Practical steps needed to achieve impact of the WHO 2019 movement behaviour guidelines for children under the age of 5: the SUNRISE study Europe group evaluation

The World Health Organisation (WHO) guidelines for the ‘24-h movement behaviours’  (physical activity (PA), sedentary behaviour (SB) including screen time, and sleep) in the under-5s were published in April 2019.

The guidelines were developed as a response to the childhood obesity pandemic, to help ensure that under-5s have healthy levels of PA, screen time, and sleep. Evidence review and synthesis showed that these behaviours influenced a wide range of other outcomes, with substantial short-term and long-term consequences (e.g., cognitive, social and emotional development; language development; cardiometabolic health; bone and skeletal health; motor development; physical fitness; growth; and wellbeing).

Five years later, it is now appropriate to test whether key actions in response to these guidelines were taken across Europe, and to consider ways of increasing the impact of the WHO Guidelines across Europe in the next 5 years.

Therefore, the SUNRISE Study Europe Group considered three tests to examine if European public health policy and clinical practice were sufficiently responsive to the WHO Guidelines:

1. Do European nations have national guidelines for the movement behaviours in the under-5s or have they adopted/adapted the WHO Guidelines?
2. Do they have adequate surveillance of the movement behaviours in these age groups?
3. Do they have specific movement behaviour policies for children under-5?

European countries have largely failed to create national guidelines or adopt/adapt the WHO guidelines (Test 1), to organise surveillance of the movement behaviours (Test 2) and create national health policy for all movement behaviours for the under-5s (Test 3) (Box 1).

This means that the opportunity for public health gain following the release of the WHO guidelines has not yet been realised. The failure of tests 1-3 is also a concern because of recent evidence from research studies on meeting the guidelines. A recent pooled analysis (manuscript in preparation) found that ±75% of European preschoolers did not meet the combined guidelines prior to the COVID-19 pandemic.

COVID-19 mitigation measures generally reduced PA and increased screen time. The prevalence of not meeting the guidelines is likely to be even higher in some population sub-groups such as those with chronic disease and/or disability.

Lack of surveillance of the movement behaviours means that this high prevalence of not meeting the guidelines is, in effect, invisible. Lack of visibility leads to policy inaction.

There are marked health inequalities in the outcomes of movement behaviours by early childhood (e.g., obesity), and interventions to reduce health inequalities are generally more (cost-)effective when implemented early in life.