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Figure 2: PA-EPI Good Practice Indicators Policy Domains (n=21)

Education (Schools)

There are public policies implemented that aim to impact on healthy physical activity environments and promote and support physical activity within the school setting.

1. E01
   Evidence informed, quality, mandatory physical education that promotes and supports the ideals of equity, diversity and inclusion and adheres to defined standards is part of the curricula in all schools.
2. E02
   National and/or subnational initiatives are in place to promote and support school-related physical activity both at school and in other settings. These initiatives should employ an inter-sectoral approach and collaborative multi-agency partnerships (e.g., links with out-of-school sports clubs, active breaks/recess, walking clubs).
3. E03
   There are shared-use agreements that utilise school spaces. Community access is supported by initiatives to promote and support opportunities for physical activity for all persons outside of normal school hours.
4. E04
   National and/or sub-national policies are in place to promote and support safe active travel to and from school.

Transport

There are public policies to promote and support active mobility for people of all ages and abilities.

5. T01
   Regulations are in place that provide a variety of infrastructures to support safe walking and/or cycling and/or wheeling, including measures to calm speed, reduce vehicle traffic and enhance active mobility.
6. T02
   There is a funded implementation plan, led by the appropriate level/s of government, to achieve improvements in active travel and increased use of public transport.
7. T03
   Guidelines and tools to support infrastructure for active mobility and/or transport plans and systems that encourage physical activity are promoted and disseminated.

Urban Design

There are public policies enacted at appropriate level(s) of government to ensure that evidence-informed urban design principles are implemented to promote and support physical activity and active mobility for people of all ages and abilities.

8. UD01
   Policies or regulations that take a “health in all” approach are adopted to reallocate space from motorised transport to active travel and/or recreation purposes.
9. UD02
   Governments adopt land use policies and planning processes, consistent with principles of mixed land use, compact urban design, and/or provision of green open spaces to support physical activity and reduce motorised transport.
10. UD03
    There are guidelines and/or regulations that improve universal and equitable access to safe outdoor and indoor spaces and facilities where people can be physically active.

Healthcare

Public policies are implemented within healthcare settings to promote and support physical activity, e.g., by providing guidelines and regulations, applying digital health technologies, and targeting at-risk groups like older adults.

11. H01
    Guidelines and regulations in healthcare include routine screening for physical activity and, for all insufficiently active patients’ brief advice, and referral to appropriately trained practitioners and/or physical activity opportunities.
12. H03
    There are consistent policies for promoting and supporting physical activity in primary and secondary healthcare settings among at-risk groups, such as people with type 2 diabetes and older adults (e.g., protocols for the assessment of the physical activity capacity; accessible, affordable, and tailored physical activity programmes; and training for caregivers for delivering physical activity programmes within residential aged care).

Mass Media / Public Education

There are national and/or subnational public policies implemented to ensure enactment of media/education campaigns that actively promote and support increasing physical activity levels for all ages and abilities.

13. MM01
    There are national and/or subnational public policies in place that ensure media and education campaigns that promote, and support physical activity are sustained and monitored (e.g., by making them part of, or aligning them with, a national action plan on physical activity and the physical activity guidelines).
14. MM02
    There are clear, consistent policies to ensure that multiple media modes/channels (e.g., via posters, social media, radio as well as TV) combined with complementary community initiatives are used to promote the benefits of physical activity and disseminate guidelines which align with the WHO physical activity recommendations.

Community

There are policies and programmes that promote and support physical activity for all ages and abilities, consistent with relevant recommendations, e.g. by supporting the implementation of whole-of-community events and approaches and promoting the shared-use of public spaces and facilities.

15. C02
    Public policies are in place to support the implementation of whole-of-community approaches to promote physical activity and networking to strengthen resources and exchange experiences (e.g., WHO Healthy Cities, Active Cities, Partnerships for Healthy Cities).
16. C03
    There are public policies in place to foster partnerships for shared-use of public spaces and facilities for community-based and community-led physical activity programmes.

Sport

There are evidence-informed public policies implemented to promote and support sport and recreation for all.

17. SP01
    There are national and/or subnational evidence informed 'Sport and Recreation for All' policies that prioritise investment in initiatives that target the least active, as well as disadvantaged groups.
18. SP02
    There are national and/or subnational evidence informed policies or action plans in place that ensure equitable access to sport and recreation spaces and places for all.
19. SP03
    There is government support for programs designed to encourage sports clubs to promote health-enhancing physical activity and other health behaviours (e.g., 'sports clubs for health' and 'health promoting sport clubs').

Workplace

There are national and/or sub-national policies implemented related to the workplace that promote and support increasing physical activity (e.g., cycle to work initiatives, physically active workplaces) and promote a culture of health for all employees.

20. W01
    There are national and/or sub-national policy initiatives and infrastructure development programmes in place to promote and support safe active travel to and from the workplace.
21. W02
    There are concepts and regulations for buildings, plots and the environment in place that promote and support employers to create physically active workplace environments through building design and provision of adequate facilities (both indoor and outdoor).

Figure 3: PA-EPI Good Practice Indicators Infrastructure Support Domains (n=24)

Leadership

The political leadership ensures that there is strong support for the vision, planning, communication, implementation, and evaluation of policies to create health-promoting policy environments to improve population physical activity and reduce related inequalities.

1. L01
   There is strong, visible, political support (at the head of state/cabinet level) for creating health-promoting policy environments to improve population levels of physical activity and reduce inactivity related non-communicable diseases and their related inequalities. Political responsibility for health-related physical activity is clearly allocated within the governmental structures.
2. L02
   There is a comprehensive up-to-date plan (including timeline, targets, funding, priority policy and programme strategies) linked to national needs and priorities to increase population physical activity.
3. L03
   Priorities are given to reduce inequalities in relation to inactivity related non-communicable diseases in the comprehensive plan (above).
4. L04
   There are clearly defined, evidenced informed population physical activity guidelines for all age groups and for people living with non-communicable diseases, pregnant women, and people with disabilities.

Governance

There are government structures in place to ensure transparency, accountability and encourage broad community participation when developing and implementing policies and actions to create healthy physical activity environments and improve population physical activity.

5. G01
   There are reliable procedures to restrict commercial influences related to physical activity environments where there are conflicts of interest with improving population physical activity levels (e.g., restricting lobbying influences that limit physical activity opportunities).
6. G02
   There are procedures in place for using evidence in the development of physical activity policies.
7. G03
   The government ensures access to, and regular dissemination of, physical activity guidelines and key documents to the public.
8. G04
   The government fosters the cooperation and coordination of all sectors to align with strategic plans to improve the physical activity environment, and where appropriate, promotes civil society participation to develop and implement these plans.

Monitoring and Intelligence

There is regular monitoring of population physical activity levels and physical activity environments, systematically linked to the regular monitoring of physical inactivity related non-communicable diseases. Ideally, monitoring should be consistent over time, integrated and occur annually, with more extensive surveys at least every five years (e.g., to allow data analysis across all jurisdictions, priority groups). Additionally, policies and major programmes should be evaluated regularly.

9. MI01
   There is regular monitoring of physical activity levels across the life-course based on representative samples, against guidelines/standards/targets.
10. MI02
    There is regular monitoring of physical activity environments across all 8 policy domains (e.g., walkability, built environment).
11. MI03
    Physical activity monitoring is systematically linked to the regular monitoring of non-communicable diseases and their related inequalities.
12. MI04
    There are regular research and evaluation of policies and major programmes to assess their effectiveness, process, and impact on achieving the goals of the physical activity and health plans.
13. MI05
    Progress towards reducing health inequalities related to social and economic determinants of physical activity is regularly monitored.

Funding and Resources

Government funding to support physical activity promotion and research is clearly identified, monitored and sufficient. It is aimed at improving population physical activity levels, creating active environments, counteracting non-communicable diseases and reducing inequalities.

14. FR01
    The budget spend on physical activity promotion across all policy domains is clearly identified and periodically monitored.
15. FR02
    There is a sufficient proportion of total health spending assigned to population physical activity promotion.
16. FR03
    A sufficient proportion of total research spending is assigned to population physical activity promotion.
17. FR04
    A secure funding stream is available for at least one statutory health promotion agency with an objective to improve population physical activity.

Platforms for Interaction

There are coordination platforms and opportunities for synergies across government departments, levels of government and other sectors (e.g., non-governmental organisations, private sector, academia) such that policies and actions in physical activity are coherent, efficient, and effective in improving environments, population physical activity, reducing inactivity related non-communicable diseases and their related inequities.

18. PI01
    There are robust coordination mechanisms across departments and levels of government to ensure policy coherence, alignment and integration of physical activity, and inactivity related non-communicable disease prevention policies across governments.
19. PI03
    There are structures and mechanisms for regular, meaningful, and inclusive interactions between government and civil society (academia, professional organizations, public-interest, non-governmental organisations, and citizens) on physical activity policies and other strategies to improve population physical activity and health.

Workforce Development

Governments have set up systems that provide a platform for population physical activity expertise to ensure that the formulation, implementation and evaluation of physical activity policies and programmes meet population needs.

20. WD01
    To address the challenge of population physical inactivity, there are sufficient resources and people with necessary skills within the government’s workforce (across all 8 policy domains).
21. WD02
    Opportunities for training and professional development are provided to relevant individuals across multiple sectors (e.g., the 8 ‘Policy’ domains) regarding the fundamentals of physical activity, its role in public health and effective strategies for physical activity promotion.
22. WD03
    Support and training systems are in place for relevant professionals (e.g., guidelines, toolkits, training workshops/modules/courses). To ensure uptake, accrediting agencies for professional education, and professional licensing entities should include minimum requirements for initial and continuing education in this domain.

Health-in-All Policies

There are processes in place to ensure policy coherence and alignment, and that population health impacts are explicitly considered in the development of all relevant government policies.

23. HIAP01
    There are processes in place to ensure that population physical activity and related health outcomes are explicitly and transparently considered and prioritised in the development of all government policies.
24. HIAP02
    There are processes (e.g., health impact assessments) to assess and consider health impacts during the development of policies indirectly related to physical activity.