You will all be more than aware of the ongoing concerns in Salisbury and it felt right this week to focus solely on this.
Yesterday, Prime Minister Theresa May visited Wiltshire and Salisbury and as part of this spent time in PHE Porton, meeting some of our team who have been involved in the response from the very start. She later gave testament to our contribution in her public statement to the media.
Many people, even those familiar with PHE, are probably unaware that over 2000 of our staff are scientists who work at the cutting edge of technology in infectious disease and other biological and environmental hazards to life. Half of them live and work in Wiltshire. We are not only responding to this outrage – we care about what happens and public safety is our number one priority.
We are working closely with many other agencies including Wiltshire Council and Salisbury NHS Foundation Trust, and also across government and with the police and security services.
While many people are following the unfolding story, for some it has directly impacted their daily lives including our own local staff. Places they eat, streets they walk every day and their homes and workplaces have been affected. Throughout we have provided accurate and proportionate advice to the people of Salisbury and are attending various community events as well as working with the media to support this.
It is clear that this substance can have a serious immediate effect on those who have a significant exposure but in contrast the general public who were in the vicinity could only have been exposed to extremely small traces, if any. Our advice, continually reviewed through an ongoing risk assessment, remains that the risk to the public is low and we will respond with any further advice as necessary. Our full advice is online here.
Obviously our thoughts are with Police Sergeant Nick Bailey, Sergei Skripal, and his daughter Yulia who are under the exceptional care of the NHS.
In the meantime, I cannot sufficiently thank those PHE staff, in London and in Wiltshire who have been working flat out and we will remain fully engaged until Salisbury is completely back to normal.
We hope our latest edition of Health Matters – on the subject of “Community-centred approaches for health and wellbeing” – will help you and other professionals by compiling key facts, figures and evidence of effective interventions.
Placing communities at the heart of the public’s health can empower people, create connected and resilient communities, engage those most at risk of poor health and reduce health inequalities. Our latest edition of Health Matters focuses on community assets and the Family of Community-Centred Approaches, a framework developed to represent some of the practical and evidence-based options that can be used to improve community health and wellbeing.
Health Matters: Community-centred approaches for health and wellbeing - YouTube
In this blog we’ve published the answers to a number of Health Matters questions we received from professionals across the UK at the recent launch teleconference.
Our Q&A panel are Dr Ann Marie Connolly, Deputy Director, Health Equity and Mental Health, PHE, Professor Jane South, National Adviser, Healthy Communities, PHE and Leeds Beckett University, Jude Stansfield, National Adviser, Public Mental Health, PHE and Terry Blair-Stevens, Public Health Consultant in Health and Wellbeing, PHE South East.
Question 1 (How do we make the case for the cost effectiveness of community-centred approaches?)
We are doing a lot of work around community-centred and person-centred approaches. We invest in this work a lot and I am very conscious that we are squeezing the budget. What is the panel's approach to ensure that we are putting money in the right places?
It's a very important question because the temptation at this time is to squeeze the sort of investment in how you engage with communities and supporting communities to be more self-sustaining. We do have evidence on the positive benefits and the positive outcomes, the social value and the economic value of engaging communities. The evidence around volunteering is very strong here, and also peer support. It's challenging because the ways to calculate costs and the sort of wider benefits that can be felt when service models shift, is more challenging to evaluate. But we do have the trends and evidence that tends to show that it brings economic and social value, but we will be looking for where areas are trying to redesign their services, and hoping that good evaluations will be able to provide some of those answers around service redesign and investment in prevention.
Question 2 (Demonstrating cost-effectiveness for the health and social care system)
I am a commissioner for these community-centred approaches and I have lots of evidence of impact on the person. Our finance department also understands the impact on the person. But what they want to measure is the impact on the system, showing how this intervention (or basket of interventions) changes behaviour or usage or makes people more resilient and able to use the health and social care system appropriately. What I am struggling with is how do you show prevention, the thing that never happened?
You raise some useful points and familiar ones in health improvement where the goals are long-term and ultimately about improving outcomes in good health and wellbeing, which we've been addressing in our work here. The first challenge is perhaps that commissioners should value health and wellbeing outcomes as legitimate goals to commission services and interventions. That is, good health in the population is the endpoint, using some of the community outcomes we mentioned such as social capital, wellbeing, participation, social connectedness - all things that can be measured. There is good evidence that these outcomes are also protective factors for health that impact on behaviours and illness. There is evidence for this in the Marmot Review and also in PHE's recently commissioned work from the Marmot team on psychosocial pathways for health outcomes.
This shows the causal pathway that can help illustrate a logic model approach - if we achieve x it is likely to impact on y. The second challenge is perhaps to use the existing evidence to model local impact. Lastly, the challenge is to have the capacity to evaluate impacts on the system. Some local initiatives do this by joining up different parts of the system in their evaluation framework e.g. monitoring use of services. The Realising the Value programme produced some useful resources for commissioners. Partnerships with local academics can be fruitful and there are funds available for evaluating local public health practice. NHS England is supporting social prescribing and this will hopefully provide some system impact data.
Question 3 (How do we sustain a project that is already running?)
We run a health champion project, which is very successful in the community, where we work from community centres, job centres and libraries. It’s about sustainability of the project and we are capturing evidence that we are making an impact. How are we able to continue this service? Because it's limited in regards to funding. And I just want to know the panel's ideas of supporting ongoing work.
It is important that we measure outcomes of projects and are able to check out the local evidence base about why a project is needed, what sort of outcomes result and the communities that are involved in that project. So, if you’ve got a champions project where you’ll be reaching parts of the communities that much more traditional services don’t manage to, then that’s part of your case for further funding. It’s the responsibility of people involved in practice to engage in evaluation, as you have done, and get the evidence. At the same time, there is a role for commissioners to try and put in place systems to gather that evidence appropriately and to understand what's needed in their local area.
They should also use some of the evidence based on large research programmes, such as through the National Institute for Health Research (NIHR). Hopefully you are well engaged with your local GPs and your CCGs to be able to continue to promote the value that you are already offering them, and to help them understand even better what you are actually delivering and providing on their behalf – communicating that this is a helpful complementary service to other clinical-based services. In the NHS, we tend to find clinical solutions whereas sometimes the solutions are right there within our local communities. There are many approaches to resilience in terms of funding and the crucial element is really relationships, both with the commissioners who are funding the work, demonstrating the strength of the impact of the work that you are doing and the benefits for the audience that you are working with, and having those relationships with your allies. NICE guidance states that this work needs long-term and sustainable approaches and that needs reflecting within local commissioning plans.
Question 4 (What scalable initiatives are there?)
I’m a director of environment in a London borough and we are aligning some of our health and environmental services priorities. Health in terms of getting communities more engaged in their area, but we’re envisaging it would have the benefits that we can retract services by passing over the control and the ownership of services to people. What evidence do we have for particular initiatives that are particularly productive in terms of health as well as in terms of getting people engaged, and that are scalable across a wide area to make a big impact?
The answer on one level is that there is no one intervention and that’s what the family of community approaches aims to show - that a range of practical models are needed. In terms of some of them that have got quite a long history, there are projects such as the C2 Connecting Communities model, which is about neighbourhood community development, some of the scalable models around time banking that come under different guises, participatory budgeting and some of the health promotion planning models that have been around a long time. The key thing is that in some ways it doesn’t really matter where you start and what you start with, it’s about the relationships that you build over time in the community.
We know from a lot of evidence that it’s the length of time that’s needed to build those relationships, and that’s what is really critical. So, take something from the family and have a go and let us know what has happened, because we’d be interested. You would also want to be looking for strong local support from the communities themselves as you were choosing what you were going to do. Ask your community involved, your community members and community workers, see what they feel would work best and involve them in deciding that and delivering it and measuring it. It is important to have a local champion, perhaps in the local authority. Local authority members are champions of the communities they represent and they’re often the best people within a council to advocate for the assets within a community, because they know their communities well. Success breeds success as well, so the tension is always between starting small and scaling up. Sometimes you can’t do community-based grassroots bottom up at scale until you have started at the grassroots and built that trust and relationships and community development over a period of time.
Question 5 (How to engage with communities)
Firstly I just wanted to make a statement. Everybody talks about engagement with communities, but actually that is a very skilled activity, and I don’t think that’s always appreciated. When we go into communities, they don’t want a tick-box exercise and I think they really get fed up with different stakeholders coming in, asking them for their opinion, and they never see that individual back again. So, I think those sort of issues at a very ground level have got to be realised by commissioners and services. They must understand the importance of a very skilled engagement activity with the communities in order to get people on board.
My question is this: When we’re working with communities and certainly for a health promotion event where we go to the communities, for example with the bowel cancer screening programme, what's the evidence for actually incentivising communities to come and attend a workshop or an event?
To your first point about the nature of engagement, at PHE we have been looking at workforce development, looking at what are the knowledge and skills needed within public health to work actively with communities, to work across different sectors and to look at the required competencies of people that are in those roles. Working across sectors and taking a place-based approach to engagement and empowerment is what’s needed. So public health aren’t doing their own thing without working with social care, police and crime, NHS, because all agencies are wanting to do more of that engagement and we need to do that in a skilled way. It is also important to understand the health literacy levels of the community. We need to avoid tokenistic engagement and using jargon. We've got to use the right word, the right language and words that people understand, when we really want to try and get buy in. Understanding the community language is vital and as commissioners and service providers, we really need to get it right.
In answer to your question, we haven’t got much evidence around incentives around community engagement, but what we do have evidence for is the importance of making it easy for people to take part and also the fact that there are a number of costs associated with taking part in things. We shouldn’t make assumptions that people are just going to turn up and give everything for free and possibly spend an afternoon having a discussion without recognising that there needs to be some reciprocity. Different communities will approach that in different ways, but people’s costs should be taken into account in terms of getting there. That’s really important. And also they should get something out of events for themselves. They’re not going to engage again if it’s just a chore.
Question 6 (Involving communities in defining outcomes)
I think one of the common stumbling blocks in engaging communities is that we are trying to fulfil our own agendas rather than the community’s. Are there any guidelines or any evidence around how that changes the relationship and are you working towards outcomes that are defined by the community? As an adjunct to that, when we are speaking to communities we find that it's not only about being connected to services that are important to them, but also about the kind of opportunities to participate and opportunities to make a contribution to the local community. Is there any evidence or examples of that in the work that you have concluded?
It's an incredibly important point. As far as guidance on this, well we have got the NICE guidance and particularly the NICE quality standards on community engagement, which were published in 2017. There are only four quality standards and these are things that are expected of the wider health system and one of them is that communities should be engaged in evaluation. What they mean is that communities should be involved in deciding what are the important things to measure in a local project, what the goals are and what the outcomes should be. So that is a valuable quality standard and you can use that as a bit of ammunition for making a case. Practically speaking, there’ll often be a mix of outcomes, things that sometimes the health system want and things that communities want, but we need to put both together, so that we can see the link between why someone who is feeling better connected leads to them being more likely to take on healthier behaviours.
A community-centred approach is actually asking a lot of professionals who are not normally involved in this to change quite a lot about the way they think, about how to approach their job, and so it's a reframing of our approaches and actually starting from where local people in communities are coming from. Participation in design and decision making is a critical part of this engagement because that is what will help you understand what are the measures that are important and what will help people understand when success has been achieved. And then the next time around when you want to talk about a new health service programme, the community is going to be more receptive if they have seen you deliver the first time around.
Question 7 (Mapping local assets)
When we’re looking at a project across the system, how do we best improve communication across the system and effectively map the assets that there are in order to reduce replication?
This has come up frequently, particularly in relation to issues like social prescribing. The first step is in knowing who your community is in all its richness and diversity. So stepping in, mapping what the community is and the positive assets that it holds in terms of the knowledge, the skills, the facilities that they have available to them locally, is a great starting point. This shouldn't be undertaken by one partner in the system on their own. With public health being based in local authorities, the default position might be that local authorities are seen to be leading on this, but really if we are trying to improve health and wellbeing for our communities, asset mapping needs to be shared across all the partners in the system. This includes the NHS partners and it should be done in partnership with those communities who are part of that wider system. There are many examples across the country of how others have done this. Some are using digital technology and digital mapping processes to map the community assets. Some are set up to enable communities to put in their own resources and what they have to offer on those digital mapping sites.
PHE has its own Strategic Health Assets, Planning and Evaluation tool (SHAPE), so that we can map assets more rigorously. One of the things that the National Information Board and others are working on is a taxonomy for these assets, because how one person describes an asset may be very different from someone else. There is some scope to develop a common language around how we describe assets, so that people know what they are and how we can find them. From a community engagement and empowerment perspective, one might say an asset is only an asset if the community says it is. And certainly when we are talking about the community assets of knowledge, interest and passion in networks, it's the community that might decide where they are and what they are. In the Call to action section in this edition of Health Matters, we've got some information about the use of the SHAPE tool. We also have examples from Wakefield where they used SHAPE to do an integrated asset map to support alcohol reduction and one that Macmillan used to support people living with cancer. So those are some examples and it would be good to hear from elsewhere as well if people have done asset mapping and it’s worked.
If you have any further questions, the Healthy Communities team here at PHE will be pleased to answer them. So please send your question by email to email@example.com.
Do please download the infographics and the slides, the case studies and all the other materials. Please keep on sharing your stories about how you have used the Health Matters materials to communicate your messages and to get things done, or if you have ideas for improvements. Just send an email to firstname.lastname@example.org.
Educating all generations about antibiotic resistance
Infections caused by antibiotic-resistant bacteria are becoming increasingly difficult to treat. As the misuse and overuse of antibiotics contributes to the rising emergence of antimicrobial resistance (AMR), it is important to engage with the public as much as possible, as they have a vital role to play in reducing AMR.
All age groups should be aware and cautious about antibiotic use, including children and young people. To this end, PHE operate a free health resource called e-Bug, consisting of lesson plans, worksheets and multimedia for educators and students from ages 4 to 18. e-Bug, which is an evidence-based resource, primarily educates students on infection prevention and control and covers a range of topics including:
The resources were developed alongside students, teachers and public health professionals. Not only is e-Bug a useful tool that links to the national curriculum, the resources have been endorsed by NICE, are available in 23 languages and are utilised by 23 countries worldwide. e-Bug also runs Train the Trainer sessions for teachers and local authority professionals on the activities and lessons to increase implementation of the resources in the UK. Since 2016, e-Bug has trained over 100 individuals.
Peer Education; an innovative method to educate young people on AMR
The peer education model developed by e-Bug involves students teaching other students of the same age or younger. A recent study by e-Bug involving secondary school students teaching primary school students on infection prevention and control showcased the benefits of this approach. Peer education on hygiene, microbes and infection prevention increased knowledge intake, and improved communication and confidence.
e-Bug currently hosts peer education resources for secondary schools and further education (A-level) on infection prevention, antibiotics and antibiotic resistance. The team are currently evaluating the further education resources with Cardiff University and Manchester University, in which university students teach A-level school students about antibiotic resistance, who in turn teach their own peers.
Our peer education model has also been highlighted in PHE’s pledge for the ‘#iwill campaign’, with hopes to use the model to teach about wider issues such as sexual health in the near future.
British Science Week 2018
As part of this year’s British Science Week (9-18 March), PHE scientists will be visiting 10 schools across England to hold interactive science workshops for pupils aged 13-14 years. The scientists taking part specialise in a range of disciplines, including toxicology, microbiology, environmental public health, microscopy, vaccine research and epidemiology.
The e-Bug team has been an important partner in the delivery of British Science Week by leading outreach training sessions aimed at all scientists taking part in the science workshops, and advising the scientists throughout the development of their activities.
From pupils extracting DNA from their own cells using household products, to a science and health-related game of Articulate and quizzes on air pollution, the aim of these workshops is to inspire the younger generation and future scientists to consider a STEM-related career and showcase the variety of areas within science that they could pursue.
British Science Week is an annual ten-day event, with this year being its 24th year running. It encourages organisations, scientific professionals, science communicators and educators to organise events that engage the general public with STEM.
To celebrate British Science Week, e-Bug is also exhibiting at The Big Bang, Birmingham; an annual fair organised to inspire young people on science and engineering. The Big Bang brings in approximately 70,000 visitors each year and this year, e-Bug will be presenting a range of their fantastic activities for attendees to get involved with. One example is Bogey Busters, an exciting activity involving a snot blaster to teach about respiratory hygiene and the spread of infection. At Big Bang, attendees will have the opportunity to test out the Snotgun, predict the speed and distance of a sneeze and take a selfie with the team using e-Bug’s new Bogey Buster Snapchat filter.
e-Bug, in collaboration with NICE, recently experimented with the use of Snapchat during World Antibiotic Awareness Week 2017, when an antibiotic themed Snapchat geofilter was piloted at We the Curious on European Antibiotic Awareness Day.
Interested in getting involved with e-Bug?
Learn about the fantastic resources and activities:
Lesson plans: These can be used in PSHE and Biology lessons, assemblies and health events. All lesson plans are in line with the National Curriculum and UK exam boards. These lesson plans cover a range of topics such as microbes, hygiene and antibiotics for students whether they are at primary school, secondary school or doing their A –Levels
Assemblies: Give an assembly to the whole school using the e-Bug assembly activities pack, downloadable from the e-Bug teacher home. The activities included are perfect for assemblies, particularly on science themed days or during national health campaigns
Secondary Peer Education : run activities where students teach their peers or primary school students about microbes, hygiene and antibiotics
A-Level Peer Education : run activities around antibiotics in which students teach their non-science peers or other students within the school
Host an afterschool science club or brownies/scout group – The Beat the Bugs course can be run during the club/group, which is full of fun and interactive activities and games
On Tuesday we began the next phase of the childhood obesity plan, with a call to the food industry to reduce overall calories in thirteen categories of food by 20% over the next five years. This builds on the sugar reformulation programme that affects nine categories of food, making 22 in all and covering 50% of all calories being consumed by children. We also launched our latest One You adult nutrition campaign, working with household names that serve millions of people every day to promote healthier food options, including McDonald’s, Greggs, Starbucks, Boots, Subway, Marks and Spencer and Tesco. The campaign aims to help people be more aware of the calories they consume while out and about, whether they are picking up breakfast on the way to work, having lunch at their desks or eating out.
It has a simple message: aim for 400-600-600, that’s 400 calories for breakfast, 600 for lunch and 600 for dinner – with a couple of snacks in between and of course drinks. With the average adult consuming 200-300 calories too many a day and our children up to 500 too many a day, each commercial partner will promote attractive meal options within the 400-600-600 benchmarks. Governments can introduce taxes, manufacturers can make their products healthier, local government can factor health into planning, but ultimately we are also individually responsible and providing information and extending choice is at the heart of this. You can read our report here and find out more in our press release and blog.
Explaining calorie reduction - YouTube
Working adults spend on average one third of their waking hours at work, meaning that workplaces have great potential to promote and encourage health and wellbeing. On Wednesday, we launched the ‘Physical activity, healthy eating and healthier weight: a toolkit for employers’, a free resource joining the suite of toolkits we have co-produced with Business in the Community (BITC). This aims to help employers of all sizes achieve a healthier working environment and encourage their staff to eat well and move more. You can see the toolkit here and read more in our blog.
In England, almost three-quarters of women start breastfeeding when their child is born, however by 6-8 weeks this drops to 44%, making our rates among the lowest in the world. We know that health visitors and midwives are absolutely crucial in supporting mothers to breastfeed for longer, and to complement this, our Start4Life campaign has created the ‘Breastfeeding Friend’ available on a range of platforms including Facebook Messenger and now on Amazon Alexa. This technology means mums can get helpful advice at any time of the day or night, quickly and easily. More information can be found here.
This week we also launched the second phase of the Sexual Health ‘Protect Against STIs’ campaign, which encourages condom use to reduce the rates of sexually transmitted infections (STIs) among 16 to 24-year-olds, and raises awareness of the serious consequences of STIs. We are using popular platforms such as Snapchat and Instagram, producing new posters that will be featured in bars and clubs, and have established a partnership with LADbible – a key channel to reach the 16-19 audience. Resources are also being made available for Local Authorities to support and promote the campaign in their localities, including posters to encourage condom use and promote free condom distribution schemes, wallet-sized cards detailing online support, digital assets, and images and films for use on social media channels. You can find out more about the campaign here.
And finally, I would like to thank all of our PHE colleagues who have been involved in the incident in Salisbury this week. This includes our Health Protection team in Bristol, toxicologists, poisons and chemical experts at our Centre for Radiation, Chemical and Environmental Hazards, and emergency response specialists. Based on current evidence, we know that the risk to the wider public is low, however PHE will continue to provide advice to the national response and to local clinicians.
International Women's Day (IWD), which has taken place on March 8 for over a century, is a global day celebrating the social, economic, cultural and political achievements of women. But, IWD is not only about acknowledging the barriers that women have overcome over the years, but also remembering that in some cases we still have a long way to go towards achieving gender parity.
Gloria Steinem, world-renowned feminist, journalist and activist said: "The story of women's struggle for equality belongs to no single feminist nor to any one organisation but to the collective efforts of all who care about human rights."
As an organisation which exists to protect and improve the nation's health and wellbeing, and reduce health inequalities, Public Health England is part of this collective effort.
It has long been recognised that people in prison are typically in poorer health. Rates of physical and mental health problems and drug or alcohol dependence are higher and this group struggle to access health services (in custody and in the community). This is often on top of other social issues such as poverty, indebtedness, unemployment, poor education and homelessness.
What’s clear is that women in prison are often even more affected than their male counterparts. For example, 65% of women in prison suffer from depression compared to 37% of men and women in prison account for 23% of all prison self-harm incidents despite representing just 5% of the prison population.
Historically, prisons have almost invariably been designed for the majority male prison population – from the architecture of prisons, to security procedures, to healthcare, family contact, work and training.
We also know that a large number of women who face prison sentences come from deprived backgrounds. Fifty three percent of women in prison report having experienced emotional, physical or sexual abuse during childhood and forty one percent of prisoners in one survey said that they had observed violence at home as a child. These negative childhood experiences can have a profound impact on women’s health outcomes and their offending behaviour. Women also tend to have roles as parents or primary care givers in families, meaning time in prison no only impacts on them but on their families and the people they look after.
Time in prison can be viewed for many as the first opportunity to turn their lives around, improve their health and access the services they need. If we want to improve women’s health and well-being in prison it is essential to focus on the root causes of their situation; to prevent negative experiences from happening in the next generation of children, to develop strategies to intervene early and to give comprehensive support to mitigate the effects of negative childhood experiences.
Preventing offending by tackling the wider determinants of health and supporting upstream prevention of substance misuse, violence, unemployment and exclusion from school
Ensuring that while in prison women have access to high quality health and care services to support improvements to their mental health, substance misuse and general health
Developing an environment in prison which gives opportunities for women to improve their health by improving nutrition and encouraging participation in physical activity
Giving adequate support to women who have children, within the prison in mother and baby units, and those who are separated from their children
Ensuring that support is available for women who leave prison in terms of housing, training and employment opportunities, appropriate access to social welfare and other benefits if applicable, continuation of treatment and referral into appropriate community services
Implementation of these standards is a shared objective for HMPPS, NHS England and PHE. We are aware that these standards are not all currently all being met and will not all be achieved overnight. But, they will form a programme of work which aims to improve quality of services and outcomes for women in prison. With these standards in place all health and justice partners can work together across the system and put in place pathways to improve the health and well-being of women in contact with the criminal justice system, in custody and in the community.
Physical inactivity and poor diet are among the top causes of ill health, and if we get ill this can negatively impact on our working life.
Conversely when we’re feeling well we’re at our best. We’re more productive and take less time off sick, so it’s no surprise that employers increasingly see that it makes business sense to support the health of their staff.
Working adults spend a third of their waking hours in work which means our workplaces are key spaces for improving wellbeing.
These environments shape our behaviour; how active we are, what we eat, so businesses are well-placed to take simple steps to promote physical activity and healthy eating.
It’s a sobering thought that around a third of adults are damaging their health through a lack of physical activity and this situation is bad for business and productivity. But employers can make a difference by making it easier for all of us to get active every day. Promoting walk-to-work or cycle schemes and providing lockers, changing and bike storage facilities as well as encouraging staff-led lunchtime walking or running clubs all make it easier for staff to be active every day.
2. Get sedentary employees moving more
Office workers often sit for hours in front of their computer – sometimes spending over seven hours per day sedentary – and this puts physical and mental health at risk. Simply encouraging employees to take short but regular breaks can help, as well as shaping the workplace through pooling bins and printers, which can be a great nudge to encourage people to get up and move around the workspace. Creating a moving culture can be beneficial to staff morale and cohesion too. Encouraging people to walk over and see a colleague rather than emailing them creates a much more personally connected workforce, as well as one that moves more.
3. Help employees eat well
When we’re busy, a fast-food lunch or reaching for the donut tray is often the easy choice and too often unhealthy food is the quickest to grab on the go. Employers have a key role to play in ensuring employees have access to healthier food and drink options. Our toolkit is packed with information on healthy eating including important questions employers can ask themselves; Do unhealthy options dominate the offering in your canteen or vending machines, could healthier options be subsidised and are there enough fridges so staff can bring fresh food or packed lunches? Do your staff go to local shops or cafes? If so, your employees are a major customer for these businesses, so could you influence them to provide a healthier choice?
Make sure you involve everyone who contributes to your business including people working part-time or working from home and even contractors. Try to ensure information and opportunities are available and suitable for everyone. Engaging shift workers is particularly important as shift work is associated with increased BMI, obesity and other health problems. Talk to your employees and understand their working patterns and the support that could be provided. This will help staff make healthier choices, creating solutions which are better embedded in their day to day working lives as they are co-produced and co-owned by and with staff.
Whether you work in the private, public or voluntary sector you can take action to create a healthier and more productive workforce, helping your employees to be their best and ultimately making your business stronger.
In England, more than a third of children are overweight or obese by the time they leave primary school, which means they are more likely to be bullied, face stigma and suffer low self-esteem.
They are also more likely to become overweight or obese adults, increasing their risk of type 2 diabetes, heart disease, and some cancers. As it stands in England, almost two-thirds of adults are also overweight or obese.
The cost of obesity to society
There’s no getting around the fact that obesity is complex and there are multiple factors – environmental, societal and personal – which have led to the obesity crisis our children and families are facing. Obesity impacts individuals and their lives in many different ways and also places a considerable cost on society.
For example, treating obesity costs the NHS £6.1 billion a year. Musculoskeletal conditions can be caused by obesity and are the biggest causes of sick leave in England. Sick leave costs the economy £100 billion a year.
When it comes to tackling the obesity crisis, change won’t happen overnight - it will take the efforts of many and a range of initiatives until we really see improvements. Just as there are many causes of obesity, we need multiple approaches to tackling it.
Explaining calorie reduction - YouTube
The role of PHE and why we are now focusing on calories
Public Health England plays a major role in addressing the obesity challenge and this includes delivering significant parts of the government’s childhood obesity plan.
We know through our National Diet and Nutrition Survey (NDNS) that our nation’s diet is not what it should be. Children are consuming around three times more sugar than needed and only a quarter of adults achieve their 5 A Day. Around a quarter of adults’ calories come from food eaten outside the home.
That’s why we’re working with the food and drink industry to improve the products we all buy. Our work with industry initially focused on reducing sugar - now that’s underway, we’re extending our work to reduce the calories people consume overall.
At its core, consuming more calories than necessary is what drives weight gain. Since last summer, we’ve been looking at the evidence behind children’s calorie consumption and have now published this with further details on our calorie reduction programme.
What does the evidence on calories show?
The evidence shows overweight and obese boys consume anywhere between140–500 calories too many each day, depending on their age. For overweight and obese girls it’s 160–290, while adults currently consume between 200–300 excess calories each day.
We’re now challenging the food industry to reduce the calories in food, including their most popular products, by 20% by 2024. This includes categories of foods making significant contributions to children’s calorie intakes, where there is scope for substantial reformulation and/or portion size reduction - such as pizzas, ready meals, ready-made sandwiches, meat products and savoury snacks.
If the target is met within 5 years, this will prevent more than 35,000 premature deaths will be prevented over 25 years and there will be savings of almost £9 billion in NHS healthcare and social care costs.
We will now work towards setting guidelines for the product categories included in the programme. This will include extensive engagement with all sectors of industry and health groups. We will publish the guidance in mid-2019.
So what public initiatives do we have to support this work?
For adults, we’ve launched our latest One You campaign alongside the calorie reduction programme. With an overarching aim of helping people be more calorie-aware, the new campaign encourages people to follow a simple rule of thumb: 400-600-600 – the number of calories to aim for at breakfast, lunch and dinner. These are not new guidelines. They are intended to help people choose healthier meals when they are out and about.
Healthy snacks between these main meals are expected to take adults to the recommended daily calorie intake – 2000 calories a day for women and 2500 for men. These guidelines on total daily calorie intake are not changing and this is primarily aimed at people who may not know how many calories are in the meals they eat outside the home.
Some household names are already playing a role in helping consumers be more calorie-aware.
As part of the One You campaign, Greggs, McDonalds, Starbucks and Subway are some of the food on the go companies who are signposting consumers to meals that fall under the 400-600-600 rule of thumb.
While our work with industry and healthy lifestyle campaigns make an important contribution, they are only part of the wider solution needed to shrink the nation’s expanding waistline. It is a long journey to becoming, as a society, more calorie-literate. This is the start of a journey and there’s plenty more to come that will help us all play a part.
The growth of the snacks and drinks market in recent years is a factor in children and families people consuming excess calories. Snacks do more than feed hunger; they are part of our habits and a response to the ubiquitous marketing and promotions which we see everywhere.
Snacking is a regular occurrence for many people and in the age of infinite choice, keeping track of how much we’re eating and making informed choices is often challenging.
This is especially the case for children and families. Half of the sugar children consume comes from sugary snacks and drinks and this can mean too many calories and tooth decay. That was the driving force behind our Change4Life campaign launched in January, which helps parents select healthier snacks for children through a simple rule of thumb - “Look for 100 calorie snacks, 2 a day max”. You can learn more about it here.
This World Birth Defect Day we can reflect on an important achievement in England: the establishment of a single, national, system for registering birth defects, which we prefer to call congenital anomalies.
The National Congenital Anomaly and Rare Disease Registration service (NCARDRS) came into being in 2015 to build on the work of the previous regional congenital anomaly registers that covered approximately half of England.
Significant congenital anomalies affect between 2% and 3% of all births, creating long-term illness for many children, considerable burdens of care for families, significant healthcare costs for society, and in worst case scenario an untimely death.
For babies born at term, congenital anomalies are the largest cause of death in their first year. Both the incidence of birth defects and the probability of death from them are strongly related to social deprivation.
Research into congenital anomalies
Much important research into congenital anomalies has been done in England, but attempts to further advance our knowledge have been restricted by the limited populations available to the previous registers.
This hampered the study of the rarest abnormalities and prevented important regional comparisons. Now we have a national register, we are in a position to address such issues, and as time goes by, we will be able to monitor changes in rates over time and investigate the causes of any changes.
The role of NCARDRS
Importantly, NCARDRS provides the data that enables strong public health advocacy for interventions that can help to reduce congenital anomalies. At a population level, issues such as obesity and diabetes in pregnancy are well known to increase the risks of congenital anomalies.
For this reason, Public Health England works closely with local authorities and NHS England to address these problems, as well as promoting general healthy lifestyle changes for all women considering pregnancy.
There is strong evidence to suggest that fortifying flour or bread with folic acid has a positive effect, and could potentially prevent around 2000 birth defects in England.
This could also be the most effective way of reaching sections of the population with lowest folate intakes e.g. young women from the most deprived areas. It is recommended that increasing folic acid intake before pregnancy, and in the first 12 weeks of pregnancy will reduce the risk of neural tube defects. If and when folate fortification is introduced, NCARDRS will be able to evaluate specifically the effects of the policy.
Making a difference
Local NCARDRS offices have built good relationships with NHS trusts, delivering maternity services to create smooth and efficient paths by which congenital anomalies can be identified both before and after birth.
At the same time, the increasing volume of digital information extracted from hospital admissions, operations to correct congenital anomalies, and other sources, has created enhanced channels by which cases can be identified, and relevant information about cases can be acquired without placing excessive burdens on busy clinicians.
Maintaining a close relationship with the clinicians delivering care, and encouraging them to use the NCARDRS data set for their own investigations and research, will be central to the continuing success of the register.
There is no other way to begin this week other than saying thank you to local authorities and to every person across the health and social care family who has battled the so called ‘Beast from the East’ to keep people safe and well during treacherous weather conditions. It takes determination, careful planning and quite literally grit to ensure vital services are kept up and running for the public during wintry spells as bad as this one. You can find our advice on staying warm and well here.
Five years ago, NHS public health services returned to local government after a 40-year interregnum. With this came a new statutory duty to improve the health of the people, and they have taken this on with pace and ambition. It is now common practice for local authorities to put the public’s health at the heart of their planning and policies. This week, the Local Government Association published a new report called ‘Public health transformation – five years on’, which presents case studies on the transformation work of local public health teams and how they are integrating services and improving outcomes. Local government have weathered the most fiscally demanding ask of any public service and we do not recognise enough the innovative work that has been taken forward, not despite the financial challenge, but often because of it. See the full report here.
Antibiotics are critical to modern medicine and have been saving millions of lives since their introduction in the 1940s. However in recent times resistance has accelerated and this is in part associated with the overall quantum of prescribing – essentially the more that gets prescribed, the greater the resistance. The good news is that prescribing has dropped by 5% since 2012, less good is that PHE research published this week shows that 1 in 5 prescriptions are inappropriate. England has a national ambition to cut inappropriate prescribing by 50%, so from this data we have a baseline that we can track progress against and we will continue to support the health system in meeting this objective.
There is currently an outbreak of Lassa fever in Nigeria, a haemorrhagic illness that is normal for the country but currently circulating at unusually high rates. Following a request from the Government of Nigeria, the UK Public Health Rapid Support Team (UK-PHRST), jointly run by PHE and the London School of Hygiene and Tropical Medicine, deployed to southern Nigeria this week. The team includes epidemiologists, clinicians and logisticians, who will provide technical support to the Nigerian Government, World Health Organisation, and other partners. The UK-PHRST continually monitors infectious diseases and other hazards globally, identifying situations where the deployment of specialist expertise could prevent these threats from turning into a global outbreak. Our press release has more information.
Placing communities at the heart of the public’s health can empower people, create connected and resilient communities, engage those most at risk of poor health and reduce health inequalities. Our latest edition of Health Matters, which was launched on Wednesday, focuses on community assets and the Family of Community-Centred Approaches, a framework developed to represent some of the practical and evidence-based options that can be used to improve community health and wellbeing. This was a record breaker with more than 350 people on the call. You can see the full edition here and learn more in our blog.
And finally, in England every year there are 800 million biomedical investigations and PHE is one of the largest providers of NHS pathology services, meaning our laboratories are incredibly busy at all times. Pathology is a vital cog in the treatment pathway and this week, thanks to excellent partnership work between PHE and the North Bristol NHS Trust, a new state of the art pathology laboratory was opened at Southmead Hospital. Thanks to everyone who worked hard to get this operational; and to our joint teams who process around 5,000 samples every day in North Bristol alone.
Welcome to the latest edition of PHE’s Health Matters, a resource for local authorities and health professionals, which for this edition focuses on community-centred approaches for health and wellbeing.
Why communities matter
Positive health outcomes can only be achieved by addressing the factors that protect and create health and wellbeing, and many of these are at a community level.
Community life, social connections and having a voice in local decisions are all factors that make a vital contribution to health and wellbeing. They build control and resilience, help buffer against disease and influence health-related behaviour and management of long-term conditions. Community-centred ways of working are important for all areas of public health – health improvement, health protection and healthcare public health.
Involving and empowering local communities, and particularly disadvantaged groups, is central to local and national strategies in England for both promoting health and reducing health inequalities.
The National Institute for Health and Care Excellence (NICE) guidance reiterates the importance of community engagement as a strategy for health improvement, particularly as it leads to services that better meet the community members’ needs.
Health Matters: Community-centred approaches for health and wellbeing - YouTube
Being connected matters for your health
Loneliness and social isolation are damaging to our health, both mentally and physically. Being cut off from social interaction affects people of all ages, especially young people and older adults.
The Community Life Survey 2016-17 found that 5% of adults in England reported they felt lonely often or always, which has remained unchanged since 2013. Most, but not all people have someone to rely on, and over half (54%) stated they felt lonely hardly ever or never.
Health inequalities persist and many people experience the effects of social exclusion or lack of social support. The Marmot Review provided evidence that in order to reduce health inequalities in England, we must improve community capital and reduce social isolation across the social gradient.
Building social capital with community-centred approaches
This edition of Health Matters focuses on the use of community-centred approaches to enhance individual and community capabilities, create healthier places and reduce health inequalities.
Community-centred approaches are not just community-based, but about mobilising assets within communities, promoting equity, and increasing people’s control over their health and lives. Most local authorities are embracing community-centred ways of working, but the challenge that many are now seeking to achieve is the scaling-up of a whole-system community-centred and asset-based approach that is built ‘bottom-up’ from the diversity of grassroots community organisations and members.
The ‘family of community-centred approaches’ has been developed as a framework to represent some of the practical and evidence-based options that can be used to improve community health and wellbeing. It includes four strands of community-centred approaches for health and wellbeing, including:
volunteer and peer roles
collaborations and partnerships
access to community resources
Read this edition of Health Matters to learn about each of the strands of the family model, some of the successful interventions that have been implemented across England, and the specific calls to action to achieve a community-centred approach to health and wellbeing, including the need to:
develop a whole-system approach across sectors
ensure genuine co-design and co-delivery
map and mobilise local assets
commission across the four strands of the family
measure community outcomes that matter
integrate community-centred, asset-based approaches as part of place-based commissioning and strategic planning
This edition also includes a suite of infographics, case studies and slides to support local commissioning and delivery.
Visit the Health Matters area of GOV.UK to see the wide range of topics Health Matters has covered (other recent editions have looked at the NHS Health Check and CVD prevention, productive healthy ageing and musculoskeletal health, preventing infections and reducing AMR, alcohol and tobacco use, and cervical screening) or sign up to receive the latest updates through our e-bulletin.