The role of public-private synergies

– Written by Liliana Leone, Caterina Pesce, Laura Capranica, Italy

WORKING TOGETHER TO TACKLE THE PANDEMIC OF PHYSICAL INACTIVITY IN YOUTH

Well-being is a fundamental human right and its promotion for the healthy cognitive, emotional, behavioural, physical and social development of the individual is a key objective of the World Health Organization (WHO)¹. Considering that the most sensitive period of the human lifecycle in which to promote long-lasting health-enhancing behaviours is childhood, youth education on active lifestyles and sport is deemed crucial². A significant factor contributing to the health, social development, learning capabilities and resilience to mental problems of children is their involvement in daily physical activity (PA), which includes free play, active transportation and recreation, physical education at school, organised sports or planned exercise^3-5. However, the majority of young people do not reach the minimum PA level recommended by public health guidelines⁶ and physical inactivity is now considered a ‘pandemic’ phenomenon^7,8, with onset as early as childhood.

The urgent need to promote active lifestyles in youth requires relevant effort and resource, which could be reached through a synergy between international conventions on children’s rights, public health agency recommendations and the promotion of PA programmes. The business sector can mobilise considerable resources, therefore corporate involvement in a social movement for the development of effective PA strategies is vital⁹. In fact, governments are increasingly working with the business sector to tackle complex health and environmental problems^10,11. Although cross-sector co-operation among public authorities, civil society and the business sector is deemed important, independence, openness and clarity of roles should be assured. This paper will present the role of international organisations in recognising the child’s rights to play and well-being, the corporate role in and reasons for promoting health-enhancing PA and selected European examples of supranational and national governmental initiatives to promote the co-operation of public, private and non-profit organisations to enhance PA. We will specifically select and present information regarding the promotion of PA for children.

CHILDREN’S RIGHT TO BE PHYSICALLY ACTIVE

The United Nations (UN) Convention on the Rights of the Child^12-15 considers PA and recreation as human rights, explicitly recognising the right of the child to health (Article 24), rest, leisure, play and to engage in recreational activities (Article 31). In particular, the UN General Comment number 4: 'Adolescent health and development in the context of the Convention on the Rights of the Child'¹⁶ draws specific attention to the importance of adequate information on health-related topics including PA (Section III, 26). Furthermore, a UN committee monitors the implementation of the Convention on the Rights of the Child in state parties and formulates General Comments on specific issues to implement the Convention. To support the development of measures, guidelines and programmes to ensure that children receive the rights set out in Article 31. General Comment number 17/2013 (Section III, 8) of the UN Committee on the Right of the Child recommends the availability of:

Environments in which play and recreational opportunities are accessible to all children and provide the conditions for creativity.

Opportunities to exercise competence through self-initiated play, enhancing motivation, PA and skill development, as well as cultural life-enriching playful interactions.

The right to rest, which ensures children have the necessary energy and motivation to participate in play and creative engagement.

The paucity of safe environments accessible for play (i.e. secure from social harm or violence, sufficiently free from waste, pollution, traffic and other physical hazards, appropriate to the age and developmental level of the young individual) and the increase in restrictive norms governing public spaces represent major limitations on young people enjoying their right to be physically active¹⁷. Furthermore, the parental perception of an unsafe environment contributes to the lack of active transport to school and is strongly related to the physical inactivity of children¹⁸.

Another barrier to the implementation of health-enhancing leisure activities for youth is the definition of the quality of ‘leisure activities’. While some Committee on the Rights of the Child national reports associate the term ‘leisure’ with the number of playgrounds and sport activities^19-21, others include a range of activities that are unlikely to be recognised as health-enhancing, being sedentary in nature, such as eating out, strolling/shopping, home audio/video entertainment, internet surfing and watching TV²². Despite the alarming incidence of child and adolescent sedentary behaviours and obesity in Western countries^23,24, according to the considerations of the United Nations on the implementation of the Committee on the Rights of the Child Convention¹⁴ only a few national reports from European member states such as Denmark, Finland and the UK²⁰ mentioned PA or healthy lifestyles, while other reports focused on healthy eating habits (France), ‘eating disorders’ or ‘better nutrition’ (Norway). Conversely, in recognising the interaction between PA and diet at individual and global levels, the European Joint Programming Initiative Healthy Diet and Healthy Lifestyle²⁵ supports the Determinants of Diet and Physical Activity Knowledge Hub. It involves 46 trans- and multi-disciplinary consortia and organisations from 12 countries across Europe aiming to:

Offer relevant indications on assessment and harmonisation of methods for future research, surveillance and monitoring and for evaluation of interventions and policies.

Improve the understanding of determinants of dietary, PA and sedentary behaviours.

Provide information for evaluation of public health and policy interventions on diet and physical activity²⁶.

THE CORPORATE ROLE IN PHYSICAL ACTIVITY PROMOTION

The European Commission defines Corporate Social Responsibility (CSR) as “the responsibility of enterprises for their impacts on society”²⁷. Voluntary CSR activities undertaken by business enterprises range from social investments to advocacy and public policy engagement. Built upon the UN Guiding Principles on Business and Human Rights and on UN Global Impact, the European Commission’s CSR strategy includes activities to integrate social, environmental, ethical human rights and consumer concerns into corporate business operations and core strategy, in close collaboration with its stakeholders. In fact, the public perception of the influence of corporates in society and their commitments in the CSR framework is influencing their business and varies across countries and industry sectors.

The UN has addressed the role of the private business sector as a service provider that can impact children’s rights in a variety of ways¹³ and has recognised the importance of voluntary CSR activities as a potential means to support and advance children’s rights. Furthermore, it has emphasised the crucial role of public legislation and regulation in creating a regulatory environment to enable business enterprises which respect children’s rights, as well as enforcing internationally agreed standards concerning children’s rights, health and business in the National policy framework.

The role of corporates as a potential determinant of PA has been recognised by recommendations and strategic documents of the UN Committee on the Rights of the Child¹³, the WHO^1,28,29 and the European Union^30,31. The WHO^1,28,29 also endorsed the support and facilitation of the development of multi-sector interventions and public-private partnerships for the promotion of healthy diet and health-enhancing PA. In particular, the WHO Europe claimed that an “explicit recognition of the obesogenic environment… and its socioeconomic determinants needs to be tackled”³¹ through legislative measures, which should ensure that the private sector meets guidelines for CSR.

To counteract the alarming obesity and sedentary lifestyle in European youth, two official EU communications recommended a strong co-operation between public agencies, non-governmental organisations (NGOs), consumers and for-profit organisations^32,33. Corporate choices and advertising broadly impact and shape the physical, socio-economic and cultural environments. Therefore, corporates have been considered social determinants of health³⁴ and may affect PA behaviours through:

Direct goals and commitments within the CSR frameworks that include sport and PA.

Indirect complex influences that shape and transform our environments (i.e. work, leisure, travel, use of land, common goods, etc.).

In the last decade, the call for a healthy lifestyle with the use of sports values has been a very common approach among corporate marketing and advertising practices targeted at young people³⁵. In the context of social alarm for rising youth obesity, CSR initiatives targeting children have widely adopted a brand association with sports values and well-being^35,36.

CSR strategies among different industry sectors offer examples of good practices³⁷. Patterns of disclosure may vary when a company belongs to an industry sector whose core business could present intrinsic conflicts (e.g. food and drink) with a CSR perspective aimed at reducing the incidence of overweight and obesity in the population. In these sectors, high-profile (i.e. high consumer visibility and political risk) companies tend to disclose CSR information aimed at changing public perception and social expectations, without changing its output, methods or goals³⁸ by:

Informing on their performance.

Associating themselves with symbols that have a high legitimate status (e.g. elite athletes, movie stars etc.).

Deflecting attention from the relevant issue to other apparently related issues.

Studies focusing on the CSR initiatives in the food manufacturing, food retail and food service sectors showed that only a few companies reformulated their business strategy according to the WHO’s Global Strategy on Diet, Physical Activity and Health²⁹, whereas many others used a ‘blaming strategy’ by underlining the consumers’ responsibility to be physically active^39,40. Food manufacturers tended to report more concrete commitments in PA than corporates belonging to other sub-sectors, but only a few had policies specifically on children.

CORPORATE SOCIAL RESPONSIBILITY INTERVENTIONS: LESSONS FOR CHILDREN’S PHYSICAL ACTIVITY PROMOTION.

Governments and public agencies not only have to promote common frameworks to prioritise PA in CSR initiatives, but also have to provide regulatory tools, guidelines and rules to avoid improper CSR deployment and tactical strategies. Therefore, effective monitoring systems and external evaluations have to be structured to ensure the enhancement of healthy and active lifestyles. Although several international platforms exist with registers of CSR reports and criteria to judge a corporate’s campaign content, the role of public authorities in monitoring and evaluating health-related CSR should be advanced further³⁷.

In 2005, the EU Platform for Action on Diet, Physical Activity and Health was launched to provide a common forum for the parties interested in:

Exchanging knowledge at a European level about CSR plans and performance.

Assembling evidence of effective activities and best practices.

Monitoring corporate commitments to health, including consumer information and education on diet-related issues and PA promotion⁴¹.

A monitoring report of the EU Platform for Action on Diet, Physical Activity and Health analysed the contents of 148 monitoring forms submitted by EU members to the European Commission⁴². Findings highlighted commitments mainly focused on food, product labelling, advertising control and eating behaviours, nutrition education and information. Conversely, commitments on PA were limited and mainly referring to structured sport participation with only limited attention to non-sport PA. A more recent evaluation report addressing the 2006 to 2012 period⁴³ showed a downward trend in PA commitments despite an overall increase in commitments over time. In general, corporates raised their awareness regarding the benefits of regular PA on workers’ health and the positive impact on health insurance fees, with a consequently increased support for the implementation of PA programmes such as cycling to work. Conversely, some unintended negative consequences emerged, especially relating to the increased exposure of children to industry brands, mainly due to their sponsoring sports events and social media marketing campaigns.

In 2010, the UK Government Department of Health launched the ‘Public Health Responsibility Deal’⁴⁴ to bring together the industries in sectors relevant to health promotion and public health organisations, local authorities, NGOs and charities. Four main health promotion topics were addressed: alcohol, physical activity, tobacco and nutrition⁴⁵. Over the last 3 years, a large number of partners committed to enhancing active transport, disseminating PA guidelines and/or increasing participation in community-based sport and PA. However, it has been argued that health benefits were unlikely to be produced due to the voluntary nature of the deal and the weak commitment of the contributing industries⁴⁶.

In considering the international initiatives designed to increase an active lifestyle in children, some indications have emerged:

The CSR framework for PA promotion is an underrated area, with advocacy and investment of resources for non-sport PA⁴³ still scarce. Commitments for PA in children, mainly undertaken by the food and drink industry, are often limited to sponsorship of big sports events or communication campaigns, with modest effects in terms of changing individual behaviours.

There is a need for credible and independent monitoring and evaluation systems, as CSR commitments are still lacking in transparency. In fact, economic support of sport programmes and events might determine biases favouring the sponsors’ product^47,48. The paucity of evaluation studies by third parties with no conflict of interest show the need for further research to better understand how to tackle different strategies of PA promotion in relation to different core businesses and to identify patterns of disclosure within the CSR framework. This would be a necessary step toward co-operation with the business sector to promote PA in the framework of the global rights of children.

The remarkable ‘Responsibility Deal’ coalition promoted by the UK Government represents a tremendous example of governmental attempts to work with business, dealing with the pressures and conflict of interests in the health area. A strong public debate emerged and some national health associations refused to sign the pledges for health promotion. However, the public disclosure of signed pledges and the annual reports from NGOs actively advocating for children’s rights to healthy life showed that it is possible to recognise and sustain virtuous alliances or denounce corporate tactical behaviours⁴⁹. Considering that corporates are exposed to public debate advocating for corporate transparency, a positive impact also for PA promotion in children within the CSR framework could be envisioned.

The future periodic national reports by the Convention on the Rights of the Child should increase their focus on PA. Networks, NGOs and health bodies should reinforce a broad strategy to counter physical inactivity trends in youth and to fulfil the right of the child to free play activities, adequate access to green spaces, active playful learning, non-competitive leisure activities and a limitation of the compulsory activities required by adults of their children¹⁵. Certainly, strong action across multiple fronts is required to counteract the alarming secular trend in unhealthy lifestyles in our children.

Liliana Leone Ph.D.

Director

CEVAS Centre of Research and Evaluation Rome, Italy

University of Rome Foro Italico

Department of Human Movement and Sports Science

Rome, Italy

Caterina Pesce Ph.D.

Associate Professor

University of Rome Foro Italico

Department of Human Movement and Sports Science

Rome, Italy

Laura Capranica M.Sc.

Professor

University of Rome Foro Italico

Department of Human Movement and Sports Science

Rome, Italy

Contact: laura.capranica@uniroma4.it

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