Guest blog: Why aren’t all children walking to school? Current challenges and potential solutions.

Guest blog: Why aren’t all children walking to school? Current challenges and potential solutions.

thumbnailDr Rob Noonan is a Lecturer at the University of Liverpool.

Twitter: @RobJNoonan

Email: R.noonan@liverpool.ac.uk

 

It’s timely for us to consider the topic of walking to school with “Walk to School week” almost upon us (20-24 May 2019).

This month we’ll see many families engage with the Living Streets initiative either in part or in full (i.e., 5 days), but how do we encourage these families to sustain their behaviour change and walk to school daily. That’s the challenge. Here, we’ll consider some of the current social, environmental and political challenges competing against this public health goal and offer a few potential solutions to overcome them.

Walking to school benefits

Walking is an easy, active and healthy way for children to travel but the number of children walking to school is in decline. Roughly half of all children in England walk to school regularly. This figure is 20% less than that seen 40 years ago (1). The Government recently committed to setting a target to increase the number of children walking to school in the Childhood Obesity Strategy (2). Whilst this is pleasing, and is a step in the right direction, it’s important for us to not just see walking to school as a way to curb childhood obesity. I say this because, firstly, the aetiology of childhood obesity is complex and multifactorial (and is influenced by other important factors such as biology, food consumption; for detail see (3,4)) and secondly, there are broader societal and public health objectives (i.e., reduced road accidents, less congestion and carbon emissions) that can be achieved if more children walk to school. These extend beyond the physical (and mental) health benefits (5) and should be a focus too.

Around twelve hundred children are involved in road accidents in and around schools every month (6). When more children walk to school the number of road users outside the school and surrounding area is cut which has the potential to improve pedestrian safety. It has the potential to reduce road congestion around schools too. Road congestion during the school run generates around two million tonnes of CO² every year (7). These high carbon emission levels place children at great risk of developing respiratory conditions including asthma and can have irreversible long-term health effects (8,9). Although the progressive move towards electric vehicles (10) has the potential to improve air quality surrounding schools (public health target (11)) we need to think of ways of changing driver (parent) behaviour too so that there are fewer cars on school roads.

Current challenges and potential solutions

Social

Social norms relating to children’s safety are perhaps the greatest barrier to increasing walking to school rates in England. Because society expects children to be under continuous direct adult supervision, strong social pressures work against any parent who understands the value of allowing their child(ren) to walk to school. Only by addressing these negative perceptions will parents feel comfortable letting their child walk to school (alone). When parents see other parents letting their children to walk to school (alone), they’re going to be more inclined to let their children walk to school too (12). How do we go about changing these (parent) attitudes towards walking to school?

Parent behaviour is influenced not least by the behaviour of other parents, but by what they see in the media too (13). As such, social marketing campaigns (via media avenues) are a viable way to change social norms related to health behaviour (14,15), and could be used to change parent attitudes towards children’s school walking (16). Social marketing campaigns work through direct and indirect pathways. For example, a media campaign focused on why parents shouldn’t drive their children to school could invoke cognitive and emotional responses from parents (i.e., direct), it could change the social norm(s) within a social network (i.e., parent groups; indirect), and it could have broader implications by generating public discussion on the topic. This broader discussion could lead to public health policy changes which may lead to constraints on parent behaviour (i.e., restrictions on driving children to school (17)). Social change may also come from public health engaging with news and entertainment platforms to promote walking to school in a positive (rather than negative) way. However, changes in children’s (and parents) walking behaviour will likely be maximised by supplementary changes in the environment and the implementation of policy measures that support opportunities to change.

Environmental

It’s then important that these competing environmental factors are addressed too. We know that home-school walking routes that are more direct and well-connected and made up of minor rather than major roads are perceived by parents to be safer and thus more supportive to school walking because they generally experience less motorised traffic and lower speed limits (18-20). Therefore, the introduction of traffic calming measures within school catchment areas such as pedestrianisation and street crossings would provide a more conducive environment for children’s school walking and should be considered by future urban planners.

Political

There are things that can be done at a policy level to increase walking to school rates. The school’s location (in relation to home) is among the strongest of influences on children’s mode of travel to school (i.e., active or passive (21,22). I emphasise this point because contemporary children live further from school than ever before, with fewer than half of all school children in England attending their nearest school (1). Although the introduction of walking school bus programmes and more specifically, the inclusion of drop-off spots for children living further away from school have proven effective in promoting walking to school (23,24), these initiatives are not always sustainable and are heavily dependent on the recruitment and engagement of volunteers to support them (25). Therefore, in such contexts, is it unrealistic to expect population level increases in walking to school, certainly among those living a distance from school? For me, the enrolment of children from wide catchment areas (creates longer walking distances) is counterintuitive to public health goals of promoting walking to school. I see the uptake and maintenance of walking to school being dependent on government policies aligning with public health priorities (in this case active school commuting).

A better way

The most successful walking to school initiatives have been those that have targeted multiple levels of influence. For example, initiatives that have delivered educational activities (i.e., teaching pedestrian and traffic safety and creating awareness of the benefits and goals of walking to schools) alongside changes to neighbourhood infrastructure (e.g., connections between streets, bicycle lanes, traffic calming measures), have not just increased walking to school rates, they’ve reduced child traffic related injuries too (26). Similar initiatives have been effective in the UK (e.g., Sustainable Travel Towns Programme (27). These studies show that it’s not just about educating children and families about the benefits of walking, it’s equally important to create supportive environments for walking too.

As with many public health initiatives (i.e., NHS five a day and Change4Life campaigns (28,29)), families (parents more specifically) generally know what’s good (and bad) for them. What they often struggle with is translating their intention into action (30,31), in an environment that’s not always conducive to health promoting behaviours (e.g., walking, eating healthily etc), and in many ways, nudges them in the unhealthy (rather than healthy) direction (32). To make the default choice, the active (not passive) healthy choice, we need to recognise these broader environmental influences and address them.

There are broad ranging public health benefits (human and environmental) to increasing the number of children walking to school, but this goal is currently challenged by various social, environmental and policy level influences. There is no single solution to this problem. To change behaviour at the population level we need to think beyond the individual. We need to change social norms towards walking to school (e.g., through advertising and education on the benefits of walking to school over motorised transport), improve built environment infrastructure around schools (e.g., improve connections between streets and create wide sidewalks) and implement policies (e.g., introduce widespread traffic calming measures, pedestrianisation, and maintain good public transport system), that both facilitate and encourage walking to school. Essentially, to achieve this, we need to embrace complex systems thinking (for detail see (33)) and take a health in all policies approach (34) whereby there’s common understanding and a multi-sector commitment to maximising positive health, with strong relationships/collaborations made between public health, academics, schools, media, local government, transport agencies and urban planners (to translate research into practice). Once everyone is reading off the same page, perhaps then we’ll start to see more children walking to school daily.

References

  1. Department for Transport. (2018). National Travel Survey: England 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729521/national-travel-survey-2017.pdf
  2. HM Government. (2016). Childhood Obesity: A Plan for Action: Chapter 2. London: HM Government.
  3. (2007). Foresight Report: Tackling Obesities: Future Choices – Project Report (2nd ed). London: Government Office for Science.
  4. Kumar, S. & Kelly, A. S. (2017). Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clinic Proceedings, 92(2), 251-265.
  5. Sarmiento, O. L., Lemoine, P., Gonzalez, S. A., et al. (2015). Relationships between active school transport and adiposity indicators in school-age children from low-, middle- and high-income countries. International Journal of Obesity Supplements, 5, S107–S114.
  6. AXA Local Road Safety Index – Update. http://roadsafetyanalysis.org/2014/12/axa-local-road-safety-index-update/
  7. Sutton Trust. (2005). No more School Run: A proposal for a national yellow bus scheme in the UK. London: Sutton Trust.
  8. Dosanjh, A. (2011). Childhood asthma and anthropogenic CO2 emissions. Journal of Asthma and Allergy, 4, 103–105.
  9. Liu, N. M., & Grigg, J. (2018). Diesel, children and respiratory disease. BMJ Paediatrics Open, 2, e000210.
  10. Van Mierlo, J. (2018). The World Electric Vehicle Journal: The Open Access Journal for the e-Mobility Scene. World Electric Vehicle Journal, 9, 1.
  11. Department for Environment, Food and Rural Affairs. (2017). Air Quality: A Briefing for Directors of Public Health. London: Department for Environment, Food and Rural Affairs.
  12. Lorenc, T., Brunton, G., Oliver, S., et al. (2008). Attitudes to walking and cycling among children, young people and parents: a systematic review. Journal of Epidemiology and Community Health, 62, 852–857.
  13. Reid, A. E., Cialdini, R. B., & Aiken, L. S. (2010). Social Norms and Health Behavior. In: Steptoe, A. (Ed.), Handbook of Behavioral Medicine: Methods and Application. New York: Springer.
  14. Abroms, L. C., & Maibach, E. W. (2008). The effectiveness of mass communication to change public behavior. Annual Review of Public Health, 29, 219–234.
  15. Apollonio, D. E., & Malone, R. E. (2009). Turning negative into positive: public health mass media campaigns and negative advertising. Health Education Research, 24(3), 483–495.
  16. Schuster, L., Kubacki, K., & Rundle-Thiele, S. (2016). Community-based social marketing: effects on social norms. Journal of Social Marketing, 6(2), 193-210.
  17. Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour. Lancet, 376(9748), 1261–1271.
  18. Noonan, R. J., Boddy, L. M., Knowles, Z. R., et al. (2017). Fitness, fatness and active school commuting among Liverpool Schoolchildren. International Journal of Environmental Research and Public Health, 14, 995.
  19. Noonan, R. J., Boddy, L. M., Fairclough, S. J., et al. (2017). Parental perceptions on children’s out-of-school physical activity and family-based physical activity interventions. Early Child Development and Care, 187(12), 1909-1924.
  20. Rothman, L., Macpherson, A. K., Ross, T., et al. (2018). The decline in active school transportation (AST): A systematic review of the factors related to AST and changes in school transport over time in North America. Preventive Medicine, 111, 314-322.
  21. D’Haese, S., De Meester, F., De Bourdeaudhuij, I., et al. (2011). Criterion distances and environmental correlates of active commuting to school in children. International Journal of Behavioral Nutrition and Physical Activity, 8:88.
  22. Duncan, S., White, K., Mavoa, S., et al. (2016). Active Transport, Physical Activity, and Distance Between Home and School in Children and Adolescents. Journal of Physical Activity & Health, 13, 447–453.
  23. Mendoza, J. A., Levinger, D. D., & Johnston, B. D. (2009). Pilot evaluation of a walking school bus program in a low-income, urban community. BMC Public Health, 9:122.
  24. Vanwolleghem, G., D’Haese, S., Van Dyck, D., et al. (2014). Feasibility and effectiveness of drop-off spots to promote walking to school. International Journal of Behavioral Nutrition and Physical Activity, 11:136.
  25. Smith, L., Norgate, S. H., Cherrett, T., et al. (2015). Walking School Buses as a Form of Active Transportation for Children—A Review of the Evidence. Journal of School Health, 85, 197-210.
  26. DiMaggio, C., & Guohua, Li. (2013). Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury. Pediatrics, 131(2), 290–6.
  27. Sloman, L., Cairns, S., Newson, C., et al. The Effects of Smarter Choice Programmes in the Sustainable Travel Towns. Report for the Department for Transport. London, 2010. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/4410/chap3.pdf (accessed 14 March 2019).
  28. (2018). 5 A Day: what counts? https://www.nhs.uk/live-well/eat-well/5-a-day-what-counts/ (accessed)
  29. (2018). Change4Life. https://www.nhs.uk/Change4life/ (accessed)
  30. Hamilton, K., & White, K. M. (2011). Identifying key belief-based targets for promoting regular physical activity among mothers and fathers with young children. Journal of Science and Medicine in Sport, 14, 135–142.
  31. Hamilton, K., & White, K. M. (2012). Social influences and the physical activity intentions of parents of young-children families: An extended theory of planned behavior approach. Journal of Family Issues, 33, 1351–1372.
  32. Thaler, R. H., & Sunstein, C. R. (2009). Nudge: Improving Decisions About Health, Wealth and Happiness. London: Yale University Press.
  33. Rutter, H., Savona, N., Glonti, K., et al. (2017). The need for a complex systems model of evidence for public health. Lancet, 390, 2602-2604.
  34. Local Government Association. (2016). Health in All Policies: a manual for local government. London: Local Government Association.

 


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