We all need much more encouragement to do much more walking and cycling. So says a hefty new set of guidelines published this week from the government’s health advisory body NICE (the National Institute of Health and Clinical Excellence). This should be music to my ears, because as a specialist fitness instructor, I spend my life cajoling, marshalling, and even bullying some very unfit people into doing just a little more walking and cycling.
But oh, the disappointment. As I waded through the 126-page report, I could feel my posture droop and my shoulders start to hunch. The guidance sprays warm words in all possible directions — local councils, voluntary groups, individuals, health bodies, schools – without any sense of priority, urgency or targeted ambition. Based on the degree of slouch it induced in me, I can confidently predict that this report will make no discernible difference to anything or anyone.
We, a countryful of dedicated slouchers, can’t afford such missed opportunities. As the report acknowledges, “only 6% of men and 4% of women achieved at least 30 minutes of moderate or vigorous activity on at least 5 days” – the official minimum dose for basic heart health.
And so much inactivity matters because the cascade of lifestyle diseases that follow from it – from obesity and high blood pressure to heart disease, stroke, diabetes and cancer – can be devastating to live with, and are bordering on unaffordable for the public purse to treat.
To reverse the accidental health damage of a century in which abundance has triumphed over effort is going to be monumentally hard. But it must be done. The only real issue is how much carrot and how much stick should we be deploying to get our nation off its spreading backside?
NICE – contrary to its own honourable reputation for toughness — is stuck firmly in carrot mode. Of course encouragement is important. It’s what I’m paid for. I worked as a trainer for two years with one client – hugely overweight, depressed, a long-term hermit in her own home. We started with wheezy five minute walks in her back yard. We blossomed into glorious two-hour round trips. Walking gave her back a life worth living. But I seriously wonder whether my twice-weekly one-to-one encouragement sessions would ever pass NICE’s value-for-money tests. You need an awful lot of encouragement to go even a little way.
Lots of the NICE carrots are about opening up more cycling and walking opportunities. Impossible to disagree with, surely. A few years back I set up a weekly walking group in my local park, pricking the council into grudging and minimal support for the scheme. We became popular, expanded to twice-weekly, and walked for three years, serving a tiny but vital local need. Throughout, the council remained steadfastly indifferent to the scheme, resolutely failing to develop the great little opportunity we had created. Today I could wave NICE’s warm words at them. But they, under a spending cosh and never overly-keen on their public health role, will take no more notice now than then. Something stronger is needed.
On Wednesday, as these guidelines emerged, the government announced it had at last decided to follow Scotland’s example and get tough on alcohol abuse by forcing prices up. Whether you agree with the specifics or not, this is the intensity of initiative that it takes to start to shift not just opinions but habits. No one seriously questions any more the outlawing of smokers to pavement huddles, but how many cancer deaths did we need before taking a big stick to cigarettes?
How I wish the NICE people had stuck their necks out and really got behind a handful of big ideas that might fire up the physical activity debate. But they didn’t, so here goes. Let’s close all streets containing school entrances to all motorised traffic for two hours a day. That would give powerful encouragement to both parents and children to walk and cycle.
Let’s close down all escalators in town centre public spaces and convert them back to steps. It’s odds-on that there will be a nearby lift access, which disabled people can continue to use. Everyone else gets to use their legs.
Here’s one that will step on NICE’s toes. Instead of merely recommending exercise as a front-line therapy for mild to moderate depression, how about removing anti-depressants from the list of options altogether, leaving GPs with a prescribing choice of talking therapies or exercise (loads more walking and cycling).
Back in the local park, I cannot see why, along with bedding plant displays and poop-scoop bins, councils should not be required to offer a full seven-day programme of walking and cycling opportunities, all year round, suitable for young and old, fast and slow.
To change our private habits is just about the hardest thing any policy-maker can attempt. Because it’s the hardest thing in the world for us to do. Thumbs up to the government for raising the price of alcohol and with it the value of our livers. Thumbs down, sadly, to NICE for offering a nation sick from too much sitting a big pink stick of candyfloss to suck on.