this has been described above. The only additional thing to add is that the Swim4Life swimming stroke competition was judged by a panel of expert that included Olympic swimmer, Mark Foster, and leading coach, Ian Armiger, and so therefore clearly had considerable support from the swimming fraternity.

Monitoring and evaluation

There is, as far as I know, no strong evaluative framework in place to assess the effects of the Change4Life initiatives, which is one of the main criticisms that have been waged against this entire approach. Clearly, given that is is taxayers money paying for these initiatives, and given that public sector finances are now very tight, the initiatives should be subjected to proper evaluation. However, even if activity levels are shown to increase over the coming years, there is always likely to be an attribution problem in this area, as many other factors are likely to affect people's activity levels, both positively (e.g. development of green spaces) and negatively (e.g. perceptions of crime). There is also the added complication of a looming general election, with the government perhaps keen to roll out 'populist' initiatives at this time, and then worry about their effects if they are re-elected (which currently seems unlikely).

Expected outcome

As far as I am aware, there are no reported outcomes to observe from these initiatives, and, as indicated above, I'm not sure if there ever will be (however, the government does claim that the free swimming policy for the young and the elderly has subsantially increased the number of people going to swimming pools). That said, one could counter the concern that these things are not properly assessed by arguing, probably quite legitimately, that some things may be worth doing even if their impact is not (and sometimes cannot be) measured. However, these particular initiatives shopuld perhaps be better assessed for the sustainability of their effect on activity, and for their eventual effects (if any) on health. 

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low neutral very high
current current   previous previous

I don't know the outcomes of the policy (and neither does anyone else), so I cannot comment on whether it is equitable or efficient. The middle classes are traditionally more adept at taking advantage of health promotion messages, and therefore the policy may even widen disparities in health in the long term. Clearly, the target for these initiatives is not the health care services per se, and therefore the quality of health care is unlikely to be affected.

References

Sources of Information

www.nhs.uk/change4life

http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&NewsAreaId=2&ReleaseID=405186&SubjectId=36

http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&NewsAreaId=2&ReleaseID=406584&SubjectId=36

http://www.culture.gov.uk/what_we_do/sport/5810.aspx

http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&NewsAreaId=2&ReleaseID=399574&SubjectId=36

Reform formerly reported in

Developments in libertarian paternalism
Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Adam Oliver. "Development in the behavioural anti-obesity effort". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/uk/a14/3