Tackling the social determinants of health with culture and sport

Culture and sport are important in themselves. They are also significant contributors to tackling many of the social, economic and environmental challenges communities face – particularly improving health and wellbeing.

Culture and sport can alleviate both physical and mental health problems. They make major contributions to ill-health prevention too. Getting and keeping people fit and healthy has huge ‘upstream' benefits, particularly for an increasingly older community.

To date, much of the contribution of culture and sport to improving health and reducing health inequalities has focused on changing the health behaviours of individuals. The enormous difference the sector can and does make to the root causes of ill-health – the social, economic and environmental determinants of health – are sometimes overlooked.

This resource aims to raise the profile of culture and sport services and their impact on health outcomes. It provides practical examples of action taken to tackle the social determinants of health others can learn from.

It is aimed primarily at senior managers and councillors in local government and health commissioners. It includes a ‘top tips' section addressed specifically to councillors and health commissioners. But it is relevant to anyone with an interest in improving health and reducing health inequalities.

The health sector's perspective on culture and sport

‘The Marmot Review: fair society, healthy lives' recognises the role of culture and sport in reducing health inequalities. Most of the policy objectives refer to the culture and sport sector, including objectives to:

  • enable all children, young people and adults to maximise their capabilities and have control over their lives (Policy Objective B)
  • ensure a healthy standard of living for all (Policy Objective D)
  • create and develop healthy and sustainable places and communities (Policy Objective E)
  • strengthen the role and impact of ill health prevention (Policy Objective F).

The Department of Health (DH) acknowledges the role local services, including leisure, play in tackling the wider determinants of health and wellbeing. Its consultation document ‘Healthy lives, healthy people' included leisure – alongside children's services, employment services, transport and housing – as services that are crucial in achieving better health outcomes.

The Chief Medical Officer recognises the role of culture and sport in promoting physical activity and exercise to improve health. ‘Start active, stay active' sets out UK-wide guidelines for the first time. These cover the volume, duration, frequency and type of physical activity required throughout life to achieve general health benefits. They include active recreation, such as recreational walking, cycling and dance, as well as informal and competitive sport and individual pursuits among the activities that benefit health.

From 2013 responsibility for public health will be transferred to local government as outlined in ‘Healthy lives, healthy people'. This is expected to ensure better integration of public health with areas such as social care, transport, leisure, planning and housing. It will to keep people connected, active, independent and in their own homes.

Culture and sport and its impact on health

As ‘Start active, stay active' shows, culture and sport make an obvious impact on improving health and reducing health inequalities by encouraging physical activity. Many studies have shown that physical activity, including through cultural and sporting activity, saves, extends and improves the quality of lives.

For example: increasing physical activity through sport delivers significant public health benefits and can be a powerful enabler for people with physical disabilities, offering them opportunities to be more mobile.

People see dance as fun, expressive, non-competitive and sociable so they are motivated to take part. Dance increases people's physical fitness, strength and abilities, often more effectively than other forms of exercise.

The benefits of regular physical activity throughout life are clear. Regular physical activity reduces the risk of more than 20 chronic conditions, including:

  • coronary heart disease
  • stroke
  • type 2 diabetes
  • cancer
  • obesity
  • mental health problems
  • musculoskeletal conditions.

It also promotes healthy development of children and young people, and improves productivity in the workplace.

Despite this, fewer than half of adults and less than a third of children in England meet previous physical activity recommendations. And physical inactivity is the fourth leading risk factor for global mortality. Increasing physical activity therefore has the potential to:

  • improve the physical and mental health of the nation
  • reduce all-cause mortality
  • improve life expectancy.

Mental ill-health is the single largest cause of disability in the UK. It contributes up to 22.8 per cent of the total burden, compared to 15.9 per cent for cancer and 16.2 per cent for cardiovascular disease.

Participation in cultural and sporting activity makes a direct impact on improving mental health and wellbeing, as well as on increasing physical activity.

For example – participation in arts activity improves mental health and reduces mental distress by:

  • increasing motivation
  • inspiring hope
  • providing relaxation and distraction.

It can also reduce the symptoms of depression, including difficulty in falling asleep at night, sadness, difficulty concentrating and anxiety.

Self-expression through creativity promotes catharsis and self acceptance, and provides alternative ways of coping, reducing mental distress. Shared reading has therapeutic benefits in relation to depression and wellbeing.

Green space in people's living environment has a positive association with the perceived general health of residents. Exposure to nature quickly decreases stress and reduces pain, slowing respiration and lowering blood pressure.

The impact of culture and sport on the social determinants of health may be less immediately obvious but it is still significant and can take many forms. As a growing body of research and the case studies on this website show, participation in cultural or sporting activity can:

  • promote social interaction and build social networks
  • develop life skills, such as leadership, teamwork, cooperation, communication and creative thinking
  • build self-esteem, confidence and emotional resilience
  • raise aspiration, increase personal choice and control, and enable self-actualisation
  • increase concentration, helping to improve absenteeism, classroom behaviour and educational attainment among children and young people, and powers of recall in older people
  • encourage informal, life-long and inter-generational learning
  • bond communities together and build bridges between people from different backgrounds, strengthening community identify, cohesion and a
  • sense of belonging
  • divert young people away from substance misuse and anti-social and criminal behaviour
  • provide volunteering, work experience and employment opportunities.

The case studies show that using culture and sport to tackle the social determinants of health to improve health and reduce health inequalities is not just a viable option. It can be a better, more cost-effective option.

Inactivity and mental illness place substantial cost burdens on health and adult social care services and the wider economy. Each year, inactivity is estimated to cost:

  • £1.06 billion in direct costs to the NHS across the UK
  • £5.5 billion in lost productivity from sickness absence and £1 billion from the premature death of people of working age in England.

The direct costs of services, lost productivity at work and reduced quality of life through mental illness have been estimated at £105.2 billion a year in England.

Using culture and sport to tackle the social determinants of health reduces demand on high-cost health, care and welfare services. So it delivers significant cost savings as well as health benefits. It is both an efficient and effective use of investment due to the low delivery costs and broad appeal.

The ‘State of happiness' report argues that participation in cultural and sporting activities:

"...may be some of the most affordable methods of increasing individual and community wellbeing".

Increasing physical activity through sport alone could save the tax-payer over £3 billion a year in avoided healthcare costs.

The potential for the culture and sport sector to play a bigger role in achieving health outcomes is immense. Local government's new role in public health presents considerable opportunities for closer links between the culture and sport and health sectors.


7 January 2015

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