Authors (BB, AB and FB) were actively involved in physical activity policy and research across government and non-government agencies at Federal and State levels during the period of the Australian historical review (1995/6–2005/6). Paper and electronic records for the review period were also examined by BB who was a State government officer and inaugural chair of the Strategic Inter-Governmental forum on Physical Activity and Health (SIGPAH), by AB who was a University academic and inaugural chair of Australia's first Task Force on Physical Activity and by FB who was a university academic and chair of the SIGPAH working party on general practice. The methods of this review comprised compiling a catalogue of events and policy development in Australia in historical sequence; this was written, checked by co-authors and refined in consultation with key government department managers appointed during the review period [see acknowledgments].
Physical Activity Policy Development in Australia 1996 – 2006
The decade of physical activity policy development in Australia from 1995/6 included periods of innovation and leadership, periods of progress and periods of stagnation and decline. Important dates and corresponding policy initiatives or events are shown in Table .
Key physical activity policy events in Australia+ 1995/6 – 2005/6
An initial stimulus was in 1995 when the Chief Health Officer of New South Wales (NSW, Australia's most populous State) issued a Special Communication on Physical Activity and Health[5
] This policy communiqué closely followed the special communication from the Centers for Disease Control (CDC)/American College of Sports Medicine (ACSM) in January of that year [6
] recommending that "Every adult in New South Wales should accumulate 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week." Research on the physical activity preferences of Australians was released in that same year provided important information and strategic principles for policymakers [7
]. The State of Victoria had the benefit of a social marketing campaign 'Active for Life" which incorporated community walking events, links with local government and a telephone information line. The initiative was developed by the Department of Human Services with the support of Victorian Health Promotion Foundation, VicFit and the Heart Foundation. Policy development was given further impetus the following year when the NSW State Health Department published an evidence based guide to the promotion of physical activity [8
]. Although produced at State level, the publication was requested by governments and NGOs throughout Australia. This so-called 'red book' was published under the auspices of the NSW Premier's Physical Activity Task Force (PATF) an intersectoral body given responsibility by the NSW State government to promote physical activity to the people of NSW. These initial developments were reinforced by the landmark publication of the United States Surgeon General Report Physical Activity and Health and by its attendant publicity [9
From 1995 (the year in which Sydney secured the millennium Olympic Games), the Australian Sports Commission (ASC – a Federal agency concerned mainly with sporting excellence) broadened its policy agenda to include community participation in physical activity. As a result, the government Sport and Recreation departments across Australia's States and Territories agreed to work with the ASC to develop a national framework. This heralded the formation of Active Australia as a truly national policy framework and paved the way for fertile policy discussion and partnerships. Initial partners were the (Federal level) Australian Sports Commission and Commonwealth Department of Health (DoH) and the (State level) NSW Physical Activity Task Force. The focus of the policy framework was on health enhancing (including incidental) physical activity within a broadened definition of physical activity. This consensus definition of physical activity spanned organised and elite forms of sport and recreation participation as well as less structured forms and transport-related physical activity and provided a platform for collaboration across policies and social marketing programs under the common "Active Australia" brand.
Three main streams of activity ensued – (i) intersectoral policy development and implementation; (ii) social marketing campaigns; and (ii) initial development of national surveillance systems for physical activity. Joint core funding was provided by the ASC, DoH and the NSWHealth Department for a pilot public education campaign in NSW featuring the slogan "Exercise. You only have to take it regularly not seriously" [10
]. The collaboration established to support campaign implementation non Government organisations, State Departments of Education, Sport & Recreation, private sector Fitness Industry bodies, as well as the three core funding agencies. The Active Australia Survey was first developed and nationally implemented in 1997 to assess the effectiveness of the campaign in NSW and provide national physical activity prevalence data. The original survey methodology was subsequently implemented nationally through the National Physical Activity Surveys in 1999 and 2000 and through the Australian Diabetes, Obesity and Lifestyle Study in 1999–2000. It was also used in various formats in State-based surveys, such as in Queensland, South Australia, New South Wales and Western Australia [11
]. This provided a better approach to national physical activity surveillance.
In July 1997, Active Australia–a national participation framework was formally endorsed by the Federal ministers for Sport and Health and all States' and Territories' ministers for Sport [13
]. A National Symposium in February 1997 and a Workshop in October that year formulated the Health sector's more specific contribution to Active Australia; this was released as a policy statement and a framework for action by the Federal Health Minister in June 1998[14
]. This was the first National Physical Activity policy statement for Australia, and included specific strategies in (i) public education, (ii) physical environments, (iii) infrastructure and capacity building and (iv) monitoring. At the state level, the NSW PA Task Force released its 5-year strategic plan for physical activity in 1998; the introduction section described formal acknowledgment by the World Health Organisation that this had been a model of best practice in health promotion [15
]. March of that same year saw a second phase of the social marketing campaign activity in NSW targeting older Australians and designed to coincide with the United Nations International Year of Older Persons [16
A national peak physical activity policy group was developed within the Health sector; this was the Strategic Inter-Governmental Forum on Physical Activity and Health (SIGPAH). It was established in 1999 with Government health representatives from all Australian States and Territories as well as observers from the Australian Institute of Health and Welfare (AIHW) and the Australian Sports Commission (ASC) [17
]. By mid-year 1999 the Federal (Commonwealth) Health Department released the first National Physical Activity Guidelines for adults [18
]. It is interesting, given the subsequent prominence of obesity-related policy, to note that the policy imprimatur and consequently the funding allocation for the 1999 adult physical activity guidelines came out of an earlier obesity policy context (Acting on Australia's weight)[19
]. In November 1999 the AIHW published the Burden of Disease and Injury in Australia study [20
]. The study was important for physical activity policy because it highlighted that in terms of preventable risk factors, physical inactivity ranked second after tobacco, and made twice the contribution of obesity, to overall morbidity and mortality in Australia.
By the end of 1999 a new national committee, known as the Active Australia Alliance (the Alliance), was established to formalise an intersectoral policy approach between Sport, Recreation and Health and to oversee the implementation and monitoring of Active Australia. The Alliance developed a draft National Plan 2000–2003 through a robust consultation process to a point where it had the endorsement of all key constituencies, was cross linked with other important plans (such as the work plan developed by SIGPAH) and was ready for formal approval and implementation. This planning process and resultant policy document represented the first comprehensive intersectoral policy for physical activity at national level in Australia. Unfortunately, this draft policy document did not receive the necessary approval from government. The timing coincided with the Federal Government's decision to change its stance on the role of ASC – the national Sport and Recreation agency, within broad physical activity policy. The government embarked on a review, and subsequently a shift in focus of the ASC. This was a policy shift by the Sports Commission, away from community participation. This changed the Active Australia initiative, removing its comprehensive focus and interagency partnerships, and undermining physical activity policy progress that had been achieved in the previous four years.
The elite sport orientation was further developed through a new sport policy, Backing Australia's Sporting Ability [21
]. The announcement came with a large government funding package reorienting Active Australia and the services performed by the Australian Sports Commission to focus on participation in elite sport. This limited the opportunities for collaboration with the Health sector. The Active Australia Alliance National Plan 2000–2003 was shelved and, given its demise, all cross referencing to it was duly removed from its new work plan by SIGPAH [22
As if to underscore the magnitude of the lost opportunity, a new report on the costs of illness attributable to physical inactivity in Australia was published in July 2000 [23
]. The report provided direct cost of illness estimates for physical activity for the first time; whilst these estimates were conservative, they nonetheless indicated costs of at least $377 million per year.
The subsequent period 2002–2005 was characterised by rapid and fragmented change. National guidelines towards better practice in the promotion of physical activity were published in 2002 [24
]; but physical activity policy levers were no longer present. There was also a remarkable and sudden rise in public and political interest in the issue of childhood obesity, leading ultimately to the establishment of a high level National Obesity Taskforce (NOTF). As a consequence of NOTF's work the following year saw the related release of Healthy Weight 2008 [25
] (a national policy initiative on overweight and obesity with a focus on childhood) and then in 2004, the Prime Minister announced $116 million of funding over four years for the Building a Healthy Active Australia initiative to address childhood obesity through an after-schools program to tackle declining physical activity and poor eating habits of Australian children [26
]. Notwithstanding the high profile they achieved, many of the early policy steps on obesity fitted with existing implementation systems within State and Federal governments. This reflected an incremental approach to policy formulation rather a more strategic platform, but may have built sufficient commitment and support to create momentum for more strategic policy at a later time [27
Further documents were released in 2004, including physical activity recommendations for children and adolescents and older adults [28
]. In this year, the World Health Organisation (WHO) released its Global Strategy on Diet, Physical Activity and Health (DPAS) [1
] that physical activity on the global NCD prevention and public health agenda. A revised Health-sector-specific national framework Be Active Australia: A Framework for Health Sector Action for Physical Activity 2005–2010 [29
] were released in the course of 2005. However, these documents had no direct national policy connections, and demonstrated the need for guidelines and strategic plans to be linked to active policy effector mechanisms.
The last few years of the decade under review saw increased government emphasis on chronic disease prevention – epitomised by the National Chronic Disease Strategy which was endorsed by Australian Health Ministers in 2005 [30
]. The integrated approach was reflected in organisational arrangements to support key strategy groups, and SIGPAH was redesignated as a "Communication Network" under the Chronic Disease and Injury Prevention Working Group. In effect, this was the demise of SIGPAH as originally constituted, and the marginalization of physical activity as a 'supportive role', subservient to the stronger focus on policy developments in obesity and diabetes [31