Plan nacional de actividad física y salud 2011-2021

Objectives

Costa Rica’s National Physical Activity and Health Plan 2011–2021 provides a population-wide framework for promoting physical activity, sport, physical education and recreation across the life course. It seeks to improve physical, mental and social health, quality of life and social peace, while helping to prevent or reduce non-communicable diseases, sedentary behaviour, drug and alcohol use, and social violence.[1][2][3]The Plan shifts attention beyond a predominantly biomedical, disease-centred model towards the social production of health and action on biological, environmental, sociocultural and service-related determinants.[4][5]

• Promote active lifestyles and regular participation in physical activity in all its forms, including play, active travel, work, domestic activity, recreation, sport and structured exercise.[6][7]
• Strengthen a culture of self-care and collective responsibility, in which people and communities support healthy behaviours and demand suitable programmes, facilities and public policies.[8][1][9]
• Improve human habitats equitably by protecting, restoring and using built and natural spaces for active mobility, sport, recreation and quality of life.[10][11]
• Develop human capabilities, with particular attention to people experiencing poverty, vulnerability, exclusion, disability or reduced capacity.[12][13]
• Expand access to safe, inclusive and accessible physical-activity, sport and recreation opportunities in communities, education settings, workplaces, health services, prisons and specialised centres.[14][15]
• Promote human rights, diversity, gender equality, equity, dignity, social justice and social cohesion, recognising physical activity and sport as rights rather than optional services for passive recipients.[16][17]
• Strengthen research, surveillance, technology access and coordination among institutions, sectors and civil society as core areas of action.[15][1]

The Plan applies age-related activity guidance, recommending at least 60 minutes of moderate or vigorous physical activity daily for children and young people aged 5–17; at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity weekly for adults aged 18–64; and the adult recommendations for older people, supplemented where appropriate by balance and muscle-strengthening activity.[7][18]It responds to evidence of persistent inactivity and metabolic risk, including a reported 50.1% prevalence of high sedentary living in 2010 and low activity levels among adolescents.[19][20]

Implementation

Implementation uses an ecological and social-production-of-health model: physical-activity practices are understood to be shaped by individual circumstances as well as social and physical environments, including culture, safety, urban planning, transport, recreation, information, policy, incentives and resources.[18][15]Delivery is multisectoral, multidisciplinary, culturally appropriate and organised across communities, educational institutions, workplaces, health services and specialised centres.[6][15]

• Coordinate national and local delivery through the Ministry of Health, the Ministry of Sport and Recreation, the Costa Rican Institute of Sport and Recreation, the Costa Rican Social Security Fund, local governments, cantonal and district sport and recreation bodies, educational institutions, universities, community organisations, professional bodies and private-sector partners.[1][21][22]
• Use the Costa Rican Network for Physical Activity and Health as an articulating mechanism for coordination among direct and indirect stakeholders.[1][21][3]
• Develop safe pedestrian and cycling routes, active-transport measures, public spaces, sports and recreational facilities, and agreements enabling community use of facilities.[8][10][23]
• Implement local socio-spatial diagnoses, marketing and planning activities, and guidance for managing sport and recreational infrastructure and programmes.[1][9]
• Train recreation promoters, community leaders, teachers and health-sector personnel, and integrate physical-activity guidance into primary healthcare, school physical education and relevant higher-education courses.[11][13][24]
• Deliver community, workplace, school, higher-education and prison programmes, including active breaks, school clubs, sport and recreation activities, and health-service referral arrangements.[25][2][21][26]
• Support inclusive provision for different life stages and social groups, including people with disabilities, older people, people in prisons and communities facing barriers to participation.[14][12][15]

The Plan includes defined operational milestones. These include diagnosing at least 90% of national territory by the first half of 2012, completing an inter-institutional management guide in the second half of 2012, implementing one plan per Regional Directorate of Health Governance in the first half of 2014, and implementing the marketing plan by 2014.[1][9]Habitat-related targets include safe pedestrian-mobility models in at least 70% of priority communities during 2012–2021, agreements covering at least 60% of sports and recreational facilities in participating communities, and use of the management guide by all canton committees and district councils.[10][23]

Monitoring relies principally on management, activity and output indicators, including plans prepared, diagnoses completed, agreements established, facilities and programmes mapped, people trained, school projects implemented, clubs established, participating cantons, public institutions operating workplace programmes, and clinics providing programmes or referrals.[1][13][2][26]The Plan also calls for nationally comparable physical-activity research, inclusion of physical activity in censuses or household surveys, a nationally representative study repeated within fewer than five years by 2013, and a surveillance system for population activity levels and behavioural change targeted for 2014.[26][3][27]

Economic, logistical, material, infrastructure and trained human resources are identified as necessary inputs.[10][11][25]The supplied material does not specify a numerical budget, costed implementation plan, financing allocation, funding gap or currency-denominated expenditure.[10][3]It nevertheless envisages transport-authority financing for non-motorised-transport promotion and possible subsidies, incentives and tax deductions through public, non-governmental and private-sector partnerships.[8][28]

Monitoring & Evaluation

The plan establishes a management-oriented monitoring approach for the 2011–2021 National Physical Activity and Health Plan, combining activity, output, coverage and institutional-development indicators. It also identifies research and surveillance as a strategic area, although many extracts do not specify reporting cycles, independent evaluation methods or formal accountability arrangements.[15][1][3]

• Monitor planning and governance through progress on the marketing plan; the number of Regional Health Governance Directorate plans operational; the number of cantons and district councils diagnosed; completion of inter-institutional guidance; review of Cantonal Sports and Recreation Committee regulations; and adjustment of the Costa Rican Network for Physical Activity and Health establishing decree.[1][9][27][22]
• Track time-bound implementation targets, including completion of territorial diagnoses covering at least 90% of the country by the first half of 2012, an inter-institutional guide in the second half of 2012, one operational plan per Regional Health Governance Directorate in the first half of 2014, and marketing-plan implementation by 2014.[1][9]
• Assess human-capacity development through the number of recreation promoters, community leaders, teachers and health-sector staff trained; training sessions delivered; publication and use of a primary-care physical-activity guide; and the number of higher-education programmes incorporating active-lifestyle content.[11][13][24]
• Measure service and education delivery through school projects and clubs, educational centres applying health-oriented physical-education programmes, physical-education posts created, workplace active-break programmes, prison sport and recreation programmes, and higher-education healthy-lifestyle initiatives.[25][2]
• Track access and local provision through the proportion of cantons offering physical-activity and recreation programmes, public institutions operating staff programmes, actions delivered, direct beneficiaries, clinics offering programmes or referral systems, and inter-institutional agreements enabling community use of sports and recreational facilities.[10][23][21][26]
• Monitor human-habitat interventions through the number of safe-space models created, implemented and regionally validated, the number of agreements covering facilities, and the number of canton committees and district councils applying the management guide.[10][23]
• Apply specific coverage targets, including safe pedestrian-mobility models in at least 70% of priority communities between 2012 and 2021; facility-use agreements in at least 60% of participating communities by the first half of 2014; management-guide implementation in all canton committees and district councils in the second half of 2012; school clubs in at least 80% of public schools and colleges in priority communities by 2014; and workplace active-break programmes in at least 50% of relevant public institutions by 2014.[10][23][2]
• Use population surveys to monitor physical-activity patterns and risk factors, including sedentary behaviour, hypertension, diabetes, cholesterol and triglyceride abnormalities, nutritional status and active travel. Survey evidence reported that sedentary or insufficiently active behaviour among people aged 12–70 fell from 78% in 1990 to 50.1% in 2010.[29][19]
• Track adolescent activity indicators, including the proportion meeting at least 60 minutes of daily activity, non-use of active travel to school, and time spent seated outside school and homework.[20]
• Establish a national surveillance system for population physical-activity levels and behaviour change, targeted for implementation in 2014, and include physical activity in national censuses and household surveys, with a nationally representative study repeated within fewer than five years by 2013.[21][26][3]
• Develop comparable national research through a common methodology, strengthened by 2012 and validated by 2014; prepare a national diagnosis of facilities and programme supply by the end of 2012; and sustain preparation, validation and dissemination of evidence-based materials throughout the plan period.[3][27]
• Conduct research on health impacts, cost-benefit relationships and intervention effects across settings and population groups, with universities and research institutes supporting evidence-informed decisions.[28]
• Maintain annual awareness-raising activities for institutional leaders between 2011 and 2021, monitored by the number of leaders sensitised and activities completed.[22]

Recommended physical-activity thresholds provide potential outcome benchmarks: at least 60 minutes daily for children and young people aged 5–17, and at least 150 minutes of moderate or 75 minutes of vigorous aerobic activity weekly for adults aged 18–64, with additional balance and strengthening activity for older people where appropriate.[7][18]Formal reporting requirements, evaluation designs, audit procedures and sanctions for non-performance are not specified in the supplied extracts.[5][16][10][23]

Costing & Financing

Financial and material inputs are recognised as necessary for implementation, but the supplied extracts do not present a costed plan, monetary budget, unit costs, allocations, funding gap, currency denomination or economic assumptions for the National Physical Activity and Health Plan.[1][9][11][13][3][27]

• Provide economic, logistical, human, material, educational, technical and infrastructure resources for activities including local programmes, training, facilities, planning, surveillance and communication.[30][10][23][11][13]
• Allocate budget support for public community programmes and projects that promote physical activity.[14]
• Mobilise resources through public, non-governmental and private-sector partnerships, including potential subsidies, incentives and tax deductions that support participation in physical activity.[28]
• Finance promotion of non-motorised transport through transport authorities.[8]
• Recognise financial support for plan preparation or publication from the Pan American Health Organization and the Costa Rican Institute of Sport and Recreation, with technical and financial support from the Pan American Health Organization also identified.[31][32]
• Consider economic effects associated with non-communicable diseases, diabetes and obesity. Obesity-related health expenditure is described as at least 25% higher than expenditure associated with a person of normal weight, while diabetes is identified as having substantial economic and social effects.[29][19]
• Recognise potential economic benefits of physical activity through lower treatment costs, higher labour productivity and fewer workplace accidents linked to fatigue or stress.[33]

The plan proposes research on the cost-benefit relationship of physical-activity programmes, but does not quantify expected savings, returns on investment, programme expenditure or the resources required for this research.[28]