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Creating a less obesogenic environment:levers and drivers for action at a local level
Prof Jim McManusDirector of Public [email protected]
Childhood Obesity Summit3rd November 2016
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Content• What can be done at a local level to create a less obesogenic
environment? • What steps need to be taken to increase physical activity of children? • What progress is being achieved and what more needs to be done? • What are the levers and drivers available to local authorities? • How can local government contribute to ameliorating the obesogenic
environment and what are the best practice examples of doing so? • What local action is being taken already? • What does success look like? • And, importantly, what additional powers are needed by local
government to achieve more?
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Some Key Points
• Environment does influence our behaviour• Environment (work, school, public realm,
immediate setting we are in) must form part of a balanced strategy on obesity
• We must do better at articulating what this means and what can be done
• Too much boffinry, not enough articulation of what can be done and may make a difference
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Place impacts on behaviour
• Much of our behaviour is pre-cognitive, so overuse of cognitive models will not work here
• Our food journey (what we see as we go through the day) influences out behaviour. Businesses know this (that’s why they advertise).
• What can we do?
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The aspects of a whole system approach• Place• Food choices• Culture of weight balance• Multiple influences for healthy weight• Support for people to get it right• Lifelong education for lifelong choices• This means we need to work together on a multitude
of issues – there is no ONE answer
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Channel 4 Dispatches...again
That doesn’t let the current national plan off the hook, though, and doesn’t stop us trying
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Our Ambitions (yes, we think long term)
• Reducing overweight and obesity and associated costs to people and economy
• Helping families and adults manage their weight for life, not short term
• Building a whole system approach• Creating a culture of physical activity by default,
for its own sake• Creating a culture of energy balance
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History and Funding• 2012 – PCT total Child Obesity budget £20,000 (yes £20k) (not
including NCMP); 2013 healthy weight into Health and Wellbeing Strategy
• 2015• Child Healthy Weight – £499k (Excluding NCMP)• Beat the Streets £100k• School Nurses £4.02m• PH funding to School Catering £100k• Full time nutritionist in School Catering £60k• Cycling Training and Support in Schools £60k• Daily Mile
• Planning and Environment workstreams• Major physical activity programmes• Disabled Access to physical Activity £250k• 127 projects across 10 district councils £1m funding• Two district councils with major focus on Child Obesity • Share of £1m District Council Partnership Funding
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Some of our schemes• Whole school healthy eating• BeeZee Bodies (aged 5-15)
• Workplace Health
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Adult weight management schemes • 13,000 residents referred to the
programme so far: • 62% completion• Shape Up” with Watford FC
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And now• Reduction in Funding by 16% real terms across LAs• Reduction in School grants• Fragmented system• Local Authority Financial Cliff• NHS only interested in prevention when it wants to be• Despite strong evidence on pupil health and pupil
attainment no duty on schools• ....where do we go from here?
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How do we do anything meaningful now?
• To move beyond commissioning• Systems approaches
– public health from societal to individual– Not just kids
• To look at the mainstreaming ethos• To build action across a range of players• To look at the Council’s role in preventing ill health and need for
public services generally• Corporate prevention programme – the leader’s personal challenge
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A precedent?• An example of systems
thinking?• Systemic approach to
crime and disorder• £326m put into vehicle
crime at 2001 prices• £7m into violence
against women at 2001 prices
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The mainstreaming duty
“Without prejudice to any other obligation imposed on it, it shall be the duty of each authority to which this section applies to exercise its various functions with due regard to the likely effect of the exercise of those functions on, and the need to do all that it reasonably can to prevent, crime and disorder in its area.”
20 secs
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What would that look like in Obesity?
• May not be stunning in crime but is a precedent• Every player considers how Everything they do
impacts positively or negatively on Healthy weight at population and individual level.
• This means schools, catering areas
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Why local authorities and mainstreaming? CDC says
• Potential for systemic change in a community’s food and physical activity environment.
• Opportunity to “level the playing field” including disproportionately impacted populations.
• Authenticity: Consider the characteristics and needs of each community and implement obesity prevention initiatives to address them.
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The fourfold application of mainstreaming obesity reduction
Local Authority Role Services ExampleCommissioner Not schools any more!
Child careCommissioned
Provider Leisure CateringOffer for families
Regulator/Planner/Place Shaper
Planning Food environment
Influencer RoadsCyclepathsCulture
Safe self-propelled transportSocial NormsSchools
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A matrix approachService Area LA Actions PartnershipsHousing
Education
Leisure
Transport
Libraries
Social Care
Childrens’ Centres
Catering
Procurement
Workforce
Planning
Licensing
Economic Development
Fire Volunteering, Awards
30 secs
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Next Plans – building a system• Healthy Childrens
Centres rolling out across 82 centres!
• School Governors for Health – mainstreaming and advocating
• The first Business Improvement District to be health friendly?
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CDC Strategy rating and my additions Criterion DefinitionReach The strategy is likely to affect a large percentage of the
target populationMutability The strategy is in the realm of the community’s controlTransferability The strategy can be implemented in communities that
differ in size, resources, and demographicsEffect Size The potential magnitude of the health effect for the
strategy is meaningfulSustainability of health impact
The health effect of the strategy will endure over time.
Legality The strategy can be delivered within the existing legal framework
Implementability
The strategy can be implemented within existing powers, structures and relationships
Affordability The strategy is affordable or brings savings
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Additional Powers?• Public health duties on the school system• tweaks to the Community Infrastructure Levy• Duty on NHS to co-operate with local authorities in
preventive work• Broad public sector prevention duty• Power to co-ordinate
BUT A WHOLE SYSTEM APPROACH NEEDS BETTER NATIONAL ACTION TOO!
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Thank you
www.hertfordshire.gov.uk/healthinherts
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Next section is not for use in session unless people ask questions on them
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CDC Framework for Preventing ObesityCDC Framework for Preventing Obesity(adapted from IOM 2005)(adapted from IOM 2005)
Energy Intake Energy Expenditure
Energy Balance
Prevention of Overweight and Obesity Among Children, Adolescents, and
Adults
Individual Factors
Behavioral Settings
Social Norms and Values Home and Family
School
Community
Work Site
Healthcare
Genetics
Psychosocial
Other Personal Factors
Food and Beverage Industry
Agriculture
Education
Media
Government
Public Health Systems
Healthcare Industry
Business and Workers
Land Use and Transportation
Leisure and Recreation
Food and Beverage Intake
Physical Activity
Sectors of Influence
Draft – last revised, March 24, 2005
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Our proposed Indicators for monitoring progress
1. Trends in % overweight children aged 4-5 and 10-11, by District/Borough– Change from looking at small areas, with small
sample sizes
2. Trends in % adults overweight, by District/Borough– RETAIN
3. Trends in % adults who are inactive– Change from % meeting national recommendations,
focus on greatest benefits
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US CDC Take on this 1Strategies to Promote the Availability of Affordable Healthy Food & Strategies to Promote the Availability of Affordable Healthy Food &
BeveragesBeverages1. Increase availability of healthier food and beverage choices in public service
venues
2. Improve availability of affordable healthier food and beverage choices in public service venues
3. Improve geographic availability of supermarkets in underserved areas
4. Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas
5. Improve availability of mechanisms for purchasing foods from farms
6. Provide incentives for the production, distribution, and procurement of foods from local farms
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US CDC Take on this 2Strategies to Support Healthy Food and Beverage Choices
7. Restrict availability of less healthy foods and beverages in public service venues
8. Institute smaller portion size options in public service venues
9. Limit advertisements of less healthy foods and beverages
10. Discourage consumption of sugar-sweetened beverages
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US CDC Take on this 3
Strategy to Encourage Breastfeeding – with what impact?Strategy to Encourage Breastfeeding – with what impact?11. Increase support for breastfeeding
Strategies to Encourage Physical Activity or Limit Sedentary Activity Strategies to Encourage Physical Activity or Limit Sedentary Activity Among Children and YouthAmong Children and Youth
12. Require Physical Education in schools13. Increase the amount of physical activity in
PE programs in schools14. Increase opportunities for extracurricular
physical activity15. Reduce screen time in public service venues
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US CDC take on this 4Strategies to Create Safe Communities That Support Physical ActivityStrategies to Create Safe Communities That Support Physical Activity
16. Improve access to outdoor recreational facilities17. Enhance infrastructure supporting bicycling18. Enhance infrastructure supporting walking19. Support locating schools in residential neighborhoods20. Improve access to transportation21. Zone for mixed-use development22. Enhance personal safety where people are or could be physically active23. Enhance traffic safety in areas where persons are or could be physically active
Strategy to Encourage Communities to Organize for ChangeStrategy to Encourage Communities to Organize for Change24. Participate in community coalitions or partnerships to address obesity