How can policy help promote physical activity in primary healthcare?

A doctor talks to a patient

Kendra ChowThere’s strong evidence that physical activity cuts the risk of cancer, but people don’t move enough on a daily basis. Can policy changes reverse this trend?

Despite strong evidence that physical activity cuts the risk of breast, colon and endometrial cancers, ever more people are failing to move enough. Global estimates indicate that 28% of adults and over 80% of adolescents are not meeting World Health Organisation (WHO)-recommended physical activity levels of at least 150 minutes of moderate physical activity per week.

In addition to the cancer risk, insufficient levels of physical activity have been linked to other health problems such as heart disease, stroke, diabetes, obesity, poor bone health and depression.

Recognising the significant link between physical activity and non-communicable diseases (NCDs), WHO member states agreed to target a 15% reduction in physical inactivity for adults and adolescents by 2030. However, if trends continue, the chances of reaching this target seem slim.

How can policy help?

A person in a wheelchair plays clay court tennis

In June 2023, World Cancer Research Fund International launched its 4th Building Momentum report: establishing robust policies to promote physical activity in primary healthcare. The report sets out the emerging evidence for the benefits of promoting physical activity in primary healthcare, and explains why designing and enacting such policies is good for individual health and economies.

This is the first Building Momentum report of its kind, offering a global policy perspective on developments and progress, as well as guidance on foundational policy processes and components.

Policies are important tools that governments can use to encourage physical activity. We need action across a wide range of areas such as health, sport, education, transport and urban design, to target where we live, learn, work and play. While the number of countries with national protocols on physical activity in primary care has increased in some WHO regions, others have seen a decrease such as in the south-east Asia and western Pacific regions. There needs to be more policies to help reach global targets on increasing population physical activity.

Best Buys for bigger impact

Implementing population-wide promotion of physical activity with links to exercise opportunities in local communities is one of the WHO’s newly updated NCD Best Buys. The Best Buys are policy interventions recommended by the WHO that help to save more lives for less money – reducing cases of NCDs and their costs to countries.

The Global Action Plan on Physical Activity (GAPPA) policy recommendations also include the promotion of physical activity in primary healthcare. Primary healthcare interventions such as screening for levels of physical activity, brief advice and referral have been shown to sustainably increase levels of physical activity for patients.

Primary healthcare professionals (GPs, nurses, dietitians, physiotherapists and others) are typically the first point of medical care contact for the population – and often embedded in their communities – and are more likely to be aware of or have developed connections to local physical activity opportunities, so they’re ideally placed to help increase rates of physical activity.

There are several potential barriers to developing such policies, including:

  • lack of enthusiasm and understanding among politicians
  • not involving those who deliver physical activity promotion in primary healthcare
  • failure by government departments beyond health to appreciate co-benefits

The 4th Building Momentum report outlines 4 foundational policy processes that are essential for effective physical activity policies in primary healthcare.

They are:

  1. Use the evidence: policymakers should use evidence to design and implement physical activity promotion policies in primary healthcare settings, and ensure sustained take-up. This includes collecting evidence from people with lived experience – the perspectives of patients and population groups being targeted by the policies are particularly valuable.
  2. Build shared policy understanding and objectives: ensuring understanding across government departments of the benefits of physical activity promotion in primary healthcare can help foster broad political support. And do not underestimate the role that policy champions can play in driving policy progress forward!
  3. Context matters: approaches must be relevant if policy is to be successfully introduced and implemented. Considerations should be given to healthcare system models, political contexts, and social and cultural realities.
  4. Equity: if designed well, physical activity policy should help contribute to improving, and not widening, health inequities. Policymakers must invite and engage with a variety of stakeholders, particularly those representing vulnerable or disadvantaged populations who may be disproportionately affected by existing policies.

Well-designed policy on physical activity promotion in primary healthcare is a key opportunity to improve the short- and long-term health and wellbeing of the population globally.

The 4th Building Momentum report has been developed for used as an advocacy tool – we want it to help build a robust case for the promotion of physical activity within primary healthcare, emphasising the use of evidence-based best practices.

It draws strongly on the experience of developing physical activity promotion policy from experts in 9 countries. There are also annexes looking at policy in World Cancer Research Fund International network countries (the Netherlands, US and UK), international policy recommendations, and on practical implementation of physical activity promotion in primary healthcare.

With the health of the world at stake, it’s time to be bold and act now to bring in policies to help people be more active.

> Read Building Momentum: establishing robust policies to promote physical activity in primary healthcare

Watch the report launch webinar