Highland NHS BoardJune 2011

Item 4.7

HEALTHY WEIGHT STRATEGY

Report by Fiona Clarke, Senior Health Promotion Specialist

The Board is asked to:

Note the progress in the implementation of the Healthy Weight Strategy. Endorse the proposal to continue to work in partnership with the Highland Council

and Argyll & Bute to ensure prioritisation of the relevant actions in the ScottishGovernment / COSLA ‘Preventing Overweight and Obesity in Scotland Action Plan’(2011).

1 Background and Summary

‘There is a growing recognition that obesity is one of the problems that, like climate change,does not have a simple solution and requires new ways of thinking’ (Scottish GovernmentHealthy Eating Active Lives 2008)1.

Highland, like the rest of the UK, has a population where overweight has become usual,rather than unusual. Obesity is a consequence of abundance, convenience and underlyingbiology and thus the Highland Healthy Weight strategy aims to improve the health and well-being of the people of Argyll and Bute and Highland by working towards targets whichimprove diet and physical activity levels. This will involve changing behaviour, theenvironment and biology. These concepts first outlined in the Foresight report (GovernmentOffice for Science 2007)2 have been further expanded in:

The Scottish Government/COSLA ‘Preventing Overweight and Obesity in Scotland routemap’ (2010)3 and ‘Action Plan’ (2011)4 are aimed primarily at decision makers in centraland local government who can work together across all public sector, third sector, andprivate sector organisations that can make the necessary changes to positively impact onthe way we lead our lives. For example tackling portion distortion (ever increasing portionsizes); clearing up environmental dereliction; implementing nutrition guidance in earlyyear’s settings etc. A full list of actions for the Public sector can be found in Appendix 1.

The Scottish Intercollegiate Guidelines Network published ‘Management of Obesity – anational clinical guide (2010)5 which provides evidence based recommendations on theprevention and treatment of obesity in the clinical setting, in children, young people andadults. It recommends that healthy weight programmes should include physical activity,dietary change and behavioural components; with a particular focus on the reduction ofthe intake of energy dense foods, fast foods and alcohol.

The Highland Healthy Weight strategy aims to influence food and activity behaviours throughworking with individuals, and communities and the environment in which we live. As well asa regional strategy, action at national level for example around food policy and the builtenvironment will also be required to make a significant impact on rates of obesity.

The objectives drawn from these strategic aims of the Highland Healthy Weight Strategy are:

1. To develop and implement initiatives which will contribute to the Highland populationmaintaining a healthy weight.

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2. To increase the number of people who consume a healthy diet that is consistent withthe UK Dietary Reference Values6.

3. To increase the number of people who are physically active in line with therecommendations in the Physical Activity Strategy7.

4. To make the greatest gains in those population groups who have the highest burdenof obesity and poorest health outcomes.

5. To create environments which promote and encourage healthy eating and physicalactivity.

6. To develop and implement a care pathway for overweight and obese individuals.

This paper outlines developments in the implementation of the strategy since it wasendorsed by the Highland NHS Board in 2008, Argyll and Bute Council in 2009 and theHighland Council in 2010, with a particular focus on physical activity.

2 Developments

The strategic approach aims to take an asset based approach to healthy weight and workwith our partners to deliver more effective and integrated interventions. A wide range ofhealthy weight related activities are in place throughout NHS Highland. The Healthy WeightStrategy Part 28 shows extensive examples of practice.

2.1 Physical Activity

Physical activity is a broad term to describe movement of the body that uses energy. It canbe as simple as walking. The goal for good health is to increase the amount of physicalactivity that we do, and confidence to try different things (Lets Make Scotland More Active –A Strategy for Physical Activity)7.

Physical activity opportunities exist throughout NHS Highland, and whilst extreme rurality is alimiting factor for some of our population, lack of awareness of local opportunities can also bea significant barrier. The wider NHS and community workforce can support individualsthrough efficient signposting, and as part of implementation of this strategy, a guide for AlliedHealth Professionals on how to do this is in development.

Physical activity provision to support healthy weight, and wider aspects of physical andmental health, is a key area of work that has been progressed within the strategy. The focusfor this section is around 2 areas: the self management agenda, and working with partneragencies:

2.1.1 Self Management

Participation in physical activity should be considered as an essential component ofsuccessful self management as it contributes to physical and mental health, providesopportunities for social interaction and can motivate people to try new activities. Thefollowing describes some of the initiatives that we currently support:

Step It Up Highland9 provide health walks throughout the north Highland region, with 29regular active groups and around 300 participating walkers. The recent addition oftargeted mental health walks, initially in the Inverness area highlights the benefits ofregular outdoor activity and walking for people with a range of mental health issues. InArgyll and Bute, there are 8 established health walk groups with around 180 participatingwalkers, under a variety of co-ordinating bodies. Overall, access to this kind of activityacross NHS Highland is good, but opportunities to extend this are being encouraged.

Outdoor activity opportunities, including bushcraft and environment management are usedin different parts of NHS Highland to support mental health– e.g. Blarbuie Woodlands10 in

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Lochgilphead, and Abriachan Forest Trust11 which links regularly with New CraigsHospital.

Cairngorms Outdoor Access Trust run a range of health walks within the National Parkboundaries, and we provide health improvement expertise.

Argyll and Bute continue to run an exercise on referral service, Argyll Active12, which issupported by local authority leisure staff.

Inclusion of the provision of physical activity in rehabilitation as a key focus of continuedservice improvement planning, through the emerging Rehab Network.

Development of work to include the role of increased physical activity across our agingpopulation as a key early stage contribution to falls prevention is being progressed.

Highland Homeless Active Referral Scheme was cited as an exemplar project in a WorldHealth Organisation compilation of good practice in promoting physical activity indisadvantaged groups and was a runner-up in the Physical Activity and Health AllianceAwards in 2010.

2.1.2 Work with Partner Agencies

Most of our work involves aspects of partnership working, but some further specific examplesinclude:

Lawson Memorial Greenspace Project is a partnership between NHS Highland, ForestryCommission Scotland, Scottish National Heritage, Sutherland Partnership and localcommunity and Friends groups which has successfully planned, consulted on andsecured funding for improvements to hospital grounds, including walking paths. It is thefirst project of its kind in Scotland, and is also being used as a case study in a majorresearch project to develop and pilot guidelines for community involvement in hospitalgreenspace projects across the country.

Both Argyll and Bute and Highland Councils have in place physical activity and sportstrategies to which NHS Highland has contributed. Both are due for review, and thisprocess in each case is subject to significant structural developments. Argyll and Bute arecompleting the final stages of a comprehensive facilities review, from which will emergepriority health and community inclusion goals. Highland Council is finalising the creationof an Arms Length Organisation in which all leisure services will reside. A continuingpartnership approach to ensure health and well being remain as priority objectives inthese strategies is underway.

The healthy Weight strategy action plan includes targets for “Active travel” - a term usedfor modes of travel that incorporate some form of exercise, and are generally limited tocycling and walking.

The Active Travel objectives are:

To increase awareness of the benefits of active travel. To increase the number of healthcare journeys made by active and sustainable travel

modes. To ensure actions achieve best value.

Work to support the active travel objectives includes involvement with key transportpartners in the Health and Transport Steering Group, which was convened in NHSHighland area in direct response to the government’s Healthcare Transport Framework(Nov 2009)14. The group developed an Action Plan which aims to ensure that patients,visitors and staff are able to access healthcare premises by convenient, affordable andsustainable transport that is appropriate to their needs. In addition, there are actionsproposed to minimise the environmental impacts of journeys to healthcare services.

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In support of the promotion of cycling as a travel option during work time, there are plansto explore the feasibility of increasing the NHSH cycling travel rate from 8p per mile to20p per mile in line with recommendations from Cycling Scotland, HMRC and adopted bythe Highland Council. It is hoped that this will promote bike usage for work travel and aresultant exponential reduction in car / public transport travel. Highland Council’s newrate was introduced in September 2010. It is too soon to assess impact on businesstravel, but there is an ever increasing number of bikes that are brought to work forcommuting purposes and potential business use.

2.2 Infants, Children and Young People

Some key achievements that demonstrate the cross-sector, partnership, and strategicpresence of the Healthy Weight strategy are:

In North Highland the Your Choice to Healthy Living, and the associated cross sectorHealth Action Group has had a significant impact on delivering improvements aroundmany aspects of Health & Wellbeing in Curriculum for Excellence, including schools’food and nutrition, health promoting environments, etc. The nutritional standardswork has now begun to extend beyond the school community to leisure facilities inproximity to schools. An information sheet outlining the full range of child healthyweight work from prevention to treatment, throughout North Highland is attached(Appendix 2).

In Argyll and Bute early years work is encompassed in the Food and Health StrategicPlan which has engaged with many partners and brought a focus to healthimprovement through improving the access and availability to good food for manysectors (Appendix 3).

Maternal & Child Nutrition Best Practice Guidance15 was developed by a multi-agencysteering group in response to the Scottish Governments Chief Executive’s letter 36on improving maternal and infant nutrition. It outlines practical best practice for allthose involved with improving nutrition before and during pregnancy; breast andinfant feeding; toddler nutrition and the early years. A training needs analysis acrosslocality multi-agency teams has now been completed and a training package is beingdeveloped.

Both the Single Outcome Agreement (SOA) and Health Efficiency Access Treatment (HEAT)targets for Child Healthy Weight set completion rates of a family based child (aged 5-15years) healthy weight interventions between 2008 and 2011. This has now been extended to2014 and children aged 2-15 years. A local 8 week programme was developed which wasbased on guidance from the Scottish Government. Difficulties in recruiting to, and deliveringthis programme led to the design and implementation of a 2 week schools based programmewhich meant that we exceeded our target of 484 interventions by March 2011. However, wenow need to return our focus to the delivery of an 8 week programme to overweight andobese children. A menu of options are currently being developed which include individualsessions, a schools programme, and community classes. This approach was recentlydiscussed at the NHSH Improvement committee and the programmes will be launched in theAutumn for the beginning of 2011/12 new school year.

2.3 Adult Healthy Weight Pathway

The North of Scotland Planning Group (NoSPG) established the North of Scotland WeightManagement Sub Group (NoS WMSG) in March 2010. The aim of this group was to exploreand develop proposals for an integrated weight management pathway across the North ofScotland (NoS), with agreed criteria for access to tertiary services within the context of awider obesity management pathway for those with Severe/Complex Obesity.

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In response to the NoS review, NHSH established a Short Life Working Group (SLWG) toproduce a range of proposals for the development of a specialist weight management servicein Highland for those with severe and complex obesity, because the provision of weightmanagement services throughout NHSH has historically been variable in both quality andaccessibility. An adult healthy weight pathway is under development as part of NHSHighland’s Healthy Weight strategy in order to provide a clinical evidenced based service forpatients who require support in managing their weight.

The pathway describes options for intervention at four levels commencing with support andinterventions in the primary care setting (Level 1), to structured weight managementinterventions (Level 2), a specialist weight management programme (Level 3), to surgicalinterventions at Level 4. Criteria for referral at each level has been developed whichrecognise co-morbidities and the complexities of behaviour change.

To date there has been a variety of weight management provision at Levels 1 and 2, noprovision at Level 3 and an unstructured access to surgery at Level 4.

The pathway and supporting documentation has been piloted circulated for comments tocertain interested practitioners including dietitians, GPs and practice nurses.

Level 2 interventions in primary care have been supported by the roll out of Counterweight®throughout Scotland. Counterweight® is a practice nurse led, one-to-one structured weightmanagement programme, for obese patients (BMI ≥30 or BMI ≥28 + co-morbidities), which was introduced to all Boards, supported with 2 years funding from the Scottish Government(2009-11). To date 39 practices across NHS Highlands are delivering Counterweight®, bynurses, physiotherapists, GPs, health visitors and health care assistants. 658 patients inNHS Highland have started on the programme. The latest weight change data werecollected in October 2010 and compares well with the national trend and published data ofCounterweight®.

Healthy Weight Well North is one of 6 pilot anticipatory care projects throughout the North ofScotland. It is based in south Skye and Lochalsh and is taking a community approach tosupporting healthy weight. A steering group representing over 30 local communityorganisations has been established and activities such as walking groups, cooking classesand community gardening have either been established, or are due to commence over thesummer. The Well North Evaluation report16 acknowledged the delay in commencing thisproject due to difficulties in staff appointments, but there is now a bedrock of communitysupport for the project and the idea of community engagement has great potential.

3 Contribution to Board Objectives

The Healthy Weight Strategy will contribute to:

H3: achieve agreed completion rates for child healthy weight intervention programme(2014)

H8: achieve agreed completion rates for inequalities targeted cardiovascular HealthChecks

Increase the proportion of newborn children who are exclusively breast fed at 6-8weeks.

SOA: healthy life expectancy is improved especially for the most disadvantaged SOA: the health and independence of older people is maximised SOA: the impact of poverty and disadvantage is reduced SOA: the cycle of deprivation is broken through intervention in early years.

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4 Outcomes Monitoring

The ultimate outcomes of the Healthy weight strategy result from behaviour changes in dietand physical activity to secure goals of a healthy weight population and associated healthimprovements; these outcomes have always been difficult to measure and collate at a locallevel. But there has been some progress in some areas:

NHS Highland has been collecting routine height and weight of children in Primary 1 (P1) for2 years (08/09 and 09/10), and this data is used to calculate Body Mass Index (BMI):

NHS Highland All participatingboards

Year 08/09 09/10 08/09 09/10

Number of P1 children measured 2,825 2,971 33,075 39,056

% Overweight (includes obese and severelyobese)

24.1 23.9 19.8 20.4

ISD 2009/1017

With only two years data it is difficult to draw conclusions in comparison to Scottishaverages; it appears that children in Highland are more overweight and obese (24%) thanthe Scottish average (20%). Highland achieves good data collection rates with a highproportion of eligible children being measured. Rates of overweight and obesity in Scottishchildren have remained constant over the last 10 years (20%). Children’s BMI is related tothat of their parents and there is some indication that adults in Highland are also heavier thanthe Scottish average (64.5% v. 62.4% Scottish Health Survey 200318).

We plan to adopt the national outcome and process indicators in the recently publishedCOSLA/Scottish Government Obesity Route Map Action Plan (2011)4 which are, or will be,available at health board or local authority level:

National Indicator

Proportion of men and women overweight and obese Health Board from 2012

Proportion of children overweight and obese Local Authority and HealthBoard

Prevalence of type 2 diabetes in Scottish population Health Board from 2009

Proportion of adults meeting physical activity guidelines Health Board from 2012

Proportion of adults engaging in active travel to work Local Authority every 2 years

Proportion of children engaging in active travel to school Local Authority every 2 years

Number of work places securing Healthy Working Lives Health Board

4 Governance Implications

Staff Governance – this strategy is for everyone who lives and works in Highlandand Argyll and Bute, including all staff of NHS Highland, and thus has implications forstaff as individuals and for their interactions with others.

Patient and Public Involvement –the Equality and Diversity Impact Assessmenthighlighted various elements of the strategy for patient and public involvement and aninitial assessment for public and voluntary sector engagement is underway. Publicrepresentation is a major focus the Well North Healthy Weight project and a parentalneeds assessment is for the Children’s Healthy Weight interventions is underway.

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Clinical Governance - the patient care pathway will be based on the best availableevidence and will require a change in interventions with patients, communities’ andreferral procedures.

Financial Impact – there are no dedicated funds to implement this strategy. Somespecific initiatives have dedicated funding. An asset based approach seeks to ensurebest value through partnership working. Implementation of other key elements withinthe strategy will depend on the availability of financial resource.

5 Impact Assessment

An impact assessment was completed by September 2008, with no major changes to thestrategy. The Planning for Fairness approach is integral to the development of all newhealthy weight interventions.

Fiona Clarke Dan JenkinsSenior Health Promotion Specialist Health Promotion SpecialistPublic Health Public Health

27 May 2011

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References

1. Healthy Eating Active Lives. Scottish Government 2008.2. Foresight Tackling Obesities: Future Choices – Project Report Government Office for

Science. HMSO 20073. Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy

Weight. Scottish Government 2010.4. Preventing Overweight and Obesity in Scotland: An Action Plan. Scottish

Government 20115. Scottish Intercollegiate Guidelines Network, 115 Management of Obesity – a national

clinical guide. NHS QIS 2010.6. Dietary Reference Values for Food Energy and Nutrients for the UK. HMSO 19917. Lets Make Scotland More Active – A Strategy for Physical Activity -

http://www.scotland.gov.uk/Publications/2003/02/16324/178958. NHS Highland Healthy Weight Strategy–

http://www.nhshighland.scot.nhs.uk/Publications/Pages/HealthyWeightStrategyPart2.aspx

9. Step It Up Highland - http://www.stepituphighland.org.uk/10. Blarbuie Woodland - http://www.reforestingscotland.org/projects/blarbuie.php11. Abriachan Forest Trust - http://www.abriachan.org.uk/12. Cairngorm Outdoor Access Trust - http://www.cairngormsoutdooraccess.org.uk/13. Argyll Active - http://www.argyll-bute.gov.uk/community-life-and-leisure/argyll-active14. Healthcare Transport Framework. NHS Health Scotland, Scottish Government. Nov

2009.15. Maternal & Child Nutrition Best Practice Guidance, NHS Highland 2010.16. North of Scotland Public Health Network: Well North Evaluation Report -

http://www.nosphn.scot.nhs.uk/?page_id=57817. Child Health Obesity statistics www.isdscotland.org/isd/363018. Scottish Health Survey 2003

www.scotland.gov.uk/publications/2005/11/25145024/50251

Appendix 1Obesity Route Map Action Plan

Actions for public sector organisations

These actions have been taken from the COSLA/Scottish Government Obesity Route Map Action Plan (2011) which has recently been published andprovides an action plan which is aligned to the Healthy Weight Strategy. A separate set of indicators has also been issued and we plan to use boththese documents to guide the implementation and monitoring of existing local plans.

Action Strategic links to current local plans

Continuing the excellent progress of the Schools (Health Promotion and Nutrition) (Scotland)Act 2007 and the subsequent Nutritional Regulations in making schools exemplary healthpromoting environments. We will encourage the uptake of balanced and nutritious schoolsmeals across all age groups by: (i) working towards providing free school lunches to morepupils in the earliest years of primary schools;

(ii) working with the food industry to deliver a wider variety of reformulated popular optionscomplying with the nutrition regs; and (iii) supporting schools to make remaining in school forlunch more attractive to secondary school pupils through a range of innovative approaches.

Your Choice

A&B Food And Health Action plan

Exploring measures to restrict access by children to nutritionally inappropriate meals and highenergy and energy dense foods from businesses located in the vicinity of schools.

Supporting implementation of the 'Beyond the School Gate' benchmarking guidance forcommunity planning partnerships on provision of lower energy and less energy-dense foodoptions in the community, for example through limiting the number of fast food outlets nearschools, leisure centres, parks and youth centres and encouraging the provision of outlets forhealthy convenience food and drink.

Your Choice

A&B Food And Health Action plan

Facilitating collaborations between schools and local food outlets to promote appealing,affordable lower energy and less energy-dense options for pupils who choose to leave schoolfor lunch.

Your Choice

A&B Food And Health Action plan

Working across the public sector to promote and support the procurement of lower energy andless energy-dense products and to support the adoption of nutritional standards analogous tothe school Nutritional Regulations 2008 to vending machines, retail outlets and public and staffcatering facilities in NHS and Local Authority premises and other public sector organisations.The leadership of the public sector will set an important example which we would wish to seeemulated by the private sector.

NHS + LA catering and procurement

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Action Strategic links to current local plans

Ensuring that everyone has access to opportunities to learn how to shop for and cookaffordable healthy meals from raw materials.

Multi agency

Increasing people's understanding related to food and diet across the population, includingthrough the Curriculum for Excellence. Schools are a crucial setting in which to equip childrenand young people with the skills to choose, purchase and prepare lower energy and lessenergy-dense meals and snacks. While schools offer valuable opportunities to increaseawareness of healthy weight, it is important that this is done in a sensitive way that does notincrease stigma and undermine the mental wellbeing of children and young people

Your Choice

A&B Food And Health Action plan

Delivering the Cycle Action Plan for Scotland. This draft plan proposes that by 2020 10% of alljourneys are made by bicycle.

NHSH Health and Transport FrameworkHC Physical Activity and Sport StrategyHC Sustainable Development TeamA&B Sport and Physical Activity Strategy

Continuing to provide support to Sustrans to maintain and extend the National Cycle Networkand provide safe routes to schools for children who wish to cycle or walk to school and toCycling Scotland to promote cycling more generally.

Your Choice

A&B Food And Health Action plan

Ensuring that in all our actions responding to the National Indicator (4) to reduce the proportionof driver journeys delayed due to traffic congestion we are promoting active travel, not creatingincentives for greater personal car use for short and local journeys.

NHSH Health and Transport FrameworkHC Physical Activity and Sport StrategyHC Sustainable Development TeamA&B Sport and Physical Activity Strategy

Using the opportunity afforded by the National Planning Framework for Scotland 2 (NPF2),which specifically seeks to 'promote development which helps to improve health, regeneratecommunities and enable disadvantaged communities to access opportunities', to ensure thatpolicies in development plans have a positive impact on active living and healthy weight.

NHSH Health and Transport FrameworkHC Physical Activity and Sport StrategyHC Sustainable Development TeamA&B Sport and Physical Activity Strategy

Implementing the lessons learned from pilots such as the Equally Well Test Site in Glasgowabout ways community partners can work effectively together to integrate health improvementinto city planning.

HC planningA&B planningCommunity planning

Applying robustly, in development plans and development management decisions, the priorityorder for personal travel opportunities (walking, cycling, then public transport, followed by thecar and other means of motorized vehicles) as set out in Scottish Planning Policy (SPP).

HC planningA&B planningCommunity planning

Ensuring that the placemaking provisions of Scottish Planning Policy, in particular those in'Designing Places', 'Designing Streets' and the provisions for open space and physical activityfrom the SPP are put into practice through ongoing training, promotion and dissemination.

HC planningA&B planningCommunity planning

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Action Strategic links to current local plans

Encouraging excellence and innovation in designing communities that incorporate a range offeatures that reduce car dependency, increase active travel and create attractive, accessibleopen spaces for recreation through the Scottish Sustainable Communities Initiative. Thesharing of this innovation and practice will help improve the quality of Scotland's builtenvironment.

HC planningA&B planningCommunity planning

Supporting the creation and maintenance of safe, attractive and accessible greenspace,including green transport corridors, close to where people live.

HC planningA&B planningCommunity planning

Make our communities safer and stronger and reduce the fear of crime through the SaferStreets Programme and the Safer Communities Programme so that more people feelcomfortable and secure being active outdoors in their neighbourhoods.

HC planningA&B planningCommunity planning

Responding to people's concerns about the safety or convenience of active travel by using adiverse range of means including:

(i) expanding safe cycling and pedestrian routes to link key community destinationsincluding public transport hubs, hospitals, supermarkets and centres of employment

(ii) publicising the availability and benefits of local pedestrian and cycle routes andimproving signage to popular destinations;

(iii) clearing up environmental dereliction such as poor lighting, vacant sites and animalfaeces that discourage people from walking in their local neighbourhoods; and

(iv) using social marketing approaches tailored appropriately to audiences dependingon their current levels of activity and motivation, with particular attention on thosewho are especially inactive or vulnerable in other respects.

HC planningA&B planningCommunity planning

Implementing widely the lessons learned from the Smarter Choices Smarter Places activetravel demonstration towns about which interventions, including both incentives for active traveland disincentives for car use, are most effective in achieving greater uptake of travel options,particularly by the least active groups.

HCA&BNHSHCommunity planning

Providing and maintaining physical environments in every community that promote healthylifestyles for children including opportunities for play, physical activity and healthy eating.

HCA&BNHSHCommunity planning

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Action Strategic links to current local plans

Working with SportsScotland to ensure the provision of opportunities for all children and youngpeople to participate in physical activity and sport and enabling the creation of pathways fromthe school to the wider community.

HC Physical Activity and Sport StrategyA&B Sport and Physical Activity StrategyActive Schools

Working together to find realistic ways of maximising physical activity within the schoolenvironment

HC Physical Activity and Sport StrategyA&B Sport and Physical Activity StrategyActive Schools

Developing curricular and non-curricular activities for children to gain the skills and confidenceto enjoy more active lives, through Active Schools, Safe Routes to Schools and opportunitiesfor outdoor learning

HC Physical Activity and Sport StrategyA&B Sport and Physical Activity StrategyActive Schools

As part of A games legacy for Scotland, using the inspiration provided by Glasgow 2014Commonwealth Games and other events such as London 2012 to encourage all Scots – youngand old – to be more active.

NHSHHCA&B council

Promoting positive environments for children and families through all our planning,regeneration and transport policies

HCA&B councilNHSHCommunity planning

Implementing the Maternal and Infant Nutrition Strategy NHSH

Continuing to develop and roll out the Getting it right for every child change managementprogramme for services affecting children and young people, founded on well-being indicatorsincluding healthy and active that encourage attention to diet and activity.

Planning for integrationA&B council and CHP

Investing to ensure that all pregnant women, and women with children aged under 4 who areeligible for Healthy Start are aware of, and apply for the Healthy Start vouchers.

NHSH

Investing to ensure that more babies are breastfed, and for longer. NHSH

Investing to support pregnant women and new mothers to develop healthy lifestyle behavioursfor example through the key elements of parenting programmes and community capacitybuilding in the Early Years Framework.

Planning for integrationA&B council and CHP

Investing to support parent’s knowledge about how they feed themselves and their babiesparticularly when babies make the transition onto solid foods.

Planning for integrationA&B council and CHP

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Action Strategic links to current local plans

Investing in a programme of education and support on maternal and infant nutrition for allthose working with parents and families to provide the best quality information and support toall parents about how they feed themselves and their babies.

Planning for integrationA&B council and CHP

Working together to develop a clear vision of the role of the public sector in promoting thehealthy working lives (HWL) approach, given that the public sector in Scotland accounts foraround 25% of the workforce.

NHSH HWL

Continuing to invest in the healthyliving award by securing commitment from all public sectoremployers with catering outlets to register for and achieve the healthyliving award in the firstinstance and thereafter the healthyliving award plus.

NHSHHCA&B Council

Following up CEL 14 (2008), Health Promoting Health Service - Action in Acute Care Settings,to ensure that NHS Boards continue to take action to implement specific health promotingactions in relation to alcohol, smoking, breastfeeding, food and health and healthy workinglives. It is likely that the focus of HPHS will be extended to include additional topic areas

NHSH

Encouraging NHS Boards to consider possible roles for public health and occupational healthin supporting the establishment of partnerships involving local businesses, and in supportingthe implementation of workplace programmes for the promotion of healthy weightmanagement, taking account of any relevant national and local schemes.

NHSH HWL

Encouraging all public sector organisations to set an example to other landowners by usingtheir estate to support greater activity by signposting walks and cycle routes.

NHSHHCA&B Council.

Despite a very complex world of influences on lifestyle

and food choices which may be unhealthy we are . . .

Child Healthy Weight in Highland

More active more often

Promoting school meals

Leisure centres

Promoting breast feedin

g

Active travel

Doing more

Creating health & wellbei

ng re

sou

rces

Providing healthy snacks

Promoting the outdoorsParents as partners

Empowering families

AC

T IV

E SchoolMeals

Leisure Centre

Eat wellStay healthy

Healthy Food

and snacks

Cafe

Prepare yourown healthysnacks

HealthyChoices

School

High Life

DoingMore

Cuideam Fallain Chloinne sa Ghàidhealtachd

Despite a very complex world of influences on lifestyle

and food choices which may be unhealthy we are . . .

Child Healthy Weight in Highland

Cuideam Fallain Chloinne sa Ghàidhealtachd

More Active More Often • Nas Gnìomhaiche Nas TriceGetting more children, more active, more oftenThrough Active Schools programs participation has increased amongst “hard to reach” groups (targeting inactive young people, girls and young women, disabilities, minorities, economically deprived, geographically isolated, and young people in transition stages).

Active Schools Co-ordinators organise a wide range of physical activity opportunities for young people, many targeted at otherwise hard to reach groups.In statistical terms, the previous 3 academic years of Active Schools (July 2007 to June 2010) has provided 66,499 activity sessions (43,074 primary age; 23,425 secondary age) resulting in:

• 1,268,721 participants (822,608 primary age; 446,113 secondary age)• 2,065 individual volunteers involved in supporting activities each term • 45 different types of activity provided each term• 156 community sports clubs supporting activity each term

Physical Education, Physical Activity and Sport in Primary Schools

PE in Highland schools aims to improve aspects of fitness and develop a positive attitude to physical activity, dance, sport and outdoor learning. Primary School Teachers have been provided with the opportunity to become specialist deliverers of physical education with a Post Graduate qualification in Primary PE, the specialist courses have been running for three years in Highland.

Promoting School Meals • A’ Brosnachadh Biadh SgoilePromoting school meals and free school mealsThe Highland Council Catering Teams work hard in continually developing nutritionally balanced menus and promotions in order to provide an appealing lunch which includes tasty, appetising, wholesome meals and snacks. Schools work in partnership to increase uptake of school meals including those who take a free school meal.

Leisure Centres • Ionadan Cur-seachadMaking sure that Leisure centres convey healthy images and offer healthy drinks / snacks tooThere is encouraging support for the implementation of school guidelines for healthy food and drinks in Leisure centres – especially in those Leisure centres that are in close proximity to schools.

Promoting Breastfeeding • A’ Brosnachadh Biadhadh-broillichPromoting breastfeeding by education and making establishments ‘friendly’Already present in some Primary schools, breastfeeding education is being piloted in secondary schools. This vitally important area has implications not only for the health of future generations, but how society views and supports new mothers and their feeding choices. The Baby Welcome Sticker Scheme is expanding throughout Highland’s public places.

Creating Health and Wellbeing Resources • A’ Cruthachadh Stòrasan Slàinte is MathaisCreating are own innovative Health and Wellbeing resources such as ‘Rising Stars’ and ‘Eat Your Words’ - Story Telling ResourceHighland has a strong reputation for producing high quality, well-designed and useable resources for teachers, health professional and others who work with children and families.

Healthy Snacks • Greimeagan FallainEnsuring all schools have Healthy Tuck shopsHealth eating guidance for tuck shops that enables schools to continue to provide attractive and viable snack and drinks sales whilst not compromising the health of pupils or consistent healthy messagesEncouraging all childcare providers to offer healthy snacks and opportunities to learn about preparing and enjoying foodAll pre-schools, breakfast and after-school clubs have guidance on the provision of nutritious foods and drinks and on developing opportunities for social development through eating together.

Promoting the Outdoors • A’ Brosnachadh a’ Bhlàir a-muighPromoting the outdoors for learning and playingFrom pre-school waterproof suits and wellies, to promoting Crofting Connections, supporting Community Woodland developments and bushcraft skills, our environment provides a wealth of opportunities to enjoy the physical and mental health benefits of being active outdoors

Parents as Partners • Pàrantan mar Chom-pàirticheanRaising parents’ awareness of the impact of physical activity on children’s developmentAll new parents of 0-5 year olds receive the play @ home books with practical ideas for active games that are fun to play, for both children and adults. The books explain how simple activities help children’s physical, emotional and intellectual development.Finding out the issues that are important to parentsAn online survey of parents and others involved in bringing up children asks parents if healthy weight and food topics are important issues for them and if so, what help they would like to see. This will be developed as a new programme of parenting support.

Empowering Families • A’ Comasachadh TheaghlaicheanProviding a targeted service to families who may be overweight or obeseWe know that 23.9% of primary one children are overweight with 8.9 % classed as 'obese'. Empowering, interactive, community programmes emphasise family communication and confidence to make sustainable healthy choices.

High Life • Sàr-bheathaGetting more families and adults to access leisure through HighlifeThe High Life scheme is viewed as exemplar practice in Scotland. Since its inception, participation rates have increased by 40% and continued to grow. The range of very affordable access options, and the single price for families regardless of numbers of children, allows whole families to participate together, and supports multiple activity choices.

Active travel • Siubhal GnìomhachMaking travelling to school easier by cycling or walkingthrough the provision and promotion of Walk to School routes and Walking Buses, cycling proficiency training, secure bike parking, campaigns to stop car-parking at school gates, reward schemes for pupils

Doing More • A’ Dèanamh BarrachdWe know that the levels of overweight and obesity are higher in Highland children (and adults) than the Scottish average. So, it is clear that we need to maintain the focus on developing and improving our healthy weight initiatives. Statistics show that 24% of Highland children are overweight or obese, the Scottish average is 20%. The same is true of adults (65% in Highland and 62% in Scotland).

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Fiona Clarke Fiona.clarke3@nhs.net Senior Health Promotion Specialist (Nutrition and Health)

Dan Jenkins dan.jenkins@nhs.net Health Promotion Specialist Healthy Weight

Louise Jones louise.jones@highland.gov.uk Health Promoting Schools Manager

Keith Walker keith.walker@highland.gov.uk Health Improvement Policy Officer

For further information or to share your ideas please contact

Poster design by graham@ogilviedesign.co.uk

food and healthStrategic Plan for Argyll and Bute

An information leaflet from Argyll and Bute Community Planning Partnership

Argyll and Bute: Leading Rural Area Vibrant Communities

Outstanding EnvironmentForward Looking

Food and Health Strategic Plan for Argyll and Bute Food and Health is more than just nutrition – it also encompasses a healthy food economy, a healthy environment and social justice. Action to support food and health is required by many of us.

Argyll & Bute Food & Health Strategy Group is a Community Planning Partnership group with representation from key partner organisations across Argyll and Bute. This group has produced an integrated, comprehensive food and health plan.

For maximum benefit we need to make use of the plan, working together on identified priorities to achieve shared outcomes.

A strong local food economy is key to ensuring access to fresh local food.

Argyll and Bute: Leading Rural Area Vibrant Communities

Outstanding EnvironmentForward Looking

The four main themes of the plan are:

Health – improving access, availability and affordability of healthy food which leads to healthier eating can benefit both physical and mental health, and promote a sense of wellbeing.

Social – the social and cultural value of food needs to be recognised and enhanced; producing, distributing, selling, preparing and eating food involves making social contacts, and can help to create community cohesion and reduce isolation as well as supporting aspects of health.

Economic – supporting and developing a sustainable local food economy has both direct and indirect economic benefits:

direct – generating incomes via local employment and development of small enterprises linked to producing, processing, marketing and retailing

indirect – through education, recreation, economic diversity, changes in land use

Environmental - food production and consumption has impacts on waste management, biodiversity, food miles and carbon footprints.

The Plan can help you to:• act as reference when developing policies, strategies

and funding bids

• link up with other partners in your area working on similar activities

• act as a lever to seek funding

• get ideas for future joint actions

• find out what is happening across Argyll and Bute in relation to food and health

Access the Food and Health Strategic Plan for Argyll and Bute via:www.argyll-bute.gov.uk/yourcouncil/partnerships/cpphomepage1/

WEALTHIER & FAIRER SMARTER HEALTHIER SAFER & STRONGER GREENER