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.