“We’re seeing younger and younger children becoming overweight and obese,” said Dr Juana Willumsen, coauthor of The WHO’s first ever guidelines on physical activity for children under five, “and that tends to track through childhood, adolescence and into adulthood.” Spending time on sedentary, passive activities like watching TV is also associated with poorer cognitive and motor development in young children, she said.
In response, the guidelines set out a variety of recommendations to improve early childhood health, from limits on screen time to targets for sleep and physical activity. These are aimed at helping policymakers around the world, from government ministries to NGOs. So how can practitioners turn them into change at scale?
From global to local
Apart from a few countries like Canada and Australia, which have begun implementing their own guidelines — such as a minimum activity time in daycare — most nations currently don’t have any standards for young children’s physical activity.
As such, the first step is to use these recommendations to create national standards, said Willumsen, for priorities like training early education and health workers.
By the end of 2019, the WHO aims to have created global standards for national governments to replicate, and will work with governments in developing them.
National guidelines can be used by governments as a benchmark for health policy, rather than absolute regulations, said Louise Choquette, a Health Promotion Consultant at the nonprofit Health Nexus, who helped to develop both the WHO’s and Canada’s guidelines. “We can’t make people in their homes turn off the TV,” she said, but you can provide targets for parents and early childhood workers to compare with and aim towards.
As an international tool, the WHO’s guidelines are necessarily general, but implementation has to be context-specific to ensure take-up from parents and early childhood workers.“It’s really tailoring the implementation to specific groups,” said Willumsen, “so that your messaging is reaching those families in a way that they will engage with the recommendations.”
In Canada, for example, where winter conditions can prohibit outdoor play, Choquette conducts workshops with parents to help promote physical activity and avoid cabin fever.
FIrstly, Choquette explained, you have to raise awareness about the issues which parents may not have thought about. While avoiding putting too much pressure on parents, she said, you have to help them recognise the problem — such as how much TV they let their young children watch.
The next step, she said, is giving parents and early childhood workers the skills to incorporate more physical activity into children’s days. In the workshops, Choquette teaches a number of indoor games which young children can play in limited spaces, instead of just turning on the TV when it’s too cold to go outside. She also makes sure to repeat the workshops at a later date, to increase the chances of healthy habits developing.
“Sometimes the early childhood educators haven’t had a lot of experience of activity,” Choquette said, so it’s important to give them the confidence to include it in their work. For example, if an educator is good with songs, she might say “well here’s a song you can dance to”. Ultimately, “kids want to be active naturally,” said Choquette, and incorporating more play can be fun.
A healthy environment
In order to tackle childhood obesity and sedentary behaviour at scale, interventions are needed across the board, said Willumsen. These range from urban planning, such as “making sure there are sufficient parks and play spaces available to parents and children,” she said, “through to that individual recommendation and support from a health visitor.”
Many urban environments are promote obesity, said Willumsen: they often suffer from a lack of play spaces, encourage a sedentary lifestyle thanks to the use of cars, and processed foods are widely available.
In particular, “we’re seeing childhood obesity rates rise at a much steeper rate in low and middle income countries,” Willumsen said, “as they undergo a very rapid transition” into this new lifestyle.
Choquette also blames cultural shifts for encouraging a lack of activity. In particular, risky outdoor play — which is connected to improved children’s wellbeing and development — can be difficult to promote in developed economies. In Canada, Choquette explained, people are “so afraid of lawsuits that they won’t let the kids do anything.”
Finding what works
There are promising examples, however, of public health policymakers using systems change to make big strides on these issues.
“The Amsterdam model has been particularly interesting,” said Willumsen; the Dutch capital managed to cut the number of overweight and obese under-18s by 12% from 2012 to 2015.
The city’s campaign involved working with school teachers, nurses and social workers to encourage a healthy lifestyle, as well as engaging parents and community leaders as part of the process. Having achieved impressive results amongst school-age children, the city has recently put a special focus on improving early childhood health, in particular through its system of health visitors.
In the United Kingdom, meanwhile, Leeds recently became the first city in the country to lower its childhood obesity rate. This was largely thanks to a program called Henry, which helps parents set boundaries for their children, including healthy heating and bedtimes. Their results were marked by significant improvements in deprived areas where childhood obesity was at its worst, said Willumsen.
Looking at the broader picture, however, these exciting examples are exceptions to the rule. In order to achieve positive results at scale, said Willumsen, policymakers need to “see where the barriers exist to actually getting the policies and recommendations implemented”.
The WHO guidelines on early childhood physical activity are a good start. Implementing them at scale, however, and across different contexts, is a far greater challenge. — Jack Graham
(Picture credit: Rob Christian Crosby/Deathtothestockphoto)