Should we privilege sport for health? The comparative effectiveness of UK government investment in sport as a public health intervention

INTRODUCTION: Claimed links between sport and health are pervasive. This paper interrogates evidence for the UK government’s theory of change that sport can be used as a public health intervention to increase physical activity among the less and least active to deliver improvements in the physical health of the population. Regardless of efficacy evidence linking sport participation to improvements in physical health, effectiveness evidence to support the processes by which it is assumed that sport participation can be increased among the less and least active is unclear. METHOD: Two time-series analyses of current and historical national survey data explore evidence for the effectiveness of sport as a public health intervention for physical health. RESULTS & DISCUSSION: There is no top tier evidence from controlled designs to support, and some second tier evidence from time-series analyses to undermine, the effectiveness of sport as a public health intervention to increase physical activity among the less and least active. Despite sustained UK government investment, sport participation has stagnated or fallen from 1990, whilst since 1997 an additional 10% of the population have become physically active in ways that do not include sport. CONCLUSION: There is no evidence that sport is effective as a public health intervention to improve physical health. In comparison to the opportunity cost of not implementing potentially effective alternatives that promote wider physical activity choices that do not privilege sport, investment in sport as a public health intervention may cause net harm to the physical health of the UK population

DEBATE: do interventions based on behavioral theory work in the real world?

Background: Behavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes. Discussion: Hagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the ‘real world’. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective behavioral interventions is needed, and behavioral scientists should engage in greater advocacy to persuade gatekeepers to invest in behavioral interventions. Weed argues there is no evidence to demonstrate behavioral theory interventions are genuinely effective in real world settings in populations that are offered them: they are merely efficacious for those that receive them. Despite behavioral volatility that is a normal part of maintaining steady-state population behavior levels creating the illusion of effectiveness, interventions fail in shifting the curve of population behaviors because they focus on individuals rather than populations. Hagger responds that behavioral interventions work in the ‘real world’ in spite of, not because of, flux in health behaviors, and that the contention that behavioral theory focuses solely on individual behavior change is inaccurate. Weed responds that the focus on extending the controls of efficacy trials into implementation is impractical, uneconomic and futile, and this has squandered opportunities to conduct genuine effectiveness trials in naturalistic settings. Summary: Hagger contends that interventions based on behavioral theory are effective in changing population-level behavior in ‘real world’ contexts, but more evidence on how best to implement them and how to engage policymakers and practitioners to provide sustained funding is needed. Weed argues for a paradigm shift, away from aggregative attempts to effect individual behavior change towards a focus on disrupting social practices, underpinned by understanding social and economic causation of the distribution and acceptance of behaviors in a population

The World Beyond Seaworld: A Comparative Analysis of International Law Protecting Cetacea in Captivity

Over the past few decades, the public has become more and more aware of the inhumane and incredibly harsh treatment of marine mammals being kept in captivity, specifically for entertainment purposes. Anger and outrage reached a heighted level after the CNN documentary, Blackfish, was released in 2013, as the film brought increased awareness to viewers across the country. However, the issue of marine mammals in captivity reaches far deeper than the SeaWorld controversy of recent years; in fact, the issue spans even beyond the United States. This article therefore analyzes the laws which allow for such captivity to take place, both nationally and internationally, while, at the same time, taking note of the impressive progress being made in both the United States and other areas around the world. As a whole, this comparative analysis will compare and contrast the best protection laws against the worst (or, in some cases, inexistent) laws, both nationally and internationally, analyze the common themes and apparent differences, and, based on such analysis, suggest an approach to this global issue

Killing Fields: Concepts and Processes

This is an accompaniment to the multi-channel video installation Killing Fields, for Visual Studies Senior Seminar. Images of violence are perhaps the most dramatically divisive and manipulative subset of consumed visuals. We refuse to condone real violence, and act appropriately shocked when violent images are labeled real, but when they are fake, we devour them with an insatiable appetite. Engaging this issue requires examination of the process by which images are perceived as violent — those particular components which make up a violent image and how visual definitions of violence are constructed, as well as issues of responsibility. What cues do image consumers use to identify what they may enjoy, versus what they must show empathy for? As image consumers, do we play of perpetrator, victim, or something else

Embedding and sustaining Change4Life Sports Clubs: regional case studies – part three

Change4Life Sports Clubs are funded by the Department of Health (DoH) and managed by the Youth Sport Trust (YST). The clubs were introduced into primary schools in 2011/12 and aim to increase the physical activity, health and wellbeing of less active 7-9 year olds through provision of fun multi-sport themes and healthy lifestyle activities. The success of the clubs has resulted in additional funding to expand the programme as a central part of a broader healthy lifestyle offer in schools. This is supported by the development of a hub of expertise focused in the areas of greatest health inequalities to support and share effective practice among schools and local authority Health and Wellbeing boards. In 2015, spear produced a Lifetime Impact Evaluation of the Change4Life Sports Clubs, drawing on data from over 7,500 children in more than 500 clubs. The Change4Life Sports Clubs 2016 research builds upon the Lifetime Evaluation with new data from children, schools and public health directorates to address three key objectives: 1) Demonstrate the wider impact of Change4Life Sports Clubs; 2) Assess the value for money and return on investment of Change4Life Sports Clubs and; 3) Capture good practice for embedding and sustaining the programme. Part Three presents Area Case Studies for six geographical regions in England to provide insight into how the Change4Life Sports Clubs have been embedded and sustained in schools across each area: East, East Midlands, London, North East, North West and South East. Each case study is informed by (re)analysis of club deliverer and School Games Organiser (SGO) survey data, site visit case studies, and interviews conducted with Public Health Teams, senior school staff, Change4Life Sports Club Leads and SGOs. The final section of Part Three presents recommendations for embedding and sustaining the Change4Life Sports Clubs

The Forest Tent Caterpillar

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Value for money & return on Investment of Change4Life Sports Clubs – part 2

Headlines Unit Outcome and Unit Cost Analyses • Change4Life Sports Clubs have a cost of £305 for every new child meeting CMO physical activity guidelines, for which cost an additional 0.2 children were lifted out of inactivity and a further 2.2 children were lifted out of low activity, with each of these children experiencing an average increase in reported wellbeing and individual development outcomes of 71%. • In comparison to the control condition counterfactual, Change4Life Sports Clubs delivered the following NET outcomes per £1,000 of expenditure: • 41 participants • 0.8 sustained clubs • 3.9 Young Leaders • 2.8 new children meeting CMO physical activity guidelines • 8.4 children lifted out of low activity • 1.3 children lifted out of inactivity • 0.1 children newly eating 5-a-day • 0.6 children reporting increased wellbeing and individual development outcomes • 5.1 children starting with low activity levels reporting increased wellbeing and individual development outcomes. Quality Adjusted Life Year (QALY) Analysis • The cost per QALY generated for the GROSS outcomes of Change4Life Sports Clubs is £3,385 (range:£3,036 to £3,806). • In comparison to the control condition counterfactual, the cost per QALY generated for the NET outcomes of Change4Life Sports Clubs is £3,791 (range: £3,413 to £4,245). • The cost per QALY generated for Change4Life Sports Clubs is significantly below NICE’s threshold for value for money per QALY of £20,000. • The cost per QALY generated for the GROSS outcomes of Change4Life Sports Clubs compares favourably to GROSS outcomes estimated for walking buses (£4,008 per QALY), dance classes (£27,570 per QALY), free swimming (£40,462 per QALY) and community sports (£71,456 per QALY). • The cost per QALY generated by the NET outcomes of exercise referral interventions in adulthood is approximately five and a half times greater than that of Change4Life Sports Clubs. Analysis of Future Health at Ages 13-15 • The Change4Life Sports Clubs cohort are predicted to do around an hour more physical activity per week at ages 13-15 than that predicted for the control condition counterfactual, and than today’s 13-15 year olds. • The estimated additional physical activity of the Change4Life Sports Clubs cohort up to ages 13-15 will generate one additional QALY for every five children that took part in Change4Life Sports Clubs. • In comparison to the control counterfactual, the cost per QALY generated by the estimated future NET outcomes of Change4Life Sports Clubs up to ages 13-15 is £120. • Across the Health Survey for England, the Millennium Cohort Study and the Understanding Society Survey, no data is available to support a robust estimation of likely health and wellbeing status associated with physical activity levels at ages 13

Lifetime evaluation of the Change4Life Primary School Sports Club Programme

ABOUT THE PROGRAMME The Change4Life Primary School Sports Club programme is funded by the Department of Health and managed by the Youth Sport Trust. The clubs were introduced into primary schools in 2011/12 and aim to increase the physical activity, health and wellbeing of less active 7-9 year olds through the provision of fun multi-sport themes and healthy lifestyle activities. SPEAR’s evaluations of the primary programme have consistently demonstrated that Change4Life Clubs can be effective mechanisms for increasing physical activity levels among less active primary children. Through provision of a safe space to learn and play, the opportunity to contribute to club delivery and encouragement of small steps toward increasing activity levels, the clubs have helped less active children build the competencies, confidence and resilience they need to be healthy and active throughout the lifecourse. The success of the Change4Life Primary School Sports Clubs has resulted in additional funding to expand the programme as a central part of a broader healthy lifestyle offer in schools. This is supported by the development of a hub of expertise focused in the areas of greatest health inequalities (priority areas) to support and share effective practice among schools and local authority Health and Wellbeing boards. ABOUT THE EVALUATION SPEAR was commissioned from October 2013 to March 2015 to conduct a third, successive evaluation of the Change4Life Primary School Sports Club programme. In October 2014, SPEAR produced an Interim Report including impact and delivery insights and progress and planning for the primary evaluation. SPEAR also recommended inclusion of a lifetime impact assessment to provide additional value to the Final Report findings and the project end date was subsequently extended to May 2015. This Final Report both supplements and supersedes the Interim Report. SPEAR’s current evaluation of the Change4Life Clubs reflects both the changing context and priorities of the primary programme and, through a systematic, controlled experimental evaluation, provides the robust evidence base necessary to support and further the programme as it develops into the future. The 2015 Final Report presents a lifetime evaluation of the programme to date. Drawing together extant data from SPEAR’s 2011/12 and 2012/13 (2011-20133 ) evaluations with new data collated across 2013/14 and early 2014/154 (2013-20155 ), this report focuses on the lifetime impact of the clubs in key areas, namely physical activity, health behaviours and wellbeing. The report shows how delivery has evolved to address programme aims, discusses challenges faced embedding clubs as a sustainable part of schools’ healthy lifestyle offer and considers preliminary evidence of the impact of the new support framework in priority areas. Data informing this report is drawn from the survey returns of over 7,500 children participating in more than 500 Change4Life Clubs and from just under 500 children in 15 control schools. Survey completions from over 2,000 club deliverers and SGOs, telephone interviews with 39 stakeholders and data from 20 site visits complements and triangulates the experimental data allowing the experiences and perspectives of a broad range of stakeholders to be presented. Key messages are summarised at the start of each section (and in the Headlines section on pages 2-5). The report is divided into three substantive sections: Who participated? What worked? and What did the clubs look like? The Influence of the Change4Life Brand is addressed and Recommendations for the programme are presented

The engagement of further and higher education with the London 2012 Olympic and Paralympic Games II

The second report from a survey of Podium's stakeholders, assessing the Engagement of Further and Higher Education with the London 2012 Olympic and Paralympic Games

2014/15 Skills2Play/Sport programme evaluation

The Primary School Physical Literacy Framework reflects the importance of the development of children’s physical literacy; “the motivation, confidence, knowledge and understanding that provides children with the movement foundation for lifelong participation in physical activity.” It also provides clear guidance as to how schools can maximise opportunities to develop the physical literacy of their pupils. Skills2Play and Skills2PlaySport are two complementary primary school physical literacy initiatives designed to support the objectives of the new Framework. Together they comprise the Skills2Play/Sport programme. Throughout this report the term Skills2Play/Sport refers to the programme, comprising both initiatives (Skills2Play and Skills2PlaySport). The programme consists of training and a resource and equipment package, which includes activity cards for both Skills2Play (blue cards) and Skills2PlaySport (purple cards) supplied to primary school deliverers by the Youth Sport Trust. Skills2Play is targeted at Key Stage 1 (KS1) and focuses on generic skill development through a range of play activities that focus on stability, object control and locomotion. Skills2PlaySport is targeted at lower Key Stage 2 (KS2) and includes multiskill activities that build from the generic skills but also introduce the connectivity with the sports through the development of skills specific to sporting ‘themes’, namely ‘Invasion’, ‘Striking and Fielding’ and ‘Net/Wall’. Further themes are currently at varying stages of development and include ‘Aquatics’, ‘Gymnastics’, ‘Athletics’ and ‘Wheels’. ABOUT THE EVALUATION The Centre for Sport, Physical Education & Activity Research (SPEAR) was commissioned by the Youth Sport Trust to conduct an independent evaluation of the Skills2Play/Sport programme between January 2014 and July 2015. The initial stages of the evaluation focused on the pilot programme undertaken in fifty primary schools. In May 2014 SPEAR produced the Pilot Evaluation Report, which captured teachers’ experiences of the training, resources and delivery of the Skills2Play/Sport pilot programme. The programme was then rolled out to 1,000 schools nationally and the objectives of the Evaluation of the national Skills2Play/Sport programme were as follows: 1. To assess how Skills2PlaySport and Skills2Play are being delivered and sustained in primary schools to support children’s physical literacy development. 2. To investigate the impact of Skills2PlaySport on the development of lower Key Stage 2 children’s physical literacy over 12 weeks of the programme. 3. To investigate the impact of Skills2Play on the development of Key Stage 1 children’s physical literacy over 12 weeks of the programme