Send Your Children Outside

to Play

Andrew Pipe, CM, MDMinto Prevention & Rehabilitation Centre,

University of Ottawa Heart Institute

“The history of epidemics is the history of disturbances in human culture.”

Rudolf Virchow

“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.”

Bailey, 1974

Statistics Canada Health Reports 2009;21(1)

Typical 12-year-old boy

Statistics Canada Health Reports 2009;21(1)

Typical 12-year-old girl

Statistics Canada Health Reports 2009;21(1)

Canadian TeensBoys Girls

Overweight 17% 16%

Obese 14% 10%

The Active Healthy Kids Canada Report Card 2010

Canadian Children & Youth MeetingPhysical-activity Guidelines

Newfoundland

25.6% of pre-schoolers are overweight or obese

“…prevention measures should begin before the age of 3 years.”

Cannning, Courage, Frizzel. CMAJ:171; 2004

A Cause for Concern...

63% of youngsters not active enough for optimal growth and development

A decline in activity with age and gender

Girls are less involved in intense physical activity

Physical Activity Monitor CFLRI, 1999

90% of children and youth don’t meet Canada’s recommendation

for 90 minutes of moderate to vigorous physical activity daily

Canada’s Report Card on Physical Activity for Children & Youth 2008

Active Healthy Kids Canada

It is difficult to maintain a healthy diet and physical activity in an environment that discourages physical

activity and encourages excessive consumption.

Am J Clin Nutr 2009;89:477-84

Our Obesogenic Environment

"Can Johnny come out and eat?"

“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.”

N Engl J Med 2005 Mar;352(11):1138-1145

“No health system is yet meeting the challenge of managing obesity, and no society has developed an effective strategy to prevent it”

Lancet May 13, 2006

“Our genes have not changed substantially

during the past two decades. The culprit is an environment which

promotes behaviours that cause obesity.”

A New Evolutionary Development ?

The Global Burden of Diabetes:

30

135

171

366

0

50

100

150

200

250

300

350

400

1985 1995 2000 2030

Global Strategy on Diet, Physical Activity and Health: Diabetes; http://www.who.int/dietphysicalactivity/publications/facts/diabetes/en/

Mill

ion

s o

f p

eo

ple

63%

Estimated Prevalence of Cardiovascular Risk Factors

Am J Med Sci 2002;324(3):127-137

Contributing Factors?

“Security”

“Solicitude”

“Screens”

“Sodas”

“Schoolbuses”

Causal Web

Obesity: A Highly Complex Issue

Each additional daily serving of soda increases

the risk of childhood obesity

by 60%.

The ‘Food’ Environment

91% of Canadian children have

bicycles…

5% ride them to school !

Active Transportation

Nature deficit disorder: a disconnect between today’s indoor children and the natural world

Richard Louv, Last Child in the Woods, 2005

“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.”

Ann Behav Med 2003;25:80-91

Am J Prev Med 2008;35(3):237-244

Newer neighbourhoods are often designed to facilitate car travel.

Walkable Neighbourhoods

Older neighbourhoods

were often designed with pedestrians

in mind.

Am J Prev Med 2008;35(3):237-244

Walkable Neighbourhoods

Adding a decade to the average age of

neighbourhod housing decreases risk of

obesity by8% in women and by

13% in men.

Am J Prev Med 2008;35(3):237-244

Travel Distances and Urban Forms

International Regional Science Review 2005;28(2):193-216

1.3 miles vs. 0.5 miles

Images are same scale, approximately 1 square mile

AA

B B

Walkable Neighbourhoods

Include the 3Ds:

population Density

pedestrian-friendly Design

Diversity of destinations

Am J Prev Med 2008;35(3):237-244

“Whenever I meditate about a disease,I always think of preventing it,

rather than finding a cure.”

Louis Pasteur

The Continuum of Prevention

Target: CVD

Patient

Target: Persons with CVD risk factors but no CVD or

diabetes

Goal: Prevent first CVD event

Target: Entire Population

Goal: Prevent risk factor development

Secondary Prevention Secondary Prevention

Goal: Prevent recurrent

CVD event

Primary Prevention Primary Prevention

Health Promotion Health Promotion

Ensuring Child Health

The ‘Active School’ Concept

An integrated array of activities:

Academic, social, nutritional, and physical activity

programmes

School as the focus and a central resource of an

‘active’ community

Ontario: Healthy Schools Program

Removal of junk food from vending machines

Ontario: Healthy Schools Program

Minimum 20 minutes daily physical activity for all elementary students…

Opening of schools for community use after hours…

Food Policy

Agricultural support policies

Regulation Ingredients ? Portion Size ? Labeling ? Marketing ?

Taxation

“Healthy Planning” Policies

Supportive Environments

“Supporting the development and availability of an array of safe, accessible environments

and policies which facilitate activity”

Am J Public Health 2010;100:1672-78

Renovated schoolyards increase the number of

children who are physically active, and their overall

activity levels.

The Globe and Mail , November 12, 2010

Interacting with nature helps children learn

Understanding the population

we serve

Adoption of appropriate behaviours

before heart disease becomes clinically

apparent increases life expectancy by10 to 14 years.

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Champlain Chronic Disease Risk Factor Profile (Adults 12+)

Area CVD

Mortality Rate*

Risk Factor Prevalence (%)**

Hyper-tension

DiabetesOver-

weight(BMI>25)

Obesity (BMI>30)

SmokingPhysical Inactivity

< 5 serv.F & V

Canada 200.7 14.4 4.6 33.3 14.8 23.0 47.3 55.2

Ontario 204.9 14.7 4.6 33.3 14.8 22.1 47.3 55.3

Champlain 206.7 14.0 6.0 36.6 14.3 21.2 43.9 54.8

Eastern Ontario 247.6 17.1 5.4 40.9 18.8 31.6 48.7 55.6

Renfrew County 257.0 16.9 5.5 36.6 18.4 27.5 47.0 58.1

LG&L 225.0 15.5 5.1 35.6 18.1 27.2 46.0 57.2

City of Ottawa 186.5 12.3 4.6 35.6 12.8 19.7 42.4 54.1

Source: Statistics Canada's health indicators data (2005)*, Canadian Community Health Survey**

The Champlain Declaration

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.

School Board Priority Areas for Action

1. Healthy nutrition environments, with an immediate focus on the following elements:

a. Healthy fundraising

b. Healthy classroom rewards

c. Healthy lunch programs & food service contracts

2. Principal and teacher training to support implementation of physical activity and nutrition-related actions

Champlain Healthy School-aged Children Initiative

Identified actions for the Champlain Healthy School-aged Children Strategy:• Create progressive, supportive school policies

across the nine Champlain School Boards (The Champlain Declaration)

• Develop a regional communications campaign to promote healthy eating and physical activity

• Develop an evaluation tool for tracking progress (i.e. Champlain Report Card)

• Facilitate opportunities for skills development among teachers, parents, children and youth

European Charter on Counteracting Obesity

Encourage children to walk to school

Establish priority bicycle routes

“There are two causes of disease, one is

pathological … the other is political.” Rudolf Virchow

Change takes place when:

There is a “crisis”

A critical mass of scientific evidence

Shifts in social attitudes occur

Public cynicism grows

Political pressures begin to build

THERE IS LEADERSHIP !

Challenge Assumptions

Healthier Children?

Parents as

Leaders

and Advocates

‘Aesculapian Authority’

“the unique credibility afforded to health professionalswhen they speak out on issues relating to the health

and well-being of the individual or community.”

“If the creator had any purpose in equipping us with a neck…he surely

must have intended that we stick it out!”

Arthur Koestler

Beware of: Ignorance, Indifference and Inertia.

ActiveVigorousHealthy

CANADIAN !

Send Your Children Outside to Play !

A single piece of advice...

SendYour Kids OutsideTo Play!

First Nations

79% of adults are inactive

40% of youth are overweight or obese

60% of children are overweight or obese

1 in 5 adults are diabetic

PreventionAlternate approaches to paymentAlternate approaches to delivery of careTransformed patterns of practice

What does the future hold?