Tackling Childhood ObesityWhat public health skills do nurses workingwith children and families need to addressthe obesity...
Expectations for today’s session What would you anticipate to be the key PublicHealth skills for nurses in the UK? To wh...
1. Introducing the public health problem.2. Presenting a study that has been recently carried outlooking at the issues sur...
An important public health issue: childhood obesity• Children in Europe showing some of the steepest increases inprevalenc...
• Recent literature = complex picture of multiple variables effectingobesity levels including not only individual factors ...
Study area – Halton & St Helens
Study area – Halton & St HelensData or information?• The health of people is generally worse than the England average. Dep...
Background – Data or information?During 2009/10, as part of the National ChildMeasurement Programme (NCMP), the heights an...
Background – the National picture• According to figures from the National Child Measurement Programme (NCMP) in 2009-10 ar...
The overall aim of this research was to determine the mosteffective methods for developing and delivering weightmanagement...
• Understand the perceptions of parents of children aged between 3 and 5 to diet and exercise andattitudes to family life;...
Methods• Focus groups– Children aged 10-11– Parents of children aged 10-11– Parents of children aged 3-5• 1-to-1 interview...
Confusion and ScepticismParents reported a feeling of confusion and scepticism about information on what to eatand what to...
Mistrust of health informationCertainly for some parents there was high level ofmistrust about ideal weight guidance for c...
Dealing with health informationConstructing their own solutionsThe response to the perceived excessive amount and conflict...
Accessing food at HomeParents clearly knew what was„bad‟ food, or „unhealthy‟ food andhad various strategies in relation t...
Rewarding healthy eatingFast food was recognised by parentsas „unhealthy‟ yet they also usedthese foods as a was of “treat...
However there was also evidence thatschools were rewarding healthy eatingpractices but in a more positive wayand parents w...
Interventions in Practice: reality of 5-a-dayThis was by far the most known of thehealth messages throughout, and therewas...
Conclusions• In Halton & St Helens we found varying individual contexts aroundfamily, culture, parenting and eating behavi...
Identifying key skills in public health training• The childhood obesity study clearly demonstrates the broadrange of skill...
 Do you agree or disagree with the following statements?– Public health is not just about epidemiology or sociology or qu...
Research skills: Epidemiology skills – understanding data in order tounderstand “what is the problem?” Qualitative resea...
 But not only research skills: Sociology:Understanding different individual, social and cultural contexts in which other...
Management of Health SystemsHow will the local health services implement, monitor and evaluate theeffectiveness of any int...
How do we relate this to training? Need to implement WHO principles of equity, health promotion,community participation, ...
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Tackling childhood obesity

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University of Liverpool Faculty Research: Tackling Childhood Obesity and the Public Health Skills Required for Effective Interventions.

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  • Children in Europe showing some of the steepest increases in prevalence of overweight children across Europe (International Obesity Task Force WHO 2005). Rising levels towards obesity need to be reversed if chronic diseases are to be reduced in later life. Childhood obesity in itself can lead to a number of serious conditions such as poor glucose tolerance, hypertension, sleep apnoea, depression and a raised risk of type 2 diabetes (Lobstein, Baur, & Uauy 2004). Despite attempts to tackle the causes of obesity, levels are continuing to rise and Public health practitioners are therefore faced with the challenge of reversing rising obesity levels by tackling the underlying causes of obesity.
  • Recent literature reviewing obesity research describe a complex picture of multiple variables effecting obesity levels including not only individual factors but social and environmental factors, all interacting to create a complex picture of influences contributing to the dramatic rise. When considering the need to develop strategies they need to be relevant to children and the diversity of influences on their lives as they develop through childhood and become adults and parents themselves, will be critical to take into account. The local context plays a significant part in how people, and in this case children, behave towards food. Public Health strategies therefore need to be informed by local cultures and behaviours in order to initiate appropriate and relevant programmes that prevent obesity (Mackereth & Milner 2007).
  • According to figures from the National Child Measurement Programme (NCMP) in 2009-10 around 9.8% of four- and five-year-olds were classed as obese (11.7% for Halton & St Helens) when they arrived in reception class. But among 10- and 11-year-olds in year six, that had almost doubled to 18.7% (21.8%).Nationally almost one in four reception pupils was either overweight or obese – 23.1% (28.9%) while among year six children the figure was 33.4% (37.4%) more than a third. These figures although only slightly, were up on previous years, but underline the continuing rise in the number of young children with weight problems.While it is difficult to calculate the direct costs, it is estimated that Halton and St Helen’s PCT spends £20.7million – £23.4 million every year treating obesity and its related conditions (Shaping Up: A healthy weight strategy for Halton and St Helens 2007).
  • Research skills:Epidemiology skills: use of verbal autopsies; developing and designing the questionnaires for the health care providers; analysis of the data; and the interpretation of the implications of the findingsQualitative research skills: used to triangulation with the quantitative survey involved designing and conducting interviews with children who were ill; the parents of children who died. Designing and conducting FGDs with mothers, grandmothers, who completed the verbal autopsies. Analysis of the data to examine in more detail the negative view of the hospital/health care providers.
  • It is therefore not enough to just to be a sociologist or qualitative researcher or epidemiologist– it is the combination of these skills that makes a good public health practitionerTraining therefore needs to provide the mix of skills to examine this complexity we are faced with when examining public health problems
  • Research skills:Epidemiology skills: use of verbal autopsies; developing and designing the questionnaires for the health care providers; analysis of the data; and the interpretation of the implications of the findingsQualitative research skills: used to triangulation with the quantitative survey involved designing and conducting interviews with children who were ill; the parents of children who died. Designing and conducting FGDs with mothers, grandmothers, who completed the verbal autopsies. Analysis of the data to examine in more detail the negative view of the hospital/health care providers.
  • SociologyUnderstanding different social and cultural contexts in which other people live their lives. For example, examining how different cultures operate will enable greater understanding of the different familial roles involved in decision making when seeking access to health care.We can also understand the formal and informal, processes associated with a traditional health care systemHealth Promotion:Recognising importance of different models of health promotion to ensure that any implementation of findings from research is relevant and sustainable for that particular communityFor example, using local HCW who speak the language of the community, work in the community and are seen as participants of the community can be more effective than bringing in health care professionalsTraining HCWs to recognise danger signs so they can provide relevant health information in a way that can be accessed by the community may help to rebuild trust in health care organisations.
  • Understanding management of health systems can help understand how to use staff more effectively and efficiently. how different barriers can change through resource provision – money versus cultural issues For example, understanding supply and demand barriers of health careSupply – barriers cost to supply, input prices (staff buildings) process of providing health care knowledge of treatmentDemand - health knowledge, education, cost of medicines, loss of wages visiting centre, quality of supply side – less likely to access – culture decision making within health service provision Knowing about management of health systems can help understand how to use staff more effectively and efficiently. If increase the number of HCW to recognise danger signs they will need an lot of training and constant updating of skills so need good management system in place. Health Economics Understanding the provision of services within existing resources as well as improving accessNo good increasing access to services if no treatments available at the health centre. Commissioning and rationalisation of resources. Health & social policyUnderstanding what policies already work and how best to implement healthcare policies across different organisations – community and statutory such as the regional health office
  • Still wanted to offer same quality of programme and learning experience so needed to retain positive aspects of the campus programme :participationcollaborative learningproblem solvingDesigning the curriculum for an online programme presented new challenges:Different set of students to campus studentsLocated all over the world including many based in LIC with eclectic backgrounds/experiencesStudents working alongside studying who are keen to apply learning in work based setting during the programme. Needed to think through the skills and knowledge that public health professionals across the world already have so we can accommodate these experiences, allow others to learn from them and also develop them through their online learning
  • Tackling childhood obesity

    1. 1. Tackling Childhood ObesityWhat public health skills do nurses workingwith children and families need to addressthe obesity epidemic in the UK?Dr Francine Watkins, Senior Lecturer, Director of MPHProgrammes, University of Liverpool.Sue Jones, Honorary Lecturer, Academic Director - Health& Psychology Programmes, Laureate Online Education
    2. 2. Expectations for today’s session What would you anticipate to be the key PublicHealth skills for nurses in the UK? To what degree are these developed within thestandard undergraduate nurse training currently? What do you imagine are the main areas of studywithin an MPH?
    3. 3. 1. Introducing the public health problem.2. Presenting a study that has been recently carried outlooking at the issues surrounding childhood obesity inan area in the UK of high deprivation.3. How can a MPH ensure Public Health professionalshave the mix of skills necessary to examine complexpublic health problems?4. Development of our Master of Public Health (MPH)programmes.Plan for presentation
    4. 4. An important public health issue: childhood obesity• Children in Europe showing some of the steepest increases inprevalence of overweight children across Europe (InternationalObesity Task Force WHO 2005).• Childhood obesity in itself can lead to a number of seriousconditions such as poor glucose tolerance, hypertension, sleepapnoea, depression and a raised risk of type 2 diabetes (Lobstein,Baur, & Uauy 2004).• Obesity levels are continuing to rise and Public health practitionersare therefore faced with the challenge of reversing rising obesitylevels by tackling the underlying causes of obesity.
    5. 5. • Recent literature = complex picture of multiple variables effectingobesity levels including not only individual factors but social andenvironmental factors• When considering the need to develop strategies they need to berelevant to children and the diversity of influences on their lives asthey develop through childhood and become adults and parentsthemselves, will be critical to take into account.• The local context plays a significant part in how people, and in thiscase children, behave towards food. Public Health strategiestherefore need to be informed by local cultures and behaviours inorder to initiate appropriate and relevant programmes that preventobesity (Mackereth & Milner 2007).An important public health issue: childhood obesity
    6. 6. Study area – Halton & St Helens
    7. 7. Study area – Halton & St HelensData or information?• The health of people is generally worse than the England average. Deprivation is higher than average andover 16,500 children live in poverty.• Life expectancy for both men and women is lower than the England average. Life expectancy is 10.6/11.4years lower for men and 11.5/7.7 years lower for women in the most deprived areas than in the leastdeprived areas (based on the Slope Index of Inequality published on 5th January 2011).• Over the last 10 years, all cause mortality rates have fallen. Early death rates from cancer and from heartdisease and stroke have fallen but remain worse than the England average.• Levels of teenage pregnancy, GCSE attainment and tooth decay in children are worse than the Englandaverage.• In Halton estimated levels of adult healthy eating and smoking are worse than the England average. Ratesof smoking related deaths and hospital stays for alcohol related harm are higher than average.• The epidemiological data also suggests that Halton and St Helen‟s PCT has one of the highest rates ofchildhood obesity in the North West (Shaping Up: A healthy weight strategy for Halton and St Helens2007).
    8. 8. Background – Data or information?During 2009/10, as part of the National ChildMeasurement Programme (NCMP), the heights andweights of Halton & St Helens school children inReception year and Year 6 were measured andcollated.• 3164 - 93.5% of eligible Receptionchildren and 3194 - 92.3% of eligible Year6 pupils were measured. 6358 in total.• A total of 2,111 pupils were classed asbeing Overweight or Obese accounting fora 1/3 of those measured.• Data also shows there is a significantincrease in obesity between Reception andYear 6.Table: Levels of overweight and obese children byPCT for Reception & Year 6Reception %Halton and St HelensPCT Overweight andObese28.9%Halton and St HelensPCT Obese11.7%Year 6 %Halton and St HelensPCT Overweight andObese37.4%Halton and St HelensPCT Obese21.8%
    9. 9. Background – the National picture• According to figures from the National Child Measurement Programme (NCMP) in 2009-10 around9.8% of four- and five-year-olds were classed as obese (11.7% for Halton & St Helens) when theyarrived in reception class. But among 10- and 11-year-olds in year six, that had almost doubled to18.7% (21.8%).• Nationally almost one in four reception pupils was either overweight or obese – 23.1% (28.9%)while among year six children the figure was 33.4% (37.4%) more than a third.• These figures although only slightly, were up on previous years, but underline the continuing rise inthe number of young children with weight problems.• While it is difficult to calculate the direct costs, it is estimated that Halton and St Helen‟s PCTspends £20.7million – £23.4 million every year treating obesity and its related conditions (ShapingUp: A healthy weight strategy for Halton and St Helens 2007).
    10. 10. The overall aim of this research was to determine the mosteffective methods for developing and delivering weightmanagement programmes to children aged 4-5 (Reception)and 10-11 (Year 6) in Halton and St Helens that initiateeffective long-term weight management strategies.So what would be the first steps?How would you approach this?Taking the next stepsAim of the research
    11. 11. • Understand the perceptions of parents of children aged between 3 and 5 to diet and exercise andattitudes to family life;• Engage parents of children aged between 3 and 5 not currently participating in children‟s andhealth services to understand reasons for non participation and any existing barriers;• Gain deeper understanding of what motivates children aged 10-11 in terms of health, diet andexercise; what barriers prevent them from active engagement in managing their diet and physicalactivity;• Talk to parents of 10-11 year olds to assess how the strategies and behavioural changes suggestedby their children could be effectively implemented by parents and service providers;• Produce a report that recommends the most effective ways of engaging parents and children fromthe identified population groups in health initiatives and weight management strategies.Study Objectives
    12. 12. Methods• Focus groups– Children aged 10-11– Parents of children aged 10-11– Parents of children aged 3-5• 1-to-1 interviews with parents not engaged in services i.e. Hard to reach group• Transcripts analysed using thematic analysis• Findings here focus on parents views of health information and how they interpret this.From this we can see the potential impact this has on what they are passing onto theirchildren.
    13. 13. Confusion and ScepticismParents reported a feeling of confusion and scepticism about information on what to eatand what to avoid. They described how health messages changed over time and had advicethat they felt was unrealistic and that created pressure so they ended up ignoring them.“The thing is you‟re told that many things. „You shouldn‟t eat this, you shouldn‟t ... don‟t eatcarbs, don‟t eat sugar, don‟t eat meat‟. I just think basically you can eat anything so justdo, but just in balance.”
    14. 14. Mistrust of health informationCertainly for some parents there was high level ofmistrust about ideal weight guidance for children.“Where do the guidelines come from, as far as I am concerned, youare telling a kid they should have a waist this size, and no I think it‟srubbish.”
    15. 15. Dealing with health informationConstructing their own solutionsThe response to the perceived excessive amount and conflicting nature of informationabout healthy foods was to talk about having a balanced diet, to not eat too much ofanything but rather a little of everything.• Further exploration of whether this reported „balance‟ and „moderation‟ were actuallyattained or whether it was a tactic to avoid dealing with issue of achieving a healthy dietwas difficult to uncover.• Similarly the definition of what is moderation was difficult to ascertain.• There appeared to be a constant negotiation amongst some parents about what to eat andhow much to eat and this was tied into wanting to keep their children happy.
    16. 16. Accessing food at HomeParents clearly knew what was„bad‟ food, or „unhealthy‟ food andhad various strategies in relation tohow children accessed‘unhealthy’ food at home.Some parents reported activelyrestricting their children‟s access tosweets for example. Others reportedhiding unhealthy foods (cakes andbiscuits), keeping them out of reachwhilst other parents gave freeaccess to all food.• “I am like that, if they don‟t eat theirdinner, their tea or their supper or youknow their breakfast, I won‟t give themsweets. I won‟t give them none of that andhe knows if he doesn‟t eat it, he is notgoing to get it so he will eat it just for thesake of getting it.‟
    17. 17. Rewarding healthy eatingFast food was recognised by parentsas „unhealthy‟ yet they also usedthese foods as a was of “treating”children and was even used as a wayof rewarding healthy eating.“We don‟t do McDonalds, notvery often because I‟m not alover of it. We go to PizzaHut, but every so often these aretreats, like a pay day treat. Whenyou get some money and you say„yes we‟ll go to Pizza Hut, we‟lldo whatever.”
    18. 18. However there was also evidence thatschools were rewarding healthy eatingpractices but in a more positive wayand parents were picking up on this as analternative.• „In our M‟s school they‟re brilliant theway they‟ve done that because they have apoint system for all foods. Every singlefood has got a point and the healthier thefood the higher the point, and then at theend because every kid is individualisedand you press your finger print for yourfood...• That’s a good idea• Well exactly, and at the end of the monthor six months or whatever the child withthe highest points gets a prize or anaward, which is good but it isn‟t becausethen our (child‟s name) coming homegoing „is pasta high? Do you think thatwill be good? And I‟m like „no (child‟sname), enjoy your food‟if you get a bowlof healthy food then sound but enjoy it.‟Rewarding healthy eating
    19. 19. Interventions in Practice: reality of 5-a-dayThis was by far the most known of thehealth messages throughout, and therewas a mixture of responses. Someparents felt it was unrealistic.• “Yes but only occasionally, it‟s notlike when you think about five a dayits massive isn‟t it.”
    20. 20. Conclusions• In Halton & St Helens we found varying individual contexts aroundfamily, culture, parenting and eating behaviour.• So designing any weight management intervention strategies we need toavoid a „one size fits all‟ intervention• Parents responded and acted on information about diet in different ways:– Some found health information confusing– Some were suspicious of health information– There was a strong view that children should be able to eat what theylike– Parents struggled to implement existing interventions such as 5 a day– Listening to the children (latest analysis)
    21. 21. Identifying key skills in public health training• The childhood obesity study clearly demonstrates the broadrange of skills needed to practice public health and theinherent complexity of undertaking a public health study• In pairs…..• Reflecting on the research just described, what skills andapproaches would you identify as key to taking a PublicHealth approach?
    22. 22.  Do you agree or disagree with the following statements?– Public health is not just about epidemiology or sociology or qualitativeresearch– It is the combination of skills and knowledge that makes a good publichealth practitioner– Training therefore needs to provide an integration of skills andapproaches to complex public health challenges.Identifying key skills in public health training
    23. 23. Research skills: Epidemiology skills – understanding data in order tounderstand “what is the problem?” Qualitative research skills – focus groups and in depthinterviews and analysis/interpretation of the data.Identifying key skills in public health training
    24. 24.  But not only research skills: Sociology:Understanding different individual, social and cultural contexts in which otherpeople live their lives. Health Promotion:Designing interventions -„Bottom up approaches„Interventions that are based on listening to the variety of experiences parentshave as they try to interpret information and make sense of it in their own livesIdentifying key skills in public health training
    25. 25. Management of Health SystemsHow will the local health services implement, monitor and evaluate theeffectiveness of any interventions/strategies?Health EconomicsUnderstanding the relationship between inputs and impact; What is the mostefficient and effective provision of services within an existing resource „envelope‟Health & Social PolicyUnderstanding the local politics and which policies work best in that communityIdentifying key skills in public health training
    26. 26. How do we relate this to training? Need to implement WHO principles of equity, health promotion,community participation, multidisciplinary involvement, collaboration,primary health care, and international co-operation Design training to encourage student-centred learning in a multi-disciplinary environment whether face to face or online. participation collaborative learning problem solving Think through the skills and knowledge that public health professionalsacross the world already have.
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