• Photograph by Creative Commons

The social determinants of physical activity

Let's exercise our policy opportunities to build healthier communities.

Exercise is tough. We all know the difficulty of getting to the gym or out for a walk, especially after a long day of tiring work. Cold or inclement weather, a regular occurrence living in Canada, doesn’t help either. We know how beneficial exercise is for our health — if only we could just… do it! So how can we make it easier for us to get some physical activity?

Most people have an understanding that physical activity is good for them, but they might not realize just how important it is. Physical activity is a first-line prevention or treatment in almost all diagnoses, but especially chronic diseases, including Cardiovascular Disease, Diabetes, Hypertension, Cancers, and Mental illness — accounting for most of our negative health outcomes and healthcare spending. Rates of these chronic diseases are rising at 14% a year in Canada, and their impacts negatively affect the productivity of our economies as well.

Increased physical activity is the solution we need. It is a proven panacea of chronic disease, and it also helps our immune system, speeding the transition of our T1- to T2-helper cell response, enhances self-efficacy and even activities in the bedroom. It also improves overall quality of life.

"If we want healthier communities, we must make it easier for individuals to feel good about physical activity in the context of their own lives."

The obvious question is “how do we help people to exercise?”. This is a challenge I distinctly remember from throughout Kinesiology, Physical Education, and now Medicine, as well as working as a trainer, teacher, and mentor within all sorts of groups and communities, most recently leading the Bicycling North project of the Making the Links program of the College of Medicine Division of Social Accountability. But we can’t just tell people to “exercise more”. The evidence shows us behaviour stems from the social, the economic and the political, much more so than from the personal.

The literature tells us, and my own experience confirms it all the time, that behaviour is directed most by our internal motivation (how we feel), which is in turn determined by the context of our daily life. Income, education, options, and community values influence the ease one perceives in being able to be active.

For example, someone of lower socioeconomic status is less likely to be able to afford equipment, a person’s neighbourhood might have limited greenspace and walkability, or someone’s community norms might not value exercise. Fortunately, we can positively influence these factors with upstream policy making. There are many ways government policies can shape opportunities for physical activity that fits with one’s life:

Bike lanes encourage individuals to exercise through commuting to and from work or school, because they facilitate integration of bicycling within one’s daily life. Locally here in Saskatchewan, Members of the Bridge City Bicycle Co-op and Saskatoon Cycles know that bike lanes support safe, economical, time-efficient, and enjoyed travel — with the health benefits of physical activity as an extra, positive effect. We see the same factors — play out in other cities, and policy that requires bikes lanes connecting all neighbourhoods is one way we can encourage physical activity from its strongest determinants.

Walkable neighbourhoods, where individuals and families can freely travel varied routes and distances, whether for leisure, to a medical clinic or grocery store, or to recreational and green spaces, encourage walking as a regular means of accessing one’s community. Well-designed neighbourhoods support social interaction and empowerment. Recreational greenspaces, like our own Meewasin Valley in Saskatoon, provide a free place to exercise. Policies that protect and promote development of these sorts of areas should be implemented.

"The evidence shows us behaviour stems from the social, the economic and the political, much more so than from the personal."

Community gardens are another great option to address the social determinants of exercise. Aside from the physical activity of gardening itself, the food produced, and social interaction cultivated would further address factors of food security, income, and community values.

We have to promote public health in our policy making for physical activity, but also in our culture. In Buffalo Narrows, a northern Saskatchewan village, the cross-country ski trails are inspired by the Cree phrase ‘waskawîhew’, which means “to move oneself with one’s own body”. Our cultural norms towards physical activity can be influenced with upstream strategies and policies like this that promote healthy behaviours, saving us a lot of negative health outcomes down the road.

If we want healthier communities, we must make it easier for individuals to feel good about physical activity in the context of their own lives. We are more likely to walk to services in our community if we have food security and appropriate shoes. We are more likely to attempt a new activity if we have the literacy and information centre to understand it better. We are more likely bike to work if we feel safe and comfortable in accessing our route. We are more likely to comply with exercises when values and promotions of our community support this.

The benefits extend beyond improved health and quality of life, to less healthcare spending and increased economic productivity. We shouldn’t abide leadership that dismisses the evidence for physical activity in making our society healthier, when we can instead make upstream policies to modify factors in our physical and social environment to support opportunities for physical activity to fit with daily life. When you get down to it, physical activity is socially determined.




20139720_10154884175087404_7127893509766142736_n.jpgBrendan Groat is a third year medical student at the University of Saskatchewan with a background in Kinesiology. He's the executive of Mindful Living, and a SWITCH mentor. He spent this past summer biking across northern Saskatchewan, bringing bike tool kits to northern communities.




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