By: Sebastian Hinde1, Dacheng Huo1, Daniel D. Bingham2, Ellen C M Silva3, Jan Burkhardt3, Gerry Richardson1, Sally E Barber3
1Centre for Health Economics, University of York, United Kingdom
2Faculty of Health and Social Care, University of Bradford, United Kingdom
3Bradford Institute for Health Research, Bradford Royal Infirmary, United Kingdom
Background to the project
Physical activity has been shown to be a key explanatory variable in the rise of many of the public health challenges faced by developed countries, including diabetes and heart disease. However, while the impacts of low levels of physical activity occur later in life, research has shown that levels of physical activity are largely determined before individuals reach adulthood, or even adolescence, such that intervention may be best in young children.
Over a five-year period from 2019 the Join Us: Move Play (JU:MP) programme was funded by Sport England, and supported by NIHR Applied Research Collaboration Yorkshire & Humber (YH ARC), to implement and evaluate an extensive series of activities to reduce the levels of physical inactivity and health inequalities in a deprived area of Bradford. Working with families, communities, schools and local organisations the aim of JU:MP was to identify and implement a range of locally relevant policies that would improve physical activity levels in school age children. Importantly, this programme also included the collection of extensive data in both the areas covered by the programme, as well as those not, to allow researchers to clearly identify the impact JU:MP had.
The JU:MP programme has already been shown to improve children’s levels of physical activity, increasing total activity by over 70 minutes a week, and moderate-to-vigorous physical activity (the amount needed to significantly improve health) by nearly 6 minutes a day[1].
In this analysis, we explored whether the approach taken in the JU:MP programme can be considered to be a ‘cost-effective’ use of the funding to improve health and wellbeing. In other words, should such programmes be funded more regularly as an effective means of improving physical activity, and the health benefits that entails, or could public money be more effectively spent in other ways.
What did we do?
We looked at both the short- and long-term impacts of JU:MP, as well as estimating how much it cost to start-up and maintain the programme. The short-term impacts were established from information collected during the programme, including questionnaires on the children’s health (EQ-5D-Y-3L and PedsQL) to understand if their physical and mental health changed because of JU:MP.
To understand the possible long-term impact of JU:MP we used an existing mathematical model to estimate the effect of the improvements in physical activity levels during the trial on future levels of related diseases, including heart disease, strokes, and diabetes. This model also allows us to understand the health impact of these diseases and how much it would be expected to cost the NHS to care for them.
An important question which the JU:MP programme has not been able to answer yet is whether the change seen in physical activity during the programme will be maintained after the intervention stops, or if it is necessary to keep providing the intervention for the children to carry on being more active. To explore this question, we included the impact of different possibilities, ranging from the best-case scenario where all of the benefits were maintained without continuing intervention, to the worst-case where the intervention would need to keep being funded.
What did we find?
In the short-term we found that while there had been an increase in physical activity from JU:MP the questionnaires on the health of the children suggested there was no change in their immediate mental or physical health.
Our long-term analysis suggested that the cost of setting up and running JU:MP had the potential to be value for money to the public, reducing the health burden of future activity related diseases and the costs of treating them. However, the uncertainty over whether the increase in activity levels would be maintained without continued investment dominated all other areas of parametric uncertainty.
What does it mean?
While JU:MP had a clear benefit to the levels of physical activity for children living in deprived areas, our analysis shows that remaining questions about the maintenance of an intervention effect has the potential to determine whether the programme was value for money for health improvement. Importantly, our analysis highlights that without continued investment there is the risk that the benefits are lost and the programme becomes a poor use of public money.
[1] New research finds JU:MP, supported by YH ARC, is having world-leading impact on getting children active in Bradford – ARC
An accompanying peer‑reviewed research paper presenting the full evaluation findings is currently under review. We will share the publication once it becomes available.