Dr. Andrew Pipe 'Send Your Children Outside To Play'
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Send Your Children Outside to Play Andrew Pipe, CM, MD Minto Prevention & Rehabilitation Centre, University of Ottawa Heart Institute
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Dr. Andrew Pipe provided a keynote presentation to the Healthy Children Healthy Spaces Initiative in Ottawa in November, 2010. As the Medical Director of Prevention and Rehab at the University of Ottawa Heart Institute, Dr Pipe speaks to the critical need to shift our children away from sedentary screen based time to outdoor, active, unstructured play.
Transcript of Dr. Andrew Pipe 'Send Your Children Outside To Play'
Send Your Children Outside
to Play
Andrew Pipe, CM, MDMinto Prevention & Rehabilitation Centre,
University of Ottawa Heart Institute
“The history of epidemics is the history of disturbances in human culture.”
Rudolf Virchow
“for the ordinary Canadian child … physical fitness … seems to be a decreasing function of age from the time we put him behind a desk in our schools.”
Bailey, 1974
Statistics Canada Health Reports 2009;21(1)
Typical 12-year-old boy
Statistics Canada Health Reports 2009;21(1)
Typical 12-year-old girl
Statistics Canada Health Reports 2009;21(1)
Canadian TeensBoys Girls
Overweight 17% 16%
Obese 14% 10%
The Active Healthy Kids Canada Report Card 2010
Canadian Children & Youth MeetingPhysical-activity Guidelines
Newfoundland
25.6% of pre-schoolers are overweight or obese
“…prevention measures should begin before the age of 3 years.”
Cannning, Courage, Frizzel. CMAJ:171; 2004
A Cause for Concern...
63% of youngsters not active enough for optimal growth and development
A decline in activity with age and gender
Girls are less involved in intense physical activity
Physical Activity Monitor CFLRI, 1999
90% of children and youth don’t meet Canada’s recommendation
for 90 minutes of moderate to vigorous physical activity daily
Canada’s Report Card on Physical Activity for Children & Youth 2008
Active Healthy Kids Canada
It is difficult to maintain a healthy diet and physical activity in an environment that discourages physical
activity and encourages excessive consumption.
Am J Clin Nutr 2009;89:477-84
Our Obesogenic Environment
"Can Johnny come out and eat?"
“Unless effective interventions to reduce obesity are developed, the steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today
may live shorter lives than their parents.”
N Engl J Med 2005 Mar;352(11):1138-1145
“No health system is yet meeting the challenge of managing obesity, and no society has developed an effective strategy to prevent it”
Lancet May 13, 2006
“Our genes have not changed substantially
during the past two decades. The culprit is an environment which
promotes behaviours that cause obesity.”
A New Evolutionary Development ?
The Global Burden of Diabetes:
30
135
171
366
0
50
100
150
200
250
300
350
400
1985 1995 2000 2030
Global Strategy on Diet, Physical Activity and Health: Diabetes; http://www.who.int/dietphysicalactivity/publications/facts/diabetes/en/
Mill
ion
s o
f p
eo
ple
63%
Estimated Prevalence of Cardiovascular Risk Factors
Am J Med Sci 2002;324(3):127-137
Contributing Factors?
“Security”
“Solicitude”
“Screens”
“Sodas”
“Schoolbuses”
Causal Web
Obesity: A Highly Complex Issue
Each additional daily serving of soda increases
the risk of childhood obesity
by 60%.
The ‘Food’ Environment
91% of Canadian children have
bicycles…
5% ride them to school !
Active Transportation
Nature deficit disorder: a disconnect between today’s indoor children and the natural world
Richard Louv, Last Child in the Woods, 2005
“A growing number of policy experts, urban planners, and transportation experts are
concerned that we have built our communities so that it is difficult, and in many cases dangerous, to walk or bike and have thus “engineered” physical
activity out of our daily lives.”
Ann Behav Med 2003;25:80-91
Am J Prev Med 2008;35(3):237-244
Newer neighbourhoods are often designed to facilitate car travel.
Walkable Neighbourhoods
Older neighbourhoods
were often designed with pedestrians
in mind.
Am J Prev Med 2008;35(3):237-244
Walkable Neighbourhoods
Adding a decade to the average age of
neighbourhod housing decreases risk of
obesity by8% in women and by
13% in men.
Am J Prev Med 2008;35(3):237-244
Travel Distances and Urban Forms
International Regional Science Review 2005;28(2):193-216
1.3 miles vs. 0.5 miles
Images are same scale, approximately 1 square mile
AA
B B
Walkable Neighbourhoods
Include the 3Ds:
population Density
pedestrian-friendly Design
Diversity of destinations
Am J Prev Med 2008;35(3):237-244
“Whenever I meditate about a disease,I always think of preventing it,
rather than finding a cure.”
Louis Pasteur
The Continuum of Prevention
Target: CVD
Patient
Target: Persons with CVD risk factors but no CVD or
diabetes
Goal: Prevent first CVD event
Target: Entire Population
Goal: Prevent risk factor development
Secondary Prevention Secondary Prevention
Goal: Prevent recurrent
CVD event
Primary Prevention Primary Prevention
Health Promotion Health Promotion
Ensuring Child Health
The ‘Active School’ Concept
An integrated array of activities:
Academic, social, nutritional, and physical activity
programmes
School as the focus and a central resource of an
‘active’ community
Ontario: Healthy Schools Program
Removal of junk food from vending machines
Ontario: Healthy Schools Program
Minimum 20 minutes daily physical activity for all elementary students…
Opening of schools for community use after hours…
Food Policy
Agricultural support policies
Regulation Ingredients ? Portion Size ? Labeling ? Marketing ?
Taxation
“Healthy Planning” Policies
Supportive Environments
“Supporting the development and availability of an array of safe, accessible environments
and policies which facilitate activity”
Am J Public Health 2010;100:1672-78
Renovated schoolyards increase the number of
children who are physically active, and their overall
activity levels.
The Globe and Mail , November 12, 2010
Interacting with nature helps children learn
Understanding the population
we serve
Adoption of appropriate behaviours
before heart disease becomes clinically
apparent increases life expectancy by10 to 14 years.
Footer
Champlain Chronic Disease Risk Factor Profile (Adults 12+)
Area CVD
Mortality Rate*
Risk Factor Prevalence (%)**
Hyper-tension
DiabetesOver-
weight(BMI>25)
Obesity (BMI>30)
SmokingPhysical Inactivity
< 5 serv.F & V
Canada 200.7 14.4 4.6 33.3 14.8 23.0 47.3 55.2
Ontario 204.9 14.7 4.6 33.3 14.8 22.1 47.3 55.3
Champlain 206.7 14.0 6.0 36.6 14.3 21.2 43.9 54.8
Eastern Ontario 247.6 17.1 5.4 40.9 18.8 31.6 48.7 55.6
Renfrew County 257.0 16.9 5.5 36.6 18.4 27.5 47.0 58.1
LG&L 225.0 15.5 5.1 35.6 18.1 27.2 46.0 57.2
City of Ottawa 186.5 12.3 4.6 35.6 12.8 19.7 42.4 54.1
Source: Statistics Canada's health indicators data (2005)*, Canadian Community Health Survey**
The Champlain Declaration
The nine school boards in the Champlain District, in
partnership with the CCPN, commit to creating healthy
school environments so that school-aged children (aged 4 to 18) in the Champlain region can be physically
active and can make healthy food choices at school on a
daily basis.
School Board Priority Areas for Action
1. Healthy nutrition environments, with an immediate focus on the following elements:
a. Healthy fundraising
b. Healthy classroom rewards
c. Healthy lunch programs & food service contracts
2. Principal and teacher training to support implementation of physical activity and nutrition-related actions
Champlain Healthy School-aged Children Initiative
Identified actions for the Champlain Healthy School-aged Children Strategy:• Create progressive, supportive school policies
across the nine Champlain School Boards (The Champlain Declaration)
• Develop a regional communications campaign to promote healthy eating and physical activity
• Develop an evaluation tool for tracking progress (i.e. Champlain Report Card)
• Facilitate opportunities for skills development among teachers, parents, children and youth
European Charter on Counteracting Obesity
Encourage children to walk to school
Establish priority bicycle routes
“There are two causes of disease, one is
pathological … the other is political.” Rudolf Virchow
Change takes place when:
There is a “crisis”
A critical mass of scientific evidence
Shifts in social attitudes occur
Public cynicism grows
Political pressures begin to build
THERE IS LEADERSHIP !
Challenge Assumptions
Healthier Children?
Parents as
Leaders
and Advocates
‘Aesculapian Authority’
“the unique credibility afforded to health professionalswhen they speak out on issues relating to the health
and well-being of the individual or community.”
“If the creator had any purpose in equipping us with a neck…he surely
must have intended that we stick it out!”
Arthur Koestler
Beware of: Ignorance, Indifference and Inertia.
ActiveVigorousHealthy
CANADIAN !
Send Your Children Outside to Play !
A single piece of advice...
SendYour Kids OutsideTo Play!
First Nations
79% of adults are inactive
40% of youth are overweight or obese
60% of children are overweight or obese
1 in 5 adults are diabetic
PreventionAlternate approaches to paymentAlternate approaches to delivery of careTransformed patterns of practice
What does the future hold?
