In the first part of this blog the focus was on economic inequality at a macro/societal level but in this second part I want to delve a bit deeper under this to the more micro/individual level and explore how much finances and social class are a barrier to physical activity.
As with most other areas of public health there is a significant correlation between socio-economic inequality and health inequality, including for lifestyle factors. As the graphic below demonstrates this inequality relationship holds true for physical inactivity, People living in the least prosperous areas are twice as likely to be physically inactive as those living in more prosperous areas.
Image source: PHE
Sadly though we tend to leave the exploration of socio-economic inequalities there, focusing at a policy level on generating economic growth and assuming that this will in turn close the inequality gap. However as household income increases at the bottom of the scale, in general it also increases at the top, meaning the inequality in income remains a persistent challenge.
So what is going on below the surface of this macro-inequality?
Cost is no doubt a barrier for the uptake of some forms of physical activity, particularly leisure facilities where there can be a significant charge and also for sport where the equipment cost can be quite high.
Cost has been highlighted as a specific barrier for young people– especially when there is social and peer pressure to have the latest kit and keep up with current trends.
Where the cost is reduced, particularly for access to leisure and fitness centres, there is academic evaluation demonstrating a positive impact on population levels of physical activity and a reducing in inequalities.
This great infographic from Street Games demonstrates some of the differences in spend on leisure and fitness between high and low income households.
But I don’t think cost alone is a barrier, there are several ways individuals can be physically active without significant equipment or joining a club, brisk walking and running/jogging are just two obvious one.
So perhaps we need to recognise that beneath the macro economic challenge there are perhaps more complex interactions going on.
Access may be an issue, although work has been done to map fast food outlets against deprivation, I wasn’t able to find a similar map for leisure and sport facilities. But in the current tough economic climate there may well be an inverse relationship between the deprivation of an area and the local physical activity offer.
Local council’s are having to make hard choices and often rationalising and centralising the leisure and fitness offer is the best that they can do to maintain access. Many are also externalising provision, and even schools are utilising commercial partnerships to generate income from facilities outside of the school day. Ironically there is some evidence that demonstrates that sport and leisure can be a powerful driver of economic regeneration, so perhaps disinvestment may accelerate a downward economic spiral?
One of the challenges is that a large proportion of the sport, fitness and leisure offer is now commercially driven and it is much harder to be financially sustainable in deprived communities. This is where the Sport, Leisure and Culture Trust model has made headway in the last decade using a charitable or social enterprise model to continue to provide access in deprived communities, and in England provides over 30% of the community offer, predominantly in deprived communities.
But access isn’t just about sport, leisure and fitness facilities, it is also about having walkable and cycle friendly environments. The National Cycling Network in the UK is a great example of creating a web of accessible and safe spaces for cycling and walking, and Living Streets Walking Cities profiles how some cities are making great strides in this space. It is great to see the social narrative about walkability and cycling friendly cities now becoming a mainstream conversation linked to local economic viability and desirability both for investment and migration.
But walking and cycling aren’t just about access they’re also about motivation and changing the social norms so that walking and cycling for short journeys is the culturally normal thing to do for every social class, not just for the middle classes.
PHE’s campaign How Are You? and the brisk walking app Active10 were designed to resonate with individuals in lower socio-economic groups. Although we are awaiting a public update on the uptake of the app and its impact, initial feedback seems positive and that it is reaching a good cross-section of society, especially men and ethnic minority communities.
Safety is also a significant barrier, and there is a correlation between poverty and crime, but perhaps this is an barrier that is under-discussed in developed countries like England.
In 2015/16, around one-fifth of people aged 16 and over in England and Wales believed that they were either ‘very likely’ or ‘fairly likely’ to be a victim of crime in the next year. The fear of crime was higher among Asian people, Black people, and those from the Other ethnic group.
From a logical perspective it is easy to understand that fear of crime will be a barrier to physical activity, especially to utility based and short trip cycling and walking.
Safety can be about fear of crime but it is also about physical safety from air pollution and road traffic accidents, the fear of the potentially negative impacts of walking and cycling in cities has grown disproportionately over the last year or two and could create a new social discourse barrier in the same way the vaccination-autism discourse has done for immunisation.
Designing healthy high streets and communities is about taking a holistic approach to the built environment in a community and addressing the social and physical factors to create sustainable solutions.
Finally I’d just flag Acceptability and Social Norming as a potential context that underpins the macro inequalities. There is limited exploration of the different social attitudes of different social class and population cohort groups to physical activity, although it underpins much of the social marketing and commercial marketing in this space.
Social norms in a community are driven by a range of factors, some historical and some contemporary. They drive both contemporaneous activity and choices as well as defining aspirational trends and individuals concepts of what they might become. This may well be an area which needs further exploration in the future, especially as we see increasing diversification between younger and older cohorts.
Ultimately in this short blog I can only scratch the surface of the complexities that lie beneath the macro socio-economic but hopefully it has inspired you to dig a little deeper!
Dr. Justin Varney 