The Miracle Pill

by Peter Walker

  A huge World Health Organization study published in The Lancet in 2019 pulled together data from 146 countries to conclude that, worldwide, about 80 per cent of all children age eleven to seventeen are not sufficiently active. It found that over the previous fifteen years, while the proportion of inactive boys had actually fallen, from 80.1 per cent to 77.6 per cent, for girls it had remained steady at around 85 per cent – an activity gender gap of more than seven percentage points. Figures for the UK more or less exactly tracked this global trend.11

  The reasons behind the low activity levels among teenagers, especially girls, are complex and long-standing, and often related, as we saw in Chapter 5, to a built environment geared more to the needs of boys. On a more cultural level, some of the best insights come from so-called qualitative studies, ones based not on raw data but exploring in detail people’s motivations and reasons for certain behaviour. In 2000, England’s now-defunct Health Education Authority produced a fascinating report using on in-depth interviews with children aged five to fifteen and their parents, which chronicled the influence of gender on activity as girls got older. ‘I feel as if I don’t want to stop,’ one six-year-old girl is quoted as saying about her joy in running around. A bit later come the views of a pair of fifteen-year-old girls: ‘Can’t be bothered,’ says one. ‘Too much hard work,’ adds her friend.12 The reasons for the change were varied, but mainly connected to entrenched social attitudes, not least the pressures the teenage girls appeared to feel around fitting into gender stereotypes. An earlier study of young people in southeast London found similar attitudes. One fifteen-year-old girl said she and her friends had dropped out of playing school netball a couple of years earlier because they thought it was ‘babyish’. This was a common attitude, the researchers found: ‘Becoming a woman, according to the norms they had learned while growing up, usually meant that sport participation was given a low priority in their lives.’13

  But it’s not good enough to merely accept such views as inevitable. The authors of the 2019 WHO report into adolescent inactivity demanded urgent government action to address the situation, particularly for girls. ‘Young people have the right to play and should be provided with the opportunities to realise their right to physical and mental health and wellbeing,’ they said. ‘That four in every five adolescents do not experience the enjoyment and social, physical, and mental health benefits of regular physical activity is not by chance, but a consequence of political choices and societal design.’14

  Schools sitting down

  A lot of these political choices manifest themselves inside schools, where children spend the bulk of their waking hours for five days a week during three quarters of the year. Many of the social and cultural norms they take into adulthood come from the classroom and playground. So what are our schools telling children about the importance of activity? It depends in part where you look.

  As we will see in more detail in the next chapter, a handful of countries very deliberately try to ensure schools are places of constant activity. Finland has a long-standing programme called Finnish Schools on the Move, which is involved in everything from how children travel to school to the way they learn when they are there. How this happens is decided by teachers, but initiatives include longer break times to provide enough time for proper physical play, as well as learning based around movement, for example doing squats to count in maths classes. Students can stand in the classroom if they want, or sit on a ball. Another example is Slovenia, which has monitored the fitness of the nation’s children for almost thirty years. Every school has two indoor sports areas and outside playgrounds and sports fields, plus access to government-owned nature camps converted from former military bases. Slovenia is now believed to be the only country in the world in which childhood obesity rates are falling.

  In England, however, the centrally set curriculum does not even mandate any amount of physical education, even though it is a compulsory subject. A minimum of two hours per week is recommended, for both primary and secondary schools, but that is all it is – a recommendation.15 A 2018 report found that around a third of English primary schools had less than this in their timetables.16 The reasons vary, but it is often due to lack of time amid the increasingly long and arduous list of curriculum tasks which are compulsory, mainly formal academic work. There are valid reasons, particularly for primary schools, to focus on skills like language and maths as a way to even out the academic inequalities from differing home backgrounds. But many fear this has now subsumed thoughts of children’s physical wellbeing.

  In all Scottish schools, the two weekly hours of PE are compulsory,17 even if, as shown by Elaine Wyllie’s experience of her unfit nine- and ten-year-olds, this is generally not sufficient to counteract a lack of movement elsewhere in the children’s lives. Wyllie told me that the packed schedule meant she initially doubted whether many other schools would take up even the fifteen minutes needed for the Daily Mile: ‘It’s an hour and a quarter a week out of a curriculum that’s twenty-five hours long, and extremely precious.’

  It is illustrative of the inertia towards activity in the wider UK education system that despite the obvious success of the Daily Mile in her school, when Wyllie tried to get officials to pay attention she was initially met with suspicion: ‘I couldn’t get anybody interested. They should have been right at my door. Instead, I got my collar felt, because it was breaking the mould.’ In the end, impetus built up for two reasons, Wyllie recalls: parents from neighbouring schools heard about the scheme and ‘started to go to their headteacher and bash down the door’. Then, when St Ninian’s started to win cross-country running events at a national level, even education authorities began paying attention.

  The low status of physicality affects not just formal PE, but also classroom learning. While the youngest primary school pupils still spend much of their day sitting on carpets, before too long they are quietly writing at miniature tables, on their miniature chairs, like scale-model versions of the sedentary office workers so many will become. The amount of sitting involved in this, particularly as children get older, is the subject of considerable angst in the physical activity research world. One paper published in 2020 noted that in Australia, which despite its popular image as a land of bronzed sportspeople actually has a similar record on activity to the UK, pupils aged eight to twelve spent 60 per cent of their time in class sitting. ‘Such broad attributes of classroom environments have changed little since the early 1900s,’ the researchers noted.18

  Equally important as healthy bones and well-developing cardiovascular systems, regular movement in childhood is vital as a template for future life. It is all the harder to persuade an adult they should cycle into work, or sit less over the day, if all they have known is cars and chairs.

  My nine-year-old son goes to a state primary school which in many ways is admirable. The teachers are committed and hugely hardworking, and they genuinely care about their young charges. It has made real efforts to get more children walking and cycling to school, blocking off the street at drop-off and pick-off times. But I worry whether it has quite got the message on physical movement during learning hours. It has yet to sign up to the Daily Mile, even if in fairness, as a cramped London school whose only grass playing field is occasionally borrowed from the very expensive private school next door, this could be for logistical reasons. Before his formal school year was curtailed by the coronavirus lockdown, it was not uncommon for my son to recount that PE was cancelled to make room for some other part of school life, often to catch up with academic obligations. It was noticeable that he would sometimes get out of school at 3:30pm seeming a bit pent-up and restless.

  So I decided to enlist him for a brief, if surreptitious, experiment. With his consent – in fact he was very keen on the idea – he spent an entire school day shortly before lockdown wearing the tiny Danish-made activity tracker I had used to monitor my own sitting time for the last chapter, carefully taped to his thigh underneath his school trousers. For
comparison, he then wore the tracker the following Saturday.

  If you have not had much recent experience of nine-year-old boys, their default setting when left to their own devices is to be in motion, or at least standing. More or less the only exceptions are watching a screen, reading, or mealtimes. Even these are not a given. When eating his breakfast my son’s preferred habit is to place his cereal bowl on the living room windowsill and eat standing up, flicking through a football magazine.

  After I download the data from his days wearing the activity tracker, the readings for the Saturday reflect this way of life. The chart, plotting the day in fifteen-minute chunks, is more or less entirely filled in with the orange, yellow and blue lines to show walking, sporadic walking and standing, even if there is a break to show that, apparently, this was one of the days when he decided to eat breakfast sitting down. The movement is not all spontaneous. There is a splash of bright green lines to show running in the mid-morning, when he was doing his usual Saturday tennis lesson with friends in our local park. But with the time in bed factored out over the 24-hour period, the accumulated inactive time comes to little more than two hours.

  When I first look at the chart for his day at school, the contrast is immediate, and dispiriting. Before school and after is the same as the Saturday – a mass of colour to show movement. But from 9am to 3:30pm the backdrop is mainly the drab grey that indicates sitting. It is not unbroken. There are bursts of activity, particularly at breaktime and during lunch. But between that, the bulk of the day is clearly spent in a chair. In both the morning and afternoon there are two-hour periods where the inactivity is barely interrupted at all. The combined total for daytime sitting is more than six hours – three times as much as the weekend.

  As we saw in the last chapter, excessive sitting can mark the start of a gradual pathway towards type 2 diabetes and obesity. For a minority of children the former is not even that far in the future. Type 2 diabetes was always seen as a condition of middle age and later. We saw in Chapter 4 how there are now more than 7,000 under-25s in England and Wales recorded as having the condition. Almost unbelievably, some of them are still in school, even primary school.19

  I’m not a teacher, and I can only try to imagine the difficulties of corralling a class of thirty children to make sure they all learn to the best of their abilities, and how much easier that must be if they are sitting down. But if we ever want our children to grow up healthy, active and delighted with their own, in-built, everyday thirst for movement, this is not how you do it.

  A life of confinement

  There is, of course, much more to the issue than sitting in school. There has been considerable public hand wringing in recent years about the perceived cosseting of children, with a lack of independence meaning many are ferried more or less everywhere in a parent’s car. Physical play is supervised and limited, without previous generations’ ability to roam, explore and experiment.

  These worries are based in fact. A useful indicator for independent childhood mobility is how children get to and from school, and there is no doubt the statistics show a decline in active travel. In England, more than four in ten primary pupils are taken to school in a car, even though many of these trips are under a mile.20 Australia keeps particularly detailed figures on school travel. One study found that in 1971, 58 per cent of schoolchildren aged nine or younger in Sydney would walk to school, with 23 per cent driven. Thirty years later the figures were 26 per cent walking and 67 per cent in cars.21

  What is the difference? Again, the villain of the piece is towns and cities dominated by motor traffic. Fear of road danger by parents is both obvious and understandable. Globally, road injuries are the leading cause of death among children and young people, killing more than AIDS, tuberculosis and diseases like dysentery, combined.22 In the UK, 70 per cent of parents who drive their primary-age children to school cite danger from cars as the main reason, even as their own transport choice adds to the problem.23 This does not only rob children of mobility. It also takes away their freedom to move about without relying on their parents.

  And yet, at least in the UK, statistics seem to show the roads are getting notably safer. In 1930, despite vastly lower numbers of motor vehicles, 1,685 child pedestrians were killed.24 As recently as 2001 there were 219 child road deaths.25 In 2018, the most current data, there were forty-eight.26 Given this astonishing safety increase, why is everyone so scared? One reason, of course, is that travel decisions are based on perceived danger, and not statistics. But there is another theory.

  In 1990, Mayer Hillman, a radical architect-turned-campaigner for liveable cities, published a study into childhood independence and mobility, the message of which still resonates today. It was called One False Move, the title taken from a then-current government-run traffic safety campaign showing a child about to step off a kerb into the road, with the slogan, ‘One false move and you’re dead.’ Hillman sought to understand the reasons for such scare tactics when, even at that point, the government was boasting with some justification about how much safer the roads had become, with deaths having fallen by a third since the 1960s. The police, he noted, had declared the UK’s roads the safest in Europe. What was going on?

  The think tank Hillman worked with, the Policy Studies Institute, had carried out a series of surveys in 1971 in five areas of England about children’s independence and mobility. He decided to replicate these, and the findings were striking. For example, in 1971, more than 80 per cent of eight-year-olds were allowed to go to school unaccompanied. Less than twenty years later this had fallen to about 10 per cent. The proportion of all children allowed to ride their bike on the road fell from nearly 70 per cent to 25 per cent. The same picture emerged in virtually every aspect of the children’s active lives.

  Hillman quoted the writer Roald Dahl recounting his joy as a six-year-old in 1922 racing his sister on his tricycle on the near-deserted roads where he grew up in Wales. The further back you went, Hillman noted, the greater the likelihood of an adult recalling the ‘good old days’ of such an independent, mobile childhood. Modern children, he argued, were not any safer; they were just more confined. ‘The “good old days” of reminiscence and the “good new days” depicted by the accident statistics are reconciled by the loss of children’s freedom,’ Hillman said. ‘The streets have not become safer, they have become, as the government’s poster proclaims, extremely dangerous. It is the response to this danger, by both children and their parents, that has contained the road accident death rate.’27 This is a vital point, and one ministers are understandably coy about when discussing traffic casualties. Childhood might now be safer, particularly on the roads, but when this is mainly achieved by shutting young people in their homes, this is something of a pyrrhic victory.

  Of course, if Hillman were to carry out the studies for a third time, the restrictions on children’s mobility would be significantly greater even than in 1990. None of this is to blame parents, just to acknowledge that instilling activity into children is severely hampered by the way our towns, cities and roads are designed. This matters because activity habits in one part of children’s lives tend to spill over into another. A study by Scottish academics which fitted activity trackers to a group of thirteen- and fourteen-year-olds in Edinburgh found that those who walked to school also racked up significantly more moderate and vigorous physical activity in their leisure time than those who were driven, and even compared to those who took the train or bus.28

  Tim Gill, the campaigner and adviser on mobility and play, whom we first heard from in Chapter 5, has spent many years warning governments, generally in vain, that the priorities of modern life are having a hugely disadvantageous effect on children’s health and wellbeing. ‘It’s very clear that children are out and playing less, pretty much all over the world,’ he says. ‘And it’s also clear that the design of residential neighbourhoods, especially, is a key reason for that. There’s hard evidence that both the speed and volume of traffic leads kids to be o
utdoors less. If you take a sort of historical view, you could almost say that the story of children and urban areas over the twentieth century was about the battle between children and cars. And in simple terms the children lost.’

  Gill notes that this phenomenon has seen the play enjoyed by children not just reducing, but becoming more structured and formalised. With cars banishing young people from the streets, they were obliged to use playgrounds and other artificial spaces. ‘The history of playgrounds is that they first emerged in cities as a response to traffic,’ he says. ‘So 150 years ago, during industrialization and the first wave of urbanisation, kids played in the street. But when cars started appearing, people started saying: this isn’t going to work. But kids still needed somewhere to play, so they created playgrounds.’29

  Gill has written a book, No Fear: Growing Up in a Risk-Averse Society, which argues that beyond even cars, the modern world has become both fearful and mistrustful of children doing very ordinary childhood things. He cites a case in the West Midlands in which three twelve-year-olds were arrested and had DNA samples taken for climbing a cherry tree which was on public land, which police justified on the basis of antisocial behaviour.

  Children, Gill argues, need to be not only physically active, but sometimes active in an environment that includes risk, and has not had all the dangers, glitches and uncertainties designed out in advance by adults. He uses this resonant quote from Helle Nebelong, a Danish landscape architect who specialises in natural play spaces: ‘When the distance between all the rungs in a climbing net or a ladder is exactly the same, the child has no need to concentrate on where he puts his feet. Standardisation is dangerous because play becomes simplified and the child does not have to worry about his movements. This lesson cannot be carried over to all the knobbly and asymmetrical forms with which one is confronted throughout life.’30