My slides for the Childhood Obesity Summit 2016 on what we can do to create a less obesogenic environment

1. www.hertsdirect.org
Creating a less obesogenic
environment:
levers and drivers for action at a local level
Prof Jim McManus
Director of Public Health
Jim.mcmanus@hertfordshire.gov.uk
Childhood Obesity Summit
3rd
November 2016

2. 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?

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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?

5. 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

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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

7. 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

8. 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

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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

13. 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

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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.

17. www.hertsdirect.org
The fourfold application of
mainstreaming obesity reduction
Local Authority Role Services Example
Commissioner Not schools any more!
Child care
Commissioned
Provider Leisure Catering
Offer for families
Regulator/Planner
/Place Shaper
Planning Food environment
Influencer Roads
Cyclepaths
Culture
Safe self-propelled
transport
Social Norms
Schools

18. www.hertsdirect.org
A matrix approach
Service Area LA Actions Partnerships
Housing
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 Definition
Reach The strategy is likely to affect a large percentage of the target
population
Mutability The strategy is in the realm of the community’s control
Transferability The strategy can be implemented in communities that differ in size,
resources, and demographics
Effect Size The potential magnitude of the health effect for the strategy is
meaningful
Sustainability 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

21. 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!

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Thank you
Jim.mcmanus@hertfordshire.gov.uk
www.hertfordshire.gov.uk/healthinherts

23. www.hertsdirect.org
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

25. 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
1. Trends in % adults overweight, by
District/Borough
– RETAIN
1. Trends in % adults who are inactive
– Change from % meeting national
recommendations, focus on greatest benefits

26. www.hertsdirect.org
US CDC Take on this 1
Strategies to Promote the Availability of Affordable HealthyStrategies to Promote the Availability of Affordable Healthy
Food & BeveragesFood & Beverages
1. 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 2
Strategies 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 SedentaryStrategies to Encourage Physical Activity or Limit Sedentary
Activity Among Children and YouthActivity Among Children and Youth
12. Require Physical Education in schools
13. Increase the amount of physical activity in
PE programs in schools
12. Increase opportunities for extracurricular
physical activity
15. Reduce screen time in public service venues

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US CDC take on this 4
Strategies to Create Safe Communities That Support PhysicalStrategies to Create Safe Communities That Support Physical
ActivityActivity
16. Improve access to outdoor recreational facilities
17. Enhance infrastructure supporting bicycling
18. Enhance infrastructure supporting walking
19. Support locating schools in residential neighborhoods
20. Improve access to transportation
21. Zone for mixed-use development
22. Enhance personal safety where people are or could be physically
active
23. 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 Change
24. Participate in community coalitions or partnerships to address obesity