Health Promotion Proposal Reducing Obesity Health And Social Care Essay

health forward motion Proposal Reducing corpulency Health And Social C argon turn upThe increase in fleshiness has been identified as a major public health threat. It has been predicated by the Government Office for cognizance Foresight that without pickings achieve n archaean 60% of the UK creation impart be rotund by 2050, which would have serious financial consequences for the NHS and the providence.1The causes are complex and related to behavioural, neighborly and surroundingsal factors in that locationfore to tackle corpulency a range of agencies and communities need to work together toChange the obesogenic nature of the local milieu.Develop opportunities to require well-preserved choices easier.Help those already obese or at graduate(prenominal) risk of becoming obese.This schema provides a framework for local action and seeks toProvide an rationality of the extent of the problem in the local creation and sets goals.Provide leadershiphip by bringing toge ther a multi agency group.Choose interventions that evidence has shown to be effective.Enable monitoring and evaluation.Build up local capacity via training. in that location is a focus on childhood leaden and fleshiness in melody with government recommendations. This two year evidence base strategy will require funding, the costs and resources required are provided in the action plan.2.0 The organisation2.1 The geographic domain and worldTo make up the target population for this strategy, 90% of Prestons population and 15% of South Ribble were chosen, this is a population of approximately 150,000.Prestons health profile3 shows in that respect are inequalities with nearly 40% of the residents living in the most deprived quintile. The percentage of children classified as obese is similar to the Eng primer average. South Ribbles health profile4 shows slight than 5% of residents living in the most deprived quintile, child poverty and deprivation rates are low, the percentage of children classified as obese is expose than the England average. Preston has a Black Minority Ethnic (BME) population of 15.5% which is greater than the England average, the largest majority be Asian (Indian the majority) or Asian British.3 South Ribble has a BME population of slight than 5%.4To find the population had a range of companionable classes, age groups and ethnic groups, two of the most deprived wards of Preston (Ribbleton GL and Fishwick GB) total population 12,720 were replaced with 3 slight deprived wards of South Ribble (Broad Oak GC, Kingsfold GL and Middleforth GU) total population 12,430, see Figure 1. This ensured the target population for the purpose of this strategy was approx 150000 with mixed class, age and ethnicity. The geographical area for the purposes of this strategy is called Preston Ribble Council.Figure 1 Wards of Preston (A) and South Ribble (B) 5(A)(B)KEYSource http//www.lancashire.gov.uk2.2 Health ImprovementAs bring out of Preston Ribble Council, the Health Improvement Team delivers a range of services and health efforts designed to improve the health and upbeat of the population of Preston Ribble.The health improvement team includes public health consultants and practitioners who work with the NHS, other organisations, the voluntary sector and local business to provide education and training services to empower residents of Preston Ribble to make hearty lifespanstyle choices.Health improvement and tackling inequalities is an intrinsical part of Preston Ribble Councils Culture. All policies that support health improvement are evidence based. Partnership working is a necessity to deliver the health improvement agenda.3.0 Obesity strategy maturementObesity is a multi-faceted problem and thence requires a multi-agency solution. A multi-agency Obesity system Group was set up with key partners from the topical anaesthetic Authority, NHS and the voluntary sector to develop this strategy. The group was lead by the Health Improvement teams consultant in public health. It sets out how partners and communities will work together to reduce obesity by taking into account the specific needs of the local population. This strategy will link in with other strategic plans to ensure tackling obesity is extravagantly up on the political agenda of Preston Ribble Council.4.0 Background4.1 Defining dense and obesity big(a) and obesity are terms used to pull in excess body fatness which weed lead to adverse effects on health and wellbeing.2 operose and obesity occurs when energy intake from food and befuddle is greater than energy expenditure i.e. what is used by the body. The causes however are more complex and related to behavioural, social and environmental factors.2The calculation of BMI body vision index (BMI=weighting/(height)2) 30 kg/m2.is a widely accepted definition obesity. The World Health Organisation produced a classification of overweight adults based on BMI, see mesa 1. submit 1 C lassification of overweight adults.6Classification BMI (Kg/m2) Risk of co-morbiditiesUnderweight Clinical problems increase)Normal weight 18.5 24.9 AverageOverweight 25Pre-obese 25 29.9 IncreasedObese class I 30.0 34.9 ModerateObese class II 35.0 39.9 SevereObese class II 40.0 very(prenominal) severeSource Obesity preventing and managing the global epidemic. composing of a WHO Consultation. Geneva. World Health Organisation, 2000 (WHO Technical Report Series, No 894)Guidance published by the theme Institute for Health and Clinical Excellence now recommends the use of waist circumference in conjunction with BMI as the method of measuring overweight and obesity and determining health risks.7Because a childs BMI varies with age and sex, the BMI score for children is related to the UK 1990 BMI growth reference charts.84.2 Obesity and HealthLife expectancy is reduced in obesity cases by an average of three years, and in severe obesity cases (BMI 40) life expectancy is reduced by eight to ten years.9 It has been estimated that the cost to the UK economy from overweight and obesity was 15.8 billion per year in 2007, 4.2 billion of which were costs to the NHS.9Childhood obesityShort term risks mostly include emotional and psychological affects associated with being overweight through being teased by peers, resulting in low self esteem and depression. There are longer term consequences as obese children are more likely to become obese adults, there are however some obesity related conditions such as type 2 diabetes which have increased in overweight children.9Adult obesityEvidence has shown that adult obesity is associated with a range of health problems including those related to the musculoskeletal ashes because of the extra strain on joints circulatory corpse e.g. coronary heart disease and stroke metabolic and endocrine system e.g. type 2 diabetes cancers such as breast and colon reproductive problems gastrointestinal and liver disease and psychological and social problems.95.0 The scale of the problem in the UKWithin the last 25 years, the prevalence of obesity in the UK has more than doubled.1 The latest Health Survey for England (HSE) in 2009 showed that the counterpoise of obese men increased from 13% in 1993 to 22% in 2009 and from 16% of women in 1993 to 24% in 2009 i.e. more women are obese than men, there were however more overweight men (44%) than women (33%).10 The 2007 Foresight Report predicted that if no action were taken, by 2025 47% of men and 36% of women will be obese and Britain could be a mainly obese society by 2050, adding 5.5 billion annual cost to the NHS.1The rise in obesity among 2-10 year olds from 1 in 10 in 1995 to 1 in 7 in 2008 appears to be flattening out.10 There are however, still 1 in 5 children that are overweight or obese by the age of 3 years.11 pass judgment of obesity are postgraduateer among some Black and Minority Ethnic (BME) communities and also in lower socioeconomic groups.12 The lates t Health Survey for England in 2009 also showed the link amid obesity and deprivation, women in the lower income quintiles had a higher BMI and greater prevalence of obesity than those women in higher income quintiles, there was no apparent pattern in men,10 see Figure 2.Figure 2 Age-standardised prevalence of overweight and obesity by equivalised household income and sex.106.0 The scale of the problem in Preston Ribble Council.Using the comme il faut costing tool13 the selected population obesity and overweight prevalence and verse were calculated, see Appendix 1. The extent of the problem is summarised in Figure 3. There are an estimated 4511 children and young spate who are classified as obese (BMI over 30), and a further 4580 who are classified as overweight (BMI between 25 and 30). There are an estimated 31993 adults who are classified as obese and a further 51821 who are classified as overweight. 22.9% of adult females and 26.8% adult males are obese.Figure 3 the extent of the problem in Preston RibbleObeseOverweightNormal weightAdultsBMI 40 n=2105*BMI 30-39 n=29888*BMI 25-30 n=51821*Children Young peopleBMI 40 n=69*BMI 30-39 n=4442*BMI 25-30 n=4580**NICE costing toolThe National Child Measurement Programme (NCMP) introduced in 2005 get hold ofs to monitor the prevalence of overweight and obesity in children in Reception Year and Year 6. The table below presents the results for the local authorities of Preston and South Ribble compared to the North West and matter averages.Table 2 local anesthetic prevalence of overweight and obesity among children for the Local Authorities of Preston and S.Ribble and for England 2009/10 and 2008/09 14ReceptionYear 6OverweightObeseOverweightObese2008/09Preston10.98.513.117.3S.Ribble11.56.815.616.3NW13.59.614.118.9England13.29.614.318.32009/10Preston12.59.112.917.0S.Ribble15.38.514.018.0NW13.79.914.819.3England13.39.814.618.7Source http//www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesityTh e table above shows an increase from 2008/09 to 2009/10 in Reception Year in the numbers of overweight and obese children in both Preston and S.Ribble. In Year 6 there was just an increase in obese children in S.Ribble. The targeted population for this strategy is Preston Ribble, as the population is 90% Preston and 15% South Ribble these increases are clearly a concern.A report by Intelligence for florid Lancashire (Joint Strategic demand Assessment) on childhood obesity in Lancashire showed that measurements of year 6 pupils from the 08/09 NCMP dataset highlighted that across Lancashire there could be set extremes of weight (underweight and obese) in the most deprived areas and there was a link between higher levels of overweight and lower levels of deprivation.156.1 The local cost of obesityUsing the NICE costing tool for the target population of Preston Ribble, the estimated savings from implementing NICE guidance is approximately 43,000 savings on prescriptions and 127,000 i n GP contacts, see appendix 1. That is the current local cost to the NHS of not implementing NICE guidance for tackling obesity is approximately 170,000. There would be however additional costs with disease associated with overweight and obesity plus costs on the economy from sidereal days off work due to obesity and associated diseases and conditions.7.0 National Drivers and GuidanceReducing obesity is a national priority for government as highlighted in the recently published white paper Healthy Lives, Healthy People Our Strategy for public health in England.16 In January 2008, the government published the national obesity strategy Healthy Weight Healthy Lives.17 It highlighted the need for a long term approach and set out a new man Service Agreement target for EnglandOur ambition is to be the first major nation to reverse the rising tide of obesity and overweight in the population by ensuring that everyone is able to achieve and view as a healthy weight. Our initial focus wil l be on children by 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels.17In 2006 Nice Guidance on Obesity was issued, this set out guidance on prevention, identification, assessment and management of overweight and obesity in adults and children in England and Wales.7 In addition to the NHS the guidance was also aimed at non-NHS settings for example, local authorities, schools early years and workplaces and sets out recommendations aimed at these various settings. It was also highlighted that obesity cannot simply be addressed through behavioural change at individual level population based interventions are needed to change the obesogenic environment of modern industrialised nations.7The Foresight Report, Tackling Obesity Future Choices (2007) highlighted that obesity is determined by a complex multifaceted system of determinants and that in the 20th vitamin C the pace if technological revolution outstrips human evolution which has left an obesoge nic environment.1 To tackle the complexities of obesity the report advocated using a multi agency or entire system approach. The report concluded that Preventing obesity requires changes in the environment and organisational behaviour, as well as changes in group, family and individual behaviour.18.0 Effective interventionsResearch highlighted in the Foresight report1 found that the top five indemnity responses which they assessed as having the greatest average impact on obesity levels wereincreasing walkability/cyclability of the built environmenttargeting health interventions for those at increased riskcontrolling the availability of/exposure to obesogenic foods and drinksincreasing the responsibility of organisations for the health of theiremployeesearly life interventions at birth or in infancy. 19.0 The Local ApproachHealthy weight, healthy lives a cross government strategy for England17 and the accompanying Healthy weight, healthy lives a toolkit for developing local strateg ies2 have been utilize to develop this strategy for Preston Ribble. It supports the governments recommended approach of focusing on five key themesChildren Healthy growth and healthy weight. The stages of pre-conception, breast feeding, infant nourishment through to early years can shape outcomes and choices made in adulthood.18Promoting healthier food choices. Supporting the governments recommendation for progression of a healthy, balanced diet.Building physical legal action into our lives. Supporting the governments recommendation of promoting progressive living throughout the life course.Creating incentives for better health. Promoting action for maintaining a healthy weight in the workplace through promotion of healthy eating choices and more opportunities for physical activity within the workplace.Personalised support for overweight and obese individuals. Providing clinical care pathways to assess and manage overweight and obesity through effective weight management service s.A life course approach has been used to assess the various stages of peoples lives where evidence has shown targeting interventions can be successful in preventing or treating overweight and obesity. This strategy uses universal population preventative approaches in addition to targeted interventions for those already obese or at high risk of developing. As evidence suggests peoples lives are shaped from very early years11,18 this strategy focuses on childrens health.To help people overcome barriers to maintaining a healthier lifestyle and changing their behaviour, this strategy takes a combined approach as recommended in the Foresight Report1 that is using types of interventions that focus on the determinants of behaviour such as the environment and education, the second type of intervention focuses on the behaviour itself in those at risk.1 The strategy uses all 5 different approaches to health promotion, i.e. medical, behaviour change, education, empowerment and social change t o tackle both the determinants and the behaviour itself.10.0 The Obesity Strategy Aim and ObjectivesThe overall aim of the strategy is to reduce obesity levels in the local population of Preston Ribble. The strategy has three strategic themes with objectivesChange the obesogenic nature of the local environment.Develop opportunities to make healthy choices easier.Help those already obese or at high risk of becoming obese.10.1 Change the obesogenic nature of the local environmentObjectivesInfluence public policyInfluence businesses to become healthy workplaces hammer with communities to make active lifestyles easierAs planning and transportation policy development can have huge effects on opportunities for activity within the local built environment, it is essential that health issues such as obesity are considered in policy decisions, Health Impact Assessment (HIA) should form part of policy development. As part of this strategys action plan HIA training will be rolled out to planni ng and transportation teams within the council..Foresight report1 found that one of the five policy responses which they assessed as having the greatest average impact on obesity was increasing the walkability/cyclability of the built environment. The report highlighted that residents of highly walkable neighbourhoods are more active and have meagrely lower body weights than their counterparts in less walkable neighbourhoods, it was also highlighted how perceptions of social nuisances may increase the risks of obesity.1 Therefore key actions of this plan include interaction between environmental Health, Housing, practice of law and communities to tackle social nuisances, set up union action teams and working with communities to empower and reassure residents.Community food growing initiatives have been accepted as providing benefits to help tackle obesity, they can offer physical activity, increase food knowledge and give a better appreciation of food that helps them make health ier food choices, in addition they help create cohesive communities and social inclusion thereby reducing health inequality.19 Because of the potential health achieve this strategy aims to set up several community horticultural projects targeting the most deprived areas likely to have high risk individuals.The influence of the workplace on health of employees is well acknowledged and the Foresight report1 found increasing the responsibility of organisations for the health of their employees was one of the five policy responses which had the greatest impact on obesity. As part of this strategy the importance of this has been recognised and therefore a newly created health wellbeing workplace incumbent will be recruited to erect and ease the development of healthy active workplaces promoting the national cogitationwell campaign20 a health and wellbeing workplace award scheme will be launched.10.2 Develop opportunities to make healthy choices easier.ObjectivesEnable young childr en to eat a healthy dietEnable adults and families to eat a healthy varied dietThe stages of pre-conception, breast feeding, infant nutrition through to early years can shape outcomes and choices made in adulthood.18 In Tackling obesity through the healthy child programme, a framework for action evidence is presented which strengthens the argument for focusing interventions in the very early years, it is highlighted that epidemiological studies have shown once obesity is established in a child it can continue into adulthood.11 The Foresight report1 found that one of the five policy responses which they assessed as having the greatest average impact on obesity was early life interventions at birth or in infancy. Therefore this strategy focuses on early years as they have been identified as critical opportunities for interventions in the life course, see figure 4.Figure 4 Critical opportunities for intervention in the life course of an individual 1Source Government Office for Science (2007) Tackling Obesity Future Choices, Foresight Report. http//www.bis.gov.uk/assets/bispartners/foresight/docs/obesity/17.pdfBreastfeeding can provide protection against obesity and related health problems in later life22 and that by breastfeeding mothers are more likely to return to their pre-pregnancy weight.23 It has been recommended by the WHO and the Department of Health that breastfeeding should be encouraged for the first 6 months of life.24 This strategy includes actions to increase uptake of breastfeeding.Both parents and childcare providers have a role in ensuring children have healthy balanced diets. This strategy includes actions to help ensure healthy eating at childcare premises. A healthy eating award scheme for childcare will be launched to encourage and provide recognition to childcare providers.NICE guidance recommends a whole school approach to tackling overweight and obesity.7 Healthy weight healthy lives highlights the importance of schools in ensuring opport unities are provided for children to develop healthy eating habits. This strategy therefore supports Healthy Schools25 and also increasing the take-up of school meals.National qualitative research commissioned by the Department of Health for the change 4 life campaign included segmentation of the population into 6 clusters, it was identified that 3 cluster types that were more at risk of obesity, Clusters 1 and 2 also had low income, these clusters separately require specific key messages.26 See Figure 5. People on low incomes (Cluster 1 and 2 ) will be targeted as the Food Standards procedure low income and diet survey highlighted they had poorer diets due to several factors including a lack of cooking skills and knowledge.27Figure 5 Department of Health Segmentation analysis 26Taking an educational approach to promote healthy food choices in the home this strategy will implement a package of workshops designed for these high risk clusters to provide knowledge, practical skills a nd confidence to prepare healthy affordable food.As BME communities have also been identified as high risk of obesity, they will also be targeted for healthy eating workshops. As suggested in Healthy Weight Healthy Lives a toolkit for developing local strategies 2 to effectively have BME communities, interventions will be culturally appropriate and group workshops will include sharing ideas how to make traditional meals healthy.The availability of affordable fresh food in deprived areas will also be address by this strategy, by introducing initiatives such as fruit and vegetable box schemes and food co-operatives which will promote local sustainable suppliers.10.3 Help those already obese or at high risk of becoming obeseObjectivesIdentify early those at high risk of overweight or obesity and direct towards appropriate interventionEnsure provision of and equal access to weight management services for those who necessitate to loose weight.As the numbers of obese individuals is fore cast to rise1 it is paramount that services are in place to meet their needs and help individuals reduce and maintain a healthy weight. For those individuals already burdened with obesity or are at high risk of becoming, comprehensive care pathways for both adults and children will be developed using NICE guidance7,28 to ensure they are evidenced based.It was recommended in Healthy Weight Healthy Lives a toolkit for developing local strategies that more weight management services should be commissioned.2 Counterweight is an evidence based weight management programme that has been shown to be highly cost effective.29 This strategy will therefore utilize this cost effective service to ensure weight management services are available for those who want to loose weight. Weight management schemes designed specifically for children will also be assed and introduced on securing funding e.g. MEND (Mind, Exercise, Nutrition, Do it).30The full Obesity Strategy perform Plan is shown in Table 4.11.0 Monitoring and evaluationThe execution of instrument and monitoring of this strategy will be overseen by the Obesity Strategy Group for Preston Ribble. To measure success of the overall aim of reducing obesity levels in the population, overarching strategy indicators are shown in Table 3.Table 3 Overarching strategy indicators.IndicatorSourceTiming1% children in Reception who are obeseNCMPAnnually Feb2% children in Reception who are overweight or obeseNCMPAnnually Feb3% children in Yr 6 who are obeseNCMPAnnually Feb4% children in Yr 6 who are overweight or obeseNCMPAnnually Feb5 prevalence of BMI or equal to 30 in adults over age of 16 in previous 15 months in GP registersQoFAnnuallyThe Obesity Strategy Action Plan shown in Table 4 includes an evaluation framework. For each action, the outcome and performance measure is indicated. The highlighted lead will be responsible for ensuring the specify outcomes and performance indicators are measured and reported back to the Stra tegic Obesity Group at the specified time.Table 4 Obesity Strategy Action PlanStrategic Theme 1 Change the obesogenic nature of the local environmentObjectives and key actionsApproach to health promotion indicated(medical / behaviour change / educational / empowerment / social change)TimescaleResourcesLead responsibility and partnersPerformance Measure / Outcome(Social Change)Objective Influence public policyEnsure HIA part of policy developmentRoll out HIA training to planning and transportation teams within the council.Within 6 monthsIMPACT 5 day HIA training course for team leaders (700 pp)In house HIA awareness 1 day course delivered by trained HIA champions.CouncilTraining providersAll team leaders completed 5 day HIA course1 day in house HIA awareness training attended by 90% of officersIncrease availability of active transport formulation and transportation to map existing cycling and walking routes around the district and undertake a gap analysis of opportunities for more r outes.Within 6 months supply Officer timePlanningParks and LeisureTransportExisting cycling walking routes mapped.Results of gap analysis reported.Restrict access to unhealthy food.Work with planning to restrict permission of fast food outlets within 500 metres of schoolsOngoingPlanning Officer timePlanning share Health PromotionNo applications granted after 1 year.Improve walkability of neighbourhoods.Improve timely interaction between Environmental Health, Housing, Police to tackle social nuisances.Monitor community satisfaction via questionnaires / community meetings every year.OngoingProcedural development time by all partners.Environmental HealthHousing DepartmentHousing AssociationsPoliceCommunity GroupsCommunity group and resident feedback of significant improvement.Establish new food growing sites to improve the health and well being of residents.Identify land available for food growing projects.Within 6 monthsPlanning Officer timePlanningSustainLand Owners4 new growing sit es to be established.Objective Influence businesses to become healthy workplacesOrganise an area forum and develop website for representatives of local businesses to raise awareness in employers of production benefits in promoting healthy lifestyles. Promote business in the community workwell campaign, case studies of good practice.Within 6 monthsHealth and wellbeing workplace officer (in Environmental Health) 30KEnvironmental Health, percent Health Promotion,occupational Health,ITExisting Area Business and Commerce ForumsForum website developed.Influence roll-out of workplace policies totackle obesity via newly appointed health and wellbeing workplace officer employed to promote and facilitate the development of healthy active workplaces.1 2 yearsHealth and wellbeing workplace officerEnvironmental Health,PCT Health Promotion,Occupational Health,Existing Area Business and Commerce ForumsFeedback from forum of increase in healthy policies. (website survey monkey at 1 and 2 years)Cr itically assess workplace practices in NHS and the Local Authority and introduce policies that encourage physical activity and healthy eating. Promote implementation of NICE Guidance 43.1 2 yearsHealth and wellbeing workplace officerEnvironmental HealthPCT Health Promotion, Human Resources teams, Occupational Health,Catering servicesAll NHS and LA workplaces assessed after 2 years.Launch a workplace health and wellbeing award scheme to encourage employers to recognise the influence that they can have on their employees health.6 12 monthsHealth and wellbeing workplace officer time, LA communications teamEnvironmental Health,Council Comms,PCT Health Promotion,Occupational Health,Existing Area Business and Commerce ForumsAward scheme launched after 12 months.(Empowerment)Objective Work with communities to make active lifestyles easierWork with communities to identify perceived needs for cycling and walking routes.6 12 monthsPlanning Officer timePlanningParks LeisureCommunity Groups Health walk Leaders