Developing a physical activity legacy from the London 2012 Olympic and Paralympic Games: a policy-led systematic review

Human rights and the olympics: from an ideological paradox to a new anti-corruption legacy

This article aims to explore the evolution of the debates surrounding human rights in the discourse(s) of major sporting events (MSEs), particularly the Olympics. The paper will first analyse the western-centric origins of the "universality" of the Olympic philosophy and how it affected the protection and promotion of human rights, as well as addressing practical challenges or limitations faced. It will then focus on unpacking the elements of sportswashing and soft power in the multi-discursive context of sport where power, privilege, politics, and position are (re)produced. In doing so it draws upon the emergent field of Sports Diplomacy as the most appropriate explanatory framework to share in this discourse. Finally, it will explore the potential impact of anti-corruption reforms on the establishment of a meaningful human rights legacy.

Optimizing Technical Training for Wheelchair-User Billiard Players through Modified Equipment Implementation

This study aims to enhance the effectiveness of the preparation process and the performance of wheelchair users in international billiard competitions through modified equipment. The research methods include analysis and synthesis of the scientific and methodological literature, sociological research methods (questionnaires), expert assessment methods, pedagogical research methods (observation, testing, experimentation), and methods of mathematical statistics. The results of our study are significant: Implementing our developed training program for billiards players with musculoskeletal disorders, utilizing the modified equipment (special mechanical bridge and straps for cue fixation during shots) we created in a pedagogical experiment, demonstrated a probable improvement of 36% in the technical and tactical preparedness of the athletes compared to previous years. This led to a 33% increase in players from the Ukrainian team's competition performance at the national and European Pool Championships (wheelchair division). In conclusion, implementing our developed training program, accompanied by specialized auxiliary equipment, demonstrated promising results in a pedagogical experiment. These findings underscore the potential of the modified equipment and tailored training programs to optimize sports training for individuals with musculoskeletal impairments in adaptive billiards, contributing to the continued humanization of the sport and offering an effective preparation process for the athletes.

Sustainable Development of Olympic Sport Participation Legacy: A Scoping Review Based on the PAGER Framework

After the 2022 Beijing Winter Olympics, Chinese officials claimed that the goal of “driving 300 million people to participate in ice and snow sports” had been achieved. Historically, the London 2012 Olympic Games had a similar goal: to increase sports participation for all by hosting the Olympic Games. Given these goals, the impact of the Olympic Games on sports participation has clearly become significant. These impacts can be referred to as the Olympic sport participation legacy, an intangible Olympic legacy. The Olympic sport participation legacy has attracted a lot of researchers’ interest in the academic field in recent years. This paper aims to conduct a scoping review of Olympic sport participation legacy studies between 2000 and 2021 to identify the progress of studies on the sustainability of Olympic sport participation legacies. Unlike previous scoping reviews on sport participation legacies, this review adopts a Patterns, Advances, Gaps, Evidence of Practice, and Research Recommendations (PAGER) framework at the results analysis stage to improve the quality of the findings. The results from the scoping review contained 54 peer-reviewed articles on three levels of research: the population level, social level, and intervention processes. Many studies indicate that achieving a sustainable Olympic sport participation legacy requires joint collaboration and long-term planning between governments, community organisations, and other stakeholders.

Understanding a Player's Decision-Making Process in Team Sports: A Systematic Review of Empirical Evidence

Three perspectives were taken to explain decision-making within team sports (information processing, recognition primed decision-making, and ecological dynamics perspectives), resulting in conceptual tension and practical confusion. The aim of this paper was to interrogate empirical evidence to (1) understand the process of decision-making within team sports and (2) capture the characteristics of decision-making expertise in a team sport context. Nine electronic databases (SPORTDiscus, PsycINFO, PsycArticles, PsycTests, PubMed, SAGE journals online, Web of Knowledge, Academic Search Complete, and Web of Science) were searched until the final return in March 2021. Fifty-three articles satisfied the inclusion criteria, were analysed thematically, and synthesised using a narrative approach. Findings indicate that the relative absence or presence of mental representation within the decision-making process depends on factors, including complexity, typicality, time available, and contextual priors available in the game situation. We recommend that future research integrate concepts and methodologies prevalent within each perspective to better understand decision-making within team sports before providing implications for practitioners.

Conditions under Which Trickle-Down Effects Occur: A Realist Synthesis Approach

Policy makers often legitimize bids for major sport events and public funding of elite sports by trickle-down effects, suggesting that hosting events, sporting success, and athlete role models inspire the population to participate themselves in sport and physical activity. According to previous review articles, empirical evidence of trickle-down effects are mixed, with several studies citing marginal or no effect. The purpose of this study is to apply a realist synthesis approach to evaluate under which conditions trickle-down effects occur (i.e., what works for whom under which circumstances?). Using rapid evidence assessment methodology, 58 empirical articles were identified in the search process and critically analyzed through the lens of realist synthesis evaluation. The analysis identified six conditions under which trickle-down effects have occurred: Event leveraging initiatives, capacity of community sport to cater for new participants, live spectating experiences, consumption possibilities on television or other media, and communities housing event venues. The findings have implications for the sustainability of sport policy decisions and public finance, as the likelihood of trickle-down effects increases with integrated planning and sustainable spending related to the above six conditions.

Physical Activity Among Urban-Living Middle-Aged and Older Japanese During the Build-Up to the Tokyo Olympic and Paralympic Games: A Population Study

This research examines physical activity (PA) parameters among urban-living middle-aged and older Japanese during the Tokyo Olympic build-up period. Population sampling was employed, and an online survey was administered with 4,000 adults across Japan's five largest cities. The International Physical Activity Questionnaire-Short Form constituted the main outcome variable, with auxiliary measures of Olympic interest and engagement, readiness for PA behavior change, perceived environmental barriers, and demographic information. Despite interest in the Olympics (>60% moderate-high interest), planned engagement with the event was low (>70% planned passive engagement). Higher levels of interest and planned engagement were both significantly correlated with greater self-reported PA participation (p < .001). Across the sample, the PA levels were in the low-moderate range (990 metabolic equivalent of task-min/week), with significant variations observed by the age-cohort and geographic area (p < .001). Age-cohort and geographic variations were also identified with regard to readiness for PA behavior change and perceived environmental barriers to activity (p < .001). Older age (65 years and above) and host city (Tokyo) residence emerged as correlates of higher levels of PA, greater readiness for behavior change, and fewer reported barriers to participation. These findings have implications for Olympic legacy management and successful transitions from middle age to later life in Japan.

Positive Externalities from Professional Football Clubs in the Metropolitan Rhine-Ruhr, Germany: Trickle-Down Effects Associated with Promotion and Relegation

Hosting sport events is costly, but the positive impact of hosting sport events has not been studied well. We consider the promotion of physical activity, known as the trickle-down effect, to be a new dimension of this kind of impact. Using exogenous variations in promotion and relegation in the Bundesliga 1, we test the effect of the presence of a Bundesliga 1 club on local non-profit football club membership. Using German city-level annual non-profit sport club membership data from the metropolitan Rhine-Ruhr, we group cities with experience of either promotion or relegation as treatment cities and other cities as the comparison group. Difference-in-difference analyses show that promotion (using a strict definition of promotion) of local professional football clubs increases non-profit football club membership by 14% while relegation does not affect membership. The presence of Bundesliga 1 clubs in a city increases non-profit football club membership by 11%. Falsification tests support the idea that the impact of promotion on membership results in a net increase in membership.

Sport Promotion through Sport Mega-Events. An Analysis for Types of Olympic Sports in London 2012

A substantial amount of attention has been devoted towards the potential sport legacy of the Olympic Games. In spite of the increasing academic interest in this topic, there is a knowledge gap as far as sport legacy is concerned by types of different sports. The authors bridge this gap by analysing the evolution of 43 different Olympic/Paralympic sport modalities in the two-year period after the London 2012 Olympics. By using data from the Active People Survey with a sample of 165,000 people annually, and considering some demographic variables and the effect of the economic environment, the paper aims to test the existence of a sport legacy. We have applied time series analysis and ARIMA models for controlling for economic influence and seasonal adjustment and for making comparisons among participation rates. The results show, for the total of the sports analysed, that there were 336,000 individuals who increased their frequency of participation, while there was no significant increase in the number of new participants in these sports. When we develop the analysis for types of sports, London 2012 is positively associated not only with the frequency of participation in some types of sport but also with an increase in the number of new sport participants. Gender and age differences are also detected. The results show the differences of sport legacy by type of sports. Moreover, this research has elucidated an important unrecognised aspect of the effect of the Olympic Games and perhaps major events: that they can become a major policy tool for reversing sporting inequalities.

What are effective policies for promoting physical activity? A systematic review of reviews

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There is a growing need for evidence on the effectiveness of different policies to promote physical activity.

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We conducted a systematic literature review to collate the available evidence.

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We identified 57 reviews with evidence on 53 types of physical activity policies from 7 areas.

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There is a solid evidence base for the effectiveness of school-based and some infrastructural policies.

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The evidence for other (e.g. economic) policies remains insufficient.

The importance of policy for promoting physical activity (PA) is increasingly recognized by academics, and there is a push by national governments and international institutions for PA policy development and monitoring. However, our knowledge about which policies are actually effective to promote PA remains limited. This article summarizes the currently available evidence by reviewing existing reviews on the subject.

Building on results from a previous scoping review on different types of PA-related evidence, we ran searches for combinations of the terms “physical activity”, “evidence”, “effect”, “review”, and “policy” in six different databases (PubMed, Scopus, SportDiscus, PsycInfo, ERIC, and IBSS). We used EPPI Reviewer 4 to further process the results and conduct an in-depth analysis.

We identified 57 reviews providing evidence on 53 types of policies and seven broader groups of policies. Reviews fell into four main categories: 1) setting- and target group-specific; 2) urban design, environment and transport; 3) economic instruments; and 4) broad-range perspective. Results indicate that there is solid evidence for policy effectiveness in some areas (esp. school-based and infrastructural policies) but that the evidence in other areas is insufficient (esp. for economic policies).

The available evidence provides some guidance for policy-makers regarding which policies can currently be recommended as effective. However, results also highlight some broader epistemological issues deriving from the current research. This includes the conflation of PA policies and PA interventions, the lack of appropriate tools for benchmarking individual policies, and the need to critically revisit research methodologies for collating evidence on policies.

Increased Physical Activity in Preparation for a Women-Only Mass Participation Sport Event: A Framework for Estimating the Health Impact

Mass participation sporting events (MPSEs) are increasing in popularity. However, little research exists into the potential value of these events for improving public health by enhancing physical activity (PA). The aim of this study is to estimate the health impact of increased physical activity as a result of preparing for an MPSE. Participants of a mass participation women-only running event were asked if they performed additional PA in preparation of the event, including the length (weeks) and intensity (min per week). Additionally, self-reported change in health status was evaluated. Based on these results, we have developed a framework for estimating the cumulatively gained quality adjusted life years (QALYs) and monetary value thereof. Of the respondents (N = 468; mean age 42.3 ± 11.9 years), 32% performed additional vigorous PA in preparation of the event, with an average of 63 min per week over 8.8 weeks. Performing additional vigorous PA significantly improved the odds of self-rated health. The estimated total health impact of participants preparing for the Marikenloop was 6.6 QALYs gained with a corresponding monetary value between EUR 133,000 and EUR 532,000. We believe our health impact framework helps to understand that MPSEs can be a notable part of the public health domain.

Can international elite sport success trickle down to mass sport participation? Evidence from Danish team handball

Many scholars do not find evidence of a trickle-down effect from elite sport success to mass sport participation. Contrary to what is assumed by the trickle-down effect "theorem", successful elite sportspeople do not seem to inspire amateurs to take up sport themselves. However, recent studies present evidence that elite sport can have an influence. In this article, we apply regression models on time series data from one of the most successful Danish sports, team handball. Our findings are mixed, but lean towards supporting scholars who argue that trickle-down effects are not necessarily an inherent part of international sporting success. Further studies should examine more sports to identify where trickle-down effects occur and why.

An observational study of spectators' step counts and reasons for attending a professional golf tournament in Scotland

Background

Spectators at several hundred golf tournaments on six continents worldwide may gain health-enhancing physical activity (HEPA) during their time at the event. This study aims to investigate spectators’ reasons for attending and assess spectator physical activity (PA) (measured by step count).

Methods

Spectators at the Paul Lawrie Matchplay event in Scotland (August 2016) were invited to take part in this study. They were asked to complete a brief questionnaire with items to assess (1) demographics, (2) reasons for attendance and (3) baseline PA. In addition, participants were requested to wear a pedometer from time of entry to the venue until exit.

Results

A total of 339 spectators were recruited to the study and out of which 329 (97.2%) returned step-count data. Spectators took a mean of 11 589 steps (SD 4531). ‘Fresh air’ (rated median 9 out of 10) then ‘watching star players’, ‘exercise/physical activity’, ‘time with friends and family’ and ‘atmosphere’ (all median 8 out of 10) were rated the most important reasons for attending.

Conclusion

This study is the first to assess spectator physical activity while watching golf (measured by step count). Obtaining exercise/PA is rated as an important reason for attending a tournament by many golf spectators. Spectating at a golf tournament can provide HEPA. 82.9% of spectators achieved the recommended daily step count while spectating. Further research directly assessing whether spectating may constitute a ‘teachable moment’, for increasing physical activity beyond the tournament itself, is merited.

Is Team Sport the Key to Getting Everybody Active, Every Day? A Systematic Review of Physical Activity Interventions Aimed at Increasing Girls' Participation in Team Sport

Background

It is estimated that 21% of boys and 16% of girls in England meet recommended physical activity guidelines. Team sport has the potential to increase physical activity levels; however, studies show that gender-based factors can influence girls' participation in team sport. Furthermore, evidence for the effectiveness of interventions promoting team sport among girls is limited. This systematic review aimed to assess the impact of physical activity interventions on secondary school-aged girls' (aged 11-18 years) participation in team sport and to identify potential strategies for increasing participation.

Methods

Electronic databases and grey literature were systematically searched for studies of interventions targeting team sport participation among girls in the UK. Results were exported to Refworks, duplicates removed and eligible studies identified. Extracted data included: participant details, such as sample size and age; components of the intervention; outcomes assessed; and each study was quality appraised. Due to heterogeneity across studies, results were presented narratively.

Results

Four studies sourced from the grey literature met the inclusion criteria. Findings suggest that physical activity interventions can encourage girls to try new sports, but evidence is limited in relation to sustained participation. Potential strategies for promoting participation included: consultation with girls, implementation of appropriate peer-leaders and friendship group strategies, early intervention and consideration of intervention setting.

Conclusions

This review highlights the limited availability of evidence on the effectiveness of physical activity interventions for promoting team sport participation among girls in the UK. Findings indicate that future research is needed to improve the methodological quality of complex intervention evaluation. Physical activity interventions may have the potential to encourage girls to try team sport, but their impact on sustained participation, and subsequent physical activity outcomes, is less apparent.

Public health policy and walking in England-analysis of the 2008 'policy window'

BACKGROUND

Although the government in England has a long-standing interest in walking promotion, this has not been accompanied by a coherent strategic plan or investment to support physical activity behaviour change. However, in 2008 the government announced its intention to invest £7 million into walking promotion. This article utilises Kingdon's Multiple Streams framework as an organising principle through which to interrogate the reasons behind the increased emphasis on walking promotion as part of the public health policy agenda in England.

METHODS

The research adopted a case study design. Data were obtained through document analysis of relevant policies and semi-structured interviews with experts in the walking sector, including both government and non-government representatives.

RESULTS

Kingdon's Multiple Streams theory proposes that at certain points in time, 'policy windows' are created through the convergence of a problem, an appropriate solution, and a receptive political environment, and this policy window presents an opportunity for major policy change. The findings of this research suggest that the success of London in securing the 2012 Olympic and Paralympic Games was the primary trigger in the creation of a policy window for walking promotion in recent years.

CONCLUSIONS

Despite previous interest in walking promotion from the health and transport sectors, it was the recent alignment with the sports agenda that led to increased political commitment. This raises concerns that the research evidence on the health benefits of physical activity and rising levels of inactivity in England, are insufficient to secure government support and investment, and that multi-sector lobbying and joined-up political action may be critical in advancing this agenda.

The impact of the Vancouver Winter Olympics on population level physical activity and sport participation among Canadian children and adolescents: population based study

Background

There has been much debate about the potential impact of the Olympics. The purpose of this study was to determine if hosting the 2010 Vancouver Olympic Games (OG) encouraged Canadian children to be physically active.

Methods

Children 5–19 years (n = 19862) were assessed as part of the representative Canadian Physical Activity Levels Among Youth surveillance study between August 2007 and July 2011. Parents were asked if the child participated in organized physical activity or sport. In addition, children wore pedometers for 7 days to objectively provide an estimate of overall physical activity. Mean steps/day and percent participating in organized physical activity or sport were calculated by time period within year for Canada and British Columbia. The odds of participation by time period were estimated by logistic regression, controlling for age and sex.

Results

Mean steps were lower during the Olympic period compared with Pre- (607 fewer steps/day 95% CI 263–950 steps/day) and Post-Olympic (1246 fewer steps 95% CI 858–1634 steps) periods for Canada. There was no difference by time period in British Columbia. A similar pattern in mean steps by time period was observed across years, but there were no significant differences in activity within each of these periods between years. The likelihood of participating in organized physical activity or sport by time period within or across years did not differ from baseline (August-November 2007).

Conclusion

The 2010 Olympic Games had no measurable impact on objectively measured physical activity or the prevalence of overall sports participation among Canadian children. Much greater cross-Government and long-term efforts are needed to create the conditions for an Olympic legacy effect on physical activity.

Euro 2012 European Football Championship Finals: planning for a health legacy

The revised international health regulations offer a framework that can be used by host countries to organise public health activities for mass gatherings. From June 8, to July 1, 2012, Poland and Ukraine jointly hosted the Union of European Football Associations European Football Championship Finals (Euro 2012). More than 8 million people from around the world congregated to watch the games. Host countries and international public health agencies planned extensively to assess and build capacity in the host countries and to develop effective strategies for dissemination of public health messages. The effectiveness of public health services was maximised through rapid sharing of information between parties, early use of networks of experienced individuals, and the momentum of existing national health programmes. Organisers of future mass gatherings for sporting events should share best practice and their experiences through the WHO International Observer Program. Research about behaviour of large crowds is needed for crowd management and the evidence base translated into practice. A framework to measure and evaluate the legacy of Euro 2012 is needed based on the experiences and the medium-term and long-term benefits of the tournament.

Healthcare planning for the Olympics in London: a qualitative evaluation

BACKGROUND

Mass gatherings, such as the Olympic and Paralympic Games, represent an enormous logistical challenge for the host city. Health service planners must deliver routine and emergency services and, in recent Games, health legacy initiatives, for the local and visiting population. However there is little evidence to support their planning decisions. We therefore evaluated the strategic health planning programme for the London 2012 Olympic and Paralympic Games to identify generalisable information for future Games.

METHODS

We thematically analysed data from stakeholder interviews and documents. The data were prospectively collected in three phases, before, during and after the Games.

FINDINGS

We identified five key themes: (1) Systemic Improvement for example in communications, (2) Effective relationships led to efficiencies and permanent gains, such as new relationships with the private sector (3) Difficult relationships led to inefficiencies, for instance, duplication in testing and exercising emergency scenarios, (4) Tendency to over-estimate demand for care, particularly emergency medicine, and (5) Difficulties establishing a health legacy due to its deprioritisation and lack of vision by the programme team.

INTERPRETATION

Enduring improvements which are sustained after the Games are possible, such as the establishment of new and productive partnerships. Relationships must be established early on to avoid duplication, delay and unnecessary expense. There should be greater critical evaluation of the likely demand for health services to reduce the wasting of resources. Finally, if a health legacy is planned, then clear definitions and commitment to its measurement is essential.

Watching sport on television, physical activity, and risk of obesity in older adults

Background

Television (TV) viewing has been associated with obesity although the effects of specific TV content on health and other behaviours remains unknown. We examined the association between watching sport on TV, physical activity levels, and risk of obesity.

Methods

We studied 6,733 (aged 64.9 ± 9.2 yrs) men and women from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Data were collected on self reported TV time and content, and physical activity. Nurses measured height and weight for the calculation of body mass index.

Results

On average, participants reported viewing TV for 5.3 ± 4.1 hours per day and 30.3% of the sample watched sport on TV at least twice a week. There was no association between watching sport and physical activity levels. Participants that watched sports every day were at higher risk of obesity [odds ratio = 1.39, 95% CI, 1.15, 1.68) after adjustment for age, sex, smoking, alcohol, physical activity, total TV time, disability, and self-rated health.

Conclusions

Watching elite athletes may have no role in the promotion of physical activity in older adults, which has implications for staging large sporting events with physical activity legacy promises.

Social marketing and breastfeeding: a literature review

Aims:

Through the review of relevant literature this study illuminates the concepts of social marketing and breastfeeding. It specifically discusses the positioning of the link between social marketing and breastfeeding within different fields of study and develops a theoretical framework that tries to bridge the gap between those disciplines.

Method:

Various electronic databases were used and through systematic selection 11 scientific articles were identified that this literature review is based on.

Results:

The review indicates that the relationship between social marketing and breastfeeding is complex. There are indications that this relationship is being investigated within three distinct fields of research: psychology/education, public health and marketing. Depending on the research field the emphasis is put on either breastfeeding or social marketing as well as on the other concepts that were discovered to be of importance within this relationship. Namely, group and individual demography as well as behaviour were revealed to be important elements of the link between social marketing and breastfeeding.

Conclusions:

Based on the results this study concludes that a more multidimensional view on the relationship between the concepts under study is needed since the focus of previous studies is very one-sided and limited to just one element when all elements should be integrated equally.

Can the London 2012 Olympics 'inspire a generation' to do more physical or sporting activities? An overview of systematic reviews

OBJECTIVE

To examine if there is an increased participation in physical or sporting activities following an Olympic or Paralympic games.

DESIGN

Overview of systematic reviews.

METHODS

We searched the Medline, Embase, Cochrane, DARE, SportDISCUS and Web of Knowledge databases. In addition, we searched for 'grey literature' in Google, Google scholar and on the International Olympic Committee websites. We restricted our search to those reviews published in English. We used the AMSTAR tool to assess the methodological quality of those systematic reviews included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was evidence for an increased participation in physical or sporting activities. Secondary outcomes included public perceptions of sport during and after an Olympic games, barriers to increased sports participation and any other non-sporting health benefits.

RESULTS

Our systematic search revealed 844 citations, of which only two matched our inclusion criteria. The quality of these two reviews was assessed by three independent reviewers as 'good' using the AMSTAR tool for quality appraisal. Both reviews reported little evidence of an increased uptake of sporting activity following an Olympic Games event. Other effects on health, for example, changes in hospital admissions, suicide rates and drug use, were cited although there was insufficient evidence to see an overall effect.

CONCLUSION

There is a paucity of evidence to support the notion that hosting an Olympic games leads to an increased participation in physical or sporting activities for host countries. We also found little evidence to suggest other health benefits. We conclude that the true success of these and future games should be evaluated by high-quality, evidence-based studies that have been commissioned before, during and following the completion of the event. Only then can the true success and legacy of the games be established.

How might the London 2012 Olympics influence health and the determinants of health? Local newspaper analysis of pre-Games pathways and impacts

OBJECTIVES

To conduct a content analysis of pre-Games local media coverage of the potential impact on health and the determinants of health in Newham, the site of the Olympic Park.

DESIGN

Local newspaper content analysis.

SETTING

Olympic park host site of the London Borough of Newham.

OUTCOME MEASURES

Media coverage of employment, physical activity and well-being.

RESULTS

Three hundred and 51 articles meeting the inclusion criteria were included in the analysis. The overwhelming majority of the articles took a positive perspective on the Olympic Games being hosted in Newham with less than 10% (32/351) addressing potential adverse effects. The frequency of articles reporting on both employment and well-being increased significantly over time (p=0.002 and p=0.006, respectively). A non-significant increasing trend was observed for physical activity (p=0.146). New employment opportunities and the promotion of physical activity in young people were the pathways most frequently reported in the local media. However, much less attention is devoted to understanding the uncertainties about how much of these new opportunities will directly improve the determinants of health in the Newham population.

CONCLUSIONS

Pre-Games reporting on the impact on health and the determinants of health increased over time in the London Borough of Newham, and is overwhelmingly positive. However, specific uncertainties around the true nature of its impact on local employment and physical activity were articulated. Further evaluation of the tangible impacts on population health, and the determinants of health and health inequalities from the London 2012 Olympics, is required.

2012 Olympics: A catalyst for behaviour change?

Aiming to make the most of the Olympic legacy, Sarah Prest and Rachel Partridge, from NHS Dorset, explain how one county is encouraging lifestyle change