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07 September, 2017

Personal perspective: WHO Global Action Plan for Physical Activity (GAPPA) 2018 in 2030

Professor Adrian Bauman, Global Editorial Board Member, GlobalPANet Executive Committee

This is an excellent document and a comprehensive and contemporary approach to physical activity in the 21st century. It builds on much of the work of recent years, particularly on the DPAS 2004 WHO diet and physical activity strategy. It also links politically to the SDGs,  and although this is sometimes a substantial stretch, it is politically essential in the ways that WHO and other UN agencies work.  One SDG example that is slightly more  difficult to relate to PA is "health as a human right", which really has traditional public health measures, reductions in interpersonal violence and victimisation at its core (although the case is made here in physical activity as the freedom to participate).

The key challenge is that the physical activity position, relative to other NCD risk factors remains relatively low, the concept of "the Cinderella risk factor". This is not brought out in the GAPPA plan clearly enough. This means that although many countries report having physical activity plans, there is no enforcement and low levels of implementation of these plans, suggesting that there is a small likelihood that most countries will achieve the Global Monitoring Framework target of 10% reduction in physical inactivity by 2025.

This GAPPA is one of the first international physical activity strategies grounded in the concepts of cross-sectoral consultation and multi-sectoral action for global physical activity. This is a major advance, and outstanding work by WHO to be working outside of the health sector as transparently and clearly as is articulated here. This leads to the implications that active travel, walkable environments, sport in some countries, and active recreation and leisure are all different (outside Health) ways in which physical activity goals can be realised at the national level.

The principles are also generic, but are sensible in focusing on a life course approach, an equity approach, safety for all activity, evidence-based interventions, mandatory cross sectoral action, and policy coherence. One of the challenges to the latter is that physical activity is often subsumed under obesity or other NCD prevention plans, and implementing cross-sectoral actions is therefore hampered. 

The concept of an active society involves changing social norms, which is seldom actually targeted in most mass media and social marketing communications, and may be politically difficult to do in many countries. This is a caveat in the action plan elements around communications strategies. 

Generic statements around active environments , active lives and active systems are all sensible,  and although well recognised and accepted in the PA literature, will still be innovative approaches in many countries and settings.

One area of great promise, but yet to be realised is the concept of health professionals as change agents in the physical activity and exercise area. Despite much potential, movements such as "Exercise is Medicine" have not realised population wide reach in many countries, but the concept remains relevant that primary health care professionals, most physicians, nurses, dietitians, physiotherapists and others all having a role in physical activity promotion.

Another excellent innovation is the concept of cross-sectoral benefit, with active commuting, active environments, green space and walkability linked to themes around urban planning, transport systems and air quality. The life course approach is also very clear, as physical activity needs to occur from preschool ages through to adults and senior citizens to promote healthy activity in different ways with differing outcomes and effects. 

In summary this is a remarkable WHO effort, and should be commended for its strategic innovation and foresightedness. Challenges for implementation will remain, but setting this agenda for change is a definite step forwards in a world that mostly steps backwards or sideways.

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