the healthy weight declaration: where been and where next? · 2019. 7. 29. · the healthy weight...
TRANSCRIPT
The Healthy Weight Declaration: where been and where next?
Robin Ireland- Director of Research (Honorary), Food Active
LGA Conference, July 17th 2019
Credit and thanks for slides borrowed, stolen and gracefully provided.
Food Active – we will cover:
• Background and Commissioning
• Local Authority Declaration on Healthy Weight
• Support Pack: Phases of Development and Implementation
• Individual journeys and Momentum
• What’s Next?
• The Liverpool City Council Approach.
• Questions and discussion
Food Active – initially a North West response
• A collaborative programme launched by the North West Directors of Public Health in November 2013 to tackle increasing levels of obesity.
• Focusing on population-level interventions which take steps to address the social, environmental, economic and legislative factors that affect people’s ability to change their behaviour.
• Less victim blaming, more environment framing
Learning from tobacco control
Food Active developed the Local Authority Declaration on Healthy Weight – following extensive consultation with NW commissioners. It provides:
• Strategic leadership: creates an opportunity for senior officers and politicians to affirm their commitment to addressing healthy weight
• Local awareness: shines a light on importance of key activities internally and externally.
• Driving activity: LAs work with local communities and partner organisations to review policies
Food Active
From 2018, Food Active has been working in partnership with Public Health England in the Yorkshire and Humber & South West Regions
So what are the healthy weight policies that can be implemented at municipal level?
• Children and adults should have access to healthy food in care settings including hospitals, schools, nurseries, residential care.
• Local authorities should procure food and drink intelligently (both in-house and in public venues)
• Town planning needs to encourage active travel and restrict fast food outlets wherever possible
• Local authorities should consider not accepting funding associated with industries that produce food and drinks high in sugar, salt and saturated fat.
Local Authority Declaration on Healthy Weight
• The declaration aims to support Local Government (and its partners) to take action to prevent excess weight and secure the health and wellbeing of residents
• The declaration requires Local Government officers and politicians to support the implementation of policies that will encourage healthy weight.
HWD Support Pack
Phase One: Scoping and Building Support
Building support:
Colleagues from Blackpool BC speaking at Leeds Civic Chambers
Phase Two: Implementation of the Declaration
Working together:
Huddersfield, Kirklees
Phase Three: Communication
Blackburn with Darwen Council
Celebration:
Phase Four: Maintain Momentum
Phase Five: Evaluating Impact
Blackpool’s Local Pledges
• Considering weighted/financial support for ‘healthier’ retail in deprivedareas
• Improving the quality of packed lunches by developing a localagreement with schools to implement guidance
• Working with schools to achieve ‘walk to school’
• Taking a stepped approach to reduce sugary drinks available in vendingmachines on locally controlled sites
• Working with commercial outlets within all public sector premises todevelop a food and drink policy
A Whole Systems Approach to Healthy Weight
“I think integration is absolutely vital to ensure unity and common understanding that there is an issue and that the issue requires attention….. It is easy to have representatives from different departments, to be on steering groups, and to attend meetings, however it is the physical changes, the policy changes, that instigate real change towards tackling this issue and other issues”. Transport Planner
“We … need to know how different depts can influence obesity and make changes to their agendas, and all depts need to work together on agreed common actions”. Transport Planner
Quotes from a ‘Perspective Pieces’ report by Food Active, March 2018
A Whole Council Commitment - Discussion
What are the opportunities/ easy wins in your local authority?
- Established partnerships?
- Effective system leadership?
What are the barriers in your local authority?
- Priority given to Healthy Weight?
- Commercial pressures?
Liverpool City Council
Healthy Weight Declaration
Our journey…
Melisa Campbell MFPH
Acting Public Health Consultant
• England’s 6th largest city
• Population 491,549
• Deprived city
• Significant social inequalities
Liverpool City
51 years
69 years
Healthy Life Expectancy
R² = 0.6842
50
55
60
65
70
75
0 5 10 15 20 25 30 35 40 45
Healt
hy Li
fe Ex
pecta
ncy (
years
)
Index of Deprivation Overall Score
Correlation between Male Healthy Life Expectancy and Deprivation by Local Authority
R² = 0.6842
50
55
60
65
70
75
0 5 10 15 20 25 30 35 40 45
Hea
lthy
Life
Exp
ecta
ncy
(yea
rs)
Index of Deprivation Overall Score
Correlation between Male Healthy Life Expectancy and Deprivation by Local Authority
Poverty damages our health
• Obesity 2.2 times higher in 5yr olds from most deprived communities
• Unhealthy foods are three times cheaper than healthy foods
• Unhealthy foods are more available in deprived communities
1.48 takeaways per 1,000 residents (29% of all the City’s food outlets) 1.09 stores/ supermarkets per 1,000 residents
Average distance from fast food 1km in Liverpool, compared to 2.6km nationally and 1.2 km in Core cities
Phase One: Scoping and Building
Support
• Local intelligence – clear messages
• Strategic champions/ local champs
• Clear messages for multiple audiences
• Shared vision across key partners
Liverpool’s Timeline
Introducedwithin LCC
Nov 2017 Nov ‘17 to Mar ‘18
Ratified
Cabinet Paper
declaration
June ‘18
Ratified
NHS Partners Pledge
July ‘18
Formal launch
joint declaration
Nov ‘18
TIME
Discussions
at a senior level with
Cllr members
Phase Two: Implementation of the
Declaration & Communications
• Whole Systems action plans
• Trusts - action plan development
Liverpool’s Timeline
Whole systems approach
Workshop one
Whole systems approach
Workshop two
TIME
Nov ‘18
Formal launch
joint declaration
Nov ‘18 March ‘19
Tackling healthy weight issues in Liverpool
NHS Partnership pledge
Liverpool City Council
Healthy weight declaration
Whole Systems Approach
Why add the Whole Systems
Approach?
• Recognises the complexity of tackling drivers for obesity
• “Systems thinking” to identify the most important factors
and make sense of changing dynamics
• Engages the wider system
Level of breast
feeding
Acceptance of breast
feeding ( social norm)
Perceived importance of
breast feeding by others
Prioritising breast
feeding
Associated stigma / shame of
breast feeding - family, friends,
media and society
Cultural beliefs of
importance
Workforce education and
attitude on benefits of breast
feeding
Role models of
breast feeding
Perceived importance and value
of breast feeding by mother
compared to formula
Breast feeding
friendly environment
Perceived ease of
bottle feeding
Formula companies
marketing
Prioritisation in heavy
professional workload
Available time to spend with
mothers to support breast
feeding
Level of professional
resource
A
B
Level of
obesity
Access to healthy food is
more difficult( i.e.
supermarkets)
Consumption of
healthy food
Cooking
confidence
Easier access to calerie
rich foods ( i.e.
takeaways)
Density of fast
food outlets
Cost of
unhealthy food
Consumer demand
for unhealthy foodMental health / self
esteem/ physical health
Income
Available
money
Quality of education
or training
Unemployment
Relationship
breakdown
Perceived time
to cook
Working patterns
conducive to good health
and well being
Recognition of alcohol
related weight gain
Alcohol
consumption
Price of
alcohol
Pricing
regulation
Access to
alcohol
Community
accesibility of outlets
Licencing
regulationConsumption
regulation
Acceptability of alcohol
consumption ( social
norms)
Levels of physical
inactivity
Motivation to be
physically active
Available time
Apprension and
confidence to be active
Physical activity in
all policies
Prioritisation of a
conducive physical activity
environment
Evidence of need for
green space
Executive team/ management
support to increase healthy
behaviours
Prioritisation of
cars
Perceived
available time
Prioritisation of
physical activity in
lifestyle
Enjoyment of
physical activity
Knowledge of benefits
of physical activity
Quality / consistency
/accessibility of message
Understanding about the
benefits of small amounts of
physical activity
Consistency in messages for
physical activity and healthy
weightUnderstanding of
healthy weight
Ability to understand
messages
Trust in
messages
Consistency in messages
from organisations and
professionals
Message alignment with
community or individuals
value sets/ beliefs
Knowing your audience -
level of insight/research
Reality based
messages /
implementable
Work / life balance
( e.g. hours culture)
Knowledge
about food
Use of early years
support
Resilience /
self-esteem
Life role
models
Family knowledge
about food
Ability to understand
food labelling
Access to early
years services
C
Perceived/actual
safety in active travel
Active travel
infrastructure/facilities for all
journey types and lengths
Volume of cars on road /
priority of other road users
Quality, access ( inc. cost)
and availability of public
transport
Perceived ability to
access green spacePerceived safety of
green space
Financial investment
in green space
Quality of
lighting
Level of
maintenance
Customer demand for
healthy food options
Ability to challenge planning
permission for unhealthy food
options
Need for money from
business rates
Value of active travel and
public transport in plans
Availability and access to
green and blue space ( inc.
restrictions)
Ability to understand the
health implications of
obesity
Standardisation of
food labelling
Production of
unhealthy food
Marketing ( inc. price
promotions, unhealthy
lifestyle messages)
Recognising
unhealthy behaviours
Involvement with design
and communication in
health
Heathy workplace culture
- promote healthy weight
Workplace facilities priority
for healthy eating and
physical activity
Access to healthy
food / vending
Breast feeding
room / fridgeSocial culture( inc.
cake / alcohol)
Catering meeting
PHE guideliness
School syllubus
inclusion
Workforce education on
risks of not breast feeding
Quality and support
standards in bottle
feeding
Overfeeding bottle
fed babies
Focus on benefits rather than
risk by professionals in mother
/parents decisons
Use of birthing method
increases need for medical
intervention
Medicalised
birth
Contact time to support
a less medicalised birth
Patient/baby safetly
concerns
Discharge
timescales
Mothers perception of
birth convenienceOwn experiences / support and
committment in pregnancy and
post pregnancy
Quality of maternal
mental health / wellbeing
Family/nearby
support
Underlying health
pregnancy
Post natal
depression
Depression
Trauma risk
Focus on tackling
clustering in policy
HR function promotes
health, wellbeing and
physical activities
Understanding the value of
breast feeding on healthy
weight
Ease of access ( inc.
physical and financially)
Knowing if it
meets needs
Knowing what's
suitable, available and
where
Social, family and peer
norms and values
Individual norms and
values around being
inactive
Quality of experiences
being active / routine
physical activity
Financial cost
related to activity
Peer and family use
and culture
Wider society use of
alcohol in activities
Level of alcohol
consumption
Functionality
Binge eating
Motivation to be
physically active / eat
well
Illegal alcohol Affordability
Distorted perception of being
overweight or obese ( e.g. what
being overweight looks like)
Cost of healthy
food
<Mental health / self
esteem/ physical health>
<Perceived ability to
access green space>
<Use of early years
support>
Use of food as a coping
strategy ( e.g. comfort
eating)
Emotional value of foods
( e.g. home cooking)
Access to food
Quality of early years
experiences related to food
and weaning
Individual norms and
values for food
Awareness of what exists in
the community / community
assets
Unhealthy eating
patterns
Ability to change
behaviours
<Access to healthy food is
more difficult( i.e.
supermarkets) >
<Ability to understand
messages>
<Social, family and peer
norms and values>
<Available
time>
<Workforce education and
attitude on benefits of breast
feeding>
Support to become more
active ( e.g. community
based support)
Access to physical
activities facilities
Low income
households
Cooking skills
People overeating
larger proportion sizes
Normalisation of sugary
drinks ( esp. for children)Marketing of
sugary drinks
Low cost of
sugary drinks
Easy access to
sugar drinks
Standard part of eating out
of the home - e.g. meal
deals
Demand for
sugary drinks
Price promotions of
sugary drinks
Lack of awareness of sugar in
standard sugary drinks ( inc. energy
drinks and those targeted at children)
Poor product
labelling
Marketing portrays as healthier
products ( e.g. aligns with healthy
activities such as sports)
Consumption of high
sugar drinks
Lack of awareness of how
much sugar children should
have
Perception of
sugary drinks
<Social, family and peer
norms and values>
Limited food and drink
marketing controls in
Liverpool
High levels of people
are overweight or obese
Food deserts
Reliance of emergency
food sources ( e.g. food
banks)
Low income
Reliance on cheap and
usually poor food quality
Energy drinks
Education on healthy
eating at school
Eating out
more
Convenience
<Available
time>
Institutes providing foods
( including schools, hospital
and care homes)
Knowledge, skills and opportunity for healthy weight
Liverpool’s Whole Systems map
Level of
obesity
Access to healthy food is
more difficult( i.e.
supermarkets)
Consumption of
healthy food
Cooking
confidence
Easier access to calerie
rich foods ( i.e.
takeaways)
Density of fast
food outlets
Cost of
unhealthy food
Consumer demand
for unhealthy food
Available
money
Relationship
breakdown
Perceived time
to cook
Levels of physical
inactivity
Understanding of
healthy weight
Ability to understand
messages
Consistency in messages
from organisations and
professionals
Knowledge
about food
Life role
models
Ability to understand
food labelling
Customer demand for
healthy food options
Ability to challenge planning
permission for unhealthy
food options
Need for money from
business rates
Ability to understand the
health implications of
obesity
Standardisation of
food labelling
Production of
unhealthy food
Marketing ( inc. price promotions,
unhealthy lifestyle messages)
Social, family and peer
norms and values
Individual norms and
values around being
inactive
Distorted perception of being
overweight or obese ( e.g. what
being overweight looks like)
Cost of healthy
food
Use of food as a coping
strategy ( e.g. comfort
eating)
Emotional value of foods
( e.g. home cooking)
Access to food
Quality of early years
experiences related to food
and weaning
Individual norms and
values for food
Unhealthy eating
patterns
Ability to change
behaviours
<Access to healthy food is
more difficult( i.e.
supermarkets) >
<Available
time>
Cooking skills
People overeating
larger proportion sizes
High levels of people
are overweight or obese
Food deserts
Eating out
more
Convenience
Themes: Food and drink in our communities
Limited access to healthier foods
Unhealthy food values
Greater access to unhealthy foods
Overeating culture
Cost of healthy eating
Ability of improve food provisions in the community
Culture of enjoying unhealthy foods
Named champs – within partner organisations and NHS trusts
prevention Champions
Named leads and agreed actions
Capacity - working groups North Mersey Group & the Healthy
Weight Strategic Network
Public Health leads now supporting Trust leads around various
hospital food standards/guidelines (next slide)
Accountability for action plans in Governance structures
Important drivers
Phase Four: Maintain Momentum
• WSO Action Plan with clear supporting groups to help us achieve
wider system aims – alignment to 14 commitments
• Support NHS Trusts further with their plans – Public Health/CCG
partnership via North Mersey Group and Healthy Weight Group
• Sustainability
6-monthly submission of plans, further embedded via PMF in
contracting processes
MECC, Hospital Food Standards already included in PMF
Work to embed ‘performance measure’ against Healthy
Weight pledge(s) more firmly into contracts
M&E Toolkit Mapping
Assessment at 1-year – Progress
Supportive Scrutiny
NIHR application
Challenges
Engaging hearts and minds
Momentum for change
Capacity and resources
Ability to audit
Top tips
Excellent strategic leadership
Develop contacts/champions
Programme management and a core team
Whole Systems methods for engaging
It takes time…
Thank you
Cllr Cain, Blackpool Council“Signing of a Declaration is just the first step. Need to ensure that it doesn’t sit on the shelf, but that is it used and generates change for the better.”
How would you drive progress / keep momentum going?- Champions - Key partners - Review process - Engagement events etc.
How to drive progress- Discussion
Healthy Weight Declaration Next Steps
• NHS Declaration
• Partner Pledge
• NIHR Evaluation??
NHS Healthy Weight Declaration
• Growing interest from NHS organisations to adopt a similar approach to Local Authority Declaration on Healthy Weight as either joint declaration or autonomous declaration
• Acknowledge that this may be far more complex for NHS organisations
• Take account of a range of factors such as the environment, workforce, clinical commitments, treatment V prevention, organisational boundaries
• Governance and accountability – how do we make this work?
NHS HWD: Pilot Programme
• Food Active in conjunction with PHE SW & NHS SW
• Already working with PHE SW on Local Authority Declaration
• Timescale September 18 to March 20
• Develop an NHS declaration specific to its own objectives and workforce
• Engage with a range of NHS stakeholders across the SW
• Supported by evidence base, guidance document and monitoring and evaluation toolkit
• Pilot the declaration across approx. three sites
Food Active – we covered:
• Background and Commissioning
• Local Authority Declaration on Healthy Weight
• Support Pack: Phases of Development and Implementation
• Individual journeys and Momentum
• The Liverpool City Council Approach.
• What’s Next for the Healthy Weight Declaration?
• Questions and discussion
