Policy Essentials for Local Authorities Event #2: National Child Measurement Programme

Wednesday, March 20th, 2013 Stobart Stadium, Widnes

C-TV: Tackling childhood obesity - National Child Measurement Programme

• network C…an online public health

and wellbeing communications hub

for Cheshire & Merseyside

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• C Resources: Access reports,

publications and presentations Click on picture to play film

http://network-c.co.uk/tv/tackling-childhood-obesity-national-child-measurement-programme

www.tees.ac.uk www.tees.ac.uk 5

National Child Measurement Programme:

Policy, Practice & Research

Dr Louisa J Ells: l.ells@tees.ac.uk

Reader in Public Health & Obesity, Teesside University Specialist Advisor to the National Obesity Observatory

mailto:l.ells@tees.ac.uk

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THE PROBLEM...

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What Causes Obesity?

Obesity develops when energy intake from food and drink is greater than the energy we use through exercise and to keep our body working.

However...

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The impact of time...

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Witness statement: children are constantly half starved when

Provisional Data: trends in BMI in age 11 girls 1900-2010 (V. McGowan)

A century later...

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- Obesity is associated with a number of serious diseases: reducing quality of life and life expectancy. - Obesity in children is linked to: * cardio-vascular and metabolic abnormalities such as

high blood pressure and diabetes *psycho-social problems such as bullying and low self

esteem. * Increased risk of adult obesity and ill health

= Significant cost to well being, the NHS and wider economy!

Obesity: The Implications Severe adult

Obesity= 10 year

reduction in life

expectancy

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Source: Health Survey for England, produced by the National Obesity Observatory

Adult Obesity

Child Obesity

ACTION is required! Current Government Ambition (2011): - 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.

Obesity has increased over time

http://www.noo.org.uk/NOO_about_obesity/trends

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THE NCMP...

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NCMP: Purpose

• Established in 2006: Annually weighs and measures all children in Reception (4-5yrs) and Year 6 (10-11yrs)

• Purpose: – help local areas to understand the prevalence of child

obesity in their area, and help inform local planning and delivery of services for children;

– gather population-level surveillance data to allow analysis of trends in growth patterns and obesity;

– enable local authorities to use the data from the NCMP to set local goals;

– Raise awareness and to engage families in weight related issues.

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NCMP: 2012/13 & Beyond • Responsibility for NCMP will transition to local

authorities in April 2013: http://www.dh.gov.uk/health/2012/10/handover-guidance-transition/

• Surveillance aspect of NCMP will be mandated from 2013/14

• NCMP data will become child excess weight indicator in the Public Health Outcomes Framework: http://www.phoutcomes.info/

• The public health ring-fence will include an allocation for the delivery of NCMP: http://www.dh.gov.uk/health/2013/01/ph-grants-las/

http://www.dh.gov.uk/health/2012/10/handover-guidance-transition/http://www.dh.gov.uk/health/2012/10/handover-guidance-transition/http://www.dh.gov.uk/health/2012/10/handover-guidance-transition/http://www.dh.gov.uk/health/2012/10/handover-guidance-transition/http://www.dh.gov.uk/health/2012/10/handover-guidance-transition/http://www.phoutcomes.info/http://www.dh.gov.uk/health/2013/01/ph-grants-las/http://www.dh.gov.uk/health/2013/01/ph-grants-las/http://www.dh.gov.uk/health/2013/01/ph-grants-las/http://www.dh.gov.uk/health/2013/01/ph-grants-las/http://www.dh.gov.uk/health/2013/01/ph-grants-las/

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Looking Forward: Local Leadership

• Local government will bring together the broad coalition of partners required to prevent obesity

• Public Health England will provide data and evidence to support local action from April 2013 NOO will

• Health and wellbeing boards will agree priorities and types of approach that make sense locally

• The NHS will retain a central role - making every contact count, & provide clinical treatment

• NICE is developing new guidance to support local Government and the NHS

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USING YOUR DATA IN PRACTICE: HOW CAN NOO HELP?

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Data Presentation: E-Atlases, Slides Sets & Maps

http://www.noo.org.uk/visualisation

http://www.noo.org.uk/slide_sets

http://www.noo.org.uk/visualisationhttp://www.noo.org.uk/slide_sets

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Supporting Local Authorities:

New web pages to help: - identify and assess obesity and related issues in your locality - understand the social, economic, health and educational impact of obesity - Joint working by outlining how different local authority departments and services (such as planning, transport, leisure, and education), can work synergistically to tackle obesity, led by public health - plan and deliver obesity prevention and management strategies and services

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Evaluation Support & Guidance

http://www.noo.org.uk/core

http://www.noo.org.uk/core

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Evidence Signposting & Summaries

http://www.noo.org.uk/NOO_pub

- Evidence briefings - Weekly knowledge updates - Fact sheets

http://www.noo.org.uk/NOO_pub

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THE NCMP & BEYOND: WHAT CAN RESEARCH DO?

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Teesside: Public Health & Obesity Research

Key aims: – Collaborative, cross disciplinary research: helping to

make obesity a priority for everyone & applying valuable cross sector learning.

– Maximise the use of existing data sources. – Create high quality, but digestible evidence:

systematic reviewing & creative presentation. – Effective, innovative translational research:

providing research support & solutions that are responsive to service need, easily implemented & evaluated.

Some example research programmes...

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NCMP: Severe childhood obesity

• Collaboration between Teesside, NOO and UCL

• Severely obese children are more likely to suffer from health problems & suffer from obesity and associated ill health in adulthood

• Childhood obesity could have serious implications for service planning and delivery

• Changes in BMI distribution suggest that severe obesity prevalence is increasing:

www.tees.ac.uk 25 BMI z score

Girls

Boys

1990 baseline

2nd centile

85th centile

91st centile

95th centile

98th centile

BMI distribution: Reception children National Child Measurement Programme 2011/12

© NOO 2012

www.tees.ac.uk 26 BMI z score

Girls

Boys

1990 baseline

2nd centile

85th centile

91st centile

95th centile

98th centile

BMI distribution: Year 6 children National Child Measurement Programme 2011/12

© NOO 2012

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NCMP: Severe obesity prevalence

Sex Boys Girls

Age Group

4-5 10-11 4-5 10-11

% n % N % n % n

IOTF morbid obesity 1.5% 4427 0.9% 2245 1.9% 5365 1.0% 2467 th centile UK90 (2.67 sds) 2.4% 7034 4.1% 10345 2.0% 5450 2.9% 7053

th centile UK90 (3 sds) 1.6% 4486 1.5% 3890 1.2% 3218 1.1% 2709 th centile UK90 (3.5 sds) 0.7% 2153 0.2% 428 0.5% 1254 0.2% 384

1

Equivalent Adult BMI of 35+

Equivalent Adult BMI of 40+

Data Source: NCMP 2011/12

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Significant Geographical Variation Data Source: NCMP 2009/10 - th centile

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Longitudinal Analyses of NCMP • Teesside PhD studentship in collaboration with NE LAs and

NOO. • Aim: To help further understand populations at high risk of

developing childhood obesity, the impact of health inequalities and the identification of appropriate time points for intervention.

• Reception children measured in 2006/07 will be measured again in 2012/13.

• Information stored on child health system help to assess: – How weight status tracks between Reception and Year 6 in

individual children? – What is the relationship between predicted weight gain,

ethnicity and deprivation? – What is the relationship between predicted weight gain and

health and educational outcomes?

Start: May 2013

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Understanding Parental Perceptions

• Collaboration between Teesside, Newcastle, UCL, NHS Choices and Newcastle LA

• Aim: To develop and evaluate new tools to help parents recognise and understand unhealthy body weight in their children.

• Evidence from the NCMP and numerous other research programmes have shown that parents find it difficult to correctly assess the size of their child & therefore find it hard to accept NCMP feedback and take action.

Study funded by NPRI, 12 mth RCT about to begin recruitment in progress if you are collecting

NCMP data April-June and would like to take part please contact me!

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3D body scans of over 600 NCMP age children facilitated the development of new body image scales

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360 button allows the user to watch a video of the body rotating.

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Translating Evidence: Cochrane Childhood Obesity Treatment Review

• Cochrane lay summary • Information is beautiful

Design4Life: a cross disciplinary team, applying design solutions to provide innovative and engaging methods of translating evidence.

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Obesity Support

• http://www.phine.org.uk/obesity-support-hub

• Established in 2012, to provide a forum to share discussion, resources and best practice.

• Contains a local authority toolkit with the latest data, information and resources to help tackle obesity.

• Supported by local case studies and open access slide sets.

New (June 13) regional responsive research and evaluation service, to: • assists policy/practice partners in using

the current evidence-base; • optimise use of existing local data and

information and help in its interpretation • undertake rapid evaluations of local public

health and community initiatives • provide useful, timely outputs, that are

independent, high quality and in plain English

• act as a portal to broker access across the five NE Universities and beyond if needed to answer specific queries

• help showcase and publicise good practice • build long term working collaboration for

the benefit of the populations of the NE and beyond

http://www.phine.org.uk/obesity-support-hubhttp://www.phine.org.uk/obesity-support-hubhttp://www.phine.org.uk/obesity-support-hubhttp://www.phine.org.uk/obesity-support-hubhttp://www.phine.org.uk/obesity-support-hub

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Obesity: 3D animation & gaming • Collaboration with the Teesside University school of computing • Aim: To use 3D interactive systems to provide a new and engaging

method of supporting cross departmental working to tackle obesity. • The new programme will build on existing work creating a virtual

bariatric ward. • A virtual town will be developed where possible using existing data

and guidance, allowing users to manipulate scenarios to demonstrate impact.

e.g. manipulating a street to remove unhealthy food outlets increases healthier food purchases. Providing a cycle lane increases cycle journeys.

• Uses: Help inform LA decision making and aid public engagement, engage young people in the agenda through the development of a sims

This programme is currently under development, funding will be sought once full scoped, but we would welcome any feedback or views as to how this can be optimised for use in practice!

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Data & information beacons will be available within the animation to allow users to access the underlying data & guidance.

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got

If we do something different, we create the potential to really make a difference!

Obesity is a complex condition

Work collaboratively

NCMP : great opportunity

to understand population need and monitor progress

In Summary:

Use evidence & be innovative

Evaluate: learn from success and

failure!

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Any Questions?

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National Child Measurement Programme Data

Chris Williamson

Lead Public Health Epidemiologist

Liverpool City Council

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Background

• Nationally mandated function of Public Health transitioning from the NHS to Local Authorities from April 1st 2013

• Child Healthy Weight forms part of Public Health Outcomes Framework

• Reception Year Children aged 4-5years

• Year 6 Children aged 10-11years

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Healthy Weight

Reception Year Year 6

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Cheshire & Merseyside 2011-12

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Healthy Weight across Cheshire & Merseyside

2011-12

Source: Information Centre for Health & Social Care Note: Local Authority data based on school postcode

Reception Year Year 6

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Obesity across Cheshire & Merseyside

2011-12

Source: Information Centre for Health & Social Care Note: Local Authority data based on school postcode

Reception Year Year 6

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Reception Year Obesity across

Cheshire & Merseyside

2009-10 to 2011-12

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Year 6 Obesity across

Cheshire & Merseyside

2009-10 to 2011-12

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Obesity & Deprivation 2011-12

Reception Year Year 6

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Obesity & Ethnicity 2011-12

Reception Year Year 6

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Halton School Nursing Service National Child Measurement Programme (NCMP)

Chris Scott, Team Co-ordinator

The Healthy Child Programme sets out the

recommended standards for delivery,

addressing key health and well being

priorities- which includes children being

offered height and weight measurement for

NCMP at Reception and Year 6

Healthy Child Programme

5-19years

Halton School Nursing

Supports children, young people and families

at four levels

• Community level

• Universal level

• Universal Plus

• Universal Partnership Plus

Aims of school nursing in weight

management and NCMP programme delivery

is outlined as follows:-

Community Level

• All communities have a range of health services for children, young people and their families. School Nursing promotes Healthy Lifestyles at a range of community events.

• Pilot in five schools with year 5 pupils incorporated within self-esteem work- promoted the NCMP with the aim of increasing year 6 participation.

Halton School Nursing

Universal

• School Nursing services provide a universal service, which means that every child at school entry and year 6 will be offered the NCMP screening.

• A targeted health assessment is completed at school entry and the NCMP results inform the health assessment. Year 6 children/parents can also get support directly from us around weight management.

Halton School Nursing

Universal Plus

• The NCMP screening will identify some children and young people who will need extra help from an expert .

• The school nurse can provide Brief Intervention regarding dietary advice and/or referral on to:

• Fit 4 Life

• Dietician

• Growth and Nutrition clinic

Halton School Nursing

Universal Partnership Plus

The NCMP screening results can inform our work with

• Young people who have more complex issues

• The School Nurse Service provides on-going help by working in partnership with different agencies

• PCAMHS

• Children’s Social Care

• Paediatrician

• Schools

Screening Process –

Snapshot

When: NCMP consent letter sent out in September

measurements are undertaken in October - December each year

Where: All primary schools in Halton participate in the programme (Its not mandatory for schools to participate in the NCMP)

Who: Trained School Health staff undertake the measurements

The privacy and dignity of the child is respected at all times the measurement is done sensitivley in a comfortable setting

Data is electronically inputted by school health into PARIS for Public Health to extract and analyse.

Where have we got to?

20012/2013

• NCMP has been offered and taken up in 100% Halton Primary schools – all reception children have been screened (exception of small number of opt outs).

• NCMP data has all been inputted

• NCMP results letters have been posted out

• NCMP Parent enquiries have commenced

• School Nursing Service responding to enquiries

Enquiry forwarded School Nurse

School Nurse responds to parent w ithin

5 working days

Promotion to parents of Fit 4 Life referral

Enquiry resolved No further action

required

Enquiry not resolved passed to

NCMP lead to resolve

Enquir y not resolved

Complaints procedure

One to one meeting ar ranged

School Health/Health promotion

intervention

Resolved

Actions recorded in Child Health

Records

Feedback Process

Halton School Nursing

• Partnership working is key to the

successful delivery of the programme:

• Public Health Team

• Schools

• Growth and Nutrition service

• PCAMHS

Next Steps

• To use the NCMP results to inform our service development:-

e.g. One of our Widnes schools staff identified a number of Year 6 children as overweight or very overweight. The plan is to deliver PHSE lesson around self esteem, healthy eating, exercise.

• To build on the partnerships and relationships established to further improve the outcome of children and young people

• To link with developing clinical networks within school health services to share good practices

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Nicola Calder North West Obesity Task Force Project Manager Food and Nutrition Lead, Heart of Mersey nicola.calder@heartofmersey.org.uk

mailto:nicola.calder@heartofmersey.org.uk

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Increasing the availability of healthy food and

complex

Achieving improvements large enough to impact on population obesity levels is unlikely to be achieved purely at with local actions

Collaborative action is required to enable regulation and legislative policy change that will support & complement local health improvement programmes & strategies

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National Government

Local Government

Food Industry

Advertising/Media

Built environment

School

Parents

Peers

Heath care professionals

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A recent review of the evidence base carried out on behalf of DsPH in the North West identified the most effective and cost effective population based actions to reduce obesity:

Food duties, especially sugary drinks

Regulatory controls on junk food advertising to kids

Front of Pack Food labelling 20mph speed limits in residential areas

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Regulation of advertising:

The current OFCOM broadcasting code in the UK only regulates food and drink high in fat, sugar and salt (HFSS) on television

NOT on digital & non - broadcast advertising (e.g. through online company websites, social networking sites)

Products high in fat, salt and sugar (HFSS) are being exploited through non broadcast media Restricting unhealthy food marketing to children has been demonstrated as a cost effective intervention

a cost effectiveness ratio of only £2940 per Disability Adjusted Life Years (DALY) averted

If all TV advertising and sponsorship excluded HFSS foods, this would result in annual benefits of £125m and Quality Adjusted Life Years (QALYs)

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Duties on sugary drinks Intake of dietary sugar has increased over the recent decade in line with the obesity pandemic SSBs form a major calorie source of this & displace healthier drinks 92 litres of sugary drinks consumed per person in UK every year 10% price increase in soft drinks will reduce consumption by 8%

160 modelling studies

A SSB Tax (implemented in the USA) could reduce consumption by 11.5% could avert 2,600 deaths, 9,500 heart attacks & 240,000 new diabetes cases every year. Biggest health gains in lower income groups = a progressive policy SSBs Tax will obviously receive objections from beverage industry.

http://www.sustainweb.org/publications/?id=263

http://www.sustainweb.org/publications/?id=263

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20 MPH speed zones:

7.5 million people live in places committed to 20 mph limits 20 mph limits are safer resulting in 20% fewer casualties (evidence from Portsmouth) 70% of drivers support 20 mph limits on residential streets Reduced local emissions, improved air quality and increased likelihood of active modes of transport like walking or cycling Slower speeds benefit large numbers of non - car users, reducing noise and allowing better urban design standards for quality places Deprived households tend to live nearer to busy roads and therefore will benefit more from 20mph limits 20 mph reduces health inequalities by extending the life expectancy of deprived people

http://www.20splentyforus.org.uk/

http://www.20splentyforus.org.uk/

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A formal NW task force is being established and aims to:

Investigate public perception and support for specific policy interventions that are shown to be effective in achieving and maintaining healthy weight

Develop research and research partnerships to establish further evidence that may enable policy changes at national & local levels Produce a range of briefings, communications & events to disseminate best practice in the implementation of local programmes and initiatives to promote healthy weight Build and strengthen partnership working across the North West

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A duty on sugary drinks A programme of work is currently underway which includes:

A review the evidence for public health policy interventions, exploring the impact and effectiveness of food taxes, with a specific focus on sugar - sweetened beverages (SSBs) Insight work to explore economic drivers of behaviour change, with a specific focus on the taxation of sugar - sweetened drinks Interviews and focus groups with adults and children will explore current attitudes to SSBs, SSB consumption and drivers of consumption Model the impact of a sugary drinks duty across the North West

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SCIENCE evidence emerges

UNDERSTANDING spreads

PROFESSIONALS accept paradigm

PUBLIC & POLITICIANS become aware, then supportive

OPPOSITION from vested interests is slowly overcome

REGULATION is introduced, often strengthened by

TAXATION reinforces regulations (eg. Tobacco & alcohol control)

77 Professor Simon Capewell UK Faculty of Public Health & University of Liverpool

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Development of Leadership Board

Establish e - communications platform

Complete research & insight work

For further information or to register an interest in the e - network please contact:

Nicola Calder

Project Manger

North West Obesity Task Group Project Manager

nicola.calder@heartofmersey.org.uk

mailto:nicola.calder@heartofmersey.org.uk

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Thank you

All today’s presentations will be available on the ChaMPs

website www.champspublichealth.com

Next CPD – Date and title

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