We’ve benchmarked national government physical activity policies for 30 countries in Europe to see what more needs to be done.
World Cancer Research Fund International has developed a benchmarking tool to assess national government policy actions on physical activity with reference to evidence-based, aspirational standards. This tool is part of the CO-CREATE project to reduce child and adolescent obesity in Europe.
Monitoring and benchmarking national government physical activity policies is important for assessing progress on obesity prevention, as a key risk factor in cancer and other non-communicable diseases.
The MOVING benchmarking tool was designed to hold governments accountable to a higher, aspirational standard rather than comparisons with other countries and with current best practices.
The tool was developed following a review of existing literature and an extensive participation with experts including policymakers, researchers and civil society, including youth representatives.
The MOVING benchmarking tool comprises:
Each policy area is allocated several benchmarks. Each benchmark is accompanied by an indicator in the form of a statement of government support, such as “National government supports schools to include physical education in school curricula”. The level of government support is then valued based on the policy attributes and the coding scheme.
The MOVING benchmarking tool includes 23 benchmarks (and associated indicators) across the 6 policy areas of the MOVING framework. The indicators are measured by 2 types of attributes:
The tool assesses the quality of policy design for national government policy actions to promote health-enhancing physical activity. It does not assesses the level of policy implementation.
The CO-CREATE project identified the need for an easy-to-use tool to assess physical activity and nutrition policy. To our knowledge, no such tool exists for physical activity policy.
The MOVING and NOURISHING benchmarking tools are monitoring and assessment tools for nutrition and physical activity policy that aim to hold national governments accountable for developing a comprehensive set of well-designed policy actions.
The tools assess national government policy actions with reference to evidence-based, aspirational standards, which is a novel approach compared with existing instruments, which compare countries with each other. This approach holds countries to a higher standard than country comparisons.
Existing tools use best practice examples, which hold countries to a lower standard and potentially limit demands on governments to innovate and improve. Aspirational criteria hold countries to a higher standard, starting from the premise that current practice is insufficient; this is aimed at encouraging further policy development.
The MOVING benchmarking tool was developed in parallel with the NOURISHING benchmarking tool. Their development was theoretically underpinned by our existing policy frameworks for physical activity and nutrition.
The development consisted of two steps:
Reviewed literature included: policy evaluations collected in the NOURISHING database, key literature on specific nutrition policy areas, such as front-of-pack labelling, marketing restrictions for unhealthy food and beverages, or health-related food taxes, and key reviews on physical activity policy identified for the development of the MOVING framework.
For a full list of literature consulted, read our paper in Obesity Reviews.
We convened an expert working group with 9 members, comprising academics and policymakers from European countries, Australia, New Zealand and the US. The group was consulted on the first version of the benchmarking tool.
In the second phase of expert consultation, a joint expert group was convened to carry out an in-depth consultation on the tools. The joint expert group (n = 23) consisted of experts in nutrition, physical activity and benchmarking, who were both CO-CREATE partners as well as experts in other relevant EU-funded projects. They were academics and policymakers from European countries, Australia, New Zealand and the US. In addition, 2 of the joint expert group members were representatives of UN agencies, specifically Unicef and the WHO Regional Office for Europe.
The expert group also included adolescent representatives, who were key in assessing whether the chosen indicators would capture policy actions that impact adolescents and embedding a youth perspective in the structure of the benchmarking tools. The adolescent representatives were instrumental in the development of specific attributes that sought to capture when policy actions either targeted adolescents directly or would impact them indirectly.
For most policy areas, experts agreed on the appropriate policy attributes based on their subject knowledge, expertise and familiarity with the evidence base. Below are the policy areas where expert opinion or the evidence base were insufficient, and how those areas were approached in the benchmarking tools.
|Policy area||Consultations process||Decision|
|Community programmes promoting physical activity||Insufficient evidence for an aspirational standard on appropriate length of programme||Attribute excluded|
|Physical activity guidelines||Expert disagreement that international recommendations (such as the WHO Physical Activity Guidelines) should be used as aspirational standards||No existing guidelines were included as aspirational standards|
Policy is a broad term, which can be defined in many ways. This tool focuses on policy actions, defined as specific actions put in place by national–level governments and associated agencies to achieve a public health objective. Actions include measures taken by national governments to promote healthy diets and promote physical activity, for example, laws and regulations, programmatic interventions, and public information campaigns. Policy actions are thus the actual options selected by policymakers and are a part of public policy. All policy actions are part of public policy, but not all policies are policy actions. For example, for the purposes of the benchmarking tools, plans and strategies are excluded.
The MOVING benchmarking tool should be applied on a complete dataset of physical activity policy actions taken by a national government. Such datasets were collected through a comprehensive scan methodology for 30 European countries and are available in our MOVING database.
Government actions to improve nutrition and physical activity policies are part of an interconnected range of actions, rather than single policies. Benchmarking individual policies is insufficient to effectively assess the overall status of government policy actions.
One advantage of the MOVING and NOURISHING benchmarking tools is that they consider the interaction between multiple policy actions and are able to assign a value to entire policy areas. At the same time, the benchmark evaluation is undertaken based on the presence or absence of aspirational policy attributes, rather than based on an expert evaluation, which other tools use.
Only national level policy actions were included; policies made at lower levels such as regional or local government were not included. Further, federal states, in which nutrition and physical activity policies are the responsibility of provincial or regional governments, may be disadvantaged by this approach. The remit and capacity of the CO-CREATE project did not allow for the considerable task of undertaking policy scans and benchmarking for sub-national level policy actions. While these tools were designed to monitor government action at national level, they could be used alongside existing tools focusing on sub-national policy action, or to guide policy analysis at local, regional or provincial level.
The tools focus on government action and exclude other types of policy such as plans or strategies, although they do include concrete policy actions arising from plans or strategies. The tools focus specifically on policy actions within the wider range of public policy.
Due to the remit of the CO-CREATE project, policies are only benchmarked if they are in effect. The roll-out of policies and how effectively they have been implemented has not been assessed. However, there is great value in evaluating the attributes of policy design as a first step in holding countries accountable, and an important aspect of policy learning among countries.
The tools do not give higher weight to areas or actions that are more likely to have an impact on health inequalities. For example, active transport infrastructure policies and public information campaigns on physical activity and health would receive equal weight in the MOVING benchmarking tool. This is due to their underpinning policy frameworks which take a comprehensive approach. This approach is supported by evidence that no single policy action is sufficient to effectively curb the rise in adolescent obesity and that action is necessary across multiple policy areas.
The tool relies on having comprehensively scanned a country to identify relevant policy actions, so it can be applied to any other country for which a full dataset was gathered using our search criteria. Using the tool requires a systematic comprehensive data set. There may also be attributes that are less relevant in different settings. We have been working with partners at the University of Cape Town to test the scan methods and benchmarking tools on nutrition and physical activity policies in South Africa. This work is ongoing.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No 774210. This content reflects only the authors’ views and the European Commission is not responsible for any use that may be made of the information it contains.