David Stobbs, Health improvement practitioner, Public Health, Newcastle City Council

Published in JHH14.1 – Children’s Health

In the 20 years I have been working in health improvement we have always recognised that the best way to help people make behaviour changes we believe would improve their health is through working with those community organisations and individuals who know them best. In Newcastle upon Tyne we have a strong commitment to working with and commissioning the community and voluntary sector to work with people ‘from where they are at’.That’s why any credit for the success of the partnership goes to Kath English, the Change4Life West Newcastle co-ordinator based with HealthWorks Newcastle.

Inequalities in access to money, power and resources … damage wellbeing and health Click To Tweet Change4Life is a partnership of providers linking up services and projects in the inner-West of Newcastle upon Tyne to encourage families to follow the national campaign’s messages of ‘eat well, move more and live longer’. The wards of Elswick, Benwell & Scotswood and Wingrove have some of the highest health and social inequalities in the city and nationally. The National Child Measurement Programme (NCMP) which measures all pupils in reception and year 6 across England found high rates of overweight and obesity in children in these areas.

Now in its sixth year the partnership, working in the areas around the area’s schools as well as in children’s centres and community settings in the inner west end, has developed a vibrant partnership with joint working taking place on a regular basis. Public Health in Newcastle City Council has confirmed funding until the end of March 2018.

Healthy Lives, Healthy People:A call to action on obesity in England (DofH, 2011) calls for:

A sustained downward trend in the level of excess weight in children by 2020

A downward trend in the level of excess weight averaged across all adults by 2020

The objectives of the Change4Life West Newcastle Partnership are to:

• increase physical activity, specifically in inactive groups
• improve nutritional and/or cooking skills of families and specific children’s groups
• help participants set realistic goals to achieve behaviour change
• encourage children, young people and parents to develop skills to help others (eg peer support/young sport leaders/young cooks/health champions)
• build capacity of frontline staff to deliver key consistent messages through the partnership
• focus on improving the health of children 0 to 11 (early and primary years) to ensure early intervention and prevention
• provide a family focus.

The partnership’s specifically funded programmes are:

• Newcastle United Foundation’s Match Fit provides nutritional information and some fun physical activity for children and young people
• Newcastle Nutrition’s specialist dietetic service for early years provides help, support and advice to families with a child under five who is very overweight
• Newcastle Nutrition’s training programme is offered free of charge to organisations and individuals working in the area around nutrition and healthy eating
• West End Women and Girls are funded separately to deliver the Seeds4Life project which provides food growing and cooking opportunities to children from local schools and early year’s settings
• Newcastle Action for Parents and Toddlers Initiative (NAPI) are funded separately to provide support and resources to parent and toddler groups in the area.
• HealthWorks Newcastle is funded to host the Change4Life West Newcastle co-ordinator who brings together the wider partnership, which successfully links in all organisations and projects in the area working around healthy eating and physical activity into the programme. HealthWorks also host the Change4Life champions support worker.

The Change4Life Partnership has 99 organisations signed up and through them has links to all the people they work with as well as their own staff. This communication system, which includes three partnership events a year, provides information to organisations about the evidence-based Change4Life messages. It also receives feedback on what works in promoting these messages and what the partners have been doing. By sharing information through networking the partners can plan work together to ensure effective and ‘fair’ provision of services in the area.

OurWellbeing for Life strategy

The Newcastle Wellbeing for Life Board’s ‘Our Wellbeing for Life Strategy’ (www.wellbeingforlife.org.uk/our-strategy) is committed to tackling inequalities by improving the conditions in which people are born, grow up, live their lives and grow old. The Change4Life Partnership supports the strategy’s focus on keeping children healthy so they may achieve and learn at school and succeed in their working lives.

The partnership creates volunteering opportunities and training for children and adults, and contributes to the target for ‘decent neighbourhoods’, providing as it does many opportunities for communities to come together to look at lifestyle choices. By linking into other programmes such as Cycling in the City it helps provide activities for children and families to be more physically active and better informed about their food choices and to celebrate the diversity of the cultures the food comes from.

Diversity equality and fairness

There is emphasis in the Strategy for Newcastle to be a place of fairness. Yet inequalities in access to money, power and resources exist in the city and these inequalities damage wellbeing and health. The concept of ‘progressive universalism’ refers to taking actions in ways that can benefit all social groups. Children and families in West Newcastle with the greatest need for support are identified by schools or community organisations in the partnership, through the NCMP or On the Go, who carry out height and weight measures in primary schools. By working not just with children, but with all family members including grandparents and siblings, the various organisations in the wider partnership works across the ‘life course’. This approach aims to tackle inequalities by providing activities and programmes for all ages.

There is a commitment to asset-based practice which recognises and builds on people’s skills, strengths, aspirations and networks, and enables them to be active in improving their own and others’ well-being and health. The partnership’s Change4Life champions programme supports local volunteers to promote messages in their own settings and communities. Many champions, whether based with partners or in schools, work face-to-face with children and families and feed back to the partnership their views and needs. Newcastle Nutrition’s wider training programmes link healthy eating, physical activity, obesity and food growing, all of which support the development and use of capacity within the city.

Outcomes

The Change4Life West Newcastle partnership has certain service outcomes for which it is solely responsible. It also contributes to important population outcomes.

Population outcomes

• The children of Newcastle are of a healthy weight (linked to the national indicator to halt the year-on-year rise in obesity in the under 11s).
• The children of the west of Newcastle are a healthy weight.
• Health inequalities are reduced, particularly child obesity and teenage pregnancy
• Children and young people enjoy their lives and have access to opportunities, culture and activities.

The key outcome of the Change4Life Partnership is to reduce obesity and overweight children under 11 years old in West Newcastle.

The 2014/2015 NCMP data tells us that in reception class:

• 1% of pupils are obese, compared with the England average of 9.1%
• 6% of pupils are overweight compared with England average of 12.8%

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And in year 6:

• 24% of pupils are obese, compared with the England average of 19.1%
• 6% of pupils are overweight compared with the England average of 14.2%

The NCMP data for Change4Life West Newcastle shows that the trend for obesity in reception is down while the

‘The Change4Life champions programme supports local volunteers’

trend in year 6 is up. In reception 14% of boys and 11.4% of girls are obese: so male and female obesity has decreased, and the overall trend is down. In year 6 however, 37.4% of males and 23.9% of females are obese: so male obesity has increased and the overall trend is up, while female obesity has increased though the overall trend is down. This clearly suggests that we need to focus more work on boys in primary school settings.

The data around ethnicity highlights that in reception BME pupils have a lower rate of obesity than non BME, both girls and boys. However, in year 6 both BME boys and girls have a higher rate of obesity than non BME pupils. Therefore more work with BME communities during primary school years appears to be needed.

Looking at Newcastle overall the most recent data suggests a small improvement in the prevalence of overweight and obesity. However, the fact that children in the Change4Life schools continue to have higher levels of obesity than children in the non Change4Life schools suggest that deprivation continues to be a factor in overweight and obesity. This further supports the need for work in areas of higher social deprivation.

Service outcomes

A range of service outcomes have been discussed and agreed and each partner has identified outcomes for their projects for which they are responsible and can measure and report on.

The main strength of the programme is that the partnership links funded programmes with the wider community and schools. There has been an increase of membership during

‘Engaging families to join our programmes continues to be a challenge’

2015/16, from 97 to 99: a small increase but understandable given that relevant organisations are already signed up as partners. The success of the programme shows in their having remained engaged, and that since the beginning of the programme the partnership has increased from 32 to 99 organisations.

72% of organisations who attended a wider partnership event completed a link-up sheet

66% of organisations who attended requested follow-up information from the speakers

61% of organisations who attended made contact with speakers on the day

90% of organisations say they benefit from attending the partnership events.

Objectives and activities within programmes continue to change in the light of experience and learning gained. Engaging families to join our programmes continues to be a challenge: we have found that people fail to recognise when they or their children are overweight, or they do not consider addressing the issue to be a priority.

Recommendations

• Tie in with the Obesity Delivery Group’s review of commissioned services to develop a whole systems approach to obesity
• Continue to fund programmes to target areas with high rates of overweight and obesity which are linked to high rates of social deprivation.
• Consider longer-term contracts or commissioning so that organisations can work on and show success with longer-term outcomes linked into other strategies and NICE guidance.
• Target more programmes at BME boys and girls in primary schools whose levels of obesity are increasing at a higher rate than non-BME pupils.
• Target more work on boys in primary schools whose levels of obesity are increasing at a higher rate than girls.
• Celebrate the success of the wider partnership and continue to promote networking which results in joined up working and greater knowledge of services and activities available in the area.
• Develop a more targeted programme or campaign to raise awareness of how to recognise overweight and obesity and raise it as an issue.

Reference

• Department of Health (2011) Healthy lives, healthy people: A call to action on obesity in England. London: DoH. Available at: www.gov.uk/government/publications/healthy-lives-healthy-people-a–call-to-action-on-obesity-in-england (accessed 25 February 2017)