An overview of the declaration and its 14 commitments and what adopting it will involve for Rotherham Council.
The Cabinet Member introduced this item by talking about the change in emphasis around the significant problem of obesity in Rotherham. Previous focus had been on Tier 3 and when people had already become obese, whereas now the attention was on earlier interventions and joined up thinking across all services, linked to the wider determinants of health. The plan was a living document and any suggestions from Health Select could be incorporated.
Kate Green from Public Health confirmed that the Council had adopted and signed the declaration in January 2020. Not all actions had been carried out but it set out a clear statement of intent, including to influence policy, service delivery and partners to work towards healthy weight being the norm in Rotherham. Work had paused due to Covid-19 and the original timeline would be reviewed but it would form part of the recovery. The table in the appendix would be updated as the original commitments had been reviewed and amended.
Robin Ireland from Food Active delivered the following presentation.
• The impact of obesity
• Statistics showing prevalence of obesity linked to deprivation and excess weight among children
• The background to the Healthy Weight Declaration (HWD)
• The 14 Commitments
• Examples from elsewhere – Blackpool/Cheshire West and Chester
• The Partner Pledge (Cheshire West and Chester Council) - contains a set of commitments which organisations pledge to work towards to impact on the health and wellbeing of their staff, clients and the wider community and aims to support the actions of the Council’s Declaration.
• The NHS Declaration - provides NHS organisations with an opportunity to state their commitment to supporting patients and staff to achieve a healthy weight
Covid – 19 and Healthy Weight
• WHO has highlighted non-communicable diseases (NCDs) as a risk factor for becoming seriously ill with COVID-19
• Obesity may be a risk factor for developing more severe Covid-19 complications, requiring hospitalisation and critical care.
• Obesity is commonly associated with decreased immune function = greater risk
• Emerging evidence suggests men with obesity are more at risk
• As obesity class increases, the risk of mortality increases. More than double with BMI of over 40 – independent of co-morbidities.
• People with obesity may be of lower socioeconomic status, race/ethnicity, poorer diets etc – implications on metabolic affects.
• Affects access to/availability of treatment for obesity – particularly those who have experienced weight stigma and may feel a sense of guilt for using NHS resources.
Food Active – a North West Response
• A collaborative programme launched by the North West Directors of Public Health in November 2013 to tackle increasing levels of obesity.
• Focusing on population-level interventions which take steps to address the social, environmental, economic and legislative factors that affect people’s ability to change their behaviour.
• Less victim blaming, more environment framing
What are the Local Authority Declarations for?
• Strategic leadership: creates an opportunity for senior officers and politicians to affirm their commitment to an issue
• Local awareness: shines a light on importance of key activities internally and externally
• Driving activity: a tool for staff to use to create opportunities for local working
Review and Refresh of the HWD
We consulted with current adoptees of the HWD and ran a small task and finish group.
• the standard commitments have increased in number from 14 to 16
• a small number of new commitments have been introduced - covering climate change, place-based approaches, partnerships, and a wider whole-systems approach to obesity
• some of the commitments have been amalgamated
• revision to some of the wording
• the commitments are now listed under key themes
The revised HWD is due to be launched in early July and will be supported by a range of materials and resources including:
• Updated evidence briefing that underpins the commitments – this reflects the outputs of the consultation in a little more detail, specifically linking through to the current policy context and new evidence.
• Updated support pack and Monitoring & Evaluation (M&E) Framework
• New Audit Tool (lighter touch M&E tool)
• HWD communications guidance (with specific reference to weight stigma)
• Briefings from cross-council communication
• A series of posters, infographics and social media assets
• New branding (no more scales)
What is in the LA gift
• Planning and licencing
• Activities/businesses on local authority premises
• Leading by example, setting the tone
• Influencing partners, e.g. via the Health and Wellbeing Board
Members welcomed this positive initiative and asked whether any metrics had been developed in the North West to measure the effectiveness of this type of initiative or if Food Active could suggest any suitable metrics.
A monitoring and evaluation system was under development with the intention of looking at the different parts of the commitments and which worked well to enable sharing and comparison between local authorities. Some quick wins were possible but other issues such as vending machines were proving to be difficult to tackle. Food Active also worked with Public Health England and linked in with their work. The overarching aim was to reduce obesity, which would take a while to turn around, and to see changes in the results of the National Child Measurement Programme.
Local evaluation would take place but it was difficult to capture and would take time to come through. The intention would be to use the Food Active tool in Rotherham and as the action plan was developed to consider how that could be monitored to gauge success. Comparison with other areas would be undertaken, together with a review of good practice from local authorities who had already adopted the declaration.
It was clarified that the information pack would not include dietary advice or diet sheets as the emphasis was on policies and what the Council could put in place before people became overweight. The focus was directed towards work at population level rather than individual level. Nevertheless, the declaration would form part of a much wider plan around healthy weight in Rotherham. The other facet would be the weight management services through Get Healthy Rotherham who provided support and advice for people to lose weight in terms of healthy eating and exercise. Both aspects were necessary, working together and Get Healthy Rotherham was up and running providing advice by telephone and working mainly on a one-to-one basis.
Commitment 1 was considered a laudable aim to encourage healthier options and portion sizes but Members felt that in Rotherham this should be about providing people with options rather than compulsion. Particularly given the previous experience and media coverage of a school that changed its food offer radically in a move that proved very unpopular with students and their families.
The problem was that most of the widely promoted options were the unhealthy ones. Another approach would be more by stealth though removing some of the unhealthy options or introducing smaller portions. Changes had to be managed carefully and discussed with people.
Cllr Roche confirmed that a previous attempt to impose restrictions on new takeaways opening near schools had been overturned but through work with Planning it was hoped to be more successful the second time. Other councils had had some success in this area and learning from their approaches would be helpful.
Members highlighted that knowing how to present things to children and families was important. With this in mind they inquired if there been progress in introducing this type of planning into the system overall rather than actions by individual schools i.e. to infiltrate them gradually and respectfully.
It was more difficult to influence schools, especially now with academies but dialogue was taking place with education staff regarding engagement with schools. A number of schools did buy into the School Improvement Service and that was a potential means of engaging about what was on offer. The Schools Catering Service had already revisited its offer, including an audit of desserts which led to the removal of a number with a high sugar content. Secondary schools were more difficult and it was also a question of engaging with young people to see what options they would like. At a session with Rotherham Youth Cabinet the young people said they would like healthier options and asked questions about options available for students who had free school meals or who were on a limited budget who might go for the most filling options rather than the healthiest choices.
Experience of working with populations that might have major cultural differences, with some possibly experiencing greater disadvantages, was highlighted. These were acknowledged as issues to pick up and work on with schools and where Members could feed in any thoughts or ideas.
Regarding takeaways, Members inquired as to how receptive local businesses might be to making the suggested changes, especially in the current economic climate.
This workstream had not really started fully but there were thoughts of linking in with Environmental Health, potentially when they inspected fast food premises. It was about offering healthier alternatives, considering portion sizes, especially when aimed at children, and how food was cooked, not removing everything and would be on a voluntary basis. At this stage it was difficult to gauge how receptive they might be to change and it would be a challenge.
Robin Ireland confirmed that it could be done, with good practice to learn from but needed resources. Salt content was a major concern in much takeaway food and sometimes it was a question of training or advice for businesses on how things could be done differently and more healthily, as fast food did not have to be unhealthy. Blackburn with Darwen Council were engaged in a Trailblazer project working with their takeaways and this was not purely about removal or reduction of unhealthy options but also promotion of healthy ones. Blackpool had a healthier takeaways scheme which was promoted on the Council website.
With regard to Commitment 10 – supporting the health and wellbeing of LA staff - Members wondered whether this could include more of the therapeutic and mental health side as well as diet and exercise as it presented a good opportunity for significant cultural change.
Some activity on small things had taken place, such as encouraging people to use the stairs but scope existed to do more. Two officers in Public Health led on the work and more could be done potentially with Human Resources on policy, procedures and culture to encourage healthier choices and how to make them easier to access. It was also a question of how to support staff working at home to look after both their physical and mental health. Information and resources were available on the intranet and internet and staff were signposted to these. Any other suggestions from Members were welcomed.
It was recognised that various good initiatives were included but that some issues needed to be addressed more at the national level. Officers were asked about garnering other local authorities nearby to influence and wield pressure nationally.
Food Active was a member of the Obesity Health Alliance, therefore by working with them Rotherham added to how Food Active contributed at a wider level. Issues such as promotion of unhealthy products during the pandemic could only be dealt with nationally and Food Active felt they should advocate strongly against junk food marketing. Learning and links across Yorkshire and Humber, including all the Directors of Public Health, and mutual support from Councils all contributed towards this.
Regarding linking this work to the Neighbourhood Strategy and ward plans, this was viewed as something to work on, including consideration of how to engage communities and ask them what they would like to see the Council doing to support them to make these healthier choices. Most ward plans had identified health as an issue so another area where support from Members would be crucial.
Officers were thanked for their interesting and informative presentation.
1) To note the information provided about the declaration and that the Council formally adopted this on 20 January 2020.
2) To schedule the updated plan to come back to the Select Commission at an appropriate time.