John Welshman

Using different physical activity measurements in eight European countries. Results of the European Physical Activity Surveillance System (EUPASS) time series survey

OBJECTIVES The European Physical Activity Surveillance System (EUPASS) research project compared several physical activity (PA) measures (including the International Physical Activity Questionnaire (IPAQ)) in a time series survey in eight countries of the European Union. The present paper describes first results provided by the different instruments regarding PA participation, frequency and duration, both at the European and national levels. The purpose of the present study is to explore and compare the specific quality and usefulness of different indicators rather than to provide valid and reliable prevalence data. Thus, the main focus is on discussion of the methodological implications of the results presented. METHODS A time series survey based on computer-aided telephone interviewing (CATI) was carried out in eight European countries over a six-month period. The study provided for about 100 realised interviews per month in each country (i.e. approximately 600 per country). Descriptive statistical analysis was used to: (1) report IPAQ results on vigorous, moderate and light PA and sitting, as well as on the overall measure of calories expenditure (MET min-1), in the different countries; (2) compare these results with national PA indicators tested in EUPASS; and (3) compare IPAQ results with other European studies. RESULTS First, the scores for the different PA categories as well as for the overall measure of calories expenditure provided by the IPAQ appeared rather high compared with previous studies and public health recommendations. Second, the different PA measurements used in EUPASS provided completely different results. For example, national indicators used in Germany and The Netherlands to date neither corresponded in absolute values (e.g. means of PA or sitting) nor correlated with the IPAQ in any significant way. Third, comparing EU countries, the ranking for vigorous, moderate and light activities by use of the IPAQ differed from that of other European studies. For example, in the present analysis, German respondents generally showed higher scores for PA than the Finns and the Dutch, while, in contrast, findings from other studies ranked Finland before The Netherlands and Germany. CONCLUSIONS The present analysis highlights some methodological implications of the IPAQ instrument. Among other things, differences in overall scores for PA as well as in the ranking of nations between the present results using IPAQ and other measures and studies may partly be due to the concepts of PA behind the measurements. Further analysis should investigate if the range of PA-related categories provided by the IPAQ is fully appropriate to measure all relevant daily activities; it may also consider the public health implications of mixing up different contexts of PA (e.g. work, leisure-time, transportation) in the IPAQ short version.

Physical activity monitoring in Europe. The European Physical Activity Surveillance System (EUPASS) approach and indicator testing

OBJECTIVES The main objective of this paper is to describe the approach and specific findings of the European Physical Activity Surveillance System (EUPASS) research project. In particular, the analysis presented aims at testing the reliability, comparability and predictive power of different sets of physical activity (PA) indicators. DESIGN First, a panel study based on computer-aided telephone interview (CATI) was designed to report PA data of a representative, selected group of about 100 persons per country at three points in time. Second, a CATI time series survey was carried out with the goal of realising about 100 interviews per month over six consecutive months. SETTING The project was carried out in eight European countries to support the development of the European Unions (EU) Health Monitoring Programme. SUBJECTS Random population samples (subjects aged 18 years and older) were drawn from each participating country. RESULTS While many PA indicators used in EU countries to date as well as the psychosocial and environmental measures tested in the present study had acceptable to good reliability coefficients, the test-retest reliability scores of the International Physical Activity Questionnaire (IPAQ) version tested (the short (last 7 days) telephone interview IPAQ; IPAQ-S7T) were rather low. The comparability between extant national PA items and the IPAQ-S7T was low for all countries. The strongest predictors of perceived health were the psychosocial and environmental PA indicators. CONCLUSIONS According to the results of the present study, more research is needed to further investigate and improve the quality of the IPAQ. In addition, the specific predictive power of the tested psychosocial and environmental PA indicators on perceived health should be of particular interest for designing health surveillance activities in the future.

From transmitted deprivation to social exclusion : policy, poverty, and parenting

Introduction Part one: The cycle hypothesis: Sir Keith Joseph and the cycle speech From problem families to the cycle of deprivation Part two: The Transmitted Deprivation Research Programme: Conceptual difficulties: setting up the Research Programme From a cycle of deprivation to cycles of disadvantage The final years of the Research Programme, Poverty, structure, and behaviour: three social scientists Part three: New Labour and the cycle of deprivation: The broader context: social exclusion, poverty dynamics, and the revival of agency From transmitted deprivation to social exclusion Conclusion.

Searching for social capital: historical perspectives on health, poverty and culture:

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam’s arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of ‘underclass’ concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the UK and the USA over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of key significance.

Tuberculosis and ethnicity in England and Wales, 1950–70

This article seeks to contribute to recent debates about ethnicity and health by exploring the history of migration and tuberculosis in England and Wales between 1950 and 1970. It concludes that the story was more complex than recent writing, with its emphasis on ‘port health’ concerns, has implied. The fear that tuberculosis was being imported by migrants was certainly a central concern of both early researchers and the medical establishment. However, some researchers did show some interest in material explanations and in the roles of housing and work patterns in the transmission of the disease. A system of medical examinations at the ports of entry was not in fact implemented and it was at the local level that a system of surveillance was set up. Finally, despite much debate about the susceptibility of migrants, racial concerns were less evident than recent writers have suggested.

Evacuation, hygiene, and social policy: the "Our Towns" Report of 1943.

There has recently been much debate about social policy in Britain during the Second World War. This article takes up Jose Harriss suggestion that historians should look not at large-scale forces, but at ‘those minuscule roots of idiosyncratic private culture’. As a way into the complex amalgam that comprised ideas on social policy in the 1940s, we look in particular at the report on the evacuation of schoolchildren entitled Our towns: a close up, published by the Womens Group on Public Welfare in March 1943. Of course it is undeniable that one report is unrepresentative of all the many surveys that were produced on the evacuation experience. However, the initial wave of evacuation in September 1939 was the most significant, and the Our towns survey, along with a famous leader article in The Economist, has already received some selective attention from historians. Here we subject the survey to a more intensive examination, looking at the backgrounds of its authors, its content, and its reception by various professional groups. The article argues that it was the apparently contradictory nature of the report that explains its powerful appeal – it echoed interwar debates about behaviour and citizenship, but also reflected the ideas that would shape the welfare state in the post-war years.

The Unknown Titmuss

Recent writing in social policy on the role of agency has made important assumptions about social administration in the post-war period. In particular it is suggested that interpretations of the causes of poverty, and the thinking of Richard Titmuss, were characterised by a ‘denial’ of agency and almost total emphasis on structural factors. The implications were that this left the Titmuss paradigm vulnerable to more individualistic interpretations in the 1980s. In this article we look more closely at Titmusss work and thought in the three decades of the 1940s, the 1950s, and the 1960s, aiming to produce a fuller and more nuanced analysis. We argue that the distinctive position adopted by Titmuss was in large part his response to earlier and on-going debates about social pathology. What he was trying to do was to make others aware of the broader context in which behaviour had to be analysed. But Titmuss himself became constrained by the paradigm that he did more than anyone else to create. Thus debates about behaviour, structure, and poverty have been marked as much by continuity as by change.

Growing old in the city : Public health and the elderly in Leicester, 1948-74

Apres la seconde guerre mondiale, une nouvelle politique en sante publique en Angleterre et au Pays de Galles contribue a considerer les personnes âgees, et a developper de nouveaux services de soins propres tels que la chirurgie pedicure, ou les services a domicile

Knights, knaves, pawns and queens: attitudes to behaviour in postwar Britain

The choice agenda is currently one of the most prominent in public policy. One of its main architects, Julian Le Grand, has used the metaphors of knights, knaves, pawns and queens to characterise changing attitudes to questions of motivation and behaviour among public servants and service users. He has said, for example, that, in the immediate postwar period, public servants were perceived as public-spirited altruists (or knights), whereas service users were seen as passive (or pawns). It was only in the mid-1980s that public servants came to be seen as essentially self-interested (knaves) and service users came to be regarded as consumers (queens). However, this highly influential model has undergone remarkably little critical scrutiny to date. This article explores the debate over transmitted deprivation in the 1970s to provide a historically grounded piece of analysis to explore the accuracy and utility of these metaphors. It challenges Le Grand’s arguments in three respects. Firstly, a concern with behaviour and agency went much broader than social security fraud. Secondly, the metaphor of pawns is inadequate for characterising attitudes towards the poor and service users. Finally, Le Grand’s periodisation of the postwar era also has serious flaws.

Towards a European Health Monitoring System

The relationships between physical activity (PA) and a wide variety of health and well-being outcomes have been well established in the last decade. Regular PA reduces the risk of premature death and disability from many medical conditions, including coronary heart disease, diabetes, colon cancer, and osteoporosis. There is also evidence for a positive relationship with well-being, particularly in alleviating depression and anxiety. Reduction of the large public health burden associated with a sedentary lifestyle has become a priority in many countries and is endorsed by the World Health Organization.