Chief Medical Officer prescribes play and risk as well as pills

Sally DaviesThe call by Professor Dame Sally Davies, the Government’s top health advisor, for children to be given vitamin pills has kick-started another lively debate about the health of our nation’s children (this morning I switched on my radio to hear film-maker David ‘Project Wild Thing’ Bond flying the flag for nature, not pills, on BBC Five Live with Nicky Campbell). But that was just one media-friendly recommendation taken from 15 chapters and appendices of material. A closer look at the report shows a more thoughtful set of prescriptions, with some significant and positive messages about the value of outdoor play and the need for a balanced approach to risk. This post is a public service. Its aim is to relay some of the CMO’s messages, so that advocates for play and the outdoors can quickly find and make use of them.

In her own Summary (Chapter 1) the CMO says, under the heading ‘building resilience’ (p.7):

We need to develop strategies to enable young people to be able to mount successful responses against life’s challenges, and to do this we need to inoculate them and thus develop resilience. By exposing young people to low doses of challenges, in safe and supported environments, we strengthen their ability to act effectively later in life.

She also recommends that “Public Health England should work with local authorities, schools and relevant agencies to build on current efforts to increase participation in physical activity.” (recommendation 5)

Chapter 7  – Life Stage: School Years – was written for the CMO by Fiona Brooks (Professor of Health Services Research at the University of Hertfordshire). It has the following to say about play (p 9):

For children of primary school age, time spent in active, free play outside school (running around and playing games) can contribute a significant amount of time to their physical activity rates. For the current generation of children in England a number of factors can be seen as contributing to a decline in free play. These include parental as well as children’s own concerns over safety and a lack of appropriate green or urban spaces to play in combined with a reduced general tolerance towards children playing on the streets. If, however, parents feel that an area is safe they are more likely to let their children play outside, which also may bring a range of physical and emotional benefits. For both younger children and adolescents, physical activity undertaken as part of leisure time outside school can enable children and adolescents to widen their friendship groups and participate in their local communities, thereby providing opportunities to develop social skills that help to build positive personal attributes such as self-esteem and self-confidence.


In addition, Chapter 7 has case studies featuring Play England’s Exploring Nature Play project and its Economic Evaluation of Play Provision, and also a case study on the Playing Out street play project (which I have featured a number of times here).

Chapter 7 also warns against a piecemeal approach, calling instead for interventions that cross different domains of health and wellbeing. It says:

Multi-domain and multifactorial approaches to promoting health-enhancing behaviours represent the greatest opportunities to build resilience in childhood. The promotion of physical and mental health simultaneously can offer great benefits for children, working dynamically to create a virtuous circle that keeps reinforcing overall health, wellbeing and achievement.

The report has other strong, progressive messages. These include the need to take into account the views and experiences of children and young people, and the value of early intervention and proportionate universalism, which the CMO defines as “improving the lives of all, with proportionately greater resources targeted at the more disadvantaged”. She also calls for a national children’s week, “to help change our national culture to celebrate children and young people.”

There are some disappointments. An explicit mention of play alongside sport in the headline recommendations would have nailed the points made in Chapter 7. On risk, the lack of discussion about risk benefit is a missed opportunity (especially given the Health and Safety Executive’s own 2012 high level statement). Nonetheless, in my view the report is a significant addition to the voices calling for greater attention to children’s outdoor play experiences. It is also timely, given that local authorities in England are taking forward their new responsibilities for public health, and setting their budgets and priorities – as is the newly-formed Public Health England itself. I would love to hear your thoughts on the report, and also any news you have on successes and failures in making the health case for play and for a balanced approach to risk.

9 responses to “Chief Medical Officer prescribes play and risk as well as pills

  1. Balanced as ever, Tim, a timely piece of public service (piece of? doesn’t sound right) from a servant of the public.

    Nice to see the terms, ‘public’ and service’ used in a positive context like this.

    I shall ‘facebook’ this ( I hate verbifications, like friending and facebooking), I won’t tweet it, because I don’t tweet, and I’m reblogging.

  2. Reblogged this on musings|scraplog and commented:
    It’s almost as if our media are being deliberately obtuse. Read this, follow the links, build your arguments for play, playpeople.

  3. Sorry, Tim, this is almost off-topic:

    One point I would take issue with is the results of the ”Play England – An economic evaluation of play provision“ project. This shows an adventure playground to be less economically beneficial than an after-school club.

    Now, I know that I would say this, wouldn’t I, but in my defence, I was a critic of the methodology from the outset. I may be making an error, but AFAIK, the ‘settings’ were asked to rate THEMSELVES against various criteria. IMHO, this has the consequence that the playwork ‘settings’ exhibited their usual low self-esteem* by being humble in their self ratings, while the after-school clubs exhibited no such feelings of low self-worth.

    * like a battered child. Playworkers, like other occupations that work with stigmatised groups, such as prisoners or HIV/AIDS sufferers, come to share that stigma themselves in the perceptions of wider society.

  4. I agree Tim, some good messages that should serve us well in making our arguments for a half decent policy response. But like you I am more than a little bit disappointed that none of the recommendations reflect the importance of play clearly demonstrated by the body of the text and the case studies. As you might expect, I bang on about this here …

  5. Thanks Arthur and Adrian for the comments. Arthur – I too have reservations about the Play England cost-benefit report, but on different grounds: I don’t think it was broad enough in its approach. I think it should have included unstaffed play areas, for instance. I also wonder whether it could have looked more closely at emotional and mental health benefits. Though I think the biggest implicit message from that study is ‘we need more empirical evidence’ – there was a lot of guesswork involved in getting to those numbers. Adrian – looks like we were blogging in parallel! Thanks for sharing your link and your thoughts here. I’ll nip over to your blog and add some of my own.

  6. On the economic evaluation of play provision, I commissioned this and so have to take some responsibility. I knew it was weak. The team we employed were very experienced in CBA but told us that the data just wasn’t available to do anything stronger. We published anyway, on the basis that if it did end up getting referenced in any future policy documents or research reviews, it would be the bottom line that people would notice: i.e. investing in play provision is sound economics. I make no apology for that, especially now its starting to do the job…

  7. I work with about 5,000 students a year through schools visiting and getting wet in streams, fishing out water invertebrates and getting muddy clambering our hills on The Long Mynd (Shropshire). Amongst outdoors promoters the value of a school visit is diminished by a perception that it is curriculum focused and thus not play. Can I promote a newly released 20 min film you can access online: showing how students can connect with countryside. Chris Stratton. National Trust Learning Officer.

  8. Hi Tim, I have just found your blog and think its fantastic. Would love for you to have a look at my blog as I am very lucky to work in the outdoors providing outdoor risky {but safe of course, council rules} activities and play opportunities to children and young people throughout Cardiff. I am also a mother to a happy outdoor 7 year old who has had an active childhood playing in the outdoors. I enjoy sharing my adventures of living and working in the outdoors, and am so passionate about the benefits of playing outdoors for children. Our children are missing out because of red tape, worried parents, technology and lack of understanding of how we can promote outdoor play. Will follow your blog with great interest.

  9. Pingback: Risk and Resilience |

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