TABLE OF CONTENTS

1........... PROCEDURAL ISSUES AND CONSULTATIONS................................................ 7

1.1........ Identification................................................................................................................... 7

1.2........ Organisation and Timing.................................................................................................. 7

1.3........ Impact Assessment Board (IAB).................................................................................... 7

1.4........ Consultations.................................................................................................................. 7

1.5........ Use of external expertise................................................................................................. 8

2........... PROBLEM DEFINITION......................................................................................... 9

2.1........ Context.......................................................................................................................... 9

2.1.1..... The importance of physical activity.................................................................................. 9

2.1.2..... Policy context................................................................................................................. 9

2.2........ Identification and analysis of the main problem(s)........................................................... 12

2.2.1..... Approach to HEPA not sufficiently cross-sectoral......................................................... 14

2.2.2..... Objectives and goals not concrete and clear enough...................................................... 16

2.2.3..... Insufficient provisions for monitoring and evaluation....................................................... 17

2.3........ Underlying reasons for the main shortcomings................................................................ 18

2.4........ Affected groups and regions.......................................................................................... 21

2.5........ Justification for EU action.............................................................................................. 22

2.5.1..... The EU’s right to act..................................................................................................... 22

2.5.2..... Added value of EU action............................................................................................. 22

2.6........ Baseline scenario.......................................................................................................... 24

3........... DEFINITION OF POLICY OBJECTIVES............................................................. 27

3.1........ General objective.......................................................................................................... 27

3.2........ Specific objective......................................................................................................... 27

3.3........ Operational objectives.................................................................................................. 27

3.4........ Consistency of objectives with EU strategic objectives................................................... 27

3.5........ Coherence of objectives with those of other policies...................................................... 28

4........... POLICY OPTIONS................................................................................................... 29

5........... ANALYSIS OF IMPACTS AND OF EFFECTIVENESS....................................... 33

5.1........ Social impacts.............................................................................................................. 33

5.2........ Economic impacts......................................................................................................... 36

5.3........ Environmental impacts.................................................................................................. 41

5.4........ Analysis of effectiveness................................................................................................ 42

5.4.1..... Option A: baseline scenario........................................................................................... 42

5.4.2..... Option B: Push for increased policy co-ordination......................................................... 43

5.4.3..... Option C: Push for increased policy co-ordination and monitoring, based on key elements of the EU Physical Activity Guidelines........................................................................................................ 45

5.4.4..... Option D: Push for increased policy co-ordination and monitoring, based on implementing all 41 EU Physical Activity Guidelines........................................................................................................ 46

5.5........ Analysis of impacts per option....................................................................................... 48

6........... COMPARISON OF THE OPTIONS....................................................................... 51

6.1........ Effectiveness................................................................................................................. 51

6.2........ Feasibility of implementation and sustainability............................................................... 51

6.3........ Efficiency...................................................................................................................... 52

6.4........ Coherence.................................................................................................................... 54

7........... SUMMARY: COMPARISON OF OPTIONS........................................................ 55

7.1........ The preferred option..................................................................................................... 55

8........... MONITORING AND EVALUATION.................................................................... 56

9........... ANNEX I: CONSULTATION OUTCOMES.......................................................... 57

9.1........ Member States (Council structures, informal level)......................................................... 57

9.1.1..... EU structures for sport.................................................................................................. 57

9.1.2..... EU structures for health................................................................................................. 63

9.2........ The European Parliament.............................................................................................. 68

9.3........ HEPA Experts.............................................................................................................. 69

9.4........ Stakeholders and the general public............................................................................... 73

10......... ANNEX II: ADDITIONAL EVIDENCE ON PHYSICAL ACTIVITY IN THE EU 74

10.1...... The benefits of physical activity and detriments caused by physical inactivity................... 74

10.2...... The persistent lack of physical activity in the EU............................................................ 74

11......... ANNEX III: MONITORING FRAMEWORK AND PROPOSED TABLE OF INDICATORS 74

11.1...... Introduction.................................................................................................................. 74

11.2...... Identifying indicators to monitor the implementation of the EU PA GL (in line with the preferred policy option in the IA)............................................................................................................................... 74

11.3...... Overview of proposed indicators for the monitoring of the implementation of the EU PA GL 74

11.4...... Operationalization, methodology and data by proposed indicator................................... 74

11.5...... Key information sources............................................................................................... 74

12......... ANNEX IV: DIAGRAM (PHYSICAL ACTIVITY MONITORING UNDER A RECOMMENDATION ON HEPA, AS OF MID-2014)................................................................................. 74

13......... ANNEX V: COSTS TO THE EU BUDGET AND ADMINISTRATIVE COSTS IN THE MEMBER STATES..................................................................................................................... 74

13.1...... Costs to the EU budget................................................................................................. 74

13.2...... Administrative costs in the Member States..................................................................... 74

List of tables used in the Impact Assessment

· Table 1: Impact assessment procedural steps

· Table 2: Overview consultations

· Table 3: Policy options to be assessed

· Table 4: Economic value of increased HEPA levels

· Table 5: Administrative costs in the Member States

· Table 6: Impact on EU budget

· Table 7: Effectiveness Option A

· Table 8: Effectiveness Option B

· Table 9: Effectiveness Option C

· Table 10: Effectiveness Option D

· Table 11: Analysis of impacts per option

· Table 12: Cost-effectiveness

· Table 13: Comparison of options

List of figures used in the Impact Assessment

· Figure 1: Future priorities for EU action in the field of HEPA

· Figure 2: Evolution of the proportion of Finns engaging in twice per week leisure time physical activity

· Figure 3: Estimated economic savings through rising levels of physical activity

Abbreviations:

EC/COM || European Commission

DG EAC || Directorate General for Education and Culture

DG SANCO || Directorate General for Health and Consumer Affairs

EU || European Union

EUR || Euro/s

EU PA GL || EU Physical Activity Guidelines

GBP || Pound sterling

GDP || Gross domestic product

GPAQ || Global Physical Activity Questionnaire

HEPA || Health-enhancing physical activity

HEPA Europe || European network for the promotion of health-enhancing physical activity

HLG || High Level Group for Nutrition and Physical Activity

IA || Impact Assessment

IPAQ || International Physical Activity Questionnaire

MS || Member State/s

NCD || Non-communicable disease

NGO || Non-governmental organisation

NOPA || European Database on Nutrition, Obesity and Physical Activity

OMC || Open method of coordination

PA || Physical activity

PAT || Policy Audit Tool

TFEU || Treaty on the Functioning of the European Union

WG WHO XG SHP || Working Group World Health Organization Expert Group on Sport, Health and Participation

Definitions:

Various physical activity ‘guidelines’ and ‘recommendations’ are mentioned throughout this report. In order to avoid any confusion of terms, documents which focus solely on the amount of physical activity that is necessary to achieve certain health effects on the individual level are referred to as physical activity ‘recommendations’. The term ‘guidelines’ is thus reserved for documents that advise policy makers how to take action on a certain topic.

The term ‘monitoring’ is used throughout the main body of this report to refer to the collection of data on physical activity and / or the implementation of policy. ‘Surveillance’ often takes this meaning in a public health context, but is not used due to the context and audience of this report. However, it is employed in many of the sources cited herein.

This IA uses the term ‘sport’ in line with the definition established by the Council of Europe in its 1992 European Sport Charter and used by the Commission in its 2007 White Paper on Sport: "Sport means all forms of physical activity which, through casual or organised participation, aim at expressing or improving physical fitness and mental well-being, forming social relationships or obtaining results in competition at all levels."

The term ‘physical activity’ is used in line with the definition established by the World Health Organization (WHO) according to which “Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. Regular moderate intensity physical activity – such as walking, cycling, or participating in sports – has significant benefits for health.”

1. PROCEDURAL ISSUES AND CONSULTATIONS

1.1. Identification

Lead service: DG EAC.D.2 (Sport Unit)

Main associated service: DG SANCO

Other services involved: SG, SJ, DG BUDG, DG COMM, DG EMPL, DG ENV, DG ESTAT, DG JUST, DG MOVE, DG REGIO, DG RTD

Agenda Planning: 2013/EAC+/013

Subject: Proposal for a Council Recommendation on health-enhancing physical activity (HEPA)

1.2. Organisation and Timing

Table 1: Impact assessment procedural steps

Action/Steps || Date

1st meeting of the Inter-Service Steering Group (ISSG) - discussion of the IA Roadmap || 19 July 2011

Finalisation of Roadmap || September 2011

Bilateral consultation with DG SANCO – focus on first part of the IA || 3 May 2012

2nd ISSG meeting – focus on first part of the IA and draft indicators || 12 June 2012

Updated Roadmap[1] || September 2012

Bilateral consultation with DG SANCO – focus on monitoring framework || 3 October 2012

3rd ISSG meeting – discussion of draft final IA || 24 October 2012

Submission of IA Report to Impact Assessment Board (IAB) || 7 November 2012

IAB meeting || 5 December 2012

IAB opinion || 7 December 2012

1.3. Impact Assessment Board (IAB)

The IAB, in its opinion on the draft of this Impact Assessment, recommended DG EAC to provide additional explanations why the EU and the Member States had failed to increase HEPA rates and how the EU could help in that respect. To reflect the Board’s comments, DG EAC has included additional information and improved the intervention logic of this IA report. In line with the Board’s suggestions, an additional effort was made to better explain the policy options and to provide a realistic assessment of impacts. Moreover, an effort was made to follow the Board’s advice to better reflect stakeholders’ opinions.

1.4. Consultations

Over the past years, Member States, experts, sport stakeholders and the general public have been consulted at different levels on their views regarding the need of and scope for the promotion of physical activity in an EU context, either directly or indirectly related to the planned EU policy initiative on health-enhancing physical activity (HEPA). After the adoption of the Communication on sport in January 2011 that includes an action point to consider such a proposal, the Commission has regularly presented its plans and the work in progress for this initiative to the policy level, to stakeholders and to experts and sought feedback within different settings. The table below provides an overview of the main discussion fora and of the level of stakeholders consulted. A detailed summary of the consultations can be found in Annex I of this report to explain who was consulted and with what results relevant to this initiative, in particular also regarding the envisaged monitoring framework. The minimum consultation standards have been respected. Views from the below fora and meetings have informed all main parts of this IA, in particular the problem section but also the development of the main ideas for the initiative, including the monitoring framework, which this IA will assess in detail.

Table 2: Overview consultations

Actors consulted || Meetings/Fora

Member States - Work in the Council - Work at the informal level || § Preparation of the Council Resolution on an EU Work Plan for Sport adopted on 11 May 2011 (Working Party on Sport / EYCS Council) and its implementation § Preparation of Council conclusions on HEPA adopted in November 2012 (Working Party on Sport / EYCS Council) § Expert Group “Sport, Health and Participation” set up by the Council (4 meetings as of autumn 2011) § Preparation of Council conclusions in the field of health (2011, 2012)

§ Meetings of EU Sport Ministers in 2011 and 2012 § Meetings of EU Sport Directors in 2011 and 2012 § High Level Group on "Nutrition and Physical Activity" (meetings of 3 February 2011 and 14 June 2012)

European Parliament || § Preparation of the EP Resolution on the European dimension in sport (adopted on 2 February 2012)

HEPA Experts || § Annual meetings of the HEPA Europe network 2008-2012 (incl. meetings of the HEPA Europe EU contact group as of 2010) § Workshop on indicators, 29 February 2012

Sport stakeholders and general public || § EU Sport Forum 2012 (Nicosia) § Expert meeting, 19 September 2012 § Sportvision2012 – DK Presidency Conference § EU Platform for Action on Diet, Physical Activity and Health § Online consultation to implement the Lisbon Treaty in the field of sport, Feb.-April 2010

1.5. Use of external expertise

As part of the preparations for this initiative DG EAC commissioned a study to assist it with specific elements, in particular the development of the envisaged monitoring framework including a set of indicators. The latter is proposed to form the core part of the planned Council Recommendation on HEPA. The study consortium (The Evaluation Partnership - TEP, the University of Zurich and VU University Medical Center) combines experience in evaluating EU initiatives and expertise in the field of HEPA. Work on the study started in October 2011 and was finalised a year later.

2. PROBLEM DEFINITION

2.1. Context

2.1.1. The importance of physical activity[2]

Physical activity, including regular sporting practice and exercise, across the life course is one of the most effective ways of staying physically and mentally fit, combating overweight and obesity and preventing related conditions. In addition, participation in sport and physical activity is correlated with other factors such as social interaction and enjoyment[3]. The myriad benefits of physical activity are well recorded and include lowered risk of cardiovascular disease, some cancers and type-2 diabetes, improvements in musculoskeletal health and body weight control[4]. There is also a growing body of evidence on the positive correlation between exercise and mental health, mental development and cognitive processes[5], including the fact that physical activity mitigates both the development and the effects of chronic stress. Mirroring these benefits is a requisite set of detriments caused by the lack of physical activity, including premature mortality[6], rising overweight and obesity levels, particularly among children, as well as a number of health problems aside from obesity (e.g. breast and colon cancers, diabetes, ischaemic heart disease). Available evidence also shows that the various health problems caused by the lack of physical activity have significant economic costs, especially in view of the fact that most European societies are ageing rapidly. Apart from these far-reaching negative health and economic effects, physical inactivity also has environmental and social implications.

2.1.2. Policy context

As awareness of the importance of physical activity has grown, many public authorities at the local, regional, national, European and international levels have stepped up their efforts to promote health-enhancing physical activity (HEPA). As sport and health policies are primarily national competences, it is within individual Member States (MS) that the most important efforts to promote HEPA are being made. As of 2010 a large majority of EU MS reported to have at least some form of guidelines or recommendations in place for physical activity[7] to enable and encourage their populations to become more physically active. Specific measures for this purpose have been launched in a number of policy areas or sectors, in particular sport, health, transport and education.[8]

At the international level, the World Health Organization (WHO) adopted a Global Strategy on Diet, Physical Activity and Health in May 2004 aimed at reducing risk factors for chronic diseases that stem from (…) physical inactivity.[9] The Action Plan for the Global Strategy for Prevention and Control of Non-communicable Diseases[10] (NCDs) 2008-2013 calls for the implementation of actions in line with the strategy.[11] The WHO has also developed Global Recommendations which recommend at least 150 minutes per week of moderate-intensity physical activity for adults.[12] In September 2011, a political declaration of the UN high-level meeting of the General Assembly on the Prevention and Control of NCDs recognised that the most prominent NCDs are linked to four common risk factors, including lack of physical activity, and strived at further advancing the implementation of the WHO Global Strategy, including the introduction of policies and actions aimed at increasing physical activity in the entire population.[13] Voluntary targets for the prevention and control of NCDs by 2025 have been agreed in the WHO global monitoring framework, including a 10% reduction in prevalence of insufficient physical activity.[14] In Europe, the WHO Regional Office for Europe has played a key role through HEPA Europe, a collaborative project established in 2005 with the aim of strengthening and supporting efforts to increase physical activity.[15] In November 2006 WHO Europe adopted the European Charter on Counteracting Obesity, which calls for a package of preventive actions relating to nutrition and physical activity. The Second European Action Plan on Food and Nutrition Policy (2007-2012) contains actions to tackle four main health challenges including physical inactivity.[16] The Action Plan for implementation of the European Strategy for the Prevention and Control of NCDs 2012-2016 takes account of the fact that physical activity is influenced by urban environments and transport policies and also calls for supporting interventions to promote active mobility.[17]

At EU level physical activity has been promoted through different competences and instruments. The lack of physical activity is being addressed through action in the policy area of sport which inter alia has the advantage of drawing on the potential of sport stakeholders to reach large parts of the EU population, including inactive people[18]. An informal EU Working Group “Sport and Health”, open to all MS, was launched in the second half of 2005. The 2007 White Paper on Sport highlighted the importance of physical activity, stipulated that the COM would facilitate the exchange of information and good practice for HEPA, and set out a plan for the COM to propose physical activity guidelines by the end of 2008.[19] These guidelines – known as the EU Physical Activity Guidelines (EU PA GL) – were drafted by a group of 22 experts from around Europe representing various disciplines and broadly representative of informed scientific opinion, approved by the Working Group on Sport and Health, and endorsed by EU Sport Ministers in November 2008.[20] They reiterate WHO Recommendations on the minimum level of physical activity, emphasise the importance of a cross-sectoral approach and provide 41 guidelines covering the relevant sectors responsible for HEPA promotion. The 2011 Communication on sport[21] pointed out that “physical activity is one of the most important health determinants in modern society” and that “sport constitutes a fundamental part of any public policy approach aiming at improving physical activity”. MS and the COM were invited to “based on the EU PA GL, continue progress toward the establishment of national guidelines, including a review and coordination process”. In response to the Communication, in May 2011 the Council agreed an EU Work Plan for Sport for 2011-2014[22] that recognised the need to strengthen co-operation between the COM and MS in sport, defined priority themes, including HEPA, and established several Expert Groups, including an Expert Group on Sport, Health and Participation (XG SHP) that got the mandate to “explore ways to promote HEPA and participation in grassroots sport”. The Group’s first set of deliverables was presented to the Council in July 2012 and provided input to the planned initiative.[23]

On the health policy side, physical inactivity has been addressed in relation to the epidemic of overweight and obesity, based on the 2007 White Paper on a Strategy for Europe on Nutrition, Overweight and Obesity-related health issues[24] that aimed at encouraging co-operation between MS and supporting them in their efforts to encourage healthier eating habits as well as HEPA. This Strategy outlines key principles for action, reiterated the importance of an effective partnership approach between different levels of government as well as different sectors of society, and emphasised the need for policy coherence across various policy areas including sport and physical activity. In particular a High Level Group on Nutrition and Physical Activity (HLG), consisting of European government representatives and chaired by the COM, was set up. Its aim has been to help share information on policies, policy ideas and practices. Among the strategy's implementation tools, there is the EU Platform for Action on Diet, Physical Activity and Health launched in March 2005 in order to create a forum for cross-sectoral co-operation between relevant private sector and non-governmental actors at European level willing to commit to tackling current trends in diet and physical activity.

As far as funding is concerned, projects promoting physical activity have been supported under various EU programmes, including the Health Programme (2008-2013), the Lifelong Learning Programme (2007-2013), the framework programmes for research[25] and also under the Preparatory Actions in the field of sport (2009, 2012). Regarding future programmes, it should be noted that the proposed Erasmus+ Programme 2014-2020 foresees €238 million of funding for European cooperation in sport, with HEPA being a priority area for action.[26]

2.2. Identification and analysis of the main problem(s)

In spite of the growing profile given to physical activity promotion in the political debates at MS as well as international and EU levels and available tools to promote HEPA (as described under 2.1.2), the rates of physical inactivity in the EU remain unacceptably high. The available EU[27] and national data outlined in Annex II shows that the vast majority of Europeans do not engage in sufficient HEPA (e.g. in 2010, 60% of Europeans responded that they exercise or play sport seldom or never).[28] It also demonstrates vast discrepancies between individual MS. This situation runs not only counter to the Europe 2020 Strategy[29], which acknowledges the need to fight health inequalities as a prerequisite for growth and competitiveness, but is also incompatible with the EU's stated policy ambitions in the fields of sport and health.

HEPA promotion depends primarily on efforts within MS at national, regional and local levels. However, most MS have not achieved the principal policy objective in this area, namely to increase the proportion of citizens who reach the HEPA levels recommended by the WHO, and reiterated in the EU PA GL. The main problem to be addressed by the initiative therefore is that in general, the HEPA promotion policies of EU MS have not been effective (although there are notable exceptions[30]).

The often disappointing results in the evolution of HEPA participation rates raises the question of why the HEPA promotion policies adopted by most MS have so far not delivered the desired results.[31] The reasons for the low effectiveness of MS policy are above all shortcomings in the way HEPA promotion policies are developed and implemented within individual MS.

To determine the main shortcomings, it is first useful to outline what is meant by ‘effective’ HEPA policy. At European level, the criteria to define effective HEPA policy are laid out in the EU PA GL.[32]

EU Physical Activity Guidelines

“It is only possible to reach the set targets through inter-ministerial, inter-agency and inter-professional collaboration, including all levels of government (national, regional, local), and in collaboration with the private and voluntary sectors.”

“Increasing the levels of physical activity falls within the remit of several important sectors, most with a major public sector component: - Sport

- Health

- Education

- Transport, environment, urban planning and public safety

- Working environment

- Services for senior citizens”

Most importantly, these GL emphasise that a cross-sectoral approach to HEPA policy is an absolute necessity, that “Targets and objectives are not enough to ensure effective implementation of national Physical Activity Guidelines”, and that national HEPA policies should be based on “the following quality criteria that have shown to increase the potential for effective policy implementation:”

· Developing and communicating concrete goals, objectives and target groups;

· Planning concrete steps, timeframes and milestones for implementation;

· Defining clear responsibilities for implementation;

· Allocating sufficient financial and human resources at all relevant levels;

· Creating a supportive policy environment with support from key actors across all relevant sectors and at all levels;

· Increasing support from the public and specific target groups through effective communication;

· Monitoring and evaluating the implementation and outcomes of the policy in a robust and systematic way.

Hereafter those criteria for effective HEPA policy are examined which the MS have evidently had the least success in implementing on a wider scale (several exceptions notwithstanding). The available evidence[33] confirms the existence of shortcomings in at least three aspects of HEPA policy that are interconnected: the cross-sectoral approach and collaboration among different ministries and bodies responsible for HEPA promotion; objective setting; and monitoring and evaluation.

2.2.1. Approach to HEPA not sufficiently cross-sectoral

The lack of a sufficiently cross-sectoral approach is the most clearly identifiable problem in the national HEPA policy of a large number of MS, a tendency that is evident in the findings of several recent studies (e.g. the 2012 Lancet series, see fn4) and was confirmed in the consultations with national policy makers, experts and other relevant stakeholders.

One study consisted of an in-depth examination of 27 policy documents from 14 countries including 11 EU MS.[34] It confirms that each individual Ministry tends to have its own agenda when it comes to taking action to promote physical activity. The assessment revealed a lack of cross-sectoral collaboration at both the policy development and implementation stages. For example, the paper cites only ‘limited evidence for intersectoral collaboration in the preparation of the policies between ministries and in most cases the documents had been prepared by a single ministry alone.[35] Moreover, while some policy documents involved authorities or bodies besides the lead ministry, one third were prepared without any form of collaboration at all. This lack of collaboration extended to plans for implementation. Nearly one third of the documents involved only one ministry or authority in policy implementation, while the majority required collaboration between a maximum of two actors.[36] Clearly, “the mere existence of a national physical activity policy or action plan does not secure its functionality or implementation”.[37]

A tool for collecting comprehensive data on HEPA policy, the HEPA Policy Audit Tool (HEPA PAT), coordinated by WHO Europe, also demonstrates the insufficiently cross-sectoral approach to physical activity promotion taken by countries. Crucially, the HEPA PAT allows a distinction to be drawn between ‘theory’ and ‘practice’. All seven countries that completed the HEPA PAT (FI, IT, NL, NO, PT, SI and CH) reported some degree of formal consultation in the formulation of government policy.[38] Examining the completed HEPA PATs collectively, it is clear that, despite good-practice exceptions (e.g. Finland and the Netherlands), active collaboration and coordination between all relevant and responsible ministries and other authorities / organisations are rare and often not sustained. The HEPA PAT data also shows that government officials in fields that have only recently taken on some responsibilities to promote HEPA, such as transport and education, have not fully benefited from the expertise of other sectors, such as public health, where the importance of HEPA is more firmly established.

Finland’s cross-sectoral approach Many national-level ministries and agencies in addition to local authorities and rural communities all share responsibility for physical activity promotion and the funding of HEPA programmes. In order to ensure collaboration and cooperation among these different actors, Finland has: – Issued a political resolution on HEPA and diet to consolidate existing documents, define the political direction and over-arching goals across sectors; – Set up advisory committees consisting of members from national ministries, local authorities, NGOs and research institutes; – Consulted relevant organisations during the development of policies. While cross-sectoral collaboration is still considered a challenge, this approach has succeeded in securing wide participation in the policy-making process and incorporating HEPA across all the sectors concerned.

Relevant governmental and non-governmental stakeholders consulted for this IA, echoed these findings: lacking cross-sectoral cooperation was cited as the key obstacle to effective physical activity promotion.[39]

A recent large-scale study of policy documents from all EU MS[40] serves to add weight to this argument. The study compiled and examined policy documents related to HEPA promotion from 26 MS, and categorised them according to the sectors concerned. The data indicates that while nearly all countries (25) have public health policies in place which promote HEPA, and 16 promote HEPA through sport policy, only ten countries have transport policies that explicitly refer to HEPA. Few MS pursue HEPA through other policy areas: only five countries had specific education policies with goals relating to HEPA,[41] while four countries have produced documents making the link between physical activity and the environment. The analysis shows that in the vast majority of countries HEPA is included in policy documents covering a maximum of three policy areas, while hardly any MS approach HEPA policy from four or five policy areas.

The lack of effective collaboration and coordination even extends to individual policy sectors. The sport sector, one of the key players in any successful effort to promote HEPA, has in some cases been singled out for prioritising elite sport at the expense of grassroots sport and sport for all, despite the benefits of the latter in terms of promoting physical activity. This was highlighted, for instance, at the last meeting of the EU WG on Sport and Health.[42] Although the organisation of sport in Europe (as described in the White Paper on Sport) demonstrates the complementary relationship between elite and grassroots sport, representatives from the sport for all movement have regularly expressed concerns[43] that the sport sector does not make the link strongly enough. This, inter alia, prevents the sport sector, and policies targeting elite sport, from achieving their potential impact in terms of increasing physical activity among the wider citizenry and contributing to health – a potential outreach which cannot be replicated in other policy sectors. It was suggested, e.g. at the abovementioned meeting, that the coordination between the different parts of the sport sector needed to be reinforced.

A recent public consultation[44] demonstrates that concerns about lacking cross-sectoral collaboration on HEPA resonate with a broad cross-section of interested stakeholders. Asked to express the extent of their agreement with several statements relating to physical activity promotion by public authorities and sport organisations, a strong majority of respondents felt that public authorities do not give enough support to physical activity, and that there is not enough physical activity in education.

2.2.2. Objectives and goals not concrete and clear enough

The available evidence also suggests that many MS do not define the objectives of their HEPA policies clearly and concretely enough, and tend not to develop sufficiently measurable indicators to track progress (see also the sub-chapter on monitoring and evaluation below). The study of 27 policy documents cited above shows that very often, objectives listed were vague (e.g. ‘to stimulate the practice of regular physical activity in the population’). Quantifiable targets to achieve stated goals only existed for 22% of the documents analysed, and examples of good practice (e.g. by 2010, at least 65% of the adult population will meet the exercise standard) were rare. Hardly any policies made specific provisions for targeting groups with particularly low levels of physical activity, such as individuals of low levels of education and / or income.

A recent analysis of national sport strategies and policies undertaken as part of the COM-funded Net-Sport-Health project[45] paid particular attention to targets and indicators, and unearthed similar results. All 25 of the documents[46] examined, which covered the national and sub-national level for 15 MS, contained (at the least) broad goals which made the link between physical activity and health for the wider population. However, hardly any countries (i.e. three) identified quantifiable targets relating specifically to physical activity and health, while only one policy document was described as ‘fully adhering to the requirements of Specific, Measurable, Attainable, Relevant and Timely (SMART) targets’.

2.2.3. Insufficient provisions for monitoring and evaluation

Collecting, recording and publicising comprehensive data on physical activity are crucial features for the effective monitoring of HEPA and evaluation of policies aimed at promoting physical activity. However, an examination of current practice reveals significant shortcomings in the majority of MS. This is at least partly due to the lack of cross-sectoral coordination, as various actors collect similar but incomparable data and / or fail to share data while precluding the critical mass (both in terms of expertise and budgetary capacity) necessary to employ suitable methodologies.

Regarding monitoring of HEPA participation rates, there is no data that is comprehensive and comparable across countries. Although the WHO has issued concrete recommendations for the effective monitoring of physical activity on the basis of the standardised IPAQ and GPAQ questionnaires,[47] the data collected for the NOPA database[48] indicates that only eight EU MS have included the IPAQ in national surveys, while just one has made use of the more exhaustive GPAQ. Moreover, hardly any of these MS repeat the exercise at regularly defined intervals, making it difficult to ascertain trends and gauge progress and / or the success of HEPA promotion policies over time. Some countries had systems in place to produce comparable data on changes to physical activity, while others altered survey questions and methodologies year on year or did not have any such systems in place. While there are a number of MS (most notably the United Kingdom, Finland and the Baltic countries) which carry out extensive and periodic surveys of physical activity outside the IPAQ, variations in methodology render statistical comparison between countries impossible.

With regard to policy evaluation, the above-mentioned Net-Sport-Health project found that although about two-thirds of the national strategies did set out requirements for evaluation, many of these lacked detail. For example, only a small number of national strategies called specifically for periodic reports on progress, while measurable outcome indicators were not provided in the majority of cases. The detailed analysis of national policies in a few countries demonstrates a similar set of issues.[49] Generally, concrete goals and performance indicators, and specific plans for measuring the success of specific policies, were vague or non-existent.

MS representatives and experts have expressed similar views regarding data availability, describing current monitoring and evaluation practices as inadequate for gauging progress or making comparisons across countries.[50]

2.3. Underlying reasons for the main shortcomings

There is a clear gap between the available evidence (benefits of physical activity; cost burden posed by present levels of inactivity; effective interventions) on the one hand, and subsequent policy action to address physical inactivity, on the other. [51] The question arises what has prevented MS to develop more effective HEPA promotion policies or why the role of physical activity has been undervalued.

The underlying reasons are likely to relate to the fact that HEPA is only starting to become a focused policy field on its own and to get recognition as a complex policy area that requires multi-sectoral interventions, such as those provided for in the EU PA GL. Physical activity has so far not enjoyed advocacy power comparable with e.g. the mobilisation of tobacco control to ensure that it receives the appropriate political recognition.[52] ‘Integrated approaches’ at the international level have helped to bring physical activity on the policy agenda. For instance, physical activity has been coupled with ‘diet’ to address obesity[53] or treated as a risk factor among others in the debate on NCDs[54] (see sub-chapter 2.1.2). However, physical activity has not been considered as a stand-alone topic requiring specific approaches, despite evidence for many independent health effects and other effects beyond health.[55] Today, scientists therefore call for a ‘specific policy focus on physical activity to tackle physical inactivity’ and to act now.[56]

While HEPA as a policy field is a rather new topic on the agenda of governments (if at all), understanding of the determinants of HEPA, which is essential for designing interventions to change physical activity levels, is even younger.[57] As a consequence, intersectoral capacities[58], improved understanding and institutional structures are still lacking in most MS to promote HEPA, in particular in those with the highest inactivity rates, in contrast with e.g. nutrition where most countries even have special academic curricula. This was confirmed in the discussions with public authorities and is consistent with the observation that on the occasion of international consultations related to obesity, nutrition and physical activity most MS participated with much stronger expertise related to nutrition (a field scientifically “mature” and historically well established in the institutional infrastructure of MS) than to physical activity (a discipline under rapid scientific development, and a relatively new area of interest for public health).[59] It is furthermore confirmed by the fact that whenever international institutions have called upon MS to appoint counterparts on physical activity, appointees were generally not experts in HEPA promotion but rather in nutrition or other related fields.[60] Evidence shows that countries with institutional capacity to promote HEPA (e.g. FI or NL) are doing better than those without it (e.g. CY or HU).

Another underlying reason for ineffective HEPA policies relates to budgetary constraints in the crisis context. Despite the urgent need for action, policy makers might have been tempted to give low priority to HEPA policy development and implementation. The current economic situation could have led MS to allocate insufficient financial and human resources to effective HEPA promotion – such cuts have, for instance, been reported for national sport departments[61]. HEPA promotion requires investments in the short term that only deliver health and economic benefits to the MS in the medium to long term. It could well be that a majority of EU MS has not been sufficiently aware of the need to design and make well-targeted multi-sectoral investments today to benefit from positive longer-term effects in the future, or, as outlined above, lacked the capacity or the available data to do so. Only some MS have taken full advantage of the ‘low-hanging fruit’ (e.g. FI).

The above situation is partly also reflected in the EU’s activities and structures dealing with physical activity. While physical activity has been promoted in different policy fields and helped give attention to the HEPA topic (see chapter 2.1.2), no single coordinated approach on HEPA exists that would encompass the relevant policy sectors and take into account the multiple effects of physical activity in the field of health and beyond. It is an achievement that physical activity could be brought on the EU agenda in the context of the Strategy on Nutrition, Overweight and Obesity-related health issues. However, due to the fact that physical activity was coupled with another public health issue (diet/nutrition) to which MS have attached great(er) importance, a focused approach to tackling physical inactivity has not yet been developed.[62] Moreover, the important prevention and rehabilitation effects of physical activity tend to be neglected in other policy initiatives, for instance those aiming to address the wider economic and social challenges for the EU, such as the ageing population, where the focus has rather been on medical treatment and IT solutions instead of "smart investment" in physical activity.[63] No consistent approach exists either in the EU's cohesion policy that would reflect the importance of investing in physical activity and that could help address the regional dimension of low HEPA rates and corresponding investment levels in the MS. With the development of the EU PA GL, an effort was made to give a specific policy focus to the promotion of HEPA. While some progress could be achieved at the EU policy level in promoting the GL further (e.g. in policy discussions and recent Council conclusions) they have not yet been implemented effectively at national level.[64] Partly linked to the lack of a focused approach to HEPA at EU level involving coordination between different policy sectors (e.g. sport, health, education, transport) and their working structures, opportunities for promoting the GL within relevant policies beyond sport have been missed out. There is considerable scope in EU policy making to encourage the implementation of the GL as a means for effective HEPA promotion and to improve existing forms of policy cooperation between the MS at EU level to help reverse the trend regarding physical inactivity. Indeed, to date, no policy coordination, neither within the EU’s approach nor between MS at EU level, exists that would sufficiently reflect the complexity of the HEPA topic as a differentiated (focused) policy area.[65]

A continuation of the current situation would not address the ineffectiveness of MS' HEPA policies since the main problem drivers (missing advocacy power behind HEPA, lack of intersectoral capacities and understanding in MS, no focused policy approach on physical activity and no coordinated policies at EU and MS level) would only marginally be addressed which means that the aspects of HEPA policy identified above (relating to cross-sectoral approach, objective setting, monitoring) would continue to be problematic.

2.4. Affected groups and regions

The planned initiative will first and foremost target public authorities in EU MS responsible for HEPA promotion and more specifically the thematic areas covered by the EU PA GL, including those key areas for which the initiative will propose specific monitoring activities. Accordingly, the initiative should help improve capacity to promote HEPA more effectively across sectors and will at least concern authorities in charge of the following areas: sport, health, education, transport environment, urban planning, public safety, working environment and services for senior citizens. It will in particular focus on those MS that have been less successful in raising HEPA levels of their citizens (generally these are countries in southern and eastern Europe) and thereby address regional disparities within the EU-28.

The implementation of the proposed Council Recommendation will have a direct impact on certain sectors of society, such as the sport or the health care sectors that will be encouraged to follow the Guidelines to promote physical activity within the sphere of their activities and competences. The initiative will also rely on mobilising stakeholders, including the ones most directly related to physical activity and with strong assets to reach out to citizens with targeted offers, i.e. the sport movement.

Ultimately, the proposed initiative aims at reaching out to EU citizens at large (e.g. children, working population, seniors) by providing new opportunities to engage in physical activity in accordance with WHO recommendations. Since the lack of physical activity is particularly pronounced among specific at-risk-groups of the population (socio-economically disadvantaged groups, women, children and the elderly), the benefits of the initiative would accrue to these groups to a greater degree than to Europeans as a whole.

2.5. Justification for EU action

2.5.1. The EU’s right to act

The EU has the right to act in the field of HEPA based on two Articles of the Treaty on the Functioning of the EU (TFEU), both of which assign a supporting competence to the EU. Article 165 stipulates that the Union shall ‘contribute to the promotion of European sporting issues’ and that action shall be aimed at ‘developing the European dimension in sport’. Article 168 stipulates that ‘Union action [...] shall be directed towards improving public health [...] and obviating sources of danger to physical and mental health’. This covers inter alia health information and education and monitoring. The Article also stipulates that the EU shall ‘encourage co-operation between the MS and, if necessary, lend support to their action’. By doing so, in line with the Treaty, the EU has to respect the responsibility of the Member States for the definition of their health policies.

In both areas (sport and public health), the TFEU states that in pursuit of these objectives, the European Parliament and Council may adopt incentive measures, and that the Council (on a proposal from the COM) may adopt recommendations. In addition, the Treaty explicitly authorises the COM to take ‘any useful initiative’ to promote policy co-ordination among the MS in the area of public health, in particular ‘initiatives aimed at the establishment of guidelines and indicators, the organisation of exchange of best practice, and the preparation of the necessary elements for periodic monitoring and evaluation’.

2.5.2. Added value of EU action

As regards the application of the subsidiarity principle, there can be no doubt that the main responsibility for promoting HEPA lies with the MS. Thus, the question is whether the EU action can add significant value, over and above what MS would be able to achieve on their own.

This question should be answered in the affirmative. On a very general level, EU support for more effective HEPA promotion policies can help reduce the significant social and economic costs of physical inactivity for all MS, and thus strengthen their ability to achieve the growth objectives set in the Europe 2020 Strategy.

EU action has the potential to render MS efforts to promote HEPA both more effective and more cost effective than would be possible otherwise. In line with the international framework and actions to promote physical activity, the EU can provide renewed political momentum to focused action on HEPA in the EU-27 and raise awareness of the need to act now.[66] The EU can, in line with its supporting and coordinating competences in the fields of sport and of health, facilitate and strengthen policy co-ordination by helping MS to share information and experience, engage in peer learning, disseminate good practice and work together to develop common approaches, and thereby contribute to improving capacity to promote HEPA across sectors and to shape policies that ensure better interventions.[67] In particular in the current crisis context, the EU could help the MS in developing and implementing effective policies for HEPA promotion, e.g. by enabling them to make well-targeted interventions in the shorter term designed to avoid future harmful economic and social consequences resulting from physical inactivity. A number of MS consider such co-ordination in the area of HEPA particularly useful given the vast differences that currently exist between them in terms of the amount of priority afforded to HEPA to date, the approaches chosen, the national policy co-ordination mechanisms and the cultural and economic differences and similarities between MS that have an effect on HEPA rates and point to measures that may be most promising.[68]

Moreover, exchange of best practices is significantly strengthened when there is actual evidence as to the effectiveness of different measures and policies. The EU is well situated to enhance provisions for monitoring and evaluation of HEPA and HEPA policies and thereby help the MS to track developments over time. As pointed out previously, robust data is seldom available, despite its value for formulating and refining policy.[69] Through the proposed monitoring framework, EU coordination will deliver the evidence to MS to justify more focused and multi-sectoral approaches to HEPA promotion. Ultimately, a ‘joint monitoring’ will help MS to save costs since it will serve to improve investment of scarce resources. This is particularly relevant in the current economic context.

The view that the EU has a role to play in contributing to promoting HEPA is shared not only by the EU institutions, existing EU level cooperation structures for sport and for health as well as at expert level, but also by a large segment of stakeholders (e.g. sport for all organisations or the sporting goods industry) and EU citizens.[70] By approaching HEPA promotion from a sport policy perspective, the EU can make a real difference, boosting its effort by drawing on the huge potential of the sport movement to reach large parts of the EU population, inter alia through membership in a sport club. Citizens usually like sport and its connotations are unmistakably positive. The results of the 2010 public consultation referred to above confirm the widespread support for EU action to promote HEPA. Asked to identity priorities for future EU action, respondents (which included individual citizens as well as nearly 400 stakeholder organisations, most of which were sport organisations, NGOs, and public authorities from across the EU) were overwhelmingly in favour of an EU role in promoting physical activity.

Figure 1: Future priorities for EU action in the field of HEPA

Source: EU-wide public consultation (2010): Strategic Choices for the Implementation of the New EU Competence in the Field of Sport

2.6. Baseline scenario

The continuation of current arrangements building on existing structures and tools at MS, international and EU level - as described in sub-chapter 2.1.2 - would lead to the following elements that would continue to work unsatisfactorily in combating the problem described.

Firstly, regarding advocacy power, recent intensified calls from experts worldwide and stakeholders (e.g. ‘Designed to move’ campaign) on the policy level “to act now” will help raise awareness on the importance of physical activity. Such initiatives are valuable in that they point to shortcomings and help to make the case for additional policy action. It is however highly unlikely that they alone could lead to real change towards more effective HEPA policy making in the EU. In addition, such initiatives are often built on an evidence base that describes the global problem, but does not contain data covering several or all EU MS.

Secondly, on the lack of capacity in the MS, a continuation of current arrangements will only marginally improve the understanding and intersectoral capacity to develop, design and implement effective HEPA policies. In the EU context, the conditions for cooperation in the field of sport (i.e. Council mandate for the XG SHP) and of health (mandate of the HLG) are expected to continue also after their current lifespan (i.e. after 2013/2014). Given the priority of HEPA in the current EU Work Plan for Sport and considering that the XG SHP has helped to foster the exchange of information, it is expected that a similar Expert Group will be set up to continue work in the field of HEPA promotion after the mandate of this group in the context of the next EU Work Plan as of 2014. Likewise, in the field of health, the HLG has provided a forum for engaging in coordinated activities as well as exchanging and raising awareness of key issues among public authorities over the past several years, and its work is likely to continue. While the achievements of the existing structures should be recognised, the continuation of these forms of cooperation consisting essentially of a mere exchange of best practices, sharing of policy ideas and discussion of 'HEPA promotion' between the MS is, however, not likely to solve the problem of ineffective national HEPA policies and, ultimately, to increase physical activity levels in the EU. Moreover, although nutrition and physical activity are stated core areas of action in the Strategy on Nutrition, Obesity and Overweight-related Health issues, the HLG combines expertise mainly in the field of nutrition[71] There are different reasons for this, one stemming from the expertise and priorities of those involved: many of the Ministry of Health officials participating in the HLG are responsible for nutrition policy but not for physical activity.[72] MS specialised capacity on physical activity would remain weak.

Thirdly, the focused policy approach to physical activity, which forms the basis for effective HEPA promotion, will continue to be inexistent in most MS and in the EU without additional EU action. For instance, recent deliberations of the Council in the form of conclusions that call for more concerted action to promote physical activity confirm the existence of the problem from the policy side, but do not foresee measures that are likely to have sufficient leverage to convince many MS to reconsider their national approaches to HEPA across sectors. There is also no reason to believe that the political statements to which European countries have signed up in broad international strategies and voluntary action plans[73] would suddenly become more effective tools than in the past to lead to a stronger policy focus on HEPA in national and EU policy making. Current arrangements are rather conducive to continued progress in those MS that are already pursuing relatively effective approaches to physical activity promotion. Thereby the noted discrepancies between MS who make progress in developing and implementing effective HEPA policies and those who do not would continue if not increase. It appears that HEPA would very likely continue to be undervalued in national and EU policy making and not get the recognition as a focused discipline requiring a multisectoral policy approach.

Fourthly, related to the above arrangements and the lack of a focused policy is the policy coordination at EU level and between the MS more particularly, which would remain weak. As a consequence the development and implementation of effective policies in the MS, such as provided for by the EU PA GL would continue to advance at a low pace and, considering developments since 2008, would leave out a number of MS, especially those that face the greatest challenges with regard to their national physical activity levels. This progress, in addition, would continue to depend on efforts by individuals in single HEPA sectors (e.g. sport, health, transport) in view of the lack of a coordinated and focused policy approach driven by the impetus from an EU initiative that is designed to reach out to all relevant sectors. Ensuring the cross-sectoral cooperation between relevant actors and Ministries in the MS, to be achieved through the implementation of the GL, would continue to be the key challenge for individual countries that often lack the necessary capacity – this can be barely changed by general policy statements or discussions on the GLs' implementation in the way it has been done until now in meetings between MS at EU level. Without stronger political support most MS are not likely to step up efforts across sectors.[74]

Finally, considering the continuation of the current situation, monitoring of physical activity aimed at achieving sound and reliable data on national HEPA levels and HEPA policies would remain difficult if the current weaknesses of collecting, validating and processing national physical activity data, reported by experts and policy makers[75], were not addressed. Further collection of information on progress in establishing national guidelines on physical activity and related actions in line with the EU PA GL, as it has been done by the XG SHP, would only serve as a general overview, but could not be considered a systematic collection of data for monitoring progress in policy development and implementation and that has value in guiding future policy. Regarding the implementation of the 'EU Strategy', information on nutrition, physical activity and obesity prevention would continue to be collated and processed within the current EC/WHO monitoring project (NOPA II) until mid-2014; this means a national coordinator in a MS would collate the information in all fields of the 'Strategy' which would then be made available and updated in the WHO information system (NOPA database). Although the WHO issued concrete recommendations for the effective monitoring of physical activity on the basis of the standardised IPAQ and GPAQ questionnaires (referred to in sub-chapter 2.2.3), the physical activity data so far collected for the NOPA database points to important methodological shortcomings regarding the data received from a number of MS. In the WHO context, independent sustainable physical activity counterparts, similar to those existing for nutrition, are considered desirable to improve monitoring on physical activity in the European Region. Within the current EU monitoring arrangements, specific coordinators on physical activity that could be expected to deliver more complete and comprehensive data in the field of physical activity would not be established. The unsatisfactory situation of fragmented or lacking data on HEPA (as repeatedly criticised by the expert and the policy levels and confirmed by the WHO)[76] is therefore likely to continue, making it difficult to track progress in individual countries over time, compare developments between them and identify trends in the EU. Not improving current monitoring arrangements would amount to a missed opportunity for informed future policy decisions.

To conclude, regarding how the problem would evolve all things being equal, it can be assumed that physical activity rates would continue to be unacceptably low in the EU. Despite the initiatives in the MS as well as at EU and international levels aimed at addressing the problem, there are currently no indications that the general trend towards stagnating or declining physical activity levels in the EU as a whole is about to be reversed. Instead, very high rates of physical inactivity can be expected to continue, leading to the described economic and social detriments.

3. DEFINITION OF POLICY OBJECTIVES

The EU has been addressing HEPA through a number of policies and instruments. It is important to note that the proposed new initiative is not intended to fundamentally alter the course of policy, but to reinforce a focused approach on HEPA by facilitating a more widespread, consistent implementation of what already exists, in particular the principles contained in the EU PA GL. The following objectives have been defined with this in mind.

3.1. General objective

The general objective can be expressed as follows:

Contribute to a healthier and more productive society through increased levels of health-enhancing physical activity in the EU.

3.2. Specific objective

The initiative would seek to increase the effectiveness of MS’ HEPA policies by enabling MS to develop and implement HEPA policies based on the EU PA GL, which would help them address the main shortcomings (lack of cross-sectoral approach, unclear objectives, insufficient monitoring). The development of policies and their implementation would take place at MS, rather than EU, level. Therefore, the single specific objective is expressed as:

Ensure the EU Member States develop and implement effective policies for HEPA by improving the uptake and implementation of the EU PA GL.

3.3. Operational objectives

Operational objectives should fulfil the specific objective and will be linked directly to underlying policy drivers and the parameters of the future initiative. They relate to areas where the EU could be expected to add value in light of the justification for EU action and baseline scenario, and consist of:

(1) Enhance policy co-ordination between the EU Member States in the field of HEPA, based on a focused approach to HEPA promotion, to improve Member States’ capacity to design and implement effective HEPA policy.

(2) Facilitate the collection of comparable and comprehensive data on HEPA and HEPA policies in the EU Member States.

3.4. Consistency of objectives with EU strategic objectives

Action to promote HEPA is desirable from the perspective of the EU as it contributes to wider EU policy objectives, in particular those defined in the Europe 2020 Strategy – as described in sub-chapter 2.5.2. The strategy highlights that, in order to reach the overarching objective of inclusive growth, the EU has to be able “to meet the challenge of promoting a healthy and active ageing population to allow for social cohesion and higher productivity”. By promoting HEPA along the EU PA GL, the EU would address one of the key factors that can contribute significantly not only to healthy and active ageing (i.e. with regard to older people in employment, their social participation and independent living), but in particular also to a healthy workforce and ultimately higher productivity.[77]

3.5. Coherence of objectives with those of other policies

The proposed initiative is also fully coherent with EU policies in a number of other fields, in particular:

· Health: The EU Health Strategy commits the EU to tackling health inequality, and to promote health and prevent disease throughout the lifespan by tackling key issues / health determinants including physical activity. It notes that: “Improving the health of children, adults of working age and older people will help create a healthy, productive population and support healthy ageing now and in the future.”[78] The importance of encouraging HEPA is also emphasised in the Strategy for Europe on Nutrition, Overweight and Obesity related Health issues.[79] At the end of 2011, the Council expressed its commitment to “accelerate progress on combating unhealthy lifestyle behaviours, such as (…) lack of physical activity, leading to increased incidence of non-communicable diseases (…).”[80] It inter alia called on the MS and the COM to reinforce and continue action to support healthy lifestyle behaviours, including encouraging the development of urban and social environment policy conducive to physical activity for all.

· Transport: The EU Action Plan for Urban Mobility[81] stresses the need to promote integrated urban transport policies, and notes that sustainable urban transport (including active commuting) can play a role in creating healthy environments and contribute to reducing non-communicable diseases.

· Social inclusion: Sport and physical activity are increasingly recognised as an instrument for social inclusion. Women and disadvantaged groups, including lower socio-economic groups, immigrants, and people with a disability generally tend to have lower HEPA participation rates, even though their participation has been shown to have a potential positive impact on integration and equal opportunities. This link has been recognised inter alia in the EU Disability Strategy[82] (in particular with regard to accessibility).

· Research: EU research policy[83] includes actions to identify, develop and apply innovative approaches and “good practices” to reduce sedentary behaviour and enhance the level of physical activity in the population, combined with dietary or other interventions. The relevant research, using the concept of social innovation, may cover various areas affecting lifestyle and should identify more effective and efficient evidence-based strategies for reducing sedentary behaviour and increasing physical activity, as well as facilitating multi-disciplinary policy environments and collaboration between different public and private stakeholders, including Small and Medium Enterprises (SMEs). The aim is a greater uptake of innovative approaches by policy makers and to make it more appealing to citizens to choose a healthy lifestyle.

4. POLICY OPTIONS

In view of the concrete objectives defined in the previous section, a range of options to support MS in their endeavours to develop and implement effective policies for HEPA promotion is being considered hereafter. The options have been elaborated with a focus on their content. Regarding the policy instruments at the COM's disposal, the implementation of these options requires either a COM Communication or a COM proposal for a Council Recommendation.

The options that have been discarded are:

· A complete cessation of EU policy coordination on HEPA, since this would contradict the EU's stated wider policy goals and run counter to the objectives of this as well as other initiatives;

· A policy option that would put the main focus on a revision of the content of the EU PA GL. The GL represent the current state of scientific knowledge and have been confirmed again by the Council in its conclusions on HEPA (Nov. 2012). It is suggested that adaptations to include possible new scientific findings on HEPA promotion and to reflect possible new developments in HEPA policies can be made in the context of the full evaluation of the implementation of the proposed Recommendation.

· To address the problems identified, a policy option that focuses solely on the adoption of new incentive measures in the area of HEPA, such as foreseen in the Sport Chapter of the Erasmus+ Programme, cannot be a solution for a policy initiative either. Recent analysis[84] has shown such an option to be relevant for the implementation of grassroots level activities, such as support for HEPA cooperation projects involving sport organisations, rather than the development and implementation of sport policies. Accordingly, the main operational objective of the Sport Chapter in the proposed Erasmus+ Programme in the field of HEPA is proposed to be support for the implementation of the EU PA GL.[85]

Table 3: Policy options to be assessed

|| Option || Brief description

A || Baseline scenario (continuation of status quo) || § Continued policy coordination with the involvement of the Expert Group on Sport, Health and Participation (XG SHP), and the High Level Group (HLG), underpinned by the EU Physical Activity Guidelines (EU PA GL), but no new policy initiative.

B || Push for increased policy coordination (Tool: Commission Communication) || § Policy document (with no mandatory authority) setting out a strategic approach for focused HEPA promotion across sectors; § Enhanced policy coordination at EU level with the involvement of the XG SHP, and the HLG, facilitated by the COM; § Actions to encourage MS to commit themselves to the principles embodied in the EU PA GL; § Call on MS to report on progress in implementing the EU PA GL taking account of existing reporting tools and structures.

C || Push for increased policy coordination and monitoring, based on a limited set of indicators on the implementation of the EU PA GL (Tool: Proposal for a Council Recommendation) || § Policy document with legal effect (establishing non-binding rules) recommending focused HEPA promotion across sectors; § Enhanced policy coordination at EU level with the involvement of the XG SHP, and the HLG, facilitated by the COM; § MS (meeting in the Council) reaffirm and commit themselves to the principles embodied in the EU PA GL; § MS agree to monitor HEPA policy development and implementation using a limited set of high-level and aggregate indicators relating to the EU PA GL and to report back to the EU level; § COM supports the monitoring framework and assists MS in their implementation efforts.

D || Push for increased policy coordination and monitoring, based on a comprehensive set of indicators covering each of the 41 EU PA GL and evaluation against targets/benchmarks. (Tool: Proposal for a Council Recommendation) || § Policy document with legal effect (establishing non-binding rules) recommending focused HEPA promotion across sectors; § Enhanced policy coordination at EU level with the involvement of the XG SHP, and the HLG, facilitated by the COM; § MS (meeting in the Council) reaffirm and commit themselves to the implementation of all 41 EU PA GL; § MS agree to monitor HEPA policy development and implementation by using a comprehensive set of quantitative and qualitative indicators relating to the EU PA GL and to report back to the EU level; § MS agree on benchmarks and targets for the implementation of the GL; § COM supports the monitoring framework, assists MS in their implementation efforts and evaluates MS' performances against benchmarks and in achieving targets.

Option A (baseline scenario) would entail a continuation of the status quo, including all of the EU policies and initiatives described under policy context (sub-chapter 2.1.2) and baseline scenario (chapter 2.6).

Option B would introduce a renewed strategic vision for the EU towards a focused approach to HEPA promotion across sectors and coordinated policies in the MS in form of a policy document with no legal effect (i.e. a COM Communication). Building on the already existing policy documents in the field of HEPA, including the EU PA GL, such an initiative would express a renewed political commitment to HEPA in line with the EU PA GL, and would in addition outline key actions involving the MS, the COM and other relevant actors. Under this option, MS would be invited a) to develop a national strategy and corresponding action plan for promoting HEPA across sectors, in line with the EU PA GL, and b) to regularly report progress against the action plan and exchange best practices within relevant EU-level structures. The proposed initiative would call for enhanced policy coordination on HEPA between MS at EU level within relevant existing structures. The XG SHP (which is supposed to continue under a new mandate from mid-2014) and the HLG (with regard to EU activities in the field of nutrition, overweight and obesity-related health issues) would remain the principal fora for this.

Options C and D would add to this political commitment to a focused approach on HEPA and enhanced policy coordination within relevant structures (i.e. the XG SHP and the HLG) another element, namely provisions for establishing a monitoring mechanism to record, measure and compare the progress made by MS, with a view to implementing the EU PA GL. The GL contain specific “guidelines for action” aimed at a number of sectors. The intention is that a reaffirmation of the GL coupled with a specific mechanism to monitor their implementation would lead to a more systematic and constructive form of coordination and peer learning, and as a consequence, a greater focus on effective HEPA policies at the national and sub-national levels. Principally, an initiative under these options would invite the MS a) to develop a national strategy and action plan for promoting HEPA across sectors, in line with the EU PA GL; b) to monitor the implementation of the EU PA GL at national level, based on an agreed set of indicators to measure changes in physical activity and in HEPA policy; and c) to report back at regular intervals on progress made. To support these activities MS would be asked to set up "national focal points for physical activity" charged with collecting data for the monitoring framework and with providing country-specific information on relevant national policies and action plans.[86]

The COM would facilitate this process in two ways: a) by providing support for the set up and running of the monitoring mechanism (e.g. support for training of focal points, developing a system for recording and managing the monitoring data making use of and complementing existing initiatives, including the WHO's NOPA database[87]) and b) by supporting MS in the development and implementation of policies consistent with the EU PA GL and thereby enhancing MS' capacity (e.g. support for capacity building provided by HEPA experts). Options C and D would apply to all MS; those who have made less progress addressing physical inactivity can learn from the progress made in other MS that have had more success in raising the physical activity levels of their citizens. Support would be targeted first and foremost at MS most in need, the choice of which would be based on a combination of HEPA expert views, information stemming from prevalence data, analysis of existing policies (incl. further work on "HEPA PAT") and the willingness of MS to develop and implement more effective HEPA policies.[88]

The HEPA monitoring framework would thereby develop further existing forms of monitoring and data collection in this field currently established under the Strategy for Europe on Nutrition, Overweight and Obesity-related health issues with the involvement of WHO Europe. It is expected that WHO Europe would prepare country-specific overviews on HEPA (‘country snapshots’) and analysis about HEPA developments and trends, building on and improving the existing NOPA database. The snapshots would be submitted to the COM and, together with other relevant information about HEPA policy development and implementation provided by the national PA focal points to be established under the strengthened mechanism, form the basis for discussion at the relevant EU level fora (e.g. XG SHP). All these elements would form the basis for periodic reports from the COM to the XG SHP and the HLG respectively to provide updates on progress and demonstrate the initiative’s contribution to the EU's strategic approaches and activities in the field of physical activity and healthy lifestyles more generally. The diagram in Annex IV illustrates the main actions and activities of the monitoring framework.

All these elements, i.e. endorsement of the EU PA GL, recommended value-adding activities in the MS (e.g. the adoption of a national strategy and a related action plan responding to countries' specific needs and conditions) and the participation in the monitoring mechanism would become part of the non-binding document stressing the need for more policy coordination, which is proposed to take the form of a Council Recommendation[89], i.e. an instrument with legal effect establishing non-binding rules.

The key difference between Options C and D relate to the comprehensiveness of the monitoring mechanism:

· Option C would focus on a limited set of indicators related to high-level information and more general aspects of the EU PA GL. Annex III gives an overview of the exact nature of the 23 indicators which are proposed to be included in such a monitoring mechanism.

· Option D would provide a more comprehensive mechanism for monitoring the implementation of the EU PA GL, as well as for the setting of benchmarks and targets against which MS’ performance would be evaluated. In addition, this option would entail a larger set of both quantitative and qualitative indicators, covering each of the 41 EU PA GL in detail.

For options C and D all MS are supposed to participate in the monitoring framework and make the necessary structural arrangements at national level (e.g. set up physical activity focal point). For a country like e.g. FI that already has a well-established cross-sectoral approach to HEPA policy making the participation in monitoring is expected to be a more comfortable and undemanding exercise as opposed to MS where effective HEPA promotion does not yet exist.

5. ANALYSIS OF IMPACTS AND OF EFFECTIVENESS

This chapter analyses the types of impacts that could be expected from a new EU initiative in the field of HEPA, i.e. direct social and indirect (but significant) economic benefits, in addition to environmental benefits from increased reliance on active forms of transport (cycling and walking). Impacts are quantified where possible and indications of their scale are provided.[90] These are similar for all policy options, but are likely to vary in scale as a function of each option’s effectiveness. Given that the detailed assessment of effectiveness of policy options (i.e. their outputs and outcomes) is a prerequisite for assessing the impacts of the initiative (options), it is merged with this chapter on assessment of impacts. In doing so, the outcomes of policy options are defined in terms of more effective national HEPA promotion policies (specific objective) while the impacts per option are defined in terms of physical activity levels (general objective) and summarised in chapter 5.5. In all cases, the effectiveness, precise benefits and costs of the initiative will depend on the policy choices of individual MS and the interventions stemming from them. Improvements in physical activity levels that could be expected from an EU initiative are therefore likely to substantially differ across MS and regions.

5.1. Social impacts

The benefits of increased physical activity

The social benefits would stem from increased HEPA among Europeans as a result of more effective HEPA policy in the EU MS and implementation of the EU PA GL, provided that MS are willing to develop and invest in such policies. Although the EU PA GL cover a wide range of policy areas, their overarching goal is that, through the development and implementation of national strategies, the MS achieve the WHO-recommended minimum of at least 150 minutes moderate-intensity physical activity weekly, or 75 minutes of vigorous-intensity physical activity, or an equivalent combination of moderate- and vigorous intensity activity.

The myriad benefits of meeting physical activity recommendations as well as the low rates of physical activity in the EU have been well documented and were described inter alia in the problem analysis section and in Annex II. Briefly, engaging in the recommended amount of physical activity has above all beneficial health effects, addressing many chronic diseases and health problems, including but not limited to those linked to obesity. This includes significantly reduced risks of eight serious health conditions: heart disease, stroke, overweight and obesity, type 2 diabetes, colon cancer, breast cancer, falls in older people, and depression.[91]

The upshot of this is that people who do not undergo enough physical activity suffer from a 20-30% increased risk of all-cause mortality compared with those engaging in at least the recommended 150 minutes weekly of moderate intensity physical activity.[92] Increased rates of physical activity among Europeans would result in a commensurate drop in the number of people suffering from this increased mortality risk.

Obviously, the detrimental effects of high levels of physical inactivity are borne first and foremost by those individuals who do not engage in sufficient HEPA. These negative impacts are more pronounced among specific countries and regions, and specific groups of people within them, in particular specific-at risk groups such as the elderly or socially disadvantaged people – as confirmed by many studies, also referred to in Annex II.[93] Thus, the initiative would be expected to make some inroads into reducing health disparities, improving social inclusion and protection. It would also contribute to ensuring a high level of human health protection (Article 35 of the EU Charter of Fundamental Rights) and to advancing equal opportunities of at-risk-groups, thereby promoting indirectly for instance the principle of non-discrimination (Article 21) and equality between women and men (Article 23). Furthermore, by providing initiatives at schools, for the elderly and "at-risk" or those from low socio-economic groups, the EU PA GL will undoubtedly have a direct or indirect positive effect on groups of society protected by the Charter: children (Article 24), the elderly (Article 25) and persons with disabilities (Article 26). When promoting or implementing such policies, the best interests of the child, the rights of the elderly to sustain an independent life and to participate in social life and the rights of persons with disabilities to benefit from measures to help them lead an integrated life in the community will come into play.

Given the manifold factors that play a role in life expectancy and similar statistics, it is not possible to attribute the differences in life expectancy directly between high- and low-physical activity countries to the level of physical activity.[94] Nonetheless, physical activity is certainly an important contributing factor for all of the reasons described above and in the problem definition section. Recent studies in the US associate leisure-time physical activity with longer life expectancy and confirm that even modest amounts of physical activity can add years to people's life (even if it does not result in weight loss)[95]. A simplified calculation shows that in the EU, levels of physical activity are positively correlated with life expectancy, meaning that those countries with higher levels of physical activity tend to have a higher life expectancy.[96]

The extent to which effective policy can lead to increased physical activity levels

Always bearing in mind that improvements are likely to substantially differ across the EU, in order to estimate how policies to promote physical activity can impact HEPA levels over the medium and long term, it is worth looking at an example. Finland identified low physical activity levels as an issue to be addressed earlier than most MS and has continued to both prioritise HEPA and monitor comparable yearly data on physical activity levels since the early 1980s. It is therefore an excellent example of a country where the medium- and long-term results of effective HEPA policy can be measured. Undoubtedly the evolution of HEPA rates over time in Finland has been affected by a range of factors other than policies specifically aimed at increasing HEPA (e.g. individual behaviour, socio-demographic factors, seasonality). Nonetheless it is instructive to consider the change in HEPA rates in Finland which, as shown in the chart below, amount to a sustained increase of about 1% increase per year over a period of 27 years.

Figure 2: Evolution of the proportion of Finns engaging in twice per week leisure time physical activity

Source: Health behaviour among the adult population, Finnish National Public Health Institute[97]

Canada, which is outside the EU but socioeconomically and culturally similar to many EU countries, is another of the few examples of countries that have prioritised physical activity promotion already for a number of decades. It has achieved similar increases, with a 21% gain in leisure time physical activity participation from 1981-2002.[98] Such change over time is also considered feasible and desirable by the WHO, which in November 2012 recommended that individual countries should set a target of a 10% reduction in the prevalence of insufficient physical activity by 2025 (see section 2.1.2), with the magnitude of change that can be expected by decisive action in the order of about a 1% change per year.[99]

There are good practice examples illustrating how targeted policy interventions focusing on specific-at risk groups, for instance women in disadvantaged communities or senior citizens, have led to increased physical activity levels. For instance, good practices have been or are currently being collected as part of transnational cooperation projects financed under the Preparatory Actions in the field of sport, e.g. in 2009 (call focusing on ‘gender’) or 2012 (call focusing on ‘physical activity contributing to active ageing’) or under the Health programme 2008-2013.

5.2. Economic impacts

Economic benefits

Enhanced health and well-being can be expected to lead to significant further benefits of an economic nature, as health care costs go down and the amount of economic output forgone due to illness and morbidity, sick leave and pre-mature death decreases. Studies have attempted to monetise the costs of these factors due to lacking physical activity. One study carried out for the British government identified costs to England of just over €3bn per year, or €63 per inhabitant[100]. Through a simplified analysis that extrapolates across the EU the same cost per inhabitant, the lack of physical activity in the EU can be calculated as costing over €31bn per year.[101]

With regard to these costs of physical inactivity, improved HEPA promotion policies if developed and implemented in line with the planned initiative would be expected to increase the proportion of EU citizens meeting physical activity recommendations, gradually chipping away at the cost of physical inactivity over time. Under an optimistic assumption based on scenarios in line with the Finnish and Canadian examples, and considering that investments would be required at different levels in the MS, effective HEPA policy can be expected to increase the proportion of citizens meeting recommended physical activity thresholds by up to about 1% per year. Taking the latest Eurobarometer figures from 2010 as a starting point, implementing effective HEPA policy could theoretically see about 65% of Europeans meeting physical activity recommendations in 25 years, with the cost of inadequate amounts of physical activity gradually heading downwards.

Figure 3: Estimated economic savings through rising levels of physical activity

Source: TEP based on Eurostat data (http://ec.europa.eu/sport/library/documents/d/ebs_334_en.pdf) and British government report ‘Game Plan"

The scenario as depicted is simplified and depends on the capacity and willingness of the MS to prioritise and implement effective HEPA policy over the long term. Finland and Canada have achieved increases in HEPA levels of about 1% per year over reasonably long periods. 1% per year also seems realistic in the light of the abovementioned global target of a 10% relative reduction in prevalence of insufficient physical activity by 2025: EU MS, as members of the WHO, are part of the works concluded on the global monitoring framework (see fn 99) and the setting of these targets that apply to all countries, including low- and middle income countries.

Over time, maintaining a momentum of 1% p.a. would gradually become more difficult, eventually reaching a point of saturation where further improvements would be prohibitively expensive. Today the MS and the EU overall are far away from this point and the projected economic benefits would be huge, in terms of avoiding the costs of physical inactivity (health care savings and increased productivity), adding up to nearly €7bn after 5 years, €22bn over 10 years and €63bn over 20 years (taking, as an approximation, the costs calculated for England as a basis). This would in turn justify requisitely large expenditure on policies and initiatives to boost HEPA levels, as shown in the table hereafter.

Table 4: Economic value of increased HEPA levels[102]

Year || % of Europeans meeting PA recs* || Annual savings due to increased HEPA levels || Cumulative economic value of increased HEPA

2017 || 45% || €2.5bn || €6.7bn

2022 || 50% || €5.1bn || €21.5bn

2032 || 60% || €10.3bn || €63.3bn

2037 || 65% || €12.9bn || €63.4bn

*figures based on the optimistic assumption of a 1% increase compared to 2010 levels of the Eurobarometer survey

According to the table, under a best-case scenario, EU-wide benefits of €6.7bn would result from initiatives to increase HEPA rates by about 1% per year over the next 5 years. These are approximations; the exact results obviously have to be validated.

Economic costs

- Impacts on Member States' budgets:

MS would have to bear costs relating to the implementation of HEPA policies following the new initiative and administrative costs stemming from the reporting requirements to the EU level. In addition, under options C and D, they would have to appoint a "national physical activity coordinator" (one per MS).

While the benefits of increased HEPA are manifold, implementing policies that encourage Europeans to take part in more HEPA entail a variety of (substantial) implementation costs. Depending on the specific policy in question, these range from the infrastructure costs of constructing, say, cycle lanes or leisure time infrastructure, to training teachers in physical activity promotion, to providing subsidies to employers that create a physical-activity friendly environment or encourage active commuting, to collecting data on HEPA-related topics so that policy can be continuously improved. The costs of HEPA promotion are not only spread around government ministries and authorities, but various NGOs and the private sector as well. Moreover, the different institutional and administrative structures, and diverse cultures of the EU MS ensure that no two MS would take the same approach to (effective) HEPA policy, meaning that costs would be highly variable. The benefits of increased physical activity largely depend on MS' willingness and ability to put money into HEPA promotion policies, with the consequence that MS would continue to evolve at different speeds. Moreover, a country such as Finland that already has monitoring in place would have to invest relatively less than a MS that has no strategic policy implementation in the field of HEPA.[103] The fact that limited information is currently made available in the MS on the budgets invested into HEPA promotion across policies makes it impossible to make an exact estimate on the investments to be made. The enhancement of monitoring provisions, as proposed by the planned initiative, should aim at addressing this shortcoming and help in adapting national policies on HEPA promotion, in particular in those MS that have been less successful in raising the physical activity levels of their citizens.

The envisaged policy coordination at EU level coupled with support for capacity building and monitoring (options C and D) would help the MS to target investments to the measures that are known to deliver the highest return, based on best practices. Thus the impacts on respective MS' budgets need to be quantified carefully as an early step in HEPA policy implementation.

Today, spending on HEPA is not recorded comprehensively across the EU. This is exacerbated by the fact that HEPA is by nature cross-sectoral, that many policies are tangentially related to HEPA and that policies which promote HEPA do not always (or often) include HEPA promotion as a primary objective. This makes calculating the budget currently allocated to HEPA fraught, especially for the purposes of making comparisons between countries. Even the HEPA PAT, which for seven countries contains the most in depth information available on physical activity promotion policies, cannot provide any estimate of absolute expenditure on HEPA in any individual EU country.[104]

It is also worth noting that MS will be responsible for the main budgetary considerations related to the initiative, in line with national circumstances and political priorities. Thus, while the effectiveness of the initiative will depend on substantial funds being allocated to HEPA promotion, the majority of the costs will be determined by MS themselves.[105]

The administrative costs of options B, C and D can be calculated, albeit only as a mere order of magnitude, by applying the standard cost model. This uses rough estimates for the time (in terms of FTEs) that would be required of MS administrations to estimate the administrative burden (based on average EU tariff per hour[106]). The calculation assumes a) that the first year would require more resources than subsequent years, as relevant staff familiarise themselves with the monitoring mechanism; and that b) relatively junior staff could be used to collect and manage the data. For option B, some limited reporting, however no monitoring based on indicators, would be foreseen and would require staff time.

Table 5: Administrative costs[107]

|| Member State FTEs || Unit cost || Admin. burden per MS

Year 1 || Year 2+ || Year 1 || Year 2+

Option A || - || - || - || - || -

Option B || 0.06 || 0.04 || € 56,425.60 / year || € 3,655 || € 2,244

Option C || 0.2 || 0.1 || € 56,425.60 / year || € 11,285 || € 5,643

Option D || 0.4 || 0.2 || € 56,425.60 / year || € 22,570 || € 11,285

- Impacts on the EU budget:

A smaller proportion of the costs emanating from the implementation of the new initiative would fall on the EU budget. Apart from costs relating to the organisation by the COM of Expert Group meetings at EU level (e.g. three meetings per year of the XG SHP) as provided for under all options, costs to the EU budget would mainly stem from the costs of setting up and managing the monitoring mechanism and support to MS (capacity building). They would therefore vary depending on the option chosen, i.e. option C or D, which are the only options that propose establishing such a mechanism. Based on COM’s experience of funding the NOPA database project and following expert judgement, the COM would bear some financial burden in identifying, coordinating and training national focal points, maintaining a centralised data base and producing periodic reports on progress. For option C, this could be expected to total approximately EUR 2,680,000 for the entire MFF period (2014-2020), with relatively higher costs for the first two years of the initiative and reduced costs in the following years, once the mechanism is fully operational. These costs would be higher for option D and would amount to an estimated EUR 3,369,000, given the more complex monitoring arrangements involving a higher number of indicators, setting benchmarks and targets and requiring additional evaluations. It is proposed that these costs would be covered by the Sport Chapter of the proposed Erasmus+ Programme.[108] Costs for meetings of the Expert Group would be covered by the general budget (Global envelope). The table hereafter provides a summary of the costs to the EU budget for 2014-2020. A further breakdown of these costs can be foun