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Seeing the bigger picture

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As local government campaigns to tackle obesity gather momentum, a new IDeA report offers guidance on how healthy lifestyles can be incorporated into existing local frameworks.

What do parks, tuck shops, breast-feeding and roads have in common? They are all tools with which local authorities can tackle the ‘obesogenic environment’, according to a report that spells out the role of councils in reducing obesity.

Tackling Obesities: The Foresight Report and Implications for Local Government, published by the Improvement & Development Agency, should leave councils in no doubt that obesity is just as much a local government priority as it is for primary care trusts (PCTs). It identifies four key areas of responsibility planning, children’s services, adult social care and parks and leisure and includes a list of ‘top 10 tips’ on how councils can get to grips with obesity.

The recommendations by researchers at Sheffield Hallam University follow on from last October’s Foresight Report Tackling Obesities Future Choices project, which estimated that without major societal change over half the UK population could be clinically obese by 2050. The government’s subsequent national strategy on obesity, Healthy Weight, Healthy Lives, made clear that the issue had to be addressed across all sectors of government.

For local government, this means seeing obesity as part of a bigger picture, says the IDeA report. Councils should be joining up some of the many successful health and wellbeing initiatives, such as the national Mind, Exercise, Nutrition, Diet programme for overweight children, with a more wide-ranging strategy to create environments less likely to promote obesity, which might include green transport or safer parks. Local authorities should also deliver leadership on obesity by using policy levers, such as the sustainable communities strategy, local development frameworks and local area agreements, says the report.

'Councils take health seriously'

Liam Hughes, national adviser on the Department of Health-funded Healthy Communities Programme that is working with local government, believes most councils are taking the issue seriously.

“Many local authorities are seeing health as their business. The beacon authorities are doing some really splendid things,” he says, naming Sunderland City Council, Bradford City MDC, Greenwich LBC and Kent CC, although others have successful, long-standing obesity-tackling schemes.

Where councils lag behind, he suggests, may be due to a preoccupation with economic development or a lack of leadership between health and planning.

“It helps if obesity strategies are built into the way everything gets done in councils, so they are part of planning and transport policy. Within health and wellbeing plans there needs to be an overarching description of what they are trying to do to tackle obesity. Then within each area there should be more specific action plans and there need to be champions pushing the issue,” he adds. “There are some places that are heads and shoulders above the rest.”

Barnsley MBC is highlighted in the Foresight report for its progressive, council-wide strategy Barnsley Fit for the Future, which focuses on physical activity and nutrition.

Barnsley’s public health director, ex-GP Dr Paul Redgrave, is an executive director at the council. He says being able to provide a primary care health perspective to senior council management has given the south Yorkshire authority a head start in meeting the recommendations for collaborative working. “The big debate is how joint is joint. There are very few public health directors with as much access to the council as I have,” he says.

Barnsley Fit for the Future spans a healthy schools initiative with physical activity co-ordinators and cooking and eating sessions for children and parents. It also has a community-based fit kids club for obese children and borough-wide activities such as walking and dancing groups. The strategy is working closely with the planning department on developing a safe routes network of paths and cycle ways.

'Work in partnership'

“Don’t go it alone,” advises the IDeA Foresight report, which stresses the importance of forming local strategic partnerships. Tower Hamlets LBC has followed this advice, working on a formal obesity strategy with its PCT since mid-2007 as part of a multi-agency steering group called Tower Hamlets Partnership.

Esther Trenchard-Mabere, Tower Hamlets PCT associate director of public health, says while there has been joint working on health for years, having a formal partnership between the council and PCT has provided the ideal arrangement to drive the obesity strategy forward.

The obesity strategy sits within the partnership’s Living Well action community plan. But there are also links with other activity areas including leisure and community safety and children and young people.

“We felt the strategy shouldn’t just be health-led, but part of other thematic groups. One of the first things we did was a mapping of everything going on in the borough against the National Institute for Health & Clinical Excellence guidelines on obesity. There already was a wide range of activity, but it was about how to better co-ordinate it. Now we are putting investment into borough-wide coverage of the most successful programmes,” she says.

Avoiding a one-size-fits-all approach by engaging with communities is another Foresight recommendation. Greenwich LBC is following this tip by carrying out needs assessments to ensure its healthy eating schemes are targeted at the right people.

Food co-op scheme

One of its programmes is a food co-op scheme where local people source and sell fruit and vegetables on street or school playground stalls in some of the borough’s most deprived areas. “Because residents have identified the problem, there is more interest in volunteering to be part of the solution and this addresses the sustainability issues,” says Dr Phil Atkinson, interim head of Greenwich’s Healthier Communities initiative.

He adds: “They are also more likely to be known locally and become advocates for healthy eating. They are not just selling fruit and veg they are giving ideas for cooking and there is more of a discussion about why they are good for you.” One of the project’s main achievements has been getting children to buy fruit from the school-based co-ops at break time.

The aim is for the 20 stalls to become self-sufficient. “They are now about 75% self-sufficient. The funding is going down but they are still flourishing,” says Dr Atkinson.

The Greenwich Healthier Communities team has also developed a toolkit to encourage the planning department to think about health within its local delivery framework, which Dr Atkinson describes as a “relatively novel” approach. “We hope that our toolkit will be used to ensure health is built into planning policy documents,” he says. It includes a system of self-assessment and is also being used to prompt developers to consider health and activity in their plans.

This is an area that Mr Hughes believes needs more work. “We are particularly interested in the role of planners. They are the building blocks and determinants of healthy communities. Local authorities need to do a lot more to make use of land. There is a conflict between development and the need to build more houses and the balance with health. It is quite difficult to get hold of spaces for people to play. Councils need to have a strategy as part of sports, culture and leisure plans to find where there are gaps.”

He points to the French Ensemble Prévenons l’Obésité Des Enfants (EPODE) project which has transformed several towns in France into so-called ‘fit towns’. “In France the towns have gone systematically through the different ways of being able to influence people through diet, weight and a lot of activities that are not just traditional sports, and there are alliances between businesses, schools and councils.”

This has led to the proportion of overweight boys almost halving from 19% and the rate among girls dropping from 10% to 7%, says the IDeA. The DH is investing£30m into healthy town pilot schemes in England, to be announced shortly.

But it appears there is no quick fix. Dr Redgrave sums up the lengthy battle ahead. “Obesity is a massive problem in Barnsley which we haven’t solved yet. We see Fit for the Future as a 10 to 20-year strategy and we are only in year four.”

The Tackling Obesities report’s top 10 tips

1. Rise to the challenge. Get a better understanding of what obesity means for your residents locally.

2. Prioritise obesity prevention. Take a holistic approach to tackling obesity and the obesogenic environment.

3. Target children and vulnerable groups in raising obesity awareness and providing opportunities.

4. Don’t go it alone. Local strategic partnerships have been developed to bring partner agencies to work together on local issues such as obesity prevention.

5. Identify ‘obesity champions’. This might be the lead for public health or children’s health, or a local mayor or lead councillor.

6. Stay local. The sustainable community strategy is intended to generate local action and solutions to obesity prevention.

7. One size does not fit all. Work with individuals at grass roots level to find out what activity projects people would attend.

8. Practise what you preach. Be a model employer and develop healthy workplace objectives.

9. Don’t reinvent the wheel. There is a lot of evidence out there to show what works to combat and prevent obesity, this can be tailored to fit local circumstances.

10. Make information accessible. Help people understand practical examples of an unhealthy energy imbalance.

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