Post on 16-Mar-2016
description
Health
Ian Wake
21st Century Playgrounds
Tackling childhood obesity in South West Essex
Ian Wake Deputy Director of Public Health
Overview
• Who are NHS South West Essex • What is Childhood Obesity and why is it a
Public Health Issue • Our Rationale • The Programme • Some outcomes
What is Childhood Obesity? • The most widely used and convenient
means of assessing body composition is the Body Mass Index (BMI).
From an epidemiological point of view, overweight is commonly defined as exceeding the 85th centile and obesity as exceeding the 95th centile.
Why Childhood Obesity?
• Major risk factor for other diseases • Rapid increase in the last 30 years
Associated co-morbidities
• Children and
teenagers • hypertension • hyperinsulinemia • dyslipidaemia • type 2 diabetes • psychosocial
dysfunction • exacerbation of
existing conditions • orthopaedic
problems
Adults
• type 2 diabetes • coronary heart
disease (CHD) • hypertension • various cancers • Osteoarthritis • Psychological
problems
Why Childhood Obesity?
• Major risk factor for other diseases • Rapid increase in the last 30 years
Rationale:
• SWE – 33% children in YrR and Yr6 are overweight or obese = 1 in 3 – Lost reality of a ‘healthy weight’ child
• Childhood obesity is incredibly complex: – Balance between consumption and activity – Multi-factorial causes – Little evidence base on interventions – Very emotive subject area – 95% of parents with an overweight child DO NOT
identify their child as being overweight – No direct correlation between deprivation and obesity
in SWE
Primary Care
- - Diagnosis and monitoring
- - Medical intervention
- - MEND referral
- - Dietetics
Parental / Home
- Parental BMI
- Parents attitudes to obesity
- Home leisure pursuits
- Parental work patterns
- Diet at home
- Parental Income
- Parental cooking skills
- Community Safety Fears
Transport
- - School travel policy
- - Cycling Lanes
- - Public Transport vs Car Ownership
Individual / Biological
- Whether breast fed or not
- Genetics
- Self Esteem
- Attitude to exercise
Wider Environment
- Access to retail outlets selling fresh fruit and vegetables
- Access to Leisure Services
- Community Groups
- Housing type
- Access to green spaces
School
- School meal nutrition
- PHSE in schools
- Cooking skills in schools
- - Level of structured PE
- - School grounds/environment
Influences on Childhood Obesity
Rationale:
• SWE – 33% children in YrR and Yr6 are overweight or obese = 1 in 3 – Lost reality of a ‘healthy weight’ child
• Childhood obesity is incredibly complex: – Multi-factorial causes – Little evidence base on interventions – Very emotive subject area – 95% of parents with an overweight child DO NOT
identify their child as being overweight – No direct correlation between deprivation and obesity
in SWE
• Health Inequalities by Life Expectancy
Tilbury Grays
South Ockendon
Basildon New Town
Billericay Brentwood
A127
Rationale:
Rationale NICE 2006 • Minimise sedentary activities during play time • Provide regular opportunities for enjoyable active play and
structured physical activity • Use a whole-school approach to develop life-long healthy eating and
physical activity practices • Ensure school policies help children to eat a healthy diet, be
physically active and maintain a healthy weight
Foresight 2007 • Range of opportunities in the built environment to increase physical
activity and help tackle obesity. • Provision of facilities for sport and formal exercise, supplemented by
actions to increase usage, particularly among disadvantaged groups
Case for change
• For all children and young people in SWE to have access to high quality outdoor educational areas that encourage physical activity for all.
• To improve the fundamental movement skills of all children and young people
• To enhance the 2hr physical activity offer in line with the 5hr target.
• For all schools to achieve the Healthy Schools Standards.
The Programme
Environmental Site Survey
Tailored package of equipment/playground
zoning
ROSPA accredited safety inspection
Zonal Playground Markings:
Improving Fundamental Movement Skills
Climbing / Jumping equipment:
Increasing Physical Activity
Creative Play Equipment:
Drama stages
Yoga Bugs
Programme
Environmental Site Survey
Tailored package of equipment/playground
zoning
ROSPA accredited safety inspection
CPD Programme for
multi-disciplinary school team
Independent Evaluation of the Programme by Leeds Metropolitan University
Dec Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec I N S T A L L A T I O N
Questionnaire ONE
Questionnaire TWO
Teacher interviews Pupil
interviews Pupil
interviews Pupil
interviews Pupil
interviews
Trainer reflexivity
Trainer reflexivity
Trainer reflexivity
Trainer reflexivity
Trainer reflexivity
16 randomly selected schools One day of observation at each round (Two observers)
Research
• How many EXTRA pupils engage with playground PA?
• How do pupils engage with playgrounds (range of multi-skill variables + miscellaneous)
• How has this come about (compared to before)?
• What, if anything, made the impact? • How sustainable are these impacts?
What we required in return • Memorandum of Understanding Signed by
each school – Sign up to and accreditation of Healthy School
Standard by March 2010 – Participation in the research – Release of staff to CPD programme
Programme roll out
• £3.2 million investment 161 schools • Sign up through Children’s Trust Boards • Sign up of Directors of Children’s Services • Letter to all heads followed by heads briefing • Briefing of Healthy Schools Coordinators and
Extended Schools Cluster Coordinators • Site visits / Installation October 08 to March 09 • Launch
Challenges
• Convincing head teachers the scheme was free
• Timescale • Logistics of checking work had occurred
within schools • Local partnership arrangements
Positives
• Sign up to Healthy Schools Programme • Improved Partnership Working • Raised Health Improvement up the
agenda • Sustainable benefit for a one off
investment
Some quotes
Firstly can I say what a difference this initiative has already made to the outside areas of our small village school. To see children actively involved in climbing, playing and role-playing were before they would have just huddled in the corner of the play ground is fantastic.
Michael Thomas, Head teacher Mountnessing Church of England Primary School
Pupils are keen to run, are motivated in sports and physical activities during playtimes and lunch times. Pupils who have social difficulties are developing team skills and interacting more with other pupils
Head Teacher, Whitmore Infants and Nursery
Some quotes
Our children are very keen & Enthusiastic about the equipment and have used it continually we have seen some real leadership qualities arising from our year 6 children as they guide and support the younger children
Head Teacher – Graham James Primary
Form time - 3 form groups each day (75 students) on table tennis. Trim trail, climbing wall. During break/lunch trim trail very popular climbing wall used by mainly boys table tennis games - sixth form and younger students . Deputy Head, Brentwood County High School
If we want more evidence-based practice,
we need more practice-based evidence.
L. W. Green (2004)
? Any Questions
Health
Ian Wake