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The city of Pelotas in southern Brazil could be doing better in providing opportunities for its inhabitants to take part in physical activity, according to Pedro Hallal, Associate Professor in Public Health at the Federal University of Pelotas, and the leading figure behind The Lancet's second Series on physical activity and health. “The city has made some improvements over the past few years, but like many urban settings around the world, promotion of physical activity is skewed to a minority of people who can afford it. We are continuing to fail in providing opportunities of physical activity and better health to those who need it the most, in the poorest parts of our cities”, he says.
Hallal has always felt connected to health, influenced by his physician father and his mother, a social worker. As a young boy, he recalls spending most of his early life playing sport, notably futsal (a Latin American version of five-a-side football), and tennis. An undergraduate degree in physical education at the Federal University of Pelotas led to a masters in epidemiology, where he met Cesar Victora, a huge influence in shaping Hallal's career over the past 15 years. “Getting to know Cesar has been a major aspect of my life”, Hallal says. “Rather like Isaac Newton's famous quote about standing on the shoulders of giants, it was Cesar who made me realise how, through research, we can change people's lives”, he says.
Another key influence in Hallal's career has been Jonathan Wells from London's Institute of Child Health, whom Hallal met while studying for his masters in Pelotas. In late 2009, Hallal moved to London to work on his postdoctoral thesis alongside Wells, primarily on research to investigate the effect of birth order and bodyweight on later development. Hallal has happy memories of this time: “I felt so free during my time in the UK. With no teaching commitments, I had time to think, where I was able to conceptualise the 2012 Lancet physical activity Series”, he says. In 2011, Hallal won a Wellcome Trust Young Investigator Award. “This award bought me more freedom”, he explains. “It has resulted in the two long-term projects that I spend most of my time on today: the 2015 Pelotas birth cohort study, and my advocacy/policy work on the Global Observatory for Physical Activity”, he says.
The overall aim of the Pelotas cohort is to investigate the long-term effects of early life exposures on health throughout the lifespan: describing levels of physical activity of children, fathers, and mothers at all stages of life, exploring the correlates of physical activity and addressing the long-term health effects of physical inactivity. Hallal helped establish the Global Observatory for Physical Activity in 2012, at the launch of the first Series on physical activity. This global advocacy forum serves to influence countrywide public health policy towards increased physical activity as a route to reducing non-communicable diseases. How does he rate the progress of the observatory 4 years after its inception? “I am pretty happy with it. We were able to prepare country cards for 150 countries in the first phase of our advocacy work. We now have representatives from all regions of the world advocating for physical activity promotion in their own countries and regions. We aim to include all countries around the world in the second phase of our advocacy, to launch in 2018”, Hallal says.
Cesar Victora, Emeritus Professor of Epidemiology at the Federal University of Pelotas, comments: “Pedro came to me in his early 20s, when he was looking for a supervisor for an MSc in epidemiology. He rapidly evolved to become a scientist/advocate who combines methodological rigour, dedication to public health, and an incredible ability to convene and motivate large groups of colleagues and students around a common cause. Coming out of a small university in a remote area of Brazil, in less than 10 years he emerged as a global leader in the physical activity movement. Control actions directed against the massive epidemic of obesity in Latin America and in other middle-income regions will greatly benefit from the work Pedro and colleagues are currently publishing in The Lancet.”
Hallal is only too aware of the difficulties ahead in realising the full potential of his field through the advocacy work of the observatory. “We have some tough challenges ahead”, Hallal says. “When governments talk about health, their priority is nearly always on financing disease treatment and in health systems infrastructure, which are, of course, essential. But we need to fund health, not just disease treatment if we are going to reap the true potential of physical activity as a key part of future health promotion”, he says. And what about Hallal's personal commitment to physical activity? “I need to do more”, he confesses. “But my attitude to physical activity mirrors the approach we need to take at a population level. Force me to go to a gym and I won't be interested. If physical activity is treated like a pill, trying to enforce 30 minutes exercise a day, it will not work. We have to try and create societies where physical activity becomes part of everyday life. Team sport needs to be prioritised, which should not be about winning at all costs, but rather about active participation, and enjoyment. If we cannot enjoy physical activity, we will not succeed in using it as a key component of promoting better health worldwide.”