Explanatory Memorandum to COM(2013)603 - Promoting health-enhancing physical activity across sectors - Main contents
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This page contains a limited version of this dossier in the EU Monitor.
| dossier | COM(2013)603 - Promoting health-enhancing physical activity across sectors. |
|---|---|
| source | COM(2013)603  |
| date | 28-08-2013 |
Physical activity, including regular sporting practice and exercise, is one of the most effective ways of staying physically and mentally fit, combating overweight and obesity and preventing related conditions. In addition, participation in sport and physical activity is correlated with other factors such as social interaction and inclusion. Physical activity is one of the most important health determinants in modern society and sport constitutes a fundamental part of any public policy approach aimed at improving levels of physical activity.
The many benefits of physical activity and exercise across the life course are well recorded and more generally add to quality of life, as confirmed by the World Health Organization (WHO). Research supports the role that sport and physical activity has in child and adolescent development and suggests that participation in sport and physical activity in adolescence is positively associated with physical activity levels in adulthood. There is also a growing body of evidence on the positive correlation between exercise and mental health, mental development and cognitive processes.[3] In the Union, physical activity levels are positively correlated with life expectancy, meaning that those countries with higher levels of physical activity tend to have a higher life expectancy.[4]
Conversely, a number of detriments are caused by the lack of physical activity, including premature mortality, rising overweight and obesity levels, breast and colon cancers, diabetes, and ischaemic heart disease. In 2009, physical inactivity was identified as the fourth leading risk factor for premature mortality and disease in high-income countries world-wide, accounting for more than 1 million deaths in the European region alone.[5] Available evidence shows that health problems caused by the lack of physical activity have significant direct and indirect economic costs due to illness and morbidity, sick leave and premature death, especially also in view of Europe's rapidly ageing societies.[6] Studies have attempted to monetise these. For instance, one study carried out for the British government identified costs to England of just over € 3bn per year, or € 63 per inhabitant[7]. Considering these facts, physical activity has been included in the goals for global action on the control of non-communicable diseases.[8]
In the Union, the promotion of health-enhancing physical activity (HEPA) is a matter primarily for Member States. In light of the increasing awareness of the importance and beneficial effects of physical activity and the growing financial burden of physical inactivity, many public authorities have stepped up efforts to promote HEPA. As of 2010, a large majority of Member States reported to have at least some form of recommendations in place for physical activity, and many have also developed specific strategies to enable and encourage their populations to become more physically active.[9] Specific measures for this purpose have been launched in different policy areas or sectors, in particular sport, health, transport and education and there are many examples of good practice involving relevant stakeholders.
In an effort to support the Member States, the Union has been promoting physical activity through its policies and financial instruments in particular in the fields of sport and health, and has provided evidence-based guidance to policy makers in the form of the EU Physical Activity Guidelines[10]. These guidelines, drafted by a group of 22 experts from around Europe representing various disciplines and broadly representative of informed scientific opinion, were confirmed by EU Sport Ministers in 2008. They reiterate WHO Recommendations on the minimum level of physical activity, emphasise the importance of a cross-sectoral approach to HEPA and provide 41 concrete guidelines for action. Already the 2007 White Paper on Sport[11] and the 2007 White Paper on a Strategy for Europe on Nutrition, Overweight and Obesity-related Health issues[12] underlined the importance of HEPA and have helped strengthen policy debate and the exchange of good practice.
Despite the growing profile given to HEPA promotion and the available tools at national, European and international level, the rates of physical inactivity in the Union remain unacceptably high (e.g. in 2010, 60% of Europeans responded that they exercised or played sport seldom or never[13]). According to the WHO, two-thirds of the adult population in the Union does not reach recommended levels of activity. As a result, physical inactivity is estimated to deprive Europeans of over 8 million days of healthy life every year, on average.[14] While evidence demonstrates vast discrepancies between individual Member States, most countries have not achieved the principal policy objective, namely to increase the proportion of citizens who reach the HEPA levels recommended by the WHO and reiterated in the EU Physical Activity Guidelines. For the Union as a whole, the HEPA promotion policies of Member States have not been effective. This situation runs not only counter to the Europe 2020 Strategy[15], which acknowledges the need to fight health inequalities as a prerequisite for growth and competitiveness, but is also incompatible with the Union's stated policy ambitions in the fields of sport and health. Research indeed confirms the “evidence-policy gap for action” in addressing physical inactivity and has led to urgent calls for policy action on physical activity as a standalone public health priority.[16]
The reasons for the inability to reverse physical inactivity trends consist primarily in shortcomings in the way HEPA promotion policies are developed and implemented. Taking account of the criteria for effective HEPA policy laid down in scientific tools, the following shortcomings are confirmed by evidence, expert opinion and consultation outcomes: the lack of sufficiently cross-sectoral approaches to HEPA (incl. collaboration among different ministries and bodies responsible for HEPA); unclear objectives and goals of HEPA policies; and insufficient provisions for monitoring and evaluation of HEPA rates and policies. Robust data is indeed seldom available, despite its value for formulating and refining policy.
HEPA is only starting to become a policy field on its own and to get recognition as a complex policy area that requires multi-sectoral interventions, such as those provided for in the EU Physical Activity Guidelines. Physical activity has so far been lacking advocacy power to ensure that it receives the appropriate political recognition.[17] Since HEPA as a policy field is a rather new topic on the agenda of governments[18], there is a need for improved understanding of the determinants of HEPA, which is essential for designing interventions to change physical activity levels, as well as for institutional capacity to promote HEPA.
To address this situation, and following expert work in the context of the implementation of the European Union Work Plan for Sport 2011-2014[19] and input from other fields and levels of expertise (e.g. health and transport), the Council in its conclusions on the promotion of HEPA of November 2012 called on the Commission to present a proposal for a Council Recommendation promoting a cross-sectoral approach based on the EU Physical Activity Guidelines, including a light monitoring framework.
The success of the initiative will ultimately depend to a considerable extent on mobilising stakeholders, especially the ones most directly related to physical activity and with strong assets to reach out to citizens. The sport sector, in particular through its activities at grassroots level and with a sport-for-all focus, is therefore a key player in any successful effort to promote HEPA.
Contents
The proposal is based on the work of the Commission and Member States in the framework of the implementation of the Work Plan for Sport 2011-2014. The substance of the proposal, including the monitoring framework, has been the subject of extensive consultations with Member States, experts, stakeholders and the general public from different backgrounds, including sport, health, education and transport. Interested parties have been consulted at different levels on their views regarding the need for and scope of the promotion of physical activity in a Union context. Following the Communication on sport in January 2011[20], which included an action point to consider such a proposal, the Commission has regularly presented its plans and the work in progress for this initiative to policymakers and stakeholders and sought feedback in different fora. In its Resolution on the European dimension in sport of 2 February 2012, the European Parliament called on the Union and on Member States to facilitate engagement in sport and to promote a healthy lifestyle, fully exploiting the opportunities of sport, thereby reducing spending on healthcare.[21]
Member States have underlined the need for further exchanges of experience and good practice at Union level on HEPA and have been supportive of a new Union policy initiative. Member States have confirmed the difficulties in involving relevant sectors at national level and the lack of solid data, while also highlighting the need to keep the burden of data collection limited. Sport stakeholders, including the sport movement but also sport-related organisations, such as the sporting goods industry, have strongly encouraged further Union action on HEPA. The view that the Union has a role to play in promoting HEPA is shared not only by the Union institutions, existing Union level cooperation structures for sport and health, the expert level and sport stakeholders, but also by a large segment of Union citizens, as confirmed in an online consultation in 2010.
The Impact Assessment Board provided its positive opinion on the draft Impact Assessment on 7 December 2012. The Board's comments are taken into account in the final version of the Impact Assessment Report.
The proposed initiative takes a focused approach on HEPA, a relatively new discipline under rapid scientific development, combining physical activity, which is closely related to sport and exercise, on the one hand, and public health on the other. To reach the objectives of the proposal and to support the Member States in their efforts to promote HEPA, the Union can act by making use of two legal bases: Articles 165 and 168 of the Treaty on the Functioning of the European Union (TFEU), both of which assign a supporting competence to the Union. Article 165 stipulates that the Union shall ‘contribute to the promotion of European sporting issues’ and that action shall be aimed at ‘developing the European dimension in sport’. Article 168 stipulates that ‘Union action [...] shall be directed towards improving public health [...] and obviating sources of danger to physical and mental health’.
In both areas (sport and public health) the Treaty states that, in pursuit of these objectives, the Council, on a proposal from the Commission, may adopt recommendations. In addition, the Treaty explicitly authorises the Commission to take ‘any useful initiative’ to promote policy co-ordination among the Member States in the area of public health, in particular ‘initiatives aimed at the establishment of guidelines and indicators, the organisation of exchange of best practice, and the preparation of the necessary elements for periodic monitoring and evaluation’. The proposed Recommendation aims to strengthen Member States' efforts in the field of promoting HEPA and to support them by providing a framework for monitoring their policies. The Recommendation aims at strengthening cooperation and policy coordination between the Member States and at providing for further exchanges of good practice within the relevant Union level structures for sport and for health.
This Recommendation respects fundamental rights and observes the principles which are recognised by the Charter of Fundamental Rights of the European Union.
Following the request from the Council, this Recommendation sets out the main elements for coherent, cross-sectoral and evidence-based policies to promote HEPA and thereby aims to help Member States in their efforts to enable citizens to become (more) physically active.
The Recommendation reflects the clear evidence that HEPA promotion policies, to be successful, need to be based on a cross-sectoral approach. It takes into account that Member States, while sharing common objectives and respecting fundamental rights, set different priorities with regard to HEPA due to different social, economic and cultural contexts and therefore take different policy approaches. Provisions for policy coordination at Union level are intended to support Member States in their efforts to develop and implement effective HEPA policies. The monitoring framework, including its indicators developed by HEPA experts, is designed as a sufficiently flexible tool to inform policy making in this context. A detailed description of the operationalization of indicators and data sources is set out in the attached Commission Staff Working Document.
The Recommendation invites Member States:
· to develop a national strategy and a corresponding action plan as well as adequate instruments for promoting HEPA across sectors, reflecting the EU Physical Activity Guidelines;
· to monitor physical activity levels and the implementation of HEPA policies by making use of the monitoring framework and indicators set out in the Annex to the Recommendation, according to their national circumstances;
· to cooperate closely among themselves and with the Commission by engaging in a process of regular exchange of information and good practice on HEPA promotion within relevant Union level structures;
The Recommendation invites the Commission:
· to assist Member States in their efforts to effectively promote HEPA and in developing and implementing policies consistent with the EU Physical Activity Guidelines;
· to provide support for the establishment and functioning of the monitoring framework, based on existing forms of monitoring and data collection in this field;
· based on the information provided by Member States, to regularly report on progress in implementing this Recommendation.
While the Recommendation will first and foremost target public authorities in the Member States responsible for HEPA promotion, it will ultimately help reaching out to Union citizens at large (e.g. children, working population, seniors) by encouraging the implementation of cross-sectoral policies providing for opportunities to engage in physical activity. The initiative will also rely on mobilising stakeholders, including the ones most directly related to physical activity, such as sport organisations.
While the main responsibility for promoting HEPA and for the definition of sport and health policies lies with the Member States, Union action can add significant value over and above what Member States can achieve on their own. The Union can provide renewed political momentum toward focused action on HEPA. More effective HEPA policies will help contribute to other policy areas where Member States have agreed to set common objectives. By helping to reduce the significant social and economic costs of physical inactivity, and by addressing key factors contributing to active and healthy ageing, a healthy workforce and ultimately higher productivity they will strengthen Member States' ability to achieve the growth objectives set in the Europe 2020 Strategy. They will also address the determinants of health inequities outlined in the Strategy as a prerequisite for growth and competitiveness. Better HEPA policies will also respond to recent calls from the Council and the Parliament for action to support healthy lifestyle behaviours, including physical activity and engagement in sport, as a means to address premature mortality, morbidity and disability in the Union. The Council conclusions on HEPA adopted in November 2012 make these requests even more explicit. The recent Evaluation of the implementation of the Strategy for Europe on Nutrition, Obesity and Overweight-related Health issues also supports a policy initiative at European level, as it encourages the Commission to raise the profile of nascent initiatives focussing on physical activity.[22]
The Recommendation's focus on enhanced policy coordination between Member States – in the form of sharing of experience, peer learning and dissemination of good practice - seems particularly useful given the vast differences that currently exist between the Member States in the priority afforded to HEPA, the approaches chosen and the national policy co-ordination mechanisms. Union support and coordination will contribute to improving Member States' capacity to promote HEPA across sectors and to shape policies that ensure better interventions. The Union is well situated to enhance provisions for monitoring and evaluation of HEPA and HEPA policies and thereby to help Member States track developments over time. The monitoring framework will deliver the evidence to Member States to justify more focused approaches to HEPA promotion.
The proposed Recommendation builds on existing strategies and tools developed at the international level, in particular the WHO Global Strategy on Diet, Physical Activity and Health of May 2004[23], the 2010 Global Recommendations which recommend at least 150 minutes per week of moderate-intensity physical activity for adults[24], and the global consensus achieved by the World Health Assembly on 27 May 2013 laid down in the 'Omnibus Resolution on Non-communicable Diseases'[25]. It takes account of the cooperation developed with the WHO Regional Office for Europe in the framework of the Strategy for Europe on Nutrition, Overweight and Obesity-related Health issues and the 2013 evaluation of the latter[26]. It aims to improve further the tools developed with regard to the monitoring of physical activity, in particular the WHO European database on nutrition, obesity and physical activity (NOPA)[27]. The information and data to be provided by the Member States in this context is to a large extent already available and collected as part of existing surveys or projects; a number of indicators are already in use. Collection of data will require more efforts only in the case of a very limited number of indicators, in particular in the early phase of the monitoring framework. It is expected to improve over time and with increasing capacity in the Member States. The monitoring framework should be implemented in close cooperation with the WHO and with support from HEPA experts.
It is difficult to calculate the budget currently allocated to HEPA policies because the costs of HEPA promotion are spread around government ministries and authorities, as well as various NGOs and the private sector. In addition, spending on HEPA is not recorded comprehensively across the Union. This is exacerbated by the fact that HEPA is by nature cross-sectoral, that many policies are tangentially related to HEPA and that policies which promote HEPA often do not include HEPA promotion as a primary objective. Member States would ultimately bear the costs relating to the implementation of HEPA policies following this initiative.
Administrative costs for the Member States would mainly stem from the reporting requirements in the context of the light monitoring framework. They would already be low in the first year, with further reductions once the mechanism is fully operational, as staff becomes familiar with the monitoring and because of better data availability over time.[28]
The costs that would fall on the Union budget relate to the establishment and functioning of the monitoring mechanism; and to the provision of support to Member States for monitoring activities in the form of capacity building. These costs would be covered by the Sport Chapter of the Erasmus+ programme for the period 2014-2020.[29] In addition, the Union budget would cover the organisation of Expert Group meetings at Union level.