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North West Behavioural Science Symposium Wednesday May 22nd 2019
Halliwell Jones Stadium WarringtonWA2 7NE
09.30 – 15.45
Tweet us on @nwphpn using #BhSci2019
10:00 – 10:15:
Welcome (5 mins)
Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council
& Opening Remarks
Dave Sweeney, Executive Implementation Lead, C&M Health & Care Partnership
10:15 – 10:20
Facilitator for the day:
Mari Davis
➢Housekeeping
➢Flow of the day
Housekeeping
➢ Tweet us on @nwphpn using #BhSci2019
➢ Please inform Mari Davis if you have any issues with promotional pictures being taken
during the day
➢ Fire exits
➢ Wifi code
➢ Toilets
➢ How the room works! Table faciltators; ideas and suggestions board
Aims for the day
➢ To learn about the new Behavioural Science strategy to improve health & wellbeing
➢ To learn from existing work and interventions utilizing behavioural science approaches
➢ To consider the opportunities for a consistent and scaled approach to integrating behavioural
sciences into health and care commissioning and service delivery across the NW geography –
what might that look like?
➢ To network with colleagues leading on behavioural science and population health
Agenda for the day
10:00 Welcome and opening remarks
10:15 Pre-conference questionnaire – Behavioural Sciences in your sphere of work – Lucie Byrne Davis
10:35 Improving People’s Health: Applying Behavioural and Social Sciences to improve population health and wellbeing in England Strategy Launch – Dr Rory McGill and Michelle Constable
11:05 Refreshment Break
11:20 Case studies – Behavioural Sciences in Action – Part 1
12:00 Workshop 1
12:45 Social Marketing Campaigns in the North West12:50 Lunch & Networking - 13:15 MEC launch Cheshire & Merseyside pop up presentation
13:30 Case Studies – Behavioural Sciences in Action – Part 2
14:10 Comfort Break
14:25 Workshop 2
15:15 Commitments to action; Summary and closing15:45 Close
Agenda
10:20 – 10:35
Pre-conference questionnaire: Behavioural Sciences in your sphere of work
Mari Davis
Pre-conference questionnaire
Please complete your pre-conference questionnaire as found on your table and give to Lucie, answering
the following:
➢ Which County or Borough do you represent?
➢ What type of organisation are you from? ➢ How do you rank your level of understanding of behavioural science approaches on a scale of 1-10?
➢ On a scale of 1-10, how much importance is placed on embedding Behavioural Science into practice within
your organisation?
➢ In your opinion, is enough being done within your organisation to embed behavioural science into practice?
➢ Do you know where to access appropriate Behavioural Science Expertise?➢ Does your Department have a budget set aside for commissioning or directly providing behavioural science
expertise?
➢ Please tell us about any specific projects or areas of practice in your organisation where they have applied
behavioural science evidence or methods?
10:35 – 11.05
Improving People’s Health: Applying Behavioural and Social Sciences to improve population health and wellbeing in England Strategy
Launch
Dr Rory McGill, Public Health Specialty Registrar, Behavioural Insights and Evaluation Team, PHE
&Michelle Constable, Chair Elect, Behavioural Science and Public Health
Network
Improving People’s Health: Applying behavioural and social sciences to improve population health and wellbeing in England
Michelle Constable and Rory McGillFor the Writing Group
(on behalf of Dr Tim Chadborn)
Why a Strategy?
Why bother?
Why should I care?
Why?• Our population faces complex health and wellbeing
challenges that stem from biological, psychological, economic, environmental, and social causes
• To effectively prevent poor health, we need an approach that takes account of the whole person, social context, and wider aspects such as education, employment, social norms, and the built and online environment
• Using our expertise, we can help design and evaluate policies, services (including digital), and communications that are centred around the people that use them
• Duncan Selbie, PHE CEO “The behavioural and social sciences are the future of public health” & “We must reach and be meaningful to people in the lives that they are leading.”
Feedback from local public health (n=50)
79% - NOT enough being done to embed BS in practice
53% do NOT know where to access support
82% - no budget for BS expertise
Vision and aims
• Framework for the broad PH system to increase impact through greater and integrated use of behavioural and social sciences
• improve health and wellbeing outcomes
• reduce health inequalities
• improve value to the public purse
• To help coalesce and coordinate efforts of national organisations to support professionals at local level
Key messages
• High-level guide with suite of evidence and theory-informed resources and more to come
• Scope: systems and organisations acting on the social and structural environment that affects the population and not only interventions focused on individuals
• Strong and vibrant behavioural and social science community
• Foster further growth in transdisciplinary approaches
System map of key stakeholders
Key Content
• Why do we need this strategy?
• National and local context
• What can behavioural and social sciences contribute to public health?
• What are behavioural and social sciences? What key theories and frameworks do they offer public health practitioners?
• The first steps to implementation and a road map
Conceptualising the contributions of behavioural and social science disciplines
• Anthropology
• Economics
• Behavioural operational research
• Psychology
• Sociology
• Other useful public health tools
Whole systems approach: Eg Smoking
Environmental and social systems
Policy
Communities and neighbours
Family and Friends
Person / Individual
Biological
Legislation (smoking age, smoking bans in public places, workplaces and cars, ban on
point-of-sale tobacco product displays, prohibition of names such as ‘light’ or ‘mild’,
pictorial warnings on cigarette packets), Fiscal measures, Guidelines
Changes in cultures and social norms
Social support, exposure to tobacco smoke, number of people to smoke with
Service Provision (commissioning of evidence based stop smoking services,
MECC, digital stop smoking interventions), Training of Health Care Professionals, Incentivisation of patients, organisations and healthcare professionals
Development of improved pharmacological treatments
Environmental/ Social Planning (Smoke free places, Designated smoking areas,
Tobacco products not on display, Ban on advertising), Communications/ Marketing (Stoptober, January Health Harms, No Smoking Day, and World No Tobacco Day)
Implementation Plans
Community of Practice
Resources- Signposting
- Access to experts
- Frameworks & approaches
- Training curricula
Evidence- Evidence reviews
and position papers
Practice- Case Studies
- Templates
Strategy Document
Strengthen the workforce
Implementation of the Strategy
Public Heath England - Behavioural Insights Masterclass
Highlights of the Road MapPriority Theme Examples of Actions
Evidence and theory
Call for case studies and share on knowledge hubs
Support applications for funding such as the LGA behaviouralinsights programme
Wider system leadership Continue work to embed behavioural science into MECC
Access to expertiseContact directory of behavioural science experts and publichealth professionals
Tools and resources Develop guidance for local public health commissioners
Capacity building
• Brief guide to employing behavioural and social scientistsin public health with a template job description
• Publish BehaviourChange Framework and toolkit
• Review training and whether competencies and standardscan be implemented and assessed more effectively
Research and translation Continue to embed in various research funding streams
Communities of practice Create online forum with resources and tools
• Survey across local government to assess needs and monitor progress
Provision of tools to help with…
• Needs assessment
• Applied Behavioural Analysis
• Effective change methods
• Co-creation methods
• Efficient evaluation methods
• Transparent sharing of results
• System improvement
Communities of practice…
North West…
(bsphn.org.uk)
(uksbm.org.uk)
Behavioural science in public health
• Transdisciplinary
• Cross-sectorial
• Transparent
• Collaboratively with communities and stakeholder
The new strategy has the potential to coordinate developments and to create synergy
Thank you to everyone who worked on this....
11:05 – 11:20
Comfort Break
Tweet us on @nwphpn using #BhSci2019
11:20 – 11:40
Case Studies – Behavioural Sciences in Action (Part 1) -
CVD Prevention Digital Exemplar, Eleanor Wilkinson & Chryssa Stefanidou, PHE National CVD Prevention Team
Q&A (5 mins)
Incorporating behavioural science
into an agile digital service design in
public health
PHE Digital: NHS Health Check
Dr Chryssa Stefanidou - Principal Behavioural Insights Advisor, PHE
Eleanor Wilkinson - NHS Health Check Digital Exemplar Lead, CVD
Prevention Team
May 2019
Scale of the problem
30
NHS Health Check
31
A national risk reduction
programme that aims to improve
the health and wellbeing of adults
aged 40-74.
It is key to preventing Cardiovascular Disease,
which is the leading cause of death worldwide.
Behavioural insights and NHS
Health Check
Historically, the two teams in Public Health England have
worked closely together to explore different elements of the
NHS Health Check programme, for example looking at:
- Invitation letters
- Risk messaging
- Branding
- Telephone invitations
- Marketing campaigns
32
Digital Exemplar
➔ To Understand the NHS Health Check service from an end user, provider
and commissioner viewpoint blending service design and behavioural insights
research principles.
➔The project vision is to understand what service changes both digital and
non-digital could improve the health check service focusing but not limited to
○ Increasing uptake of the service
○ Increasing the impact of the service
➔Conceptualise and prioritise possible service improvements as
candidates for an Alpha.
33
Multidisciplinary team
34
Dr Chryssa
Stefanidou-
Behavioural
Scientist
Eleanor Wilkinson-
CVD Subject Matter
Expert
Andrea Hewins-
Product Manager
Manisha Mistry-
Delivery Manager
Dellis Roberts-
User Researcher
Prof. Jamie
Waterall- Service
Owner
Megan Roger
Senior Interaction
Designer
Callum Bates
User Researcher
Vicki Litherland
Content Designer
Iain Cooper
Senior Content
Designer
Kate Burn
Senior Service
Designer
CVD preventionBehavioural
insightsDigital
Behaviour change in a digital
service
⮚ Currently Behavioural Insights are
not embedded in the agile service
design process as a mandatory step
⮚ Public Health England are
commissioning the development and implementation of a digital service
with a Behavioural Insights Advisor
as part of the multidisciplinary team
7
8
Intro to digital
Behaviour change in discovery
9
Identify target behaviours associated with the uptake and follow up of the
NHS Health Check from an end user, provider and commissioner viewpoint
Identify evidence base for the research questions from
high-quality systematic reviews
Consult with experts to identify needs of the target population
Recruitment of participants according to socio-economic, behavioural and
cognitive characteristics in order to reflect a diverse range of participants
COM-B model of behaviour change for designing and analysing the
interviews
Comprehensive analysis for all identified user needs using COM-B and TDF
(explore barriers and need for a digital intervention)
Develop recruitment screeners using
psychological models and theories
10
Recruitment of participants according to socio-economic,
behavioural and cognitive characteristics in order to reflect a diverse
range of participants
Diary study to
monitor
people’s
lifestyle
behaviours (smoking,
exercising,
drinking etc.)
Assessing
people’s
readiness to
change their
unhealthy behaviours
Health
Confidence Scale
to monitor
people’s
confidence in their
ability to manage
their own health
Digital Inclusion
Scale to
consider the
different levels
of digital literacy for
individuals
Identify user needs through qualitative
semi-structured interviews
11
The COM-B model informed the development of discussion guides to
identify the barriers and facilitators of behaviours relevant to NHS Health
Check
Behaviour: Start Action Plan (end users)
Capability Do you think you have the skills to start the action plan?
Capability Do you understand the next steps?
Opportunity Do you have the support of your friends and family?
Opportunity Do you have the time required to do it? Is there something to follow your
progress (tools)?
Motivation Do you believe that it would be a good thing to do?
Motivation How important is it for you to be able to develop a better and clearer plan for
doing it?
Understanding user needs through
Behavioural analysis
12
Target Behaviour: Start action plan
Attend referral (end users)
COM-B Theoretical
Domains
Framework
Facilitators Barriers
Psychological
Capability
Knowledge A lack of knowledge about next
steps/action plan both in terms of what could do and how to do it
Social Opportunity Social Influences Encouragement from people around
them (partner, family, friends)
Physical
Opportunity
Environmental, Context
and Resources
Access to technology; Significant life
changes like moving home;Monetary incentive (ex. not wanting
to waste a paid gym membership)
Perception that time and location
can be a barrier - finding the correct time; Perception that lifestyle
services are not easy to access;
Time limit on lifestyle service provision; Data privacy
Reflective
Motivation
Beliefs about
consequences
Identification of risk and early
detection of disease (ex. “prediabetes”)
Potential challenges of changing
lifestyles if visible symptoms don't exist
Automatic
Motivation
Reinforcement Digital reminders/prompts; Seeing
other people's progress and achievements
NHS Health Check User Journey
13
Target
Behaviours
• End User
• Provider
• Commissioner
Facilitators
+ Highlights
Barriers +
Pain points
Moving on to the alpha phase
14
Identify intervention content which targets the influences on behaviours
Provide a preliminary list of intervention functions and Behaviour
Change Techniques
Work closely with the service design team to translate this knowledge into
engaging digital content and designs
Test prototypes with embedded behaviour change techniques
Key learnings
15
⮚ We need to collaborate in multidisciplinary approaches to develop a service that
is viable, desirable and feasible.
⮚ Behavioural science provides robust, validated frameworks that increase the
likelihood for intervention effectiveness and can enhance the governmental
digital service process.
⮚ Embedding behavioural science into the service design process can help
overcome subjective bias (e.g. small sample sizes).
⮚ Cross-government stakeholders should increasingly interact with and draw upon
behavioural insights expertise to optimise public health services.
Appendix
A Behavioural Approach
1.Define the problem in
behavioural terms
2.Select the target behaviour
3.Specify the target behaviour
4.Identify what needs to change
Stage 1: Understand
the behaviour
Behaviour
Capability
Motivation
Opportunity
A Behavioural Approach
5. Intervention functions
6. Policy categories
Stage 2: Identify
Intervention Options
A Behavioural Approach
7. Behaviour change techniques
8. Mechanisms of action
9. Modes of delivery
Stage 3: Identify content &
implementation options
11:40 – 12:00
Cheshire & Merseyside MECC approach, Dave Sweeney, Executive Implementation Lead, C&M Health & Care Partnership & Louise Vernon,
C&M MECC Implementation Lead
Q&A (5 mins)
Population Behaviour Change in Cheshire & Merseyside
Louise VernonCheshire & Merseyside MECC Programme LeadChamps Public Health Collaborative
Dave SweeneyExecutive Implementation LeadCheshire & Merseyside Health & Care Partnership
Vision in C&M for Making Every Contact Count (MECC) at scale
• MECC is a behaviour change approach that supports positive health and well being choices, signposting the public to further information and support
• We want to see MECC flourish in every place, building on great existing local and sub-regional work and creating innovative approaches
• The aim is to create a culture shift and focus on prevention
• Every front line contact can add up to a huge impact on population health and wellbeing in C&M
Our approach in Cheshire & Merseyside
1. Systems Leadership
• C&M has 2.5 million people, nine local authorities, 12 CCGs, nine trusts, one STP and two fire and police authorities
• In Aug 17 C&M DsPH Board agreed to help drive the delivery of MECC at scale using a systems leadership approach with partners
• The Champs Public Health Collaborative are working with those key partners (PHE, HEE, NHSE, LA’s, STP and voluntary sector) to create a new innovative and large scale approach
• Jan 2018 Scoping exercise report – assets and variation in practice
• NICE Behaviour Change Guidelines PH6 and principles underpin the programme - including planning, assessment, training, programme delivery and evaluation
2. Co-production of the vision/strategic framework
In April 2018 partners from across C&M met to establish a shared vision/ strategic framework. Key recommendations included:
1. Create a consistent and standardised approach to MECC, with an online portal to share resources
2. Establish a culture focused on prevention, this was seen as critical to enable staff to fully utilise MECC training
3. Produce an effective Communication and Engagement Strategy and ensure senior leadership ownership
4. Establish a Partnership Board to oversee the work on behalf of the broader MECC network.
5. Develop robust and standardised evaluation methods
3. Distributed Leadership – Partnership Board
• Established Partnership Board co-chaired by Dave Sweeney, Executive Implementation Lead, C&M Health & Care Partnership and Dr Charlotte Simpson, Healthcare Public Health Consultant , PHE NW and NHSE.
• Essential representation from groups across the sub region
• 3 active partnership working groups supporting the board in;a) Training and Education
b) Communications and engagement
c) Evaluation
• DsPH and the SCN co-fund a programme lead post
4. Workforce Development
• C&M ambition to create a focus on prevention and embed a sustainable model
• An accredited face to face training programme is one of a suite of learning opportunities available to everyone
• Development of a train the trainer model by September to strengthen the approach at scale
• Suite of resources co-created and available to increase awareness and knowledge
• Creation of a network of MECC leads and champions
5. Communications & Engagement
• www.mecc-moments.co.uk launched today for colleagues to view containing tools and support for local implementation
• Communications and engagement strategy developed from insight through 1:1 interviews with senior leaders, MECC leads and frontline staff in all public and voluntary sector organisations
• Raising awareness and build understanding of behaviour change and a shift in culture to focus on prevention, stimulating action
• Co-produced with focus and test groups across C&M MECC campaign, tools and resources to support behaviour change, including an on-line services signposting portal
• Implementation leads and a new network of colleagues will be supported to become MECC ambassadors
6. Evaluating impact
• Guide - C&M How to Evaluate for MECC guide developed
• Training evaluation process including impact on practice/confidence
• Communications framework - Pre, mid and post developed to evaluate activity using a set of key indicators
• Leadership Insight project by PHE on how to support system wide implementation of MECC
Lessons Learnt – Perceived barriers from insight work
Early indications from PHE led organisational/system insight highlights;
• Pressure/capacity
• Commissioners need to be engaged; commissioning for full impact
• Low priority in comparison to other challenges
• Benefits realisation not understood
• Simple and clear definitions needed
• Public ask and vice versa
Innovative opportunities in C&M
• Fire and Rescue safe and well checks
• PHE Insight work shared with key senior leaders (DoN’s, HRD’s)
• STP NHS Prevention Pledge to include MECC
• Pharmacy Network and Healthy Living Pharmacies
• Primary Care Network pilots development with NHSE (2019)
• PHE Dental Programme – Mouth Care Matters programme (2019-20)
• DWP potential collaboration
• Cancer Alliance collaboration on early detection
12:00 – 12:30
Workshop One - Exploring the 8 key themes in the behavioural science strategy
Mari Davis
8 key themes in the behavioural science strategy
Workshop One
Questions on your tables – please use the booklet
1. Why is this theme a priority? 2. Where and in what way are we already doing this? 3. What are we not doing?4. What further actions might we take?
Tables 1 and 9 ……….. start with priority theme 1.. then 2 etcTables 2 and 10 ………..start with priority theme 2.. then 3 etcTables 3 and 11 ………..start with priority theme 3..then 4 etcTables 4 and 12 ……….. start with priority theme 4..then 5 etcTable 5 ……….. start with priority theme 5.. then 6 etcTable 6 ……….. start with priority theme 6..then 7 etcTable 7 ……….. start with priority theme 7..then 8 etcTable 8 ……….. start with priority theme 8..then 9 etc
12.30 – 12.45
Workshop One plenary session
Mari Davis & Chairs
12.45 – 12.50
Social Marketing Campaigns in the North West
Paula Hawley Evans, Health and Well Being Programme Lead/Public Health Specialist, (PHE North West) introducing a
Showcase film on behalf of Claire Troughton, Regional Marketing Manager (PHE North West)
https://campaignresources.phe.gov.uk/resources/
12:50 – 13:30
Lunch & Networking:
13:15 – 13:30 - Optional pop-up presentation - MECC launch Cheshire & Merseyside
Tweet us on @nwphpn using #BhSci2019
13.30
Introduction to the afternoon session:
13:30 – 13:50
Case Studies – Behavioural Sciences in Action The power of combining behavioural science and social marketing, Sue Cumming, Liverpool City Council, Head of Behavioural Insight & Change
Q&A (5 mins)
Public Health Liverpool
The power of combining Behavioural Science and Social
Marketing
Sue Cumming, Head of Behavioural Insight & Change, Public Health Liverpool, Liverpool City Council
This Session…Much of the global burden of
disease arises from unhealthy
behaviours
BUT….. We still struggle to change behaviours
Our behaviour is often not
deliberate and considered
By understanding drivers of behaviour including attitudes,
motivations, barriers and psychology
we can create shortcuts in the brain to change behaviour
BUT….. Habitual and unconscious
AND ….. In line with how we perceive other people to
behave
BEHAVIOUR
MOTIVATION
AUTOMATIC REFLECTIVE
REFLECTIVE AUTOMATIC
Problem Solving
Effortful
Logical
Planning
Slow
Habit
Impulses
Emotional
Automatic
Fast
Behaviour occurs as an interaction between three necessary conditions
AUTOMATIC REFLECTIVE
Behavioural InsightsNudge Theory
Insight and Social Marketing
BI preference for Randomised Controlled Trials SM uses marketing channels at scale
BI uses routine data, literature, psychology and qualitativeresearch, then tests
SM uses market research and commissionsinterventions
AUTOMATIC
Behavioural InsightsNudge Theory
Insight and Social Marketing
AUTOMATIC REFLECTIVE
Tools for Nudge
MINDSPACEMessenger
Incentives
Norms
Defaults
Salience
Priming
Affect
Commitments
Ego
Reducing Obesity in Children
Campaign to reduce sugar consumption in 4 – 11 year olds
AUTOMATIC REFLECTIVE
38.8% of 11 year olds are obese or overweight
34.6% of 5 year olds have decayed teeth
2 children a day (on average) under age 10 have to be admitted to hospital to have teeth removed
INSIGHTS
Parents simply don’t know how much sugar their children are consuming.
Food labels are bewildering and parents find it hard to understand how much sugar is in their children’s food
Single items e.g. breakfast cereals don't appear to be high in sugar
Parents of under 18s are more likely to believe that if a sugary cereal has other nutritional benefits, its ok to have for breakfast
Parents are not aware of the Maximum Daily Amount of sugar
REFLECTIVE
Much of sugar consumption is
through ‘mindless consumption’ –
dependent on the environment
AUTOMATIC
The Liverpool sugar reduction journey
EVALUATION - Obese or overweight prevalence – year 6 children
Source: PHE, NCMP profile
EVALUATION• Over 85,000 visits to our website www.savekidsfromsugar.co.uk since launch 19/6/17
• 16,500 completion of our online sugar checker that shows the total amount of sugar a child has each day from a cereal, snack and drink.
• In November 2017 a representative population survey was conducted with parents of children aged 4 -11 to evaluate the campaign. Total number of interviews 310:
• 65% of parents recalled seeing the campaign• 67% of parents who recognised the campaign said they did make a change as a
result of the campaign • 9 in 10 parents say the campaign will have an impact on them.
0
500
1000
1500
2000
2500
Jan-19 Feb-19 Mar-19 April
Save Kids from Sugar web hits 2019
USING NUDGE, INSIGHTS AND SOCIAL MARKETING
Campaign to motivate higher risk drinkers to
drink less
AUTOMATIC REFLECTIVE
• 1 in 3 people in Liverpool are drinking above the national alcohol guidelines of 14 units per week. This is above the national average for England of 1 in 4
• For those aged 40 – 64 Liverpool has higher than national figures for the number of hospital admissions related to alcohol - 1945 people per 100k people compared to 877 for England
Liverpool data
INSIGHTSLimits often see as ‘scaremongering’. Some feel that they are set artificially low “14 really means 28”
People disengage with info on ‘Units’
Most people don’t realise how much they are drinking
People disassociate with the long term health risks of drinking
People are motivated with the short term effects such as effects on appearance
REFLECTIVE
Normalised own behaviour – perceive other people drink more than them
People strongly believe they are in control of their drinking and that they drink less than
‘heavy drinkers’ or ‘alcoholics’. This results in them lacking any sense of risk or urgency
to drink less
AUTOMATICMuch of Alcohol consumption has become habitual
and automatic
People sensitive to being identified as
someone who needs to cut back on alcohol
❑ Potential red line to be introduced on weight gain
❑ Realisation that heavy drinking reflects own behaviour
❑ Challenge habitual drinking as lacking control
People want validation that their drinking is within a healthy level, but
find units confusing and off-putting
Triggers
What’s been achieved one year later
• 25,500 drinks checker completions. 2,000 completions per month.
• 91,100 website users, 14,500 of these are returning users
• GP referral pilot – 330 Patients
Barriers and Enablers in the application of behavioural science to tackle Public Health.
Enablers• ‘Nudge’ topical
• Behavioual Insight Team
• LGA Grant Funding to run trials
• Evidence creates acceptance
Barriers• Takes more effort
• Budgets
• Expertise
THANK YOUQuestions?
13:50 – 14:10
Taking A Whole System Approach to Obesity, Julie Holt, Public Health Specialist, Oldham Council
Q&A (5 mins)
109109
Oldham’s journey towards a whole
system approach for obesity
Utilising behavioural sciences to improve health and
wellbeing event
22nd May 2019, Warrington
Julie Holt, Public Health Specialist, Oldham Council
110110
Overview
• Scale of overweight and obesity issue in Oldham –
adults and children
• Start of the journey – previous strategy
• Whole system activity – stakeholder event
• Pioneer site for PHE Whole System Approach to Obesity
(WSO) supported by Leeds Beckett University
• Next steps - planned activities in Oldham
111111
All age overweight and
obesity
112112
Excess weight in adults in Oldham 2016/17
Overweight and obesity
(Excess weight)
Adults (18+)
England average 61.3%
Oldham average 66.4%
almost 7 in 10
Oldham’s population of 18 – 64 years is 137,000
Over 91,000 are overweight or obese
113113
NCMP results for children in Oldham 2017/18
Definition Reception year Year 6
Oldha
m
England Oldham England
Healthy weight 75.2 76.6 62.3 64.3
Overweight 12.3 12.8 12.9 14.2
Obesity* 10.9 9.5 23.4 20.1
*Of which is severe
obesity
3.0 2.4 4.7 4.2
‘Excess weight’
Overweight and
obesity combined
23.2 22.3 36.3 34.3
114114
Energy imbalance
between calories in and calories out
Cause of obesity – simple view
115115
116116
How active are adults in Oldham?
Adults (16+) 2016-17
Oldham England
No. of respondents 1010 198,911
Active 55.9% 62.6%
Fairly active 12.5% 12.3%
Inactive 31.6% 25.1%
Oldham England
No. of respondents 1007 196,675
Participating at least 2
x per week
71.8% 77.2%
Adults (16+) 2017-18
117117
How active are children and young
people in Oldham?
Sport and physical activity levels
Activities taken part in over the last week
Academic Year 2017-18
Activity levels Oldham C&YP in
School years 1-11
England C&YP in
School years 1-11
Active every day
60mins and over
9.1% 17.5%
Active across the week
60 mins/day but not every day
20.9% 25.7%
Fairly active
30-59 mins /day
24.9% 23.9%
Less active
less than 30mins /day
45.3% 32.9%
118118
Causes of obesity – a complex system
119119
Previous activity in Oldham
• ‘Healthy Weight, Healthy Lives for Children in
Oldham 2010-2015’ Strategy
• Based on Foresight report
• Some activity undertaken
• Scale and capacity challenges
• Obesity rates have continued to rise
120120
Obesity prevention
‘The aim of obesity prevention is:
‘to stabilize the level of obesity in the population, to
reduce the incidence of new cases and, eventually, to
reduce the prevalence of obesity.’
121121
Comprehensive approach to prevention
• Should address both dietary habits and physical activity patterns of the
population;
• address both societal and individual level factors;
• address both immediate and distant causes;
• have multiple focal points and levels of intervention (i.e. at national,
regional, community and individual levels);
• include both policies and programmes;
• build links between sectors that may be otherwise viewed as
independent.
123123
Stakeholder Event, Chadderton Town Hall
19th November 2015
124124
Oldham Priorities
Physical Childhood excess Adult excess Diabetes inactivity weight weight
Heart disease
Poor eating / Poor oral health Strokes drinking habits
Cancers
125125
Asset based approach
• Asset v deficit approaches
• What are assets?
• What are assets for health?
• Asset based tools and techniques
126126
127127
128128
129129
Roundtable discussion 1
Opportunities for action to address overweight
/ obesity and enable healthy weight
Enabling and supporting behaviour change:
• around physical activity and play
• around eating and drinking behaviours:
Supportive environments:
• around physical activity and play
• around healthy eating and drinking
• wider aspects including built environment / green space / housing and active travel
130130
Roundtable discussion 2
131131
Barriers
Several themes were identified:
• accessibility
• communication,
• education,
• funding,
• regulation
• services.
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Priorities identified
1. A multi-agency strategy
2. Communication, education and
health promotion.
3. Information on services and
activities
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Whole System Approach to Obesity
Oldham was a ‘pioneer site’ in the Public Health
England funded programme supported by
Leeds Beckett University.
The aim of the programme was
‘to explore how a local area could use all its
levers, resources, leadership and relationships
to create a more effective, sustainable, system-
wide approach to tackling obesity’.
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WSO activity
• Attended trainings
• Used and reviewed manual
• Held 2 multi-agency workshops in November 2017
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Mapping the causal system – topics exploredTable
number Facilitator/s 1 2 3 4 5
1 Anna Tebay
Convenience foods
Lack of physical activity
Lack of awareness: healthy choices portion sizes
Lack of skills to prepare healthy
foods
Low income
2 Oliver Barnes Joint
Parenting skills/ knowledge/ understanding of healthy diets
Access and availability of
unhealthy fast food
Perceptions of what a healthy diet is
Physical activity – emergence of technology
Low income
3 Gloria Beckett Cultural values and beliefs
Social norms Reduced skills and education
East access to take away/ convenience foods
Poor mental health
4 Lianne Davies Learnt behaviours passed down for generation to generation
Availability of fast foods
Conflicting
policies - not being consistent
Technology Advertising
5 Dominic Coleman Cultural influences
Joint
Large numbers of takeaways and unhealthy food
Low incomes
Infant feeding / breast feeding / antenatal care
Physical activity – access for all
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The food environment –
hot food takeaways
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Behaviour change through the life course -
Pre-conceptual, maternity and early years
• Pregnancy advice
• Breastfeeding
• Healthy Start
• Early Years
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Food and drink choices
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School aged children
• ‘Whole school approach’
• School Governors’ training
• Foster carer’s training session
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Play and Physical activity
• Promote play
• GM Moving
• Schools - sports
development, daily mile,
‘Health champions’
• Park runs
• Walking – ‘Walking for
health’
• Cycle – Infrastructure
development
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Adults
• NHS Health Checks
• National Diabetes Prevention
Programme
• Get Oldham Growing
• Weight Loss Voucher Scheme
• Prediabetes cooking programme
• Community activities:
– Slimmin’ without women
– Man V Fat
• MECC
• Health literacy
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Opportunities for prevention
• Planning
• Licensing
• Environmental Services
• Children’s services
• Adult Social Care
• People Services- Fit for Oldham
• Thriving Communities – Place Based Initiatives / social prescribing
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The proposed 5 waves of public health
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Support and treatment - care pathways
• Training of staff to raise the issue with individuals, families and carers
• Embedding play, physical activity and healthier eating in care pathways
• Need to agree clear weight management care pathways for pregnant
women, children and families and adults with access to commissioned
services and alternatives to meet needs
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Senior leadership support
Data and intelligence
Partnership and collaboration
Dedicated time and commitment from the team implementing the approach and the w ider system netw ork
Dedicated time and resource to support development of w orkforce capacity
Accountability and governance structures
Outputs Activities and Participants
Short term outcomes (1-2 yrs.)
Medium term outcomes (2-4 yrs.)
Long term outcomes
(5yrs+ yrs.)
Inputs
Collate and use data and intelligence to develop a narrative that makes the case for change and demonstrates
how health inequalities w ill be addressed
Health in all Policies Approach being
implemented across the Council Provide leadership to persuade
stakeholders to take action
Community engagement in the approach
Collaboration w orking across departments and w ith other
organisations
Development and implementation of a localised obesity action plan that
identif ies, prioritises and aligns actions(including policies and
programmes) across stakeholders
Engage stakeholders to support a w hole systems approach to tackling
obesity
Actions in place to target health inequalities
Develop collective stakeholder ow nership of the issue through
development of systems map that depicts obesity causes in the local
area
Prioritised and aligned set of actions being delivered to tackle obesity across the
local system, that address health inequalities
Feedback loops betw een activities and
outcomes
Systems thinking practice being integrated across the
Council
Assumptions Central Government action will enable/ amplify local action on tackling obesity.
Systems change will impact on obesity related outcomes
Local delivery & implementation will vary to ensure suitability and relevance to local circumstances
Activities are cyclical – not linear- and feedback loops will be key
Systems behaviours embodied by the local
authority and local stakeholders
Collaborative w orking across departments and w ith other organisations
Improvement in intermediate markers of health and inequalities (healthier eating and
physical activity)
Transferable w orkforce skills and capacity related
to systems w orking developed
Community and other assets being used
effectively
Reduction in child and adult obesity in the
local areas
Reduction in health inequalities
Improvement in w orkforce productivity
Savings- health and social care
Systems change Health outcomes
Whole Systems Obesity Logic Model
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Strategic approach
• Oldham Council (Health and Wellbeing) Directorate Senior Management
Team – Briefings and detailed papers/ presentation
• Scrutiny Committee – Presentation/ workshop
• Elected Members development session planned
• Portfolio Lead Health and Wellbeing – meetings/ briefing papers
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Strategic activity – Next steps
• Multi-agency steering group
• Strategy and action plan
• Focus on opportunities:
– Council responsibilities and functions
– Training
– Communicating consistent messages
– Public sector workforce - Council and NHS
– Community and Voluntary Sector
– Place-based resources including greenspace
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Aim
‘A local whole systems approach responds to complexity through an
ongoing, dynamic and flexible way of working that enables local
stakeholders to come together, share an understanding of the reality of the
challenge, consider how the local system is operating and where there are
the greatest opportunities for change. Stakeholders agree actions and
decide as a network how to work together in an integrated way to bring
about sustainable, long term change’.
14:10 – 14:25
Comfort Break
Tweet us on @nwphpn using #BhSci2019
14:25 – 15:00
Workshop Two -
Mari Davis
How do we take a shared and scaled approach to integrating behavioural sciences into health, care and public health commissioning?
Service delivery across the NW geography – what might that look like?
Questions on your tables
Action 1: Identify the barriers and enablers- Barriers – what will hold us back?- Enablers – what will propel us forward?
Action 2: Identify the opportunities and how we might make this workOpportunities:-In our organizations -With partners in our local area -With partners in the NW region
➢ 15.15 – 15.35
1. Identifying our personal, organizational & regional commitments to actions in the strategy
2. . Post-conference questionnaire & evaluation form
Identifying our personal and organisationalcommitments to action
-What can we each commit as first steps to taking action
-Write on your post it and put your name on the post it
-Share with a partner for 2 mins each
Post-conference questionnaire & Evaluation form
Please complete your pre-conference questionnaire as found on your table and return to Marie, answering the following:
➢ Which County or Borough do you represent?➢ What type of organisation are you from?
➢ How do you rank your level of understanding of behavioural science approaches on a scale of 1-10?➢ On a scale of 1-10, how valuable was the symposium in enhancing your knowledge of how behavioural science can be embedded within your
organisation? In your opinion, is enough being done within your organisation to embed behavioural science into practice? ➢ On a scale of 1-10, how valuable was “Improving People’s Health: Applying Behavioural and Social Sciences to improve population health and
wellbeing in England Strategy Launch” in enhancing your knowledge of how behavioural science can be embedded within your organisation?
Does your Department have a budget set aside for commissioning or directly providing behavioural science expertise? ➢ On a scale of 1-10, how valuable was “Case Studies – Behavioural Sciences in Action (Part 1)” in enhancing your knowledge of how behavioural
science can be embedded within your organisation? ➢ On a scale of 1-10, how valuable was “Workshop One” in enhancing your knowledge of how behavioural science can be embedded within your
organisation?
➢ On a scale of 1-10, how valuable was “Social Marketing Campaigns in the North West” in enhancing your knowledge of how behavioural science can be embedded within your organisation?
➢ On a scale of 1-10, how valuable was “Case Studies – Behavioural Sciences in Action” in enhancing your knowledge of how behavioural science can be embedded within your organisation?
➢ On a scale of 1-10, how valuable was “Workshop Two” in enhancing your knowledge of how behavioural science can be embedded within your
organisation?
15:35 – 15:45
Chairs Summaries and closing remarks
Safe journey home
