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Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
Physical activity policy and program development: the experience of Finland
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Physical activity policy and program development: the experience of Finland

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  • 1. Physical Activity Policy and Program Development: the Experience of Finland Ilkka Vuori, MD, PhD, professor (emeritus), Tampere, Finland,ilkka.vuori@uta.fi ”Sport and Health Policies”, 2nd International Sport Countries Conference Barcelona, November 24 - 27 2008
  • 2. Foundation for Sport and Health Policies Very strong scientific evidence shows the great potential of physical activity for health, www.health.gov/PAGuidelines Well known fact to us, but not so well known to, or internalized and accepted by policy and decission makers at various levels Strong advocacy (agitation) is needed! The experience of others may be useful
  • 3. Regarding health, PA is • for individuals: ”a health insurance” decreasing the risks and increasing the capacity to bear the consequences of the materialized risks • for societies: an investment for better health, lighter burden and smaller costs of diseases and infirmity.The individual health benefits of PA accrued during the whole life span are collectively seen in the population´s health.
  • 4. But the qualities of PA´s make a difference regarding its effects on health!
  • 5. Health-Enhancing Physical Activity (HEPA) (Vuori 1990) Any physical activity that regardless of its reasons (motivations) has been shown to produce effects that enhance health (physical, mental, social) without undue risks or harms. In order to meet the criteria above the activity has to be frequent, continuous, and moderate in relation to the capacity of the person practicing recommendations, guidelines.
  • 6. Health, fitness Benefits benefits s Training rm for sport ha Exercise nd Active Activity for fitness isksa living for health R Light, Moderate Moderate, Strenuous moderate About daily vigorous Several times a week Daily At least 30 min 3 times a week Variable Tens of At least 20 min minutes, even hours Type and amount of activity Vuori / UKK Institute 1
  • 7. Because of the great values of PA • it is decleared to be the right of everyone ”Sports for All” ~ ”PA for All” • opportunities for PA should be available to everyone. Systematic promotion of PA is a task of the society
  • 8. Successful promotion of PA in a population is a very demanding task because • large number of insufficiently active people • many factors (determinants) influence in favour of and against change of an individual´s physical activity
  • 9. Physical Activity: determinants Willingness Abilities Opportunities Support • emotional: • skills • sites and • social experiences • health services: • professional expectations available • economical • rational: accessible knowledge affordable • norms and acceptable values appropriate
  • 10. Successful PA promotion requires systematic use of multiple large-scale, long- standing measures in co-ordinated fashion that address the critical determinants. Planning, funding, and implementation of these kind of measures calls for acceptance of PA promotion as an important goal at the state or community level, and for agreement of the directions to reach the goal, i.e. policies.
  • 11. What policies are needed? Examples Especially for Sport, recreation Sites, services Youth, elderly, gender Equal opportunities Education, school Education, instruction Health Information, counseling Urban planning Accessible opportunities Building, construction Accessible, appropriate -”- Transport Safe, accessible opportunities Safety, consumer Safe, appropriate equipment, services, sites Insurance Incentives, safety Research Evidence, guidelines Media Information, attention, boostering, advocacy? © Ilkka Vuor
  • 12. In health, Finland advocates ”Health in all policies” Should we advocate ”PA in all policies”!
  • 13. Elements of Effective PA Promotion Policies Sport, recreation Youth, elderly, gender Education, school Information, media Health, insurance Urban planning Building, construction Transport Safety, consumer Research Actions, programmes Willingness Abilities Opportunities More Movement © Ilkka Vuori, 2001
  • 14. What have the Finnish policy and decission makers done to make ”PA for All” a reality? How well have they succeeded in making Finns physically active?
  • 15. HEPA in Finland Recommendations ”Social for local HEPA Justification National promotion for PA and New HEPA Sports Sport” I coalition UKK Act Institute National New sport HEPA HEPA Sports for young ”Social funding Committee Committee Finns Justification policy for PA and Sport” II Z 1980 1980 -90 -91 -90 -91 -92 -92 -93 -93 -94 -95 -96 -97 -98 -99 -94 -95 -96 -97 -98 -99 2000 2000 Finland on the Move FIT FOR LIFE I FOR FIT FOR LIFE II
  • 16. First Sport Act (1979) • Significance: strongest policy, legal positioning and ”protection” of PA, important especially during ”difficult times (economic crisis etc.) • Grounds: social functions of sports, e.g. health • Division of duties – Responsibility of the state and the municipalities: establishment of sites and basic services on equal basis to all – Responsibility of voluntary organizations: arrangement of leisure time physical activities – The state supports financially the municipalities and sports organizations. – In addition, the state supports sports-related research.
  • 17. Sport Act 1999 Purpose: to advance physical activity and sports and related civic activity, to enhance population health and well-being through sports, and to support young peoples´ growth and development • Division of responsibilities: mainly as in the first sport act • The municipalities have the responsibility to create opportunities for health-enhancing physical activities by developing local and regional collaboration, by supporting civic activity, and by offering sites and services, also considering people with disabilities.
  • 18. Government programs States the directions of a new government, (State Council) strongly binding policy documents Former government´s program: State funds will be directed to sport of children and young people that enhances health and emphasizes educational and ethical aspects. • Enhancement of health and functional capacity of adults, elderly, and peolple with disabilities through sport will be supported.
  • 19. Current government´s program Sport policy will be used to enhance well-being, health, and functional capacity of the population. Action lines and measures will be defined in the National Program for Sports and Physical Activity government resolution (with emphasis on public administration)
  • 20. 1st Government Resolution on Health- Enhancing Physical Activity (2002) • Expresses the commitment of all ministries in the Finnish government to promote physical activity for health, and the ministries are responsible for developing measures increasing and improving conditions for health-enhancing physical activity in their own sectors. • Many measures directed to increase physical activity explicitly for health
  • 21. 1st Government Resolution on Health- Enhancing Physical Activity • Principles included: – Collaboration among government sectors – Consideration of PA in land use, environmental planning, community structure, and everyday settings – Inclusion of PA as an explicit part of municipal wellness policy – Increased research and education related to health-enhancing physical activity • Also funds: 2 million euros in 2003, more in 2004
  • 22. 2nd Government Resolution on Health- Enhancing Physical Activity (2008) • Also diet included • Sites and services for HEPA belong to the basic municipal services, to be included in the planning and evaluation • All age groups addressed • Physically active commuting to be stimulated • Opportunities especially for balance and strength training for the elderly • Emphasis on environments enabling and stimulating for HEPA • Counseling for HEPA to be increased
  • 23. Transport policy Increase of walking and cycling in transport (partly for health): series of policies and programs since 1992, the By Foot ongoing. Evaluations mainly positive demonstrating the need of longstanding cooperation of multiple partners in research, development, demonstration, and implementation of numerous simultaneous and successive measures to reach the goals
  • 24. Implementation of policies: major programs and measures
  • 25. Programs Two national HEPA programs since 1991: • Finland on the Move 1991 – 1994 • Fit for Life 1 1995 – 1999 • Fit for Life 2 2000 – 2004 • Fit for Life 3 2005 – 2009 • Fit fort Life 4 2010 -2014, decided Largely the same basic ideas and principles, gradual enlargement in aims,size, target population, and number of partners
  • 26. Fit for Life:aims (gradually developed) • To activate insufficiently active individuals • To develop models for producing high-quality and sustainable HEPA services at local level through co-operation • To create networks of HEPA actors • To get transport and environmental sectors involved
  • 27. Fit for Life: Principles • free access • local ideas (new, innovative) • networking • targeting insufficiently active people • sustainable changes • financial support based on competition • supporting independent activity
  • 28. Criteria of project competition Target: large number of middle-aged people Good idea • to reach the non-exercising people • to motivate them to begin exercising • to support them to continue exercising regularly Co-operation between sport and other sectors Continuation and resources: persons, money, facilities
  • 29. Fit of Life: Means • financial support • Information (print, audio-visual, media) • training • networking • evaluation
  • 30. Projects, funds, partners • Currently more than 800 projects supported, projects have been in nearly every municipality, only a part of them have sustained • Currently the annual budget is 1.9 million euros, about half of this to the projects • Partners: Ministries of Education, Social Affairs and Health, Transport, and Environment; Forest and Park Service, and for a period Social Insurance Institution, an insurance company and some commercial sponsors
  • 31. Fit for Life: Some lessons learned The bottom-up mode innovative and effective Networking effective new, also cross-sectoral collaboration at national and local level Light organizational structure cost-effective but weak in strategic leadership ”Seed money” for the projects key instrument but has led to fragmented and diffuse impact Population impact (PA, health, function) difficult to assess despite surveillance and evaluations
  • 32. Other national programs including HEPA • Finnish Heart Health Program: HEPA one of the best realized parts • Diabetes Prevention Program: HEPA a key part • Strength for Old Age • Movement Prescription Project • National Bone and Joint Program
  • 33. Strength for Old Age Program Aims: to increase functional capacity, autonomy and quality of life of elderly persons (75+) with decreased functional capacity by creating high quality, permanent services providing strength and balance exercise programs
  • 34. Measures 1. 35 projects, mainly in service homes : exercise programs epecially for strength and balance, implementation supported by education, instruction, stimulation and guidance of the instructors and the participants 2. Advocacy: nation-wide information, communication, and networking activities to influence decision makers, interest groups, and media 3. Dissemination of the products (knowledge, experience and good practices) through a national network of instructors, Web, newsletters, publications, and fairs.
  • 35. Preliminary results 80 % of the projects experienced that the guidance benefited their developmental work greatly or very greatly; majority of the first projects led to permanent exercise programs in the service homes. HANKERYHMÄ 2005 Effect of exercise Testattuja 426 henkilöä measured by 9% 9% performance Tulos parantunut Tulos pysynyt ennallaan Tulos heikentynyt tests: blue = 17 % 65 % Erisuuntaiset tulokset improved
  • 36. Movement on Prescription • 4-year national project supported by the Ministry of Social Affairs and Health, and by the Finnish Medical Association • The program was not effective in increasing the frequency of asking about PA habits or the frequency of using the prescription or other written material in PA counseling
  • 37. Other implementations, examples Change of criteria for state subsidies to sports organizations (1995): more weight to health, fitness, and youth sports effective in supporting HEPA (more funds, new interested partners) Change of criteria for state subsidies for construction of sites for PA (2001): priority to sites serving ordinary people in their daily environment effective in changing emphasis.
  • 38. Thus, what has been done regarding Physical Activity: determinants Willingness Abilities Opportunities Support • emotional: • skills • sites and • social experiences • health services: • professional expectations available • economical • rational: accessible knowledge affordable • norms and acceptable values appropriate
  • 39. Strong policies attempting to • address all population groups on equal basis but emphasizing the needs • direct resources to sites, services, and functions advancing ”PA for All”
  • 40. Rather extensive measures to increase willingness of • the politicians to advance PA by producing, collecting, summarizing, and disseminating evidence on social significance of PA (e.g. books, campaigns in connection with national and local elections) • the people by disseminating knowledge and information of the value of and opportunities for PA, and by offering opportunities for favourable experiences in and through PA
  • 41. Rather extensive measures to increase abilities = skills related to PA of • teachers, instructors, trainers, peers etc.: to plan, organize, instruct, guide etc. ”PA for All” by providing education and training at various levels from university degree to short courses • the people to practice PA by providing mandatory physical education in schools (for > 160 years!), and by using the services and activities of the municipalities and the ~ 9000 open-access sports clubs, and of the PA programs described earlier
  • 42. Rather extensive measures to increase opportunities for PA by • developing and maintaining sites and services, e.g. ~ 30 000 built sports facililities (1/170 Finns), construction costs subsided by the state, 75 % owned and run by municipalities affordable to most people • financial support of the state and municipalities to the sports and other civic associations to provide low cost services
  • 43. Measures to increase support • Social support: the functions of the sports associations; Network for Familysports; World PA Day; PA Day for the Elderly etc. • Professional support: extensive education and training of PA professionals; some attempts on the health sector, e.g. the PA on Prescription –project • Financial support: low cost sites and services; PA vouchers provided by employers to employees (tax free for 200 euros/year for both parties, culture vouchers (2009 - , 400 euros/year) to subsidize costs of participation
  • 44. State funding and major actions for HEPA promotion: 1990 - 2006 milj. euros 8 Strength to ageing/RAY 7 HEPA/Min Edu HEPA/Min Health 6 Youth pa/Min Edu 5 FFL programme/Min Health FFL programme/Min Edu 4 Finland on the Move/Min Edu 3 j 2 1 0 -90 -91 -92 -93 -94 -95 -96 -97 -98 -99 -00 -01 -02 -03 -04 -05 -06 1990 1994 1995 1999 2000 2001 2002 2003 2004 2005 2006 LYP KKI Liikuntalain TELI Terveys VN:n Vanhasen OPM:n KKI III Kansall. Liikuntakomitea: hallitus- Hyvinvointia uudistus paikalliset 2015 peri- TELI- liikunta- suositukset aate- ohjelma raha RAY:n ohjelma liikunnasta – liikuntaa kaikille Lipposen TELI päätös STM:n tuki alkaa II hallitus- Liikunta- komitea- TELI- Voimaa Voimaa 1991 ohjelma paikkarak. mietintöTELI raha vanh. vanh. Liikunta-Suomi tukea neuv.- -ohjelma -ohjelmalle -projekti OPM:n JALOIN kunta lähiliikunta- lasten ja paikkoihin -ohjelma TELI nuorten neuv.kun- liikunta- KKI II nan ohjelma II kausi LYP II
  • 45. Initiation, planning, and implementation of the health-related PA policies and programs Difficult to be sure of the initiation chain and of the most important actors Agenda setting: the role of research and researchers has been important, evidence based advocacy, ”making the case”. Planning: key role played by the central administration, esp. Ministry of Education. Most policies are developed by committees representing large numbers of stakeholders. Implementation: key roles played by the sport sector of the municipalities and the state, while the health sector and traditional sports organizations have been slower to join.
  • 46. Has PA of the Finns increased?
  • 47. Proportion of thoProportion of those among 15–64-year-olds who pursue leisure time physical Proportion of those among 15–64-year-oldsleast leisure time physical – 2006 activities for least 30 min at least 2 and at who a week in 1978 leisure time physical se among 15–64-year-olds who pursue 4 times pursue activities for least 30 min a 15–64-year-olds t 4least 2 1978 – 2006 least 4 times a activities for least 30 min at least 2 and at least times a week in and at week in 1978 – 2006 least % Women Men % 100 100 80 80 60 60 >2 times a week 40 >2 times a week 40 20 20 >4 times a week >4 times a week 0 0 -78 -80 -82 -84 -86 -88 -90 -92 -94 -96 -98 -00 -02 -04 -06 -78 -80 -82 -84 -86 -88 -90 -92 -94 -96 -98 -00 -02 -04 -06 Year Year Source: Health Behaviour and Health among Finnish Adult Population 1978 – 2006 (National Public Health Institute)
  • 48. Daily walking and cycling to work among 15-64 y old women and men: 1978 – 2006 (%). % women men % 100 100 80 80 60 60 40 40 20 >15 min per day 20 >15 min per day >30 min per day >30 min per day 0 0 -78 -80 -82 -84 -86 -88 -90 -92 -94 -96 -98 -00 -02 -04 -06 -78 -80 -82 -84 -86 -88 -90 -92 -94 -96 -98 -00 -02 -04 -06 year year Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys (AVTK) 1978 – 2006 (KTL)
  • 49. Daily pa among 65-84 y old: 1997-2005 % 100 90 80 70 60 50 Men, walking 40 Women, walking 30 20 Men, other pa 10 Women, other pa 0 1997 1999 2001 2003 2005 Eläkeikäisen väestön terveyskäyttäytyminen (EVTK) 1997 – 2005 (KTL)
  • 50. How do we interpret the results? Much posititive: – Increased awareness and positive attitudes among most politicians and people proven by surveys – Potentially effective policies and programs and their serious implementation – Various physical, administrative, organizational, and social infrastructures – Victory in a ”defense battle”?: slight increase in leisure time PA but decrease in total PA; high ranking in international comparison
  • 51. Participation (hours per week, in %) of adults in LTPA in 15 EU countries (de Almeida et al. 1999). Country None < 1.5 h 1.5 – 3.5 h > 3, 5 h % % % % Austria 13 1 7 77 Belgium 38 2 9 50 Denmark 23 2 7 67 Finland 8 1 6 84 (1) pation (hours per week, in %) of adults 2 LTPA in 15 EU countries (de Almeida et al. France 35 in 9 54 Germany 30 1 8 61 Greece 40 1 6 54 Ireland 13 1 6 80 Italy 38 3 8 52 Luxembourg 18 4 10 68 Netherlands 16 1 9 73 Portugal 60 3 7 30 Spain 37 3 11 49 Sweden 10 2 5 83 UK 23 1 9 67
  • 52. What has been learned? (1) Evidence-based advocacy and marketing effective research, surveillance, evaluation, communication needed Sustainable results call for large-scale, long-term concerted actions by multiple partners HEPA is or can be important issue on several sectors and for many public and private organizations and institutions within and outside PA and health sectors good and increasing opportunities for collaboration
  • 53. What has been learned? (2) Administration and organization at the national level are needed to ensure sufficiently high political commitment, visibility, leadership, and supporting functions. Participation in PA takes place at the local level. Therefore, municipalities and local organizations are the primary partners to be supported and strengthened. Civic organizations are nearest to the people, and they should play key roles in carrying out the practical work
  • 54. What has been learned? (3) Key role of research: Thorough understanding of the deep roots of PA behaviour is needed in order to have reliable basis to plan effective, cost-effective, and acceptable policies and measures to increase PA. Without this knowledge, the effectiveness of the efforts will be insufficient to convince the policy makers to move for movement, and to make people to increase their movement.
  • 55. What could be done better? To apply social marketing theories and approaches more systematically in order * to offer right products to right people at right times in right places for right ”price”, and * to develop effective and sustained collaboration with multiple partners by creating ”win – win” situations. To implement well-focused and well-planned measures on even more areas, in even larger scale and for even longer periods. To keep in mind, that all decissions at all levels related to PA are after all made by persons ~ individuals (even if they are bureaucrats!) they have to be made willing to move for movement.
  • 56. Dear Friends and Colleaques PA promotion is an important and fascinating area for research and practice. It is an ultraendurance task that needs skillful and energetic experts to cover the whole spectrum from ideology to practical applications. But it is worth the effort! Take it and enjoy it, best luck!
  • 57. Muchos gracias!
  • 58. HEPA development in Finland Min HEPA Health National PA Committee funding programme Report for New Sport HEPA On Foot Act. Programme Social Social Significance Government Min Edu Sport Significanc of Sport 1 Resolution funding for Committee: e of Sport 2 on HEPA HEPA PA for all HEPA “Strength Fit for Life 1 Finland Advisory to Aging” Local HEPA Board 1 UKK on the Fit for Life 3 Guidelines Institute Move HEPA Fit for Life 2 Advisory Board 2 1980 1990 1991/93 1994 1995 1999 2000 2001 2002 2003 2004 2005 2006

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