Yesterday brought more news of a looming public health crisis. Over one in three English adults has pre-diabetes (blood glucose levels that place them at significant risk of full-blown type 2 diabetes) according to a new academic study. What is more, the proportion has more than tripled between 2003 and 2011.
Diabetes is already a huge public health problem. According to Diabetes UK, nearly one-tenth of the NHS budget (£12 billion a year) is spent on treating type 2 diabetes: lest we forget, a largely preventable illness.
Being more physically active cuts the risk of type 2 diabetes. Physically active children are more likely to grow up to be physically active adults. And there is robust evidence that improving outdoor play opportunities boosts children’s physical activity levels. (I will say more on this when my evidence report is published shortly.) All of which adds up to a compelling public health case for investment in play provision. So why are play advocates not saying more about the contribution we can make to the nation’s physical health?
The answer reflects a long-standing nervousness from some British play advocates about the very ideas of evidence and outcomes.
For some, an interest in outcomes runs counter to the qualities of children’s free play – its unconstrained nature and the lack of adult-imposed agendas – that they hold dear. Playwork academics Stuart Lester and Wendy Russell state in Play for a Change, their 2008 report for Play England, that “the ‘outcomes’ of playing cannot be externally determined and measured,” and that “attempts to do so will inevitably frustrate the very qualities inherent in children’s play” (summary report, p.23).
In a similar vein Bernard Spiegal, my regular collaborator on risk, wrote an article a few months back questioning the merits of evidence-gathering exercises (a piece prompted by my engagement in the completion of just such an exercise). He argues that to take in interest in outcomes is to buy into a flawed ideological framework. He says, “The idea that free play could or can secure a firm foothold within either past or present political and value orientations strikes me as pretty well near absurd.”
I understand the worry that children’s play experiences may be tainted if we focus too much, and in the wrong way, on how they might shape children’s futures. And I accept that child policy in recent years has had an unhealthy focus on measurement (especially in education). But there is no essential conflict between evidence and values. What is more, good evidence is vital in helping us to make the case for play initiatives.
We can believe that children need time and space in the here and now for play, and also show that their long-term health is improved by enjoying better play opportunities, and hence that play is worth the attention of government. We can believe that children’s play is complex and elusive, and also show that improving play opportunities makes a measurable difference to them, their families and the communities in which they live. If governments are prone to manipulate evidence and argument – to focus on the wrong outcomes – then we can make the case for better measures and arguments.
Of course we should not forget that children’s play is rich and multi-faceted. For children, play is about choice, freedom and control. It does not always involve being physically active. So we need to guard against initiatives that excessively restrict or control children’s play choices. But I see little evidence that this is happening.
Many of the play initiatives that are in the evidential spotlight – natural play spaces, loose parts play, street play – are all about expanding children’s free choices and control through creating more engaging, supportive physical and social spaces.
I am not just making a tactical point that play advocates should hold our noses, sup with the devil and hitch our wagons to physical activity because that is where the money is. My point is that we should engage with the evidence because that is the right thing to do.
Governments should have an interest in the outcomes of their programmes, and the rest of us should too, as I have already argued. For one thing, evidence helps us to sort out good interventions from bad ones (for a taster, read this article on how robust evidence demolished the case for a popular youth crime initiative).
Likewise, if we paid more attention to outcomes it would be not be so easy for governments in future to claim – in the face of the evidence – that spending billions on hosting the Olympics will lead to more sports participation. (Which is not to say there may not have been other good reasons for the decision. Again, in weighing up the pros and cons, evidence will help.)
The political reality – that play services are facing huge cuts, and that neither of the main political parties in England are showing any interest in play – makes the task even more urgent and important.
Children who play actively do so because they want to. In taking pleasure from what their bodies can do, they are not only getting healthy physical activity through their playful engagement in the here and now. They are also fostering their sense of themselves as physically competent people who feel comfortable and confident in their own skin – something that will be of value for the whole of their lives. Play initiatives have a unique selling point (compared to organised sport, for instance) precisely because they are grounded in children’s free choice. To neglect the evidence in support of this selling point is to sell children short.
Rethinking Childhood 
Caution: extensive comment below!
” So why are play advocates not saying more about the contribution we can make to the nation’s physical health?”
1. they don’t feel they have or don’t have expertise in the area of children’s health
2 – making a living, not easy or impossible
3. who are these ‘play advocates’?
4. how are the costs of play advocacy met?
5. funding controls have sharpened to the point that an activity not directly related to ‘outcomes’ is expunged by funders.
6. events, dear boy, (to quote Harold Macmillan) – such as Adrian Voce, lack of.
7. disillusionment. The energy put in and the results obtained from play advocacy are not encouraging. Witness: ACPR, NCPRU, PlayEngland…
8. Others aren’t listening. They have similar pressures. Local government and Health are both victim to 1, 5, 2a
9. ‘Professionalisation’. What was done for love is now only done for pay, perhaps?
NOTES:
1. Learning about health, penetrating professional firewalls, learning the language, all take an investment of time -and therefore money – point 2, 3d.
2. a living:
2a. they are utterly busy trying to keep open savagely slashed direct services (APs, playschemes, etc) to children
2b. they are frantically trying to make a living in the field
2c. they have left the field,seeking a living, either permanently or temporarily, moving to allied fields (such as forest schools, etc) or any field in which they might have transferable skills
3. I can discern some types of advocate:
3a. PAs – see 1 and 2.
3b. gentlefolk, and philanthropists such Lady Allen, where are they now? Perhaps their energies, in this age of rampant global financial inequality (aka ‘austerity’) are directed to more ‘deserving’, or more pressing and stark needs such as food banks and homelessness in the UK, or elsewhere, landmines in Iraq, global warming, saving whales, fighting fracking and the like.
3c. other occupations such as journalists, writers, academics – do they have any free time? ( and see point 5)
3d. play advocacy is an aging ‘profession’. Where are the new advocates? Perhaps they are victim to the narrowing of academic education and work-based training (also see 3b above). Perhaps play advocacy is a generational thing.
3e. Whilst recognising point 3d and 5, the question: why do our well-paid academic play ‘experts’ in our universities, not advocate in the public arena?
•••••••••••••••••••••••••••••••••••••
The funeral of one of play’s most effective, caring, committed, knowledgeable, skilled and warm-hearted human beings takes place this week. RIP Perry Else. We will not see his like again.
•••••••••••••••••••••••••••••••••••••
4. costs: to be a play advocate: you need not just things to say but opportunities to say them. Not living in London, the cost of attending a single advocacy opportunity (meeting or lobbying an individual, etc) is at least £120
5. funding: Who funds ‘general running costs’ the catchall category that includes attending meetings, lobbying and what have you? No one, or almost no-one. Funders talk to each other and fashions and approaches affect them mutually. ‘String-free’ funding is deprecated.
6. events – mr Voce – by which I mean when the noble AV(OBE) moved on from his directorship of the NCB project known as PlayEngland, we lost a competent play advocate and reasonably well-funded entity.
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will this do? I used both sides of the blog and put my name at the bottom.
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Fantastic Tim I completely agree, but when I arguerd the importance of play outcomes at a UoG event 2 years ago I was playfully booed by the audience. Jusdt started a new job with Bristol Playbus providing a Sensory Truck for disabled children. The sensory and play outcomes are being recorded by UWE ocupational therapy dept. But what reallly intertests me is the collection and evidence of social and cultural outcomes when children play. Keep going I’m convinced this is the door that play must open!
Tim, this is a very thought-provoking post and it does worry me the fact that neither of the main political parties show any interest in play. I agree this is urgent and as advocates of play the health evidence can be used to support our play initiatives.
I work in a University environment where sport dominates and what I feel generally that play has going for children and young people, that is so often overlooked, is that playing has mass appeal- you could call it ‘play- appeal’. You cannot always encourage children to be enthusiastic about sport but children can be active when playing and play is something that children naturally want to do anywhere and everywhere and it is, as you rightly say about their free choice. More so than this, it is also what it doesn’t have that makes it appealing- you know the things in sport that put some children off, like the competition elements/ rules etc. For a society seeking to encourage citizens to be more active (as ours is given the forecasts about diabetes) the conditions have to be right i.e. the provision of a supportive physical and affective/ emotional environment and there has to be a desire by the folk to get involved and move their bodies. Where play is concerned, I think the latter exists, children want to play, what is needed are conditions to support play and that is where the play sector is ideally placed in regards to best practice and expertise given ( 70 years of knowledge or so).
We are living in austerity Britain, but I feel that the old adage is useful here ‘prevention is better than the cure’ (it is better to try to keep a bad thing from happening than it is to fix the bad thing once it has happened) and potentially makes better economic sense.
Very much enjoying reading Peter Grays book (2013)
“Free to learn”.
I am a parent, grandparent, preschool teacher in both Playcentre and in Montessori education. As a teacher/ observer of both schools of thought that ” play is work” and “work is play” I am enjoying observing and learning the distinctions between formal play and informal play….
Arthur, Tom, Leonie, Bronwyn – thanks for commenting. Arthur – a sound effort that earns you an A* (with extra marks for complexity, of course). Your point 3e resonates strongly. Also your interjection: as I said on my comment on Adrian Voce’s moving tribute, I didn’t know Perry at all well but share Adrian’s view (and yours) of his qualities. Bridging the gap between the playwork milieu and the wider world is sometimes difficult, but Perry made it look easy.
Tom – part of the aim of this post is to get play people to stop seeing evidence as a necessary evil, and to start seeing it as a) a fair ask and b) helpful to our cause. Nothing wrong with bean counting, as long as you are counting the right beans in the right way and for the right reasons.
Leonie – the comparison with sport is apposite, and may be the topic of a future piece here. If we are to raise play’s profile by comparison, then good evidence will be crucial – public health folk live and breathe it. What my report will show is that there’s ample evidence to do this.
Bronwyn – yes Peter’s work is valuable, and it’s good to see the profile it is getting.
Tim, I think I can see where Bernard Spiegal was coming from. We need unbiased evidence. In your blog you say
“We can believe that children need time and space in the here and now for play, and also show that their long-term health is improved by enjoying better play opportunities”,
The problem is that these are tow quite different statements, and whilst I believe there is ample evidence to support the first I’m not so sure about the second, I am still trying to find research that supports the view that exercise helps reduce Type 2 Diabetes, or the likelihood of developing it. Its intuitive, and I would dearly like it to be true, but I cant find the research to support it.
What is clearly true is that it takes an AWFUL lot of exercise to ‘burn off’ a chocolate bar, or even a pint of beer. (About half an hour of ‘vigorous cycling’ in the case of the pint of beer!)
I suspect the relationship between body weight and exercise is much MUCH more subtle. Body weight is more to do with calorific input – what we eat – and that if we have an active fit life style we don’t WANT to eat so much. It will put us so off going for that cycle ride if we have a big meal, and conversely we wont want a big meal AFTER a cycle ride. Moreover, its hard to eat a big meal WHILST having that cycle ride.
So I suspect its more integrated and psychological than straight forward and physiological. So here’s the big question: does anyone know about ANY good studies to support this view?
We perceive that overweight people tend not to do so much exercise and people who exercise a lot tend not to be overweight. But WHY? Whats the relationship?
Marcus
Hi Marcus and thanks for the comment. Chasing primary evidence can be a forensic task. I took your question as a challenge. I started with Start Active, Stay Active from the 4 nations Chief Medical Officers. References from this led me up a blind alley via the WHO report Global Health Risks: Mortality and burden of disease attributable to selected major risks, which claimed that “Physical inactivity is estimated to cause around 27% of diabetes burden” but did not appear to have references to back this up (poor show, WHO). I then resorted to google using the search terms {“physical activity” diabetes research} which took me to this 2006 systematic review entitled Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes: A systematic review which appears to answer your question. It concludes: “Adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes”. It took me about 20 minutes (and I’m experienced at this stuff). Of course, I am also trusting that the reviewers know what they are doing (because I know when I’ve reached my pay grade).
The relationship between physical activity and health is complicated. For instance (as I’m sure you know) PA is not just about burning calories – it is also about bone and muscle fitness, and subjective well-being amongst other things. And some of these measures are in turn open to interpretation and challenge – subjective well-being is clearly influenced by cultural factors. Ben “Bad Science” Goldacre has a maxim for interpreting scientific evidence, and it is this: “it’s a bit more complicated than that.” Having a head for numbers and a statistical bent helps (which is one reason – though not the only one – why some are tempted to junk the whole project of gathering evidence).
Postscript: I’ve just found another review that gives a figure for the causal influence of physical inactivity on type 2 diabetes. The figure it gives is not 27% as per the WHO report above: it’s 7%.
Speaking of evidence, did you follow up with Ben Tawil at Glyndwr? Their research findings should be available now.
(study using sports science tracking technology to assess impact of various forms of activity in school playground: unsuppotred free play, organised, playworkers present, etc.)
This maybe the most methodologically rigorous research ever done. IMHO.
Yes – Ben put me on to Dr Sue Taylor at Glyndwr, who is leading the study. She told me it is in the process of being peer reviewed. When I hear more I’ll certainly share it around, even if it’s too late for inclusion in my report.
Good. But I don’t understand why you can’t quote their preliminary findings,, already presented to the Play Wales seminar on Play in Schools back in March, I think it was.
I didn’t put it in because all the researchers could send me was a one-paragraph summary. I would need to see more than this before including it. I also didn’t include a widely-discussed NZ study where a school in essence scrapped playtime rules, for the same reason. Even though this was not a systematic review, I had some basic criteria for inclusion – for instance that claims and findings would be referenced, and that those references would give enough information to allow readers to make informed judgements about the claims.
I think we need to frame evidence and outcomes in relation to play as important in the here and now as well as further down the road. Happiness, well-being, mental and physical health now as well as in 20 or 80 years time. I also think that the play(work) sector should unashamedly engage with the public health and well-being policy area – the here-and-now argument sounds very much to me like the early intervention/preventative approach. It also seems that no matter what the result of the next general election, responsibility (and funding) for public health and well-being will remain at local authority level – not least because what my health campaigner friend Ken Meharg described as a National Illness Service will become very difficult to sustain.
Mick – I agree. Part of my argument is that there is no inherent contradiction between thinking about play in the here and now and the longer-term effects of playing. Tension yes – but not contradiction. On public health and sustainability: my reason for starting my piece with those scary diabetes facts is that the long-term public health implications are so enormous. This article in today’s Guardian – on the growth in child obesity in Australia – has this quote from a public health expert: “I am profoundly pessimistic about the future of action on obesity. I don’t think we have even started to take the problem seriously and doubt that we will actually see any real action for decades to come.”
“I didn’t put it in because all the researchers could send me was a one-paragraph summary. I would need to see more than this before including it. I also didn’t include a widely-discussed NZ study where a school in essence scrapped playtime rules, for the same reason. Even though this was not a systematic review, I had some basic criteria for inclusion – for instance that claims and findings would be referenced, and that those references would give enough information to allow readers to make informed judgements about the claims.”
shame.
2 of the best and most persuasive pieces of research. Can’t you make an exception, get a bit more info from authors and add in a footnote, appendix?
There are other studies mentioned in the report with similar findings, so leaving these 2 out does not change the picture much. CPPF and I agreed at the outset that it was important that the claims would stand close scrutiny (and Cabinet Office staff indicated they expected this).
Makes perfect sense, Tim. Thanks for explaining. When do we get to see a copy? I assume after the Cabinet Office have?
My problem, Tim, is that in response to neglect and WILLFUL ignorance, you are returning to that same old mantra about evidence. Come on, get real, they KNOW the evidence, they simply have no political will to do a blind thing about it. How much longer will we sing this old dirge that it’s OUR fault they don’t know. They don’t WANT to, proving our case time and time again has not and will not work. They even ADMIT they know the truth but always always always, it’s the “sorry chaps, time not right, when things improve” and so on and forth and back-wards. What was the first casualty of this coup which now runs the UK? Why, Play England, now reduced to a shell, much thanks you all got for your efforts, that pile of turd Gove isn’t interested, and we all know it.
Play has always shied away from real campaigning, and yet that is what is now needed. We are in the run up to 2015’s election, time to organise. The facts are there about obesity, risk to health, the superior value of play, and they are perfectly well aware of it – why do you think they have decimated it? They don’t WANT it, haven’t we sussed that by now. Nothing we say will change this lot, time to work so that the next lot, including at local government level, aren’t the sort of arses who pick on play and youth work first and disproportionately to cut and who blithely break the law in doing so.
We could spend ages unearthing all the previous studies that have disappeared into the Black Hole Maw of Government, with maybe a short period of activity if it’s Labour and then all clawed back and lost when the economy falters. That is not Play being recognised, it is the short-termism that afflicts all government in this country.
Play is important, they know it full well, time to campaign they do something about it. Use this new study by all means but don’t hold your breath with Gove in charge. The Cabinet Office has Play because Gove shoved it there, and it needs a strong and major departmental commitment with the resources to match. Like nothing less than a National Play Council (and I mean a la Sports and Arts Councils, budget proportional to the child population at least and with real funding power and commissioning status). Fair Play set that down in 1986, and all that has happened since – NCPRU and PE, show that nothing less will suffice.
Instinctively, they distrust play, it doesn’t fit with their ordnung for das youth, you vill learn to consume and obey from age 2.
One thing is for a blinding rebuff to HMG at the UNCRC re the shameful report section on play and A31 – lamentable. Better if we all say it but if not FP will be submitting something on those lines with chapter and verse. Evidence? How about the FoI stuff we have about cuts and about expenditure levels anyway. Poll all candidates in 2015 and get them to commit to better if elected.
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Tim, first, thanks for the tweet of my ‘On Evidence. On the Politics’.
I had intended to leave a comment on your blog concurrent with my return to the ‘evidence’ subject, but that did not quite work out. But I’m here now. Thanks, first, for your contribution to the debate and the actual work of gathering ‘evidence’.
I’ll try and offer a brief summary of my more extensive blog effort hoping, in part, that I can act as a sort of discordant Pied Piper and tempt your extensive, and no doubt super-sophisticated audience, to pop over and take a peek at my efforts.
But now to the matter in hand.
I hope I’ve settled once and for all that I am not opposed to the evidential hunt, and see that it is necessary. But I share again my scepticism about the belief – the hope? – that evidence is weighed and sifted in a notional rationalist decision-making process. I say that it is rather values and political orientation that informs decisions, though masked in the language of evidence.
However, for the present, my feeling is we need not pursue the debate about evidence because our baseline positions are similar: we both agree that it is necessary to have it. We may – stress, ‘may’- have a different take on the context within which it operates.
I did, in my article (I really dislike the word ‘blog’) try to look more broadly at what might be called the politics of the matter. I introduced the idea of a Play Establishment (if somebody else has done this previously, I’m happy to acknowledge that), and made clear that, assuming it to be a useful concept, I think having an Establishment is a jolly good idea. There are of course debates to be had about it – if it is agreed to exist – but, in principle, it’s good that there is one.
The concept of the Establishment did allow me to travel a little more widely and to notice what I think is the narrowing of the ‘political’ space available to discuss issues and questions that bear down on, in this case, play. And that led to a raising of the old and hoary question, put with some spirit in FPFC’s comment, where is the ‘campaigning’ for play?
I proposed two questions here: one, a ‘should’ question – should there be overt political campaigning for play? but also a second ‘can’ question: Can play summon up the wherewithal to enter the overtly political fray? It may be that it should, but cannot in practice summon up the energy and commitment to undertake the task. I did not commit myself either way.
Finally, I also suggested that the Establishment, qua Establishment, is constitutionally incapable of this sort of overt political campaigning. That judgment was not framed as a criticism, simply as a matter of fact that we would do well to recognise, and then ponder the consequences as it affects the question of overt, political campaigning. This is a rich theme that it will be interesting to explore. And to which I will return.
Thanks for this comment Bernard. In an effort to spread the online debate, I’ll leave a substantive reply over at your site.
This is what play advocacy looks like:
Click to access 1325042991.pdf
Arthur – that’s a solid body of work, to be sure, and one example of play advocacy. There are others. I’d be interested to know what impact the report had – any thoughts on this?
FPFC does some excellent work, the recent report on ABCs, ASBos and the like for example, and their speedy and low-cost CRB service for tiny vol.orgs. to name just a couple. I’m well aware that you two (Tim and Jan – Cosgrove, GS of FPFC), have not always seen eye to eye with each other in the context of national play politics in the recent past.
Of course one does not have to agree with everything Jan says to agree that wider dissemination of FPFC’s findings and services would benefit the sector, which is why I mention them. Membership is free. I commend their work to your readers, Tim.
FPFCnews – I appreciate the time and energy put into your comment, and apologise for the delay in replying. I agree that a more widespread public campaign is needed – indeed I have argued for such a move here. How such a campaign might be built and run is not an easy question to answer.
I do not agree with your views on government or on the value of engaging with the evidence. Evidence evolves, for one thing. Some of the most robust, convincing studies in my report have only been published in the last 2 or 3 years.
It is also vital to distinguish between play and play provision (a distinction that is often ignored, as playwork academic Wendy Russell argues). In public policy terms, there are some parallels between play experiences and diet. Everyone agrees on the importance of diet, and there is broad consensus about what a good diet involves. But there is a lot of debate about the roles and responsibilities of government and public bodies – as against consumers and parents – in promoting better diets. Evidence about the impact of different kinds of government and public service intervention – guidance, regulation, public education, planning controls, direct provision, clinical treatment – is helpful in making policy decisions (though it is not the only factor). The same is true of play and play provision – or rather, the same should be true.
I hear your views on the current administration. You may be right about the prospects of engagement. But I also think we have to be even-handed in our dealings with governments of different political hues. If play becomes a party political issue then the rollercoaster ride the sector has been on in the last decade will only get worse.
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Arthur, thanks. Tim, I have to say I have been here before, and I wish you well. I doubt the FP reports had any impact, though we had some good responses – on the ABC, Tower Hamlets and Stolen Streets, Stolen Childhood efforst. The value of play is well-known to decision-makers, but childhood hasn’t much priority, not in its own terms. Yes, to train as factory fodder and zero hours contract new poor. Early years now being co-opted into the same maw. Imagination, independence of thought, creativity, cooperation – stamp them out! That famed comment from the cabinet office in Blair’s time when the debate about childcare’s aims was either education or care … so long as they aren’t just playing around.
Guerilla Play (or gorilla) Play Riots Occupy the street for play The Red Flag Movement (people walking in front of cars in residential streets to slow them down). Don’t settle for one day a month if it has r in the name Take over the street every day, get arrested. Use the various Petition formats. Get enough for a debate in Parliament and shame the lot of them.
Until we all stop playing this “the poor dears only need to be shown the facts”, they will go on doing just the same – nothing.
There is an Act of Parliament, the 1996 Education Act, s508 which is not just about youth work. It is also about Play and every LEA has a duty plus enabling powers.
s507a and b were added in 2006. 507b (13-18) has statutory guidance, but also cop-out …. so far as is practicable. S508 contains a mandatory aspect about delivery through the vol sector. s507a is about u-13s. No statutory guidance to LEAs yet it lays upon LEAs very serious duties:
Click to access 1363944956.pdf
Let’s write a draft SG, there is not the escape clause of s507b, the law is ignored. Get counsel’s opinion.
Hold them to account at the UN Committee, respond to that wretched apology for an entry, use GC 17. Good as they are, bodies like CRAE will not give play its due either, so we are the ones with that duty.
I know FPfC is not much regarded here, used to that. But you and others have to answer the very serious question, as this has been tried many times before, why are we still on the same old merry-go-round. Sitting in academic ivory chairs hasn’t worked to date, you assume the buggers can read.
Thanks for the good wishes Jan. I remain of the view that evidence helps, though I don’t for a moment believe – and have never said – that it is enough on its own. As I argued over on Bernard Spiegal’s website, government policy tends to change in response to a broad set of pressures, agents and activity, and a mix of styles of engagement ranging from evidence-based argument to raw emotion. Me, I prefer a more reasoned approach, but each to his (or her) own.
It is easy to be a lone voice calling to man the barricades. It is harder to get others to take up the rallying cry. It is even harder to move from protest to change. I often wish that more people would get more militant about reclaiming streets from cars. But wishing doesn’t make it so.
Thank you all – I have thoroughly enjoyed reading your comments!! I can only do my small bit in this huge puzzle but my local authority Aberdeenshire is currently consulting on its play provision. I’m off to wham them with your thoughts. Mandy Tulloch.