Well-being without boundaries
As featured in the Australian Leisure Management magazine - March 2023
A new year is an opportunity to set new intentions and revisit our visions for our lives and businesses. So will this be the year that our sector will change course for a fairer future?
As we continue to advocate for how important the contribution of the sport and physical activity system (system) is to the health and well-being of society, what impact are we really having?
We may pat ourselves on the back at how good we are for having altruistic intentions in helping others with their health. But in reality, are we adding to the problem?
The data is clear, inequalities and health inequity in Australia are getting worse. It’s unacceptable and avoidable. Concurrent to this, there’s a shift in our sector away from simply leisure and towards well-being. In this article, I discuss the system in Australia and what this shift means. This is also a call to action, to work together through cross-sector collaboration to make a measurable impact on the causes of health inequity at all levels of society.
Setting the scene
There’s lots of things happening in the macro that inevitably effects the health system. Cost of living, inflation, macro economic effects.
We live in a time of volatility, uncertainty, complexity, and ambiguity (VUCA) where unpredictable change has become the norm. There is now more disruption, rapid change, and hyper competition than ever. As John Allen Paulos told us 73 years ago in 1945, “The only certainty is uncertainty”.
Global threats like pandemics and the exacerbation of conflicts, like we have seen with the war between Russia and Ukraine, pose significant risks to the well-being of Australians. These macro events, and economic uncertainty will continue, so we must find a way to consciously navigate the complexity.
In October 2022, the World Health Organisation published a report stating that almost 500 million people will develop chronic diseases such as heart disease, obesity, diabetes, mental health disorders and other noncommunicable diseases (NCDs) attributable to physical inactivity, between 2020 and 2030 (WHO 2022, 84).
The economic burden of physical inactivity is significant and the cost of treating new cases of preventable NCDs will reach nearly $520 billion USD by 2030, that’s around $72.7 billion AUD annually (Costa Santos et al. 2022). How bad will things have to get before we act? We do not lack the resources to solve these problems, we lack the volition.
Adaptive systems
On Boxing Day, I watched the start of the Sydney to Hobart race. As I observed the yachts start their epic 1,056 kilometre journey, I was struck by the complexity of their mission and destination to sail to Hobart.
To be successful, they would need to overcome a multitude of hurdles such as strong winds, rain, ocean currents, waves, mechanical issues, competition, sleep deprivation and teamwork for the round the clock 3-to-4-day challenge.
I reflected on how the yacht teams navigate the uncertainty and complexity of the race as an adaptive system. It got me thinking and comparing this to our system.
The destination for the Sydney to Hobart race is clear; to dock into Tasmania, safe and sound. To achieve this goal, the crew would need to work in unison overcoming any challenges including the fury of mother nature.
So what is our system’s destination and how do we measure success? Is it winning green and gold medals in the 2032 Brisbane Paralympic and Olympics? The Matildas lifting the FIFA World Cup? The Aussies winning the Ashes? Children learning to swim? Improving physical literacy levels? Supporting people with disability, mental health conditions or new settlers?
I could go on, but you get the picture. It’s evident these are all important destinations and I appreciate there are many layers and influences with varying objectives. But if we widen our perspective of our system, what are we collectively trying to achieve?
The current scale of health inequalities in society and the world tells us a good deal about the quality of our society and the way we organise our affairs.
I believe the common thread for our system’s destination is to improve everybody’s health and ultimately well-being.
We must be honest with ourselves though; is what we are currently doing working? Do we pursue the best interests of everyone in society, or is it just a selection of groups? Is there equity of access for all communities?
Sadly the data confirms that health inequalities and inequity are in fact, getting worse. Health inequalities are not only about poor health of poor people. The social gradient operates on a sliding scale, affecting health outcomes for everyone on the social ladder.
Do we have the political will and capability to change tact like the yachts in the race when navigating the elements?
What is health equity?
I was fortunate enough to present my views at the Parks and Leisure Australia conference in November 2022 on ‘Reducing health inequity within our communities’.
Health equity is achieved when every person can ‘attain his or her full health potential’ and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances” (Centre for Disease Control 2013). This is related to the social determinants of health, that’s the nonmedical factors that influence health and quality-of-life outcomes (Marmot 2014).
More than half of Australians do not meet the physical activity guidelines (Australian Department of Health and Aged Care 2021). One in two Australians have a lifestyle-based chronic disease, which can be prevented. This affects life expectancy and the lower your socioeconomic status the lower your life expectancy; but that’s not the whole story. Groups with shorter life expectancies are also more likely to suffer from significant health problems that result in a poorer quality of life for longer periods of time. Long-term conditions such as diabetes, some cancers, dementia, heart disease and stroke are all closely linked to physical inactivity and cause significant morbidity and mortality.
In Australia, those living in the most disadvantaged areas are significantly more likely to experience chronic disease with 24.9% having two or more versus only 12.8% in the most affluent suburbs (Australian Bureau of Statistics 2022). Besides the economic impact of preventable diseases, people with chronic conditions are 60% less likely to be employed and are more likely to experience pain with increased rates of psychological distress (The Australian Prevention Partnership Centre 2022). You can read more about the burden of disease in Australia here.
Poverty, physical inactivity, and health outcomes are intrinsically linked. Depending on your postcode, life expectancy can be a difference of 12 years.
In my presentation I put forward the case that the system is broken and even targeting the most deprived is counterproductive.
As Sir Michael Marmot eloquently postulates, we need universal services that improve everybody’s health but put the most effort into those in greatest need (Strategic Review of Health Inequities in England post-2010 (SRHIE) 2010). Add place-based collaboration, community-led with committed political leadership and we could start to reduce health inequity.
We know that sport and physical activity can’t solve every social issue, but it’s widely accepted that physical activity is a golden thread to improving individual well-being and the health of communities.
In saying that, our system is part of a wider eco-system.
The wider eco-system includes social issues such as poverty, crime and recidivism, drug abuse, poor educational attainment, employment for marginalised communities, housing instability, trauma, and mental health issues. Health inequity does not occur in a vacuum. If we don’t address the underlying causes of inequity our progress will be limited.
We need to build awareness of self and our role in our system, as well as how we connect and influence the wider eco-system we are a part of.
A new era of well-being
As discussed earlier there is momentum building with a shift and dialogue away from leisure to well-being, which is encouraging. But we need to go beyond the rhetoric and convert this into social actions and results if we’re really going to improve the well-being of communities.
In 2019, I plucked up the courage, quit full-time employment and founded a social enterprise, Collective Leisure. Our purpose is to enable well-being without boundaries. Meaning no matter who you are, where you’re from or what your background is, you should be able to be a well-being. This was inspired from my own personal experiences, and deep sense of social justice. The awareness that global health and well-being are tracking poorly, and the desire to create a sustainable social enterprise. Proving you can be a business for good and be profitable.
I passionately believe social enterprise as a ‘business for good’ in the sport, physical activity and wider system can support the evolution of societies towards a brighter future, putting people and planet before profit (but that’s for another article).
In October 2022, Australia’s Labour government launched its first well-being budget inspired by our neighbours across the ditch in New Zealand. Which aims to put the health and happiness of its population front and centre. It’s early days as the budget does not have targets linked to well-being but there appears to be a commitment towards goals this year. There is a broader discussion on working towards a well-being economy that serves people and nature, but this article focuses on people.
It's been great to observe AUSactive rebranding from Fitness Australia with their vision for ‘Activating Everybody. Every way. Every day’ - as the united body for Australian’s health and well-being.
And in December 2022, our colleagues at Sport England published a report outlining a shared vision for the future of public leisure as the sector looks to transition from delivering traditional services to a wider focus on active well-being.
Two years ago, I launched a podcast series called Part of the System with the goal to chat with people and organisations that are part of the wider sport and physical activity system across Australia, New Zealand, England and America, through a well-being and systems lens. Guests have included representatives from public health, government, leisure, health, sport and recreation, peak bodies, not-for profits, education, disability and the social economy.
It’s been very humbling to chat with so many wonderful people and I’ve learnt a lot. The guests have shared their perspectives from all intersecting points of the system. From lived experience with incarceration, recovering drug addiction, people suffering from mental health, CEOs, managers, consultants, founders, civil servants, professors and people supporting those most vulnerable such as working in aboriginal health.
My intention is to increase our awareness and deepen our understanding of the system, to engage different perspectives, challenge assumptions and connect the dots, while trying to improve my own personal knowledge as a practising systems leader.
Beyond the rhetoric to practical social change
We now have a declaration towards well-being from the Australian government and the leaders in our industry which is encouraging.
In systems change, the theory goes that we must hit the edge of chaos before the system changes. My concern is how bad do things need to get for the system to change? How close are we to the edge of chaos right now?
The shift in thinking and greater focus on well-being is promising, but if we only change the name and not the ingredients, the recipe will turn out the way it always has.
Do we have the courage, insights, collaborative leadership and political will to make the necessary changes?
Well-being is such a complex concept. AusActive’s focus is ‘health and well-being’ and Sports England’s is ‘active well-being’. But there is so much more that simply health that contributes to a person’s well-being.
In our work at Collective Leisure we look at well-being from a “whole of person” lens. Using our wheel of well-being we support communities, covering the areas of purpose, financial, spiritual, physical, growth, relationships, nourishment, emotional and environment; all grounded in habits, with the golden thread being physical activity.
Hopefully, more organisations will move towards a well-being focus.
Its time for us to stop focusing on the parts of the system most visible to us. We must help each other to see our part in our system as well as the larger eco-system, which we also influence. Working collectively towards a shared vision beyond the rhetoric to practical social change.
References
Australia. Department of Health and Aged Care. 2021. About physical activity and exercise. https://www.health.gov.au/topics/physical-activity-and-exercise/about-physical-activity-and-exercise.
Australian Bureau of Statistics. 2022. Health conditions prevalence. ABS. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/health-conditions-prevalence/latest-release.
Centre for Disease Control. 2013. Attaining health equity. https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/overview/healthequity.htm
Costa Santos, A., Willumsen, J., Meheus, F., Ilbawi, A and Bull, F.C. 2022. “The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis.” The Lancet 11 no. 1: E32-E39. https://doi.org/10.1016/S2214-109X(22)00464-8
Marmot, M. 2014. “Social Determinants of Health Equity.” American Journal of Public Health 104(Suppl 4): S517-S519. https://doi.org/10.2105/AJPH.2014.302200.
Strategic Review of Health Inequalities in England post-2010. 2010. Fair society, healthier lives: The Marmot review. The Marmot Review. https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review.
The Australian Prevention Partnership Centre. 2022. What is the burden of chronic disease? https://preventioncentre.org.au/about-prevention/what-is-the-burden-of-chronic-disease/.
World Health Organisation. 2022. Global status report on physical activity. https://www.who.int/publications/i/item/9789240059153.