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Birmingham’s blueprint for behaviour change

Eighty per cent of Birmingham’s 1.1 million residents are inactive. Head of Wellbeing at Birmingham City Council Karen Creavin discusses the initiatives that are helping to break down the multiple barriers to physical activity in England’s second city.

Such is the size of Birmingham and the scale of its inactivity crisis, that the task of turning the tide of sedentary behaviour in the city has been compared to turning an oil tanker.

It remains a colossal challenge facing Karen Creavin as Head of Wellbeing at Birmingham City Council.

But the rewards are colossal too, and her team has made significant strides in overcoming deeply-ingrained issues that have been having a detrimental effect on the behaviour habits of residents.

There are a multitude of complicating factors associated with achieving sustained behaviour change, but the two biggest in Birmingham are ethnicity and economic deprivation.

‘The poorer you are the more likely you are to be sedentary,’ says Karen.

And with 408,000 Birmingham citizens living in the top 10% most deprived households in England – that’s 40% of the city – it presents a huge barrier to people getting active.

Karen adds: ‘Poverty is a significant factor in the landscape I am dealing with and impacts on life expectancy, quality of life, likelihood of achieving good work and education and, therefore, people’s ability to participate to society.’

The correlation between ethnicity and inactivity is just as stark.

Not all Black and Minority Ethnic (BME) people in Birmingham are poor and inactive but, statistically, you are much more likely to be inactive and live a shorter life, with poorer health, if you are of non-white descent.

The troubling truth is that there is a nine-year difference in life expectancy between those living in the poorest areas of the city as against those in the most affluent areas.

‘My job is to tackle those inequalities, and we do that through sport and physical activity,’ says Karen, who detailed some of the schemes run by Birmingham Wellbeing Service in her keynote presentation at this year’s UK Coaching Summit in Northern Ireland.

Mobilising the masses

Behaviour change graphic
The graphic highlights the health cost of Birmingham’s inactivity epidemic in terms of life expectancy

The range of initiatives Karen and her team have undertaken have helped to remove some of the obstacles blocking the path to behaviour change.

This has impacted positively on the physical and mental health of traditionally hard to reach sections of the community, showcasing what can be achieved through innovation and ingenuity, inspiration and motivation, and no shortage of hard work.

Nationally acclaimed projects Karen has overseen include:

  • B Active: A scheme offering free leisure centre activities, including gym usage, fitness classes and swimming sessions.
  • Active Parks: Encouraging residents to get outside and exercise in some of the city’s 594 public parks and 10,000 acres of green space – with the Wellbeing Service putting on activities such as cycling, tai chi and start-up running groups with friends and family.
  • Active Streets: Closing streets to traffic for play and physical activities coordinated by local residents. The idea is that neighbours get to know each other socially while their children interact physically, with a range of multi-sport and family fun activities provided. A hundred roads have participated so far in the pilot scheme. ‘There is one residents’ group, for example, who close their street every Thursday night to play badminton,’ says Karen.
  • Big Birmingham Bikes: The Council bought and gave away 3,500 free bikes to some of the poorest residents of the city. They were fitted with GPS trackers to monitor mileage, with the condition that, to keep the bike, you had to ride it at least once a week for the first six months. The real-time data provided by the trackers generated a heat map, which has been invaluable to the transport department in informing their strategy on best location of cycle paths on routes in and out of the city.

In one year, these projects involved a million residents and encouraged the formation of more socially cohesive, connected communities as well as massively increasing participation in physical activity.

The key metrics collected have been used to secure fresh funding for future projects from partners and collaborators.

‘I can show we are keeping the community healthy and happy, which is saving social care money,’ says Karen. ‘That’s why we do so much analysis, as it helps me articulate that message [to potential funding partners].’

Stealth tactics

The crux of successful intervention projects, says Karen, is to refrain from using the word ‘physical’ in conversations with community members, and stress the word ‘social’ instead.
‘The mention of the words physical activity is off-putting to some people,’ she explains.

‘But if we ask people to come and meet their neighbours on a street corner and get them walking round their local park three or four times, that works. It is physical activity by stealth.’
Placing a greater emphasis on the social element of exercise is one simple behaviour change tactic.

But a more elaborate plan was needed to tackle the issue of cost among deprived Birmingham residents.

‘We’ve got classes going on in parks in the inner city where I have seen young single mums living in a tower block doing star jumps in flip flops and with one hand over their boobs because they haven’t got a sports bra,’ she says.

‘They want to come, we make it free so they can some, but they can’t afford the appropriate kit.’

Other major stumbling blocks that can perpetuate unhealthy habits include:

Geographical distance to venues: ‘If the venue is on the other side of the city, that could be two different buses and then a pram push across a bridge for another few hundred metres. Chances are you won’t go.’

Lack of body confidence: ‘Not seeing people like you reflected back in the class can be demoralising.’

Shortage of venues: ‘Or not using venues in the right way. You see a lot of signs in parks like “Keep off the grass” and “No ball games” but how often do you see a sign stating, “Please kick a football around with your mates”.’

A bird’s-eye view

The process of how, and who, to engage is key to achieving behaviour change in inactive communities, with Karen advising: ‘Word of mouth from a trusted source is the number one way of influencing people to get active.’

• Step 1: Identify priority communities and establish who is already working with those residents.

• Step 2: Forge a relationship with them by sharing intelligence and agreeing outcomes.

• Step 3: Collaborate to identify the barriers for communities.
• Step 4: Remove or mitigate the barriers.

The four-step process is crucial in building a sustainable model of behaviour change.

Karen uses the analogy of a flock of geese in explaining the importance of having the right community volunteers on board to advertise the message, buy into the philosophy and recruit new participants. If someone gets tired, it means there is always someone else waiting in the wings to take over the pilot role (a cycling peloton is the sporting equivalent).

‘So yes, we will initiate a scheme and set the formation off, but we will quickly drop back because it’s not about us.’

A marathon not a sprint

One adult intervention project Karen has overseen – with the aim of getting 15,000 complete beginners running, and inspiring 100,000 people who are not currently running to spring into action – illustrates how to find solutions to common problems.

The annual Birmingham half marathon and marathon snakes through some of the most deprived areas of the city but only a tiny proportion of the runners are from those neighbourhoods.

Hardly surprising, as it costs £55 to run the Birmingham International Marathon and £35 to enter the Great Birmingham Run half marathon.

After contacting The Great Run company, they agreed to give Karen 20 free places for the half marathon.

‘We chose people who had never run before, as my job isn’t to get active people more active, it’s getting the inactive active.

‘I’ve never seen so many fluffy anoraks, handbags and headscarves. But what’s wrong with that if that’s what is needed to get them to turn up?’

One lady ran her first half marathon carrying the same handbag she brought with her to every training session. And this, for Karen, is a really important lesson in effective behaviour change.

Participants must feel comfortable in their alien environment. It is a case of whatever works for you to make you want to keep coming back. If that means running with a handbag over your shoulder, then so be it.

A turn for the better

The gamut of social inclusion projects aimed at nudging inactive residents into forming healthier habits is a major diversification from the Council’s traditional mandate of providing sport for the sporty – and more opportunities for those already playing sport.
For modern-day coaches and health and wellbeing practitioners (in their many guises) ‘coaching’ is not about the transfer of sporting skills.

Karen’s experiences will hopefully give other local authorities and coaching providers some valuable ideas and techniques to inform and inspire future strategies for their sport or community that will have significant health benefits to participants and residents alike.
What began as slow progress has, through the team-work and unstinting efforts of those in the Birmingham community and Council’s Wellbeing Services team, kick-started a sea change in people’s behaviour habits, leaving an exhilarating sense of accomplishment in its wake.

The tanker is well and truly turning.

Organisations: Find out more about how to organise the UK Coaching ‘Behaviour Change Tactics’ workshop.

Coaches: To find a ‘Behaviour Change Tactics’ workshop running near you, visit the UK Coaching Workshop Finder.

Coachwise are experts in enabling sports and physical activity programmes. We relish evolving operations that facilitate growth in participation and ensure community role models feel supported. Find out more about how we can help you.