Agenda item

This paper provides the Board with an update on the implementation and delivery of Goal 5 in the Joint Local Health and Wellbeing Strategy 2022-2032. It also includes information on performance monitoring. The Board are asked to note the report.

The report was presented by the Director of Public Health. He advised that this item addressed goal 5 of the Health and Wellbeing Strategy, which was to reverse the rise in children and adults living with an unhealthy weight. He noted that this had been a sustained and long-term rise, meaning that 1 in 4 reception age children, 1 in 3 year 6 children and 2 in 3 adults were currently living with an unhealthy weight.

He stated that a number of actions had been established by the Public Health team in order to achieve this goal:

13.     Support adult residents to achieve improved health behaviours in relation to eating, moving and mental wellbeing, as part of a wider shift to a compassionate approach to weight.

14.     Continue to deliver the National Child Measurement Programme and offer targeted support to families with children and young people in bigger bodies.

15.     Deliver the Breastfeeding and Infant Feeding Strategy across the city, to support parents to make informed feeding choices and practise age-appropriate introduction of solids; and ensure that families are supported to achieve their feeding goals by professionals with evidence-based training.

16.     Deliver the Health, Exercise, and Nutrition in the Really Young (HENRY) approach in our 0–5-year population.

17.     Support the implementation of HENRY awareness for professionals.

Board members expressed praise that HENRY was going well – having worked hard to establish this alongside the previous Director of Public Health.

Members noted that the published statistics did not split results on gender lines but asked if there was a difference between boys and girls in this area.

The Director of Public Health advised that it was possible to make this distinction within the statistics and in fact this information was published elsewhere; the intention of this report had been not to overwhelm with too much detail, but he would be happy to include a gendered breakdown in future.

He stated that it was clear that gender differences, and the way in which bodies change at different stages of development, was something that affected genders differently here. He didn’t want to suggest this was more of an issue for one gender or another because it was not, and as much as one might focus on a discussion of underweight teenage girls, one might also discuss the under-reporting of boys’ eating difficulties. While gender differences in this area were a complex issue, they were observable in the data, reflected on and targeted by the Public Health team.

Members asked about what happens regarding HENRY when children reached Year 6.

The Director of Public Health responded that by extending HENRY up to Year 6 this took them to 10-11 years, and health trainers can work and support individuals aged 13 and above. There would be a small gap between these points and the Public Health team were looking for possible ways in which this might be filled. He noted that it was now a much smaller gap than in the past and they were gradually moving toward a point where support should be available throughout.

He noted that primary school goes up to Year 6, and they did not wish to overly weight manage at this stage as the most effective interventions at a population level were to provide really good universal information, as well as the food provided in schools, the extent to which people can afford that food, the availability of free school meals and the nutritional value of school meals.

Members asked what the demand was for HENRY courses?

The Director of Public Health said that there had been smaller than expected numbers signing up, but he acknowledged that doing so was a big commitment for families. They had responded to this by involving Child Development workers to assist with childcare where other children need support while one child attends a HENRY session with their parents. He acknowledged that they could only offer to people who had been referred and that there were limited places on the courses (6-8 families at a time). There was still low capacity on the course and referrals did need to increase, but they were steadily increasing. He anticipated the numbers going up into 2026.

Members commented about recent feedback from secondary school children, who suggested that fast food was the most affordable option for eating out in town and reiterated the importance of the Commercial Determinants of Health work discussed at the previous meeting.

The Director of Public Health highlighted the York Hungry Minds scheme and the work it had done providing children with nutritious free school meals, both breakfasts and lunches, which had been a great success. He noted that it was giving children an opportunity to see different healthier food choices because the meal provided was much healthier than the equivalent packed lunch. He stated that there had been a tangible positive outcome from this scheme, and he hoped it would be progressed further.

Members discussed the issue of Breast Feeding, commending York’s application for status as a “Feeding Friendly” city but alongside this, asking whether the tongue tie clinic at York Hospital would be available.

The Director of Public Health responded that having spoken to the Chief Executive and the Director of Midwifery, the gap in the pathway had been closed and this issue regarding the tongue tie clinic would now be resolved.

On the subject of becoming a Feeding Friendly City, he confirmed that his team were developing the UNICEF Baby Friendly Initiative submission stage by stage; the specialist lactation clinic was now up and running and staff were sorting out schemes like the aforementioned tongue tie pathway. Progress had been made both within the council and with local businesses. He assured the board that he would update them on their progress in a couple of years, by which time he hoped to have some real success stories in terms of the number of businesses who have signed up.

Members asked whether there was any way of understanding whether or not particular groups were engaging with the approach outlined in the strategy, or more particularly whether there were groups that this approach struggled to reach?

The Director of Public Health stated that in terms of the population, there were axes of inequality and it was not as simple as saying there were “deprived areas and less deprived areas”, although that was a very important factor.

He advised that the issue of gender, as previously raised, was a significant axis, as were ethnicity and an individual’s weight; genetically for example, when combined with high weight there was high predisposition to diabetes in South Asian communities.

He noted that another axis was neurodiversity and the way in which data suggested that food types and texture often provided barriers. Regarding schools and the food environment, he said the canteen was often the noisiest place in a school, in terms of sensory stimulation, and therefore flexibility would be needed to the school meal strategy in such cases.

He did not feel that this was a job for Public Health alone and invited partners and the wider community to all get involved in ensuring more people were living to a healthy weight, since the alternative was early death and disability.

Members praised the change of approach to communication to a less confrontational/accusatory tone where parents in the past had felt persecuted for having “fat children”.

The Director of Public Health advised that he had a statutory duty to send that letter and he agreed that the obligation needed to be undertaken in the most sensitive and caring way possible. 

Members asked if therewas an understanding of the impact of the COVID pandemic, such restrictions on being out of your house or the drop off in participation in after school activities such as sport and dance, and ultimately was there a plan for active engagement?

The Director of Public Health said there was a separate upcoming goal on the Health and Wellbeing Strategy which would more directly address the issue of physical activity. He explained that the reason these had been divided into separate goals was that while physical exercise was incredibly good for mental health, bone health, cardiovascular health; it was not particularly good at helping to lose weight, although evidence showed it had a modest effect. He advised that for weight loss, diet and more specifically calories were the place to start, because that that is the driver of weight.

He explained that the recent active travel fund from the Combined Authority amounted to £4 million. This would undoubtedly result in more cycle paths and infrastructure. He suggested that he would respond more fully, and make sure items raised were well reported when addressing goal 9 of the strategy at a future meeting.

Members asked about the language used and the idea of a “compassionate approach”. They asked if this had been attempted elsewhere and if so how much of an impact had it made.

The Director of Public Health explained that this approach was based upon a well known intervention in Doncaster called the “Compassionate Approach to Healthy Weight” where the authority took a decision to decommission their weight management services and go for this supportive early prevention instead. This had achieved a good result and had been deemed a success.

He explained that Mounjaro and other weight loss drugs were coming onto the market, and these gave support to this approach because increasingly people would be able to manage their weight down at a particular BMI category and would have the option of those drugs He emphasised that the more that could be done at this level to help people earlier on, and to help them with things that lead to long-term maintenance around eating and exercise and being active, the better.

Resolved:   That the board would note and comment on the updates provided within this report and its associated annexes.

Reason:     To ensure that the Health and Wellbeing Board fulfils its statutory duty to deliver on their Joint Local Health and Wellbeing Strategy 2022-2032.