Project Grant number: EAC-2016-0388 Promoting physical activity in the European Union (PROMPAEU) – a joint collaboration WHO/DG-EAC Final Technical Report 2016-2018 1 © World Health Organization 2019 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. 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The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. 2 Specification of the project grant Project title: Promoting physical activity in the European Union – a joint collaboration WHO/DG-EAC Acronym: PROMPAEU Starting date of the Project: 1 January 2017 Duration of the Project : 24 months Priority area: Health Enhancing Physical Activity Main partner information and contact person: Joao Breda, a.i. Programme Manager Nutrition, Physical Activity & Obesity - WHO Regional Office for Europe Partners involved in the Project (Institution, Acronym, Contact Person): University of Zurich, Brian Martin & Sonja Kahlmeier ISS – Erlangen University, Alfred Rutten List of collaborating partners: University of Zurich, ISS – Erlangen University RIVM, the Netherlands HEPA Europe Network 3 Acknowledgements WHO would like to express their gratitude to all of the European Union Physical Activity focal points from Member states for this collaboration and their efforts in collecting the data needed to develop a range of materials that contribute to knowledge of the policy and epidemiological situation of physical inactivity and sedentary behaviours while sharing experiences and of success stories and good practices. This collaboration has continually improved and the network is now a great example of a successful inter-country network working together to achieve better health for their population. WHO would also like to acknowledge the Organization for Economic Cooperation and Development for their support as well as all of the researchers, academics and experts who presented their findings and shared their knowledge at the regular meetings of the focal point network. Finally, WHO would like to express their great appreciation for the commitment and support from DG-EAC of the European Commission, WHO hopes to continue to work side-by-side with DG-EAC in a joint effort to increase population physical activity and sports participation across the European Union. 4 Contents Project Grant number: EAC-2016-0388 .................................................................................... 0 Promoting physical activity in the European Union (PROMPAEU) – a joint collaboration WHO/DG-EAC ............................................................................................................................ 0 Specification of the project grant ............................................................................................... 1 Acknowledgements .................................................................................................................... 3 Declaration by the project coordinator ...................................................................................... 7 Executive Summary ................................................................................................................... 8 Initial scope of the Project ......................................................................................................... 9 Rationale and background...................................................................................................... 9 Achievement of objectives ................................................................................................... 11 Project’s Deliverables and Outputs .......................................................................................... 12 Detailed description ............................................................................................................. 12 • Impact and outcomes of the project .............................................................................. 31 Project Results and Visibility................................................................................................... 31 Coordination with Networks and EU projects ..................................................................... 31 Project Coordination ............................................................................................................ 32 Communications plan .............................................................................................................. 32 Dissemination activities during and after the project .......................................................... 33 Stakeholder matrix and key dissemination strategies .......................................................... 34 Project website ..................................................................................................................... 34 Results and visibility for main deliverables ......................................................................... 34 Changes to the original planning ......................................................................................... 35 Conclusions and key messages ............................................................................................ 35 European added value / relevance towards the strategic issues related to the EU Programme .............................................................................................................................................. 36 Evaluation of the project ...................................................................................................... 37 Indicators.............................................................................................................................. 38 Logical Framework .............................................................................................................. 38 Future recommendations ...................................................................................................... 40 Annex I: Proposed changes to Staff Working Document .................................................... 42 General changes ................................................................................................................... 42 Possible changes per indicator ............................................................................................. 43 Indicator 1: National recommendation on physical activity for health ......................................... 43 Indicator 2: Adults reaching the minimum WHO recommendation on physical activity for health Indicator 3: Children and adolescents reaching the minimum WHO recommendation on physical activity for health .......................................................................................................................... 43 Indicator 4: National coordination mechanism on HEPA promotion ........................................... 44 5 Indicator 5: Funding allocated specifically to HEPA promotion .................................................. 44 Indicator 6: National Sport for All policy or action plan Indicator 9: Target groups addressed by the national HEPA policy Indicator 22: National HEPA policies that include a plan for evaluation ...................................................................................................................................................... 45 Indicator 7: Sport Clubs for Health Programme ........................................................................... 45 Indicator 8: Framework to support offers to increase access to exercise facilities to socially disadvantaged groups .................................................................................................................... 45 Indicator 9: Target groups ............................................................................................................. 45 Indicator 10: Monitoring and surveillance of physical activity .................................................... 46 Indicator 11: Counselling on physical activity Indicator 12: Training on physical activity in curriculum for health professionals ............................................................................................... 46 Indicator 13: Physical education in primary and secondary schools ............................................ 46 Indicator 14: Schemes for promoting PA in schools Indicator 16: Active travel to school .......... 46 Indicator 15: HEPA in training of physical education teachers .................................................... 46 Indicator 17: Level of cycling and walking .................................................................................. 46 Indicator 18: European guidelines for improving infrastructures for leisure-time physical activity ...................................................................................................................................................... 47 Indicator 19: Schemes to promote active travel to work Indicator 20: Schemes to promote physical activity at the workplace ............................................................................................................... 47 Indicator 21 Schemes for community interventions to promote physical activity in older adults 47 Indicator 22 ................................................................................................................................... 47 Indicator 23: National awareness raising campaign on physical activity ..................................... 47 Annex II: Roadmap for physical activity in Latvia ............................................................. 48 National roadmap for the improvement of physical activity of the population in Latvia ........ 48 Introduction .............................................................................................................................. 49 1. Rationale for a National Physical Activity Road Map.................................................. 50 Vision ................................................................................................................................... 50 Goal ...................................................................................................................................... 50 Scope .................................................................................................................................... 50 2. Global and Regional Commitment to Promoting Physical Activity ............................. 51 3. Current Situation in Latvia............................................................................................ 51 3.1. Data and statistics................................................................................................................... 51 3.2. Existing policies and implemented actions ....................................................................... 53 3.3. Main challenges ................................................................................................................ 56 4. Priority areas and recommended actions ...................................................................... 59 Priority area 1 - Providing leadership and coordination for the implementation of policies and interventions to promote physical activity .................................................................... 59 6 Priority area 2 – Supporting safe physical activity during pregnancy, after childbirth and during infancy also including preschools ............................................................................ 61 Priority area 3 – Supporting the development of children and adolescents ......................... 63 Priority area 4 – Promoting physical activity for adults ...................................................... 68 Priority area 5 – Strengthen monitoring and evaluation, research and surveillance ............ 74 Annex III: Potential enhancement of EHIS in the area of physical activity ........................ 76 Harmonization with existing Global, Regional and National Surveys ......................................... 76 Current EHIS questions and potential new questions for better alignment with existing international surveys and ongoing work to harmonize surveillance of physical activity and sports participation .................................................................................................................................. 77 General comments ........................................................................................................................ 77 Existing EHIS Physical Activity Question in the Work domain .................................................. 77 Potential questions and answers to supersede or integrate with EHIS-PAQ in the sedentary behaviour domain .......................................................................................................................... 80 Annex IV: Concept note on a methodology to estimate physical inactivity related socio- economic costs. .................................................................................................................... 81 Annex V: Power point presentation in English, on the results achieved through this grant 84 7 Declaration by the project coordinator I, as project coordinator of this project grant and in line with the obligations stated in the Grant Agreement declare that: • The report represents an accurate description of the work carried out under this project grant for this reporting period; • To my best knowledge, the financial statements that are being submitted as part of this report are in line with the actual work carried out and are consistent with the report on the resources used for the project. Name of the project coordinator: João Breda .................................................................... Signature: .................................................................... Date: .................................................................... 8 Executive Summary The PROMPAEU project, running 24 months from January 2017 to December 2018 is a joint WHO/DG EAC initiative under the priority area of Health-Enhancing Physical Activity. The overall aim of the project was to contribute to the achievement of the WHO Global Target of 10% reduction of physical inactivity levels in the EU Member States by 2025, by supporting the implementation of the 2013 EU Council Recommendation on HEPA and of the Physical Activity Strategy for the WHO European Region 2016-2025. Moreover, the current grant will enhance the collaboration between the WHO Regional Office for Europe and the European Union while providing support to Member States in the achievement of the aims of existing policy frameworks. The main target groups of this project were Member States and policy-makers from key policy sectors, local and regional governments, NGO’s in the field of health enhancing physical activity and public health, Civil Society Organizations (CSO’s), Academia and Expert Networks. The project intended to build on previous work and on-going WHO/EC collaboration, by re- enforcing the existing reporting mechanisms, fine-tuning the functioning of the EU Physical Activity Focal Points, supporting the enhancement of the monitoring of physical activity among Member States and developing novel tools for PA promotion. It provided further support and enhanced the capabilities of the National Focal Points in order to ensure a sustainable system of data collection at National level that served as the basis of a new edition of country fact sheets and extensive reporting on progress towards the objectives of the EU Council Recommendations on HEPA and the WHO Global Target on the reduction of physical inactivity alongside the Physical Activity Strategy for the WHO European Region 2016-2025. The project has successfully contributed to monitoring and surveillance of health enhancing physical activity in the European Union Member States. All relevant stakeholders were engaged and thoroughly collected and debated policy relevant information on HEPA within all Member states of the European Union. Moreover, the project has disseminated quality and substantiated reports on the European situation and updated the Gateway database. During this project, extensive support was given to the Physical Activity National Focal Points within the EU Member States, a network which was set up through this WHO/EC collaboration. Four HEPA Focal Point meetings were held, where innovative physical activity developments were presented and discussed, good practices were shared among Member States and the monitoring framework for physical activity was addressed. A key output of this project is the Factsheets on Health- Enhancing Physical Activity in the 28 European Union Member States of the WHO European Region. The Factsheets contain both an overview of the European- and individual Country situation regarding prevalence data of physical activity and policy actions to promote HEPA among various sectors. These Factsheets have been disseminated to all relevant Stakeholders through WHO channels, as well as through 9 a launch through the European Commission, timely planned in connection to the European Week of Sports. Moreover, as a novel product, data from the monitoring framework was used to create thematic factsheets on the topics of physical activity in the health and in the education sectors. These provide an overview of success stories highlighted by Member States, which can serve as inspiration for the development and scaling-up of new initiatives to promote physical activity in these sectors. PROPMPEAU has proven to be a successful initiative between DG/EAC and WHO. The close collaboration has been sustained by the EAC´s participation in the HEPA meetings as well as in joint dissemination of the activities. The contribution of EAC to the work and activities of PROMPEAU has been highlighted in presentations, logos and acknowledgements. Dissemination of the projects results has been far reaching and occurred via the organizations’ websites and social media, European-wide networks and by timely and targeted launching of the key results and findings. Initial scope of the Project Rationale and background Each year, one million people die and 8.3 million disability-adjusted life years are lost in the WHO European Region due to physical inactivity. Physical inactivity is estimated to cause 5% of the burden of disease of coronary heart disease, 7% of type 2 diabetes, 9% of breast cancer, and 10% of colon cancer. By taking action on promoting physical activity (PA) and reducing sedentary behaviour, the number of people dying and suffering from noncommunicable diseases (NCDs) could be drastically reduced. Similarly, it is recognized that physical inactivity contributes significantly to overweight and obesity. On the other hand, physical activity is at the core of health and of well-being, and the benefits of being physically active, including reduced risks of NCDs, reducing stress, anxiety, and depression, are well recognized. Nonetheless, staggering figures from the latest Eurobarometer among European Union (EU) Member States (MS) indicate that in a given week, over half of Europeans do not engage in any vigorous physical activity and around half do not do moderate physical activity. WHO recommends that adults undertake at least 150 minutes of moderate intensity physical activity each week. Estimates indicate that at least one third of adults in Europe remain insufficiently active, in particular those from low socioeconomic backgrounds. Additionally, a significant decline in physical activity levels is observed among adolescents of 11-15 years old, with girls being consistently less active than boys. Furthermore, it is estimated that only 34% of 13-15 year-olds are active enough to meet the current WHO recommendation. Similarly, research from the WHO European Childhood Obesity Surveillance Initiative (COSI) shows that in some European countries, more than 40% children are overweight and 20% are obese. In 2013, EU Member States adopted the Council Recommendation on HEPA across sectors which have served as a basis for political action and a road map for action. More recently, in September 2015, 53 Member States of the WHO of the European Region adopted the first ever 10 Physical Activity Strategy for the European Region 2016-2025 which, aims to cover all forms of physical activity promotion throughout the life-course, primarily focusing on the burden of noncommunicable diseases associated with insufficient physical activity levels and sedentary behaviours. Several of the 28 EU Member States of the WHO European Region have implemented physical activity policies to promote health and wellbeing. However, it is widely accepted that more needs to be done in order to address the appalling levels of physical inactivity. In order to guide and develop adequate and effective physical activity policies, it is important to fully understand current levels of physical activity, as well as existing actions to promote it, thus the high importance of monitoring and surveillance in the EU. In response to the abovementioned challenges and following the 2013 Council Recommendation on HEPA, the European Commission and the WHO Regional Office for Europe have started a joint initiative that aims to develop and scale-up monitoring and surveillance of health-enhancing physical activity (HEPA) in the European Union Member States. An important aspect of this initiative has been the establishment of a network of national physical activity focal points to help provide and validate information on physical activity from EU MS, in line with the monitoring framework established by the Council recommendation. The EU Physical Activity Focal Point Network met for the first time in Rome in October 2014 and has subsequently continued to meet twice per year. Since the inception of the network the focal points have provided answers to a questionnaire on the 23 indicators of the monitoring framework in two occasions in 2015 and 2018. The aims of the meetings have been to present and to discuss lessons from the overall group of indicators and information provided by the Member States to WHO, as well as to present draft country profiles. Additionally, these serve as networking opportunities and to provide examples of good practices and relevant projects related to HEPA to inspire Member States to take action in their country. Participants included the EU HEPA focal points representing Member States, the European Commission (DG EAC/Sport Unit), the World Health Organization and often external experts. An example of an important outcome from the EU focal points network are the first and second publications of the Factsheets on health-enhancing physical activity in the 28 European Union Member States of the WHO European Region, as well as the innovative thematic factsheets on HEPA in the education sector and in the health sector from 2018 (all available in English on: http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/data-and- statistics/physical-activity-fact-sheets). The current grant has enhanced the collaboration between the WHO Regional Office for Europe and the European Commission while supporting Member States to achieve the aims of existing policy frameworks, as well as promoting the development of new actions to monitor, enhance and promote physical activity among European citizens. 11 Achievement of objectives During the grant period, successful activities were implemented, which led to the achievement of the objectives included in the grant agreement as follows; OBJECTIVE I: To support the development and scaling up of monitoring and surveillance of HEPA in the EU, in line with the monitoring framework, with the view to improve evidence- informed policy-making in the EU. This objective was achieved through; (1) The provision of support, capacity building and networking opportunities to Member States, mainly through meetings held twice per year for the network of HEPA focal points, including joint meetings with other networks such as with the High-Level Group for Nutrition and Physical Activity and meetings back to back with HEPA Europe conferences. (2) The revision and improvement of the physical activity questionnaire used in 2015 based on feedback from HEPA focal points and external experts. (3) The second round of data collection through the revised questionnaire, using improved methods, while ensuring the comparability of its results with the first version. (4) Proposed updates for the Staff Working Document to support the revised HEPA questionnaire; (5) The provision of technical support for the coordination of the EUPASMOS project, an Erasmus+ funded initiative, led by Member States, which aims to harmonize and improve the quality of physical activity/inactivity and sport measurement tools and methodology. OBJECTIVE II: To issue revised country factsheets on physical activity and to update the WHO European database on nutrition, obesity and physical activity (NOPA) with recent data, good practices and success stories, in line with the monitoring framework. This objective was achieved through; (1) The integration of data from the HEPA questionnaire from the 2015 and 2018 collection rounds on the WHO European Health Information Gateway (formerly known as the NOPA database); (2) The publication of the second set of country Factsheets on HEPA, using the revised questionnaire and a tool for the collection of best practices from around the EU; (3) The publication of two thematic factsheets compiling good practices and success stories from across Member States on i) physical activity in the education sector and ii) physical activity in the health sector. 12 OBJECTIVE III: To support governments and other stakeholders in their initiatives aiming at increasing levels of physical activity and reducing sedentary behaviours (e.g. national physical activity guidelines, and/or guidelines for specific groups such as children or the elderly). This objective was achieved through support for individual countries to develop evidence- based physical activity guidelines, recommendations and roadmaps for physical activity policies in different sectors. OBJECTIVE IV: To design a methodology to estimate physical inactivity related socio- economic costs. This objective was achieved through collaboration with the OECD to develop a concept note of a collaborative project to estimate the socio-economic costs of physical inactivity. Project’s Deliverables and Outputs Detailed description (all the different activities carried out, overall assessment of the results of the action (number of participants, targeted audience, people who benefit directly and indirectly of the action…) and proof of their dissemination (communication and information plan), published material (CD, DVD, publication, photographs, press releases…) Table 1. Summary of deliverables included in the grant Number Deliverable Status Supporting document 1 Final technical report Finalized Current document 2 Final financial report Finalized Attached separately 3 1st meeting of the National PA Focal Points Organized Finalized http://www.euro.who.int/__ data/assets/pdf_file/0016/3 51304/Toledo-HEPA- Focal-Point-Meeting- report-0210.pdf?ua=1 4 2nd meeting of the National PA Focal Points Organized Finalized http://www.euro.who.int/__ data/assets/pdf_file/0003/3 64395/zagreb-hepa- meeting.pdf?ua=1 5 3rd meeting of the National PA Focal Points Organized Finalized http://www.euro.who.int/__ data/assets/pdf_file/0005/3 13 84017/8th-hepa-fp- meeting-rep-eng.pdf?ua=1 6 4th meeting of the National PA Focal Points Organized Finalized http://www.euro.who.int/__ data/assets/pdf_file/0005/3 92873/9th-hepa-focal- point-meeting-eng.pdf 7 Report of the 1st National Focal Point Meetings published Finalized http://www.euro.who.int/__ data/assets/pdf_file/0016/3 51304/Toledo-HEPA- Focal-Point-Meeting- report-0210.pdf?ua=1 8 Report of the 2nd National Focal Point Meetings published Finalized http://www.euro.who.int/__ data/assets/pdf_file/0003/3 64395/zagreb-hepa- meeting.pdf?ua=1 9 Report of the 3rd National Focal Point Meetings published Finalized http://www.euro.who.int/__ data/assets/pdf_file/0005/3 84017/8th-hepa-fp- meeting-rep-eng.pdf?ua=1 10 Report of the 4th National Focal Point Meetings published Finalized http://www.euro.who.int/__ data/assets/pdf_file/0005/3 92873/9th-hepa-focal- point-meeting-eng.pdf 11 Data collection round completed Finalized http://www.euro.who.int/en /health-topics/disease- prevention/physical- activity/data-and- statistics/physical-activity- fact-sheets 12 Staff working document revised, with the support of relevant experts and a brief Finalized https://eacea.ec.europa.eu/si tes/eacea- site/files/study_implementa 14 summary of the proposed additions/changes tion_pa_guidelines_2016.p df Annex 1: Brief report on recommended changes to the staff working document 13 Publication of updated physical activity country factsheets Finalized http://www.euro.who.int/en /health-topics/disease- prevention/physical- activity/data-and- statistics/physical-activity- fact-sheets/physical- activity-country-fact-sheets 13a Publication of thematic factsheet on physical activity in the health sector (2018) Finalized http://www.euro.who.int/__ data/assets/pdf_file/0008/3 82337/fs-health- eng.pdf?ua=1 13b Publication of thematic factsheet on physical activity in the education sector (2018) Finalized http://www.euro.who.int/__ data/assets/pdf_file/0006/3 82335/fs-education- eng.pdf?ua=1 14 Gateway (formerly NOPA) database updated with recent data, and with enhanced visualisation and communication capabilities Finalized https://gateway.euro.who.in t/en/themes/obesity- physical-activity-and- nutrition/ 15 Support provided to several countries in developing national physical activity guidelines of guidelines for specific groups Finalized Annex II 16 Concept note on the possible development of guidelines for children in Early Childhood Education Pending (justification under deliverable 16) 17 Support provided for the enhancement of EHIS in the area of physical activity Finalized Annex III 15 18 Support provided to international initiatives aiming at harmonising or improving comparability of existing questionnaires/surveys used for physical activity surveillance notable by ensuring support to National PA focal points but not exclusively On-going http://eupasmos.com/ 19 Concept note on a methodology to estimate physical inactivity related socio-economic costs Finalized Annex IV 20 2 to 4 relevant scientific publications 2 publications published in scientific journal https://www.ncbi.nlm.nih.g ov/pmc/articles/PMC59938 69/ https://www.termedia.pl/Sc hool-based-physical- activity-and-good- practices-in- Europe,99,34343,0,1.html 21 Participation at relevant conferences and other events and stimulating workplace health promotion activities in the context of international organization, namely EU and UN Finalized HEPA Europe conference: http://www.euro.who.int/en /health-topics/disease- prevention/physical- activity/news/news/2017/11 /european-network-for-the- promotion-of-health- enhancing-physical- activity-8th-conference- and-13th-annual-meeting EWOS event 2017: http://www.euro.who.int/en /health-topics/disease- prevention/physical- activity/news/news/2017/10 /who-celebrates-the- european-week-of-sports EWOS event 2018: https://europeanweekofspor t.dk/news/_/47 https://europeanweekofspor t.dk/news/_/51 Healthy Meetings guide: http://www.euro.who.int/_ 16 _data/assets/pdf_file/0005/ 373172/healthy-meetings- eng.pdf 22 Power point presentation in English, on the results achieved, for presentation to the public Finalized Annex V 23 Support to the implementation of 1 HEPA Europe meeting Finalized http://www.euro.who.int/__ data/assets/pdf_file/0006/3 25734/HEPA-5th-FP- Belfast-meeting-report.pdf 24 Brief report of the HEPA Europe meeting supported by WHO and DG EAC Finalized http://www.euro.who.int/__ data/assets/pdf_file/0005/3 32942/HEPA-12th-FP- Belfast-meeting- report.pdf?ua=1 N/A Set of web news and tweets in connection with the project Finalized http://www.euro.who.int/en /health-topics/disease- prevention/physical- activity/news/news/news?r oot_node_selection=52717 In the following individual tables, each deliverable will be described in further detail; Deliverable 3 Title of deliverable 1st meeting of the National PA Focal Points Organised Deliverable number in grant agreement 3 Nature (eg. Meeting, report, book, website etc.) Meeting Detailed description Number of participants: 42 Targeted audience: members of HEPA focal points network, CSO’s and expert networks People who benefit directly and indirectly of the action: Member States, local and regional governments and EU citizens. 17 Source and Evidence http://www.euro.who.int/en/health-topics/disease- prevention/physical-activity/news/news/2017/05/sixth- meeting-of-the-european-union-physical-activity-focal-points- network Status Finalized Deliverable 4 Title of deliverable 2nd meeting of the National PA Focal Points Organised Deliverable number in grant agreement 4 Nature (eg. Meeting, report, book, website etc.) Meeting Detailed description Number of participants: 54 Targeted audience: members of HEPA focal points network, CSO’s and expert networks People who benefit directly and indirectly of the action: Member States, local and regional governments and EU citizens. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0003/364395/zagreb- hepa-meeting.pdf?ua=1 Status Finalized Deliverable 5 Title of deliverable 3rd meeting of the National PA Focal Points Organised Deliverable number in grant agreement 5 Nature (eg. Meeting, report, book, website etc.) Meeting Detailed description Number of participants: 38 Targeted audience: members of HEPA focal points network, CSO’s and expert networks People who benefit directly and indirectly of the action: Member States, local and regional governments and EU citizens. 18 Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0005/384017/8th- hepa-fp-meeting-rep-eng.pdf?ua=1 Status Finalized Deliverable 6 Title of deliverable 4th meeting of the National PA Focal Points Organised Deliverable number in grant agreement 6 Nature (eg. Meeting, report, book, website etc.) Meeting Detailed description Number of participants: 80 Targeted audience: members of HEPA focal points network, CSO’s and expert networks People who benefit directly and indirectly of the action: Member States, local and regional governments and EU citizens. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0005/392873/9th- hepa-focal-point-meeting-eng.pdf Status Finalized Deliverable 7 Title of deliverable Report of the 1st National Focal Point Meetings published Deliverable number in grant agreement 7 Nature (eg. Meeting, report, book, website etc.) Report Detailed description Report summarizing the presentations and discussions of the meeting. Targeted audience: Member States, members of HEPA focal point network and expert networks. 19 Source and Evidence http://www.euro.who.int/en/health-topics/disease- prevention/physical-activity/publications/2017/report-of-the- sixth-meeting-of-the-european-union-physical-activity-focal- points-network Status Finalized Deliverable 8 Title of deliverable Report of the 2nd National Focal Point Meetings published Deliverable number in grant agreement 8 Nature (eg. Meeting, report, book, website etc.) Report Detailed description Report summarizing the presentations and discussions of the meeting. Targeted audience: Member States, members of HEPA focal point network and expert networks. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0003/364395/zagreb- hepa-meeting.pdf?ua=1 Status Finalized 20 Deliverable 9 Title of deliverable Report of the 3rd National Focal Point Meetings published Deliverable number in grant agreement 9 Nature (eg. Meeting, report, book, website etc.) Report Detailed description Report summarizing the presentations and discussions of the meeting. Targeted audience: Member States, members of HEPA focal point network and expert networks. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0005/384017/8th- hepa-fp-meeting-rep-eng.pdf?ua=1 Status Finalized Deliverable 10 Title of deliverable Report of the 4th National Focal Point Meetings published Deliverable number in grant agreement 10 Nature (eg. Meeting, report, book, website etc.) Report Detailed description Report summarizing the presentations and discussions of the meeting. Targeted audience: Member States, members of HEPA focal point network and expert networks. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0005/392873/9th- hepa-focal-point-meeting-eng.pdf Status Finalized 21 Deliverable 11 Title of deliverable Data collection round completed Deliverable number in grant agreement 11 Nature (eg. Meeting, report, book, website etc.) Data collection Detailed description Second round of data collection on HEPA policies, actions and status among EU Member States. Targeted audience: Member States, members of HEPA focal point network, HEPA experts Source and Evidence Published factsheets using data from data collection round. Link to all resources published with data from the second data collection: http://www.euro.who.int/en/health-topics/disease- prevention/physical-activity/data-and-statistics/physical- activity-fact-sheets Status Finalized 22 Deliverable 12 Title of deliverable Staff working document revised Deliverable number in grant agreement 12 Nature (eg. Meeting, report, book, website etc.) Brief report on proposed changes to staff working document Detailed description Targeted audience and beneficieries: Member States, members of HEPA focal point network, European Commission Source and Evidence https://eacea.ec.europa.eu/sites/eacea- site/files/study_implementation_pa_guidelines_2016.pdf Proposed revised HEPA questionnaire (online version): https://monitoringhsd.limequery.com/911548?token=JeOy5i0Fet6MsxF&newtest=Y Status Finalized Deliverable 13 Title of deliverable Publication of updated physical activity country factsheets (2018) Deliverable number in grant agreement 13 Nature (eg. Meeting, report, book, website etc.) Report Detailed description People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. 23 Source and Evidence http://www.euro.who.int/en/health-topics/disease- prevention/physical-activity/data-and-statistics/physical- activity-fact-sheets/physical-activity-country-fact-sheets Status Published Deliverable 13a Title of deliverable Publication of thematic factsheet on physical activity in the health sector (2018) Deliverable number in grant agreement 13 Nature (eg. Meeting, report, book, website etc.) Report Detailed description People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0008/382337/fs- health-eng.pdf?ua=1 Status Published Deliverable 13b Title of deliverable Publication of thematic factsheet on physical activity in the education sector (2018) Deliverable number in grant agreement 13 Nature (eg. Meeting, report, book, website etc.) Report Detailed description People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence Found in: http://www.euro.who.int/__data/assets/pdf_file/0006/382335/fs- education-eng.pdf?ua=1 24 Status Published Deliverable 14 Title of deliverable Gateway (formerly NOPA) database updated with recent data, and with enhanced visualization and communication capabilities Deliverable number in grant agreement 14 Nature (eg. Meeting, report, book, website etc.) Website Detailed description The NOPA database was enhanced and renamed WHO European Health Information Gateway. HEPA data from the 2015 and 2018 data collection were incorporated into the database. People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence https://gateway.euro.who.int/en/themes/obesity-physical- activity-and-nutrition/ Status Finalized Deliverable 15 Title of deliverable Support provided to several countries in developing national physical activity guidelines of guidelines for specific groups Deliverable number in grant agreement 15 Nature (eg. Meeting, report, book, website etc.) Report and paper Detailed description Physical activity guidelines for Latvia were developed. Additionally, two publications intending to support countries to develop or expand their own national PA guidelines are being finalized; Pending 25 • A review comparing PA guidelines in place across EU countries, focusing on the special populations included. This intends to promote the development of PA guidelines for special population (in draft) •A review summarizing the different methodologies used to develop national PA guidelines to provide a tool for use by countries in developing and expanding their own guidelines for different population groups (in draft) These two publications are under development in collaborating with the WHOCC at the University of Erlangen but have not yet been published.A consultant has been seconded to the WHOCC to work on these publications but was only hired in November 2018. The drafts are available on request but will be published in 2019. People who will benefit from the action: Member States, policy-makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence http://www.euro.who.int/en/countries/latvia/news/news/2017/07/prevention- of-ncds-in-latvia-a-roadmap-for-physical-activity-and-the-launch-of- latvian-cosi-report Annex II Status On going Deliverable 16 Title of deliverable Concept note on the possible development of guidelines for children in Early Childhood Education Deliverable number in grant agreement 16 Nature (eg. Meeting, report, book, website etc.) Concept note Detailed description People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence 26 Status Pending. Justification: WHO HQ is developing Global Guidelines for PA, sedentary behaviours and sleep time. The above publication reviewing PA guidelines in place across the EU will also inform the need for these in the EU once the Global guidelines are published. Therefore, this deliverable should be completed after the Global WHO Guidelines are published. Deliverable 17 Title of deliverable Support provided for the enhancement of EHIS in the area of physical activity Deliverable number in grant agreement 17 Nature (eg. Meeting, report, book, website etc.) Report Detailed description This report will summarise recommendations to expand on the EHIS PA questions to better align with Global, Regional and National surveys with physical activity question. People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence Annex III Status Finalized Deliverable 18 Title of deliverable Support provided to international initiatives aiming at harmonising or improving comparability of existing questionnaires/surveys used for physical activity surveillance notable by ensuring support to National PA focal points but not exclusively Deliverable number in grant agreement 18 Nature (eg. Meeting, report, book, website etc.) Website and on-going technical and administrative support Detailed description Technical and administrative support is being provided to coordinate an ERASMUS+ funded project aiming at creating an 27 integrated EU monitoring system for PA and sport (EUPASMOS) including the preparation of a technical manual for data collection. Targeted audience: EU Member States and CSO’s in the field of physical activity and sport. People who will benefit from the action: Member States, policy- makers from key policy sectors such as health and sport, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence www.eupasmos.com Status On-going Deliverable 19 Title of deliverable Concept note on a methodology to estimate physical inactivity related socio economic costs Deliverable number in grant agreement 19 Nature (eg. Meeting, report, book, website etc.) Concept note Detailed description People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence Annex IV Status Finalized 28 Deliverable 20 Title of deliverable 2 to 4 relevant scientific publications Deliverable number in grant agreement 20 Nature (eg. Meeting, report, book, website etc.) Scientific publications Detailed description Two papers were published during the grant period. One on school-based physical activity initiatives and one on the achievement of the 23 indicators from the monitoring system based on the Council recommendation, based on data from the first collection round. Main target audience: Member States, HEPA experts, academia and European population People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993869/ https://www.termedia.pl/School-based-physical-activity-and- good-practices-in-Europe,99,34343,0,1.html Status 2 papers published in scientific journals Deliverable 21 Title of deliverable Participation at relevant conferences and other events and stimulating workplace health promotion activities in the context of international organization, namely EU and UN Deliverable number in grant agreement 21 Nature (eg. Meeting, report, book, website etc.) Active participation in the following conferences or relevant events: • HEPA meeting in Zagreb November 2017 • Workplace physical activity promotion event during the European Week of Sport (EWOS) at UN City in collaboration with ISCA in 2017 and 2018 • Preparation of a guide for planning healthy and sustainable meetings 29 Detailed description Targeted audience and beneficiaries: UN staff, UN agencies hosted at UN city, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s). Source and Evidence HEPA Europe conference: http://www.euro.who.int/en/health- topics/disease-prevention/physical- activity/news/news/2017/11/european-network-for-the-promotion-of- health-enhancing-physical-activity-8th-conference-and-13th-annual- meeting EWOS event 2017: http://www.euro.who.int/en/health-topics/disease- prevention/physical-activity/news/news/2017/10/who-celebrates-the- european-week-of-sports EWOS event 2018: https://europeanweekofsport.dk/news/_/47 https://europeanweekofsport.dk/news/_/51 Healthy Meetings guide: http://www.euro.who.int/__data/assets/pdf_file/0005/373172/healthy- meetings-eng.pdf Status Finalized Deliverable 22 Title of deliverable Power point presentation in English, on the results achieved, for presentation to the public Deliverable number in grant agreement 22 Nature (eg. Meeting, report, book, website etc.) Power Point presentation Detailed description People who will benefit from the action: Member States, policy- makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence Annex V Status Finalized Deliverable 23 Title of deliverable Support to the implementation of 1 HEPA Europe meeting Deliverable number in grant agreement 23 30 Nature (eg. Meeting, report, book, website etc.) Meeting Detailed description The Fifth meeting of the European Union Physical Activity Focal Points Network was held back-to-back with the HEPA Europe conference in Belfast in 2016. Support was given to the organization of the conference and annual meeting. People who will benefit from the action: HEPA Europe, Member States, policy-makers from key policy sectors, local and regional governments, NGO’s in the field of HEPA and public health, Civil Society Organizations (CSO’s), academia and expert networks. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0006/325734/HEPA- 5th-FP-Belfast-meeting-report.pdf Status Finalized Deliverable 24 Title of deliverable Brief report of the HEPA Europe meeting supported by WHO and DG EAC Deliverable number in grant agreement 24 Nature (eg. Meeting, report, book, website etc.) Report Detailed description The 12th annual meeting of HEPA Europe in Belfast in 2016 was supported by WHO/DG EAC. People who will benefit from the action: HEPA Europe, Member States. Source and Evidence http://www.euro.who.int/__data/assets/pdf_file/0005/332942/HEPA- 12th-FP-Belfast-meeting-report.pdf?ua=1 Status Finalized Deliverable 25 Title of deliverable Set of web news and tweets in connection with the project Deliverable number in grant agreement N/A 31 Nature (eg. Meeting, report, book, website etc.) Web news Detailed description Various news on HEPA in connection with the project were published in the WHO/Euro website. Source and Evidence http://www.euro.who.int/en/health-topics/disease- prevention/physical- activity/news/news/news?root_node_selection=52717 Status Finalized • Impact and outcomes of the project The results of this project will improve the quality of the monitoring and surveillance of health enhancing physical activity in the EU from epidemiological data to policy developments. Additionally, Member States have been supported and inspired for the development and scaling-up of successful physical activity policies and interventions. Systematically informing policy-makers on trends in physical activity and health, as well as the development of European and national approaches to HEPA can contribute to the development and fine-tuning of intersectoral policies sensitive to health promotion and physical activity. Maintaining and strengthening the HEPA Focal Point Network is a key element of this project. Representatives from Member States meet regularly to discuss and learn about new trends, available evidence and recent developments in the area of HEPA. This allows for countries to be well informed on the possibilities for HEPA promotion in their countries, highlights the importance of HEPA and maintains this important topic in the agenda of national policy-makers. Moreover, it promotes the social, economic and political significance of physical activity and sport and has attracted new partners, actors in the political arena, and raised awareness of the need for leadership and effectiveness of physical activity and sport policies. The availability of up-to-date European data on HEPA in the form of country factsheets, published scientific papers, as well as data on the Gateway database, will allow for more awareness at population, academic as well as policy-making levels on the advancements and areas in need for the development of physical activity actions, as well as facilitate proper evaluation of the different existing policy frameworks. Moreover, the thematic factsheets will allow for countries to inspire one another on successful policy actions that can be implemented or adapted to increase physical activity levels through collaboration between sectors. Project Results and Visibility Coordination with Networks and EU projects HEPA Europe is a network of academics and researchers that work together to conduct research, review evidence and identify strategies to promote physical activity among all people in the WHO European Region. The HEPA Network strengthens and supports efforts to increase participation and improve the conditions for healthy lifestyles. 32 WHO/Europe has collaborated closely with the network and the shared goals of the programme on Preparatory Action, European Partnership on Sports and specifically on the priority area of Health- Enhancing Physical Activity as well as the Council Recommendation on monitoring HEPA indicators. The dissemination of information and exchange of experiences have occurred during the meetings of HEPA Europe where the coordinator for the EAC project participated at meetings of the HEPA Europe Network, the European Obesity Conferences and the WHO Regional Office for Europe Regional Committee1. The WHO/DG EAC project has further taken into account key findings from The Networking for Physical Activity (PHAN) project coordinated by WHO and co-funded by the EU in the framework of the Health Programme 2008–2013. This project aimed at the promotion of networking and action on healthy and equitable environments for physical activity. Specifically, it complemented the WHO/DG EAC project on the promotion of health-enhancing physical activity through the sport sector2. The EU PA network also helped to establish a project to harmonise the monitoring and surveillance of physical activity and sports participation across the WHO European Union. The European Union Physical Activity and Sport Monitoring System (EUPASMOS) is supported by the EC and coordinated by one of the EU PA network members with a coordination team comprising other focal points and WHO advisors. A joint meeting of the EU focal point network with the High-Level Meeting on Nutrition and Physical Activity, coordinated by DG-SANTE, was held in Luxembourg in November 2018. This meeting brought together the two networks to share experiences and coordinate joint action between the two networks at national and regional levels Project Coordination The project has been coordinated by the WHO Regional Office for Europe as the leading partner and coordinator of the project. All the partnerships were able to deliver and comply with commitments and deadlines within this direct agreement. Moreover, the implementation of various deliverables has been supported by WHO Collaborating Centers, notably University of Zurich and Erlangen University. Communications plan 1. Overall communication objectives The primary communication and visibility objectives of this CVP were: - To provide appropriate visibility for EU finding to the PROMPAEU project and its support to the partners and target groups - To promote and report on health-enhancing physical activity 1 There are details on the meetings with HEPA Europe found at the WHO/Europe website at http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/activities/hepa- europe/hepa-europe-membership-and-meetings/meetings-of-hepa-europe, 2 Information on the PHAN project is found at: (http://www.euro.who.int/en/health-topics/disease- prevention/physical-activity/activities/promoting-networking-and-action-on-healthy-and-equitable- environments-for-physical-activity-phan ) 33 2. Target groups and specific objectives Target groups and objectives are defined in the application, and listed here: The main target groups of this project are Member States and policy-makers from key policy sectors, local and regional governments, NGO’s in the field of health-enhancing physical activity and public health, Civil Society Organizations (CSO’s), academia and expert networks. 3. Main activities and Communication tools Actions were undertaken to ensure that the results and deliverables of the project were made available to the target groups (policy makers, research community and civil society organizations). The dissemination was mainly done through: • Scientific publications; • Participation at relevant conferences and other relevant events identified jointly by the EC and WHO; • Set of web news and tweets in connection with the project; • Country and thematic factsheets on HEPA widely disseminated; • Meeting reports of the 4 meetings of the National Physical Activity Focal Points to be published online; • Social media communication of the Project initiatives jointly planned by WHO and EC; • Preparation of a high-quality power-point presentation on the project results, to share results with a wider public. Specific dissemination channels will be chosen according to the audience, target groups and type of messages. The objective is to disseminate tools, reports and best practices in a timely manner, e.g. in connection to other major events. In order to have an EU-wide dissemination, the tools, reports and good practices will be spread to and through EU and EC platforms, networks and communication channels, Action Networks Members, WHO Networks notably the Healthy Cities Networks, among others, and targeted national and local authorities and projects as well as through the HEPA Network channels. 4. Resources - project manager will be responsible for the content and implementation of CVP; - financial resources related to the CVP are reflected in the budget. Dissemination activities during and after the project A significant number of dissemination activities have taken place and the project manager implemented a number of press and media appearances. On European level there have been important press dissemination activities through the WHO/Europe website which is an excellent approach reaching a large group of key stakeholders on European levels. Other dissemination activities included publications in scientific journals, networks, meeting news items and reports, as well as conferences. The results can easily be included in DG EACs dissemination activities as they are direct contributions 34 to the Council Recommendations implementation: http://www.euro.who.int/en/health- topics/disease-prevention/physical-activity/news/news/news?root_node_selection=52717 Stakeholder matrix and key dissemination strategies Low Interest High Interest High Influence CONTEXT SETTERS High level authorities from Education, Transport and the Environment have been invited to meetings 3 to debate HEPA policy and monitoring development KEY PLAYERS High level authorities from the public health sector; Academia, IGO’s (i.e. WHO and the EU); Expert Networks such as the HEPA Europe were all partners and contacts with these continued throughout the project Low Influence PUBLIC The general public has access to the projects findings through WHO/Euro website4 SUPPORTERS Civil Society Organizations have access to the projects findings through WHO/Euro website Project website All the deliverables and meeting reports are available through the WHO/Europe website. It was decided not to build a specific website for the project, but to include information on the WHO/DG EAC project at the WHO/Euro website on physical activity. This was judged appropriate since the WHO/Euro website has a wide scope and is considered to be the key information hub on HEPA in Europe. Thus, the inclusion of the WHO/DG EAC project’s results and outputs at the WHO/Euro website on physical activity has acted to reinforce the visibility and dissemination. Results and visibility for main deliverables The following table illustrates the number of downloads of the main reports produced within this gran since their launch in September until early April 2019. Nonetheless, the reports are also available 4 http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity 35 through the European Commission’s website, thus the amount of downloads presented here, does not represent the total amount of downloads of these documents. Period title language Downloads Sept 2018- April 2020 Physical activity factsheets for the 28 EU member states EN 1017 Sept 2018- April 2019 Promoting physical activity in the health sector EN 474 Sept 2018- April 2021 Promoting physical activity – Education sector EN 328 The following table summarizes the top five most accessed pages and the amount of views within the physical activity section of the WHO EURO website. This shows how the physical activity factsheets, along with data on physical activity were among the most visited sites. Title Language Page views Home page EN 19651 Data and statistics EN 18695 HEPA Europe EN 15312 Physical activity fact sheets EN 6004 Physical activity country fact sheets EN 5675 Changes to the original planning Aside from the planned country factsheets, in order to increase and improve the support for Member States, as well as seize the data provided through the HEPA questionnaire, it was commonly decided to produce the two thematic factsheets, thus providing a set of examples of good practices which Member States can benefit from when planning new HEPA initiatives or policies. As for the Concept note on the possible development of guidelines for children in Early Childhood Education, the WHO team decided to postpone this deliverable, as WHO headquarters is in process of developing Global Guidelines for PA, sedentary behaviours and sleep time. The above publication reviewing PA guidelines in place across the EU will also inform the need for these in the EU once the Global guidelines are published. Therefore, this deliverable will be completed after the Global WHO Guidelines are published. Conclusions and key messages This project is a targeted response to important challenges related to physical activity, as a result of societal trends which impact upon the growing rise of NCD’s, health systems and economies. 36 PROMPEAU has contributed to scale-up monitoring and surveillance of health enhancing physical activity in the European Union Member States, by successfully applying the Council recommendation for the second time, supported a Network of National Focal Points who have assisted in data-collection, indicator development and reporting on the European Situation on HEPA, facilitated the exchange of good practice examples to support the promotion of HEPA in Europe and strengthened the scientific evidence base on HEPA at European level. To conclude, The PROMPEAU’s key results will continue to support policy and capacity-building among the European Union Member States on various dimensions: • Exchange good practices and fostering European collaboration through the network of Focal Points and publication of thematic factsheets • Fostering the development of new projects to influence HEPA-related policy • Fine-tuning of indicator-based data-collection on HEPA in all EU Member States • Capitalization of policy relevant information regarding HEPA • Dissemination of relevant data on HEPA The key messages from this project suggest that: • Since the beginning of this project, there has been overall progress among Member States in the area of promotion and monitoring of HEPA, but continuous support is needed; • Member States should continue to invest in monitoring and surveillance of HEPA; • WHO/DG EAC should continue to support Member states in terms of indicator development, data-collection methods, dissemination and exchange of good practice and tools for capacity- building and policy development. European added value / relevance towards the strategic issues related to the EU Programme Both the Council Recommendation on promoting health-enhancing physical activity across sectors and the Physical Activity Strategy for the WHO European Region 2016-2025 underline the need to work towards effective HEPA policies by developing a cross-sectoral approach involving relevant policy areas. By identifying concrete actions for the delivery of adequate strategies and policies as well as monitoring physical activity levels, identifying success stories and HEPA policies by means of using an accepted and agreed monitoring framework the current project has served as an indispensable and effective roadmap to support Member States in their efforts to reduce the burden of physical inactivity and sedentary behavior. The ongoing collaboration with the HEPA Focal Point network is an important step towards increased HEPA capacity at national and EU level, as well as providing a space for networking and good practice- sharing among Member States. This network is increasingly promoting the social, economic and political significance of physical activity and sport and has attracted new partners, actors in the political arena, and raised awareness of the need for leadership and effectiveness of physical activity and sport policies. The HEPA focal point meetings held twice per year, have served as a platform for this purpose and have also enabled the improved collection of physical activity and sport data. This collaboration has 37 also fostered new international initiatives with the aim of harmonising and improving comparability of existing data for physical activity surveillance. An example of such an initiative is the ERASMUS+ funded project ‘EUPASMOS’, led by EU Member States, which was born during a Focal Point meeting and is ran mainly by members of the Network. This initiative has been supported by WHO, in its role as an external advisory partner to the project, has supported the coordination of this project since its conception to ensure quality project design, implementation and collaboration between Member States. As part of the external dissemination of this project, scientific evidence is being developed. Notably, one paper has been published which reviewed the current state of surveillance, policy development and implementation on promoting HEPA in Europe. Additionally, a paper on initiatives for physical activity in schools, based on additional data provided by the Focal Point Network was published. These papers will contribute to the evidence-base of most relevant topics in the area of physical activity in Europe, and can serve for guiding and supporting more effective and evidence-based EU policies in the area of HEPA. Moreover, the publication of data has improved through dissemination of graphical representations of data collected through the network on the WHO European Health Information Gateway. Overall, the current project has built on previous work based on successful collaboration between WHO and EC. Existing reporting mechanisms have been reinforced and functioning of the EU Physical Activity Focal Points network has been fine-tuned. The project provided support and enhanced the capabilities of the National Focal Points in order to ensure a sustainable system of data collection at National level which served as the basis of a new edition of country fact sheets and extensive reporting on progress towards the objectives of the EU Council Recommendations on HEPA and the WHO Global Target on the reduction of physical inactivity alongside the Physical Activity Strategy for the WHO European Region 2016-2025. This project’s findings and deliverables have contributed to helping the EU and WHO in encouraging and supporting governments to join forces with relevant stakeholders and working across sectors to implement the strategy. Additionally, the project has provided support to Member States in enabling their citizens to have better and longer lives by promoting regular physical activity as part of their everyday lives. Evaluation of the project This evaluation was made during the last months of the project implementation. Thus, it is mainly summative in nature and predominately based on interaction with the coordinator and project team and secondary information. What follows is a short summary evaluation of this project with the overall aim to assess the: • Process level (Project Meetings, Management) • Output level (Data collection, HEPA National Focal Points Network, Scientific papers and reports) • Outcome level (Dissemination and Quality) 38 Indicators Different indicators have been used to measure how activities are implemented (i.e. process indicators), what the project was able to deliver (i.e. output indicators) and whether it has an effect (i.e. outcome indicators). An overview of the different indicators is included in the logical framework on the next pages. Logical Framework Promoting Physical Activity in the European Union (PROMPAEU) – a joint collaboration WHO/DG-EAC Specific Objective Action/Activities Process Indicators Output Indicators Outcome Indicators Methods of data collection I: To support the development and scaling up of monitoring and surveillance of HEPA in the EU, in line with the monitoring framework, with the view to improve evidence- informed policy-making in the EU. -Revision and improvement of the physical activity questionnaire used in 2015 based on feedback from HEPA focal points and external experts. -Second round of data collection using improved methods, while ensuring the comparability of its results with the first version. -Proposed updates for the Staff Working Document (SWD) to support the revised HEPA questionnaire; Revisions to questionnaire presented to and discussed with Focal Points Revised questionnaire sent to Focal Points for completion Staff Working Document revised and discussed among WHO team Revised questionnaire finalized Revised HEPA questionnaire returned by all Focal Points Document prepared stating proposed revisions for SWD All HEPA FPs have collected and submitted updated data on HEPA through the questionnaire Questionnaires sent directly to FPs Feedback sessions held for HEPA questionnaire and comments incorporated in the changes Page 39 of 97 Specific Objective Action/Activities Process Indicators Output Indicators Outcome Indicators Methods of data collection II: To issue revised country factsheets on physical activity and to update the WHO European database on nutrition, obesity and physical activity (NOPA) (currently Gateway database) with recent data, good practices and success stories, in line with the monitoring framework. -The integration of data from the HEPA questionnaire from the 2015 and 2018 collection rounds on the WHO European Health Information Gateway (formerly known as the NOPA database). -The publication of the second set of country Factsheets on HEPA. -The publication of two thematic factsheets compiling good practices and success stories from across Member States on i) physical activity in the education sector and ii) physical activity in the health sector. Updated HEPA data prepared and uploaded to the Gateway Country and thematic factsheets prepared and validated by Focal Points New country and thematic factsheets published Upcated data published in the Gateway database HEPA data, country and thematic factsheets freely and readily available online -Questionnaires received from FPs -Data validated -Draft factsheets prepared -Drafts validated by FPs -Revisions made -Factsheets published Specific Objective Action/Activities Process Indicators Output Indicators Outcome Indicators Methods of data collection III: To support governments and other stakeholders in their initiatives aiming at increasing levels of physical activity and reducing sedentary behaviours (e.g. national physical activity guidelines, and/or guidelines Support for individual countries to develop evidence-based physical activity guidelines, recommendations and roadmaps for physical activity policies in different sectors. Meetings and consultations with relevant representatives from Latvia Research for publications Development of Physical activity guidelines for Latvia Development of two publications intending to support countries to develop or Publications freely available online -Consultation -Research -Drafting - Publication Page 40 of 97 for specific groups such as children or the elderly). expand their own national PA guidelines are being finalized; Lessons learned Some of the lessons learnt from the project relate to methods for collecting policy indicators and how to balance between the length and detail required for a country appraisal. Moreover, considerations should be made on how to assess the continuity between levels of policy across different levels of jurisdiction and how to capture implementation at sub-national and local level. Future developments, building on the lessons, include an online version of the HEPA questionnaire, the development of new thematic factsheets addressing other sectors and the continuation of HEPA FP meetings, particularly including occasional collaboration with other relevant groups, such as the High-Level group on Nutrition and Physical Activity. Future recommendations The key messages from this project suggest that: • Member States should continue to invest in monitoring and surveillance of HEPA • WHO/DG EAC should continue to support Member states in terms of indicator development, data- collection methods, dissemination and exchange of good practice and tools for capacity-building Specific Objective Action/Activities Process Indicators Output Indicators Outcome Indicators Methods of data collection IV: To design a methodology to estimate physical inactivity related socio-economic costs. Collaboration with the OECD to develop a concept note of a collaborative project to estimate the socio-economic costs of physical inactivity. Consultations with OECD Concept note developed on socio-economic costs of physical inactivity Availablility of reliable data on the socio-economic costs of physical inactivity Discussions, preparation of drafts and feedback in collaboration with OECD Page 41 of 97 and policy development. • Member States should continue to share good practices and support each other in the scaling up and expanding of relevant initiatives in various contexts. • WHO/EAC should continue to collaborate in their efforts to promote physical activity and sports participation in the European Union. Page 42 of 97 Annex I: Proposed changes to Staff Working Document General changes As recommended in the Study on the implementation of the European physical activity guidelines (2016), the provision of additional support for Focal Points through webinars has now been established as part of the process to support data collection in support of the European Union (EU) Physical Activity guidelines and the WHO European Physical Activity Strategy. Similarly, the questionnaire will be made available in an online survey which can be easily shared with in-country colleagues. This was done in response to feedback from EU Focal Points and will be particularly useful when the questionnaires need to be shared in-country. It will also provide higher quality data as there will be in-build data checking mechanisms to save some of the manual labour that has been required in previous rounds of data collection. In order to facilitate a common understanding of the terms used and to avoid the need to turn to additional documents, the scope and relevant definitions for all indicators will be included in the questionnaire, as an introductory section to each indicator. This includes defining age groups such as children and adolescents, adults and older adults, in line with the Staff Working Document (SWD). Additionally, links to supporting documents should be made available in the same section, when applicable. It has been reported that success stories have been well received and a useful resource. Therefore, it is proposed to include the option of providing success stories for every indicator and this could be incorporated with the SWD. To facilitate the validation of the information provided, links or documents to support the responses should be requested. Additionally, if no supporting information is provided, Focal Points will be asked in due time to provide it. If it is not provided, the response will be treated as negative. When it comes to the implementation of programs or recommendations, such as in indicators 1, 8 and 18, it is proposed to substitute the request for information of implementation within the next two years, by a question regarding if there are national recommendations currently being developed and to specify at which stage of development the recommendations are (e.g. drafting phase; awaiting endorsement etc.). In questions regarding monitoring and surveillance, such as in indicators 2 and 3, it is proposed to include a request for a description of the type of surveillance method used, such as the specific questionnaires and instruments used. Options should be the following: National survey, Global Health Observatory Data Repository, European Health Interview Survey, Eurobarometer and Other. Specific instruments used should also be requested, including IPAQ, GPAQ, Accelerometers and Other. This will provide a better understanding of the methodology used to gather data in each country, which will permit assessing the comparability of the data. Additionally, the year of data collection should always be requested. Terminology in the SWD and in the subsequent questionnaires should be standardized. Schemes, programmes and frameworks are used interchangeably and definitions are not provided. This has caused some confusion in the past. It is suggested to standardize the definitions and recommend the use of ‘programmes’ whenever it is suitable. Page 43 of 97 There also needs to be space for sub-national and community programmes to be reported, without changing the definition of the indicator. Some countries have reported being frustrated that they could not report programmes in place that were effective and successful but not specifically led at the national level. In general, the themes in the EU Physical Activity Guidelines may need to be reviewed at some point when the EU is in a position to do so. Some indicators should be moved to different themes, some combined, and some possibly revised so that they don’t only ask about specific EU policies when many similar programmes are in place. Additional indicators could also be added for certain themes which are being neglected and which are a major part of the WHO PA Strategy, such as for older adults. This would affect the measurement of trends for some indicators, but it was difficult to track trends anyway due to the following • the differences in questionnaire design, • Different focal points responsible for collecting the data, some with experience and some without • Different definitions used Possible changes per indicator Indicator 1: National recommendation on physical activity for health As mentioned, terminology should be standardized throughout, and specifically for this indicator, the different age groups e.g ‘children and adolescents’ should be used in place of ‘children and youth’ or ‘young people’ to avoid confusion . Recommend the standard three age groups align with WHO recommendations: • Children and adolescents (5-17) • Adults (18-64) • Older adults (65+) Recommendations for additional key population groups requiring guidelines for physical activity should also be included and specified, including: • children <5 • Frail / very elderly (85+) • Women during pregnancy and breastfeeding, • People with disabilities (specify) • People with chronic diseases (specify) • Other (specify) Indicator 2: Adults reaching the minimum WHO recommendation on physical activity for health Indicator 3: Children and adolescents reaching the minimum WHO recommendation on physical activity for health It would be suggested to combine these indicators in the SWD and then rename the indicator to Prevalence of physical activity. All age groups could then be collected in the one component of the survey. The different prevalences could still be reported as in previous years, but the questionnaire would make more sense to respondents. It would also still be possible at the data management stage to separate the categories as in previous years if needed. Page 44 of 97 Many countries reported many more age ranges that were used when reporting prevalence, sometimes prevalence for up to eight different age groups were reported. This made it difficult for countries to aggregate the data from the different age ranges so that they could align with WHO definitions of children and adolescents being 5-17, adults aged over 18, and older adults 65+. When asking about the prevalence of physical activity in adults, the questionnaire only gives the option of 150 min/week of moderate-intensity and ‘Other’, thus excluding the option of 75 minutes of VPA or an equivalent combination. The definition of minimum WHO recommendations on physical activity for health needs to be harmonized so that it can be compared between countries that do use the exact WHO recommendations, as well as promoting the correct definition included in the WHO recommendation. The length of 10 min duration of each PA session (summing up the total periods throughout the day) is also in question - should this condition be included as a neccessary part of the indicator? This was also confusing to respondents. As an example to show how the definition used for WHO recommendations can affect the questions asked, the following possible questions could be asked and are correct as the definitions stands: • Do you perform no less than 60 min physical activity per day after school? • Do you perform no less than 60 min physical activity per day including school PE lessons? • Do you perform no less than 60 min moderate-to- vigorous intensity physical activity per day? • Do you perform no less than 60 min moderate-to- vigorous intensity physical activity per day, most of it being aerobic? • Do you perform no less than 60 min moderate-to- vigorous intensity physical activity per day, most of it being aerobic and including muscles and bones strengthening exercises? WHO HQ is also developing recommendations/guidelines for physical activity, screen time and sleep. So a question on prevalence for this age groups needs to be added. Indicator 4: National coordination mechanism on HEPA promotion The definition of a national coordination mechanism could be more stringently defined as there was some confusion on what was considered a national mechanism. A mechanism should be better defined, and it is important that the mechanism is specifically set-set up for HEPA promotion as a range of different types of mechanisms were reported so the indicator was not collected in a standardized way. Indicator 5: Funding allocated specifically to HEPA promotion It is recommended that it is not useful to ask about the exact amount of funding specifically for HEPA promotion. It would be of more use to ask which sectors have allocated specific funding for HEPA to indicate those that need to do more. Many countries found it very difficult to provide an accurate figure for HEPA funding and was one of the most difficult indicators to respond to for Member States. It also did not provide comparable data due to the different sized countries and economies in the EU. A qualitative description of the funding may also be more useful and could provide a more accurate indication of progress in funding allocation in future data collection rounds. Page 45 of 97 Indicator 6: National Sport for All policy or action plan Indicator 9: Target groups addressed by the national HEPA policy Indicator 22: National HEPA policies that include a plan for evaluation As the three indicators all deal with not only sport for all policies but a range of policies from different sectors, many relevant policies would be excluded if they only focused on sport for all policies Both in 2015 and 2018, we asked for all relevant policies, not just sports for all and received a wealth of information about what each country was doing to promote physical activity in a range of sectors. Each policy reported should at the same time ask which target groups are addressed by the specific policy (indicator 9) and also whether there was an evaluation plan for that policy (indicator 22). For indicator 9, it is proposed to include additional target groups such as: • Deprived of liberty • Migrants • Older adults (65+) • People with disabilities (specify) and • Chronic diseases (specify) • Other (specify Indicator 7: Sport Clubs for Health Programme This indicator is problematic as it asks about the specific ‘Sports Clubs 4 Health’ programme where many countries answered ‘no’. However many sports clubs for health programmes were reported besides the specific EU ‘Sports Club for Health’ programme, as many countries actually have very similar and widespread programmes to promote HEPA through sports clubs. This may change as the EU ‘Sports Clubs for Health’ programme is more heavily promoted and rolled out but at this stage this indicator does not provide accurate information about what countries are doing in this area. Further, an option to provide information on programmes implemented at the national, regional or community level could also collect information on the useful programmes in place. While only the national programme would be considered to meet the indicator, highly useful information could be collected for scale up to the national level and also to share experiences with other Member States. Indicator 8: Framework to support offers to increase access to exercise facilities to socially disadvantaged groups This indicator was confusing for some countries as it is not really clear what it is asking and who it is targeting. It was also not clear the difference between a framework, a scheme and a programme. This information could be collected under Indicator 6 if broadened as for the few countries that did respond to this question, they had already reported the policy/framework/scheme under indicator 6.This could be re- written so that is more specific or deleted. Indicator 9: Target groups Should be combined with indicators 6 and 22. Page 46 of 97 Indicator 10: Monitoring and surveillance of physical activity This indicator was designed to only ask about surveillance systems in the health sector and is part of the health theme in the EU PA Guidelines. However, many countries have monitoring and surveillance systems led by other sectors and information from those should also be requested, including not only Health but Education, Sports and Transport. Many countries have surveillance systems in place that are led by sectors outside of health but they were not able to report these in line with the SWD definition. This theme would also need to be adjusted and would suggest asking along with prevalence data for indicators 2 and 3 as it is more logical to be alongside the prevalence indicators rather than the health theme. Indicator 11: Counselling on physical activity Indicator 12: Training on physical activity in curriculum for health professionals These indicators could be combined and ask if counselling or prescription of physical activity is provided and which professionals are provided with training. As it is, there is much cross over and it was confusing to answer for Member States. The indicator could also be expanded to ask about referral of patients to community exercise specialists or community programmes. It would also be useful to know which Member States reimburse health professionals for prescribing physical activity as preventive or secondary treatment. This is an important factor in whether health professionals actually prescribe exercise for treatment. Training of health professionals should be asked for all qualified health professionals including nurses and physiotherapists. It would also be strengthened by asking already qualified health professionals if they are provided with on-the-job training for physical activity counselling and exercise prescription. Indicator 13: Physical education in primary and secondary schools Recommend to also ask if the quality of physical education is being monitored and how this is done (e.g. benchmarks, UNESCO checklist).It would also be interesting to know if there have been changes in the number of mandatory hours of physical education and about the differences between primary and secondary schools. Indicator 14: Schemes for promoting PA in schools Indicator 16: Active travel to school These 3 schemes should be reviewed in line with the evidence to ensure they are the most up-to-date, evidence informed, schemes to be used to promote physical activity outside of formal physical education classes. In addition, active travel to school programmes could also be included here as the 4th scheme rather than asked separately as part of indicator 16. Indicator 15: HEPA in training of physical education teachers Based on guidance from the Physical activity strategy for the WHO European Region 2016–2025, it is suggested to add if in addition to PE teachers, there are any other teachers, childcare professionals or sports trainers provided with HEPA training. It seems obvious that PE teachers would have training in HEPA. This indicator could be reworked and ask the percentage of PE teachers per school for example. Indicator 17: Level of cycling and walking This indicator could ask whether a national travel survey exists and, if it does, what are the results. It could also be captured if combined with Indicator 10 on existence of a Monitoring and Surveillance system if that was broadened to include not only health monitoring systems but also in education, sports and, importantly, Page 47 of 97 transport. Reporting of the results were problematic as the few countries that reported this used different measures which could not always be compared. This information is also already available elsewhere. Indicator 18: European guidelines for improving infrastructures for leisure-time physical activity Recommend asking more generic question rather than one based on the IMPALA programme. The existence of national infrastructure guidelines unrelated to the IMPALA project are also important to monitor. This indicator could also be replaced by a new indicator identified through a review of the recent evidence. Indicator 19: Schemes to promote active travel to work Indicator 20: Schemes to promote physical activity at the workplace These could be combined as many schemes to promote physical activity at the workplace encourage active travel. Also, the active travel to work indicator could be broadened or re-worked to capture programmes that promote active travel to the general population or be developed into an active transport indicator along with the level of walking and cycling indicator. Indicator 21 Schemes for community interventions to promote physical activity in older adults This indicator was confusing to Member States as many had already reported target groups of policies in indicators 6 and 9 including older adults. It was difficult to answer for Member States at the national level and doesn’t align with the other indicators which specifically ask for national programmes. Suggest deleting or reworking to be more relevant. A review of the evidence and discussion with experts could also help to identify a more useful indicator. Indicator 22 Combine with indicators 6 and 9 Indicator 23: National awareness raising campaign on physical activity Proposed to include the type of media used, including options such as TV, Radio, Newspapers, Social media, Public events, Public figures and Other. Page 48 of 97 Annex II: Roadmap for physical activity in Latvia National roadmap for the improvement of physical activity of the population in Latvia (Recommendations for policy makers) Developed by the Ministry of Health of the Republic of Latvia in cooperation with World Health Organization Regional Office for Europe (2017) Page 49 of 97 Introduction Physical activity, including regular sport practice and exercise, has many health benefits. Some of the known benefits include a reduced risk of cardiovascular diseases, hypertension, diabetes and certain types of cancer. It also has an important role in the management of chronic conditions, prevention and management of overweight and obesity and can help to maintain good mental health by reducing stress, anxiety, depression and possibly delaying the effects of Alzheimer’s disease. For children and adolescents, it is important for the development of basic motor skills and musculoskeletal development. For adults, it maintains strengths, improves bone health and increases fitness. For pregnant women and also women after birth it improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being. For older adults, it is necessary for the maintenance of health and agility, functional independence and may help to prevent fall injuries. It is well established that physical activity is one of the most effective ways of staying physically and mentally healthy throughout the lifespan. Participation in sport and physical activity is also associated with other factors such as social interaction and inclusion. Active living gives people of all ages the opportunity and abilities to interact with their community and environment. Sports and leisure activities also offer people the chance to develop new skills, meet people, and may reduce crime and antisocial behavior. Physical inactivity is the fourth leading risk factor for premature mortality and is associated with rising overweight and obesity levels, breast and colon cancers, diabetes and ischemic heart disease. It is estimated that 1 million deaths (about 10% of the total) and 8.3 million disability-adjusted life years that are lost per year in the WHO European Region are attributable to physical inactivity. Evidence indicates that there are significant economic costs due to health problems caused by physical inactivity. Increasing population physical activity could significantly reduce the costs to society of the growing burden of noncommunicable diseases (NCDs). Physical activity is a broad term, which encompasses a range of activities including walking, cycling, dance, play, sport, work, leisure activity and exercise. Using a broad definition offers greater potential to engage the range of different sectors that are needed to promote physical activity outside of the health, sport and leisure sectors, such as the transport and urban planning sectors etc. Page 50 of 97 1. Rationale for a National Physical Activity Road Map The Ministry of Health, Center for Disease Prevention and Control and Ministry of Education and Science, in collaboration with the WHO Regional Office for Europe, developed a national physical activity roadmap with the aim of guiding the implementation of indicators and goals set in national policy planning documents in Latvia. Formulating a physical activity road map will give support, coherence and visibility at the political level and will allow the various institutions involved, including government sectors, regions and local authorities, other stakeholders and the private sector, to be coherent and follow a common set of objectives as well as to negotiate and assign roles and responsibilities. It also can help to foster greater allocation of resources and accountability and ensure the efficient and cost-effective funding of activities with large population reach or impact. Vision To work across sectors to reduce morbidity and mortality from noncommunicable diseases by ensuring that all people in Latvia are physically active and live, work and spend leisure time in environments that encourage daily physical activity. Goal To create a physical, legal, social and cultural environment that will support the reduction of physical inactivity in all age groups and achieve indicators and goals set in national policy planning documents in Latvia. Scope This road map covers all forms of physical activity throughout the life course. It focuses on physical activity as a leading factor in health, well-being and the prevention of NCDs associated with physical inactivity and sedentary behaviors. The Ministry of Health will be the lead organization but support from other ministries and other partners (municipalities, state agencies, NGOs) is required for the successful implementation of the recommended actions in the road map. Page 51 of 97 2. Global and Regional Commitment to Promoting Physical Activity The ‘Political Declaration of the 66th high level meeting of the General Assembly of the UN on the Prevention and Control of NCDs’i called on countries to develop multisectoral policies that create equitable health-promoting environments that empower individuals, families and communities to make healthy choices and lead active lives. The ‘Global Strategy for the Prevention and Control of NCDs’, developed by WHO in response to the Political Declaration, set nine voluntary targets including an overall goal of a 25% reduction in premature mortality from NCDs by 2025 and a 10% reduction in physical inactivity relative to 2010 levels. Increasing population physical activity levels will also be important to help countries meet the Sustainable Development goals. At the 65th session of the WHO European Regional Committee in 2015, Member States adopted a ‘Physical Activity Strategy for the WHO European Region 2016-25’, which covers all forms of physical activity throughout the life-course and across relevant policy domains and settings. Despite the known benefits of physical activity for the health of individuals and societies, rates of physical inactivity are high and increasing worldwide. WHO recommends that adults, including older adults, participate in at least 150 minutes of moderate-intensity aerobic physical activity each week. Older adults should also participate in strength and balance training to reduce the risk of falling. Children and young people should accumulate at least 60 minutes of activity every day. Additional health benefits can be gained from higher levels of physical activity and participation in vigorous-intensity activities. According to WHO global estimates, around 1/3 adults and the majority of children and young people do not meet these recommendations. 3. Current Situation in Latvia 3.1. Data and statistics In Latvia noncommunicable diseases (NCDs), primarily cardiovascular diseases and cancers are currently the leading causes of death. According to the Register of Causes of Death in Latvia 57% of deaths were caused by cardiovascular diseases, but 21% - by oncological diseases in 2016. The main risk factors of NCDs are clearly defined and they all are modifiable by changing in lifestyle. These are unhealthy diet, physical inactivity, the harmful use of alcohol, tobacco, drugs and other psychoactive substances use as well as addiction from different processes (like gambling etc.). Page 52 of 97 The WHO recommends that adults dedicate at least thirty minutes every day to physical activities5 however according to the latest national data from 20166 only 12.5% of adults (aged 15—74 years) are physically active for at least 30 minutes four and more times per week. The data also shows that 55.3% of the population of Latvia (15-74 years old), never practically practicing physical activity. In general men are physically more active than women according to the study data. Insufficient physical activity is one of the most significant factors that negatively affects the health of school-aged children. The WHO recommends that children and youth aged 5–17 should accumulate at least 60 minutes of physical activity daily7. According to Study of Health Behaviour in School – Aged Children8 for 2013/2014, only 18.5 % of Latvian school children aged 11, 13 and 15 years (averaging 22.0 % boys and 15.3 % girls over the three age groups) are sufficiently physically active. The overuse of mobile phones, smart phones and increased screen time is a problematic issue for children and youth. According to the data of Anthropometric Measurements of Children and School Environment in Latvia for school year 2015/20169 12.2% of the children of age 7 and 16.5 % of the children of age 9 spend more than 3 hours per day in front of the TV or electronic devices; on holidays, this percentage grows respectively to - 51.6 % and 57.3%. But according to the Study of Health Behavior in School – Aged Children10 for 2013/2014 at least 18.8 % of school children watch TV programmes, including video and DVD, at least four hours per day, on weekends the share almost doubles reaching 36.4 %. Due to insufficient physical activity and unhealthy dietary habits the overweight and obesity rates in Latvia are high among adults and children. According to the data of the Anthropometric Measurements of Children and School Environment Study 11 in Latvia for school year 2015/2016, of all the 7-year-old children measured 21.7 % were overweight and obese and among 9-year-olds the rate was even higher – 25.8 %. Also, according to the most recent survey data of the as compared to 2010, there has been a relevant growth 5 http://www.who.int/dietphysicalactivity/publications/9789241599979/en/ 6 https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/FINBALT/finbalt_2016_2.pdf 7 http://www.who.int/dietphysicalactivity/publications/9789241599979/en/ 8 https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/HBSC/hbsc_2013_2014_aptaujas_ rez.pdf 9https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/B%C4%93rnu%20antropometris ko%20parametru%20p%C4%93t%C4%ABjums/bernu_antropom_parametru_petijums_2015_20 16.pdf 10 https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/HBSC/hbsc_2013_2014_aptaujas_ rez.pdf 11https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/B%C4%93rnu%20antropometris ko%20parametru%20p%C4%93t%C4%ABjums/bernu_antropom_parametru_petijums_2015_20 16.pdf Page 53 of 97 in the prevalence of overweight and obesity, especially among 11-13 years’ old school children. The prevalence of overweight and obesity in 2010 and 2014 was shown to be higher for boys in all age groups. Also in adult population (15-74) the obesity rates are increased and according to the anthropometrical measurement data of 2016 in the Health Behaviour Study of the Latvian Population12, 54.6% had an increased BMI of which 31.4% had overweight and 23.2% had obesity. 3.2. Existing policies and implemented actions In Latvia the Ministry of Health and the Ministry of Education and Science share the main responsibility to develop and coordinate the policy implementation to promote sufficient physical activity among Latvian population. The Ministry of Health is the main institution which is responsible for public health and health promotion including promotion of sufficient physical activity. The Ministry of Education and Science is responsible for physical and sports education at kindergartens, schools and elite sport development including also Sports for All promotion. The Public Health Strategy 2014–2020 by the Ministry of Health highlights the importance of physical activity for public health. In line with this Strategy, and the EU funding period, during the coming years Latvia is planning to have extensive health promotion and disease prevention activities in order reduce the main non-communicable diseases risk factors in the Latvian population while paying special attention to priority target groups such as children, elderly, unemployed, socioeconomically disadvantaged, people with disabilities and people living in rural and remote areas. These health promotion activities will also aim to increase physical activity. The Sports Policy Guidelines for 2014—2020 were created by the Ministry of Education and Science. This document addresses Sports for All promotion, including youth, paralympic and elite sports. The policy aims to: promote physical activity, including the preparation of athletes within competitive programmes; improve disabled peoples’ access to sports opportunities; and promote the development of sports infrastructure. In addition, The Ministry of Education and Science of Latvia has developed the Education Development Guidelines 2014—2020, which address the integration of physical activity in education. This includes general (primary and secondary) education, along with vocational higher education, and also focuses on ethnic minorities, low socioeconomic groups, and children and youth. As the promotion of physical activity and sport is a complex issue the role of other ministries and institutions is crucial. For example, The Ministry of Transport has devised the Transport Development Guidelines for 2014—2020. These aim to strengthen the public transport infrastructure and encourage people to use more active modes of transport. The Ministry of Transport, in cooperation with other ministries and institutions, are now working on a specific plan for 2018-2020 to promote bicycle traffic among the Latvian population. This plan includes public awareness activities and infrastructure development. The Regional Policy Guidelines, devised by the Ministry of Environmental Protection and Regional Development in 2013, 12 https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/FINBALT/finbalt_2016_2.pdf Page 54 of 97 highlight the importance of regional development projects and local public services which can improve public infrastructure in order to also improve opportunities for physical activity. In Latvia, municipalities also play an important role in the promotion of physical activities. According to the Law of municipalities13 , local authorities need to promote healthy lifestyles and sport. They are responsible for the vast majority of public sport infrastructure, education institutions and they have a vital capacity to create favorable conditions for the availability of sport and physical activities to the entire community. In 2013, the Ministry of Health, in collaboration with the Center for Disease Prevention and Control (CDPC), created the Latvian National Healthy Municipality Network. Currently 94 % of the Latvian municipalities have joined the Network. To educate and inform policy makers in municipalities about health promotion, as well as support local government to organize health promotion activities, the Ministry of Health in 2011 developed ”Health Promotion Guidelines for Local Governments” 14. Regular physical activity in childhood and adolescence is important for promoting lifelong health and well- being and preventing various health conditions. In Latvia, educational institutions play an important role to encourage children to be physically active. Physical activity and sports are part of education process starting from kindergarten. In primary schools, it is mandatory to include 2 hours of physical education (PE) in the curriculum. Educational institutions have the right to increase the number of hours dedicated to PE per week, and many schools choose to provide more than 2 classes of PE per week. The content of PE is determined by Regulations of the Cabinet of Ministers for primary and secondary schools. These regulations determine the aims and objectives of PE, its compulsory content and what learning goals must be met. Now the Ministry of Education and Science is working on the new content of the education standards for kindergartens, primary and secondary schools and it includes also physical and health education. In addition, for facilitating involvement of school aged children, their parents and school staff in promoting health, including physical activity, Ministry of Health renewed Health Promoting School Network in 2014. Currently the Health Promoting Schools Network involves 100 schools. As public awareness play an important role to promote physical activities CDPC constantly carries out campaigns and other activities to promote a physically active lifestyle within the general adult population, as well for children and youth. In 2014 several campaigns take place in Latvia. For example, during the “Summer of Health” campaign specific examples of the most suitable types of exercise for various age groups have been provided. The CDPC also held training for leaders of physical activity in local communities on the promotion of active lifestyles. Also in 2014, during the campaign “Let Every Day be Active!” in cooperation with five Latvian municipalities (Jūrmala, Tukums, Ogre, Cēsis un Varaklani) 13 www.vvc.gov.lv/export/sites/default/.../On_Local_Governments.doc 14 http://www.vm.gov.lv/images/userfiles/phoebe/ministrija_sabiedribas_lidzdaliba_ab75e1a6c38b 637dc22573d800293aaa/health_promotion_guidelines_for_local_governments.pdf Page 55 of 97 specific Health Routes have been established offering possibilities to walk in combination with age- appropriate exercises with posters demonstrating examples for simulation. In addition, a social project “I know that You can do it!” has been implemented in cooperation with youth and sport organizations during the summer of 2014. The aim was to promote active and healthy lifestyle and discourage young people from engaging in risky behaviour or substance use in favour of physical activities. In Latvia doctors (general practitioners) and nurses are one of the most important information givers to society about healthy and active living. Every year State Sports Medicine Centre organizes free-of-charge courses for health care professionals (general practitioners, nurses, and sport doctors) including on physical activity issues and its impact on health. In 2014 a methodical guidance “Prescribing physical activity at the family doctor’s practice” was issued by the State Sports Medicine Centre with an emphasis on the role of medical staff in promoting physical activity in the population. It included a prescription template for physical activities. In addition, family doctor teams were given training over 2014 and 2015 on how to write out the prescription and on the role of physical activities for children and adults. However, the material has not been fully disseminated to its entire potential. In 2014/2015 national physical activity recommendations for residents of Latvia15 have been developed for different population groups – children and teens, adults, seniors, women during pregnancy and after birth, people with disabilities and chronic illnesses. As enough funding for health promotion is important to organize activities and campaign to encourage people be more physically active, under the EU funds planning period for 2014-202016 health promotion and disease prevention measures, including promotion of physical activity, have been planned, especially, for the people affected by territorial, poverty and social exclusion risks. Activities have been planned at national and local level. National level activities include public awareness campaigns focused on promotion of healthy nutrition, physical activities, reduction in the prevalence of addictive substance use, sexual and reproductive health and mental health promotion. Educational activities on health-related issues for persons who coordinate health promotion activities in the local communities, teachers etc. and studies, including on physical activity and dietary habits will be also implemented at national level. Furthermore, local level activities will be organized by the municipalities and CDPC, for example, educational and practical sessions, lectures, seminars for the promotion of healthy nutrition, physical activities, discouraging addiction, mental health improvement and promotion of sexual and reproductive health. In addition, also under the EU funds planning period for 2014-202017 specific activities to improve health care and health care support persons 15 https://spkc.gov.lv/upload/Veicin%C4%81%C5%A1ana/Fiziskas%20aktivitates/fizisko_aktivitu_ieteikumi_latvijas_iedzvotjiem.p df 16specific support objective 9.2.4. of the “Growth and Employment” programme “improving access to health promotional and disease prevention activities, especially with regard to the population under the risk of poverty and social exclusion” 17 specific support objective 9.2.6. of the “Growth and Employment” programme “to improve health care and health care support qualification” Page 56 of 97 qualification will be implemented. Within this measure life-long learning activities are planned strengthening the role of health care professionals and social care specialist’s in health promotion and disease prevention. 3.3. Main challenges Although physical activity promotion is addressed in many policy planning documents and relevant institutions implement different activities still there is lack of leadership to advocate the importance of regular physical activity. The cooperation and coordination among different institutions and sectors (education, health, transport, regional development, and environment etc.) to promote physical activity to different age groups in population in Latvia is also insufficient and need to be improved. The approach “health in all policies” and intersectoral cooperation is very important component to successfully implement policies that encourage physical activity. The physical activity level in Latvian population is low and that negative affect the public health indicators in Latvia. There is a lack of interest and motivation in society to start and to continue to practice regular and adequate physical activity. To encourage population to be physical active public awareness campaigns for different society groups (children, older people, and families) are crucial. Although in Latvia several public awareness campaigns and activities have been organized in recent years, still the campaigns are short term and there is lack of sustainability and specific activities for different age and gender groups, especially to motivate the inactive population groups by using interactive and appropriate methods. To organize effective awareness campaigns and activities cooperation and enough funding is the key. Therefore, it is necessary to collaborate with NGOs, local companies and media experts, because they can better bring the right messages and information to different society groups. Physical activity in all stages of life maintains and improves health and wellbeing. Physical activity in pregnancy has minimal risks and has been shown to benefit most women. Women with uncomplicated pregnancies should be encouraged to engage in appropriate exercises before, during and after pregnancy. In Latvia, we have several activities at municipalities to encourage women during and after pregnancy to be physically active. Physical activity recommendations for residents of Latvia including women during pregnancy and after birth have been developed but not fully disseminated and used. Taking account previous mentioned there is a need to continue to inform women during and after pregnancy about adequate physical activity, as well as inform young parents about active play and movement development among infant and young children. It also important to continue to organize practical activities and classes for women during and after pregnancy and young families with infants and children at municipalities to engage in appropriate exercises. Although materials and guidelines about the role of appropriate physical activities in health promotion and disease prevention have been developed for several health care professionals for Page 57 of 97 example general practitioners, nurses and sport doctors still there is a lack of materials and guidelines for other professionals for example gynecologists, midwifes, physiotherapists, pediatrician etc. who can also consult patient groups like pregnant women, women after birth and young families about adequate physical activity. The same situation is regarding training courses for health care professionals. In Latvia, several training courses have been organized in recent years for general practitioners, nurses and public health specialists. Nevertheless, the training courses have been irregular and not suitable for all medical specialists like gynecologists, midwifes, physiotherapists, pediatricians etc. who can also guide and motivate their patient about adequate physical activity. Communities and education institutions – from kindergartens to colleges and universities – are important partners in promoting physical activity. Through physical education and health promotion activities at kindergartens, schools provide instruction for skill development and educate children about healthy, active lifestyle choices. Improvement of pre-school and school-based physical education is crucial to educate and motivate young children and later adolescents to be physically active every day. Therefore, it is important to start with physical education from kindergartens. It is important that in primary, secondary and vocational schools there are enough sport lessons and possibility to have physical activities after school. To ensure that young people continue to be physically active also at colleges and universities, it is essential to encourage college, university students to have access to A or B part courses that provide different sport of physical activity after studies. The quality of sporting hours is greatly enhanced by modern sports equipment suitable for the realization of sports education programs. Kindergarten and school playgrounds, sports halls and facilities and physical education lessons should be adapted to all children and pupils, also to those who have disabilities or other health problems. Most of the schools and preschools have good facilities and equipment for physical activity but they are not being used to its full extent. In addition, one of the challenges especially for schools is to find best ways how to better promote outdoor physical activity after school and on weekend. To make physical education meaningful and successful for all children and youth, innovative learning methods need to be considered, evaluated, and implemented. To reduce the number of exemptions from physical activity lessons and to promote the possibility of participation in sports for children with various health disorders, it is necessary to provide suitable and individualized physical activity in accordance with the state of health of the students. Therefore, there is the need to train and educate teachers at preschools and schools. People are more active when they can easily access destinations such as parks, workplaces, sport, recreation facilities and shops. Design elements in the built environment, such as street layout, land use, the transport Page 58 of 97 system and the location of recreation facilities, parks and public buildings, are components of a community that can encourage active living. Appropriate infrastructure for example available and safe walking and cycling areas and public transport routes encourage people to be more active every day. Most of big cities and municipalities in Latvia have developed appropriate and available infrastructure to promote physical activities, but still there is a need to improvement, especially in small municipalities. Because most adults spend about eight hours or more each day at work the promotion of physical activity can be an important part of an active living strategy. Workplaces can affect the health and fitness of their employees by providing supportive policies and environments, access to facilities, health promotion information and incentives for active travel to and from work. Employers need to motivate employees to be physical active and organize physical activity supportive environment (organize bicycle storage, showers, sport games and festivals, discounts in sport clubs etc.). Although several employers in Latvia have implemented specific programmed for employees to promote active lifestyle still there are is a need to involve more workplaces. A healthy workplace movement need to be developed and coordinated in Latvia to protect and promote the health, safety and wellbeing of all workers and the sustainability of the workplace. Adequate, reliable data is important for policy decision-making and implementation processes. Research into physical activity and health is essential for understanding patterns, prevalence, trends and determinants of physical activity. Policies and programmes that are evidence-based and delivered appropriately will be much more effective. There are currently some gaps in available data and research related to population physical activity in Latvia. Also, there is a need to increase cooperation between different stakeholders like state agencies/ministries, research institutions, academic institutions, national experts and international organizations to identify research priorities in the field of physical activity and sport. To tackle all the challenges emphasized previously and to continue implement national and local policies that promote healthy lifestyle and physical activities among Latvian population priority areas with a set of recommended actions have been defined further in this document also identifying coordinating institution/- s and possible partners for cooperation. Page 59 of 97 4. Priority areas and recommended actions Priority area 1 - Providing leadership and coordination for the implementation of policies and interventions to promote physical activity Promoting physical activity for health is complex. While leadership by the health sector is critical, a comprehensive physical activity policy will require the collective effort of many different government agencies, levels of government, sectors and organizations. While the Ministry of Health will be the lead technical organization, support from other ministries is required for the successful implementation of the policy and recommended action in this road map. The quality of implementation also depends on the coordination of the work of some ministries and agencies, NGOs and the media. A cross-government mechanism can help to integrate policy development and implementation across the different sectors, provide guidance to support planning and establish shared goals and joint actions. OBJECTIVE RECOMMENDED ACTIONS COORDINATING INSTITUTION/ -S PARTNERS Provide high level leadership by the health sector and improve coordination between relevant ministries, agencies and other partners 1.1. Launch roadmap at convenience of Ministry of Health Ministry of Health Ministry of Education and Science, Center for Disease Prevention and Control, WHO Regional Office for Europe and Latvia Country Office 1.2. Disseminate roadmap to relevant sectors and stakeholders in different levels to promote physical activity and implement policy and recommended actions. Ministry of Health, Center for Disease Prevention and Control Ministry of Education and Science, Ministry of Environmental Protection and Regional Development, Latvian Association of local and regional governments, schools and municipalities 1.3. Integrate in an exciting council (example Nutrition council) or establish a multisectoral advisory council on physical activity that includes representation from all relevant agencies and ministries including health, sports, education, Ministry of Health Ministry of Education and Science, Ministry of Transport, Ministry of Environmental Protection and Regional Development, Center for Disease Prevention and Control, Latvian Association of local and Page 60 of 97 OBJECTIVE RECOMMENDED ACTIONS COORDINATING INSTITUTION/ -S PARTNERS environment, urban planning, transport, tourism etc., identifying responsible persons in all relevant sectors and create a communication network for all interested stakeholders. regional governments, Latvian Sports for all association, Riga Stradins University, Latvian Academy of Sport Education, Latvian Sports Medicine association, Latvian Medical Doctors association, Latvian Big cities association, other NGOs. 1.4. Collaborate with relevant national, regional and local organizations and international organizations through participation in regional and international scientific conferences, symposiums, training and workshops related to physical activity promotion and share country experiences Ministry of Health Ministry of Transport, Ministry of Environmental Protection and Regional Development, Center for Disease Prevention and Control, municipalities, NGOs, Riga Stradins University, Latvian Academy of Sport Education, World Health Organization 1.5. Using the Health Promoting Schools Network and the National Healthy Municipality Network as a platform and a communication network to promote physical activity and implement policy and recommended actions in the roadmap. Center for Disease Prevention and Control Ministry of Health, Ministry of Education and Science Page 61 of 97 Priority area 2 – Supporting safe physical activity during pregnancy, after childbirth and during infancy also including preschools There are number of physical and psychological benefits of physical activity during pregnancy. In addition to the health benefits, it is important that pregnant women and those planning to have children are educated and aware of the importance of physical activity for their children. Physical activity is fundamental for the development of basic cognitive, motor and social skills, as well as musculoskeletal health in children. Physical activity after childbirth is also important and help women recover their physical form after childbirth. Activity for infants focuses on gross motor skills and early movement serves as the basis for skillful movement for activities in later childhood and adulthood. Caregivers can help infants to develop the skills they need by providing stimulating environments that encourage infants to moveii. Preschools and kindergartens play an important role in the promotion of physical activity, therefore preschool facilities and environment should be safe and suitable for active play and movement development among young children. OBJECTIVE RECOMMENDED ACTIONS COORDINATING INSTITUTION/ -S PARTNERS 2.1. Promote the importance of physical activity during pregnancy, women afterbirth and among young families 2.1.1. Develop and implement training programmes for health care workers (gynecologists, midwifes, GPs) about physical activity during pregnancy, after childbirth including information and advice to future parents (including fathers) about physical activity. Ministry of Health Center for Disease Prevention and Control, Riga Stradins University, Latvian Gynecologists and Obstetrician association, Latvian Midwife association, Latvian Family Doctor association, Latvian Rural Family Doctor association, Latvian Physiotherapist association, municipalities 2.1.2. Develop and disseminate physical activity guidelines during and after pregnancy including while breastfeeding for health care professionals (gynecologists, midwifes, GPs etc.) including importance of healthy weight gain in antenatal classes. Ministry of Health Center for Disease Prevention and Control, Latvian Gynecologists and Obstetrician association, Riga Stradins University, Latvian Midwife association, Latvian Family Doctor association, Latvian Rural Family Doctor association, municipalities Page 62 of 97 2.1.3. Develop and disseminate guidelines/informative materials for pregnant women and women after birth on physical activity. Center for Disease Prevention and Control Ministry of Health, Latvian Gynecologists and Obstetrician association, Latvian Midwife association, municipalities, private sector, other NGOs 2.1.4. In cooperation with local municipalities and NGOs organize practical sports and physical activity lessons and other activities for pregnant women, women after birth and young families with infants Center for Disease Prevention and Control Ministry of Health, Latvian Association of local and regional governments, preschools, municipalities 2.2. Support physical activity during infancy and in preschools 2.2.1. Develop and implement training programmes and informative materials for early childhood care providers (GPs, pediatricians, physiotherapists, physical and rehabilitation specialists etc.) to ensure they provide guidance for parents about active play and movement development for infants and pre-school aged children. Ministry of Health, Center for Disease Prevention and Control Latvian Family Doctor association, Latvian Rural Family Doctor association, Latvian Pediatrician association, Latvian Physiotherapist association, Latvian physical and rehabilitation specialist’s association, municipalities, Riga Stradins University 2.2.2. Provide access to facilities, daycare centers for parents with infants and young children and ensure that adequate and safe facilities, playgrounds and equipment are available in all preschools and daycare centers and are suitable for active play and movement development among infants and young children Consumer Rights Protection Centre, Health Inspectorate Ministry of Welfare, Ministry of Environmental Protection and Regional Development, Ministry of Economics, Ministry Education and Science, Ministry of Health, Latvian Association of local and regional governments, preschools, daycare centers, child supervision services providers, municipalities 2.2.3. Develop and implement training programmes and informative materials for preschool teachers, daycare Ministry of Education and Science Ministry of Health, National Centre for Education, Latvian Physiotherapist association, Latvian physical and Page 63 of 97 center workers and persons providing the child supervision services to include adequate physical activity in education programs and to promote active play and movement development for infants and pre-school aged children. rehabilitation specialist’s association, municipalities, Latvian National Healthy Municipality Network, Health Promoting School Network 2.2.4. Develop and implement awareness campaign and informative materials educating future parents and young families on recommendations for physical activity and reduction of screen time among young children. Center for Disease Prevention and Control Ministry of Health, Ministry of Education and Science, preschools, municipalities, public media Priority area 3 – Supporting the development of children and adolescents Childhood and adolescence are critical formative years where skills and knowledge are developed and lifelong physical activity habits can be established. In addition to the health benefits and importance to a child’s physical, mental and emotional development, if young people achieve at least the recommended daily amount of physical activity there are potentially broad social and academic gains as evidence links physically active youth with academic achievement. There is a worldwide trend of children becoming increasingly less active throughout the day while they spend more time engaged in sedentary recreational activities. Almost all children and adolescents in Latvia now attend school and spend most of their time there, so this is an ideal setting to increase physical activity in this population. Page 64 of 97 OBJECTIVE RECOMMENDED ACTIONS COORDINATING INSTITUTION/ -S PARTNERS 3.1 Deliver quality physical education and promote physical activity in all schools 3.1.1. Ensure physical activity is specified for all ages, boys and girls, up-to-date and in line with current best practice (UNESCO/WHO Quality Physical Education Guidelines) Ministry of Education and Science National Centre for Education, schools, 3.1.2. Ensure regular monitoring of physical activity curriculum in all schools/ages to assess compliance with the current best practice and make recommendation to improve the quality of physical activity education State Education Quality Service Ministry of Education and Science, National Centre for Education 3.1.3. Increase the number of mandatory hours of physical education in primary, secondary and vocational schools Ministry of Education and Science Ministry of Health, National Centre for Education, Latvian Academy of Sport Education, schools 3.1.4. Develop informative materials and guidance to current sport teachers and sport trainers to include adequate physical activity in education programmes for student with different chronic diseases and disabilities Ministry of Education and Science, Ministry of Health National Centre for Education, Center for Disease Prevention and Control, Latvian Sports Medicine association, Latvian Academy of Sport Education, Latvian University, schools 3.1.5. Conduct regular training for current sport teachers and sports trainers to increase knowledge and skills to implement education programmes that are safe, developmentally and culturally appropriate National Centre for Education Ministry of Education and Science, Ministry of Health, Center for Disease Prevention and Control, Latvian Sports Medicine association, Latvian Physiotherapist association, Latvian Page 65 of 97 and inclusive for all students, also for students with different chronic diseases and disabilities physical and rehabilitation specialist’s association, Latvian Academy of Sport Education, Latvian University, schools 3.2 Ensure physical and social environments in schools support physical activity throughout the day for all students and adequate equipment is available 3.2.1. Ensure that adequate and safe facilities, sports grounds and equipment are available in all schools based on the national regulation for essential physical infrastructure and equipment that should be available in all schools (including walking pathways, sport halls with suitable equipment) Ministry of Education and Science, municipalities National Centre for Education, State Education Quality Service, schools 3.2.2. Support implementation of active and safe transport possibilities for all students by ensuring adequate and safe infrastructure and collaborate with parents to promote active travel to school Ministry of Health, Ministry of Environmental Protection and Regional Development Ministry of Education and Science, Latvian Association of local and regional governments, municipalities, schools 3.3 Increase extracurricular opportunities for participation in sport and physical activities for all students including for children with disabilities 3.3.1. Establish partnerships and encourage exchange of best practice between public health, health promotion and sport organizations and schools to promote and motivate students to be more physically active, also by using the Healthy schools network as a platform Ministry of Education and Science, Center for Disease Prevention and Control Ministry of Health, Latvian Association of local and regional governments, municipalities, schools 3.3.2. Ensure extracurricular opportunities for participation in sport and physical activities are available for all students and schools including for children with disabilities Ministry of Education and Science Ministry of Welfare, National Centre for Education, Latvian Association of local and regional governments, schools, municipalities 3.3.3. Open schools and their facilities (sports grounds, playgrounds, sports halls etc.) for afternoon and evening PA, during the weekend, vacation Municipalities Ministry of Education and Science, Latvian Association of local and regional governments, schools Page 66 of 97 periods and guarantee availability for all students and their families (if possible free of charge) 3.3.4. Ensure opportunities for children with disabilities to be involved in physical activities after school and support development of special programms as well as allocating adequate resources and facilities Ministry of Education and Science, Ministry of Welfare Latvian Physiotherapist association, Latvian physical and rehabilitation specialist’s association, Latvian Association of local and regional governments, municipalities, schools, NGOs 3.3.5. Encourage colleges and universities enable students to choose A or B or C part courses or lessons that provide different sport of physical activities during and after studies. Ministry of Education and Science Riga Stradins University, Latvian Academy of Sport Education, Latvian University, all colleges or higher education institutions 3.4 Raise awareness of the importance and availability of physical activity and sports opportunities among children and adolescents emphasizing motivation to start and continue active lifestyles 3.4.1. Develop and implement coordinated and comprehensive health and sports promotion campaigns using a range of media including the mass media, social media and and innovative approaches to encourage physical activity among children and adolescents (peer network approach, novel information and communication technologies,) Ministry of Education and Science, Ministry of Health National Centre for Education, Center for Disease Prevention and Control, NGOs, mass media, municipalities 3.4.2. Develop and produce informative materials using different communication methods and technologies promoting sports and physical activity targeting children and adolescents Ministry of Education and Science, Ministry of Health National Centre for Education, Center for Disease Prevention and Control, NGOs, mass media, municipalities Page 67 of 97 3.4.3. Develop partnerships with community, youth organizations, public health and sport organizations including famous athletes and other persons to create programmes for adolescents and youth to motivate and involve them in physical activity and other activities that promote healthy and active lifestyles Ministry of Education and Science, Center for Disease Prevention and Control Ministry of Health, National Centre for Education, Latvian Association of local and regional governments, sport organizations, schools, municipalities, mass media 3.4.4. Organize sport and physical activity days emphasizing participation not solely competition at schools, sports centers, stadiums, halls and other facilities suitable for active lifestyle Ministry of Education and Science, NGOs Ministry of Health, Center for Disease Prevention and Control, municipalities, schools, sports organizations, Page 68 of 97 Priority area 4 – Promoting physical activity for adults Many adults are now physically inactive during the day due to changes in occupations and the way that recreational time is spent. As with children in schools, most adults now spend most of their time in the workplace and this is a critical setting to address physical inactivity and sedentary behaviours in the working population. The sport sector has a central role in promoting health enhancing physical activity, not just for the development of elite and competitive sports. Sports groups and clubs are excellent strategic partners for the development of physical activity and inclusive participatory programmes. The health sector is important for the promotion of physical activity to the general population and especially for at-risk adults and the inactive as healthcare professionals reach a large proportion of the population in Latvia. Specific strategies need to be implemented to reach inactive adults and older adults. Communication strategies using different types of approaches, such as mass media and social media, can raise awareness about physically active as well as educate people on places and ways to be active for health. Communication campaigns are crucial to facilitate and enhance the other activities included in the road map. OBJECTIVE RECOMMENDED ACTIONS COORDINATING INSTITUTION/ -S PARTNERS 4.1. Create urban environments and transport systems that encourage daily PA 4.1.1. Promote physical activity friendly principles to urban and transport planning policy makers and professionals through exchange of good practice to ensure development of safe and accessible pathways for walking/cycling and designing of public transport systems and any new residential development Ministry of Environmental Protection and Regional Development, Ministry of Transport Ministry of Health, Latvian Association of local and regional governments, municipalities 4.1.2. Conduct health impact assessments of all regional and local urban and transport planning proposals ensuring they are encouraging physical activity and encouraging walking and cycling Ministry of Environmental Protection and Regional Development Ministry of Health, Ministry of Transport, Latvian Association of local and regional governments, municipalities Page 69 of 97 4.1.3. Provide available and safe public transport at national, regional and local levels to encourage active living (walking) and increase access to destinations such as parks, sports and recreation facilities were people can be physically active Ministry of Transport, Ministry of Environmental Protection and Regional Development Ministry of Health, Latvian Association of local and regional governments, municipalities 4.1.4. Ensure and implement traffic control and safety measures that guarantee the safety of pedestrians and cyclists and, in cooperation with local governments, improve neighbourhood safety to encourage walking and cycling Ministry of Transport, Ministry of Environmental Protection and Regional Development Ministry of Environmental Protection and Regional Development, Latvian Association of local and regional governments, municipalities 4.1.5. Promote the development of parks, facilities and other infrastructure for physical activity at national and local level including provision of equipment, safety, accessibility and opportunities for different age and gender groups Ministry of Environmental Protection and Regional Development Latvian Association of local and regional governments, municipalities 4.1.6. In cooperation with sport organizations and sport coaches, develop and implement programmes (eg. walking groups, exercise classes) that provide physical activity opportunities for the community in local parks to attract inactive populations and those from vulnerable groups (unemployed, adults with low incomes and people with disabilities) Center for Disease Prevention and Control, municipalities Ministry of Health, Latvian Association of local and regional governments, NGOs Page 70 of 97 4.2. Promote physical activities in workplaces 4.2.1. Ensure that physical activity promotion during and after work is included as part of the preventive health components of national workplace and OHS (occupational health and safety) policies, including in regulations and legislation Ministry of Welfare Ministry of Health, Center for Disease Prevention and Control, State Labor Inspectorate, workplaces, NGOs 4.2.2. Develop and disseminate information, materials and support for workplaces to update organizational policies to promote physical activity and healthy lifestyles Ministry of Welfare, State Labor Inspectorate Ministry of Health, Center for Disease Prevention and Control, workplaces, NGOs 4.2.3. Develop and increase participation of organisations in the national healthy workplace network in Latvia Ministry of Welfare, Ministry of Health State Labor Inspectorate, Center for Disease Prevention and Control, workplaces, NGOs 4.2.4. Provide training on the promotion of physical activity and active lifestyles for OHS (occupational health and safety) officers and organize training for workers to empower them to be physically activity throughout the work day Ministry of Welfare, State Labor Inspectorate Ministry of Health, Center for Disease Prevention and Control 4.2.5. Promote the implementation of physical activity programmes and active travel to work (encourage companies to use cycle racks, changing rooms, showers and adequate public transport options) Ministry of Welfare, State Labor Inspectorate Ministry of Health, Center for Disease Prevention and Control, workplaces, NGOs 4.3. Increase capacity of health system to promote PA to all patients but especially 4.3.1. Revise and adopt national recommendations on physical activity for the general population and special subgroups. Center for Disease Prevention and Control Ministry of Education, Ministry of Health, Latvian Academy of Sport Education, Riga Stradinš University, Latvian Sports Medicine association, NGOs Page 71 of 97 at-risk patients and older adults 4.3.2. Develop guidelines and other informative materials for primary health care workers ensuring early identification of those at risk and increase physical activity prescription andcounselling for different age and gender groups including patients with chronic diseases Ministry of Health Center for Disease Prevention and Control, National Health Service, Latvian Family Doctor association, Latvian Rural Family Doctor association 4.3.3. Build capacity of primary health care providers through training and skill development on physical activity assessment, prescription and counselling for different age and gender groups including patients with chronic diseases Ministry of Health Center for Disease Prevention and Control, Latvian Family Doctor association, Latvian Rural Family Doctor association 4.3.4. Identify possible incentives or other motivation systems to encourage primary health care providers to integrate physical activity promotion to patients within their daily practice Ministry of Health National Health Service, Latvian Family Doctor association, Latvian Rural Family Doctor association 4.3.5. Develop and disseminate educational materials on physical activity for different age and gender groups including patients with chronic diseases Center for Disease Prevention and Control Ministry of Health, National Health Service, Latvian Family Doctor association, Latvian Rural Family Doctor association, Latvian Academy of Sport Education, Riga Stradinš University, Latvian Sports Medicine association 4.4. Increase participation in sport for all by involving sport clubs in promotion of health-enhancing physical activity 4.4.1. In cooperation with professional sport organizations and sport coaches promote health- enhancing physical activity programmes at sports clubs and facilities, providing opportunities for Ministry of Education and Science Latvian Academy of Sport Education, Riga Stradinš University, The Latvian Association of Physiotherapists, professional sports organizations, sport coaches, sports clubs and centers, municipalities Page 72 of 97 programmes at sports clubs and facilities different types of physical activities for males/females, different skill levels and abilities and age groups 4.4.2. Organize open sport events and activities that promote participation and “sport for all” principles, not solely competition Municipalities, NGOs Ministry of Education and Science Latvian Olympic Committee, Latvian Association of local and regional governments, professional sports organizations, sports clubs and centers, municipalities 4.4.3. In cooperation with universities and colleges d integrate training on health enhancing physical activity with sport coaches’ education programmes Ministry of Education and Science Riga Stradins University, Latvian Academy of Sport Education, colleges or higher education institutions responsible for sport coaches’ education, professional sports organizations and sports clubs 4.5. Raise awareness about physical activities through multi-faceted education and behavior change campaigns 4.5.1. Develop and implement multifaceted national education campaign promoting physical activity (articles, programmes in mass media, websites, social media) targeting adults in communities, workplaces and mass gatherings Ministry of Health, Center for Disease Prevention and Control Ministry of Education and Science, NGOs, mass media, municipalities 4.5.2. In cooperation with municipalities and NGOs organize regular events (family days, competitions) promoting participation in physical activity and use major sporting events to improve public awareness, attitudes and practices related to physical activity and active lifestyles Center for Disease Prevention and Control, municipalities Latvian Association of local and regional governments, NGOs, mass media 4.5.3. Develop and disseminate; guidebooks andmaps showing locations to be physically active including sports, cycle, walk and park facilities; promotional Ministry of Environmental Protection and Regional Development, Center for Ministry of Education and Science, Ministry of Health, Latvian Association of local and regional Page 73 of 97 posters for use in parks; information materials and manuals utilizing ICT to promotie sports and physical activity targeting inactive populations Disease Prevention and Control governments, professional sports organizations, municipalities 4.6. Increase physical activities among older adults 4.6.1. Promote ‘age-friendly’ policy implementation at national and local level (flexible working hours and modified work environments for older people, footpaths, safe local neighbourhoods, access to health centres and rehabilitation programmes). Ministry of Welfare Ministry of Health, NGOs, professional sport organizations, municipalities 4.6.2. In cooperation with existing social structures like care centers, community centres, faith-based organizations, sports organizations and municipalities, develop programmes for community physical activity interventions for older adults targeting inactive older adults, particularly those from socially disadvantaged backgrounds Ministry of Welfare, municipalities Ministry of Health, NGOs, municipalities 4.6.3. Develop and provide guidance materials and counselling to national and local existing social organisations and structures to encourage development of appropriate programmes and physical activities opportunities for older adults. Ministry of Welfare Ministry of Health, NGOs, municipalities Page 74 of 97 Priority area 5 – Strengthen monitoring and evaluation, research and surveillance There are currently some gaps in data related to population physical activity in Latvia and this needs to be rectified to guide implementation of the overall strategy and to understand the effectiveness of the different approaches to increasing physical activity levels. In addition to evaluating the range of actions to increase physical activity levels, clear mechanisms can help to ensure evaluation results are communicated to policymakers and inform future policy and action. Research into physical activity and health is essential for understanding patterns, prevalence, trends and determinants of physical activity. Research is also essential to inform national action and the development of physical activity policies, programmes or individual interventions. Policies and programmes that are evidence-based and delivered appropriately will be much more effective. There are also likely to be local-level barriers and facilitators for participation in physical activity which need to be understood. OBJECTIVE RECOMMENDED ACTIONS COORDINATING INSTITUTION/ -S POSSIBLE PARTNERS 5.1 Strengthen the physical activity research agenda and community focus 5.1.1. Promote research activities in physical activity field by identifying gaps and consulting with stakeholders on how to increase research on physical activity in Latvia in next years Center for Disease Prevention and Control Ministry of Health, Ministry of Education and Science, Latvian Academy of Sport Education, Riga Stradins University 5.1.2. Establish links between variety of agencies/ministries and research institutions and collaborate with academic institutions, national experts and international organizations to identify research priorities that will support the implementation of the recommended actions set in the national physical activity roadmap Center for Disease Prevention and Control Ministry of Health, Ministry of Education and Science, Ministry of Transport, Ministry of Environmental Protection and Regional Development, Ministry of Welfare, Central Statistical Bureau, Riga Stradins University, Latvian Academy of Sport Education, World Health Organization, European Commission Page 75 of 97 5.1.3. In cooperation with municipalities, evaluate the effectiveness of community based physical activity interventions and identify local level barriers and enabling factors for participation in physical activity Center for Disease Prevention and Control, Ministry of Health Municipalities 5.2 Strengthen the systematic monitoring of physical activity 5.2.1. Identify planned surveys and ensure measures of population physical activity are included as a key component (for example COSI, HBSC and Health behavior survey for adult population) and estimate the proportion of the population meeting WHO physical activity recommendations Center for Disease Prevention and Control Ministry of Health, World Health Organization 5.2.2. Collaborate with urban planning, transport, education and sport sectors as well as with academic institutions and civil society to identify data that can be collected in different sectors on physical activity and used for the evaluation of the implementation the recommended actions set in the national physical activity roadmap Center for Disease Prevention and Control Ministry of Health, Ministry of Education and Science, Ministry of Transport, Ministry of Environmental Protection and Regional Development, Central Statistical Bureau, Riga Stradins University, Latvian Academy of Sport Education, municipalities Page 76 of 97 Annex III: Potential enhancement of EHIS in the area of physical activity • While for EHIS 2, improvements were made following implementation of EHIS 1, the EHIS physical activity questions can be further enhanced in a number of broad ways. • There will always be challenges to integrate EHIS with existing national, regional and global surveys due to the different priorities of the surveys, countries involved and organizations and individuals responsible for designing, validating and implementing the surveys. Harmonization with existing Global, Regional and National Surveys • Harmonization of the EHIS with national health surveys needs ongoing efforts to ensure the data collected is comparable within and between countries • There are also always challenges to integrate multinational health surveys into existing national health monitoring systems, especially in countries where existing monitoring of PA and sports participation is strong. • As the STEPS survey was initially designed for use in low income countries due to the low cost and relative ease of implementation, it has so far not been implemented in any European Union Member States. However, as use of the STEPS survey has continued to include more countries (10 as of 2018), there are plans to refine the survey so that it is more relevant and acceptable for use in middle-high income countries to provide highly accurate, reliable and comparable data on NCD risk factors across the WHO European Region. This would benefit both EU Member States and countries in the wider WHO European Region, particularly those with ambitions to eventually join the EU. • It is important that the EHIS physical activity questions are in line with the General Physical Activity Questionnaire (GPAQ). • GPAQ is the WHO recommended population survey on PA and is used in the the STEPwise survey of noncommunicable disease risk factors (STEPS) among many other surveys conducted by researchers around the world. Harmonization of the EHIS physical activity questions with the STEPS survey physical activity questions will enable greater comparability of results between countries within the WHO European Region as well as many studies from around the world that have conducted surveys using the GPAQ. • The EHIS wave 3 will need to consider a number of projects which are addressing the difficulty of measuring the prevalence of population physical activity and sports participation accurately using different tools and methods between and sometimes even within countries. Page 77 of 97 • Recent projects such as EUPASMOS seek to harmonise the different methods of monitoring physical activity and sports participation levels in the EU. This project compares the physical activity components of the EHIS, the Eurobarometer as well as National PA surveys with objective measures using accellerometery to develop an EU-wide standardized system of measuring physical activity and sports participation. • The overall goal of this project is to allow the standardized system to accurately estimate the prevalence of physical and sports participation in participating EU Member States. This will allow the effective prioritisation of countries needing support as well as to identify the national, policies, strategies and interventions that are effective over time. • This EC supported project is underway and it is important to include an enhanced EHIS physical activity questions for incorporation into the formulae that will be used to convert measurements of PA and sports participation into a standard system that can accurately estimate population prevalence. • Standardisation of physical activity questionnaires and survey methodologies may also help harmonise the data collected from national surveys, national statistical offices and public health research institutions across the EU. Current EHIS questions and potential new questions for better alignment with existing international surveys and ongoing work to harmonize surveillance of physical activity and sports participation General comments • For all questions, the rationale and desciption for the interviewers or responders should be brief but in easy to under language so that both questioners and responders are clear about the intent and ensure the questions are answered as accurately as possible. • A list of potential activities for all questions and showcards that are locally relevant and appropriate should always be used to improve the accuracy of the responses. Existing EHIS Physical Activity Question in the Work domain • PE1: Physical effort of working tasks (both paid and unpaid work activities Page 78 of 97 Potential questions and answers to supersede or integrate with EHIS-PAQ in the work domain Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate like for at least 10 minutes continuously? Yes/No In a typical week, on how many days do you do vigorous intensity activities as part of your work? Hours : minutes Does your work involve moderate-intensity activity, that causes small increases in breathing or heart rate such as brisk walking for at least 10 minutes continuously? Yes/No Does your work involve moderate-intensity activity that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 minutes continuously? Yes/No In a typical week, on how many days do you do moderate intensity activities as part of your work? Number of days Existing EHIS Physical Activity Questions in the Travel domain • PE2: Number of days in a typical week walking to get to and from places at least 10 minutes continuously • PE3: Time spent on walking to get to and from places on a typical day • PE4: Number of days in a typical week bicycling to get to and from places at least 10 minutes continuously • PE5: Time spent on bicycling to get to and from places on a typical day Page 79 of 97 Potential questions and answers to supersede or integrate with EHIS-PAQ in the travel domain Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? Yes/No In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places? Number of days How much time do you spend walking or bicycling for travel on a typical day? Hours : Minutes Existing EHIS Physical Activity Questions in the Recreational domain • PE6: Number of days in a typical week doing sports, fitness or recreational (leisure) physical activities that cause at least a small increase in breathing or heart rate for at least 10 minutes continuously • PE7: Time spent on doing sports, fitness or recreational (leisure) physical activities in a typical week • PE8: Number of days in a typical week doing muscle-strengthening activities Potential questions and answers to supersede or integrate with EHIS-PAQ in the recreational domain Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or football] for at least 10 minutes continuously? Yes/No In a typical week, on how many days do you do vigorous intensity sports, fitness or recreational (leisure) activities? Number of days How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day? Hours : minutes Page 80 of 97 Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, [cycling, swimming, volleyball] for at least 10 minutes continuously? Yes/No In a typical week, on how many days do you do moderate intensity sports, fitness or recreational (leisure) activities? Number of days How much time do you spend doing moderate-intensity sports, fitness or recreational (leisure) activities on a typical day? Hours : minutes Existing EHIS Physical Activity question in the sedentary behaviour domain • PE9: Time spent sitting on a typical day Potential questions and answers to supersede or integrate with EHIS-PAQ in the sedentary behaviour domain How much time do you usually spend sitting or reclining on a typical day? Hours : minutes Page 81 of 97 Annex IV: Concept note on a methodology to estimate physical inactivity related socio-economic costs. Project Proposal: Estimating the Economic Burden of Physical Inactivity in the European Region Background Inadequate physical activity is a leading risk factor for the health of the population living in the European Region. Physical inactivity is a key cause of diseases including cancers, cardiovascular diseases and other major non-communicable diseases (NCDs). Recent statistics suggest that more than half of the population living in the WHO-European Region is not active enough to meet health recommendations. More than 1 million deaths (i.e. 10% of the total number of deaths) and 8.3 million disability-adjusted life years (i.e. 5% of the total burden of disease) in the WHO European Region are attributable to physical inactivity18. In addition to being major causes of ill health and premature death, physical inactivity has become a threat to the economy of countries at all levels of income. It was calculated that in 2013, physical inactivity cost health-care systems 53.8 billion INT$ worldwide19. Of this sum, 31.2 billion was paid by the public sector, $12.9 billion by the private sector, and $9.7 billion by households. Evidence from OECD countries suggests that the impact of physical inactivity on the national health budget would be in the region of 1.5 to 3 per cent20. While evidence of the health impacts of NCDs linked to physical inactivity is widely available, evidence of the magnitude of economic impacts, particularly for what concerns the impact on the broader economy, is significantly more limited. This project aims to bridge this important gap in the information available to support key health policy decisions aimed at addressing the health and economic consequences of physical inactivity and the NCDs associated with it. More specifically this project will focus on physical inactivity and associated NCDs and will assess their economic impacts in terms of health care expenditures, other public and private expenditures, and broader economic costs. The geographical scope of the project will include a large set of countries in the WHO-European region. WHO-Euro and OECD are two leading intergovernmental institutions with a distinctive cross-sectoral expertise and a global reach, which are placed in a unique position to help countries tackle physical inactivity and associated NCDs. OECD is a leading economic institution helping countries implement effective and efficient policy actions that will improve the economic and social well-being of their citizens. As part of its programme of work on public health, OECD has developed a microsimulation model to assess the health and economic impact of major behavioural risk factors and their associated NCDs. WHO is the body of the United Nations responsible for directing and coordinating health. Among the other, its core functions include: i) Monitoring the health situation and addressing health trends; and ii) providing technical support, catalysing change, and building sustainable institutional capacity. Thus, by joining forces, OECD and WHO-Euro can play a critical role to make the economic case to invest in policies to tackle physical inactivity and to support the development and the implementation of effective strategies. Methods and work packages 18 Source: http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/data- and-statistics/10-key-facts-on-physical-activity-in-the-who-european-region 19 https://doi.org/10.1016/S0140-6736(16)30383-X 20 http://dx.doi.org/10.1787/9780335262274-en Page 82 of 97 It is proposed to base the project on the following four work packages (WP). 1. Development of a framework to assess the direct and indirect costs caused by insufficient physical activity and its associated NCDs. As part of this WP, OECD will develop a framework to carry out a full economic assessment of the economic impact of insufficient levels of physical inactivity and its associated NCDs. The scope of economic impacts covered in the framework may include the following: a. Health care costs, funded through either public or private expenditure, including any extra costs associated with the medical treatment of patients with the risk factors in question, relative to patients treated for the same conditions but without the risk factors. b. Labour market impacts of physical inactivity and the main NCDs associated with this risk factor, mainly in terms of labour force participation and productivity at work (including sick leave), and their possible impacts on countries’ national income (GDP). c. Economics impacts of welfare benefits and other transfer payments linked with physical inactivity, including, for example, increased receipt of unemployment, sickness, disability, and early retirement benefits. The framework will be designed to be broadly compatible with other similar analyses on obesity and harmful alcohol consumption undertaken by OECD. This will increase comparability of results and will support the decision process at the country level to invest on priority actions. 2. Identification and preparation of the data to feed the analyses WHO-Europe and OECD will work together to identify and prepare suitable input data to feed the analysis. While the OECD microsimulation platform already includes key epidemiological parameters for a number of OECD and EU countries, this WP will be carried out with the following objectives: a. To expand the geographical scope of the model to include additional key countries in the WHO-Europe Region including, for example, the Russian Federation and Turkey that are not currently incorporated in the model. b. To get access to additional country-level estimates of the treatment costs of key NCDs. OECD has already secured access to country-level data for a limited number of European countries. Country- specific estimates are then used to extrapolate treatment costs for countries for which data is not available. Country-specific data for additional countries will be used to further improve estimates of direct costs. c. To carry out some epidemiological analyses on international datasets to inform the final report and set the scene for the economic analysis. For example, this could include some analyses on the physical activity-related questions part of the WHO Childhood Obesity Surveillance Initiative (COSI) survey. 3. Carrying out of the analyses and interpretation of the findings OECD will develop the model with and will carry out the analyses. The OECD platform produces standard results for a number of epidemiological and economic outputs. For this specific project, the model will be adapted to produce economic outputs as described in WP1. More specifically, this will entail the production of outputs in terms of: i) impact on healthcare expenditure (i.e. direct costs); ii) impact on the labour market, including labour force participation, absenteeism and presenteeism; iii) the economic impact of welfare Page 83 of 97 benefits and other transfer payment; and iv) the impact on GDP. OECD and WHO-Europe will work together to interpret the results of the analysis. 4. Writing up of the report and dissemination of the results Both OECD and WHO-Europe will contribute to the drafting of the report, building on their respective competencies. OECD will mainly focus on the presentation of the results of the economic modelling work while WHO-Europe will have a leading role in the sections setting the scene and in the sections describing the global commitments to tackle NCDs and how findings from this project can support countries in meeting the agreed objectives, including for example the Millennium Development Goals. The two Organizations will work together on the sections outlining the policy implications of this analysis. The two Organizations will also collaborate to disseminate the results of this project by agreeing on a potential launch event (and/or country events). Timeline and deliverables The project will be designed as a 18 month project, with delivery of the final report three months after the end of the project. (i.e. 21 months after the beginning of the project). A first interim report, focusing only on direct costs (i.e. healthcare costs) will be delivered 10 months after the beginning of the project (i.e. about at the end of 2018, assuming a beginning of the project on the 1st of March 2018). The interim report as well as the final report will be released as joint publications of the OECD and WHO-Europe. Page 84 of 97 Annex V: Power point presentation in English, on the results achieved through this grant Promoting Physical Activity for Health in the European Union: PROMPAEU – a joint collaboration WHO/DG EAC Lea Nash, João Breda, Stephen Whiting Nutrition, Physical Activity and Obesity WHO Regional Office for Europe Background HEPAP project 2013-2015 Page 85 of 97 PROMPAEU project 24 months: Jan 2017-Dec 2018 Joint WHO/DG EAC initiative Priority area: Health-Enhancing Physical Activity Main Collaborator s • DG-EAC • HEPA Focal Points • University of Zurich • Erlangen University • RIVM, the Netherlands • HEPA Europe Network • OECD Page 86 of 97 Global Action Plan for Physical Activity Physical activity strategy for the WHO European Region 2016–2025 Global targets Page 87 of 97 Objective I To support the development and scaling up of monitoring and surveillance of HEPA in the EU, in line with the monitoring framework, with the view to improve evidence-informed policy-making in the EU. Focal Points meetings • Support, capacity building and networking opportunities • Development of new projects and initiatives • Exposure to other networks Page 88 of 97 Monitoring and surveillance • Revision and improvement of the HEPA questionnaire • Proposed updates for the Staff Working Document Objective II To issue revised country factsheets on physical activity and to update the European Health Information Gateway database (formerly NOPA) with recent data, good practices and success stories, in line with the monitoring framework. Page 89 of 97 Country Physical Activity Factsheets Thematic factsheets: Education and Health Page 90 of 97 Availability of data Objective III To support governments and other stakeholders in their initiatives aiming at increasing levels of physical activity and reducing sedentary behaviours (e.g. national physical activity guidelines, and/or guidelines for specific groups such as children or the elderly). Page 91 of 97 • Physical activity roadmap for Latvia • Review comparing PA guidelines across EU countries including special populations • Review summarizing the different methodologies used to develop national PA guidelines Page 92 of 97 Objective IV To design a methodology to estimate physical inactivity related socio-economic costs. Methodology to estimate physical inactivity related socio-economic costs Page 93 of 97 Participation in relevant events • Meeting reports • Resources in WHO website • News items • Social media posts • Launch of Factsheets by DG EAC • Scientific publications Communication and dissemination Page 94 of 97 Downloads 1017 474 328 Page visits 5675 15312 18695 19651 0 5000 10000 15000 20000 25000 Physical activity country fact sheets HEPA Europe Data and statistics Home page Page 95 of 97 Thank you! Page 96 of 97 The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. 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World Health Organization (WHO) · Technical Documents
Final technical report 2016–2018: project grant number: EAC-2016-0388: promoting physical activity in the European Union (PROMPAEU) – a joint collaboration WHO/DG-EAC
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