The essence of this proposal is to develop, change and review public health policy as it relates to Obesity in Royal Borough of Greenwich based on evidence including statistics by World Health Organization(WHO), Public Health England, Joint Strategic Needs Assessment for Greenwich and NHS Greenwich Clinical Commissioning Group.
According to WHO, Obesity is defined as abnormal or excessive fat accumulation that may impair health (Fact Sheet Reviewed February 2018). Body mass index(BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2). For Adults obesity is a BMI greater than or equal to 30. In 2016 WHO estimates more than 1.9 billion adults aged 18 years and older were overweight and 650 million adults of these were obese. Overall about 13% of the world’s adult population was obese in 2016. (http://www.who.int/mediacentre/factsheets/fs311/en/)
According to Public Health England, two thirds of adults and a quarter of children between two and 10years old are overweight or obese. In February 2016 Health Secretary Jeremy Hunt described rising rates of childhood obesity as a national emergency. Obesity in the United Kingdom is a significant health concern leading to preventable causes of death. Obesity increases the risk of number of health issues including diabetes, heart disease, cancers, depression, anxiety and musculoskeletal disorders.
However, severely obese individuals are three times more likely to require social care resulting in increased risk of hospitalisation, associated health and social care costs than those with a normal weight. Estimates suggest obesity cost NHS £5.1 Billion in 2006/2007, including increase use of bariatric surgery, new equipment to accommodate larger people and obesity medication which is more than smoking and alcohol related ill health. Obesity cost Social Care a further £352 million in extra hours of help.
Obesity is complex, consequence of numerous factors such as diet, genes, levels of physical activities, social, cultural, environmental factors and many of the causes appear to be beyond the scope of Public Health. Obesity in adults is known to increase the risk of several long-term conditions and strongly associated with poor mental health. Obesity is experienced at far greater rates in the more deprived sections of the society contributing to the challenges these communities face.
In Greenwich the problem of obesity is more significant with children in reception experiencing the 3rd highest rate of overweight/obesity in London and a greater than England or London rate in Year 6. Local data suggests that the proportion of secondary school children getting their 5 A Day vegetables and fruit is steadily declining with just 14% achieving this. (Healthy Greenwich, Healthy People 2015-2018)
In 2013 Public Health responsibilities were transferred to Greenwich council which they claimed helped to strengthen their focus on improving health through planning and regeneration, environment, children, adults, leisure services, housing and community safety. In November 2014 Greenwich Health and Wellbeing Board met to consider the full range of health and wellbeing identified by Joint Strategic Needs Assessment and by December 2014 they agreed for 2015-2018 strategy with a focus on tackling Obesity. Their aim and objective is to make the borough a place that provides services, support and environment that enable people choose good healthy food and be physically active as part of their daily lives.
The borough recorded significant improvements in employment rates, have reduced number of people who smoke, improved rates of childhood immunisation, halved teenage conceptions but faces significant challenges to the health of local population. High levels of obesity in children and adults is leading to increased diabetes and other health related problems that if not addressed would reverse population health gains made.
Obesity is a consequence of numerous factors from diet, genes, levels of physical activity, surrounding environment as well as social and cultural factors. Greenwich in the process of tackling obesity agreed it is critical to engage a very wide range of partners, holding series of meetings, workshops, events with a wide range of statutory, private and third sectors with community groups and interested residents to develop clear action plans.
The priorities as identified and set into three key levels are the underlying social, economic and environmental factors impacting on obesity that is the causes. Second factor is individual lifestyle or behavioural risk factors impacting on obesity that is direct causes and thirdly preventable or modifiable conditions. An on-going role of this board is to ensure clear actions are in place to address all the priorities for Greenwich and that progress agreed towards outcome is being achieved. Where there were already existing mechanisms such as strategies or plans in which case there was not a need for the new strategy to duplicate this work but where their opportunities for significant additional value to be gained from bringing the resources of all partners across all agencies involved to have a big impact at scale and speed.
Obesity and poor diet as well as lack of physical activity are areas where there is a particular and pressing need so tackling this fundamentally relies on people improving their diets and increasing their physical activity. Changes in diet and physical activity will take place in a wider context which influences how easy choices are made for everyone especially those who are disadvantaged. Reducing and preventing obesity depends on working across the whole system to impact on social, environmental, economic and personal spheres to enable and empower individuals to make the right choices and changes to their behaviours.
Having analysed how the borough plans to tackle Obesity the approach adopted is Rational Approach in the sense that the problem was identified coupled with evidence provided to substantiate this in children of the borough that are obese.
The actions to tackle the problem were outlined with some to give immediate results while some results are futuristic and some are on-going. Some of their action plans to increase the focus and strengthen combined efforts at tackling child and adult obesity apart from diets improvements but to get everyone active. Changing and developing environments to support physical and mental health from low tech approaches to healthy regeneration, planning and development of ‘living streets’. Working with local food businesses to increase availability and uptake of healthy, affordable and sustainable good food in Greenwich. Creating vibrant social movement to make healthy food choices the attractive choice for everyone. Supporting families and children to adopt healthy lifestyles from pre-pregnancy, early childhood and onwards into adult life.
The stage of Intervention referring to Nuffield Ladder are Provide information and Enable choice irrespective of policy engagement whether local, national or global. All policy makers and health professionals working on obesity provide information on the health- related risks of obesity. Plenty of information is available for help. Enable choice is very important and using a range of choices provided by working with local businesses, supporting families to improve diets through availability of affordable, healthy and sustainable foods in the borough.
I would combine the use of Rational Approach with Incremental policy to enable making minor adjustments overtime because environment and people changes overtime since they are not static coupled with technology daily innovation, discoveries and upgrading every time. Reducing and preventing obesity depends on looking across the whole system to impact on social, economic, environmental and politics to support people who need to manage their weight more effectively across all ages. Setting up of Weight loss classes or group was not mentioned which is very important to encourage and support different groups of people irrespective of age, colour, sex, ethnicity would come together to keep active and socialise. The need to engage the services of professionals such as Dieticians is very crucial to recommend calorie-controlled diets as well as encouraging people to eat balanced diets. Psychological support from trained healthcare professionals to help change people’s thought about food and eating. Teach and encourage people to on regular basis monitoring their weights, set realistic goals on weight loss and have self- control or discipline as regard what they eat and drink. Having considered the diversity of Greenwich with significant migration into the borough from different parts of the world there is a need to understand how their culture, religion, taboos and beliefs influences people decisions in relation to their health so that one can get them change their behaviour. For instance, some African culture especially some parts of Nigeria up till today does not accept or think obesity/overweight is health related issue but out of ignorance strongly believe it is an evidence of good living and in some cases an evidence of a wealthy person. Here we can see that there is a complex network of interests, rights and ideals to consider so it is not possible to prescribe a mechanistic formula that would dictate how values should be applied but incorporating all the ethnic groups to be well represented. In the development of environment parks with modern day facilities for easy reach and use for those who cannot afford to register at a gym. Promotion of various sporting activities within the communities making it competitive with incentives to encourage especially those who are obese. More proactive actions from government at the national levels, powerful international players, charities, private sectors, industries and media to partner with NHS and Public Health to influence changes at the society level and globally.
The major obstacles I would face in attempting to change the policy is the challenge of diversity where approximately half of the borough population are now of black and minority ethnic background with different cultures, languages, religions, beliefs and taboos. So, tackling this would involve engagement of services from local people that speaks, understand and are able to communicate in the languages of the diversity groups to carry everyone along.
Having looked at the above to get the desired result in a mixed environment such as this with all the ethnicity, finance will be a major challenge and one cannot rule out health inequalities at this point when the finance is not forth coming or not enough to execute the plans.
To get all the groups and parties involved to move and deliver at same pace can be challenging. At the Local government level influencing local planning can also meet with brick-wall where they may need to debate, put to vote, seek local people’s views and sometime engage services of third parties.
Incorporating obesity to core businesses to ensure the workforce working hours, regular meal break times, food options and health promotions are adhered to and reasonable.
WORDS: 1750
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PART 2
SLIDE PRESENTATIONS
Obesity is defined as abnormal overweight or excessive fat accumulation that may impair health.
Public Health England statistics that two thirds of adults and a quarter of children between two and ten years old are obese or overweight.
From the first slide Obesity is defined followed by the statistics for England which was further narrowed down to the local area of Greenwich. Obesity is a worldwide problem but a significant health concern to United Kingdom which leads to preventable causes of death. Having examined a few causes of obesity it all boils down to people improving their diets because of their attitudes and behaviour about eating which can be worked upon considering the health- related problems it can result into.
The government equally have significant role to play in environment development and changes in line with the needs of the people to provide modern facilities, play grounds and parks especially for those that cannot afford to pay to go to the gym. Social factors in line with government role to ensure every gap of in-equalities is filled and create equal opportunities for everyone. When the basic infrastructures are in place it will not only boost people’s health it also reduces government spending’s and interventions around health of the people. Physical activities such as jogging, walking, swimming or playing tennis to burn off calories also depend on the facilities readily available and security of the environment where all this can be done.
In my local area Greenwich with diversity culture, religion, taboos and beliefs plays a significant role in the lives of the people so the need to engage the services of local people that speaks, understand and able to communicate at grass root level will help to deliver home the message and no one would be left out.
Local Weight loss group to be created in each community to encourage and support the people. Trained Health professionals with specialities in areas of food such as dietician to advice and counsel people as regard their dietary intake as well as build their confidence against any form of stigmatization or harassment.
All local food stores, markets and businesses can take a cue from the initiative by Tesco store at Woolwich that ensures children pick fruits of their choice from the assorted fruits kept in a drum close to the elevator by the entrance to Tesco shopping hall which is a way of promoting fruit eating habit which is better and healthier than chocolate or sugar snacks.
Public Health to enforce labelling of foods and drinks with their calorie contents, production of all processed foods and drinks to comply with set standards. Inspection and visits to food production sites and factories to ensure compliance to be intensified by Public Health England
However, co-ordination, aligning and working in partnership with various groups, organizations, companies, government bodies, at national and international levels to get the financial support and backing from various quarters. Projects to be evaluated in line with plans, time frame, reports and results if it commensurate with the financial input as well as feed- back from the people on areas to improve upon and work more to get desired results and meet the needs of the people.