Dr. Andrew Pipe 'Send Your Children Outside To Play'


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Dr. Andrew Pipe provided a keynote presentation to the Healthy Children Healthy Spaces Initiative in Ottawa in November, 2010. As the Medical Director of Prevention and Rehab at the University of Ottawa Heart Institute, Dr Pipe speaks to the critical need to shift our children away from sedentary screen based time to outdoor, active, unstructured play.

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Dr. Andrew Pipe 'Send Your Children Outside To Play'

  1. 1. Send Your Children Outside to Play<br />Andrew Pipe, CM, MD<br />Minto Prevention & Rehabilitation Centre,<br />University of Ottawa Heart Institute<br />
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  4. 4. “The history of epidemics is the history of disturbances in human culture.”<br />Rudolf Virchow<br />
  5. 5. “for the ordinary Canadian child … physical fitness … seems to be a decreasing function of age from the time we put him behind a desk in our schools.”<br />Bailey, 1974<br />
  6. 6. Statistics Canada Health Reports 2009;21(1)<br />Typical 12-year-old boy<br />
  7. 7. Statistics Canada Health Reports 2009;21(1)<br />Typical 12-year-old girl<br />
  8. 8. Statistics Canada Health Reports 2009;21(1)<br />
  9. 9. Canadian Children & Youth MeetingPhysical-activity Guidelines<br />The Active Healthy Kids Canada Report Card 2010<br />
  10. 10. Newfoundland<br />25.6% of pre-schoolers are overweight or obese<br />“…prevention measures should begin before the age of 3 years.”<br />Cannning, Courage, Frizzel. CMAJ:171; 2004<br />
  11. 11. A Cause for Concern...<br />63% of youngsters not active enough for optimal growth and development<br />A decline in activity with age and gender<br />Girls are less involved in intense physical activity<br />Physical Activity Monitor CFLRI, 1999<br />
  12. 12. 90% of children and youth don’t meet Canada’s recommendation for 90 minutes of moderate to vigorous physical activity daily<br />Canada’s Report Card on Physical Activity for Children & Youth 2008<br />Active Healthy Kids Canada<br />
  13. 13. Our Obesogenic Environment<br />It is difficult to maintain a healthy diet and physical activity in an environment that discourages physical activity and encourages excessive consumption.<br />Am J Clin Nutr 2009;89:477-84<br />
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  15. 15. "Can Johnny come out and eat?"<br />
  16. 16. “Unless effective interventions to reduce obesity are developed, the steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today may live shorter lives than their parents.”<br />N Engl J Med 2005 Mar;352(11):1138-1145<br />
  17. 17. “No health system is yet meeting the challenge of managing obesity, and no society has developed an effective strategy to prevent it”<br />Lancet May 13, 2006<br />
  18. 18. “Our genes have not changed substantially during the past two decades. The culprit is an environment which promotes behaviours that cause obesity.” <br />
  19. 19. A New Evolutionary Development ?<br />
  20. 20. The Global Burden of Diabetes:<br />63%<br />Millions of people<br />Global Strategy on Diet, Physical Activity and Health: Diabetes; http://www.who.int/dietphysicalactivity/publications/facts/diabetes/en/<br />
  21. 21. Estimated Prevalence of Cardiovascular Risk Factors<br />Am J Med Sci2002;324(3):127-137<br />
  22. 22. Contributing Factors?<br />“Security”<br />“Solicitude”<br />“Screens”<br />“Sodas”<br />“Schoolbuses”<br />
  23. 23. Causal Web<br />Obesity: A Highly Complex Issue<br />
  24. 24. Each additional daily serving of soda increases the risk of childhood obesity by 60%.<br />The ‘Food’ Environment<br />
  25. 25. Active Transportation<br />91% of Canadian children have bicycles…<br />5% ride them to school !<br />
  26. 26.
  27. 27. Nature deficit disorder: a disconnect between today’s indoor children and the natural world<br />Richard Louv, Last Child in the Woods, 2005<br />
  28. 28. “A growing number of policy experts, urban planners, and transportation experts are concerned that we have built our communities so that it is difficult, and in many cases dangerous, to walk or bike and have thus “engineered” physical activity out of our daily lives.”<br />Ann Behav Med 2003;25:80-91<br />
  29. 29. Newer neighbourhoods are often designed to facilitate car travel.<br />Am J Prev Med 2008;35(3):237-244<br />
  30. 30. Walkable Neighbourhoods<br />Older neighbourhoods were often designed with pedestrians<br />in mind.<br />Am J Prev Med 2008;35(3):237-244<br />
  31. 31. Walkable Neighbourhoods<br />Adding a decade to the average age of neighbourhod housing decreases risk of obesity by<br />8% in women and by 13% in men.<br />Am J Prev Med 2008;35(3):237-244<br />
  32. 32. Travel Distances and Urban Forms<br />1.3 miles vs. 0.5 miles<br />B<br />B<br />A<br />A<br />Images are same scale, approximately 1 square mile<br />International Regional Science Review 2005;28(2):193-216<br />
  33. 33. Walkable Neighbourhoods<br />Include the 3Ds:<br /> population Density<br /> pedestrian-friendly Design<br />Diversity of destinations<br />Am J Prev Med 2008;35(3):237-244<br />
  34. 34. Louis Pasteur<br />“Whenever I meditate about a disease,<br />I always think of preventing it, <br />rather than finding a cure.”<br />
  35. 35. Target:<br /> CVD Patient<br />Secondary Prevention <br />Secondary Prevention<br />Goal:<br />Prevent recurrent <br />CVD event<br />Target: <br />Persons with CVD risk factors but no CVD or diabetes<br />Goal: Prevent first CVD event<br />Primary Prevention<br />Primary Prevention<br />Target: Entire Population<br />Goal: Prevent risk factor development <br />The Continuum of Prevention<br />Health Promotion<br />Health Promotion<br />
  36. 36. Ensuring Child Health<br />
  37. 37. The ‘Active School’ Concept<br />An integrated array of activities:<br />Academic, social, nutritional, and physical activity programmes<br />School as the focus and a central resource of an ‘active’ community<br />
  38. 38. Ontario: Healthy Schools Program<br />Removal of junk food from vending machines<br />
  39. 39. Ontario: Healthy Schools Program<br />Minimum 20 minutes daily physical activity for all elementary students…<br /> Opening of schools for community use after hours…<br />
  40. 40. Food Policy<br />Agricultural support policies<br />Regulation<br />Ingredients ?<br />Portion Size ?<br />Labeling ?<br />Marketing ?<br />Taxation<br />
  41. 41. “Healthy Planning” Policies<br />
  42. 42. Supportive Environments<br />“Supporting the development and availability<br /> of an array of safe, accessible environments<br />and policies which facilitate activity”<br />
  43. 43. Renovated schoolyards increase the number of children who are physically active, and their overall activity levels.<br />Am J Public Health 2010;100:1672-78<br />
  44. 44. Interacting with nature helps children learn<br />The Globe and Mail , November 12, 2010<br />
  45. 45. Understanding the population we serve<br />
  46. 46. Adoption of appropriate behaviours before heart disease becomes clinically apparent increases life expectancy by10 to 14 years.<br />
  47. 47. Footer<br />Champlain Chronic Disease Risk Factor Profile (Adults 12+)<br />Source: Statistics Canada's health indicators data (2005)*, Canadian Community Health Survey**<br />
  48. 48.
  49. 49. The Champlain Declaration<br />The nine school boards in the Champlain District, in partnership with the CCPN, commit to creating healthy school environments so that school-aged children (aged 4 to 18) in the Champlain region can be physically active and can make healthy food choices at school on a daily basis.<br />
  50. 50. School Board Priority Areas for Action<br />Healthy nutrition environments, with an immediate focus on the following elements: <br /> a. Healthy fundraising<br /> b. Healthy classroom rewards<br /> c. Healthy lunch programs & food service contracts<br />2. Principal and teacher training to support implementation of physical activity and nutrition-related actions<br />
  51. 51. Champlain Healthy School-aged Children Initiative<br />Identified actions for the Champlain Healthy School-aged Children Strategy:<br /><ul><li>Create progressive, supportive school policies across the nine Champlain School Boards (The Champlain Declaration)
  52. 52. Develop a regional communications campaign to promote healthy eating and physical activity
  53. 53. Develop an evaluation tool for tracking progress (i.e. Champlain Report Card)
  54. 54. Facilitate opportunities for skills development among teachers, parents, children and youth</li></li></ul><li>European Charter on Counteracting Obesity<br />Encourage children to walk to school<br />Establish priority bicycle routes<br />
  55. 55. “There are two causes of disease, one is pathological … the other is political.”<br />Rudolf Virchow<br />
  56. 56. Change takes place when:<br />There is a “crisis”<br />A critical mass of scientific evidence<br />Shifts in social attitudes occur<br />Public cynicism grows<br />Political pressures begin to build<br />THERE IS LEADERSHIP !<br />
  57. 57. Challenge Assumptions<br />
  58. 58. Healthier Children?<br />Parents as<br />Leaders <br />and Advocates<br />
  59. 59. ‘Aesculapian Authority’<br />“the unique credibility afforded to health professionals<br />when they speak out on issues relating to the health<br />and well-being of the individual or community.”<br />
  60. 60. “If the creator had any purpose in equipping us with a neck…he surely must have intended that we stick it out!” <br />Arthur Koestler<br />
  61. 61. Beware of: Ignorance, Indifference and Inertia.<br />
  62. 62. Active<br />Vigorous<br />Healthy<br />CANADIAN !<br />
  63. 63. Send Your Children Outside to Play !<br />
  64. 64.
  65. 65. A single piece of advice...<br />Send<br />Your Kids<br /> Outside<br />To Play!<br />
  66. 66. First Nations<br />79% of adults are inactive<br />40% of youth are overweight or obese<br />60% of children are overweight or obese<br />1 in 5 adults are diabetic<br />
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  70. 70. What does the future hold?<br />Prevention<br />Alternate approaches to payment<br />Alternate approaches to delivery of care<br />Transformed patterns of practice<br />