PUBLIC POLICY PRIORITIES OF THE NATIONAL COALITION FOR PROMOTING PHYSICAL ACTIVITY (Revised Draft - 7/3/96 - 8 pages) ACTIVELY IMPROVING HEALTH AN OVERVIEW The links among physical activity, fitness, and health are well-established scientifically and medically. Much scientific and medical evidence indicates that physical inactivity is a major risk factor for cardiovascular, metabolic, and other diseases. Even moderate levels of regular physical activity confer significant health benefits. However, large segments of the American population remain inactive, with little or no physical activity in their daily lives. Current trends are not promising. More than 60 percent of American adults do not receive the recommended amount of physical activity, and 25 percent of the adult population is not active at all. The year 2000 could begin an era of worsening health habits, with major health and financial consequences for families and the entire nation. Given that context, the National Coalition for Promoting Physical Activity (NCPPA) was created in May 1995. Composed of over 100 member and participating organizations, the Coalition is working to sustain and extend U.S. leadership in the 21st century in the understanding, communication, and promotion of physical activity and health. Its aim is to achieve constant increases in physical activity among all persons in the United States in order to improve and maintain health and quality of life. To achieve that goal, the Coalition provides an organizational vehicle to enhance meaningful cooperation among associations and voluntary health organizations, foundations, government agencies, academia, and industry. The Coalition has several important areas of activity, including: (1) Communication and Education: stimulating and staging effective health promotion and education activities, and updating the media frequently. (2) Research and Clinical Practice: supporting efforts to improve the strength of the scientific, behavioral, and clinical practice aspects of physical activity and health. (3) Liaison and Inter-organizational Outreach: reaching out to relevant organizations and identifying means and opportunities for effective collaboration. (4) Advocacy and Political Education: providing accurate information and education to the media, decision-makers, and opinion leaders at all levels of government and community, while encouraging governmental and regulatory policies and practices that will improve the understanding and support of physical activity and health, and that will motivate and positively re-enforce people to engage in physical activity. The National Coalition for Promoting Physical Activity believes that all adults and children should participate in regular moderate or vigorous physical activity. All should have as a minimal goal the accumulation of at least thirty minutes of moderate physical activity on most and preferably all days of the week. Those already meeting that guideline may well derive further health and fitness benefits by becoming more physically active or including more vigorous physical activity in a regular routine. Furthermore, the National Coalition also believes that optimal progress across the nation cannot be made without a program that communicates, educates, and advocates favorable policies and practices at the federal, state, and local levels. The National Coalition also believes that the release of the first Surgeon General's Report on Physical Activity and Health is an opportunity to focus the attention of the Nation and its leaders on the importance of physical activity and the need for change. To accomplish its aims and to build on the release of the Surgeon General's Report, the National Coalition has identified five major priority areas for action, and will support policies, practices, and strategies at all levels that are consistent with the recommendations for each of these priority areas: 1. Education 2. Research 3. Health Care and Health Insurance 4. Community and Employer 5. Target Populations PROMOTING PUBLIC AND PROFESSIONAL UNDERSTANDING EDUCATION PRIORITIES Effective educational programs for all segments of the population are needed to reduce the prevalence of physical inactivity among Americans, and the health and economic costs associated with sedentary lifestyles. In addition to such well-known indicators as abnormal blood lipid and blood pressure levels, obesity, tobacco use, and alcohol abuse, physical inactivity has been identified as a key risk factor associated with several serious health problems. A growing body of evidence demonstrates the relationship between physical inactivity, or lack of exercise, and cardiovascular diseases, hypertension, diabetes, obesity, some cancers, and depression. Conversely, recent studies show that regular physical activity plays a significant role in the prevention and management of these serious health problems. Support is needed from legislators and policy makers at the federal, state, and local levels for education programs. The National Coalition recommends the following as goals at the federal, state, and local levels: 1. All schools should deliver quality daily physical education and comprehensive health education to all students, K-12. Unfortunately, physical activity declines dramatically with age during adolescence. In high school, enrollment in daily physical education classes dropped from 42 percent in 1991 to 25 percent in 1995. Effective school-based education programs are essential for the development of positive attitudes and behaviors that will carryover and foster active and healthy lifestyles throughout the adult years. In addition, schools should strive to maximize physical activity access and opportunity for students (e.g., keeping facilities open after normal hours, and providing equipment and supervision during those non-traditional times. 2. All Americans should have an opportunity to learn and internalize what it means to be physically educated. These guidelines should include being one who learns skills necessary to perform a variety of physical activities, is physically fit, participates regularly in physical activity, knows the implications of and the benefits from involvement in physical activities, and values physical activity and its contributions to a healthful lifestyle. All individuals should have an appreciation for the wide range of physical activity options from which one can gain health benefits, including competitive or recreational sports, participation in exercise programs at health and fitness clubs, use of at-home exercise equipment, dancing, and incorporation of moderate physical activity into everyday routines (e.g., walking the dog, taking the stairs). 3. All individuals should understand the importance of combining regular physical activity with a healthy diet that conforms to the 1995 Federal Dietary Guidelines for Americans. In this regard, all persons should appreciate the integrated nature of a more healthy lifestyle, so that the promotion of physical activity and the avoidance of tobacco, for instance, can be found in and related to nutrition education and vice versa. 4. Appropriate education programs should be developed and targeted specifically to at-risk populations among whom physical inactivity is particularly prevalent, including the socio-economically disadvantaged, the less educated, persons with disabilities, older adults, and youth between the ages of 13-19 whose levels of inactivity and body weight have increased in recent years. 5. Funding for quality school health promotion programs should be increased from both traditional sources, such as apportioning state sales taxes, and from newer resources, such as earmarking revenue from state lottery programs. Also partnerships should be established with corporations in order to fund innovative health education programs, so that all can benefit from a healthier working population in the next century. 6. Advice on, assessment of, prescription for, and referral to resources on physical activity should be provided by medical care professionals (e.g., physicians, nurses, exercise physiologists, allied health personnel) to patients as they are seen in the clinical setting. This advice and referral may be presented to the patient as part of routine health maintenance examinations or be considered as patients seek clinical assistance for predetermined medical reasons. BUILDING THE NATION'S CAPABILITY IN RESEARCH AND PREVENTION RESEARCH PRIORITIES Investment in biomedical research ensures the good health and well-being of our nation, families, and children. Recent polls reflect this need and show that an overwhelming majority of Americans believe that more money should be spent on medical research to better diagnose, treat, and prevent diseases. The public also is aware that biomedical research extends well beyond the basic treatment and control of diseases, but also to the prevention of diseases. The National Coalition promotes basic and applied biomedical and outcomes research. While many people know that exercise is good for them, many do not know why nor do they understand how much or what kind of exercise is right for them. Study after study has demonstrated a link between physical activity and the prevention of cardiovascular diseases, certain cancers, and diabetes. Exercise also helps control weight, promotes mental health, and builds and maintains healthy bones. Evidence on what helps people incorporate physical activity into their lives is not clear. Physical education classes in schools, worksite health promotion programs, and counseling by health care providers have been effective in promoting physical activity. More needs to be learned about what helps individuals change their physical activity habits and how changes in community environments, policies, and social norms might support that process. The National Coalition supports the development and implementation of effective programs that promote physical activity. The National Coalition for Promoting Physical Activity recommends the following: 1. Growth in the National Institutes of Health (NIH)-supported biomedical research nationwide. Ensure growing support of the research process and capitalize on all opportunities for scientific breakthroughs. This growth should include: (a) an increase in federal funding and research grant and training budgets to adequately support research as it pertains to physical activity. (b) significant real growth in federal funding for biomedical research programs of the National Institutes of Health, in particular, the National Heart, Lung and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Child Health and Human Development; the National Institute of Neurological Disorders and Stroke; and the National Institute on Aging. (c) increased federal funding for clinical, behavioral, and outcomes research under such agencies as the Agency for Health Care Policy and Research (AHCPR). The AHCPR plays an important role through the establishment of clinical practice guidelines and conduct of outcomes research. Practice guidelines and outcomes research help ensure that high quality and cost-effective medical services are provided. 2. Increased funding and promotion of such federal agencies as the Office of Disease Prevention and Health Promotion (ODPHP) to promote and support physical activity among all Americans. The ODPHP is the federal office responsible for prevention policy activities of the Department of Health and Human Services. The ODPHP promotes activities in the private sector, services a national information center, and offers programs, research, and communications support for disease prevention and health promotion. The cornerstone of ODPHP's mission is the development, monitoring, and implementation of the Healthy People 2000 program. 3. Increased support for the Centers for Disease Control and Prevention along with other relevant federal agencies. CDC is developing a comprehensive physical activity program that will build on research, of the kind emerging from the National Institutes of Health; will support state, school, and community interventions; and will expand communications to professionals and the public. Increases in funding are needed to support: * A coordinated national communications effort: In order to disseminate effective physical activity and nutrition messages. * Program development: Earmarked support for states to establish physical activity capacity in health departments, develop local physical activity programs, form coalitions and work closely with the managed care industry. * An increase for the Preventive Health and Human Services Block Grant: An important primary source of federal funding for states to support prevention activities. * An increase for CDC's school health programs: Support for states to implement model school health programs that address physical inactivity, diet, and tobacco use, currently received by only 13 states. * Surveillance and epidemiology: Support to develop, validate, and disseminate improved standardized methods for assessing physical activity in target populations, including women, minorities, adolescents, and disadvantaged populations. * Interventions research: Funding to develop and evaluate practical model interventions to promote physical activity in various settings, such as work sites, churches, health care settings, and schools. CHANGING POLICIES AND SYSTEMS HEALTH CARE AND HEALTH INSURANCE PRIORITIES Rising health care costs place an extreme burden on federal, state, and local governments. Medical and scientific research demonstrates that appropriate interventions and modifications of lifestyles can reduce or eliminate large numbers of health risks. An expansion in health promotion and preventive care represent tremendous opportunities for the United States. No where is this more dramatic than in the area of health benefits to be gained nationally by increasing, even moderately, the population's level of physical activity. Simply put: a massive gain in improved health is possible if we can lower the number of sedentary, physically inactive people. As HMOs and other managed care delivery options continue to grow, the National Coalition considers it an important priority that preventive care -- including counseling on physical activity -- is routinely and effectively provided to patients. In addition, a number of other important policy matters related to health care and health insurance would assist with this improvement in American's health. Several matters pertinent to the U.S. Congress and state legislatures are important to physical activity. For example, Congress has proposed changes in tax laws to encourage individual savings for health care expenses. Depending on how such a proposal is written, individuals either could be encouraged or discouraged to seek preventive care, including counseling in regard to the risks of poor health habits, such as being physically inactive, or the benefits from changes in lifestyle. Furthermore, in debating insurance reform, some states have attempted to prohibit health insurance companies from offering incentives for health plan members to engage in fitness or physical activity programs. Outlawing a financial incentive lessens the attractiveness of such a program. Also, health care providers and allied health professionals continue to play a vitally important role in providing information, instruction, and encouragement to patients and clients in regard to the importance of regular physical activity. The National Coalition for Promoting Physical Activity recommends the following at the federal, state, and local levels: 1. States should allow and encourage insurance companies doing business in their jurisdiction to allow incentives for insured members to participate in fitness and physical activity programs and engage in other healthy lifestyle habits, as many already are doing for tobacco-free clients. Encouragement and flexibility should be provided to the states by the federal government in order to achieve such flexibility. 2. Any federal initiatives relative to health care policy and reform should include support for and encouragement of health promotion, preventive care, and rewarding healthy habits, such as regular physical activity, that have a demonstrated ability to avoid or postpone disease and disability. 3. Programs, training, and incentives should be identified and developed for health care providers and allied health professionals to ensure accurate and consistent information and counsel is provided to patients and clients. This should result from a combination of federal funding and private sector support for quality initiatives, as well as a careful review and any necessary modification of the education and training of health professionals. 4. In clinical practice, a lack of time and absence of a means for reimbursement creates barriers for health care providers to give adequate attention to counseling patients about physical activity and nutrition. Such advice to patients has great potential to help individuals stay healthy, and therefore should be considered of sufficient value within the U.S. health care system to merit appropriate reimbursement. In addition, a careful examination should be made of the diverse practice settings in the United States -- from HMOs to V.A. hospitals -- to ensure that each environment provides an adequate focus on health promotion and disease prevention measures. BUILDING PARTNERSHIPS FOR HEALTH IMPROVEMENT COMMUNITY AND EMPLOYER PRIORITIES Communities present a tremendous opportunity for health promotion and disease prevention. Relatively simple measures can have a major impact, such as building zone ordinances that encourage rather than discourage options to be physically active, the inclusion of bikeways and walkways in communities, security measures to provide safe, well-lighted areas for outdoor activities, and regulations that allow access to recreation and sports facilities and play fields. In addition, business and industry must invest in the health of Americans to maintain a productive workforce and control health care costs. To achieve this, corporations, schools, hospitals, and non-profit organizations must assist government by integrating physical activity into health policies and programs. The National Coalition for Promoting Physical Activity will work with the private and public sectors to identify and support national, state, and local policies that promote physical activity. To that end, the National Coalition recommends the following federal, state, and local policies: 1. Various incentives should be provided to participating employees as part of worksite wellness programs and/or health benefits programs, and financial incentives should be provided for employees who reduce health risks by becoming physically active. 2. Access to safe and affordable recreation facilities and opportunities -- such as safe walking and bike trails and roadways -- should be expanded. 3. The regulatory and physical environment conducive to increased physical activity should be improved. 4. Employees should have opportunities to use facilities and other means of engaging in physical activity. 5. Community, media, and public leaders who themselves are physically active should be encouraged to help educate and encourage the population to engage in physical activity. 6. Employers should become familiar with and consider instituting health promotion programs in the business environment. The numbers of employers offering aspects of health promotion has increased, and opportunities for further progress are abundant. For example, employers -- and particularly smaller employers --- should be encouraged to cooperate with other organizations, in order to more effectively provide such opportunities to their employees. 7. In each community, leading corporations should be identified and partnerships created with affiliates and government agencies in order to promote physical activity. 8. Existing facilities should be upgraded, and open space developed in order to achieve safe and affordable supervised recreation programs. 9. Regulatory ordinances that promote physical activity and safety should be identified and used, such as building codes, zoning, and urban design (e.g., sidewalks, well-lighted stairs, and street lights.) FOCUSING ON PHYSICAL ACTIVITY NEEDS OF ALL TARGET POPULATION PRIORITIES In regard to the general population, the public health benefits of increasing physical activity are enormously important, due to the prevalence of sedentary lifestyles and the impact of activity on disease risk. Obviously, physical activity also is extremely important in regard to non-diseased and chronically diseased and disabled populations. Such groups include older adults and persons with disabilities, as well as those less educated and socio-economically disadvantaged. These groups also possess unique behavioral, physical and/or physiological characteristics and needs. Physical activity not only plays an important role in health maintenance within these populations, but can assist with the management of various diseases and conditions and allow daily living with a minimum amount of assistance. Therefore, the National Coalition stresses the importance of the following general priorities: 1. Expand and extend health promotion and prevention programs -- including counsel on physical activity -- to American populations with special needs and circumstances. 2. Increase funding and support for research programs and public education initiatives that are relevant to these populations. 3. Encourage and assist the adoption of lifetime recreational and physical activity habits that are appropriate and beneficial to the health of such populations.
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