An introduction to physical activity surveillance in Australia

Building surveillance systems for physical activity

Background

Physical inactivity is an important problem. In Australia, 1 in 2 adults and 3 in 4 children are not active enough for good health, meaning that most Australians are at risk of developing chronic disease.

Australia has committed to addressing this, as it has signed up to the WHO target of reducing physical inactivity by 15% by 2030.

A key part of understanding how we are doing in achieving this goal, is by monitoring the behaviours of how many people are being active and the environments in which they are active.

There are two main things we’d like to discuss today: How are you measuring and monitoring physical activity behaviours and environments?

We’d also like to have a blue sky, off the record discussion about what should form part of a comprehensive physical activity surveillance system; what are the things we should be measuring across a range of sectors and agencies that would help inform a national approach.

We’re having discussions like this with other states and territories to see if there is a common or minimum set of indicators we can recommend. We’re not in a position to implement any recommendations, but we’re hoping to bring together in a deidentified way, the information and perspectives shared in these meetings to feed back some broad guidelines that will help build a more informative and standardised physical activity surveillance system.

How is physical activity measured in health surveys?

We have already done some work to understand how physical activity is measured by the states and territories in population health surveys. What you see here are estimates of the proportion of the adult population meeting physical activity guidelines, as reported by each state and territory. Some jurisdictions have numbers against their trend lines and these represent points in time where they changed their questions or definition of meeting PA guidelines. What it shows, is a great deal of variability between jurisdictions, and fluctuations over time.

But this variability and these fluctuations cannot all be attributable to that jurisdiction’s policy or program settings because in this graph, we can see from the state-based analysis of the national health survey, that the jurisdictions are more similar than the previous graph would suggest.

What we’d like to understand through the discussions we’re having with each of the states/territories, is whether we can achieve greater standardisation of physical activity measurement in health surveys that would allow greater comparability between and within jurisdictions over time.

What does the physical activity system look like?

Let’s take a moment to zoom out a bit and consider the broader physical activity system. What you see here is a conceptual systems map that we developed to provide a big picture reference for how to think about the multiple influences on physical activity. So in the centre in the black square, is human movement or physical activity. Around the black square in the dark blue, are the core influences on physical activity such as individual psychology, physiology, demographic status and the social/physical environment and norms. Moving out another level, in the light blue, we have eight intervention points across system which are known as the 8 best investments for physical activity. On the far left, we have elements in dark green that remind us of the macro elements that support or hinder actions on physical activity, and in the far right in the light green, we have elements around governance and knowledge mobilisation which is where surveillance systems fit.

What does surveillance relate to?

If we pull out surveillance systems, we can more clearly what it links to. Surveillance is of course linked to physical activity (the black box, not shown here) as well as the core elements of demographic status, social and physical environment, and social norms. There are direct linkages to each of 8 intervention points or ‘best investments’ so we can understand what is happening in these areas. Surveillance is also linked to the legal and policy environment (e.g. what do laws cover, are they fully implemented)? And it contributes to the knowledge environment (allowing multiple sectors to gain insight into what each other is doing to progress this issue). Finally, for obvious reasons surveillance is linked to governance, transparency and accountability (it helps us to understand whether we are on track to meet our goals and targets, and the level of engagement/investment across the 8 system intervention points).

What does a surveillance system look like for tobacco?

Let’s pause for a second and consider an example outside physical activity, in this case tobacco.

The WHO Framework Convention on Tobacco Control (FCTC) is an International Treaty which sets out key agreed actions on tobacco control. The actions which deal with “demand reduction” measures are described using the acronym MPOWER shown in the image. Importantly, the first letter – “M” stands for “Monitor” meaning monitor tobacco use and prevention policies. To give effect to this agreed action, the WHO, member states, and key international organisations (such as CDC, Johns Hopkins University and others) have developed the GTSS – the Global Tobacco Surveillance System.

The state of selected tobacco control policies in the world

This image shows the status of the MPOWER tobacco control policies in the world. The surveillance system provides a very high level view of policy implementation across the world. For example, it shows that around 40% of the parties to the treaty (signatory countries) had ‘complete policies’ on Monitoring (M) and on Warning Labels (W), whereas only 13% had cessation (or quit smoking) programs.

Reports generated from GTSS data

You can see here that a number of reports have been developed over time, drawing on data from the Global Tobacco Surveillance System and focussing on an element of MPOWER. For example, in 2009, the report had an emphasis on the implementation of Smoke Free Policies, whereas in 2015 the emphasis was on taxation and raising the price of tobacco products.

The surveillance system allows the generation of this graph, which shows the growth (2007 – 2016) in countries with at least one tobacco control policy implemented at the highest level (from 42 countries in 2007, to 121 in 2016)

It’s important to note that only a comprehensive surveillance system allows us to see progress as well as gaps across the portfolio of actions.

This means designing a system which monitors policies and implementation and not only individual or population knowledge, attitudes and behaviours.

Does a comprehensive system exist for physical activity?

So does such a comprehensive system exist for physical activity? There is a leading example in Canada. Since 1981, a non-government organisation in Canada has been funded by the Canadian Federal government and by the Provinces (states) and Territories to carry out national and provincial level physical activity surveillance. This group, the Canadian Fitness and Lifestyle Research Institute, is a small, funded organisation that monitors physical activity and its antecedents. It produces reports, policy briefs and community fact sheets throughout the year.

Canadian Physical Activity Monitoring Framework

Initially, the Canadian Fitness and Lifestyle Research Institute developed a framework for physical activity monitoring, and built a surveillance system which comprises surveys every three years of schools, workplaces, audits of the built environment as well as measuring social and economic consequences of physical activity. This is in addition to a routine physical activity survey which has included objective pedometer measurement of representative samples of Canadian schoolchildren. It continues to be funded by all provinces and the national government, who jointly value it for physical activity and for sport sector surveillance.

What now?

So we hope that has provided you with some useful background and maybe some inspiration, for our discussion today.

Thank you for listening.

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