Is the lack of physical activity strategy for children complicit mass child neglect?

Child activity paradoxes

A rapidly burgeoning evidence base demonstrates a link between academic performance and physical fitness (closely linked to physical activity) for children of all ages and socioeconomic groups.1–3 There is also an inverse association between physical fitness and reported violent and antisocial incidents in school.2 Physical education, games and sport for children have a demonstrable positive impact on physical health, and affective, social and cognitive function.4 Furthermore, physical activity habits in childhood seem to determine, in part, adult physical activity behaviour,5 6 which is a key determinant of adult health.7

A recent BMJ editorial8 suggested that child health in the UK lags behind most European counterparts,9 and that despite numerous initiatives since 1999, only children from wealthier and more advantaged families seem to have benefited.10 A recent British Medical Association (BMA) report called for the need for a total prevention approach for children, but the leadership and strategy for such urgent and challenging public health measures are totally absent.11 The apparent importance and pervasiveness of physical inactivity among school children has led to a recent Lancet call for physical activity to be ‘a priority for all schools’ that requires ‘whole school’ strategies and government support12 and the Welsh government has committed ‘to make physical literacy as important a development skill as reading and writing’, yet has failed to deliver this pragmatic strategy.13 The English Secretary of State for Education recently announced a set of reforms to school curriculums for 2014, but showed no commitment to revolutionising physical activity and physical education for children. These physical activity-lacking reforms were announced with a great fanfare to the media and praised by the Prime Minister as providing the ‘very best education for their future and for our country’s future’.

School age boys and girls spend an average of 7–8 h a day being sedentary (ie, sitting).14 Much of this waking time is spent in obligatory sitting in lessons at school.15 Thinking about the day-to-day context for children's activity, reality bites: for substantial parts of their lives children seem to have little choice and opportunity to be physically active and are practically forced to be sedentary, not only for much of the school day, but also during travel to school, as safety is a concern to parents, and safe access to recreational activities is heavily influenced by financial capacity and other political and sociogeographical factors, always beyond children's control.

Physical activity promotion should not be the preserve of adulthood. Evidence suggests that many disease processes may begin before birth in the mother's womb.16 The promotion of physical activity for expectant mothers may be as important for the health of the child as activity promotion for young children, a message frequently forgotten by the public, doctors and obstetricians.17 Physical activity should be encouraged from birth, and children of preschool age who are capable of walking unaided should be physically active daily for at least 180 min (3 h), spread across the day.18 Children and young people (aged 5–18 years) should engage in moderate-to-vigorous intensity physical activity for at least 60 min and up to several hours every day, with vigorous intensity weight-bearing activities that strengthen muscle and bone being incorporated at least 3 days a week.18 All children and young people should minimise the amount of time spent being sedentary.18

Despite the well-accepted benefits of physical activity and the recognised importance of schools in delivering the crucial physical literacy and activity opportunities, the erosion of physical education in schools combined with ever-reducing play facilities has the opposite effect, forcing the children to literally sit for most of their school day.

Some experts have predicted that today's children will be the first generation in modern times to have a lower life expectancy than their parents.19 Non-communicable chronic diseases were considered afflictions of later life, but our children are now developing these conditions while still at primary school. Childhood physical inactivity has been linked to cholesterol and fatty streaks appearing in the aorta in the first decade of life and in the arteries of the heart, brain and peripheral arteries in the second and third decades.16 Furthermore, obesity, insulin resistance and inflammation (ie, paediatric metabolic syndrome), type 2 diabetes mellitus and other risk factors for cardiovascular disease have been found to be common in inactive children, following a similar distribution pattern in adults.20 In the UK, more than one in five children are obese when they start schooling, rising to one in three children leaving primary school and 82% of these children will go on to become obese adults.21 The number of children developing type 2 diabetes (which is directly linked to physical inactivity) is growing rapidly and there are cases of children as young as 7 years developing this disease typically only affecting adults.22 Higher levels of sedentary behaviour are associated with worse mental health and lower cognitive function.23 Compared with their inactive peers, physically active children will be significantly healthier7 and wealthier as adults.24

Notwithstanding the well-recognised link between physical activity and health, objective data show that only 33% of boys and 21% of girls aged 4–15 years old in England meet the minimum levels of physical activity for basic health benefits (ie, the modest 60 min of moderate-to-vigorous activity a day), while about another half number of boys and two-thirds of girls fail to achieve even half the daily recommended levels.14 Academic examination grading is heavily measured and targeted; however, an April 2013 Freedom of Information Act (2000) request to Ofsted (Office for Standards in Education, Children’s Services and Skills) exposed that the curriculum time children spend in physical education and activity at school is not monitored or known by the educational and regulatory authorities.

Government promises

Despite the 2012 Olympic legacy promises and pledges to protect school playing fields, the Education Secretary has repeatedly over-ruled his own independent School Playing Fields Advisory Panel over the last 3 years allowing profit-driven sale and development of school playing fields.25 This has resulted in heavy dependence on charities with limited authority and power, such as Fields in Trust, who have managed to protect over ‘1467 sites for future generations to enjoy’.26

A total of £347 million is to be invested by the UK Sport over the next Olympic and Paralympic Games cycle to help win medals in Rio de Janeiro, 2016 with only those sports deemed likely to win a medal receiving funding.27 Perhaps in response to public outrage, £150 million each year for 2 years has been pledged to improve the provision of physical education for primary school children and according to the Prime Minister will ‘inspire future Olympic and Paralympic stars’.28 When compared with the £57 billion29 (not including considerable local government expenditure) to be spent on education in the UK this fiscal year, this investment seems pitiful, it may not suit many children's physical activity preferences, and does not help secondary school children, who suffer the same inactivity-related problems. A £150 million a year investment may appear generous; however, together with funding delays and bureaucratic red tape associated with such, so-called, ‘generosity’ the £9500 per primary school to spend as it sees fit on physical education seems a derisory gesture in the absence of a child and school physical education and activity strategy. The Department of Health has committed £4.2 million a year to Change4Life School Sports Clubs until 2015 and the government has committed £28.4 million towards Schools Games to support a competitive interschool sports competition.30 31 The School Sports Partnership programmes were scrapped by government and reinstated in a U-turn following public outcry, albeit to a significantly lower level of overall funding.32

Intense political focus on sport is misguided, because physical activity participation for young children has been found to be more enjoyable when children are not being forced to compete and win, but encouraged to experiment with different activities.33 Furthermore, there is no evidence that any of these initiatives will increase, or have to date increased, child physical activity levels across the population and previous reports suggest that these initiatives seem to benefit only those who do not appear to need these services in the first place—the most advantaged and wealthiest in a society.10 In the absence of strategy these initiatives also neglect those inactive children who prefer non-sport physical activity.

It is nearly one year following the 2012 London Olympics, with political and Olympic bid promises of youth health and sporting legacies turning rapidly into a distant memory. Around the time of the London Olympics, political rhetoric and media coverage focused public attention on finding and nurturing future sporting talent and inspiring the children and adults to take up sport. Ironically, at the same time, the physical activity targets were quietly shelved. It is understandable to feel guilt and confusion celebrating Great Britain achieving third in the 2012 Olympics medal table, when, at the same time, the women and men from our country achieved first and second, respectively, in the European obesity league tables.34 The only current ‘visible’ national physical activity strategy remains in the hands of conflicted industry interests through the ‘Responsibility Deal’. Without a jot of evidence base, even if principals seem on the surface fair, it remains questionable how the industry will selflessly improve the physical activity levels in children or adults alike.

Is the on-going lack of child physical activity policy in schools an overlooked case of child neglect?

The government definition of child neglect is “the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.”35 Government definition of child abuse includes child neglect and occurs through ‘failing to act to prevent harm’.35

All political parties have neglected state policy on child physical activity for decades. While physical activity guidelines recommend children to spend at least an hour a day being physically active, schools are able to provide no physical education, optional physical education or limited physical education opportunities.36 Furthermore, a lack of focus, political and public debate on these issues highlights a lack of interest of political parties and educational authorities in the physical literacy of our children and future citizens.

A 2012 Ofsted report highlighted that “warm-ups were too short and too easy, and were often followed by long periods of inactivity as teachers introduced PE lessons. Only a few schools had adapted PE programmes to suit the individual needs of obese pupils, or engaged with health agencies, parents and carers to improve the lifestyle of these pupils.” Perhaps more worrying is that this same Ofsted report highlighted that “2 h of PE and school sport each week was an aspirational target for schools introduced by the previous government. There is no statutory requirement for schools to devote a specific amount of time to PE.”36 Given the overwhelming evidence supporting physical activity for the physical health, mental health and productivity of children, the lack of policy, lack of cross-party debate and interest, lack of leadership and strategic action on physical activity within schools are complicit and tantamount to state child neglect. This serves to undermine a general understanding of the importance of physical activity for child health and well-being and critically undermines parental responsibility in ensuring their children lead physically active lives.

When considering the magnitude of such an important health-related issue, the minimal funding, lack of interest and absence of a child physical activity strategy strongly support the notion that the state is failing to act to prevent harm against children and persistently failing to meet children's basic physical needs, likely to result in the serious impairment of their health and development. This is quite literally indistinguishable from the government's own definition of child neglect.

Conclusion

We call on current and future governments to create a comprehensive and thorough national policy for child-centred physical education provision. This must include a serious financial investment and future commitment in a broad range of interventions and greater opportunities for children to take part in a wider variety of compulsory and inclusive physical education at school. A greater curriculum emphasis on improved education about physical activity benefits, physical activity self-care, physical activity motivation and how to take control of their own health through participation in regular, varied and fun physical activity is urgently needed. The accountability of the state and education authorities for child PA and fitness is urgently needed, alongside greater availability and access to physical activity facilities for all children, including those from disadvantaged socioeconomic backgrounds.

The expert opinion of the International Council of Sport Science and Physical Education, which is supported and endorsed by leading scientists, educationalists, global sporting bodies and the United Nations, which represents 193 member states, states that. “Physical education develops physical competence so that all children can move efficiently, effectively and safely and understand what they are doing. The outcome, physical literacy, is an essential basis for their full development and achievement. Physical education in school is the most effective and inclusive means of providing all children, whatever their ability/disability, sex, age, cultural, race/ethnicity, religious or social background, with the skills, attitudes, values, knowledge and understanding for lifelong participation in physical activity and sport.”37

Schools are the cornerstone of nurturing fitter, happier, healthier children; however, their task would be greatly aided by cross party debate, cross party support and a government childhood physical education and physical activity policy. Children's grades will improve, they will develop healthier habits for later life and the impact on family member lifestyle habits may also benefit. To continue to focus on traditional academic subjects and grades at the expense of physical literacy is short sighted, naive and demonstrates a lack of understanding of basic human behaviour and developmental needs.

Can we really afford to continue allowing our children and schools to have no childhood physical activity strategy, no mandatory school physical education time, no physical education quality expectations, selling of school playing fields, virtually non-existent investment in physical education, and lack of provision to non-sporting physical activity opportunities? We call on the state, education authorities and the public to put a stop to the ongoing child physical activity neglect, take responsibility and develop a strategy of substance.