June 2017
Welcome to the ebulletin Welcome to the June edition of the Public Health Network Cymru e-bulletin. This month’s spotlight topic is Childhood Obesity. The week will run from 3 July to 9 July 2017. By the age of 11, more than 40% of Welsh children are either obese or overweight. Research shows that the vast majority of obese children tend to grow up to become obese adults. Obesity has a significant impact on the economy. In 2011, obesity alone was estimated to cost the NHS in Wales £73m, with between £1.4m and £1.65m spent each week treating diseases resulting from obesity. Advisory Group member, Dr Lucy Griffiths, talks to us about her areas of expertise in Research and Child Health. We have recently completed our annual roadshow across Wales which received positive feedback. We are in the process of discussing our next seminar, details of which will be released in the next couple of months. Finally if you have any news or event items that you would like to see included in next month’s issue please email publichealth.network@wales.nhs.uk
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of our Future Spotlight on Childhood Obesity This month’s ebulletin focuses on Childhood Obesity. In 2016, Health officials in Wales launched a 10-step checklist to tackle chilldhood obesity. One in four children in Wales are overweight or obese when they start school. The 10 Steps to a Healthy Weight outlines positive actions to help prevent the problem. Public Health Wales said it wants every child who is born in Wales to get to their fifth birthday at a healthy weight. The advice focuses on three age ranges - pre conception and pregnancy, 0-2 years and 2-5 years. It is designed to support professionals and help families across Wales to prevent the growing problem of childhood obesity.
Childhood Obesity in Wales
Claire Beynon, Specialty Registrar, Public Health Wales Childhood obesity is a significant public health issue as obesity is estimated to cost the NHS £5.1 billion annually and the prevalence of childhood obesity in Wales is 12%. Children who are obese experience more social and emotional problems than children of a healthy weight. The health consequences of this in adulthood can include type 2 diabetes, heart disease, some cancers, liver disease and problems with mobility. As part of my specialty training I undertook a study using the Welsh Health Survey data from 2008 to 2013 to determine which risk factors were associated with childhood obesity. The analysis used a large data set of 11,279 children aged 4-15. Variables were considered in two groups: socio demographic/socio economic factors (limited ability to change these factors) and lifestyle variables (potential to change these factors). The socio demographic and socio economic factors included: sex, age, Welsh Index of Multiple Deprivation quintile; National Statistics Socio Economic Classification and housing tenure. The lifestyle variables considered as potential risk factors for obesity included: consumption of sugar sweetened beverages daily; unhealthy food consumption i.e. eating crisps, chips, sweets or chocolate daily and meeting the physical activity guideline of an hour of physical activity daily. In addition, the child’s health status was considered (number of currently treated illnesses). A total of 1,582 children (19.6%) were obese. The most important modifiable risk factor was physical activity. There was a 33% increased risk of obesity for children that did not meet the physical activity recommendation of an hour’s activity per day. There is a strong evidence base that being physically active protects against obesity and this study helps to reiterate the importance of every child meeting the physical activity recommendations. Public Health Specialists and Practitioners involved with commissioning and planning physical activity for children should recognise that this is essential to addressing the preventative agenda and reducing obesity in the future. The study also found an association with a currently treated illness: 20% increase in risk of obesity for children with one treated illness, and 50% increase in risk of obesity for children with two or more treated illnesses. This is supported in the published literature where studies of individual illnesses and obesity report similar results. This has major implications for the way the NHS treats children with an illness. The recommendation from this study is that children with an illness should recevie a holistic care plan that not only addresses the illness but also helps children prevent or manage obesity. For those commissioning or planning Children’s Services this is important to consider. Are you commissioning holistic services for children that address obesity too? The full study will be published in the Journal of Nursing Children and Young People in 2017 or to view the abstract see the Lancet Risk factors associated with childhood obesity in Wales: A secondary analysis of cross-sectional data from the Welsh Health Survey, or search ‘Lancet Claire Beynon Obesity’.
New project ‘Fit in 5’ inspiring health and wellbeing As part of continued commitment to improve the Health and Wellbeing of Ceredigion’s primary school pupils, a new project has been launched to provide more opportunities to develop their physical health. The project is called Fit in 5 and asks schools to do 5 minutes of physical activity every day in school - in addition to play times and Physical Eduction lessons. Last year, a school in Scotland introduced The Daily Mile to increase physical activity of children. In Ceredigion, Ceredigion Actif have been discussing with teachers at a Healthy Schools meeting regarding doing a similar project, and received some valuable feedback. Ceredigion Actif have worked with Llwyn Yr
Eos school to develop a ‘similar approach’ that was easier to implement and sustain but more importantly ensured inclusivity and the development of pupil’s Physical Literacy. Lucy Davies, Ysgol Llwyn Yr Eos Foundation Phase coordinator said, “There are many benefits to taking part in this programme including improving physical and mental wellbeing and pupil’s concentration levels. This initiative will allow pupils to feel good about themselves as they seek out new opportunities and take part in a variety of physical activities on a daily basis.” Pupils can take part indoors in a hall or outside on a yard or field. This could be at any time of the day as the schools involved in the pilot identified clear lulls in concentration late morning and mid-afternoon. Alwyn Davies, Ceredigion Actif, said, “As a simple and innovative approach to improve the health and wellbeing of children during the school day, it is hoped that Ceredigion primary schools will take part in Fit in 5. With no set up, equipment, or changing time required (pupils run/walk in their uniform), the simple initiative Fit in 5 is adaptable to suit the needs of all primary schools. We believe this is an effective and sustainable way of implementing a project similar to the Daily Mile but with increased benefits.” A short video has been produced to outline these benefits and how the project is run which can been seen here: http://www.ceredigionactif.org.uk/programmes.html Ceredigion Actif want to hear from schools who are interested in taking part in this new, exciting project for the health and wellbeing of the county’s children. Get on board and visit www. ceredigionactif.org.uk to sign up online and one of the Ceredigion Actif officers will contact your school.
Every Child Wales Public Health Wales is launching Every Child Wales, a new drive to improve the health and wellbeing of children in the early years. Every Child Wales will bring together a range of new and existing programmes which aim to support parents in giving children a happy and healthy start in life. The new programme will start by focusing on the 10 Steps to a Healthy Weight. Information about Every Child Wales and the programmes that sit within it will soon be accessible through a national website. The overarching message focuses on the rights of each and every child in Wales to have the very best start in life. If a child starts their first years healthy and happy, they are more likely to grow into healthy adults. 10 Steps to a Healthy Weight Programme Public Health Wales developed the 10 Steps as the first stage of the Obesity Prevention programme for Wales. These are 10 evidence based steps, which Cohort studies suggest are most likely to help prevent children being obese by the age of 5. The steps run from before pregnancy; through the first year of life into the pre-school period. The website provides practical tools and ideas for parents and professionals working with families. 10 Steps to a Healthy Weight Step 1: Aim to be a healthy weight when you’re starting a family • If you as parents are a healthy weight your child is more likely to be a healthy weight too. Step 2: Avoid putting on too much weight when you’re pregnant • Pregnancy isn’t a good time to try to lose weight but making sure you gain weight within the recommended levels is a good idea for your health and that of your baby. Step 3: Breastfeed your baby • Babies who are breastfed are more likely to be a healthy weight by school age. Step 4: Wait six months before weaning • Before six months old breast milk or infant formula has all the goodness and nutrients your baby needs. Step 5: Help your baby grow steadily • Babies who grow rapidly in the first year of life are more likely to be overweight when they are school age. Step 6: Play outdoors every day • Children who play outdoors every day are more likely to be a healthy weight. Step 7: Limit screen time • Children who spend less than 2 hours a day using a screen, including a phone, tablet, computer or TV, are more likely to be a healthy weight. Step 8: Give fruit and vegetables every day • Fruit and vegetables are rich in fibre, vitamins and minerals which all help to keep your child healthy. Step 9: Help your child get enough sleep • Regularly getting enough sleep will help your child be a healthy weight. Step 10: Stick to water and milk • These don’t contain any added sugars, so your child will be less likely to be an unhealthy weight or have tooth decay.
Dr Julie Bishop, Director of Health Improvement at Public Health Wales, said: “A healthy child is a happy child and we want every child growing up in Wales to have the very best start in life. “As the findings of the Child Measurement Programme show we have work to do to turn the curve on these figures. We remain concerned that parents and professionals may find it difficult to recognise when children are overweight because it is becoming more common. There is quite a lot of research that shows that parents are more likely to identify children who are a healthy weight as underweight. This may give them false reassurance that their child is OK.” Public Health Wales will continue to develop Every Child Wales to provide parents and carers with a whole range of easily accessible resources and practical advice to support the management of their child’s health. Dr Bishop added: “This is an ambitious body of work and 10 steps is just the first in a series of programmes we will deliver under the Every Child Wales umbrella. “We know that every parent wants the best for their child. We want to support parents to do just that. If we get it right during the early stages, children are more likely to stay healthy as they grow into adulthood too.” More information on Every Child Wales, and the 10 steps to a healthy weight Programme, can be found on the Every Child Wales website - www.everychildwales.co.uk
Play Wales has four asks for play, for health, for children, for everyone Play Wales advocates that decision makers at all levels and in all sectors should prioritise provision for play. Recognising that having time, freedom and good places for playing are of paramount importance to all children, their families and the wider community. Our advocacy work is based on the growing body of solid evidence that supports both the long-term and immediate benefits of providing for children’s play. Studies show that the long-term health benefits of playing include boosting physical activity levels which helps to tackle child obesity, and supporting children to become more resilient. Everyone knows that playing is good for children. Evidenced studies show that play projects: • are just as effective as sport and PE programmes in boosting physical activity levels and hence helping to tackle child obesity • supporting children to become more resilient through the development of their emotional and social self-management skills • provide powerful opportunities for children to engage positively with their school and the wider community, and with nature and the environment • encourage neighbourliness, volunteering and social action, and improve community cohesion. Children and parents report many barriers to playing - speed and volume of traffic, lack of outdoor space and intolerant adults. We need to address barriers to playing; this is a task for all of us. Policy on planning, traffic, housing and open space, schools and childcare have a direct effect on opportunites to play. The right to play is enshrined in the United Nations Convention on the Rights of the Child (UNCRC). Welsh Government, with all party support, has taken an international lead in adopting a Play Policy and more recently legislating for children’s play in Wales; the first government in the world to do so, for which it rightly receives continued wide acclaim. To support children to realise their right to play and improve their sense of wellbeing, there is a need to continue this momentum and consider the following set of initiatves:
In schools: recognition of the need for play before school, during play/break times and after school hours. Addressing this need could involve playtime support including training and awareness- raising for school staff and parents, coupled with the provision of suitable equipment and materials for active, creative play. See our Use of School Grounds for Playing Out of Teaching Hours Toolkit: http://www.playwales.org.uk/eng/schoolstoolkit In neighbourhoods: recognition of children’s need to play out in their community. Addressing this could involve the wholescale reduction of traffic speeds, support for the development of regular sessional road closures in residential streets, and linked to active travel policies. Also, support for parents and residents to facilitate street play projects by reducing red-tape around traffic regulations, consultation, and insurance. See an example of community led street play sessions here: http://bit.ly/2sTGIjn In parks and public play space: recognition of the benefits of children’s presence in parks and public space. A rich play environment is one where children and young people can make a wide range of choices; where there are many possibilities so that they can invent and extend their own play. It is a varied inspirational and interesting physical environment that maximises the potential for socialising, creativity, resourcefulness and challenge. It is a place where children feel free to play in their own way, on their own terms. Read more about play space: http://www.playwales.org.uk/eng/richplayenvironment In staffed play services: recognition of the key role of adults in facilitating children’s play. This could involve recognising the immediate and deferred benefits of staffed provision and investing in playwork projects which deliver locally organised play projects. Find out more about playwork: http://www. playwales.org.uk/eng/playwork
By considering, supporting and investing in play, decision makers can be confident that their actions will result in improvements in children’s health and wellbeing, and hence a reduction in the pressures on the National Health Service and the public purse. What is more, the level of investment needed would be modest, cost-effective and support local authorities to comply with their statutory duties to assess and secure sufficient play opportunities for children in their areas. The importance of play for children’s health and wellbeing Freely chosen, self-directed play has traditionally served the human race well in terms of chidlren’s health and wellbeing - it has a significant contribution to make to the current health agenda. Free, unstructured play is childern doing as they wish in their own time and in their own way and it is this type of play that is increasingly recognised as essential to healthy childhoods. Playing is crucial to children’s physical, mental, social and emotional health and wellbeing, and therefore to their families and to communities as a whole. Children have an inborn urge to play - research suggests that playing has an impact on the physical and chemical development of the brain - it influences children’s ability to adapt to, survive, thrive and shape their social and physical environments. To children and young people themselves, playing is one of the most important aspects of their lives - they value time, freedome and quality places to play. Consultations with children and young people show that they prefer to play outdoors in stimulating places. In this situation children tend to be physically active and stretch themselves both physically and emotionally. There is increasing concern about the mental and physical health of children and young people. At the same time there is growing evidence from health professionals and researchers that play makes a significant contribution to the fitness and wellbeing of children. Play and physical activity When given the opportunity to play, children are likely to be physically active by running, jumping, dancing, climbing, digging, lifting, pushing and pulling. Active play is the most common type of physical activity that children take part in outside school, and unstructured play is one of the best forms of physical activity for children. Active play is one of the easiest and most natural ways that children of any age can engage in the necessary levels of physical activity. The contribution that playing makes to children’s physical wellbeing includes: • Prolonged and wide-ranging exercise that develops stamina (informal sports, chase games, climbing, building).
• Climbing develops strength, co-ordination and balance, while jumping contributes to bone density. • When children repeat an action as part of their play they are often in the process of calibrating - learning to manage their growing bodies - and developing agility, co-ordination and confidence. Play and emotional wellbeing Playing allows for peer interactions that are important components of social and emotional wellbeing. When playing alone, children begin to recognise their own emotions, feelings and thoughts, and how to control them. Children also learn to feel comfortable with being by themselves and learn ways to manage their boredom on their own. Through play children experience a range of emotions including frustration, determination, achievement, disappointment and confidence, and through practice, can learn how to manage these feelings. The contribution that playing makes to children’s emotional wellbeing includes: • Creating and encountering risk of uncertainty in their play opportunities develops children’s resilience and adaptability, contributing to their confidence and self-esteem • Socialising with their friends or on their own terms gives children opportunities to build emotional resilience, to have fun and to relax. • Fantasy play allows for imagination and creativity, but it can also be a way of children making sense of and ‘working through’ difficult and distressing aspects of their lives. Addressing Adverse Childhood Experiences Through Play Even under persistent stressful conditions, the negative consequences of toxic stress can be alleviated through the provision of play opportunities. Playing generates concrete and first hand experiences that underpin much of a child’s development. It is widely agreed that early experiences influence how children learn, cope with stress, form friendships and adult relationships, and how they view themselves and their world. Stable, nurturing relationships with caring adults can prevent or reverse the damaging effects of toxic stress. Many of the issues that parents might find challenging can be addressed by improving access to play opportunities and services that are facilitated by staff who understand and advocate for play. Quality provision increases children’s ability to support their own wellbeing and aids parents in understanding and coping with their children’s development. It also supports children where opportunities to play are absent in the home. Nurturing and play-friendly environments - or lack of them - affect the healthy development of children. A rich play environment is flexible adaptable, varied and interesting. It maximises the potential for socialising, creativity, resourcefulness, challenge and choice. It is a trusted space where children feel free to play in their own way, on their own terms. Characteristics of quality children’s spaces include chances for wonder, excitement and the unexpected, but most of all opportunities that are not overly ordered and controlled by adults. These spaces are crucial to children’s own culture and for their sense of place and belonging. Interventionist programmes can be useful in minimising som eof the damaging impact, but they must be complemented by a focus on supporting children to be active participants in building their own resilience. It is essential that the systems which underpin the provision for children living in and experiencing adverse conditions do not erode their right to explore and develop through play as enshrined in the UNCRC. Play is central to a healthy child’s life. Trying to change behaviour or build new skills later in life ultimately requires more intervention and is more expensive. It is difficult to influence positive change in adults who are living with the consequences of damaging circumstances in childhood. It is far more practical to provide nurturing and play-friendly community based experiences earlier in life. The role of public health professionals in promoting play As adults we need to help children by raising play on the agenda at every appropriate opportunity – with parents and carers, with school management, with decision makers and planners. We need to support the provision of sufficient time and space for children to play every day within their communities. Children with impairments in particular may need support to access play and socialise with their friends. Those of use who take an interest in, or have a responsibility for, children’s health and wellbeing can contribute
by: • Promoting the importance of play in health publicity campaigns. • Including the support of play provision for all children in health or related strategies and plans including Local Development Plans, child poverty strategies and health, social care and wellbeing strategies. • Considering impacts on children’s play in Health Impact and Health Equity Impact assessments • Providing information to parents which highlights the value of playing and its role in a healthy lifestyle. • Creating links with local play services. Trained playworkers facilitate opportunities that support children to play freely with their friends in their own communities. • Identifying partnership funding to appoint playworkers in communities. The role of healthy schools Children tell us that playtimes are the most important part of the school day to them. Many children also tell us that at school is the main opportunity they have to spend time playing with their friends. Schools often offer ideal space for children to play and interact with one another. It is important to develop a strong play element to provide a healthy school environment. Healthy school coordinators can ensure play is set within the healthy school approach by: • Advocating for well-designed playable space when capital improvements are being made. • Advocating that adequate time is given for both lunch and playtime (children tell us that they often rush eating their lunch at school to have more time to play. ‘People will chuck their lunch at school to have more time to play. ‘People will chuck their lunch away so they have more time to play and other people sneak out of the canteen’). • Ensuring that playtime is protected. The withdrawal of playtime is often used as punishment. School playtimes are as important to children as break times are to school staff. Like adults, school playtime is part of children’s ‘work/life balance’. • Advocating against school playtimes being shortened. • Advocating for the use of school grounds out of teaching hours to provide space for children to play freely in their own communities. www.playwales.org.uk
Using Health Record Linkage in the UK Millennium Cohort Study to Investigate Childhood Obesity Lucy Griffiths, Ronan Lyons, Carol Dezateux The potential of electronic health records research to support public policy is recognised. The UK has an internationally acclaimed reputation for its birth cohort studies, which involve multiple surveys of large numbers of individuals from birth and throughout their lives. These studies are key sources of evidence for social and health policy and have made substantial contributions to our understanding of disease and health trajectories across the life course. One feature of these studies has been their use of record linkage to enhance information obtained directly from cohort members. Our study is linking information collected in a large scale contemporary UK cohort study, the Millennium Cohort Study (MCS), to electronic health records. This will allow important scientific and public health questions relevant to children’s health to be addressed. The MCS was set up to study the social, economic and health-related circumstances of British children born at the start of this century. It includes children born between September 2000 and January 2002 who were living in England, Wales, Scotland and Northern Ireland, including representation from disadvantaged social circumstances and ethnic minorities. The first survey of nearly 19,000 children’s families took place when the Cohort were nine months old and they have since been surveyed at ages three, five, seven, 11 and 14 years. At each of these ages, researchers have collected a range of information and measurements. Capturing information on childhood obesity has been a priority in this Cohort and repeated measures of height, weight, waist size and body fat have been obtained over the years. At age seven, parents were also asked to provide consent for researchers to link information collected in MCS to their children’s electronic health records. Within Wales, 1,840 (94.3%) of 1,951 parents of children provided consent for this. The Wellcome Trust has funded linkage and exploration of this important information, with the project being jointly led by Professors Ronan Lyons at Swansea University and Carol Dezateux at the Great Ormond Street Institute of Child Health, University College London (UCL) in collaboration with the Director of the MCS, Professor Emla Fitzsimons at the UCL Institute of Education. This work is being undertaken using the Secure Anonymised Information Linkage (SAIL) databank, which was established in 2006 to bring together, link and anonymise a wide range of person-based data to support health research. This research is also supported by the Farr Institute and the National Centre for Population Health and Wellbeing Research. We have successfully linked MCS children to coded information from the National Community Child Health Database, Wales’ national community child health database, primary care (general practitioner) records, inpatient hospital records and emergency department records. This allows us to explore important questions about children’s health, including injuries, asthma, infections, immunisations and obesity. Childhood obesity is one important focus of this work as this is a serious public health concern. The research team are currently examining the health problems faced by obese or overweight children. This work will inform prevention and treatment strategies. This is one of the first nationally representative children’s cohorts that has been linked to electronic health records and we hope it will generate interest and learning for other record linkage studies being carried out in the UK. The project is also linking information from MCS to electronic health information in Scotland. A documented set of variables derived from linked health records will be deposited with the UK Data Archive once the project has been concluded. Project members: Ronan A Lyons, Karen Tingay, Amrita Bandyopadhyay, Sinead Brophy and Ashley Akbari at Swansea University Medical School, Swansea. Carol Dezateux, Lucy J Griffiths, Suzanne Walton, Mario Cortina-Borja and Helen Bedford at Great Ormond Street Institute of Child Health, UCL, London. Emla Fitzsimons at UCL Institute of Education, London.
Encouraging a Positive Body Image in Your Kids Are you worried about your child having an unrealistic or unhealthy view of their bodies? In our special blog we look at what ‘body image’ means and look at some ways to deal with negative attitudes. What do we mean when we use the term ‘body image’? ‘Body image’ is widely recognised as the way we think our body looks to others. This could be the size of our figure, our facial features, our hair, basically any part of our body. Unrealistic images in the media Whoever we are, whatever our ages or sex, the media presents us with a perfection that can be unrealistic and unachievable to most people. Have you ever heard the saying “the camera adds ten pounds”? That’s not so true today! Before they are published in magazines or on the Internet, clever computer programmes often tweak photos. The programmes can airbrush skin to look unblemished by spots or stretch marks or change someone’s figure to drop a few pounds. The problem is that we often judge ourselves harshly against the unrealistic standards set by the media. But what impact is this having on our children? Not only do they have to go through the difficulties of puberty, growing up and school life, but they are also over exposed to these images of perfection. This may make them feel confused or inadequate when they compare themselves. Negative Body Image Negative feelings about the body image’. Suffering with such as eating disorders, self of body altering drugs such an eating disorder check out
way that you think your body looks is what we might call ‘negative negative body image has been linked to other unhealthy behaviours harm, a lack of self esteem, social isolation and in some case the misuse as Steroids. If you’re concerned that someone might be suffering with our article Eating Disorders and How to Help on the FamilyPoint website.
Body Dysmorphic Disorder Negative body image can also have an impact on mental health. It has been linked to conditions such as depression, anxiety and self-harm. There has been a lot of talk recently about Body Dysmorphia. Body Dysmorphic Disorder or BDD is an anxiety condition that leads to a person having a distorted view of their appearance. It can have a massive impact on that individual’s life and can lead to obsessive/compulsive behaviours. NHS direct (2017) predicts that 1 in 100 people in the UK suffer with BDD and that this figure could be more, as it is easy to hide. The NHS direct website has more information about the condition. All the conditions listed above, including BDD, are serious mental health concerns. As a parent, if you are worried that your child could be suffering with any of these, you should talk to your GP. If you’re unsure whether to do this Young Minds can help. They have a free helpline for parents to talk about mental health issues on 08088025544 Tackling Negative Body Image • Talk about it Talking is a good place to start. Schools are talking about body image more and more and a new education law will ensure that this subject is on the curriculum. But it is also important to talk about it at home. You can’t shield your children away from the airbrushed, unrealistic images in the media. Instead you should try and be open about it and discuss what they are seeing to make them more aware.
• Praise You should praise your children’s achievements and their good qualities. This will build their confidence and make them realise that it is what they do that matters, and not how they look. Make a point of introducing them to people in the media who are praised for their achievements and qualities rather than their looks. This will remove focus from the superficial. • Promote confidence Encourage a healthy lifestyle through sporting activities and other extra-curricular activities. This may be a good way to increase your child’s confidence and allow them to get to know their body in a positive way. • Set a good example When we get together with a group of friends, we’re all guilty of talking about the latest fashion fails in the well-known gossip magazines. But think how this could encourage your child to think it’s ok to judge someone on their looks. You could try and set an example by encouraging them to see the positives a person has to offer, and not on the way they look. This might stop them from judging themselves in this way too. • Explain the reality of perfection Explain to them what airbrushing is and why it’s used. It’s important that they’re aware that the original picture may differ from the published picture. It might be worth explaining that airbrushing is not just used to cover spots. It is also used to lengthen limbs, enlarge certain features etc. Have a look on YouTube for videos (like the one below) showing how a magazine picture is created; it may help to reinforce your message. Resources to help • Dove – There are lots of tips on the Dove website about how to reinforce a positive body image. They have set up the Self Esteem Project that aims to promote a healthy approach to the way we look at our bodies. The website provides free resources for parents, teachers and young people. • Be Real Campaign – Another great resource is the Be Real Campaign that works with beauty companies and the government to promote body confidence. There are lots of good resources and activities, and it also has a page for parents. • FamilyPoint.cymru Helpline – If you have any concerns about someone you care about and want some more information get in touch with the FamilyPoint helpline. Our advisors can talk to you and transfer you to services that can help. The helpline is open 9am – 5pm Monday to Friday.
On The Spot This month we have Public Health Network Cymru Advisory Group member Dr Lucy Griffiths on the spot. Lucy is a social epidemiologist and works with University College London and Swansea University.
Where do you currently work and what is your area of expertise?
I am a Senior Research Associate at the University College London Great Ormond Street Institute of Child Health and I hold an honorary appointment at Swansea University. My research focuses on the determinants of health and health related behaviours in children and young people; examples of my work include using life-course data from a British cohort study to examine risk factors for childhood obesity and determinants of physical activity and sedentary time. I am passionate about my research and improving the health and wellbeing of children and young people.
Why did you join the PHNC Advisory Group?
I represent the field of academia/research and believe it’s important to share information and knowledge about child health. I contribute to the development of the Network resources, and being part of this group enables me to learn from other expert members on topical public health issues in Wales.
This month’s e-bulletin spotlights Childhood Obesity, what do you think are the main challenges facing us in addressing this issue in Wales? What is the most important message that should be conveyed to professionals and the public around childhood obesity?
Rates of childhood obesity in Wales are the highest in the UK. Childhood obesity is a complex and multidimensional problem and continued effort is needed by government and partners to reduce this problem, due to the immediate and long-term impacts on physical, social, and emotional health. On an individual level, we need to encourage young people to be more active. A wide range of strategies and initiatives are in place across Wales to increase levels of physical activity in order to improve health and well-being. For instance, Wales has embraced the physical literacy movement, an overarching concept that builds confidence, motivation, physical skills and knowledge and understanding of physical activity. The idea is to help children to be both active now and in the future. I believe that everybody has a part to play in helping children to be physically literate.
I support the notion that NHS Wales should ensure that all health professionals make every contact that they have with children and young people who are overweight or obese count; discussing weight can be a difficult and sensitive topic and effective training may be needed, as is a clear route for access to support and treatment.
What do you think Wales could be doing to actively promote or participate in Childhood Obesity Week?
Let’s continue to promote and support the Public Health Wales 10 Steps to a Healthy Weight campaign, which builds on a life-course approach to childhood obesity prevention, i.e. by starting with maternal health and wellbeing and continuing with healthy diet and lifestyle once children are born and grow. As an example, step 6 focuses on giving children opportunities to play outdoors. Weather may be a barrier to physical activity for some, but doesn’t seem to bother children – I’ve never come across a young child who doesn’t like splashing in puddles! We need to educate and support parents and carers on outdoor opportunities. Wales is a beautiful country with accessible playing areas, beaches, woodland walks, cycle routes and mountains. We should all be out there making the most of what is on offer.
If you were granted 2 wishes what would they be?
I have two big wishes: • For parents, teachers and all others involved with children and young people to help them build positive self-esteem – this is an essential building block in helping them to grow up feeling confident, secure and loved, and paves the way for success. • To reduce inequalities in childhood obesity…in fact, to reduce child health inequalities generally. The recent State of Child Health Report 2017, published by the Royal College of Paediatrics and Child Health, reports that children and young people from deprived backgrounds have worse health and well-being than their more advantaged peers, and this is a growing inequality. Today, 30% of children in the UK are defined as living in poverty – this is shocking – let’s all wish for a reduction in child poverty and an improvement in their life chances.
What are your personal interests/hobbies?
Walking in the fabulous Brecon Beacons with my family; baking with my children; browsing antique/ salvage/charity shops.
The Association for the Study of Obesity (ASO) is proud to announce the fourth UK Congress on Obesity (UKCO) which takes place at University of South Wales– Treforest Campus, Pontypridd, Wales from the 7-8th of September, 2017.
This year’s theme is – Obesity, Health & Social Inequalities
Key Topics and Speakers Social Inequalities, Obesity and Health – Professor Clare Bambra, Newcastle University Professor Sir Stephen O’Rahilly, University of Cambridge – The causes and consequences of obesity: Lessons from human genetics Professor Rachel Battherham, University College London – Abnormalities of the gut endocrine axis in obesity and type 2 diabetes Dr Thomas Yates, University of Leicester – From standing more to high intensity exercise: Tailoring physical activity for metabolic health
Programme Features
ASO Symposia Diabetes UK (CYMRU) Symposia Oral presentations and posters Member-led Symposia Awards for best posters Networking buffet dinner included in registration
Registration is now open! Early Registration deadline – Friday July 14th To find out more about this event please visit the Conference website at www.aso.org.uk/events/ukco
SAVE THE DATE! Well-being in Wales: Planning today for a better tomorrow Monday 17 July 2017 First Session 8:00-10:30 Second Session 10:30-16:00 SWALEC Stadium, Cardiff CF11 9XR On 17 July we are organising two events which will draw upon the insight the Future Generations Commissioner for Wales has gained from reviewing the well-being assessments across Wales in order to promote and support shared learning between the Public Services Boards and their partners. First, there will be a breakfast meeting (8:00-11:00) for senior leaders and chief executives who are members of the Public Services Boards. Senior leaders will have the chance to explore their role as members of Public Services Boards and how this relates to leadership in their own organisations in the context of planning for well-being. The second event (10.30-4:30) will bring together the officers who support the work of the Public Services Boards from across Wales, together with other organisations that have an interest in working together to improve the well-being of current and future generations. Sophie Howe, the Future Generations Commissioner for Wales will also be discussing how her work and that of her team on the emerging priorities will inform her advice, support and duties. This will be a timely opportunity to share your learning from the well-being assessments and use it to inform and develop your approach to well-being planning. Public Services Board teams, academics and national public bodies will be able to: • connect with each other, working together in using the five ways of working to make the most of their contribution to each of the seven well-being goals; and • challenge business as usual and develop ideas for responding to the issues that are affecting planning for well-being and the delivery of local objectives. Please save the date in your diary. Further details on the events and registration will follow soon.
The Grapevine This section of the ebulletin is dedicated to news from the network members. You can submit news on the work being undertaken in your area, write us an article, showcase an upcoming project or show off your achievements! If you would like to submit an article for the Grapevine, please email publichealth.network@wales.nhs.uk The article should be no longer than 500 words and pictures are always welcome!
Active Families The Active Families project has 2 main aims: • to provide a programme whereby children have opportunities to develop key physical skills through play • for parents to receive training and mentoring in the provision of key play opportunities for their children. There are 5 Family Centres in Ceredigion, in Borth, Penparcau, Tregaron, Lampeter and Llandysul. This project has been piloted in Tregaron with successful and positive feedback. At Tregaron Family Centre, both parents and staff are now keen to move the project forward. This is an inclusive project for families who live in a rural area. The project is available to all pre-school children that attend Family Centres and Flying Start groups in Ceredigion. Support and guidance will be provided by Disability Sport Wales to ensure all play opportunities are open or where required specific to children’s needs. Centre staff will receive training in order to deliver a course to parents ‘Physical Literacy in the Community: A Journey Through Life’. A resource bag will be provided to each parent so that all games/activities can be played at the centre or at home. A set of skill cards will also be provided which include play ideas for parents and staff. Ceredigion Actif staff will deliver the training and provide mentoring to ensure that the play opportunities are set up for the children. The resource bag will include Bean bags, Marking spots, Hoop, scarf, sensory ball, Mini Tennis Racket, A Fluff Ball, a skipping rope and the set of skill cards. For more information please contact Alwyn Davies, Ceredigion Actif on Alwyn.Davies@ceredigion.gov.uk
The ACTIVE Project - Improving Activity Levels of Teenagers in Swansea Teenage obesity is a significant health issue in contemporary public health. Current teenage obesity levels are at a worrying level with one in four teenagers reported to be clinically obese by the age of 15. The increased risk of heart disease, type two diabetes, cancers and stroke in later life mean that it is vitally important these levels are addressed for the current and future health of teens. Inactivity is considered a significant risk factor for teenage obesity. The rise in popularity of games consoles and social media means there has been a trend for teenagers to adopt a more sedentary lifestyle. The ACTIVE Project at Swansea University aims to tackle sedentary behaviour via physical activity vouchers. These vouchers can be spent on activities of the teenager’s choice - whether it is dancing, trampolining, swimming or skateboarding. By giving this group a choice, ACTIVE aims to empower teenagers to take ownership of their behaviours and tailor activity directly to what they individually enjoy. Before giving out vouchers, (September – December 2016), we conducted focus groups with boys and girls separately in order to get their views of activities that were already available. The teenagers made some key recommendations. They would like activity to be more local as they currently have to travel and this is costly. They would also like more maintenance of existing facilities in their area as they say equipment in local parks is often broken and littered with rubbish. Teenagers would like activities that are more specific to teenagers such as fitness classes in gyms. There is currently a minimum age limit on classes such as Zumba and Yoga and teenagers would like to see this lifted. Local provision was deemed boring due to the same sports clubs being offered every week. More choice and variety of activities was important for teenagers, especially activities that can be done with friends. They would like to see more unstructured forms of activity made available to them (for example trampoline parks, sports halls and parks where they could play freely) and not an increase in sports clubs (football, netball etc.). We have seen this reflected in the voucher usage, for example the majority of vouchers are used in places like the trampoline park, water park (with slides and wave machines) and at a FootGolf course which combines both football and golf to form a fun, less structured version of both sports. Early findings at baseline show that 74% of pupils tested were classed as unfit and 16% had high blood pressure. It is anticipated that if ACTIVE vouchers help teenagers to become fitter this will also reduce the number of children with high blood pressure. In addition, ACTIVE will also help teenagers access existing provisions or set up their own and will be looking to establish lunch-time and after-school activities to improve local provision of activities. To do this, we are working with local activity providers and Swansea City Council, in order to help facilitate the opportunity for teenagers to access more un-structured and non-competitive forms of their favourite activities closer to home. The response to the ACTIVE Project from both pupils and teachers has been very positive. It is a constantly evolving and dynamic project that promises to provide exciting physical activity prospects for teenagers in Swansea and consequently, reduce the obesity risk of this age group. The findings of the ACTIVE project will help inform decision-making and the development of sport and physical activity opportunities locally. It could revolutionise investment in projects to improve activity levels of teenagers. Michaela James - ACTIVE Trial Manager - m.l.james@swansea.ac.uk
‘Come and Play’ on Anglesey Anglesey County Council have recently launched its new and improved ‘Anglesey Come and Play’ guide which will give children more opportunities to play. This guide is the second edition Anglesey County Council have now produced within the last two years due to popular demand, working in collaboration this time with the Local Public Health Team to promote the ‘10 Steps to a Healthy Weight’ messages. The first edition that the Anglesey Play Development Unit published was inspired by a book that was produced by the Conwy Play Development Team about their area.
The Anglesey Play Development Officer has worked in collaboration with the Local Public Health Team supporting Betsi Cadwaladr Health Board to highlight elements of the ‘10 Steps to a Healthy Weight’ which include recommendations like prospective parents getting to a healthy weight before starting a family, giving under five year olds the chance to play outside every day and limiting their screen time. It also includes useful information and advice about numerous destinations, including the best beaches, parks, playgrounds, wood, walks and nature reserves on the Island. During the launch of this guide, Anglesey’s Play Development Officer, Siwan Owens explained “this new guide builds on the success of the previous version, sharing even more fantastic places for young people and families to explore and have fun. There is a map showing all 36 of the best locations, as well as top tips for getting the most out of them. As simple as it seems, getting outside and having fun is fundamentally important for the proper development and the health & wellbeing of children, their families, and the wider community on Anglesey.” MsTeresa Owen, Executive Director of Public Health for Betsi Cadwaladr University Health Board, said “Playing outside is really important for children’s physical, mental and emotional health, it can even help them to sleep and concentrate better. We hope that with the help of this guide, families will put on their wellies and run, jump, splash, climb, paddle and crawl their way through some of the best play spaces that Anglesey has to offer!” Anglesey’s Play Development Officer Siwan added, “Whether it’s building sand castles, rolling down hills, or hunting for bugs, we hope this guide will inspire people to get out there, get healthier, and enjoy this wonderful Island.” You can access the guide which was funded by the Welsh Government from: Anglesey Come and Play Guide If you have any further questions about the guide or play in general please contact Siwan Owens on 01248 752968 / SiwanOwens@ynysmon.gov.uk In Conwy Borough Council, the Play Development Team have recently had some paper copies of their ‘Conwy Come and Play Guide’ printed and added the entries from the brochure onto the Family Information Services database. Information about activities taking place during the school holidays is also provided on the Family Information Services website: www.conwyfamilyinformation.co.uk.
Flintshire County Council Play Development Officer has reported that their play guide is currently being printed and due out soon..... The guide, which was funded by the Welsh Government, http://www.anglesey.gov.uk/Journals/b/l/k/ ACC30568-Anglesey-Playable-Spaces-ENGLISH-2017-WEB.pdf If you have any further questions about this guide or play in general please contact Siwan Owens on 01248 752968.
Vale of Glamorgan Healthy & Sustainable Pre-School Scheme Pre-school aged children across the Vale of Glamorgan are donning their aprons, washing their hands, and with a bit of help from the grown-ups, cooking a range of healthy and tasty treats. It’s all part of an initiative led by the Vale of Glamorgan Healthy and Sustainable Pre School Scheme, which aims to promote health among pre-school aged children, by working through the childcare settings they attend. Contributing to the effort to reduce childhood obesity is an important aim of the scheme. Working with food teacher and trainer Richard Shaw from Cooking Together, healthy cookery sessions have been taking place in childcare organisations across the Vale of Glamorgan, involving children, childcare workers and parents too. Simple recipes such as pizzas, soup and muffins have been made by the children, who under close supervision have been undertaking the vast majority of tasks themselves. The sessions have been fun, and with all costs covered by the Healthy and Sustainable Pre School Scheme. The idea is that the sessions ‘kick start’ a programme of healthy cookery that will then become a regular feature in childcare organisations. In an effort to make it as easy as possible for everyone to take part, the Healthy and Sustainable Pre School Scheme has also developed a Cookery Equipment Loan Scheme. A set of equipment including a cooker is delivered to the setting, for them to borrow for anything from 3 weeks to 2 months - ideal for settings that don’t have the finance to purchase equipment, of the space to store it.
Catherine Perry co-ordinates the Healthy and Sustainable Pre School Scheme in the Vale of Glamorgan, and has been encouraged by the enthusiastic uptake of both the healthy cookery sessions and the equipment loan scheme. ‘Pre-schoolers are full of energy, and are interested in everything. They can’t wait to get started in these cookery sessions, and get such a sense of satisfaction at being able to actually eat what they have made. We hope that by involving parents, and making recipes available to them, cooking healthy food will be something children do on a regular basis, and will develop into a lifelong interest in eating healthy food’ Ceri and the childcare team at West End Playgroup in Barry found the healthy cookery sessions to be inspirational: ‘I just wanted to let you know how well our cooking session went today. They (the children) made vegetable samosas which were delicious. Richard has such a lovely way with the children. We always feel inspired after his visit. We feel very privileged to have had this session and would welcome any future opportunities.’ All the training and resources provided by the Vale of Glamorgan Healthy and Sustainable Pre School Scheme are free of charge to participating settings. For further information about the scheme please contact: Catherine Perry Senior Health Promotion Specialist: Healthy Schools Public Health Wales, 1st Floor, Global Link, Dunleavy Drive, Cardiff, CF11 0SN 02921 832131 catherine.perry@wales.nhs.uk
Shared Practice This month’s project is NUTRITION SKILLS FOR LIFE™. NUTRITION SKILLS FOR LIFE™ is a programme of quality assured nutrition skills training and initiatives developed and co-ordinated by dietitians working in the NHS in Wales. The programme aims to support a wide range of community workers, including those from health, social care and third sector organisations to promote healthy eating and prevent malnutrition by incorporating food and nutrition skills into their work. The programme aims to reach community groups who may not have the knowledge, confidence and skills to prepare and eat a healthy balanced diet. By training those who work closely with, and understand the needs of local people, the programme successfully supports communities across Wales to learn more about healthy eating and put knowledge and skills into practice. Participants also have the opportunity to gain an accredited qualification which is particularly important for those who may have left formal education early. If you would like to add your own project to the Shared Practice Directory there is an easy online form (only accessible to members) and once approved by one of the coordinators your project will then appear on the directory. There is also a Self Assessment Toolkit which can be printed off or completed online and allows coordinators to quality assure the development and delivery of new and existing projects. If you need help completing the toolkit or have any questions please contact one of the coordinators at publichealth.network@wales.nhs.uk
News Round-Up Welcome to the News Round-Up. Click on the headings of the news item to take you to the full news story on the Public Health Network Cymru Website.
Children and Young People Children consuming sports drinks unnecessarily A high proportion of 12-14 year olds are regularly consuming sports drinks socially, increasing their risk of obesity and tooth erosion, concludes a Cardiff University School of Dentistry survey.
Alcohol First Minister sets out legislative priorities First Minister of Wales, Carwyn Jones, has set out his government’s legislative priorities for the year ahead.
Agriculture / Natural Environment Tyfu Fyny - a new programme to support community growing in Wales The project, open to all existing and emerging community growing projects in Wales, has been funded by Welsh Government Rural Communities – Rural Development Plan 2014-2020.
Physical Activity Persimmon Healthy Communities Persimmon Healthy Communities are giving away £600,000 to support young people in sport.
Nutrition An app has been launched to enable preventative and early intervention for those suspected of having an eating disorder The evidence-based Diet or Disorder? app is a collaboration between Swansea University and Aneurin Bevan University Health Board, with substantial input from the Tier 3 Adult Eating Disorders Service, sufferers, carers and the third sector, with advice from Child and Adolescent Mental Health Service Network (CAHMS), public health, education and primary healthcare professionals.
Noncommunicable Diseases A Healthy Heart Your Goal UEFA, the World Heart Federation, the Dutch Heart Foundation and the Royal Netherlands Football Association (KNVB) are coming together at the UEFA Women’s Euro 2017 to promote heart health and fight against cardiovascular disease, the number one killer in the world.
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UCL Health and Society Summer School: Social Determinants of Health London Strive to Thrive: Moving PE forward in times of challenge and change Burton on Trent Children and Young People’s Mental Health: Taking Early Action London
Motivational Interviewing Summer School Cardiff Together for Mental Health Cardiff
ACE Support Hub presents RESILIENCE: The Biology of Stress & The Science of Hope Cardiff YMCA
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Contact Us Capital Quarter 2 Floor 5 Tyndall Street Cardiff CF10 4BZ www.publichealthnetwork.cymru If you have any news or events to contribute to the next edition please submit them to publichealth.network@wales.nhs.uk Deadline for submission is the 3rd Friday of every month.
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