Transcript Scottish Public Health Network

The Review of the
Child Healthy Weight
Programme by an
Expert Group
Phil Mackie
Alison McCann
On behalf of the Expert Group
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Report of the SPHOSIG Expert Sub-Group on the
Child Healthy Weight programme in Scotland
The SPHOSIG Expert Group report and recommendations to the
Minister and the Scottish Government has now been submitted.
The period of Purdah in the run up to the Scottish Independence
Referendum commenced on 22 August 2014, so no response to the
report will be made by Scottish Government until October 2014
(at the earliest).
Therefore the content of the report and recommendations
is to be treated as confidential until this time. However,
Scottish Government has agreed that the general ‘direction of
travel’ can be shared more widely with colleagues.
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Creating Child Health Weight
• Health for all Children – Hall 4: 2005-2007
– The 2005 Child Health Surveillance
Guidance:
• Routine child weight monitoring @ P1
introduced;
• P7 monitoring recommended, but not
universally adopted;
• No interventions required.
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Creating Child Health Weight
• Delivering the HEAT Target H3: 2008-2011
– The 2008 Guidance;
• H3 Target – “Reduce the rate of increase in
the proportion of children with their Body
Mass Index out with a healthy range by
2018;
• Health Boards to create an “approved” CHW
interventional programme;
• BMI referral threshold for clinical treatment.
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Creating Child Health Weight
• Delivering the HEAT Target H3: 2011-2014
– The 2011 Guidance:
• Required Health Boards to deliver a tiered
approach (based on SIGN 115):
1 Prevention;
2 Treatment;
3 Specialist (clinical) assessment & care;
• Revised H3 Target – focussed on delivery of
Tier 2 interventions.
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Creating Child Health Weight
“Whilst the intention behind the 2011 guidance was clearly
to provide a specific focus on the Tier 2 behavioural change
interventions in a flexible manner without losing a necessary
rigour around monitoring impact
…this had the unintended consequence at the local level in
creating a focus on Tier 2 developments to the exclusion of
Tier 1 preventative approaches and Tier 3 specialist
treatment in many areas.
…intervention delivery became more focussed on data
collection and monitoring than was intended.”
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Flagrant
Plug
The Projected Prevalence of Obesity in Primary 1 Children in
Scotland for Scottish Index of Multiple Deprivation Quintiles 1 & 5
compared to Scotland as a whole: school years 2001/02 to 2019/20
The fruits of our labours – 1
• These projections must be interpreted cautiously.
• BUT, if we continue as we are we can expect:
– further reductions in obesity risk in children from more
affluent areas;
– little or no effect on reducing obesity risk in children
from more deprived areas;
– the rate of reduction in national obesity risk remaining
slow; and
– an ever-widening inequality gap in childhood obesity.
Are we surprised by this?
• Public Health interventions to manage any epidemic
should:
– treat individual cases affected with the disease or
illness;
– manage those exposed or at increased risk of
developing the disease or illness; and
– prevent epidemic spread by removing the causes
of the epidemic
The fruits of our labours – 2
• The Expert Group also found that:
– the evidence-base for what works at all three Tiers
is clear and well documented by SIGN, NICE etc
– there is a depth of experience at local, Health
Board level which can be used to develop more
holistic, population-based interventional
programmes
– there is evidence of effective clinical treatment
from those Health Boards where it was provided
What is needed?
• In the context of the current obesity epidemic in
Scotland, we need programmes which:
– provide clinical treatment of those who are currently
obese or morbidly obese;
– provide interventions which promote healthy weight
and prevent the transition from being overweight
into obesity; and
– address the underlying social, economic and
cultural causes of obesity and reduce the
contributions from the obesogenic environment
What is needed?
• To support these aims we should be:
– developing enhanced child weight surveillance and
performance monitoring;
– developing child healthy weight impact and inequality
assessment of polices; and
– building the asset-base for child healthy weight.
– assessing the health economics of preventing obesity
• Partnership working is vital to delivery of CHW
programmes and addressing the obesogenic
environment, as well as health inequalities.
The
Expert
Group
Discipline
Representative
Organisation
CHAIR
Drew Walker
NHS Tayside
Nutrition
Laura Stewart
NHS Tayside
Physical Activity/Academia
John Reilly
University of Strathclyde
Health Promotion Managers
Moyra Burns
NHS Lothian
Child Healthy Weight Leads
Tom Houston,
NHS Forth Valley
Dan Jenkins,
NHS Highland
Consultant in Public Health
Graham MacKenzie
NHS Lothian
Local authority
Cath King
Highland Council
NHS Health Scotland
Ann Kerr
NHS Health Scotland
Ass. Dir. of Education in Scotland
Gillian Brydson
Dumfries & Galloway Council
RCPCH
Charlotte Wright
University of Glasgow
Scottish Government
Kate McKay
Scottish Government
ScotPHN
Ann Conacher,
Scottish Public Health
Phil Mackie,
Network
Alison McCann,