I would be interested to stay but, unfortunately, I have other business to attend to.
I thank the Senators for proposing this motion, in particular, Senator Eamonn Coghlan, whose reputation needs no introduction. I welcome a member of his family here today, his brother-in-law, Mr. Con Martin, who is from Skerries and the snooker player, Mr. Ken Doherty.
I support this motion and as I stated, I thank the Senators for raising it. It gives me the opportunity to speak on the issue, which is of immense importance, in which I have had an interest long before I came into politics and on which I had a motion before the World Medical Association on the role of the physician in the treatment of obesity and the area of exercise.
In particular, I wish to state categorically that obesity is a major health problem of epidemic proportions that affects a significant proportion of the population and is, in fact, a ticking time bomb in terms of the health risks it poses, particularly in regard to diabetes and cardiovascular disease, and the significant burden it places on health spending and the areas that Senator Colm Burke mentioned as well. A substantial part of the solution to the epidemic must lie with a deeper appreciation of the benefits of physical activity and a greater awareness of these benefits to be instilled in the general population, young and old alike. I accept that teaching children at an early age the value of this when they are receptive to it is the place to begin.
The term "physical activity" should not be mistaken with "exercise". Physical activity includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities such as gardening. Children and young people take part in various kinds of physical activity, for example, by playing games, participating in different sports and by active commuting. However, a cause for concern is that their daily habits, which have changed in recent years, as Senator Eamonn Coghlan pointed out, due to new leisure patterns such as TV, Internet and video games, have contributed to increasing rates of childhood overweight and obesity. It is far easier for parents to supervise a child sitting in a playroom playing the various computer games than if he or she were out in the street. We all remember, certainly my generation does, that children would take off in the morning and if they did not come home for lunch, parents would not be overly alarmed whereas now if a child is missing for more than ten minutes, everyone is in a state of panic, although, unfortunately, probably with good reason.
The Government is committed to an integrated and cross-departmental approach to addressing this issue. From the beginning of schooling, physical education forms part of the curriculum in primary and post-primary schools. In addition, social personal and health education, which is mandatory for all students in primary schools and in junior cycle, specifically addresses the need for regular exercise, and examines food and nutrition issues and the need for a balanced diet. This is supplemented by the emphasis at second level on balanced eating and exercise in subjects such as home economics and science.
Physical activity, health and quality of life are closely interconnected. Physical activity benefits every aspect of health and quite apart from the physical health benefits, it brings many other social and psychological benefits. There is sufficient evidence to show that those who live a physically active life can gain a number of health benefits including improved self-image and self esteem, reduced anxiety and depression and increased enthusiasm and optimism.
Physical inactivity is now identified as the fourth leading risk factor for global mortality. It is estimated to be associated with 1 million deaths — approximately 10% of the total — per year in the WHO European region. It is also one of the leading risk factors for health and is a proven risk factor for the development of many chronic illnesses and is the main cause for approximately 21% of breast and colon cancers, 27% of diabetes and 30% of ischaemic heart disease burden, according to the WHO in 2010. The economic burden of chronic disease is considerable, not only for the health system, but also for families and society as a result of reduced income, early retirement, an increased reliance on social care and welfare support and diminished productivity and absenteeism. The World Health Organization in Europe has estimated that a 10% to 15% increase in chronic diseases would reduce a country's GDP by an order of 1% over the next decade.
On the cost of physical activity alone in economic terms, based on studies in Switzerland and the UK, physical inactivity is estimated to cost about €150 to €300 per citizen per year. Even based on a conservative estimate of 10% of the population being inactive here, that would put the cost at between €67.5 million and €135 million.
More than three quarters of the Irish population are not active enough for good health and are consequently at risk of developing health problems. While physical activity is a key determinant of health, many of the other determinants such as education, income, gender and environment influence participation in physical activity. Conversely, an inactive or sedentary lifestyle can influence the other determinants.
As the best cure for ill health is prevention, it is important that healthy and active lifestyles are established as early as possible. Children need to be encouraged to reduce the amount of time spent in sedentary activities such as TV and video viewing and playing computer games. There is no one single solution to increasing physical activity. An effective comprehensive approach will require multiple concurrent collaborative strategies to be implemented. Increasing physical activity is a societal, not just an individual, problem. Therefore, it demands a population-based, multi-sectoral, multidisciplinary, and culturally relevant approach.
Schools are playing their part in promoting regular exercise and healthy lifestyles among students. The state of the nation's children report 2010 ranks Ireland as first out of the 41 OECD countries surveyed in terms of the proportion of children who take regular physical exercise. Children spend less than 25% of their waking hours in school, and it is important that the national strategy in this area should provide a strong focus on encouraging good nutrition and exercise outside of school time.
Although the task force on obesity recommended that every child should be enabled to achieve a minimum of 30 minutes physical activity every day in all educational settings by restructuring the school day, a range of evaluations have pointed to curriculum overload. It will, therefore, be difficult to extend the length of time available for PE. In addition, the Department of Education and Skills has recently asked all primary schools to spend additional time on literacy and mathematics as part of the national literacy and numeracy strategy. To alter the length of the school day will involve major industrial relations issues and could significantly increase costs. The length of the school year in hours at primary level is longer than the international norm, but we must address this issue. I agree we must think outside the box.
There are proposals for reform in junior cycle which provide that: physical education will remain an essential area of learning to be experienced by all students over the three year cycle; the existing range of subjects will be continued, including PE; schools will have the option of providing locally developed short courses of 100 hours duration, including in physical education; and there will be a cap of eight on the number of subjects which can be taken for qualification purposes. The proposals are implicitly designed with a view to freeing time in schools for broader educational engagement by students.
Due to the constraints of the current budgetary climate the scope for curriculum reform is limited and while the priorities in the period ahead are to strengthen achievement in literacy and numeracy, to implement reforms in mathematics, Irish and science, and to progress junior cycle reforms, the issue of exercise at school must be addressed also.
The Department of Education and Skills' 2009 lifeskills survey of 2,225 primary schools indicates that 86% to 95% of primary schools, depending on the class group, are delivering at least the recommended one hour per week of PE, and that activities are being provided across all six strands of the curriculum. However, there is a dominance of games, dance and athletics, with the other strands receiving less attention. The lifestyle skills survey also indicates that in addition to providing PE, some 78% of primary schools and 89% of post-primary schools promote sport outside of school time. Furthermore 97% of primary schools promote healthy lunch policies. Initiatives such as the national healthy eating week, food dudes, and the SPHE curriculum promote the importance of a balanced diet in schools. Sport for all day, the active school flag award, and active school week all promote the key message that regular exercise is critical to health and well-being. At this stage, 750 primary schools and 101 post-primary schools have registered their interest in the active school flag award, and 90 schools have been awarded the flag.
I note the suggestion in Senator Eamonn Coghlan's report, Points for Life, to make PE a mandatory subject, and the comment that students are excluded from PE at the whim of a note to the teacher from parents. It is the policy of the Department of Education and Skills that all students should be offered PE and that every effort should be made in schools to include all students, including those with special needs. I am also aware that schools make Trojan efforts in this regard. Parents who seek to exclude their children from PE generally do so for medical or injury reasons or for reasons of conscience. Schools are not in a position to refuse such requests. Article 2 of Protocol 1 to the European Convention on Human Rights requires that the State shall respect the right of parents to ensure education and teaching in conformity with their own religious and philosophical convictions. This is also a requirement under section 30 of the Education Act. However, teachers should and do take the opportunity to educate parents on the value of exercise for their children.
The provision of multipurpose rooms and outdoor play areas for primary schools forms part of new school building and major extension projects funded by the Department of Education and Skills. At second level, it is the policy of the Department to provide a PE hall as part of new school building projects. These issues are considered as part of the design brief for new schools and of major renovation or extension projects, subject to available resources and overall published criteria for prioritising projects. The schools capital allocation for 2011 amounts to €408 million, for both primary and post-primary schools. These funds will be fully expended by the end of the year. Furthermore, an additional sum of approximately €28 million will be expended on the 2011-12 minor works grant to be issued to primary schools shortly.
The Government's medium term infrastructure and capital investment framework, which was published recently, includes an allocation for education capital of just over €2.2 billion over the five years of the plan. This is an average annual allocation of just over €440 million. In addition to general purpose and PE halls included in major building projects, grants issued to schools specifically in respect of physical education in the amount of €9.5 million in 2006-07 and €16 million in 2010.
The HSE fully supports the SPHE programme and is currently working with the SPHE co-ordinators on its implementation along with a health promoting school model which has been agreed with my Department and the Department of Education and Skills. The HSE also supports the schools through a number of programmes, including action for life; be active after school activity; supporting all local sports partnerships; sponsorship of community games for post-primary schools; the soccer league for boys and girls; active school flag; and other various localised projects and programmes
Earlier this year, I established a special action group on obesity, comprising key stakeholders, including a representative from the Department of Education and Skills, to examine and progress a number of issues to address the problem of obesity. I acknowledge that no single initiative will reverse the trend, but a combination of measures should make a difference. For this reason the group is concentrating on a range of measures, including actions such as calorie posting in restaurants, nutritional labelling, restrictions on the marketing of food and drink to children, the improved detection and treatment of obesity, revised healthy eating guidelines and the promotion of physical activity. The group will liaise with other Departments and organisations as required. While there have been many initiatives and programmes introduced to help people make the healthy lifestyle choices which go hand in hand with good health, there is much more to be done.
As I have often said, the first step to addressing any problem is to recognise it. The HSE is considering opportunistic monitoring of overweight and obesity carried out on a routine basis during health checks. Recently, algorithms for the treatment of overweight and obesity were developed. These tools will make it easier for health care professionals to monitor and treat overweight and obese children at primary care level. The adult algorithm is now available while the one for children is at the final stages of agreement and will be available shortly. The whole issue of overweight and obesity and physical activity and nutrition are intertwined and one cannot talk about one without referring to the others.
There is ample evidence showing that in Ireland, like other developed countries, we have become increasingly sedentary in our daily lives. We know from research that three out of every four Irish adults and four out of five Irish children do not meet the physical activity levels required for health and consequently are at risk of developing serious health problems due to inactivity. It was for this reason that my Department and the HSE developed national physical activity guidelines in 2009. These emphasise the importance of physical activity to overall health and well-being and set out the minimum levels recommended for different sectors of the population. Children need 60 minutes of moderate activity a day. As the Romans used to say,mens sana in corpore sano, a healthy mind in a healthy body. It is well known that exercise produces endorphins in the system that make people feel better, feel well and less likely to suffer from depression.
A dedicated website —getirelandactive.ie — was also developed to become a one-stop-shop for physical activity information. As the aim of the website is to encourage people to become more physically active by creating awareness of the opportunities for physical activity at local, regional and national levels, the main feature is a well-designed search facility that enables users to search for activities happening in each county.
Increasing the physical activity levels of our population would save significant public money by reducing health care costs. Participation in sport improves health, contributes to the economy, builds communities, establishes pride in Ireland at home and abroad, drives tourism and makes us feel good. However, in Ireland, there are still major social and economic gradients between those who do and do not take part. Sedentary behaviour refers to activities that do not involve participation in physical activity and it is a major underlying cause of death, disease and disability.
Walking and cycling are two sustainable forms of transport that improve health and are carbon and cost neutral, yet only four out of ten children walk or cycle to or from school. Adults and children who walk or cycle to school or to work are known to be more active, to use motorised transport less, to gain enhanced health benefits and to develop social capital. Active commuting can help children clock up the required 60 minutes of moderate intensity physical activity they need. It does not all have to be done at once. It can be built up over the day by doing a number of short bouts of at least ten minutes of activity at a time. Regular moderate intensity physical activity, such as walking, cycling, or participating in sports, has significant benefits for health. For instance, it can reduce the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. Moreover, adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help control weight. As anybody here who is a parent knows, the natural disposition of a child is to move and rather than suppress that, we should encourage it.
In 2004, the 57th World Health Assembly endorsed Resolution WHA 57.17 — global strategy on diet, physical activity and health — and recommended that member states develop national physical activity action plans and policies to increase physical activity levels in their populations. The evidence shows that successful approaches to physical inactivity are long term and involve many sectors and agencies. National guidelines alone are insufficient to increase participation levels and work is now taking place on the development of a physical activity plan. The aim of the plan is to give clear direction for the promotion of physical activity in Ireland. A special group, chaired by the HSE, comprising Departments and key stakeholders is currently developing a national physical activity plan in order to provide strategic direction enabling an increase in and maintenance of the proportion of the population in Ireland who are physically active.
Research tells us that the consumption of energy rich, nutritionally poor food from the top of the food pyramid is high among the Irish population. It is clear that people need to be made more aware of the importance of nutrition. My Department has revised the healthy eating guidelines, including the food pyramid, and I will be making these available in the coming months. They will help inform people about the food and drink choices required for health and set out in plain and simple language the food servings the Irish population need to consume to maintain health and well-being.
The World Health Organization recommends that no more than 10% of daily energy should come from added sugar. They have serious concerns over the high and increasing consumption of sugar-sweetened drinks by children in many countries because of their link to obesity, and hence to diabetes, and I am currently considering measures to reduce the consumption of sugar-sweetened drinks in Ireland. Among the measures I am considering is sending a memorandum to Government shortly regarding a sugar tax on sweetened drinks.
Calorie posting on restaurant menu boards was one of the measures identified by the special action group on obesity as being able to contribute to addressing the problem of obesity. I wrote to food establishments in Ireland last month inviting them to support me in introducing calorie posting in Ireland. It is a simple concept and educates the general population on calorie content of food portions. The calorie content per portion is displayed in the same colour and font as the price and beside the price on the menu board. In that regard we should commend our own restaurant on displaying healthy options.
Another important initiative under way is Your Health is Your Wealth: A Policy Framework for a Healthier Ireland 2012 — 2020. The aim of the public health policy framework is to develop a high-level policy framework for public health to cover the period from 2012 to 2020. Following extensive consultation, drafting has now commenced. It will address the broad determinants of health and health inequalities through our health services, community and education settings. It is anticipated that the review will identify a number of key lifestyle policy issues such as smoking, alcohol and obesity where further action is required. It will identify practical ways to strengthen working between sectors to promote and protect the health and well-being of all sectors in our society. It is the aim of this process to engage leaders and policy makers across government and society to recognise that improving the public's health is the responsibility of all sectors of society and not just the responsibility of the health service public health workforce.
All the initiatives being considered by the special action group on obesity will form part of the development of this public health policy framework to enhance the health and well-being of all the population.
Being physically active is one is one of the most important steps one can take to improve one's health, whatever one's age or ability. The evidence shows that successful approaches to physical inactivity are long-term and involve many sectors and agencies. We must take a more holistic approach to promoting, maintaining and improving rates of active living. By encouraging physical activity and active living from an early age, the population can reap the benefits into old age. We must ensure that is made possible through supportive policies in health, education, environment, sport and transport, both at national and local levels. I firmly believe that together we can ensure that people can lead more active and healthy lives.
As I am supportive of the motion put down by the Senators I once again thank them for raising such an important issue and giving me the opportunity to appraise the Seanad of the work being progressed in this area. Neither I nor the Government wish to preside over a situation where we are the first generation to outlive the generation behind us. I commend the motion to the House.