Dr William Bird’s blog explaining the principles of “Proportionate Universalism”


Beat the Street Leicester

 

The Beat the Street game has been played by more than 1.2m people since I created it in 2012 and key to its popularity and success with funders is that it actively addresses health inequalities at scale.

In England the programme has been supported by £3.3m of National Lottery funding from Sport England, and will be delivered across the country as lockdown eases us out of our homes.

These include places who have been severely affected by lockdown such as Leicester, Sheffield, Derby, Barnsley and Rotherham.

In total, we hope that more than 200,000 people of all ages and abilities will take part in the game in 2021 this spring.

However, Beat the Street was founded long before COVID, to address long-term conditions such as diabetes and COPD and enable people to make positive change themselves. By really understanding the barriers and motivations to getting active then gamifying through competition, fun incentives and social norming, Beat the Street has consistently managed to engage disadvantaged sectors of the population.

Working with key stakeholders and local councils and public health, the game is designed to be free, simple and accessible to all communities.

It means that getting active is possible from your front door and opens up a healthy lifestyle to all – not just those who could afford gym memberships.

This is where the concept of ‘proportionate universalism’ comes in – an idea first introduced by Sir Michael Marmot who coined the term to describe a system where solutions are made universally available, but with an intensity that is directly proportionate to the level of social disadvantage.

The problem of health inequality has been increasing since 2011, and left unchecked, will have a devastating impact on the NHS and the public purse.

There is a life expectancy gap between the rich and poor of up to 15 years – sometimes between people who live just 100m apart in the same borough.

As we ease out of lockdown, it’s tempting to try to return to normal and a focus on reopening gyms and leisure centres and sports.  These are vital and full of joy and relevance for many of us but with 38% of adults inactive or fairly active we need to be more creative and bold with how we get people moving.

The pandemic provides us with a unique opportunity to try to do things differently.

The Beat the Street game was created to inspire people from all walks of life to get active and to incorporate healthy lifestyle habits into their daily lives.
The game takes place outdoors with a focus on helping people get outdoors into green space. Now, , outdoor exercise is preferable to indoor environments where Coronavirus could spread.
Beat the Street has been described as “the best buy in public health”.  It has significant long-term benefits for inactive adults helping families and whole communities to get moving and keep active. As of November 2020, the National Lottery provided funding for 216,000 participants. Of those who were inactive (who do less than 30 minutes of physical exercise a week) 70 per cent of inactive adults and 73% of less active children have remained active 12 months following the game.

Many participants are those who would not traditionally go to a gym or club.

Lin and Dave got in touch during the Beat the Street Eastbourne game which helped them walk at least once a day together.

Dave said: “We’d get the map out, choose a different part of the town each day and get walking. Even though we know Eastbourne quite well, there are some parts that you would never see unless you were doing a job up there. I never knew there was so much green space around the north of the town and now have got to know all the paths and cut throughs!”

Lin would walk up to three times a day and developed a route taking her from the eastern side of Eastbourne out to the seafront, along the promenade and onto the beach, before taking a circular route back home.

She said: “It made me realise how competitive I am! I kept a close eye on the leaderboards to the point where I could tell which players were walking and which were cycling. Sometimes I would see that the team above us had done 20 Beat Boxes, so it would make us go out and do the same. Sometimes I would go out in the morning and then again in the afternoon, and then again with Dave in the evening.

“It was good to get out together and to walk without distraction and to chat without one eye on the TV.”

We have also shown we can tackle health inequalities at scale. A total of 5,824 adults have provided data on their physical activity pre- and post-game. Across all games there has been a 10% drop in inactivity and an 11% increase in those doing 150+mins per week.

This level of behaviour change remains consistent across all demographic groups and behaviour change is greater those who face the greatest inequalities.:

Decrease in Inactivity Increase in 150mins
Overall (N=5824) 10% 11%
High Deprivation 10% 11%
Low Deprivation 8% 7%
BAME Background 13% 10%
Disability (not incl LTC) 11% 13%

 

We know prevention is better than cure but it’s also more cost effective. Beat the Street cost £66.12 for each person (adult or child) who moved from inactive to active through the programme.

Stuart Rogers, Senior Public Health Officer at Barnsley Metropolitan Borough Council said: “What we like about Beat the Street in Barnsley is that we create a movement that reaches every community in our district. It is free and available to everyone to play which helps to creates the interest,  momentum and inclusivity in engaging everyone. It fits with our approach of creating solutions that are for everyone but where we can provide enhanced support in communities where the greatest inequalities exists to increase physical activity levels. This certainly helped our Beat the Street game in 2019 with unbelievable results across all communities.”

The key is now that we all work together to ensure that resources are allocated to where they’re most needed and that we improve everybody’s health and outlook.

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