plā′wėrk′ings, n. Portions of play matters consideration; draft formations.

Archive for April, 2018

The war on the war on obesity

Further to my recent post on the childhood obesity agenda, a little refinement is necessary. This is a subject matter that might gain continual return in my writing. Briefly, my current thinking is that play, as precious and beautiful and as fraught or vociferous as it is, is engaged in for the sake of itself; play ‘used’ for instrumental gain by external parties is disingenuous to what play is, for the player. So, by not so stealthy means (and despite the fact that the ‘p’ word — as playworkers know it — hardly gains any real degree of recognition in those external parties’ outpourings), when play is manipulated (albeit under the guise of, say, ‘physical activity’) towards solving issues (societal, economic: political), I’m in disagreement.

The manipulation in question here is the obesity agenda. My writing/thinking is a reframing of prevalent perceptions of play: play, for the player, is autotelic. Regarding autotelic theory, Burghardt (2005) writes that this ‘derives from the view that all play is done for its own sake . . . the play performance is its own gratification, not the putative end or goal. Thus, autotelic means that the goal (telos) of the behaviour is itself (auto)’. Compare this to the one reference to ‘play’ I’ve managed to find, to date, amongst government documents — under a section entitled ‘supporting early years settings’ in the Department of Health and Social Care’s (2017) document Childhood obesity: a plan for action, it’s stated that:

‘In early 2017 . . . we will update the Early Years Foundation Stage Framework to make specific reference to the UK chief medical officers’ guidelines for physical activity in the early years (including active play).’

It is only ‘active play’ deemed as beneficial: there is an agenda for its use; furthermore, it’s included in a section specifically referenced to the early years. It is as if play doesn’t or shouldn’t exist beyond the early years because it will, by then, have further transmuted into other forms of activity that have (playworker un-endorsed) measurable outcomes. If playworkers continue to jump on the bandwagon of using the ‘play as physical activity to help solve obesity agenda’, then play for play’s sake loses out, even if the funding is provided. Well, some might say, play the game, twist things for your project’s benefit: it helps keep the real play agenda going. That it might, but it doesn’t help in the long run, I’d say. The wider perception of play for play’s sake won’t be enhanced because people haven’t been adequately informed.

Play for play’s sake: this is the message we should be continually shouting out. We have to call it as it is.

This ‘calling it as it is’ brings me back round to the government’s obesity agenda. It has long been my contention that, despite the rhetoric of concern for the health and well-being of the nation, the actual bottom line is that the economic strain on the NHS, and by extension, the government coffers, is the real driving force. So, it’s apposite that the following news report has been filed today: Nick Triggle (2018) writes for the BBC that the ‘NHS needs £50bn extra by 2030’, citing ‘a former health minister and leading surgeon’, Lord Darzi.

A few days ago, I felt obliged (though, really, I didn’t actually want to) to wade around in the murky depths of the Tory Party Manifesto — more technically reference-able, perhaps, as The Conservative and Unionist Party Manifesto (2017). I felt obliged to root around in order to feed my obesity agenda concerns, to get some evidence, though I felt dirty for it afterwards! I do it so you don’t have to. A few nuggets unearthed, for your consideration:

The manifesto is aimed at what it calls ‘ordinary working families’, stating explicitly that ‘[t]hey are the people to whom this manifesto is dedicated.’ (p.8). Does this then presuppose that everyone not included in the narrow overlap of whatever ‘ordinary’, ‘working’ and ‘family’ are considered to be are not included?

‘We do not believe in untrammelled free markets. We reject the cult of selfish individualism.’ (p.9). (The jury appears to be out on this one, given the reputation of ministers of recent times, based on actions). Let’s move onwards though with the economic agenda.

Under the heading of ‘five giant challenges’, the manifesto points to ‘[t]he need for a strong economy’ (p.6), and this bullet point comes top of the list. The capitalist agenda is, contrary to feeble attempts to persuade us otherwise, prevalent: ‘Without business and enterprise, there would be no prosperity and no public services.’ (p.9); ‘A strong economy is the basis for everything we want to achieve as a nation.’ (p.13); ‘Capitalism and free markets remain the best way to deliver prosperity and economic security.’ (p.16).

How does the party plan our present and our future? We’re in the sausage machine of ‘productivity’, don’t forget:

‘[W]e will continue to strive for full employment.’ (p.54); ‘We need to give every child in our country the best possible education if we are to provide them with the best opportunities in the world.’ (p.50) (that is, employability). Education is filed under a section entitled ‘The world’s great meritocracy’, where it’s stated that ours should be ‘a country where everyone has a fair chance to go as far as their talent and their hard work will allow, where advantage is based on merit not privilege.’ (p.49) (work hard, be productive, be a part of the machine, the economy requires it). Let’s just gloss over the quote about privilege here because it’s laughable.

So, we come to the NHS and the economy and the productive units of society. It must stick in the throats of the Tories who might well prefer that the NHS is sold off, to be more profitable, but it can’t, yet, when the manifesto declares that ‘[t]he Conservative Party believes in the founding principles of the NHS . . . care should be free at the point of use.’ (p.66). The ghost of Aneurin Bevan must be howling for conflicting reasons.

The manifesto attempts to temper the subtitle that is ‘The money and people the NHS needs’ (p.66) with its touch of the human element, but really it’s the money that stands out. Yes, it is a service that needs paying for, this can’t be denied, but the humanity rings hollow, the sentiment as read thereafter that the nation’s health and well-being are paramount is secondary (if that high up at all) to the finances. So it is we come back to childhood obesity and ‘the crisis of obesity’:

‘We will continue to take action to reduce childhood obesity . . . We shall continue to support school sport, delivering on our commitment to double support for sports in primary schools.’ (p.72). Yes, I’m cynical and no, I don’t apologise: use play, or approximations of it, or near-guesses of it, to ramp up fitness, to deliver (or pump in ‘education’) academic achievement, to create ‘opportunity’ for jobs, to become productive units for the economy. Blah.

Returning to the Department of Health and Social Care’s (2017) Childhood obesity: a plan for action document, it is stated that:

‘[N]ot only are obese people more likely to get physical health conditions like heart disease, they are also more likely to be living with conditions like depression . . . [t]he economic costs are great, too.’ I suspect that the last line here, being the first line of the second paragraph, is the real first line of the document. The first line though, as given, is rather: ‘Today nearly a third of children aged 2 to 15 are overweight or obese.’ What this doesn’t do, however, is play straight with the document it cites for this. This document, the Health and Social Care Information Centre’s (2015) National child measurement programme (England, 2014/15 school year), gives statistics for reception age (four year olds) and Year 6 (eleven year olds), not 2-15 year olds. The focus of the former document is on obesity, but the latter document has four categories of weight, being: underweight, healthy weight, overweight and obese (also combining the last two for comparison purposes). What is then read in Childhood obesity: a plan for action, no doubt, is that the ‘overweight’ category becomes subsumed into an all-encompassing ‘obesity’.

The Health and Social Care Information Centre’s (2015) document also suggests that, in fact, the trend for obesity in four year olds is going down, not up:

‘The prevalence of obese [reception age] children (9.1%) was lower than 2013/14 (9.5%) and 2006/07 (9.9%). Over a fifth (21.9%) of the children measured were either overweight or obese. This was lower than in 2013/14 (22.5%) and 2006/07 (22.9%).’ (p.9).

A closer look at the whole range of percentages for the four categories of weight, for four year olds, allows us to see a picture that isn’t just focused on the ‘negative news’, putting things in perspective:

‘Table 1: Prevalence of the BMI classifications, by school year and sex, England 2014/15: [Underweight] 1.0 [%]; [healthy weight] 77.2 [%]; [overweight] 12.8 [%]; [obese] 9.1 [%].’ (p.10).

Plugging my previous post’s figures for population of four year olds (662,738) into an equation that has it that 9.1% of these are obese (coming out at 60,309, give or take), and with the assumption of 16,786 state-funded schools for children of that age, we still come out at 4 children per school, rounded up, falling into this category. Four. Now, the added extra to the thinking is the explicit acknowledgement of children’s BMI categories being played off against each other and only those at the 95th percentile (i.e. 95% of the reference population weights are less) are seen as obese: surely, in any reference population where percentiles are made use of, a certain number are going to be in that top bracket, no matter what their weight?

Let’s come back full circle. The Department of Health and Social Care’s (2017) Childhood obesity: a plan for action document states that:

‘There is also evidence that physical activity and participating in organised sports and after school clubs is linked to improved academic performance.’

Ramp up fitness, to deliver (or pump in ‘education’) academic achievement, to create ‘opportunity’ for jobs, to become productive units for the economy. Blah. There’s even reference to how Ofsted will be used as a stick to ensure compliance of the above, though not, of course, in those words.

Poor play (or loose approximations of it, notwithstanding the argument that ‘sport’ and ‘play’ can, philosophically, be deemed as different things entirely). It is to the perception of play, or its grouping together with ‘sport’, ‘physical activity for xyz benefit’, and so forth, that I write of. Poor play: used to improve academic performance, for greater ‘opportunity’ to access the ‘world’s great meritocracy’, to be economically purposeful, to be a part of the sausage machine of productivity, to not cost the government coffers too much.

What of play, for play’s sake?
 
 
References:

Burghardt, G. M. (2005), The genesis of animal play. Cambridge, MA: Massachusetts Institute of Technology.

Department of Health and Social Care (2017), Childhood obesity: a plan for action [online]. Available from: https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action/childhood-obesity-a-plan-for-action (Accessed April 26, 2018).

Health and Social Care Information Centre (2015), National child measurement programme (England, 2014/15 school year) [online]. Available from: https://files.digital.nhs.uk/publicationimport/pub19xxx/pub19109/nati-chil-meas-prog-eng-2014-2015-rep.pdf (Accessed April 26, 2018).

The Conservative and Unionist Party Manifesto (2017), Forward together: our plan for a stronger Britain and a prosperous future [online]. Available from: https://s3-eu-west-1.amazonaws.com/2017-manifestos/Conservative+Manifesto+2017.pdf (Accessed April 26, 2018).

Triggle, N. (2018), NHS needs ‘£50bn extra by 2030’ [online]. Available from: http://www.bbc.co.uk/news/health-43898963 (Accessed April 26, 2018).
 
 

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Play, for play’s sake

The rhetoric of play as an instrumental tool is everywhere (within the limited incidence of its national discussion). It seems that politicians (if they even engage with the idea of ‘play’ at all), journalists, the majority of those who work with children in any capacity, et al, seem to be predominately fixated on outcomes, desirable goals, end product, future-fixing. Play, in this construct, is a means to an end. Play, in this formation, is an adult-manipulation. What children see is different, and it is what children see and how and why they engage in their play that should be the most important consideration when play is the subject of contemplation.

For a long while I’ve been banging this particular drum, but recently and specifically I’ve been somewhat grated by the whole affair that is the instrumental use of play in order to help ‘solve’ the ‘national obesity crisis’. The cynic in me suspects (though can’t yet substantiate) that there is no great and overwhelming desire for the health and well-being of people in the eyes of the government and other powers that be: it’s more to do with counting the beans and keeping the costs to the NHS down. I do wonder about the numbers. That is, I’m dubious about how much of a crisis this ‘crisis’ really is. I’m particularly dubious with regards to the contention that there’s a huge obesity crisis in school children.

Now, before I go further, some balancing out: yes, I have witnessed some examples of particularly overweight children in my day-to-days in various locations, and it’s fair to say that this highlights that those children exist, of course, beyond the dry spreadsheet data. I’m also aware that some areas of the country, or of particular towns, cities or rural areas, might be more prone to a greater occurrence of higher body mass index (BMI) in children (by way of all manner of complex socio-economic factors). However, having worked in some areas of recognised socio-economic ‘deprivation’, I just don’t see what the statistics are saying. (I don’t claim extensive observational evidence, of course: who could? I accept that this is a snapshot).

Could it be that, simplistically, all the obese children are indoors on their Xboxes and Playstations and not out and about playing? Well, the instrumental argument follows a simple cause and effect of ‘run around, get fit’, after all. That said, why aren’t all the underweight and, for want of an appropriate word, ‘normal’ (whatever that is) weighted children (within the acceptable BMI percentile) who play in such ways considered in that equation? i.e. not seen out and about, so must be lazy, on their way to obesity, need to be ‘fixed’. The discussion is wider than the one that often goes along the lines of: if we use play to make children fit, then there will be less obesity and people will be better for it. ‘If we use play’ is a red flag to this particular playworker.

So, this post is an entire exercise in ‘back of an envelope’ calculations and notes. (Fair warning: there will be some rough workings and plenty of scribbling of numbers). How many obese children are there actually? We get fed the message of a ‘crisis’ or an ‘obesity epidemic’ but we don’t always get the numbers to back it up. Then, when we receive some data, we get this in handy sound-bites too, without really knowing how that relates to the whole. This line of thinking struck me on reading a recent article in The Guardian entitled Obesity putting strain on NHS as weight-related admissions rise (Boseley, 2018). Apart from the article’s title feeding my cynicism re: the economic impact on the NHS, the main point of interest was the following:

Childhood obesity has not shifted very much since the school measurement programme was introduced in 2006-7. Last year [2017] 10% of children starting school in the reception year were classed as obese, a slight decrease over time.

It was number crunching time! For the purposes of balance here, Boseley does go on to add that ‘the proportion for those leaving in Year 6 for secondary school was 20%, which is a small increase.’ It’s beyond the scope of this particular post to speculate on the causes of the apparent 10-20% increase between school years R-6 (age 4 to 11 in the UK) because I’m interested in comparing observational (and albeit piecemeal) data with the statistics of younger children deemed to be obese.

Are there really such huge numbers of obese four year olds in the UK? Ten per cent screams out like a crisis. However, what are we really looking at here? Before we go any further, a quick overview of body mass index (BMI) and ‘obesity’. According to information given by diabetes.co.uk, if your BMI (measured by dividing your weight in kg by your height in metres squared) is 30 or above then you’re classed as obese. If there’s an obesity crisis in children (in this study, four year olds in Reception class), another question is how much might all these children weigh to be classed as obese?

So, to the number crunching. The Department for Education (DfE) (2017) provides figures for England on school attendees (so, the start of back of an envelope workings-out if extrapolation needs doing for the UK as a whole). It states that there are, as of January 2017, some 4,689,660 children at state funded primary schools in England and that there are 16,786 state funded primary schools in this country. This gives an average of 279 children per primary school. According to the Office for National Statistics (2015), 2011 being the most up to date census, in which admittedly, all the following are closer to secondary school age now than Reception age, there were at that date some 763,851 four year olds in the UK. It doesn’t give the figures for England alone so some creative extrapolation needs to be done: ukpopulation.org suggests that, as of 2017, there were around 54.99 million people in England. Calculating, from the 2011 census, that the percentage of four year olds to the UK total population was around 1.21% (763,851 out of 63,379,787), this gives a current working figure of around 662,738 four year olds in England (yes, I’m aware that I’m working on 2011 and 2017 data sets, but it’s back of the envelope stuff, this). That is, 1.21% of 54.99 million total population of England, rather than the UK. If we divide this 662,738 by the DfE statistic of 4,689,660 children at state funded primary schools in England in 2017, we reach the figure of some 14% of primary school children being 4 year olds, i.e. Reception age. (Checking my maths is fine, and please let me know if you see an error in the calculations).

If there are 279 children per primary school on average, then 14% of this figure gives us an estimate of 39 four year olds per primary school. Citing the Organisation for Economic Co-Operation and Development (OECD) (2017), Boseley (2018) reckons on 10% of four year olds being obese. That, according to my number crunching, equates to four Reception class four year olds per primary school in England (i.e. 10% of 39 children per school). Four.

Now, as the quote goes, there are lies, damn lies and statistics, but four isn’t a crisis, is it? There are those who will, no doubt, shout out that even one is too many. Yes, if we’re talking about genuine health grounds for concern, then maybe. We should look at what BMI calculations for four year olds mean in numbers. If the average four year old is, taking into account variations for gender, around 1.05m tall (or, 3 feet 5 inches in ‘old money’) then their weight would need to be in the region of 33kg (or, around 5 stone 3lbs, because, frankly, you might as well ask me to weigh someone out in buckets of sand for all I know about how much 33kg is!) for their BMI to hit the obese classification of 30. Here’s the point: 33kg, or a little over 5 stone, is a lot for a four year old to weigh. How many of those do you actually see?

I’m still dubious after all my number crunching. There’s an extra layer of cynicism here as well though: this may well come back to bite me in some way but if playworkers jump on the ‘obesity agenda’ bandwagon to get their work funded, for example, then aren’t they falling into the trap that supports the notion that play has to be ‘for’ something, future-fixing? We know what play’s about, playworkers. We really do. If the future fixers over-ride the idea of play for play’s sake, as children know it to be, then play gets fully subsumed as a subset of sport, citizenship, social engineering and so on. Play should not be taken over by the soft- or hard-line control agenda. The agenda goes something like this: play in ‘xyz’ way because sport/fitness, or any other health agenda, will help you be healthy model citizens, you’ll be ‘responsible’ (i.e. thinking in the same way as the rest of the masses), and you won’t cost the country as much, economically or otherwise.

Play is better than this, more magical than this, more ineffable. On the rare occasion that it does manage to be uttered from the mouth of a politician, it often comes out distorted. I recently sat through forty minutes of a recorded online ministerial debate, poorly attended as it was, though at least play was nominally the subject (my apologies for not yet being able to transfer the link). It was brought up for discussion by Chris Leslie MP (Labour) and though he did bring the subject of funding for playgrounds up (so, all good there), he did bang the ‘play and obesity’ drum a little too much. I sighed, again. Still, the other fella (Conservative MP, Rishi Sunak) was playing on his phone somewhat and not giving the impression he was paying attention and thus, I suspect was the case, when his turn came he rattled off his pre-prepared speech, slipping in an attempted one-up to the Rt Hon other fella by claiming one more offspring, and then going on ad nauseum about the instrumental nature of all things play without ever mentioning play, in essence, at all (sport, fitness, yes, as I remember it, even mental health, and social cohesion, but not play).

Thus ends today’s sermon of number crunching and disconsolation at the instrumental perception of play, to the accompaniment of the banging of drums and the shrill peeping of pipes, which — being maybe in so high a pitch that very few can actually hear — keep on saying, over and over: play for play’s sake, play for play’s sake.

Or, to shift the inflection with the flick of a comma: play, for play’s sake.
 
 
Addendum:

Thank you to Jim Ley (see comments below) for the feedback on the difference between BMI calculations for adults and children. In the spirit of how this blog has always been written, these posts are all works in progress (playworkings in themselves) and so an addendum is required to the above writing. As Jim points out, a BMI of 30 for children would be extremely high and different figures are considered for those of a younger age. Whilst I was aware of the percentile aspect of the BMI calculations, this didn’t get relayed in my writing. So, although some of the calculations above are going to change, the argument still stands that the obese child is not, as observed, as prevalent as we’re led to believe.

Jim suggests a more ‘mid-healthy’ BMI for a child to be 15 rather than 23 for an adult and, whilst knowing where the line is crossed for obesity in an adult is said to occur (stated as 30), the calculation isn’t so clear for a child.

The Centers for Disease Control and Prevention website states that: ‘Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex’, meaning that ‘the child’s BMI is greater than the BMI of 95% of [children] in the reference population.’

So, to return to my calculation of a 3 feet 5 inch (1.05m) tall four year old and using a back of the envelope BMI of 23 (assuming this to fall above the 95th percentile for this age) then that child would still need to weigh a little over 25kg (4 stone) to be classed as obese. The argument still stands.

Thank you again, Jim, for your corrections. This blog and its posts are an ongoing conversation, so I leave the original in its place with this addendum (in the spirit of showing all my workings!)
 
 
References:

Boseley, S. (2018), Obesity putting strain on NHS as weight-related admissions rise [online]. Available from: https://www.theguardian.com/society/2018/apr/04/obesity-putting-strain-on-nhs-as-weight-related-admissions-rise (Accessed April 17, 2018)

Department for Education (2017), Schools, pupils and their characteristics [online]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/650547/SFR28_2017_Main_Text.pdf (Accessed April 17, 2018)

Office for National Statistics (2015), 2011 census: population estimates for the UK [online]. Available from: https://www.ons.gov.uk/file?uri=/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/2011censusunitedkingdomsubmissionforunitednationsquestionnaireonpopulationandhousingcensuses/part2/rfttable1_tcm77-392509.xls (Accessed April 17, 2018)

Organisation for Economic Co-Operation and Development (OECD) (2017), Obesity update 2017 [online]. Available from: https://www.oecd.org/health/obesity-update.htm (Accessed April 17, 2018)
 
 

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