Public Access Strategy - Review & Analysis - Health & Social Exclusion Issues & Latent Demand

 Public access opportunities, and the processes by which they are achieved, are closely connected to health and social exclusion issues in North Lanarkshire.  These connections reach beyond the obvious health benefits of opportunities for exercise and recreation.  The potential benefits to community health and steps towards social inclusion which might stem from the public access strategy will only be maximised if relationships between location and characteristics of communities, and access opportunities are carefully considered.

Health and social exclusion in North Lanarkshire:  background

• North Lanarkshire has one of the poorest health records in Scotland and one of the worst socio-economic situations in Scotland - these two factors are very strongly connected.
• North Lanarkshire has the fifth highest proportion of population on income support in Scotland (at 9.6% in August 1999).  About 58 percent of households in North Lanarkshire are dependent on some form of benefit assistance.
• North Lanarkshire has the sixth highest unemployment rate of the 32 unitary authorities in Scotland (8.9%).  The number of claimants in North Lanarkshire continues to gradually rise.
• Although the number of long-term unemployed people in North Lanarkshire is lower than in Scotland as a whole, it continues to have a high proportion of young people out of work.  In January 1999 about 30% of all unemployed claimants were under the age of 25. Youth unemployment in North Lanarkshire continues to rise steadily.
• Lower levels of car ownership persist in North Lanarkshire – 47% of households had no car in 1991.
• About 1000 residents die every year from heart disease -- about 30% of all mortality in the area.  Significantly, the rate of heart disease of North Lanarkshire residents is 22% higher than the figure for Scotland as a whole.  About 800 residents die from cancer per year, with lung cancer the biggest killer.  Between 400 and 500 people die from respiratory disease every year in North Lanarkshire.
• About 35% of adults in North Lanarkshire are technically overweight, and approximately 12% are obese.  Being overweight and taking little exercise are both very significant risk factors for heart disease.
• The government's stated target is to reduce the age standardised mortality rate from coronary heart disease in people under age 75 by 50% between 1995 and 2010 (Towards a Healthier Scotland).

The current HEBS recommendation for exercise (1997) is that we should all try to accumulate 30 minutes or more of moderate intensity physical activity over the course of most days of the week.  Results from 1996 Lanarkshire health and lifestyle survey suggest that a good proportion of the residents of Lanarkshire as a whole are well on the way to achieving this kind of target but that many, often those most at risk of heart disease, need to do more.  The survey does however, present an encouraging picture of a population generally prepared to become more physically active in order to feel fitter and healthier and, to a lesser extent, with the intention of preventing disease and ill health.

Sports scientists often classify the population into five groups:

• those taking no exercise and not intending to
• those currently taking no exercise but thinking about starting
• those occasionally exercising already
• those who have recently begun to regularly exercise
• those who have been regularly exercising for some time.

Many health promotion strategies concentrate on moving people from their current 'group' into the next most desirable group (i.e. getting people who currently take no exercise, and have no intention of doing so, to think about beginning to exercise, or getting those who are occasionally taking exercise, to do so more regularly).  Experience shows that with encouragement and the right kind of opportunities, this can be a successful approach.  A good access strategy should recognise that people are very unlikely to move directly from group i to iv and that persuading people to build in "exercise" as part of their daily lives (for example, walking to work) might be a better route to enhancing their health than persuading them to set aside time for a specific activity.

About 80% of respondents to the (1996) Lanarkshire Health And Lifestyle Survey reported that they did some walking out of doors.  We could thus reasonably expect access routes for walking to be of interest, or possibly of use, to a large proportion of North Lanarkshire's population.  It is unlikely that most of this walking is simply for pleasure, illustrating the high proportion of the population who might be encouraged to use routes for commuting, shopping and other non-recreational activities.  About 45% of the respondents were currently either taking exercise occasionally or thinking about starting exercise in the next six months.  From a health perspective, this makes a good proportion of the population ripe for attempts to encourage and involve them in access issues.  A new route with associated community activities, information and promotion might be the push these people need to start exercising or make their current activities more regular.

Some 18% of respondents were not exercising at the time of the survey and did not intend to be in the following six months.  Rather than being the groups for whom this access strategy means least, these must be the groups for whom it is made most relevant.  Those either not intending to exercise, or still just thinking about it are likely to be those at highest risk of cardiovascular disease and those hardest to get active.  They may also be those with greatest difficulty in accessing routes and with most to fear from them.  There is currently least provision for people in areas where exclusion is high, and car ownership is likely to be low.  As a result, the barriers to using access routes for any kind of exercise (recreational or as part of everyday life) are currently too high.  Research has also shown that people not exercising nearly always know that they 'should' be, and the potential benefits of doing so.  The health aspects of public access are unlikely to need a focus on educating people about the benefits of exercise.  They need to be focused on activation and facilitating that action.  The access strategy for North Lanarkshire should be seen as an opportunity to assist the government in reaching its target for coronary heart disease (see background section).

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