The Australian Systems Approaches to Physical Activity (ASAPa) project

ASAPa presentation (Australian systems approach to physical activity), ISPAH symposium Oct 2021

Slide 1.

Hi, my name is Tracy Nau, and I’m a research officer at the University of Sydney. Before I present some of our work on supporting systems approaches for physical activity in Australia, I’d firstly like to acknowledge and pay my respects to the Cammeraygal people, the traditional owners of the land on which I’m presenting today, and the important and rich contribution of our First Nations people as the original systems thinkers and from whom we have much to learn. I’d also like to acknowledge the rest of my team: Karen Lee and Professors Bill Bellew, Ben Smith, and Adrian Bauman.

Slide 2.

To give you an overview, I’ll start by providing a brief history and policy context to this project. I’ll then move onto ‘mapping the 3Ps’ which was about understanding the physical activity landscape in Australia, some resources we’ve developed for policy makers on using systems approaches for physical activity which includes Getting Australia Active 3, and then I’ll touch on legal approaches for physical activity which is an area we are starting to investigate, before summing up.

Slide 3.

Systems approaches are a relatively new concept in public health, but the general concept of intersectoral policy planning for physical activity is not entirely a new one in Australia. Several jurisdictions at the state and national level, have attempted it in the last 25 years but they haven’t been sustained due to shifts in political agenda and will. The release of the World Health Organization’s Global Action Plan on Physical Activity (GAPPA) provided a renewed opportunity to revive physical activity as a political priority, and this has been followed with some other supportive policy developments in Australia – including the development of Australia’s first national sport plan which adopts the WHO GAPPA goal as a major policy objective, as well as some other national and state strategies for physical activity that are being developed.

Slide 4.

Some states are also explicitly recognising the value of intersectoral approaches to health and wellbeing and they’re taking some key steps towards this, such as by establishing new structures to foster cross-government collaboration, and I’ve just included a few examples on this slide.

Slide 5.

So it was out of this context that ASAPa, our project, arose. Our aim was to foster systems thinking and support systems approaches for physical activity. We firstly set out to map and understand the existing landscape in relation to adults and to the 3Ps (Policies, Programs and Prevalence). So how physical activity is being addressed in policy and programs across different sectors and how jurisdictions are measuring population physical activity. We approached the mapping work by engaging early with our government stakeholders. Fortunately, there happens to be a legacy network, called the National Physical Activity Network (NPAN), an informal cross-sectoral network of interested and engaged policy makers involved in physical activity. It was through NPAN, that we gathered over 30 policy makers from health, transport, planning and sport – to two national meetings to share information about the 3Ps. Through these meetings we learnt there was some awareness of what systems approaches were about, but limited experience in using them, suggesting a need and opportunity for building capacity in this area. So, our later work has tried to address this, by developing resources such as a conceptual systems map for physical activity; and Getting Australia Active 3; and more recently, developing understanding about the role of particular policy levers such as law and regulation, and supporting efforts to build national consensus around a comprehensive and standardised physical activity surveillance system.

Slide 6. [3:57]

In the next few slides, I will highlight some key findings from our mapping work noting that they may no longer reflect the current situation as it has been a few years since we conducted this work.

Slide 7.

In relation to the policy audit, we identified over 100 relevant policies mainly at the state and territory level, mostly aimed at the general population.

Slide 8.

We found considerable action related to the planning and transport sectors to promote the GAPPA domain of more active environments. And we saw this in a few ways. For example, planning and infrastructure was a key sector lead for developing relevant policy. It was also a key policy domain where action was proposed, along with transport and environment. And most of these policies addressed physical activity in terms of it being a co-benefit of a different objective such as improving liveability, or road safety.

Slide 9 [5:05].

We were also interested in understanding to what extent agencies are working in connected or siloed ways when developing and implementing physical activity relevant policy. Here we found some encouraging indications of multi-sectoral engagement, for example, almost half of the policies were developed using 2 or more agencies. Responsibility for policy implementation was also most commonly described as shared, such as between lead and partner agencies. And in most cases, policies addressed physical activity by covering 2 or more different policy domains. All in all, this suggested some existing linkages that could be leveraged or strengthened for a more coordinated, systems approach to physical activity in Australia.

Slide 10 [5:52].

We did however identify a few areas for further attention. The audit revealed limited consideration about high needs groups and what can be done in healthcare and workplace settings. It also suggested scope to use a wider range of policy mechanisms because the most common mechanism was informational in nature – such as education, or the provision of guidance for policy makers and practitioners. Finally, the findings suggested greater attention is needed towards the active systems component of GAPPA because few policies described clear arrangements for funding or specific indicators to support and monitor their implementation – and where governance arrangements were described, these were very rarely independent of government.

Slide 11.

In terms of the programs audit, we found that most were similarly aimed at the whole of population although some programs contained components that were aimed or adapted for specific groups such as older people.

Slide 12.

In contrast to the policy audit where planning and transport policies were quite prevalent, most programs were aimed at sport/recreation and local government/communities settings. Similar to the policy audit, there were far fewer programs in the workplace and healthcare settings.

Slide 13.

We wanted to understand what modalities the programs used to promote physical activity, so we adapted an existing international classification for physical activity interventions which covers those with an individual, group, provider and environmental focus.

Slide 14.

The most common modality used by programs was funding (to support the delivery of programs by others). Provision of information was also quite common, and we included mass media campaigns in this category. And what you can see on the other end of the spectrum are that environmental change and transportation interventions were the least commonly described or used, suggesting a potential disconnect between policy development and implementation.

Slide 15.

In relation to our final P – prevalence. What you see here are the prevalence estimates of the proportion of the adult population meeting physical activity guidelines, as reported by each state and territory. What you can see is that some jurisdictions have numbers against their trend lines, and these represent points in time where they changed their questions or their definition of meeting physical activity guidelines. What this graph shows overall is a great deal of variability between jurisdictions, and fluctuations over time.

Slide 16.

But this variability and these fluctuations cannot all be attributable to that jurisdiction’s policy or program settings because what we can see from the state-based analysis of the national health survey which uses standardised questions and methods over time, is that the jurisdictions are more similar than the previous graph would suggest and that they are following a similar trajectory.

Slide 17.

This lack of standardisation limits the comparability of prevalence rates within and between jurisdictions, and how informative they can be for understanding the impact of policy and practice. This has been a longstanding issue that the national physical network (our stakeholders) has recognised and what they have tried to grapple with over time, and they have expressed support for building a more standardised and comprehensive surveillance system that not only captures changes in physical activity levels but also integrates measures of the built environment and data from non-health sectors. In the next few months, we’ll be progressing these discussions with each of the individual jurisdictions before deciding whether we take it back to a national forum.

Slide 18 [9:49].

In the next few slides, I’ll present some of the resources we’ve developed including Getting Australia Active.

Slide 19.

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. In the centre in the dark blue, we have the core influences on physical activity; in the light blue – we have the intervention points in the system and 8 domains for investment; in the dark green – we’ve identified politics, lobbying and social advocacy as other factors that interact with the system; and in the light green – governance and knowledge mobilisation. So this map helped us to structure Getting Australia Active 3, or the GAA3, which I’ll speak about next.

Slide 20 [10:36].

Getting Australia Active 3 is an evidence-based guide for policy makers on implementing a systems approach to PA in Australia. As the name suggests, it’s not the first of its kind in Australia but the most recent in a long lineage of evidence reviews for physical activity that Bill Bellew and Adrian Bauman have led in the last 25 yrs.

Slide 21.

What is particularly different about this version, is its explicit focus on a systems approach – so in chapter 2 – we explain in detail what we mean by this. We also set out evidence-based recommendations for the 8 domains which you saw earlier. And since population subgroups received limited attention under existing policies and programs, we’ve included a separate chapter on addressing equity. Finally, we’ve outlined considerations for a comprehensive surveillance system with some recommendations around how to measure population physical activity as well as measuring changes in the broader physical activity system. This can all be freely downloaded from the Prevention Centre website, and I’ve included a link at the bottom of this slide.

Slide 22 [11:42].

To aid knowledge translation and to promote uptake of this guide, we developed policy briefs to highlight key messages from our major chapters. The feedback from NPAN has been very positive but we recognise that the GAA3 is just one tool to help build capacity in this area and translate evidence into practice.

Slide 23.

Finally, I’ll touch on our initial work in exploring legal approaches for physical activity.

Slide 24 [12:15].

The reason we started exploring this area is that it was identified by NPAN (our stakeholders) as a priority area. Compared to tobacco control for example, law is a relatively underutilised, not particularly well understood tool for physical activity, so potentially by building understanding and knowledge in this area, we’re offering or presenting new levers for accelerating progress towards the GAPPA target.

Slide 25.

This is a framework [image of RAMPARTS framework] that we developed to help understand the role of law for physical activity and to help unlock some of its potential. I’ll just walk you through some of the key elements. At the centre, in the purple, we have lawmaking, and that refers to the determinants of lawmaking for physical activity (e.g. what influences governments to use law in the first place to address this issue or understanding how physical activity promoting laws get passed). Surrounding this, you can see 7 different legal mechanisms: educating or informing, providing funding, creating incentives, requiring something or setting standards, authorising or establishing a mandate, prohibiting or discouraging, and exempting or deregulating; and these are all the different ways in which law can operate to effect change. In the outer 4 boxes, we’ve identified the GAPPA areas in which change can be effected, and in the light blue ring, we’ve identified compliance, implementation and enforcement as key mediators of action – because the effect of laws on physical activity not only depends on what they say and what they cover, but also how well they are implemented or complied with and enforced. So how to use this framework. For researchers, this framework can be used to help develop research questions or ideas, and for policy partners, it can be used to prompt consideration about the breadth of areas where law and regulation might make a difference for physical activity.

Slide 26.

To sum up, Australian policy for physical activity has had periods of advancing well and then faltering as a result of shifts in political agendas and priorities. Recent developments have created a renewed opportunity for using systems approaches for physical activity, and coincide with some state-based efforts to pursue more intersectoral approaches to health and wellbeing. Our project has adopted a collaborative approach with policy makers, and taps into an existing physical activity network, to foster systems thinking, improve understanding of the existing physical activity landscape and encourage action towards better policy and practice. Our mapping work revealed some key gaps and opportunities where policies, programs and prevalence or surveillance systems could be improved. From the mapping work, we developed an evidence based guide for policy makers (Getting Australia Active 3) which aims to provide action-oriented guidance on implementing a systems approach for physical activity, primarily with an Australia context in mind. We’re building on some conceptual work into legal approaches for physical activity, and we’re also planning some workshops with the state/territories to advance discussions about building a more standardised and comprehensive physical activity surveillance system in Australia.

Thanks so much for tuning in, and thank you ISPAH for the opportunity to present our work and have this important discussion.

Slide 27.

Finally, I’d like to once again acknowledge the members of the ASAPa team – Karen Lee who was instrumental in the early stages of setting up this project, and the investigators Professors Bill Bellew, Ben Smith and Adrian Bauman as well as our funding partner.

Slide 28.

Visit the project page for more resources.

Contact Tracy Nau.