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Street Play and Public Health

“Playing Out is a community idea, designed as a way to give children the space, time and safety to play actively right outside their front doors. To call it a low-cost, multi-generational initiative might seem like unnecessary jargon but in public health terms that’s what it is”. Claire Lowman, Public Health Lead, Bristol City Council.

“The evaluation, “Why temporary street closures for play make sense for public health” provides strong evidence that street play can deliver meaningful health and social benefits at scale.” Professor Angie Page, University of Bristol.

 

1. Introduction

In the Playing Out model, residents close their street to traffic for a short time, creating a safe, accessible space for children to play out. Neighbours ‘steward’ each end of the street and allow residents car access. Play is generally free, undirected and child-led.

This model has four main areas of impact:

  • Children’s health and wellbeing
  • Stronger communities
  • Active citizenship
  • Culture change

Research shows that street play increases children’s physical activity, helps build stronger communities and reduces isolation, even for non-participants. It also creates active citizens who gain confidence through effecting change on their own streets and it shifts people’s attitudes towards seeing streets as being for people not just cars.

 

2. The Evidence Base: Physical Activity For Children

 2.1   Children are not getting enough physical activity.

Currently, just 23% of boys and 20% of girls meet the national recommended level of activity which is one hour a day of medium to vigorous physical activity (MVPA). Furthermore, 1 in 5 children start primary school overweight or obese, rising to more than a third by the time they leave. (PHE 17th July 2017 and England statistics on physical activity, obesity and diet 2017) (1). There are similar figures available for Wales and Scotland.

In 2016 Persil launched its “Dirt is Good” campaign with a survey of parents that discovered that “children spend less time outdoors than prisoners.” The survey found that most (74%) of children, “spend less than one hour playing outside each day.” (2)

The ‘playing out’ model is an important part of the solution, it gets children get outdoors running around, without them having to participate in any formal sporting activity.

 2.2    How does ‘playing out’ increase children’s physical activity?

Research by the University of Bristol (3) published in July 2017 has shown that children are three to five times more active during playing out sessions than they would be on a ‘normal’ day when they didn’t have the chance to play in their street.

In a controlled study on streets who have adopted the Playing Out model, it was found that “children were outdoors for a large proportion (>70%) of the time the streets were closed and spent on average 16 minutes per hour in moderate to vigorous physical activity (MVPA) per hour during street closures. This can make a meaningful contribution to whether children are likely to meet the 60 minute MVPA daily target set out in the UK physical activity guidelines.”

Professor Angie Page who conducted the study said,

“Temporary street play closures are a scaleable intervention that can, with support for residents and local authorities, be rolled out locally and nationally….” .

A study by Professor Greet Cardon in Ghent in 2013(4) found that,

“Creating a safe play space near urban children’s homes by the Play Street intervention is effective in increasing children’s MVPA and decreasing their sedentary time” The study measured children’s physical activity during a play street pilot in school summer holidays. It found that children living on a play street had 15 minutes more MVPA per hour than a control group.

2.3    NICE Guidance

The NICE guidance note The Environment and Physical Activity(5) (PH8) emphasises the importance of finding ways to create opportunities for children to be physically active.

“Increasing levels of physical activity is a challenge, not just for those directly involved in public health but for professionals, groups and individuals in many sectors of society. Adults, young people and children can achieve the national recommended levels by including activities such as walking, cycling or climbing stairs as part of their everyday life. However, while individual interventions to promote such activity may be important, they are not the only (nor possibly the main) solution. Other issues, including environmental factors, need to be tackled. As Schmid and colleagues say (1995), ‘It is unreasonable to expect people to change their behaviours when the environment discourages such changes’.”

NICE Evidence statement one (PH8) says:

“The evidence suggests that traffic-calming interventions may be useful in enabling children specifically to benefit from physical activity through play outdoors in the short and long term.”

2.4    The PEACH project

This project has demonstrated further evidence relevant to the beneficial effects of playing out for children.

The PEACH project (Personal and Environmental Associations with Children’s Health: www.bris.ac.uk/enhs/peach) is currently the only large longitudinal study to combine objective measures of location outdoors (measured by personal GPS receivers) and physical activity (measured with accelerometers) with parental and child perceptions of their neighbourhood. 1307 UK children were first measured in their final year of primary school and then again one year later in their first year of secondary school.

It has found that:

  1. Children are on average five times more active outside compared to when they are inside (6)

For example, 22.6% of children’s time spent outside after school is moderate to vigorous physical activity compared to 4.4% of time spent inside. Conversely 52.5% of children’s time spent inside is sedentary compared to only 23.6% of time spent outside.

  1. Children who report more freedom to travel around unsupervised have higher levels of physical activity (7)

Of all the environmental influences that were investigated in the PEACH Project independent mobility (how often children were allowed out without an adult) was the only factor consistently related to physical activity in the three main contexts children use for physical activity (active play, active travel to school, structured exercise/sport)(8).

  1. Children spend the majority of their time outside on the streets

Only a small proportion of time outside is spent in green space (2% of monitored time), the majority of children’s time outside being spent in the streets (9). Both green space and built environments are important for activity.

  1. Children’s time spent outside is decreasing

Children in their final year of primary school spend on average 42.4 minutes outside after school between the hours of 3.30 and 8.30pm. One year later at secondary school they spend on average 29.5 minutes outside – a significant drop of over 30%. (10)

  1. Girls and other low active groups spend less time outside compared to other children of the same age but are just as active when they are outside

Girls spend less time outdoors compared to boys in primary and secondary school but they are no significant differences in time spent active once girls are outside. (11).

The relevant public health outcome framework indicator is 2.06, children’s excess weight.

 

3. The Evidence Base: Reducing Social Isolation 

3.1    Why is social isolation a public health concern?

 Loneliness and social isolation are harmful to our health: research shows that lacking social connections is as damaging to our health as smoking 15 cigarettes a day (Holt-Lunstad, 2015) (12)

Research by PHE on social isolation (13) explains how the quality and quantity of social relationships can affect people’s physical and mental health.

For example, social isolation is associated with increased risk of coronary heart disease, in part, because social isolation and feelings of loneliness can be a physical or psychosocial stressor resulting in behaviour that is damaging to health, such as smoking.

The PHE blog (14) and recently published guidance on community centred approaches for well-being(15) demonstrates that positive social relationships and networks can promote health for people at any age through providing individuals with a sense of belonging and identity by

  • sharing knowledge on how to access health and other public information and services
  • influencing behaviour, for example through support from family or friends to quit smoking, reduce alcohol intake, or to access health care when needed
  • providing social support to cope with challenges such as pressures at school or work, or life changes such as becoming a new parent, redundancy, or retirement

3.2    How can ‘playing out’ reduce social isolation?

 The report, “Why temporary street closures for play makes sense for public health” (1) (UoB 2017) also documents how street play reduces social isolation. See the diagram below:

 When Playing Out sessions happen on a street, the atmosphere of a street changes and both adults and children are present on the street. This enables individuals who could be feeling isolated to meet and chat to their neighbours in an informal setting. As the sessions are usually monthly, this enables people to build up relationships with each other over time, and form closer ties with their neighbours.

The report states:

“One of the strongest themes to emerge from analysis of interviews from 23 adults and 37 children was the opportunity that temporary closures provided for increasing social interaction within the community. This related to both building new connections: ‘People are seeing people they have never seen, and getting to know people they wouldn’t normally interact with.’ (mother of nine, six, five and two-year old, non-resident but parents live on street nearby) and strengthening connections that were already in place but were based on limited and/or infrequent social interaction” (P36)

Playing Out conducted its own UK-wide survey of participants in 2016(15).

The survey asked people to indicate how much playing out has helped to build trust and social contact with neighbours. The majority of respondents agreed that:

  • They know more people on their street (91%)
  • Their street feels a friendlier, safer place to live (81%)
  • Children on their street have made new friends (80%)
  • They feel they belong more in their neighbourhood (84%)

The report, “Street play initiatives in disadvantaged areas: experiences and emerging issues”(16) by Tim Gill found that all interviewees felt that significant progress had been made towards building community spirit and a sense of neighbourliness through being involved in resident-led street play.

 

4. How Public Health supported Playing Out in Bristol

As well as putting a ‘Temporary Play Street’ policy in place, Bristol City Council supported Playing Out through their public health budget.

This enabled Playing Out to provide general support and publicity, and enabled resident ‘activators’ to help streets implement the model, particularly in areas of deprivation. Notable success was found in the inner-city communities of Easton and St George. The ‘activator’ model uses peer-support and both a physical and social asset based model of community development. It involved employing people already living in communities to help others to open their streets for play. The Council also funded information packs and road closure ‘kit’.

In Bristol, one of the most successful aspects was the steering group that enabled public health, highways, neighbourhoods, the police and Playing Out to work together and create a joined up approach to street play throughout the city. In 6 years since the TPSO policy was launched, over 160 Bristol street communities have ‘played out’ on a regular basis.

 

5. Evaluation Methods and Topics

Playing Out was evaluated using the Standard Evaluation Framework for Physical Activity interventions’ by the Public Health team at Bristol City Council as part of the contract with Playing Out.

At a simple level you can record the number of streets closed on a regular basis, the duration and the number of people directly benefitting in all the ways we know. Based on past evaluations and surveys, we estimate that for each street playing out, an average of 30 children and fifteen adults take part, but other neighbours and the wider community may also benefit from the increased community cohesion. It is also good to record qualitative outcomes such as neighbour interactions and feedback.

The Hackney Play streets work was evaluated by Tim Gill (17) exploring four topics:

  • the programme’s reach, (the number of children and families that have taken part, the demographics of the areas where the schemes are running)
  • the perceived benefits of the initiative for children, parents and wider community
  • The impact of the schemes on traffic movement and
  • The programme’s sustainability and potential for growth.

Counts were made of the number of children taking part and the numbers of vehicles redirected during sessions.

 

6. Cost Benefit Analysis

The evaluation of the first project in Bristol showed a cost of £6 per participant. A formal cost/benefit analysis has not yet been carried out, but we are confident that all the above benefits far outweigh this minimal cost. Read more in our FAQs for Local Authorities.

 

7. Impact

 As of December 2017:

50 Local Authorities were actively supporting the playing out model

At least 600 streets had played out – the majority on a regular basis.

Approx. 18,000 Children and 9,000 Adults have directly benefitted.

 

References

  1. Statistics on UK physical activity, obesity and diet, England 2017, published 30th March 2017. http://digital.nhs.uk/catalogue/PUB23742
  2. https://www.theguardian.com/environment/2016/mar/25/three-quarters-of-uk-children-spend-less-time-outdoors-than-prison-inmates-survey
  3. Page A, Cooper A, Hampton L, Read J, Tibbitts B. (2017) Why temporary street closures for play makes sense for public health. Play England. http://www.playengland.org.uk/wp-content/uploads/2017/07/StreetPlayReport1web-4.pdf
  4. D’Haese S, Van Dyck D, De Bourdeaudhuij I, Deforche B, Cardon G. (2015) Organizing “Play Streets” during school vacations can increase physical activity and decrease sedentary time in children International Journal of Behavioral Nutrition and Physical Activity 12:14 https://doi.org/10.1186/s12966-015-0171-y
  5. NICE Guidance note PH8: The Environment and Physical Activity https://www.nice.org.uk/guidance/ph8
  6. Cleland V, Crawford D, Baur L A, Hume C, Timperio A, Salmon J (2008). A prospective examination of children’s time spent outdoors, objectively measured physical activity and overweight, International journal of obesity, vol. 32 (11): 1685-1693.
  7. Ginsburg KR & the Committee on Communications and the Committee on Psychosocial Aspects of Child and Family Health (2007). The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics, 119:182-191.
  8. Cooper AR, Page AS, Wheeler BW, Hillsdon M, Griew P, Jago R (2010). Patterns of GPS measured time outdoors after school and objective physical activity in English children: the PEACH project. International Journal of Behavioural Nutrition and Physical Activity, 22;7:31 [open access].
  9. Page, AS, Cooper, AR, Griew, PJ, Davis, LH & Hillsdon, M. ‘Independent mobility in relation to weekday and weekend physical activity in children aged 10-11 years: The PEACH project’, The International Journal of Behavioural Nutrition and Physical Activity, 6: 2, 2009. [open access].
  10. Page AS, Cooper AR, Griew PJ, Jago R (2010). Independent mobility, perceptions of the built environment and children’s participation in play, active travel and structured exercise and sport: The PEACH Project ‘, The International Journal of Behavioural Nutrition and Physical Activity, 19;7:17 [open access].
  11. Wheeler BW, Cooper AR, Page AS, Jago, RP (2010). Greenspace and children’s physical activity: A GPS/GIS analysis of the PEACH project, Preventive Medicine, 51 (2), 148-152.
  12. Holt-Lunstad J, TB, Layton JB. 2010. Social relationships and mortality risk: a meta-analytic review. PLoS Medicine7 (7) http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000316 
  13. Ali N, (2017) Recognising the Impact of Loneliness: a Public Health Issue. Public Health England http://www.insidegovernment.co.uk/uploads/2017/05/nuzhatali.pdf
  14. https://publichealthmatters.blog.gov.uk/2015/12/08/loneliness-and-isolation-social-relationships-are-key-to-good-health/
  15. https://www.gov.uk/government/publications/health-matters-health-and-wellbeing-community-centred-approaches/health-matters-community-centred-approaches-for-health-and-wellbeing
  16. http://playingout.net/wp-content/uploads/2017/07/Playing-Out-Survey-Report-2017.pdf
  17. Gill T, (2017) Street play initiatives in disadvantaged areas: experiences and emerging issues (Play England).
  18. Gill T, (2015) Hackney Play Streets Evaluation Report (Hackney Play)