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Healthy Lifestyle - from Science to Policy and Action

A preliminary response from Higher Education Institutions to "Health Challenge Wales"

Background

There is a substantial body of evidence that lifestyle has an impact on health. Reduced physical activity in children and adults as well as excessive calorie intake has resulted in increasing obesity in the population. Obesity is associated with an increased risk of potentially lethal diseases such as diabetes, raised blood pressure, stroke and coronary artery disease. As well as increasing mortality and shortening lifespan, diabetes causes blindness, loss of limbs, kidney failure and an increased risk of congenital anomalies in the babies of mothers with diabetes.

Conversely, there is incontrovertible evidence that increased physical activity and reduced calorie intake can reduce the problem of obesity, prevent the onset of diabetes for those who are susceptible to it, and reduce mortality.

But these problems do not begin in childhood or in adulthood — they probably begin much earlier; there is a relationship between low birth weight and increased risk of death from coronary artery disease in adults, and low birth weight is more common in less well-off communities. Evidence strongly suggests that poor nutrition in the mother during pregnancy pre-programmes the baby for diseases in adulthood including obesity, diabetes, raised blood pressure, coronary artery disease and stroke (sometimes called "the metabolic syndrome"). This could help to explain the much higher incidence of these diseases in people from socio-economically deprived backgrounds. In utero, it is suggested that, in these circumstances, the foetus is prepared for a low calorie environment when it is born, but in infancy and childhood an excessive calorie intake and low physical activity can lead to childhood obesity and increasingly early onset of the diseases described above. Therefore, as well as reduced physical activity and excessive calories in childhood and adulthood, there is an element of pre-programming for adult disease due to foetal malnutrition, associated with poor nutrition in the mother. However, it is not only people who are less well off in whom these problems occur; obesity, reduced physical activity and poor nutrition are increasing in young people from all social groups. Furthermore, whatever their background, overweight children are likely to become overweight adults.

Thus lifestyle has an enormous impact on health and disease and on life expectancy. If the current situation continues, it could well be that we are looking at a generation of children and young people who will suffer from cardiovascular and other diseases and will die in their thirties and forties, leaving behind not only their children but also their parents. The human and socio-economic cost of this morbidity and mortality is potentially catastrophic.

What can we do?

  • Provide more education about lifestyle, beginning with children when they start school.
  • Promote increased physical activity for all with well planned and properly evaluated initiatives that support this.
  • Support research into behaviour change to improve nutrition and increase physical activity.
  • Make resources available, for example through local authorities and universities, that will increase access to sports and exercise facilities.

Proposal

An all-Wales programme which focuses on increased physical activity and improved nutrition, targeting especially children, young adults and the less well off.

The way forward

  • Seek from all higher education institutions in Wales, information on educational programmes and research undertaken in the areas of sport science, exercise medicine, nutrition and outreach activities into their local communities.
  • Establish databases of educational programmes and research in these areas.
  • Identify areas of good practice.
  • Establish new co-ordinated research, educational and outreach programmes.

Organisation

(A) All-Wales Co-ordinating Group with 4 subgroups:

  1. Education
    We need to know what undergraduate and postgraduate courses are available in sports and exercise, in nutrition and in psychology. We can then identify gaps and decide whether those gaps in provision should be filled in.
  2. Research
    We need a database of research in all aspects of life-style and health in Wales so that we can share expertise, develop collaborations and avoid unnecessary duplication of effort.
  3. Outreach
    We need to learn from good practice and replicate it. There are "Healthy Universities" that focus on the health of their students and staff and some universities are already "local heroes" providing access to facilities for people (especially children) in local communities. This provides a tangible interface between the local university and its community, enabling improved access and wider participation in Higher Education, as well as providing a much needed service. Our students are an untapped resource of expertise (e.g. in sports science and nutrition) and our best ambassadors. This outreach activity could also include screening children to detect obesity and associated ill health problems at an early age, whilst at the same time identifying enthusiastic and gifted people with aspirations to sporting excellence.

    Furthermore, properly trained university students, as part of the "Healthy University" programme could provide education in schools, for example, in lifestyle and heart disease, cancer awareness, sexual health, drugs and substance misuse and lifestyle and genetic susceptibility to disease. This would build upon what UWCM already does in South Wales. It could be planned and delivered with colleagues from TechniQuest.
  4. Clinical services
    Clinical services for people with exercise-related injuries are mainly delivered in primary care and in the private sector. There is relatively easy access for elite athletes but not for the general public. If we encourage people to be more active we must provide services that will treat injury quickly and effectively, and equally important, provide education on how to prevent injury.

(B) A network of Centres of Excellence in Lifestyle and Health

Each Higher Education Institution (HEI) which is part of the proposed network, may wish to focus on a particular area within the all-Wales portfolio.

For example, the new Cardiff University may wish to focus on molecular and cellular aspects of sports and exercise related injuries, on research into physical activity and cardiovascular disease, and on determinants of health behaviours and interventions; at UWCM’s Health Sciences Centre in Wrexham an all-Wales database of GP sub specialty interests is being developed which will aid identification of those GP’s interested in Lifestyle and Health. Bangor University has expertise in psychology related to changing nutritional behaviour in children and has already set up an Institute for Food, Active Living and Nutrition in Cymru (IFANC) with involvement of its 5A RAE-rated School of Sport, Health and Exercise Science. Swansea has interests in the increasing problem of obesity in children and in Sports Science, the North East Wales Institute (NEWI) and the University of Wales College Newport (UWCN) have experience in outreach activity which encourages local children to increase physical activity and provides advice on healthy eating. Aberystwyth University has well equipped laboratories for measurement of cardiopulmonary and muscle function and body composition. The University of Wales Institute Cardiff (UWIC) has outstanding sports facilities, including a superb gym especially focussing on the needs of people with disabilities. At the University of Glamorgan, Swansea Institute and Trinity College Carmarthen, there are innovative education programmes and research expertise in Sports, Health and Leisure Science.

(C) The People

There are internationally distinguished researchers, teachers and clinicians in all the relevant disciplines in HEI’s in Wales. Moreover in Wales, we also have academics and NHS colleagues who are known throughout the world for their expertise. People such as the Chief Physiotherapist for the Great Britain Olympic Squad, the Chief Medical Officers for the Welsh Rugby Union, Glamorgan County Cricket Club and the British Boxing Board of Control, the team doctors for the Welsh National Rugby Team, for Cardiff City and Swansea City Football Clubs, a former international hockey player, and an Olympic discus thrower etc. etc. All of these people are committed to improved lifestyle for everybody.

With the Welsh Assembly Government’s commitment, at the highest level, to addressing the problems of Lifestyle and Health, HEI’s now have a real opportunity to make a major contribution to the future health and well-being of people in Wales. There are numerous stakeholders with whom we must work not only within HEIs and HEFCW, but in Government, local authorities, the Health Promotion Division of the Welsh Assembly Government, the Food Standards Agency, the food industry, the Wales Centre for Health, the Sports Council for Wales, the Countryside Council for Wales, the insurance industry and many others who can contribute to knowledge, influence policy making and effect change.

The HEI’s in Wales must respond to Health Challenge Wales, decide what our unique contribution can be, and work with other stakeholders to make a difference — the need is urgent; let’s get started!

(D) What do we need?

  • A launch conference for the initiative.
  • Infrastructure to support the overarching group and the four subgroups.
  • Pump-priming for academic developments in research, education, service and research.

(E) How can we refine this outline?

  • By seeking advice from HEFCW about possible funding for a feasibility study.

This draft document is a preliminary response from Higher Education Institutions to the Welsh Assembly Government’s ‘concept’ document, Health Challenge Wales.

If you would like to submit comments on this draft document, please feel free to contact Professor Stephen Tomlinson.