Bicycle Network: Prevention
Inactivity epidemics and prevention in society
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- Harry Barber
Many respondents said that they would support a strong effort by government and the community to get people to meet the minimum physical activity guidelines.
The online survey was filled in by 2 362 riders during September 2009.
One thousand (1030) of the respondents were Bicycle Network Victoria members, 29% (562) riders had not met Bicycle Network Victoria before. All but 10 respondents are bike riders.
The summary will cover the responses of the whole group. Where the member cohort had a different response rate this will be indicated and if appropriate discussed. In general there was little difference between the views of members and non members.
Results and commentary
The first set of questions sought to explore perceptions around diseases related to physical inactivity.
Q1, 2 The urgency of the inactivity epidemics
We explored the respondents understanding of the ‘new epidemics of disease’ that we face as a society.
Using diabetes as example – reportedly it is the fastest growing chronic disease – we asked respondents to estimate the scale of the problem and the rate of growth. We expected that if people thought that we were experiencing an epidemic of diabetes they would chose higher proportions of the population and higher growth rates.
The respondents have a good idea of the scale of the current problem. Most respondents (63%) made the estimate that the number of people with Type 2 diabetes was greater than 1.2m. The balance either did not know or made an estimate that is well below the diagnosed level of around 1 million cases. (There is a consensus that the number of diagnosed cases is matched by the number of undiagnosed cases.)
The respondents are conservative about the rate of growth. Estimates of growth in diabetes vary but the consensus is that it will be significant around 100 000 diagnosed cases a year. Half the respondents estimated the lowest growth rate offered 10% or did not know (51.9%). The balance of the respondents took the much higher rate offered in the survey.
Fewer than 10% of the respondents strongly overestimated the scale and rate of growth. Around half the group have what might be called a ‘non urgent view’. Either they don’t see the epidemic of diabetes that our society is experiencing or they see it and assess that it doesn’t relate to them.
The ‘non urgent’ response may reflect the high level of activity of the group. Later on we will see that the respondents – compared to the general population – are significantly more active. The respondents may have a sense of immunity from a disease linked to inactivity.
We clearly need to develop our understanding of the perceptions of the general population and bike riders on the health risks related to physical inactivity.
It would be both interesting and useful to know if less-active people had a greater sense of urgency about the inactivity epidemics. If so then it will be an easier task to draw them into physical activity.
If we found that the population, both active and inactive, shared the view that the inactivity epidemics were not a big problem, then the focus could shift to the government and the health system. It would then be necessary for a general effort to get across the urgency of the situation. We are unlikely to get concerted action to tackle the problem until a significant number of people think it is a serious problem.
Q4, 5,6: Efficacy of physical activity
We asked respondents about the diseases that are related to physical activity.
There is a consensus among the respondents about the solution. Three quarters knew that physical activity was an effective ‘vaccination’. This group clearly has a sound foundation of understanding; in working with them we can assume this knowledge.
We asked the respondents to indicate which diseases are strongly related to physical activity. The ‘correct’ answer was all of them:
• Nearly everyone (>90%) picked out cardiovascular disease, type 2 diabetes, stress/anxiety/depression.
• Most (>80%) picked out mental health and reduced confidence/self esteem.
• Many (>60%) identified arthritis and falls among older people.
• Only 39% picked cancer. This suggests that it might be useful to emphasise the link between physical activity and cancer prevention.
Nearly (>90%) everyone linked physical activity and recovery from some diseases and management of some diseases.
Apart from the link to cancer, we can say that the respondents understand the efficacy of physical activity.
Q7, 8: The social emphasis on prevention
We asked where our society should concentrate its effort in tackling disease.
Most (79%) said we should make prevention the main emphasis. Remediation & treatment and research were equal second in emphasis.
We then asked where our society should concentrate its effort in tackling disease when we know the disease is preventable by physical activity. This did not significantly change the proportion of respondents who wanted a substantial emphasis on prevention and control (81%).
This result suggests that from a social point of view, inactivity that leads to disease is currently an acceptable behaviour and that this group would be uncomfortable holding others accountable for actions (or inactions) that result in disease.
By analogy with drink driving we are back in the 1960s when driving drunk was significantly more acceptable.
This suggests that any regime of system signals, incentives and penalties that reflect the social cost of inactivity will need to be brought in gently and skilfully and developed over a period of time – as was the case with drink driving.
The pace of change may even be slower than with drink driving. In the case of a drunk driver, someone else’s behaviour might have an immediate and significant impact on another individual. Inactivity diseases spread their harm slowly. The impact on the active person is indirect and only communicated through the tax system.
On the other hand when we asked if the respondents would support a strong effort by government and the community to get people to meet the minimum physical activity guidelines, many (71%) said ‘Yes, certainly’. A further 25% said ‘yes, to some extent’.
Although the respondents don’t want the health system to change to tackle the inactivity diseases, they are comfortable with public information and awareness initiatives.
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