Review date March 2015 VERSION 11 260314

NHS GRAMPIAN

Strategic Framework and Delivery Plan to

promote healthy eating and active living

2020

March 2014

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This strategic framework and delivery plan is also available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on (01224) 551116 or (01224) 552245. To assist NHS Grampian staff to communicate with non-English speaking individuals and their relatives, a “face to face” interpreter or the “Language Line” telephone interpretation service can be made available when consultations take place. Material in translation can also be provided. If the individual has a communication disability, appropriate communication support such as British Sign Language (BSL) interpreters, audio, accessible/pictorial material, large print and other formats and support can be provided. Any questions about this document should be sent to Caroline Comerford, Health Improvement Coordinator 01224 558601 caroline.comerford@nhs.net.

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Introduction

This document outlines a strategic framework and delivery plan for NHS Grampian which draws together and coordinates healthy eating and physical activity. It promotes healthier lifestyles and healthy weight from birth to old age. The document is designed to guide, facilitate and support infrastructure and skills development to support health improvement within organisations, communities and families. A successful approach will require collaborative work between NHS Grampian and its partners to make deep, sustainable changes to the environment in which we live. This will create an environment that enables healthy choices to encourage healthy eating, active living and a healthy weight. The policy context is outlined in Appendix 1. Vision and aim

Healthy lifestyles are the norm in Grampian. Children and adults are informed, able and motivated to make positive healthy eating and physical activity choices, and also achieve and maintain a healthier weight. Disadvantaged individuals and disadvantaged communities are prioritised. Principles

We aspire to create a bias in favour of the choice to eat healthily, be more active and maintain a healthy weight in Grampian.

The essential skills to achieve and maintain a healthier weight are learned in childhood and lay the foundations for life-long health.

Communities actively take part in healthy eating and physical activity initiatives which will build on their skills and resources.

There is a genuine partnership between a well-informed public, patients, public organisations and committed professionals.

The public receives clear information on how to eat a healthy diet, be more active and achieve and maintain a healthy weight.

We will provide information on what services that the public can reasonably expect and outline what responsibilities they have in return.

Services for children, young people, elderly and disadvantaged groups are co-produced. They focus on the prevention of ill-health

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and meet the needs of those people in the most disadvantaged circumstances.

The health needs of our population are monitored and this information guides our planning.

Objectives

To work in partnership to create healthy environments in which we can eat healthy food, be more active and achieve and maintain a healthy weight.

To support communities, children and their families to grow well and make healthy choices.

To tackle inequalities in health.

To support NHS staff to be confident and competent in promoting healthy eating, active living and healthy weight with their patients.

To support the NHS workforce to eat healthily, be more active and achieve and maintain a healthier weight.

To continue to develop and provide sustainable services for people who wish to achieve and maintain a healthier weight.

Benefits of change

Physical activity has many health benefits both to prevent and manage the effects of chronic disease, notably heart and lung disease, diabetes, depression and cancer. It also improves energy levels, wellbeing and quality of life.

Potential health gains from a shift from private motorised transport to walking and cycling include reduced respiratory and cardiovascular disease from air pollution and less exposure to traffic injury risks and noise stressi.

A healthy diet can reduce the risk of chronic disease, including some cancers, heart disease, diabetes, osteoporosis and obesity.

Breastfeeding is the most natural and healthiest way for a woman to feed her baby. There are also many well documented short and long term health benefits for both mother and baby. Breastfeeding is a major factor in bonding and attachment for babies.

Achieving and maintaining a healthy weight reduces the risk of chronic disease (including cancer), and a range of musculoskeletal, circulatory, metabolic, endocrine, reproductive, gastrointestinal and respiratory health problems.

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Drivers for change

Cultural barriers still exist to the acceptance of breastfeeding in public.

Younger mothers in particular are not considering breastfeeding as an option for their baby, or themselves.

There is a significant gap between our more affluent and more deprived areas, where the exclusive breastfeeding rate can range from over 50% to under 20%.

The proportion of adults meeting recommended physical activity levels increased between 2003−2008 and over the longer term (1998−2008). However, inequities in physical activity levels persist among women, girls and older adults as well as in more deprived areas.

There has been a significant rise in male and female obesity levels in Grampian from 2003 to 2011 and the greatest increase was seen in our least affluent communities.

Obesity and overweight is generally higher in the most disadvantaged groups but the socio-economic status gradient is much clearer and steeper in women, than men.

For more detail please see Appendix 2. Changes required Support the population to:

Achieve UK wide physical activity guidelines Start Active, Stay Active. The guidelines recognise the importance of activity for people of all ages and also provide guidelines for the early years and a focus on reducing sedentary behaviour.

Eat a healthy, balanced diet using the ‘eatwell plate’. This model makes healthy eating easier to understand by showing the types and proportions of foods we need to have a healthy and well balanced diet.

Achieve and maintain a healthy weight by balancing the energy we take in to our body (from foods and drinks) with the energy we use up (through activity). This is known as energy balance.

Achieve and maintain a healthy weight through the provision of patient centred weight management services.

The scale of change that is needed cannot rely on individual behaviour change alone. We also need to act at a community and population level so that these changes become the norm in Grampian. It will also be important for the work to take an assets-based approach to the creation of health in our communities. An assets-based approach focuses on

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improving health and reducing inequality by building on communities’ existing strengthsii. Assets-based approaches are not a replacement for investing in service improvement or efforts to tackle the structural causes of health inequalitiesiii. Benefits realised The Scottish Government has set out a national performance framework for obesity (see Appendix 3). These outcomes highlight the importance of activity to reduce energy intake and increase energy expenditure within the environment (social, physical, economic and workplace), early years (children), communities (individual behaviours) and service delivery. This framework has been expanded by NHS Health Scotland into an evidence-informed Healthy Weight Outcomes Framework which will be used to align our local healthy weight outcomes and indicators with national policy. Delivery Plan The Delivery Plan will support activity over four themes: Environment

We will accelerate activity to create and maintain healthy environments for the whole population.

Grampian’s natural and built environments will promote increased levels of physical activity.

The NHS will provide leadership by working in collaboration with its Community Planning partners to develop population plans for healthy eating, active living and healthy weight.

Employers will make it easier for people to be more physically active, eat a healthy diet and maintain a healthy weight as part of everyday working lives

The NHS will lead by example by providing a health promoting workplace environment for its own staff.

Children and Families

We will nurture and support our children to grow well by supporting them to eat a healthy diet, be more active and maintain a healthy weight early in their lives.

We will work with our partners to make sure that all places of learning in Grampian promote increased physical activity, healthy eating and a healthy weight.

We will increase the rate of exclusive breastfeeding by addressing the link between low breastfeeding rates and health inequalities.

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Communities

We will consolidate and expand activity to provide community based lifestyle support for families and adults to eat healthy food, be more active and achieve and maintain a healthier weight.

The NHS will work with communities to build on community assets using a community development approach. Mobilising these assets and strengths will help us to address the needs of our disadvantaged communities and groups and support them to overcome the challenges they face.

Priority programmes will take focus on pregnant and nursing mothers, children and families, teenagers, prisoners and older people.

NHS Provision

We will provide support for our staff and patients to eat healthy food, be more active and achieve and maintain a healthier weight.

NHS and care services will promote the recommended levels of physical activity.

The NHS will put in place healthy eating and physical activity policies.

The NHS will provide sustainable, cost effective and appropriate weight management services and treatments for people in Grampian.

For the full Delivery Plan please see Appendix 4. Delivery Partners Collaborative work is needed both within the NHS and with partners in the public, private and voluntary sectors to develop and implement partnership plans to support our population to eat healthy food, be active and achieve and maintain a healthier weight. These agendas also link directly with other health improvement issues, including alcohol and mental health. It is not within the scope of this strategy to outline specifically how these links should be made and maintained. However, it is anticipated that the links between these complementary areas of work will be made as the strategic framework is implemented. Measurement Demonstrating the impact of health promotion is not a straightforward task. The impact of health improvement activity is often long term and

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not easily predicted, controlled and measured by conventional means. Both quantitative and qualitative information is needed to capture evidence of the effects of interventions. In order to maximise learning and ensure effective interventions over time, it is important that individual interventions are sensitively and appropriately assessed for their effectiveness and learning is shared. The Delivery Plan will be used by NHS Grampian to support work within the NHS, and with wider partners to deliver Grampian’s Single Outcomes Agreements with the Scottish Government. Agreed performance outcomes and indicators will be monitored and form the basis of local work plans. This will include measurement indicators used in local Single Outcome agreements. Indicators will include (where available) information on performance by:

40% most deprived

gender

age group

Cost Profile A Business Plan is being prepared to support the Delivery Plan and will be presented separately.

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Appendix 1: National policies This strategic framework supports outcomes from the Scottish Government's National Performance Framework:

Our children have the best start in life and are ready to succeed

We live longer, healthier lives

We have tackled the significant inequalities in Scottish society

We have strong, resilient and supportive communities where people take responsibility for their own actions and how they affect others

We value and enjoy our built and natural environment and protect it and enhance it for future generations

Maternal and Infant Nutrition Framework This document emphasises the importance of the need to promote and support breastfeeding and improve the nutrition of pregnant women and young children. It stresses the importance of nutrition in the earliest years for long term health and wellbeing. The Breastfeeding (Scotland) Act 2005 makes it an offence to prevent or stop a person in charge of a child feeding that child milk in a public place. This means that any person should be able to feed a child when required and in the most appropriate place for them, without the fear of interruption or criticism.

Early Years Framework (EYF) This framework encourages partnership working to deliver a shared commitment to giving children the best start in life and to improving the life chances of children, young people and families at risk. The Early Years Collaborative has been established to accelerate the conversion of the high level principles set out in the EYF into practical action. Key priorities within the EYF include the need for parents to be supported to build strong attachments with babies (for example through breastfeeding) and young children and the importance of play. A More Active Scotland: Building a Legacy from the Commonwealth Games A Scottish Charter for Physical Activity has been produced to support the implementation of Let's Make Scotland More Active, Scotland’s physical activity strategy and to create and sustain a legacy for the 2014 Commonwealth Games. The Plan seeks greater commitment to health enhancing physical activity for all and covers the built and natural environments, education, NHS Scotland, transport and planning, active

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recreation and workplaces. It articulates the importance of promoting population-wide participation in physical activity and developing a targeted approach for those less likely to engage. Key priorities include:

increased opportunities for NHS staff, patients and visitors to be more physically active,

the development and implementation of physical activity care pathways to support the delivery of brief advice and brief interventions within the NHS,

NHS staff equipped with the knowledge and skills to deliver routine and opportunistic physical activity brief advice and brief interventions.

Preventing Overweight and Obesity in Scotland: A Route Map towards Healthy Weight This document provides a clear steer for the direction that is needed and identifies four key areas in which action is likely to have the greatest effect:

reducing demand for and consumption of excessive amounts of high calorie foods and drinks,

increasing opportunities for uptake of walking, cycling and other physical activity,

establishing life-long healthy habits in children,

increasing the responsibility of organisations for the health and wellbeing of their employees.

Obesity Route Map Action Plan The plan details cross Governmental actions to be taken forward with partners to address the increasing prevalence of obesity in Scotland. The Action Plan reflects the direction of travel set out in the Obesity Route Map and is being used as a means of determining progress in tackling obesity. Recipe for Success Scotland’s National Food and Drink policy complements the Route Map by promoting sustainable economic growth while recognising the challenges of health, environmental sustainability and affordability.

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Local Policies Single Outcome Agreements The Scottish Government and Grampian’s local authorities share an ambition to see Grampian’s public services working together with private and voluntary sector partners, to improve the quality of life and opportunities in life for people across Grampian. Single Outcome Agreements are an important part of this drive towards better outcomes. They are agreements between the Scottish Government and Community Planning Partnerships and set out how each will work towards improving outcomes for the local people in a way that reflects local circumstances and priorities. Child Health 2020 Child Health 2020 is NHS Grampian’s plan for the future for children and young people. It outlines the activity required to ensure that children and young people are as healthy as possible and is part of NHS Grampian’s overall vision known as Healthfit 2020.

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Appendix 2: Drivers for Change

Breastfeeding In Grampian, the exclusive breastfeeding rate is higher than the national average. Latest figures for the year 2011/12 show an exclusive breastfeeding rate of 31.9 % and a mixed feeding rate of 45.4% at 6-8 weeks. However, there is also a significant gap between more affluent and more deprived areas, where the exclusive breastfeeding rate can range from over 50% to under 20%, demonstrating a clear link to deprivation and health inequalities. Physical Activity The Scottish Health Survey (2011) survey indicated that 39% of adults (45% of men, 33% of women) met the physical activity guidelines of 30 minutes of moderate activity on five or more days per week. Since 2008 there has been no significant change in the proportion of adults meeting the recommendations. The ‘Let's Make Scotland More Active’ national target for 2022 is to have 50% of adults meeting the recommended level. The proportion of adults meeting recommended levels increased Scotland-wide between 2003−2008 and over the longer term (1998−2008). However, inequities in physical activity levels persist among women, girls and older adults as well as in areas of lower socioeconomic statusiv. The trend data for % meeting recommended levels of physical activity in Scotland shows no improvement from 2008 to 2010 for all ages (see Figure 1). There was no improvement in 2009 seen at all with either a reduction or numbers staying the same. In 2010 there was an increase in groups 16-24, 35-44 and 45-54, a decrease was seen in groups 25-34, 55-64 and 65-74, with age 75+ remaining the same throughout the 3 years.

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Figure 1: Adults Meeting Recommended Physical Activity Levels Data Source: Scottish Health Survey (2011)

Grampian is performing better than Scotland for all age groups and both sexes for participation any physical activity (see Figure 2). However, when broken down by sex and age men are still performing better than Scotland but for women in the age groups 25-34 and 55-64 they are performing worse but within 5% of the Scottish figure.

Figure 2: Adult Participation in any Physical Activity Data Source: Scottish Health Survey (2011)

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The report on physical activity for health from the UK’s Chief Medical Officers Start Active, Stay Active includes guidelines on the volume, duration, frequency and type of physical activity required across the life course to achieve general health benefits. It updates existing guidelines and will be used as a measure in future Scottish Health Surveys. Healthy Weight (Adults) Since 1995 there has been a steady increase in the prevalence of overweight and obesity among both men and women in Scotland (see Figure 3). In 2010 27% of men and 28% of women aged 16 or over in Scotland were obese. Recent figures indicate that obesity prevalence increased with age peaking amongst men and women aged 55-64 years. Two thirds (over 66%) of adults over 45 years are therefore not just overweight, they are obese. In addition, for women, obesity is significantly associated with area-level deprivation (but not for men)v.

Figure 3: Obesity and Overweight in Adults (Scotland)

The percentage of overweight men has fluctuated between 2003 and 2011, and showing a significant but slight reduction of less than half a percentage point when comparing 2011 to 2003. In Scotland the reduction has been of less than one percentage point. The percentage of overweight women have risen between 2003 and 2008, then has fluctuated to 2011, but showing a significant increase of 6 percentage points when comparing 2011 to 2003. Meanwhile in Scotland there has been a reduction of less than one percentage point.

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There has been a significant rise in male obesity levels from 2003 to 2011. In Grampian the rise was 16 percentage points from 14% to 30% of the population. This compares to a rise of 9.6 percentage points in the Scottish male population, from 16.4% to 26.0%. There has also been a significant rise in female obesity levels from 2003 to 2011. In Grampian the rise was 10 percentage points from 15% to 25% of the population. This compares to a rise of 7.3 percentage points in the Scottish male population, from 16.2% to 25.3%. Healthy Weight (Children) In a recent study of P1 childrenvi in Grampian there is evidence that children first became taller and then heavier. The survey shows that since the 1970s the catch up in weight gain appears to have overshot compared to the gain in height, especially among children from less affluent communities. Whilst obesity prevalence has risen across the whole population, the greatest increase was seen in our least affluent communities. Figure 4 (below) shows the proportion of P1 children who were underweight, healthy weight, overweight and obese when measured in 2009/10, 2010/11 and 2011/12. In a recent analysisvii a significant difference1 was found for Grampian as a whole in the three individual years for the percentage of overweight children, but not for the percentage of obese children. This finding is repeated for Moray, but not for Aberdeen City or Aberdeenshire. It is only in Moray where there has been a recorded increase in the percentage of P1 children who are overweight, and who are obese in the three consecutive years. For Grampian, Aberdeen City and Aberdeenshire, the lowest percentage of P1 children in these categories was recorded in 2010/11. Whilst this was welcomed at the time, the reversal the following year now invites caution in the interpretation of the pattern. If the results for 2011/12 are compared with 2009/10, it is only in Moray where a significant difference2 (increase) is found in the percentage of overweight children. There is no significant difference for Grampian, Aberdeen City or Aberdeenshire in the overweight or obese categories.

1 CHI squared test, 95% confidence level

2 T-test for difference, 95% confidence level

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Figure 4: BMI category within each CHP area 2009/12

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Appendix 3: National Performance Framework for Obesity

Review date March 2015 VERSION 11 260314

Appendix 4: Delivery Plan

Indicators will include (where available) information on performance by 40% most deprived, gender and age group.

Indicator Milestone

Source

Direction

Proportion of babies exclusively breastfed at 6-8 weeks.

Annual

Child Health Surveillance Programme – Pre-School

Increase

Proportion of 27-30 month year old children within the healthy weight range.

Annual

Child Health Surveillance Programme – Pre-School

Increase

Proportion of P1 children within the healthy weight range.

Annual

Child Health Surveillance Programme - Schools

Increase

Completion rates for national child healthy weight target.

Annual

Child Health Surveillance Programme – Schools

Increase

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Numbers and percentage of children walking/cycling to school.

Annual

Hands Up Survey

Increase

Proportion of men and women within the healthy weight range.

Annual

Scottish Health Survey

Increase

Proportion of registered patients aged 16 or over with a BMI ≥30.

Annual

QOF/OB001

Decrease

Proportion of people with Type 2 Diabetes.

Annual

Scottish Diabetes Survey

Decrease

Proportion of adults meeting physical activity recommendations.

Annual

Scottish Health Survey

Increase

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Actions

Milestones

Responsibility

Benefits3

1. Environment

Agree Strategic Framework, Delivery Plan and Business Plan internally within NHS Grampian.

Endorsement by NHS Grampian Board. Endorsement by Public Heath Steering Group. Endorsement by Sector General Management.

Public Health Directorate.

Increase in proportion of children and adults within the healthy weight range.

Establish a common, long term, strategic commitment to tackling obesity between NHS Grampian and partner organisations.

Endorsement by Local Authorities. Endorsement by Community Planning Partners.

Head of Health Improvement Public Health Leads within Community Health Partnerships (CHPs).

Co-delivery of national obesity outcomes. Changed social norms.

3 NHS Health Scotland Healthy Weight Outcomes Framework http://www.healthscotland.com/documents/5590.aspx

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Actions

Milestones

Responsibility

Benefits3

Alignment with Single Outcome Agreements.

NHS leads within Community Planning Partnerships (CPPs).

Embed physical activity as a normative culture and an important contributor to health improvement and healthcare within NHS Grampian.

Engagement with key local Stakeholders. Health Promoting Health Service (HPHS) action plan developed implemented and evaluated.

Public Health Directorate. Allied Health Professional (AHP) Associate Director. AHP Sector Leads.

Increased access to physical activity. Increased knowledge, skills and awareness.

Establish local area alliances with a remit for evidence informed coordination, decision making, monitoring and evaluation of the action plan.

Role, function, membership and remit of local alliances agreed.

Public Health Leads within CHPs. NHS leads within CPPs.

Co-delivery of national obesity outcomes. Changed social norms.

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Actions

Milestones

Responsibility

Benefits3

Local alliances use available data and benchmarks to plan and monitor progress with each area.

Local action plan agreed. Effective range of interventions in place to increase prevalence of healthy weight.

Public Health Leads within CHPs. NHS leads within CPPs.

Delivery of the national Obesity Route Map. Changed social norms.

Support public sector Chief Executives to provide leadership to focus on food/physical activity environments within own buildings/workforce/service provision.

Meetings have taken place. Actions identified, agreed and monitored within local action plans.

Public Health Leads within CHPs.

Decreased availability and affordability (exposure) of high energy food and drink.

Work with Elected Members to increase ownership of the healthy weight agenda and to act as champions in key service committees.

Meetings have taken place. Champions identified.

Public Health Leads within CHPs. NHS leads within CPPs.

Decreased availability and affordability (exposure) of high energy food and drink.

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Actions

Milestones

Responsibility

Benefits3

Work with Local Authority partners to ensure that Local Authority planning processes take into account the healthy impact of activity including opportunities for active travel and safe places to play.

Meetings/links have been made. Opportunities identified and agreed. Processes in place.

Public Health Leads within CHPs. NHS Leads within CPPs.

Improved built natural environments and infrastructure for active travel.

Work in partnership with retail outlets to improve the display and promotion of healthy foods in stores including promoting the work of the Scottish Grocer’s Federation Healthy Living programme.

No of retailers working with Scottish Grocer’s Federation.

NHS Lead within CPPs.

Prioritised responsible promotion and marketing of healthy choices.

Promote healthy eating, active living (including walking/active travel) and weight management programmes within the workplace, through employers and Scottish Healthy Working Lives.

SMEs taken up Scottish Slimmers incentive scheme. Workplaces achieving the Healthy Living

Employers. Scottish Healthy Working Lives.

Improved access to weight management services. Increased access to physical

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Actions

Milestones

Responsibility

Benefits3

Award. activity. Decreased availability and affordability (exposure) of high energy food and drink.

Increase opportunities for NHS staff, visitors and patients to be physically active and encourage and support them to be more active.

HPHS action plan developed implemented and evaluated. Chief Executive’s Letter 01 (CEL01) outcomes monitored and delivered. Physical Activity Policy developed, implemented and monitored.

CEL01 Steering Group Public Health

Increased access to physical activity.

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Actions

Milestones

Responsibility

Benefits3

Develop a consistent approach to healthy eating for all food service providers across the NHS.

CEL01 outcomes monitored and delivered. Nutrition Policy developed, implemented and monitored.

CEL01 Steering Group

Prioritised responsible promotion and marketing of healthy choices.

Establish a consistent approach to enable active travel for NHS staff exploring joint initiatives with partners where feasible.

HPHS action plan developed, implemented and evaluated. CEL 01 outcomes monitored and delivered. Active Travel Policy implemented and monitored.

CEL01 Steering Group

Promotion of active travel/active workplaces.

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Actions

Milestones

Responsibility

Benefits3

Enhance the infrastructure within the NHS built/natural environment to provide more opportunities for safe and accessible physical activity, particularly walking and cycling.

Review and update walking maps for NHS sites. Make links with national Green Exercise Partnership (GEP). GEP Challenge/NHS Grampian Endowment fund available.

CEL01 Steering Group

Increased access to physical activity.

2. Children and Families

Continue to implement, monitor and evaluate the national Maternal and Infant Nutrition (MIN) Framework through the delivery of the MIN Action Plan.

Action plan monitored annually. Proportion of new born children

Public Health Directorate. Public Health Leads within CHPs.

Improved maternal and infant nutrition.

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Actions

Milestones

Responsibility

Benefits3

exclusively breastfed at 6-8 weeks.

Establish links and collaborative working with partner organisations (e.g. Active Schools, Play Forums, Early Years Partnerships) and private sector (e.g. Streetsport) to ensure programmes are aligned, develop, evaluate and share best practice (including targeted programmes with key target groups).

Links established. Collaborative initiatives identified, implemented and evaluated. Key groups targeted.

Public Health Lead within CHPs. NHS Leads within Community Planning Partnerships Public Health Directorate.

Increased play and physical activity opportunities for children and young people.

Work with Education partners to monitor and maximise impact of the Health Promotion and Nutrition Act Scotland 2007.

Links established and maintained. Opportunities identified. Progress monitored.

Public Health Leads within CHPs. Education Leads within CHPs.

Prioritised responsible promotion and marketing of healthy choices. Decreased availability and affordability

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Actions

Milestones

Responsibility

Benefits3

(exposure) of high energy food and drink.

Work with Education partners to create pathways that link physical education with school and community based physical activity and sport.

Links identified Pathway from school to community sport developed and strengthened.

Local Authority Active Schools

Increased play and physical activity opportunities for children and young people.

Work with Education partners to provide support for initiatives ‘Beyond the School Gate’ including improved pupil access to healthier food outside school at lunchtime.

Initiatives identified and supported.

Public Health Leads within CHPs. NHS Leads within Community Planning Partnerships Education leads within CHPs.

Decreased availability and affordability (exposure) of high energy food and drink. Increased availability and affordability of low energy options.

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Actions

Milestones

Responsibility

Benefits3

Continue to work with Education partners to deliver, extend and embed healthy eating, active living lifestyle initiatives (e.g. Grow Well Choices (GWC), practical food skills) within schools.

Delivery of child healthy weight (CHW) trajectory by March 2014. Continued delivery of age appropriate GWC beyond March 2014.

Public Health Leads within CHPs. CHP HEAL coordinators. CHW Coordinator.

Increased awareness, knowledge, skills and empowerment. Increased physical activity opportunities for children and young people.

Provide support for the development of nutrition incentive schemes within Education and Leisure settings.

Food Dudes trial completed and evaluated.

Public Health Leads within CHPs. Partnerships. Public Health Directorate.

Prioritised responsible promotion and marketing of healthy choices.

Work with partner providers to establish and promote free/low cost opportunities for physical activity for families

Opportunities identified, implemented and monitored.

Public Health Leads within CHPs. Partnerships. Public Health Directorate.

Increased play and physical activity opportunities for

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Actions

Milestones

Responsibility

Benefits3

children and young people.

Communicate key messages to the general public in positive, creative, innovative and novel ways including through proactive media engagement.

Key messages agreed and promoted.

Public Health Directorate. Community Dietetic Department.

Prioritised responsible promotion and marketing of healthy choices. More supportive media environment and changed social norms.

3. Communities

Support the development of community food initiatives (e.g. community kitchens, community gardens) including the Third Sector and Social Enterprise.

Initiatives established and monitored.

Public Health Leads within CHPs. Partnerships. Public Health Directorate.

Decreased availability and affordability (exposure) of high energy food

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Actions

Milestones

Responsibility

Benefits3

and drink. Prioritised responsible promotion and marketing of healthy choices.

Provide support for active travel schemes and enhancement of green space provision within schools and wider communities.

Initiatives established and monitored. Numbers and percentage of children walking or cycling to school.

Public Health Leads within CHPs. Education Leads within CHPs.

Increased physical activity opportunities for children and young people. Increased opportunities for active travel.

Work collaboratively to enhance and support partnerships to promote and encourage physical activity in communities (e.g. through the establishment of Healthwalks,

Initiatives established and monitored.

AHPAD. AHP Sector Leads. Public Health Leads within CHPs. Public Health Directorate.

Increased access to physical activity. Increased opportunities for

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Actions

Milestones

Responsibility

Benefits3

support for the Living Streets, Walkable Communities project and Walk, Jog, Run initiatives) with a focus on disadvantaged communities and groups (least active/most sedentary).

physical activity.

Provide support for families with young children to develop parenting skills in healthy eating, practical cookery and physical activity with a focus on natural life stages (e.g. weaning, toddler, transition to school, play@home, and protective factors e.g. positive involvement in activities and hobbies, shared family mealtimes).

Confidence to Cook programme reviewed. Initiatives established and monitored.

Public Health Leads within CHPs. Public Health Directorate.

Increased awareness, knowledge, skills and empowerment.

Work with communities to identify healthy eating active living assets

Links established with communities.

Public Health Leads within CHPs.

More supportive media

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Actions

Milestones

Responsibility

Benefits3

and deliver their priorities (including heath information/awareness).

Assets identified, initiatives implemented and evaluated.

NHS Leads within Community Planning Partnerships.

environment and changed social norms.

Raise awareness of and promote the benefits of a healthy diet and regular physical activity to prisoners.

NHS Grampian’s Health Improvement Strategy 2014-17 for HMP Grampian implemented.

Health Improvement Strategy Steering Group

Increased awareness, knowledge, skills and empowerment. Increased opportunities for physical activity.

Develop and implement a standardised training programme and associated resources to increase knowledge and awareness of healthy eating, active living messages and how to raise the issue of healthy weight for multiagency partners, professionals and

HPHS action plan developed implemented and evaluated. Training programme piloted and established.

Public Health Leads within CHPs. NHS Leads within Community Planning Partnerships Community Dietetic Department. Public Health Directorate.

Increased awareness, knowledge, skills and empowerment. Prioritised responsible promotion and

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Actions

Milestones

Responsibility

Benefits3

communities. Maximise links to alcohol agenda.

marketing of healthy choices. Changed social norms.

Ensure identification and removal of barriers to the uptake of training opportunities by professionals in our communities.

Barriers identified and addressed.

Public Health Leads within CHPs. NHS Leads within Community Planning Partnerships Community Dietetic Department. Public Health Directorate.

Increased awareness, knowledge, skills and empowerment. Prioritised responsible promotion and marketing of healthy choices. Changed social norms.

Proactively build and provide support for an accessible Grampian-wide network of venues, facilities and multiagency facilitators to deliver

Network established and maintained.

Public Health Directorate. NHS Leads within Community Planning Partnerships

Increased awareness, knowledge, skills and

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Actions

Milestones

Responsibility

Benefits3

practical food skills in localities, with a focus on areas of deprivation. Include protective factors e.g. positive involvement in activities and hobbies, shared family mealtimes.

empowerment.

Support the establishment of community based champions for physical activity within NHS Grampian and with Local Authorities partners to maximise impact, tailoring where needed.

Champions identified and established.

Public Health Leads within CHPs. NHS Leads within Community Planning Partnerships

Prioritised responsible promotion and marketing of healthy choices.

Review key nutrition, physical activity and healthy weight key messages from a multi-dimensional health perspective (including portion sizes, UK physical activity guidelines, healthy growth, affordable healthy eating options and safe outdoor play).

Key messages reviewed and disseminated.

Public Health Directorate. Community Dietetic Department.

Increased awareness, knowledge, skills and empowerment.

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Actions

Milestones

Responsibility

Benefits3

Pilot and evaluate generic exercise classes for individuals with a range of long term conditions on a trial basis as part of a wider physical activity pathway.

Generic exercise classes trialled and evaluated.

Public Health Directorate.

Increased access to physical activity.

Commission weight management services to provide subsidised weight management on referral for specific target groups. Ensure commissioned weight management services are aware of and promote healthy messages around alcohol.

Commercial weight management trial completed and evaluated.

Public Health Directorate.

Improved access to weight management services.

4. NHS provision

Provide support for NHS staff to achieve and maintain a healthy weight.

Initiatives established and monitored. Baseline

Public Health Directorate. Scottish Healthy Working Lives.

Increased awareness, knowledge, skills and

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Actions

Milestones

Responsibility

Benefits3

information gathered. Health needs assessments conducted.

empowerment.

Raise awareness with NHS staff and visitors of the importance and benefits of physical activity.

Physical activity promoted through NHS communication networks and social media.

HPHS action plan developed implemented and evaluated.

Increased awareness, knowledge, skills and empowerment.

Provide weight management support for overweight/obese women of childbearing age. Maximise links to alcohol agenda.

Programme piloted. Uptake of service measured and evaluated.

Community Dietetic Department.

Improved access to weight management services. Improved maternal and infant nutrition.

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Actions

Milestones

Responsibility

Benefits3

Continue to establish and monitor the Adult Weight Management Pathway (ICP) through the delivery of the Adult Weight Management Action Plan.

Multi-disciplinary workshop – September 2012. Action Plan developed and implemented. Grampian Weight Management Service established.

Acute Sector. Adult weight management Steering Group. Community Dietetic Department. Public Health.

Improved access to weight management services.

Implement Children and Young People’s Weight Management Pathway (CICP) through the development and delivery of the Child Healthy Weight Action Plan.

Action Plan developed and implemented.

Community Dietetic Department.

Improved access to weight management services.

Develop, implement and monitor a Physical Activity Pathway to support the delivery of brief advice and brief interventions.

HPHS action plan developed implemented and evaluated.

Allied Health Professionals/Public Health Directorate. Acute Sector.

Increased access to physical activity. Physical activity

39

Actions

Milestones

Responsibility

Benefits3

Feasibility study complete in both Primary and Acute Sectors. Pathway rolled out as appropriate. Evidence of increased NHS staff awareness in the impact of physical inactivity and importance of regular activity on health and wellbeing. NHS staff promote recommended levels of physical activity.

routinely promoted where appropriate. National Physical Activity Pathway embedded in all appropriate clinical settings across the healthcare system. Links forged between the health system and the community, enabling signposting to local opportunities.

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Actions

Milestones

Responsibility

Benefits3

5. Monitoring and evaluation

Review activity annually within agreed public health reporting framework.

Annual reports provided.

Identified Leads.

Single system accountability and joint working established. Services targeted effectively according to population need.

Collate and monitor progress.

Annual reports provided.

Public Health Directorate.

Single system accountability and joint working established. Services targeted effectively according to population need.

41

Actions

Milestones

Responsibility

Benefits3

Monitor progress on headline benchmarks.

Annual reports provided.

Health Intelligence.

Effectiveness monitored. Health needs of population being met.

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Appendix 4: Contributors

Lead Author: Mr Ray Watkins, Consult in Dental Public Health.

Co-author: Caroline Comerford, Health Improvement Coordinator.

Developed:

with guidance and support from members of the Public Health Directorate Healthy Eating Active Living

Team.

in consultation with members of Aberdeen City CHP Public Health Team, Aberdeenshire CHP Public

Health Team, Moray HSCP Public Health Team and NHS Grampian Community Dietetic Department.

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References

i World Health Organisation, 2014. Health in the green economy. Co-benefits to health of climate change mitigation. http://www.who.int/hia/hgebrief_transp.pdf ii Scottish Community Development Centre, 2011. Community resilience and co-production. Getting to grips with the language. http://www.scdc.org.uk/co-production-scotland/co-production-useful-resources/ iii Glasgow Centre for Population Health, 2011. Asset based approaches for health improvement: redressing the balance. http://www.gcph.co.uk/assets/0000/2627/GCPH_Briefing_Paper_CS9web.pdf iv Halliday E, Mutrie N, Bull F. Br J Sports Med Published Online. First published July 23rd 2013, doi:10.1136/bjsports-2013-092467 v Scottish Government, 2011. The Scottish Health Survey: Topic Report: Obesity. http://www.scotland.gov.uk/Publications/2011/10/1138 vi Turner, S., Smith, S., Craig, L., and McNeill, G., 2012 The Study of Trends in Obesity in North East Scotland (STONES). Aberdeen University (unpublished). vii NHS Grampian, 2013. Draft Grampian P1 Children BMI Report 2009 to 2012.

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