With all the organisational change happening around public health, it's important that we do not lose sight of the need to continue finding interventions which work, and which add up both in terms of the science, and in terms of their 'do-ability'.
It's a tall order, writes Jim McManus, Director of Public Health for Hertfordshire in this guest post for StepJockey.
One of many priorities is the health of adults of working-age; the accumulation of risk and development of non-communicable (and largely preventable) disease in this population is something we are seeing increasingly in the UK.
The Marmot Review, and its ambitions for the health of our population across the lifecourse, understood that change in our culture and social structures is needed¹. This was also recognised by Wanless².
But often as public health practitioners we feel this is easier said than achieved. As we continue to see the distribution of preventable illness grow and change, and continue to feel the costs of its secondary prevention and management increase, the impetus to find sustainable solutions grows, and the challenge can seem daunting.
Entrepreneurial signs in public health
But equally there is opportunity to do something new. There are signs that behavioural interventions exist which, as part of a wider approach, could be useful in tackling these challenges. And one encouraging example of where we could go with this is StepJockey.
StepJockey is one of the projects funded through the Small Business Research Initiative (SBRI). It is noteworthy because the people behind it have been entrepreneurial and this has informed, helpfully I think, their approach to translating science into practice.
The unique selling point of the initiative is that it takes the evidence and insights from social and behavioural sciences and turns them into something simple and easy to take up. It takes on a complex public health and scientific challenge but - at the user end - it is not a complex initiative. That means it is more likely to be taken up.
StepJockey in essence tries to answer the question, 'if nutrition labels influence consumer behaviour on pre-packaged foods³, can labels on stairs, walkways and other bits of our physical environment encourage physical activity?'
"Government tells people how many calories they are consuming but we don’t tell them where they can burn them off," says Monkey See, the company that developed the StepJockey idea. "We see the world as a gym and through StepJockey we are labelling it as such".
So what does it actually do?
StepJockey aims to tackle obesity and promote physical activity through a technical platform and business model which:
- Allows anyone to calculate the calorie-count for any staircase anywhere in the world
- Enables concerned citizens to label rated stairs with free-to-print smart signs which display their calorie-rating
- Encourages users to open accounts through which they track and compare their performance using the smart signs
The project is aimed at office workers and others who struggle to fit exercise into their day or who don't see themselves as 'sporty'. Its smart posters continually prompt small bursts of exercise by flagging up hidden exercise opportunities that exist under our noses.
The system has two behaviour change mechanisms:
- Posters displaying calorie counts which are designed to sub-consciously prompt stair climbing in passers by
- Smart tracking technology which allows more active users to scan the posters with mobile applications and track and compare their performance with others
While this may sound complicated, for employers and local authorities it’s actually very simple and cheap to set up, with the StepJockey platform doing most of the work. And for individuals it will be free.
The first field trial of the system has just been completed - a trial that we in Hertfordshire took part in, along with another large office building in London.
The use of stairs, lifts and escalators was baselined using sensors over two weeks, and then when the posters were put up they were monitored for four weeks to assess change in use. The results:
- The presence of the smart signs resulted in significant increases in stair usage across all 3 buildings (p < 0.0001; n=261,062)
- Upward journeys were more influenced than downward, which sounds almost counter intuitive, the highest uplift being 29%
- 92% of new stair climbers reported that stair climbing had become habitual, which is important for sustainability
- The ability to track stair usage resulted in a five fold increase over baseline and an eight fold increase when users were incentivised to compete for shopping vouchers.
Among those most influenced by the intervention were target populations public health would want to reach:
- Overweight (BMI > 25)
- Infrequent takers of physical activity (< 2 x per week)
- 25-35 year olds
Reduced carbon emissions
There is another benefit too. As a Local Authority, we have environmental targets to reduce carbon use and one of the things this points to is a need to reduce lift and escalator journeys.
Lifts and escalators can be inefficient in carbon terms. So anything which decreases their use is welcome. Commercial companies which, like local authorities, must report their carbon footprint may well find this as valuable too.
Making it real
So, is StepJockey something to integrate into health and wellbeing programmes for employees? Yes, but it’s also something to integrate into environmental performance programmes, too.
Okay, it is no panacea. But we should know that if our health status is part of a complex manifold including individual and social elements; no single intervention would be the catch-all.
As part of a portfolio of interventions it could work, and it could also be an important part of achieving some of the cultural change we need to achieve the Marmot ambitions.
Interventions have to be simple for them to be taken up; they need to work, and they need to be sustainable. That’s why we intend to roll this out in Hertfordshire. It has been useful for us, and as part of our working age health plans, I think has real potential.
1. Marmot, M. Fair society, healthy lives. The Marmot Review : strategic review of health inequalities in England post-2010. (2010) ISBN 9780956487001
2. HM Treasury. Securing Our Future Health: Taking A Long-Term View - an independent review by Derek Wanless. (2003)
3. Sarah Campos, Juliana Doxey and David Hammond (2011). Nutrition labels on pre-packaged foods: a systematic review. Public Health Nutrition, 14, pp 1496-1506. doi:10.1017/S1368980010003290