Making the case for 'physical activity security': the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective.

With relatively few exceptions, the majority of evidence concerning the health benefits of physical activity (PA) has been gleaned from high-income countries (HICs).1 In the opening editorial to this special issue,2 the editors suggest that under-representation of lower and middle-income countries (LMICs, often referred to as ‘Global South’) in the PA literature is more than ‘just another research gap’. Arguably, this gap reflects very real differences in context, competing health and developmental priorities, available resources and undoubtedly, political will. Juxtaposed against the clear benefits of PA, most LMICs are characterised by the coexistence of both non-communicable and infectious chronic diseases, such as tuberculosis and HIV/AIDS.3 Obesity often coexists with maternal and childhood undernutrition and household food insecurity and health disparities have been exacerabated by the COVID-19 crisis. Political circumstances are often adverse, with many LMICs experiencing conflict, humanitarian crises, and/or social unrest and embedded inequalities (eg, the legacy of apartheid in South Africa). Lack of safety from crime and traffic, poorly designed and often overcrowded urban environments, low prioritisation of physical education in schools, and inequitable distribution of green space, are endemic to most LMICs.4 5 Thus, PA, even for transport, is difficult at best, and largely undertaken by necessity rather than by choice. Meanwhile, recreational PA is inaccessible for most in these settings.6 As such, and with rapid urbanisation in LMICs, often into poverty,7 we are required to view PA through the ‘lens’ of equity. This demands us to elevate the discussion for PA above health, and frame it as a …