by Peter Walker
Again, it is hard to overstate the value of the work Parkrun manages to achieve. But once more, this has to be seen in context. It is an even smaller charity than the Youth Sports Trust, with an annual income of just over £4 million and a heavy reliance on volunteering and goodwill. Like the Daily Mile, it operates in the slightly precarious intersection between campaigning and an almost official role. In the case of Parkrun, this includes links with doctors’ surgeries, so GPs can ‘prescribe’ taking part in Parkruns to patients who arrive with conditions associated with inactivity. So far it has connected to around 1,500 GP practices, almost a fifth of all those in the UK. It also helps arrange Parkruns in more than twenty prisons and young offenders’ institutions, something as much connected to welfare and rehabilitation as fitness.
All this is admirable and does a huge amount of good, but it remains fundamentally different to the more centrally planned approach adopted by other governments, where activity can be added into every aspect of official policy. To take yet another example from Finland, when I see Nina Korhonen to discuss her work in making kindergartens more active, we decide to meet at Helsinki’s very new and hugely grand central library, a light-filled modern space with two excellent cafés, one of which we sit in. In keeping with the more communal Finnish approach, like many of the country’s libraries it does much more than just lend books and serve very good coffee. There are meeting rooms and recording studios which can be booked for free, as well as sewing machines and even a 3D printer. You can also borrow sports equipment, while some other libraries can lend a pedal-powered cargo bike able to carry heavy loads.
This is not to say that this is the only model for every country. Helsinki’s library cost nearly €100 million, and it takes a certain political consensus for voters to accept the levels of tax needed to fund not just projects like this, but the wages of Joonas Niemi’s Finnish Schools on the Move teams, as well as one sports facility per 175 people.
But the experience of physical activity programmes across the world all point in the same direction: for all the amazing work of people like Chrissie Wellington and Chris Wright, if you want true, population-wide benefits, relying on charities is not enough. This is the work of governments.
Winning the obesity battle
None of this is to say that Finland now has the problem of inactivity solved. It remains very much an ongoing process, particularly when it comes to young people. The mammoth and ongoing Global Report Card study on childhood activity levels across forty-nine countries, mentioned in Chapter 1, gives Finland an ‘A’ score for efforts in schools, but notes that even with this only around a third of its nine- to fifteen-year-olds manage the recommended hour a day of sufficient exertion. This is much better than the UK, even if different reporting methods mean there is not a direct comparison. For the UK, only about 20 per cent for the broad group aged five to fifteen meet the activity minimums, a figure which is inflated by the generally higher activity levels among younger children.17
But, as also mentioned in the first chapter, when it comes to childhood activity, one country shines through: Slovenia. The tiny former Yugoslav state, which became formally independent only in 1991, is becoming known as the new activity success story in town, and one which has seen this achieved within a generation.
So rapid has been the progress that you can see it, starkly, in national statistics. Slovenia’s figures for adult activity are, to be blunt, fairly underwhelming. These are broadly the same as for the UK, with about 60 per cent of people reaching recommended weekly exertion levels,18 even if more precise comparison is tricky as, again, the two countries release figures for different age points. In contrast, the Global Report Card study gives Slovenia by far the most glowing write-up of the forty-nine countries surveyed for activity levels in children, noting that more than 80 per cent of those aged six to nineteen are reported as meeting the one-hour-a-day threshold for activity.19
I go to Ljubljana to try to find out how this happened. The Slovenian capital is very much a city of two parts, with the beautiful and tranquil old town surrounded by a bigger and considerably less lovely mass of busy roads and 1960s-vintage offices and apartment blocks. When it comes to everyday activity, the city is, similarly, something of a mixed bag. There are numerous cycle lanes, with about 10 per cent of all trips made by bike. I spend my day successfully and safely navigating between various interviews on one of Ljubljana’s public bikes. But simultaneously, the moment you move outside the mainly pedestrianised old town, the roads are often wide and generally jammed with gridlocked cars.
Polona Demšar Mitrovič, who is head of sustainable mobility at the Ministry of Infrastructure, based inside one of the many 1960s office blocks, tells me that outside the capital, Slovenia is even more dominated by motor vehicles, in part because of the terrible state of public transport, with no city metro systems, a single-track intercity rail network and ‘awful’ cross-country buses. ‘When I came to work for this ministry ten years ago, it was still called the Ministry for Roads,’ she says. ‘It was all about building roads and highways. When we started this programme, my colleagues called me “the green one” – meaning the crazy one.’20
Demšar Mitrovič’s role is to push cycling and public transport. Enjoyably blunt about her ministerial bosses, she says that most of the support in this area, both financially and politically, has come from the EU rather than Slovenian politicians, who she describes as being stuck in the past. ‘They just want to build more and more road space,’ she says. ‘They don’t realise that it’s about using the existing roads in a better way. In the same EU funding document where we were seeking money for sustainable travel, we also asked for money to pay for an extra lane on the Ljubljana ring road. It’s a strange situation – we want a third lane, to bring more traffic into the city, but at the same time we want to close streets in the city to cars.’
Other areas of activity promotion have proved more fruitful. About twenty minutes’ cycle ride away, in another looming office block, Mojca Gobec, head of public health in the Ministry of Health, says she has seen at least some politicians starting to listen. Her department leads a huge, ten-year nationwide campaign based on greater activity and better diets, called Dober Tek, a pun using the Slovenian pre-meal equivalent of bon appetit, which also has a literal translation connected to movement.
‘Our tourist strategy is based on Slovenia being an active, healthy and green destination,’ Gobec says. ‘If we’re offering that, it should be natural that we’re trying to live that kind of life. We’ve come quite a long way because the Ministry of Sport used to see elite athletes as a priority, the Olympics and so on. But now it’s more and more about everyday physical activities.’21
As mentioned, by far the greatest success in Slovenia’s physical activity record has come with children. Like Finland, this is the result of many years of government-led intervention, even if the feel is somewhat different. If Finland’s approach is a typically Nordic, social democrat–type, Slovenia’s programme for young people and schools feels almost communist – and, in fact, did originate in Yugoslav times.
Since 1982, in April every single student at all of Slovenia’s primary and secondary schools has undergone the same battery of standardised tests and measurements: height, weight and skinfold body fat, then eight physical tests, including a standing jump, 600m run, 60m run, and a bent arm hang. The participation rate is virtually universal, higher even than that for compulsory childhood vaccinations, with results added to a database now covering more than half the country’s population. Children are ranked against national percentile scores, meaning modern children can compare their rankings against children from the 1980s, in some cases including their own parents.
Gregor Starc, an exercise scientist at the University of Ljubljana, who co-runs the programme, known as Slofit, says the results alone can prompt action: ‘Some parents are shocked when they realise their kids are not doing as well as them, so realise they need to change,’ he says. ‘S
ome families have altered their entire lifestyles.’ But the main focus is on activity in schools, something Starc says was a deliberate policy choice: ‘We saw that whenever countries were counting on parents to take care of the physical fitness and physical activity of children, it failed. That’s why we focused on schools. So now Slovenia has one of the highest qualities of physical education teaching in the world, and the infrastructure is excellent.’22
As mentioned in the last chapter, every Slovenian school has two gyms and an outdoor play area, as well as track and field facilities. Beyond PE lessons in the curriculum, each child has five ‘sports days’ per year, and is given another week off for outdoor activities, often held at former Yugoslav army bases now run by the education ministry. ‘All the equipment is there, the bicycles, the bows and arrows, the skis, climbing equipment, whatever they want,’ Starc says.
Such has been the success of all this that Slovenia identifies itself as the only country in the world where child obesity rates are going down. ‘There are other countries that have a levelling off of obesity, but in our country, it has gone down from 2010/11. The rates are going down and physical fitness is going up,’ Starc says. Fitness has particularly improved in girls, he explains, in part due to wider social changes: ‘When I was a child, we were playing cowboys and Indians outside, the girls would only be nurses, tending to the wounded. But nowadays, they do everything – play football, they play whatever they want to. Girls today are 20 per cent fitter than their mothers were. The boys are close to fathers, but still like a percent below. But they’re getting there. If we don’t do anything stupid in terms of politics, they will catch up within five years.’
This is not to say that everything is well. A particular worry is the small minority of children who are morbidly obese, the proportion of which is not falling. This is, Starc says, a wider problem: ‘We cannot repair them in school. They need a holistic approach, and probably the entire family has to be involved.’
This is perhaps an obvious point, but also one worth stressing: for all the importance of the state in leading national health efforts, official action cannot do everything. Slovenia can provide the best sports facilities possible in schools, and spend thirty years monitoring fitness, but no child can be properly active without at least some family support. It was the same for Puska Pekka. Even after his team pulled every lever of officialdom and government to improve public health, the key to change was persuading housewives in North Karelia that they could make changes in their own households to stop their menfolk getting heart attacks.
At the same time, it is notable that the two countries in Europe most associated with recent improvements in activity levels both take a notably interventionist position. This will not, and cannot, solve everything. But for all the valiant and inspiring efforts of people like Chris Wright and Chrissie Wellington, and the very real benefits they bring to thousands of people, it is inevitable that charities and voluntary groups, however much they seek to integrate into official public health programmes, can never have the same reach. It’s just not realistic.
Does this mean countries like the UK are condemned to limp on with an ever-growing personal and societal burden connected to immobile living? For all Pukka Peska might dismiss the idea of the Finns being special, can other countries change? The answer for now is that we don’t know. But one thing is clear: other countries have shown they are able to act decisively. A lesson from the coronavirus pandemic has been that when it comes to governments interfering directly in the lives of their populations to keep them healthy, things can change very quickly indeed.
Next steps:
If a lot of countries, like the UK, are not as motion-friendly as Finland or Slovenia, that can in part be because MPs and councillors don’t really consider it an issue. Many politicians have told me that car drivers tend to be much more vocal than people who more commonly travel by bike or on foot. So if you want a more human-friendly local area, it can be worth making that known.
10 So What Now? A New Era of Health
I can remember exactly where I was at the moment the British prime minister, Boris Johnson, announced that the country was going into enforced lockdown to try to slow the spread of coronavirus. As with so many key political moments over the past few years – and perhaps not the best image for the message of this book – I was sitting hunched over a laptop, typing up facts and quotes to turn them into a news story as fast as possible.
People were ordered to stay at home in all circumstances other than for vital work, purchasing necessities, for medical needs, or one form of exercise. They would be fined if they did not, under a law rushed through parliament earlier that day, carried with no dissenting voices, and without even a formal vote among MPs. The restrictions were onerous and unprecedented, even in wartime. They would jeopardise millions of jobs and send the national economy into a nosedive. And yet the public were hugely in favour. Many, in fact, had wanted the rules imposed weeks earlier. All this, of course, was being done under the justification of saving lives. Similar regulations were imposed in many dozens of other countries, most likely sparing hundreds of thousands, if not millions, of people who would otherwise have died from the virus.
I’ve mentioned several times in the preceding chapters that this book is being written amid this lockdown. In fact the process has more or less completely coincided with the peak of restrictions in the UK. And it is an undeniable paradox to have spent my days chronicling successive government failures over one public health disaster when, at precisely the same moment, many of them are tackling another life-threatening crisis with genuine boldness.
In terms of scale, inactivity is not quite so acute as coronavirus, which, according to the scientific modelling which eventually persuaded Johnson to confine people to their homes, could have killed between 250,000 and 500,000 people in the UK alone if nothing was done.1 Coronavirus has also provoked a particularly urgent response by being new, rapid in its destructiveness, and directly fatal. In contrast, someone in their twenties who flops down on a sofa tonight might not start to feel the impact of an inactive lifestyle for several decades, and then only through the impact of various chronic illnesses.
All that said, it must be remembered that inactivity is by no means the only public health emergency treated with at least some neglect by many governments. Air pollution, much of it from motor vehicles, is responsible for anything up to around 40,000 deaths a year in the UK,2 and yet ministers have fought court cases to avoid being held even to minimum EU standards over clean air.3 Similarly, while road casualties have fallen greatly over the decades, if it was terrorism which still killed an average of five people a day and left another hundred in hospital, many with injuries that will permanently transform their lives, you can bet that this toll would not be normalised and largely ignored.
This dual approach to the health of nations puzzled me long before COVID. But it seems all the more relevant now. If governments can treat a virus as a national emergency, why can’t more of them deal with the many, well-proved repercussions of population-wide inactivity with at least the same seriousness and focus as the Finns or Slovenians? I decided to take advantage of my job and ask a few politicians.
I spoke to Jeremy Hunt after coronavirus had arrived in the UK, but a couple of weeks ahead of the lockdown. The Conservative MP spent just under six years as Health Secretary, the longest period anyone has held the job in Britain. After coming second to Johnson in the race to succeed Theresa May as prime minister, he now chairs the committee of backbench MPs who examine health issues. Hunt is fascinating in that he almost epitomises the approach to inactivity I have seen so often from British politicians: a clearly sincere personal commitment to, and understanding of, the issues, but one which either becomes a bit elusive when it comes to actual policies, or finds itself frustrated by a wall of official inertia.
Hunt is effusive about his own activity regime, saying one of the benefits of losing a ministerial post was being able to cycle
freely around London again. His last job in government had been as Foreign Secretary, a role that comes with 24-hour police protection. While the police officers would happily cycle with him if asked, Hunt tells me, it was complex to arrange and, as he puts it, ‘I never got my cycling act in order.’
He describes himself as a ‘passionate believer’ in everyday physical activity and is a fan of the Daily Mile programme. Hunt, who has young children, is particularly keen on more movement in schools. ‘When I was Health Secretary I asked the chief medical officer whether she would be willing to give public advice to all schools that every child should have an hour of exercise a day,’ Hunt tells me. ‘I was really shocked when my own children became old enough and they went to a state school, they weren’t getting an hour of exercise automatically built into their daily routine.’
However, in an experience echoing that of Elaine Wyllie with the Daily Mile, it was not that straightforward. And remember, rather than an individual headteacher, like Wyllie, seeking change, this was one of the most powerful politicians in the land. ‘It was a real battle with the Department for Education, because their view is that schools are overloaded with instructions and requirements, and we were starting to undermine the autonomy of heads because we’ve overloaded the curriculum,’ Hunt recalls.
On more general efforts to push activity, Hunt argues that the key in the UK is to not be too prescriptive: ‘I think the way that it works is that in a free country, you have to take public opinion with you. And the trick as a government is to be a little bit ahead of public opinion on issues like this, guiding public opinion. But not so far ahead that you put everyone off and you lose them.’ To an extent, this is the ‘voter is king’ maxim expressed by Pukka Peska in the last chapter. But what perhaps differentiates someone like Hunt from a Finnish politician, apart of course from several fewer decades of national focus on public health ideas, is a greater sense of caution when it comes to nudging, or leading, voters onwards. Hunt says: ‘Public health campaigns always have to deal with the complaint of being nanny state. And so there is always a sensitivity, there’s always a constituency dead against any kind of nanny state interventions.’4