Physical inactivity is a plague affecting the entire world today, not just the United States. The World Health Organization (WHO) recognizes this crisis and is committed to leading the world in a treatment plan. In a webinar, conducted by the ISBNPA and ISPAH, two international societies for physical activity and health, Dr. Fiona Bull (WHO) described their detailed plan of how to combat physical inactivity in the world called the Global Action Plan on Physical Activity (GAPPA).
The ultimate goal of GAPPA is to decrease insufficient physical activity (PA) by 10% relative to each country involved. The four thematic objectives in this plan are to create active societies, environments, people, and systems. The core part (Part 3) of the plan outlined how specific actions fit into each of these objectives. For example, an active environment is achieved by improving urban design, improving safety, and fast-tracking those methods through necessary political channels. The final part of the plan is the practical application of the theoretical ideas. While this section is currently under development, it will link GAPPA to the already established Global Physical Activity Toolkit in the hopes of providing countries with tangible resources to accomplish each objective.
During the second half of this webinar, Dr. Charlie Foster (ISPAH President) and Dr. Jo Salmon (ISBNPA Past-President) facilitated a discussion to address weaknesses or confusing areas of GAPPA. One topic that came up repeatedly was how countries begin to take action and how to evaluate their progress when each country has a different starting point. Dr. Bull emphasized a portion of the plan that discusses “best buys,” or successful interventions the WHO deemed most cost effective in their analysis. By far, the two best strategies were mass media efforts and physician-based care from primary care professionals. Another interesting point that came up during the discussion was the question of how to set the PA goals for each country in 2030. On the one hand, should it be “bigger and bolder” than the goal set for 2025, assuming that the basics have been set and have started working? Or should it be a more conservative goal that may be more realistic and within reach? There wasn’t enough time in this short session to come up with a convincing answer. Questions and dilemmas about GAPPA, including those just mentioned, are also questions of interest to public health researchers. Their work should continue to guide the work of WHO and similar organizations.
As someone new to the public health field, learning about the logic model in class was somewhat frustrating because it didn’t feel practical. Too often we read research that describes a perfectly realistic model but does not translate into palpable changes in PA or nutrition. GAPPA is a detailed, comprehensive logic model that details specific actions that will be used in implementation. It was perhaps the first time I fully understood the purpose of a logic model and how it can drive action to reach a goal.
Hi Carly, thanks so much for the great overview of GAPPA. I know that the WHO is putting a ton of effort and other resources toward this initiative, and it seems as though they have a really solid framework. As I was reading your description, however, I did begin to wonder how they are planning to assess progress toward their goals. As we learned when discussing public health programming, it is important to make sure that you’re able to measure change in key aspects as a result of a program. Did the speakers describe any specific means by which they are planning to measure progress? I would think this would be especially important in a project of this scale. Not only are they trying to cause change in a community or state, but on the country level worldwide. This makes me think that it’s even more important for them to be extremely straightforward with their intentions and plans for measuring the changes they want to see. Thanks again for the great post!
Hey Ginny, I thought about that question too. She spoke about it briefly in the webinar, but not in much detail. More than anything else, she made it clear that it was a problem they were aware of and are still working on. I think she was looking for some guidance from the professionals participating in the webinar. The main problem is how to equally assess progress in so many different countries who are implementing different programs. Additionally, each country may have different demographics and different physical activity goals, which would likely alter the way progress is measured in each. She mentioned this specifically on a large scale when she talked about how to create plausible PA goals for 2030. But I think that general theme runs true on all levels of the program. Perhaps the best option is to delegate those responsibilities to more local organizations with the WHO only looking on from afar. That seems to be part of their goal, specifically with local governments, but we know how well that works sometimes…
I am very interested in the “best buys” that you mentioned, which the WHO believes are the most cost effective methods for reducing our global issue of inactivity.
Did they elaborate on what type of mass media campaigns (such as gain frame vs. loss frame messages) have been successful ? Also, is there a collection of the mass media materials available online for use by other nations?
Did they describe what specific modes of physician-based care (i.e. motivational interviewing or handouts) are helpful ?
Those are awesome questions, and I’m glad you brought them up. She actually didn’t specify anything in the webinar, but she did point to an appendix to the GAPPA plan that describes the findings of each cost-effective analysis they conducted for interventions targeting different risk factors (http://who.int/ncds/management/WHO_Appendix_BestBuys.pdf?ua=1). Even in this appendix though, they don’t get into the level of detail that you’re asking about. My impression is that the Global Physical Activity Toolkit they mentioned as part 4 of the plan will include these resources for all countries to utilize. Again, she didn’t go into much detail about that in this particular webinar. Since I’m still new to this world of public health and interventions, do you know which of these characteristics you mentioned are most effective? Are there ones that are easier to implement than others?
Yes, hopefully the Global Physical Activity Toolkit will have mass media resources for countries to use. Sharing those resources could save countries a lot of money.
I am not familiar enough with the body of literature to say which characteristics of mass media campaigns and physician counseling would be most effective at reducing inactivity. Obviously physician time is very costly so the less time they take up in a counseling session the more money will be saved.
I think it is interesting how the appendix you shared lists increased taxes on alcohol and tobacco as some “best buys.” I think increased taxes would fall under loss frame since the consumer has to spend more money to obtain the products.
As someone with an interest in preventative healthcare I really like that they include physical activity counselling and referral as part of routine primary health care services as a “best buy.” What are some of the “best buys” listed in the appendix that you think should be the top priorities for our country?
I think your point is well made about loss frame instead of “best buys”. I don’t think they were thinking about the techniques in those specific terms, just in terms of what works best. Then they gave those a catchy phrase, like “best buys”. When looking at the again, I actually think the ones they list as least effective would be the most effective. The plans implementing after school and community wide programs would be my preference. I don’t think there is strong enough evidence to suggest that education and motivation campaigns work that well. I think the best way to make people more active is to make activity fun and I think the best tools we have for that are classes or sports programs that bring people together to be active. Community wide programs that get the whole family out for an afternoon are going to be more effective in my opinion than playgrounds in undesirable areas that remain empty. I wonder how much of the research conducted on these “best buys” measures subjective intentions to exercise or preferences about PA. As we’ve discussed in class, there’s often a disconnect between how people say they will act and what they actually do. I trust the WHO does their homework on research and uses evidence-based practices, I’m just skeptical because it seems we’re always reading articles about interventions that have a minor effect on actual PA if any.
I can definitely relate to the frustration of trying to understand community or global interventions in order to address physical inactivity and /or improving nutrition habits. The four key action areas are interesting. As it relates to creating an active society, I wondered what exactly does this entailed. Does that portion of the plan focus on education? And the second step of creating an active environment also seems so challenging. Does this include building parks and greenway trails (not necessarily gyms?)? I would be interested in looking into GAPPA for more information on this plan, to fully understand the phases and implementation steps.
Thanks for the great questions, LaShawnna! For the active society objective, they are taking 4 specific actions to “create positive attitudes and values in communities and professionals.” These actions were as follows: implementing the best practice communication campaigns, creating mass participation incentives, strengthening awareness, knowledge and capabilities in people in all job areas, and fostering community wide awareness. These actions definitely include education, but I think education is a key aspect in all the actions associated with each objective. None of them mentioned education specifically, or formal education techniques. However, compared to the other three, this objective may involve the most education as it aims to change peoples’ attitudes and values. The other three seem to be more tangible changes in the environment and in specific places like schools or workplaces. Yes, you’re absolutely correct with the steps of creating active environments. I didn’t mention them all in my post, but other actions included improving urban design and transport and designing new and refurbished buildings and public amenities, including perhaps gyms and parks. It all seems super challenging, but I thought the plan was laid out really nicely. Another thing I didn’t mention in the post is that they are working on specifying clear indices of success for each objective. This part of the plan is still in development but it’s absolutely crucial in my opinion to create as many tangible markers they can to actually implement all these actions. If you want to know more, you should definitely check out the webinar https://www.youtube.com/watch?v=UC0dyw_8cYI). Hopefully here will be more info coming out as they get closer to implementing it.
Thank you for breaking down the specific actions; that provides some clarity to this project. This is a necessary plan to address this global epidemic, which I hope does contribute to changing people’s approach and beliefs to physical inactivity. As you have pointed out part of the plan is still under development, but having the quantifiable and more concrete markers does seem to be a very central and key for execution. I am going to look into GAPPA further, because it appears to tackle some of the main obstacles I have studied about to engaging in physical activity: education and access. I am now curious about the timeline and actual costs of implementation.