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A healthier and more active future for the North East of Scotland Implementing the Scottish diet, activity and healthy weight strategies, for the North East of Scotland 2019-22
A healthier and more active future for the North East of Scotland
Implementing the Scottish diet, activity and healthy weight strategies, for the North East of Scotland
2019-22
Executive Summary 4
Introduction 6
The ideal future – imagining a healthier and more active North East 8
The current – the current situation in the North East 14
The future – identifying areas for priority action 22
Conclusion 24
References 26
Appendix 1 28
Appendix 2 29
Appendix 3 31
A healthier and more active future for the North East of Scotland
Implementing the Scottish diet, activity and healthy weight strategies, for the North East of Scotland
2019-22
Executive summary
Developing a vision for the futureThe Scottish Government’s national strategy A Healthier Future, and subsequently the More Active Scotland strategy and the Type 2 Diabetes Framework, makes recommendations to improve the nation’s diet, increase levels of physical activity and facilitate the maintenance of healthy weight. To support the delivery of these strategies in North East Scotland, colleagues across NHS Grampian and the Health and Social Care Partnerships have created an evidence-based vision for what a healthier and more active North East would look like.
The gap between the vision and current realityComparing this vision with the current position brings the gap between aspiration and reality into focus. Initial suggestions for implementing A Healthier and More Active Future across the North East are provided:
A healthy food environment and a healthy diet
1. Scottish Government and its national agencies have a clear role to play in influencing food production, advertising, consumer labelling and information, and marketing and retailing practices.
2. Local community food initiatives have an important local role in the availability of sustainable and affordable healthy food, and should be nurtured and supported by local public authorities.
3. All organisations, whether in the public, private or third sector, have a role to play in ensuring healthy food provision in their premises. The national healthy working lives programme is an important source of support for employers wanting to ensure they have healthy living policies in place.
4. Public authorities and community planning partnerships have an important role to play in addressing poverty in all its forms. Ensuring accessibility of emergency food aid is important, but eradicating the need for emergency food aid must remain a priority.
5. All organisations whether in the public, private or third sector must continue to promote and encourage breastfeeding as a social norm.
A physically active population
6. Local authorities, NESTRANS and HITRANS should continue to consider how their strategic plans can encourage safe and enjoyable physical activity through the built environment and travel infrastructure, making use of the Place Standard, and with particular focus on greenspace and other developments in less affluent neighbourhoods.
7. Employers should encourage active travel to work of their employees, and healthy working lives is an important source of advice and support on how to do this.
8. Integrated children’s services groups have a vital role to play in ensuring opportunities for physical activities are included in nursery and educational settings, including the Scottish Government’s Active Schools programme and the daily mile.
Health promotion
9. Food and cooking skills should continue to be provided by a range of public and third sector providers.
10. The health service should pay particular attention to understanding the specific healthy eating and healthy weight needs of NHS staff.
11. The NHS should continue to fund Child Healthy Weight interventions, should incorporate healthy weight into the Health Visiting Pathway, explore options to further support families with weaning and work with partner public authorities and integrated children’s services groups on healthy eating and physical activity programmes which include parents, carers and families.
12. All organisations, whether in the public, private or third sector, have a vital role to play in encouraging people to be more physically active and to eat well. The health system should provide training for clinical staff to discuss weight, portion control and eating behaviour in a sensitive and supportive manner. The implementation of making every opportunity count should continue to expand as an inclusive and enabling approach for a healthier future.
13. The health service should include changes in physical exercise and diet as routine interventions for the prevention and treatment of a range of physical and mental health conditions, and should promote appropriate physical activity in pregnancy and following birth.25
Healthy weight management
14. With over 300,000 overweight and obese adults in the north east of Scotland alone, the NHS cannot hope to be the sole provider of weight management services for the population. NHS Grampian should seek to increase access to weight management services and resources must be focused on those with greatest clinical need. Staff across a range of organisations may need training and support to raise the issue and intervene.
15. The health service should provide an integrated Tier 3 service for those experiencing obesity-related clinical conditions and symptoms.
16. NHS Grampian should consider how bariatric surgery might be made available to a larger number of eligible patients.
17. Develop and implement a NHS Grampian Diabetes Plan in line with the Healthier Futures Framework for the Prevention, Early Detection and Early Intervention of type 2 diabetes.
Next stepsWe are actively seeking to discuss this strategic assessment with partners from all sectors and agencies, through existing strategic groups and individually, to explore how to successfully implement A Healthier and More Active Future in the North East.
54
You are what you eat(attributed to Victor Lindlahr, 1942)
We’ve all heard the saying you are what you eat. It’s self-evidently true. The cells and chemical components that make up our body and brain are literally built from the foods we eat. Food is one of the basic necessities of life, alongside air, water and shelter. When life involved greater physical labour for most people, food was necessary as fuel for the physical exertion involved.
But food has also always represented much more than fuel and survival. Food has cultural and social meaning. Food – its selection, preparation, presentation, and consumption – is central to many of our social gatherings and ceremonies. We use food to collectively acknowledge significant life events such as weddings or funerals; to celebrate feasts or special occasions; and to enjoy social interaction with friends and family. Many traditional gatherings can involve physical activities such as dancing or a long walk after dinner. And many people participate in sports and other activities as an important part of their social life.
We gift food to say thanks, congratulations or to express love and friendship. Food also has psychological meaning and purpose. We don’t just eat when we’re hungry. We’ve all heard of comfort eating. Some of us eat when we’re happy, some when we’re sad, some when we’re anxious. Likewise walking, sports and exercise are important elements of coping with life’s stress for some.
We seem to have solved the problem of food supply. There is now enough food produced to feed everyone in the world. But we haven’t solved the problem of food distribution, as not everyone has equal access to the food that is produced. We haven’t solved the problem of nutrition, as some people who can obtain sufficient calories – even excess calories – can still suffer from malnourishment. And there are growing concerns that we haven’t solved the problem of ensuring that food production doesn’t damage the world that we depend on for life. All of this is as true in Scotland as it is globally.
We have also solved the problem of manual labour. Modern technologies, from the internal combustion engine, to domestic appliances to digital technology have liberated people from crushing exertion and allowed travel and communications previous generations could only dream of. But we haven’t solved the problem that getting sufficient exercise now needs deliberate effort, and the ‘always on’ digital economy leaves many of us time poor and over-stretched.
Modern life is taking a toll on our health and wellbeing. Achieving a nutritious diet and maintaining sufficient exercise is increasingly difficult to achieve for many of us. This is not to moralise or judge. It is to recognise how often modern life gets in the way of good intentions and a healthy life. We have a collective interest in creating a world where everyone can eat well, stay active and be healthy in their weight. The publication of the national strategy, A Healthier Future, should provide us all with an impetus to make that collective interest a reality for.
A healthier and more active future for the North East of ScotlandA Healthier Future, A More Active Scotland and Type 2 Diabetes Framework – the national strategies for diet and nutrition, physical activity and healthy weight, were developed partly in response to the growing demands on the National Health Service to respond to conditions arising due to malnourishment, obesity and the effects of modern living.
These strategies aren’t published in a vacuum. For a long time, many agencies and organisations have been working to promote healthy eating, physical exercise, healthy living and healthy weight. We decided to explore the recommendations in the consultation draft of A Healthier Future and reflect on our current efforts in the North East in light of these. (NB The consultation draft of A Healthier Future contained recommendations on physical activity2; these were subsequently transferred to A More Active Scotland on final publication. It also refers to a national Diabetes Framework which has now been published. Our local approach remains to address all of these together).
We first compared the recommendations in the consultation draft of A Healthier Future with those of two other major reports, one by McKinsey Consulting3 and one by the Foresight group4 (see appendix 1). We used these three reports to think through what would logically be required for everyone to eat well, be healthily active, and to be healthy in their weight. We set this out in section two.
We then collated selected information to help us understand what the current position is in the North East. We set this out in section three.
By comparing sections two and three we then identified where further focus would be helpful in delivering A Healthier Future and A More Active Scotland for the North East. We set this out in section four.
We finally consider how to support efforts for the future in section five.
Introduction
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The ideal future: imagining a healthier and more active North East
Bringing together the recommendations in the consultation draft of A Healthier Future with those in the Foresight and McKinsey reports allows us to describe how the world would necessarily be if they were fully realised. We have summarised our description under four headings below, namely diet and nutrition, physical activity, health promotion, and weight management.
Diet and nutritionIn a world where everyone was able to eat well and healthily the following would necessarily have to be true:
• Food producers and retailers would prioritise the manufacturing, advertising, marketing and sales of healthy food and drink. The majority of food sold by retailers would be healthy. Food production would be sustainable and would not involve destruction of Earth’s ecology. Corporate profits would never be prioritised before people’s health.
• People’s diets would be largely based around fruit and vegetables, complex carbohydrates, and small portions of fish and meat.1 Fresh, healthy food would be more affordable than discretionary foods (for example, foods such as cakes or crisps) which would be consumed as the exception rather than the rule.
• Healthy meals would be the norm, whether in the home, or in restaurants and cafes, in workplace canteens, in schools and nurseries, and in hospitals, prisons and other institutional settings. Portion sizes would reflect calorific needs.
• People would have more time to shop for, select, prepare and eat home cooked meals at home. People would have the work – life balance to allow this to happen. People would be able to access fresh healthy food supplies, have the necessary knowledge and cooking skills, the necessary kitchen equipment and the means to cover the energy costs to power these.
• Breastfeeding of infants would be the norm. Mothers would have every support (from healthcare professionals, family, friends and wider society) to enable them to breastfeed for as long as they want.
Physical activityIn a world where everyone was able to be as physically active as required to keep fit and healthy,2 the following would necessarily have to be true:
• Physical activity would be actively encouraged in all settings, for example, through the design of buildings to promote the use of stairs, workplace team challenges and gym memberships, the content of the school curriculum and access to extracurricular activities.
• We would have an environment in which it is easy, safe and enjoyable to walk or cycle, including as a method of transport for people to get to and from work.
• We would have an environment in which it is easy, safe and enjoyable for people, including children, to undertake physical activity outside.
• Sports facilities and classes would be accessible and affordable to all, including people who work shift patterns.
Health promotion In a world where everyone was supported to eat well, stay active and maintain a healthy weight, the following would necessarily have to be true:
• Diet and nutrition, physical activity and healthy weight would be openly talked about. Health, social care and local authority professionals would routinely consider these areas as part of their work, and anyone facing challenges would be offered assistance.
• The development, design and implementation of healthy weight interventions would seek to engage the participation of those who would be impacted by them. Programmes to promote healthy weight in children would necessarily involve parents and families.
• Diet and physical activity would be routinely considered in all sectors’ strategic planning and policy development, and inequalities in access, affordability or knowledge and skills would be addressed by these.
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Weight managementIn a world where everyone who wanted support to maintain a healthy weight was able to obtain this, the following would necessarily have to be true (in addition to the above):
• A range of weight management services would be available to those who were seeking to lose weight due to overweight or obesity. These services, termed ‘Tier 1 and 2’ services, would be provided by the NHS, by non-profit organisations or by commercial organisations. These services would offer proven, effective interventions that would help people to lose clinically significant body weight and maintain this loss into the future and help reduce the incidence of a number of long term conditions e.g. Diabetes, Stroke, Cardiovascular Disease etc.
• A more intensive ‘Tier 3’ specialist weight management service would be available for those with obesity for whom Tier 2 had not been successful.
• Weight loss surgery would be available as a Tier 4 service for those who remained severely obese after engagement with Tier 3 services.
Body weight is often measured by the body-mass index (BMI). This is simply the ratio of our bodyweight to a measure of our height. To calculate BMI we divide our bodyweight in kilograms by the square of our height in metres. Thus BMI = kg/m2. A BMI between 18.5 to <25 is usually labelled as ‘healthy weight’. A BMI between 25 to <30 is usually labelled as ‘overweight’. A BMI of 30 and over is usually labelled as ‘obesity’.
10
Prison• Healthy meals for those in prison, visitors
and staff.*• Limit accessibility to discretionary foods.• Staff walk or cycle to work/staff incentives.• Staff support behaviour change.
Services• Staff support behaviour change.• Support women to breastfeed.• Tier 1 - 4 weight management services.• Use of technology and social marketing.
*Through increased availability, use of nutritional labelling, marketing/promotions, healthier cooking processes and reformulation, adherence to nutritional standards, decrease portion sizes.
Prison
Health services
Environment• Healthy meals for patients, visitors, staff.*• Limit accessibility to discretionary foods.• Staff walk or cycle to work/staff incentives.
Nurseries, schools, colleges and universities• Healthy meals in educational
establishments.*• Limit accessibility to discretionary foods in
and nearby.• Staff and pupils walk or cycle.• Optimise school/university sports facilities.• Curriculum and extra-curricular activities
encourage physical activity and the development of knowledge/skills around diet and nutrition.
• Staff support behaviour change.
Adverts• Have the knowledge and skills to prepare
healthy meals at home.• Adopt family healthy eating behaviours.• Restrictions on high calorie food and drink
advertising.
Gym/other leisure activities• Increased access to sports facilities and
classes.• Access to green space.• Feel safe and enjoyable to be outside. • Participate in activities with friends and
family.
Places of work and volunteering• Healthy meals at work.*• Limit accessibility to discretionary foods.• Staff walk or cycle to work.• Staff incentives to increase physical activity.• Support women to continue to breastfeed if
they wish.
Education
Shops
Eating out
Restaurants and cafes• Healthy meals when eating out.*• Women feel comfortable to breastfeed.
Shops• Marketing/product placement/promotions
to encourage the use of healthy foods and recipes and discourage unhealthy ones.
• Increased availability and affordability of fresh healthy produce (particularly in areas where currently low).
• Decreased availability and affordability of high calorie, low nutritional foods.
Home
Places of work
Adverts
Leisure activities
12 13
The present: the current situation in the North East
This section outlines the health of the North East’s population in relation to diet and nutrition, physical activity and healthy weight. Our assessment of current actions across these areas is knowingly partial and incomplete, and a full mapping will require the involvement and participation of wider authorities – we make recommendations on how to progress this in section five.
However, our assessment does provide a starting point, and is informative given the content set out in section two. As before, we have summarised our findings under four headings, namely diet and nutrition, physical activity, health promotion, and weight management.
Diet and nutrition
1. There is significant marketing and promotion of discretionary foods.
2. Most people do not meet dietary recommendations in Scotland. An estimated 20% of daily calories are from discretionary foods.5
• 17% of adults and 33% of children eat crisps once a day or more.
• 28% of adults and 51% of children have chocolate or sweets at least once a day.
• 20% of adults and 35% of children drink non-diet soft drinks at least once a day. About 22% of the Scottish population’s sugar intake is from sugary drinks.
Most adults and children in the North East only eat three portions of fruit and veg per day.6,7
3. The diets people report through the Scottish Health Survey suggest that there is widespread provision of food and meals that don’t support people to meet the national dietary recommendations.7
• Only 32% of adults and 16% of children have oily fish once a week or more.
• Only 50% of adults and children have potatoes, pasta or rice at least five times per week.
• 32% of adults and 42% of children eat processed meat at least twice a week.
The Scottish Health Survey captures self-reported diet in the North East:
4. There are growing concerns that some households are finding it difficult to afford to eat.
Average expenditure on food and drink is £42 per person per week; of which £12 is on eating out; the proportion of income spent on food increases with deprivation.8
Fruit and vegetable intake is associated with increasing income.7
Food banks: Aberdeen City 15,000 food parcels in 2017, up from 10,000 in 2016; Aberdeenshire North 2,849 people in 2017; Moray food bank, 2,759 people.
Fuel poverty is defined as households spending more than 20% of their income on fuel; Aberdeen City 9% of households, Aberdeenshire 14%, Moray 23%.
Primary children in receipt of free school meals, Aberdeen City 16%, Aberdeenshire 7%, Moray 11%.
Food poverty is defined as ‘the inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so.’ 9
Over half of chocolate, sweets, crisps and sugary drinks are bought when on promotion.5
1514
5. Breastfeeding of infants is not the norm.
Physical activity1. Two thirds of adults in the North East report weekly physical activity that meets the national recommendations. Physical activity is more commonly reported by men than women, and by adults living in more affluent areas.
Only half of infants are breastfed at six to eight weeks in the North East, either exclusively (one third) or partially (one in five in Aberdeen, one in six in Aberdeenshire and one in ten in Moray).10
White Scottish women, younger mothers and those from areas of higher deprivation are less likely to breastfeed.10
Three fifths of infants are weaned onto complementary food earlier than the six-month recommendation.11
2. Under one third of journeys in the North East are made on foot, and a very small proportion of journeys are made by bicycle.13
3. The majority of children have access to a play area in their neighbourhood (>90%), but children living in less affluent urban areas are less likely to have access to open green spaces and natural environments, with lower perceptions of safety.14
4. There has been an increase in the proportion of people walking for at least 30 minutes once a month over the past decade, but participation in other exercise and sports has not changed significantly.7,14
• Proportion of journeys made by foot: 30% Aberdeen City and Moray, 16% in Aberdeenshire.
• Proportion of journeys made by bicycle across Aberdeen, Aberdeenshire, Moray 1% to 2%.
• Half of children walk and 1% cycle to school; they are less likely to walk to secondary than primary school.
Girls aged 11 to 15 years are less likely to meet the guidelines than boys of the same age, with no apparent pattern by affluence.7,12
One fifth of adults in the North East have very low levels of physical activity, more commonly reported by women than men, and particularly by adults over the age of 75.6
One in five children (aged between 2 and 15) in the North East are not meeting the national guidelines for physical activity.12
16 17
Health promotion 1. There are a range of current activities aiming to promote access to healthy food, physical activity and healthy weight
2. Food, physical activity and healthy weight is currently included in public sector strategic planning.
• NHS Grampian and partners help fund the Sustainable Food Cities programme in Aberdeen City.15
• Partners such as Community Food Initiative North East are leading the Food Power programme16 to tackle food poverty across the North East.
• NHS Grampian delivers the national UNICEF Baby Friendly Initiative, comprising Confident Weaning Choices, Breastfeeding Peer Support Service, Baby Steps, Baby Friendly.
• Healthy Helpings – a six-week course for adults to find out more about healthy eating.
• Confidence to Cook – a practical food skills course for those working in community settings.
• Grow Well Choices – lessons delivered in primary school settings for children around being healthy and healthy choices.
• NHS grant funding for the Grampian 50+ Network who enable physical activity for older adults.
• Grampian Health and Transport Action Plan.
• Health and social care partnerships are ensuring provision of structured healthy walking groups.
• The 50+ network is a charitable organisation that encourages and supports walking for older adults.
• NHS Grampian is providing active support for staff to cycle to work.
• Make Aberdeenshire More Active.
• Move More18 is a programme delivered in partnership with MacMillan Cancer Support.
Local Authorities’ Local Development Plans incorporate physical planning and greenspace.
Community Planning Partnerships’ Local Outcome Improvement Plans and the multi-partnership plans underpinning these (e.g. integrated children’s services plans) include references to food, physical activity and healthy weight.
The North East’s two transport networks (NESTRANS, HITRANS) include active travel in their strategic plans.
3. The NHS-led Making Every Opportunity Count (MEoC) approach is being used by many partners in the North East, including NHS Grampian, the local HSCPs and in the third sector.19 People using the services are supported to have relevant opportunities to maximise their health and wellbeing, such as to eat well and be active.
The MEoC framework acts as a guide to the nature and scope for conversation and professional action, creating an environment where it is normal to ask about people’s health and wellbeing.
Tier 1 Brief conversation and signposting to available activities and services.
Tier 2 Specific longer conversations, for example, through Healthpoints.
Every year, NHS Grampian Healthpoint staff:
Tier 3 Structured, in depth conversations and interventions for those with complex needs.
Have 2,200 conversations about
diet and nutrition.
Have 1,800 conversations about physical
activity.Make 150
referrals to Healthy Helpings.
18 19
• Two-thirds of adults in the North East are overweight or obese, equally distributed across Aberdeen City, Aberdeenshire and Moray.6
• Some NHS staff have higher levels of obesity than the general public.20
• The proportion of adults with BMI ≥40 continues to increase.21
• There are 180,000 adults in the North East who are overweight, with BMI between 25 and <30.6
• More than a quarter of adults are obese in the North East, with a BMI ≥30. This equates to 136,000 adults across the North East.6
• Obesity reduces in women from more affluent populations, but shows no economic patterning men.7
• Almost one third of children (aged 2 to 15) in the North East are on an overweight or obese trajectory (which reflects the potential for children to ‘grow out of’ childhood overweight or obesity).22
• Every year the HealthPoint service receive 6,000 enquiries about weight management.
• Boys and girls are equally likely to be at risk of being overweight or obese and there is no particular pattern with age.22
• Almost a quarter of primary 1 children in the North East are at risk of being overweight and one in ten are at risk of obesity.23, 24
• Overweight and obesity reduces in primary 1 children from more affluent populations.23, 24
• An estimated 11,000 are at risk of being overweight and 15,000 children are at risk of obesity, equally distributed across Aberdeen City, Aberdeenshire and Moray.12
Weight management1. There is a clear need and demand for healthy weight services in the North East.
2. NHS Grampian has no Tier 3 service provision.
3. NHS Grampian currently provides around 26 people with bariatric surgery each year (estimated to be <2% of clinical need in the population). Two-thirds of adults in the North East are overweight or obese.
A range of Tier 2 services are provided across the North East, delivering assessment, advice, support, monitoring and referral to a lifestyle adviser or community dietician.
• Community dieticians received 100 weight management referrals for children and 300 referrals for adults in 2017/18.
• Healthy Helpings received 700 referrals in 2017/18.
20
The future – identifying areas for priority action
This section is derived by comparing section two (‘what must be the case’) and section three (‘what is currently the case’). The gap between the ideal and the existing is drawn out, and the consultation draft of A Healthier Future (including the physical activity recommendations transferred to A More Active Scotland) was used to inform the location for action to reduce this. We have identified an initial set of 17 actions:
A healthy food environment and a healthy diet
1. Scottish Government and its national agencies have a clear role to play in influencing food production, advertising, consumer labelling and information, and marketing and retailing practices.
2. Local community food initiatives have an important local role in the availability of sustainable and affordable healthy food, and should be nurtured and supported by local public authorities.
3. All organisations, whether in the public, private or third sector, have a role to play in ensuring healthy food provision in their premises. The national healthy working lives programme is an important source of support for employers wanting to ensure they have healthy living policies in place.
4. Public authorities and community planning partnerships have an important role to play in addressing poverty in all its forms. Ensuring accessibility of emergency food aid is important, but eradicating the need for emergency food aid must remain a priority.
5. All organisations whether in the public, private or third sector must continue to promote and encourage breastfeeding as a social norm.
A physically active population 6. Local authorities, NESTRANS and HITRANS should continue to consider how their strategic plans can encourage safe and enjoyable physical activity through the built environment and travel infrastructure, making use of the Place Standard, and with particular focus on greenspace and other developments in less affluent neighbourhoods.7. Employers should encourage active travel to work of their employees, and healthy working lives is an important source of advice and support on how to do this.8. Integrated children’s services groups have a vital role to play in ensuring opportunities for physical activities are included in nursery and educational settings, including the Scottish Government’s Active Schools programme and the daily mile.
Health promotion 9. Food and cooking skills should continue to be provided by a range of public and third sector providers.10. The health service should pay particular attention to understanding the specific healthy eating and healthy weight needs of NHS staff.11. The NHS should continue to fund Child Healthy Weight interventions, should incorporate healthy weight into the Health Visiting Pathway, explore options to further support families with weaning and work with partner public authorities and integrated children’s services groups on healthy eating and physical activity programmes which include parents, carers and families.12. All organisations, whether in the public, private or third sector, have a vital role to play in encouraging people to be more physically active and to eat well. The health system should provide training for clinical staff to discuss weight, portion control and eating behaviour in a sensitive and supportive manner. The implementation of making every opportunity count should continue to expand as an inclusive and enabling approach for a healthier future. 13. The health service should include changes in physical exercise and diet as routine interventions for the prevention and treatment of a range of physical and mental health conditions, and should promote appropriate physical activity in pregnancy and following birth.25
Healthy weight management14. With over 300,000 overweight and obese adults in the north east of Scotland alone, the NHS cannot hope to be the sole provider of weight management services for the population. NHS Grampian should seek to increase weight management services, and resources must be focused on those with greatest clinical need. Staff across a range of organisations may need training and support to raise the issue and intervene.15. The health service should provide an integrated Tier 3 service for those experiencing obesity-related clinical conditions and symptoms. 16. NHS Grampian should consider how bariatric surgery might be made available to a larger number of eligible patients.17. Develop and implement a NHS Grampian Diabetes Plan in line with the Healthier Futures Framework for the Prevention, Early Detection and Early Intervention of type 2 diabetes.
2322
Conclusion
We are keen to see the successful implementation of A Healthier Future and A More Active Scotland in the North East of Scotland.
17 actions drafted for action across the North East…
Our initial consideration of an ideal future against the local context in the North East has led our drafting of the 17 overarching areas for action identified in section four. This does not exclude the potential for other important action areas to be identified by partners, who we would be delighted to work with on this.
…a strategic group to oversee the implementation of the actions…
We propose to convene a quarterly healthier future strategic group to oversee the implementation of the 17 actions across the North East.
…with working groups to develop detailed action plans, and to support the incorporation of the 17 actions into existing
strategic groups…
Supporting the strategic group, there will be a working group to develop a detailed action plan for healthy eating, physical activity and health promotion; and a working group to develop a detailed action plan for NHS weight management services.
…underpinned by our desire to reach out and engage as widely as possible with partners, to seek embedding of the
17 actions into existing partnerships’ strategic planning, and to welcome involvement in the strategic and/or working groups.
We will now seek to discuss a healthier and more active future with partners, particularly those identified in section four, with the hope of exploring ways to take this agenda forward together. We will happily discuss membership of the strategic and/or working groups with any partner who would be interested in being involved.
To make contact in relation to any aspect of this report please email public health at [email protected].
24
1. Scottish Government (2018) A healthier future: Scotland’s diet and healthy weight delivery plan https://beta.gov.scot/publications/healthier-future-scotlands-diet- healthy-weight-delivery-plan/ [Accessed 7th July 2018]
2. Scottish Government (2017) A healthier future – actions and ambitions on diet, activity and health weight: consultation document www.gov.scot/Publications/2017/10/1050 [Accessed 7th January 2018]
3. Dobbs R, Sawers C, Thompson F et al (2014) How the world could better fight obesity McKinsey Global Institute
4. Butland B, Jebb S, Kopelman P et al (2007) Tackling obesities: future choices project Foresight, Government Office for Science
5. Food Standards Scotland (2015) The Scottish diet: it needs to change www.foodstandards.gov.scot/publications-and-research/the-scottish-diet-it-needs-to- change [Accessed 20th March 2018]
6. McLean J, Christie S, Gray L (eds) Scottish Health Survey: Results for Local Areas 2013/2014/2015/2016 www.gov.scot/Publications/2017/10/6398 [Accessed 6th March 2018]
7. McLean J, Christie S, Gray L (eds) Scottish Health Survey 2016: A National Statistics Publication for Scotland www.gov.scot/Resource/0052/00525472.pdf [Accessed 6th March 2018]
8. Department for Environment, Food and Rural Affairs. Family Food Survey 2015. [online] Available at: https://www.gov.uk/government/collections/family-food-statistics [Accessed 6th March 2018]
9. D’Ambruoso L, Abbott P, Douglas F, McPherson E, Okpo E. Case Study: Empowerment approaches to food poverty in NE Scotland in the Shaping Health programme on learning from international experience on approaches to community power, participation and decision-making in health. University of Aberdeen, TARSC; 2017
10. Information Services Division (online) Infant Feeding in Scotland Dashboard: 2016/17 https://isdscotland.scot.nhs.uk/Health-Topics/Child-Health/Publications/2017-10-31/ visualisation.asp [Accessed 6th February 2018]
11. Scottish Government (2017) Scottish Maternal and Infant Nutrition Survey www.gov.scot/Publications/2018/02/7135/downloads [Accessed 23rd March 2018]
12. NHS Grampian Health Intelligence Department. Scottish Health Survey: Grampian data for 2016.
13. Transport Scotland (2016) Transport and Travel in Scotland Report 2016 www.transport.gov.scot/media/39692/sct09170037961.pdf [Accessed 22nd December 2017]
14. Scottish Household Survey Project Team at Scottish Government (2016) Scottish Household Survey: Scotland’s People Annual Report 2016 www.gov.scot/ Resource/0052/00525075.pdf [Accessed 29th December 2017]
15. http://sustainablefoodcities.org/findacity/cityinformation/userid/462
16. www.sustainweb.org/foodpower/
17. www.ramblers.org.uk/nhsmedalroutes
18. www.macmillan.org.uk/about-us/health-professionals/programmes-and-services/ move-more-scotland.html
19. https://www.hi-netgrampian.org/people-networks/public-health-directorate/health- inequalities/making-every-opportunity-count/
20. http://dx.doi.org/10.1016/j.ijnurstu.2015.10.015
21. Scottish Health Survey obesity trend data www.gov.scot/Topics/Statistics/Browse/ Health/scottish-health-survey/Publications/Trend2016
22. NHS Grampian Health Intelligence Department. Scottish Health Survey: Grampian data for 2012-2015 combined.
23. Information Services Division (online) Body Mass Index of Primary 1 Children in Scotland: School Year 2016/17 www.isdscotland.org/Health-Topics/Child-Health/ Publications/2017-12-12/2017-12-12-P1-BMI-Statistics-Publication-Report.pdf [Accessed 29th December 2017]
24. NHS Grampian Health Intelligence Department. Grampian P1 Children BMI Report 2010 to 2016. March 2017
25. Academy of Medical Royal Colleges (2015) Exercise: the miracle cure and the role of the doctor in promoting it www.aomrc.org.uk/reports-guidance/exercise-the- miracle-cure-0215/ [Accessed 08 June 2018]
References
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The foresight programmeForesight projects are undertaken under the UK Government Office for Science and are intended to provide a scientific evidence-base that policy makers can draw on to ensure that their decisions are ‘future-proofed’.
One of the first projects explored the science of obesity, and the Foresight report on obesity was published in 2007.
While over a decade old, the report and the scientific reviews that informed it remain relevant to decision-making today.
• www.gov.uk/government/collections/tackling-obesities-future-choices
• https://foresightprojects.blog.gov.uk/2017/10/04/dusting-off-foresights-obesity-report
McKinsey McKinsey undertook and published a comprehensive review of the scientific evidence underpinning interventions to tackle population obesity. Their report identified 44 interventions, supported by evidence and assessed as relevant to the UK.
• https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-the-world-could-better-fight-obesity
A Healthier Future and A More Active Scotland The development of the national strategies for diet, physical activity and healthy weight has been led and published by the Scottish Government and can be aligned against the new national public health priorities.
Diet and nutrition• Food Standards Scotland and Scottish Government recommendations:
• Five fruit and vegetables per day.*
• Two portions of fish per week.
• One portion of oily fish per week.*
• About one-third of food consumption should be starchy carbohydrates such as potatoes, bread, rice and pasta.
• 30g of fibre per day for adults from foods such as wholegrains, cereals, fruits and vegetables.*
• No more than 70g of red and processed meats per day such as sausages and bacon.*
• No more than 35% and 11% of total energy intake to come from fat and saturated fat, respectively.*
• No more than 5% of energy intake to come from free sugars; this doesn’t include, for example, sugar in milk and fresh fruits.*
• No more than 6g of salt per day for adults.*
• Discretionary foods should be limited to small amounts and infrequently, if at all. These are foods that are not nutritionally required and include cakes, sweets, chocolate, biscuits, crisps and full-sugar soft drinks.
• Six to eight glasses of fluid per day; predominantly water, milk and sugar-free drinks.
World Health Organisation recommendations (supported by Scottish Government):
• Babies should be exclusively breastfed until they are six months old.
• Children should continue to be provided breast milk until they are two years old.
*Scottish Dietary Goals
Appendix 1 The reports used as source materials
Appendix 2 National recommendations
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Physical activityThe Active Scotland Outcomes Framework:
• We encourage and enable the inactive to be more active.
• We encourage and enable the active to stay active throughout life.
• We develop physical confidence and competence from the earliest age.
• We improve our active infrastructure – people and places.
• We support well-being and resilience in communities through physical activity and sport.
• We improve opportunities to participate, progress and achieve in sport.
UK Chief Medical Officer moderate/vigorous physical activity guidelines
Minimum for children under five years:
• Floor based play and water activities encouraged from birth.
• Unaided walkers active for 180 minutes per day.
Minimum for children 5 to 18 years:
• Moderate activity for 60 minutes per day.
• Vigorous and muscle strengthening activity three days per week.
Minimum for adults:
• Moderate activity for 150 minutes a week OR.
• Vigorous activity for 75 minutes a week.
• Muscle strengthening activity two days per week.
• Older adults at risk of falls – activities to improve balance and coordination at least two days per week.
Appendix 2 National recommendations
Appendix 3 Health impact screening and meeting the Fairer Scotland Duty
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The Fairer Scotland Duty places a legal responsibility on particular public bodies (including the NHS and Integration Joint Boards), to demonstrate for each major strategic decision that there has been consideration of inequalities in outcome by socioeconomic disadvantage.
Health impact screening is a process which identifies the population groups most likely affected by a strategy, policy or plan and how this may impact on health inequalities. This can be used to meet the Fairer Scotland Duty.
A health impact screening workshop was held on 3rd July 2018. This highlighted that A Healthier and More Active Future will provide a range of benefits, not solely around diet and exercise. This includes improvements in employment, crime, living and working conditions, mental wellbeing, pollution and climate change. The full results and recommendations can be viewed here:
• https://www.hi-netgrampian.org/wp-content/uploads/2018/08/2018-Healthier-Future-FSD-Assessment.pdf
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Information Resources Service on 01224 558504 or email [email protected]
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