The last slide highlighted some of the things that affect our health for good or bad. This diagram is an attempt at representing all the factors involved, starting, at t he centre wi th: you the individual and the things you can’t change T hen the behaviours you have adopted, the ways in which you live your life Then t he friends, leisure activities and social networks And so on. This is important to us at StreetGames, beca us e it is really difficult for us to get more people to our sports sessions i.e. to change their individual lifestyle factors and social networks, if they haven’t got a job, they’re failing at school, or they can’t get to a doctor when they need to. Those things are going to be much more on their mind, and affecting their behaviour, than anything we have to offer. It doesn’t mean we can’t do anything about it – we can – but we do need to be mindful of where people are coming from. You c an start to see how the factors involved in what makes us healthy, or not, inter-relate wi th eachother. This diagram is not about inequalities. It applies to everyone. But you can see that where there is a poor provision in one band, it is going to impact on another.
Maps show the correlation between areas of high deprivation (right) and areas of high child obesity levels (left)
Top line is life expectancy: 7 years gap. Bottom line is DFLE and much steeper: 17 years gap. Great majority of the population suffering from some form of ill-health by age 65; consequences for pension age increase (will it shift from pension to disability benefits?), but also for built environment, especially in terms of accessibility for the ageing population. These data is at the MLSOA (mean population 7200), so it is quite finely graded and it is geographically based, although of course there are also significant differences within each area. DFLE is based on the census question: Do you have any long-term illness, health problem or disability which limits your daily activities or the work you can do? The tendency to approach the problem from a policy point of view has been to target the 10% most deprived area, hence spearhead areas, the new deal for communities, etc. We advocate that the issue of the whole gradient should be addressed – a ‘proportionate universalism’, meaning that interventions should be universal, addressed at the whole population, but with greater intensity the further down the gradient.
Different SG projects will take different lines through this diagram. Moving from one bubble to the next opens up conversations with new partners. It also shows how issues are connected and that having impact in one area can also benefit another
Validated Physical Activity Questionnaire for Children (PAQ-C), available as an online survey. Download paper version here: www.dapa-toolkit.mrc.ac.uk/documents/en/ PAQ / PAQ _manual.pdf
Questionnaire for young adults, available from StreetGames. Uses questions developed by BIG Lottery Fund and CLES
StreetGames has interpreted the NICE Guidelines for Promoting PA to Children and Young People and written a guide to how to implement them. Available on StreetGames website – Health section
Needs Assessments Focussing exclusively on the 10% most deprived communities in England, clubs will employ JSNA, NCMP and Community Health Profile data, as well as their own primary research In the form of local consultations, to understand exactly who they will be working with, what capacity already exists locally, what people want and what the barriers are. Evidence Base Taking the recommendations from NICE and Cochrane on effective physical activity interventions and combining them with our own practitioner expertise from case studies and programme evaluations, we will create a theory about how and why our intervention will work, and test it. We will incorporate transtheoretical models of behaviour change, as well as Behavioural Insight (Nudge) theories. We will work at multiple levels (individual, community and policy) and address multiple determinants (lifestyle, employment, environment) as the evidence shows this is necessary in order to have lasting impact. Data With clear objectives to increase physical activity levels, improve wellbeing, increase local capacity and remove barriers to active lifestyles, clubs will regularly collect data to measure their progress against a stated baseline for each objective. This will be a formative assessment, enabling clubs to make changes as they go, and will therefore include both qualitative and quantitative data. We will measure physical activity levels against the CMO guidelines issued in 2011: Start Active, Stay Active. We will measure wellbeing using tools developed by CLES and NEF for the BIG Lottery Fund Wellbeing Programme Training The people who wear the shoes know best where they pinch. That is why we will train local volunteers and leaders to be the motivators and activators. Training builds local capacity, improves personal prospects (for employment) and values the skills, knowledge and potential of individuals who want to give things back to their own community. As with the Department of Health’s Health Trainer programme, clubs will be taking an assets-based approach, designing the service so that it taps into the capabilities of the community, rather than simply tries to fill gaps. The training will incorporate the RSPH Level 1 Award in Health Awareness and the Level 2 Award in Understanding Health Improvement. Above all, it is the approach and demeanour of the activity leader that determines whether or not an individual joins the club and keeps coming back. Partners As the lead agency for the Children & Young People’s Taskforce in the Department of Health’s flagship public health initiative, the Public Health Responsibility Deal, StreetGames will create new and develop existing partnerships at both national and local level, and across private, public and voluntary sectors. Partnership means we can share knowledge and resources with others who are also working to improve health in the same communities as us. We will support the emerging commissioning structures and Health & Wellbeing Boards by serving as a conduit to people living in the most disadvantaged communities, and by providing process and outcome evaluations that can be used to replicate the approach elsewhere. Our current partners in the Responsibility Deal and other programmes include MEND, YMCA Central, Coca Cola GB, the Cooperative, the Association of Colleges, Clubs for Young People, National Governing Bodies of Sport and around 80 local authorities. Sustainability The social inequalities that exist in disadvantaged communities are systemic and can be avoided. Where the symptom is poor health due to physical inactivity, we will address this at individual, community and policy level. At the individual level, the cause of the inequality is personal deficit: people are lacking awareness, self-belief or the competence to act. The solution is to provide education, information, opportunities and motivation. At the community level, the cause is social exclusion: isolation, powerlessness, lack of hope. The solution is to bring people together to work collectively on improvement, giving and receiving within their own community; social action puts people at the heart of local decisions and democracy. At the policy level, the causes are low income, poor employment rates, lack of job security and low educational attainment. The solution is to create new evidence-based policy that demonstrably reduces the gradient of inequalities. The combination of supported volunteering, mentoring, social action and partnerships offers a sustainable solution.
Health Impacts - How to plan for, deliver and demonstrate the health impacts of your project
Health ImpactsHow to plan for, deliver and demonstrate the health impacts of your project
“The potential benefits ofphysical activity are huge. Ifa medication existed whichhas a similar effect, it wouldbe regarded as a wonderdrug or miracle cure.” Professor Sir Liam Donaldson Chief Medical Officer, March 2010
Learning outcomesYou will be able to:3. Identify, plan for and demonstrate the health impacts of your project(or at least have a better idea of where to start)
Quiz – fill in the blanks• Children and young people (5-18) should do at least ___ minutes of ____intensity activity every day• Adults (19-64) should do at least ___ minutes of moderate intensity activity, or at least ___ minutes of ____intensity activity weekly• __ % of boys and __ % of girls in England do the recommended amount of activity• Those in the ____ income quartile are more likely than those in the ____ income quartile to be doing the recommended amount
Family Noise Alcohol Education Genes Smoking Drugs Physical Crime activity Neighbours Job PollutionMoney Training Stress Friends Sleep Sex Green space
Who commissions?Currently: Coming soon:PCTs and some Local authoritieslocal authorities and Health & Wellbeing Boardswith withDiscretionarybudgets Ring-fenced funding
What is commissioning?A structured way of deciding how public money should be spent strategically.It involves: Assessing need Identifying resources available Procuring services Monitoring and evaluatingIt is more than just contracting.
Doorstep Sport Clubs as HealthImprovement Agencies
Why bother?Delivering and demonstrating health impacts is:Good for your participantsGood for your credibility as a projectAnd it:Improves your chances of funding, especially from healthsourcesSets you apart from other projects
The truthsYou don’t need to be experts in public healthYou don’t need to know how the body works medicallyYou do need to understand what Directors of Public Health wantYou do need to prove you can help e.g. by getting people active long-term
National work• Responsibility Deal• National partners (CTC, MEND)• Tools• Pilots• NHS• Briefing papers
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