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“How much physical activity people do depends largely on their access to places or facilities where they can be active — whether this is walking or cycling to work or doing other physical activity at school or work,” explains REPOPA project coordinator Arja Aro. To a large extent, policies determine communities’ access to facilities — for example, gym equipment in public parks, cycle tracks and sports fields in schools.
But REPOPA’s analysis of 29 policies from 6 European countries showed that most policies aren’t based on evidence. “For the most part, the policies are based on other factors such as political pressure, the media and financial constraints,” explains Aro. The seven-country project team sought to turn this around by putting evidence at the heart of policy decisions.
The challenge — integrating research on health into policymaking
“Policymakers often have a hard time finding and applying research evidence in their real life policymaking,” reports Aro. “We can’t simply tell municipalities to create certain policies — for example, cycle lanes or paths — and expect them to implement them. This is because the research evidence is not the only factor policymakers must take into account,” she explains.
They need to consider the needs, priorities and values of multiple sectors, such as community groups, schools, hospitals, transport networks, leisure facilities and political groups. To help policy makers, the project developed a checklist of 28 items. Policymakers can use the checklist to determine whether they are creating evidence-informed policies and have considered all the relevant factors.
Collaboration — the key to developing effective policy
“Unfortunately, most policymakers often work in silos — rather than together,” says Aro. Some municipalities have established groups and committees to develop more effective policies that increase physical activity. “Designed to help policymakers incorporate the needs of multiple stakeholders, these groups have had positive results,” she points out.
For example, in an initiative not linked to REPOPA, a city in Finland has established a group that initiated the integration of physical activity into all lessons at school. After implementing this policy for five years, obesity in schoolchildren decreased.
REPOPA has built an international online platform to facilitate the work of national platforms. These platforms have taken different forms; for instance a subgroup of a national public health association has been established to facilitate research-policymaking collaboration in Denmark. In the Netherlands meanwhile, the online platform is linked with the Dutch portal for health promotion and prevention.
“Through genuine collaboration across sectors, policymakers and researchers can directly influence society by using resources more effectively, creating win-win solutions and environments. The impact on society is even greater if citizens have the opportunity to participate in the process,” emphasises Aro. For example, if parents are consulted in creating a pedestrian zone in the streets around a school, they are more likely to support the initiative.
Tailor-made solutions — delivering what communities need
“By working with local authorities, we showed that research and policymakers can really get results when they work together. The REPOPA project didn’t simply hand over the research. We teamed up with local authorities to learn what policymakers actually need and how researchers can help them achieve their goals. Together we worked to create positive change,” reports Aro.
For example, REPOPA researchers collaborated with municipalities in Tuscany, Italy, and in Utrecht in the Netherlands, and with two municipalities in Denmark. They applied the stewardship approach to policy making within public health: “This approach assesses the needs and values of stakeholders, including municipalities and other target groups of policy makers, and incorporates cross-sector priorities to develop effective policies,” says Aro.
“In Tuscany the concept of evidence-informed policy making was relatively new. The local municipalities needed to focus on raising awareness about research use and the possibility of applying scientific knowledge to local needs in health policy making,” reports Aro. This intervention raised awareness in local schools and resulted in more groups of children being walked to school by adults. The community has continued these organised school walks since REPOPA’s involvement ended.
In Utrecht, the project researchers assessed the elderly’s physical activity needs alongside existing facilities that cater for them. “We then worked with the local municipality and brought different initiatives such as ‘participation to ability’, ‘welcoming neighbourhoods’ and ‘residential health care’ together to form a network. This enabled us to collaborate and build policies that would ensure the provision of seamless and easy-to-access physical activity services to the elderly,” she explains.
“In Denmark, the project interventions have led policymakers to start asking researchers for more information in order to better inform their decisions. For example, in one city policymakers asked researchers what other countries are doing about obesity and looking to share ideas. This led to a collaboration contract to carry out a literature search on obesity prevention interventions in Nordic countries and the Netherlands,” reports Aro.
From now on, these policymakers can use the REPOPA online platform to access best practices, case studies and news in the field of evidence-informed policymaking in physical activity for health. Policymakers focused on other areas of healthy living can also draw on the tools and lessons learned in REPOPA.