Creating a less obesogenic environment

www.hertsdirect.org

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

www.hertsdirect.org

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?

www.hertsdirect.org

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

www.hertsdirect.org

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?

www.hertsdirect.org

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

www.hertsdirect.org

Channel 4 Dispatches...again

That doesn’t let the current national plan off the hook, though, and doesn’t stop us trying

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

Some of our schemes• Whole school healthy eating• BeeZee Bodies (aged 5-15)

• Workplace Health

www.hertsdirect.org

Adult weight management schemes • 13,000 residents referred to the

programme so far: • 62% completion• Shape Up” with Watford FC

www.hertsdirect.org

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?

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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.

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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?

www.hertsdirect.org

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

www.hertsdirect.org

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!

www.hertsdirect.org

Thank you

[email protected]

www.hertfordshire.gov.uk/healthinherts

www.hertsdirect.org

Next section is not for use in session unless people ask questions on them

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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

www.hertsdirect.org

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