When Lincolnshire County Council began to map the complex factors that lead to childhood obesity; from food availability and marketing, transport choices and social norms to activity levels and deprivation, the intricate diagram of causal loops was a powerful visual illustration that a Whole Systems Approach was necessary.
The mapping exercise demonstrates the environmental, social and economic complexities in the large rural county that influence and constrain lifestyle choices.
Children in Lincolnshire have similar levels of obesity to the England average, but rates across districts within the County reveal a marked variation. In Boston and East Lindsey, with its seaside towns of Skegness and Mablethorpe, rates are significantly higher than the national average.
The mapping of pockets across the county reveals that children from the most deprived backgrounds were twice as likely to be obese by the time they leave primary school.
With the help of Leeds Beckett University and North Kesteven District Council, a Whole Systems Approach (WSA) pilot area, the county council, NHS and local district councils, held a series of meetings to identify the causal factors and overarching themes that emerged from the mapping exercise, including food and nutrition, from marketing to availability, activity levels and transport availability and choices.
The next stage is to create specific working groups for each of the key themes that emerge to put in place action points for the whole system, including the private and voluntary sectors.
Andy Fox, Acting Consultant in Public Health, said: “The idea behind a WSA is that if every single area and every player can make positive changes of 2 or 3 per cent, rolled out across the entire system, we would see a significant improvement in child obesity.”
Working with schools is a key theme. As Councillor Sue Woolley, Chair of Lincolnshire Health & Wellbeing Board, puts it, “prevention means working with those who look after our children”. For rural areas in particular, schools are a focal point and key resource in the community.
Lincolnshire has developed a portfolio of interventions for schools including information and practical tools to help staff with all aspects of food education, to guidance and support for early years settings.
One school in particular is leading the way. A groundbreaking taste education programme, developed by Jason O’Rourke, head teacher of Washingborough Academy, in Lincoln, has earned him the Food Hero of the Year 2019 accolade, awarded by the Caroline Walker Trust.
TastEd teaches elements of the primary curriculum, such as literacy and creativity, through food and nutrition, a particularly pertinent approach in a county like Lincolnshire which has a big food production economy.
The initiative reconnects children with healthy food through everyday lessons and by planting, growing, cooking and eating food on school premises.
“We have children who have never held a vegetable and never eaten some types of fruit and vegetables,” said Fox. “It is about teaching the syllabus using food and cooking as much as possible.”
From reception class, children are encouraged to sample fruit and vegetables and talk and write about what they experience; the taste, texture, sounds and smells of the food they are handling. The results demonstrate how food can inspire the imagination and bring home to children the joy and fun of healthy eating. It prompted one nine-year-old to liken a pea pod to “a bobsleigh team”. Another child wrote that eating cucumber sounded like “stepping in the snow.”
As part of the WSA, the county council wants to harnessing local initiatives to encourage and inspire others. Three schools are now trialling the TastEd foundation stage and Year 1 lesson plans.
“What we want to do is to support and disseminate this learning and its overall message, which we can do via our route to schools, “said Andy Fox.
Lincolnshire’s WSA is in its early stages but support for the approach is clear. Initial discussions about the approach included a workshop attended by more than 100 people from across all sectors. These have led to an agreement on the Local Authority Declaration on Healthy Weight and the mobilisation of co-ordinated, partnership bids for central government funding.
A key message to come out of Lincolnshire’s work is that one solution on its own is not going to fix the problem of child obesity.
The WSA leads away from the “super intervention” mode of thinking to a plan that brings about incremental gains in myriad areas that add up to a sea change.
Another pointer is to support community trailblazers to run with their initiatives and avoid the temptation to control their progress or overburden them with bureaucracy.
How is the approach being sustained?
Working groups will put in place to take action points forward, overseen by public health and with support across the council.
Andy Fox, Acting Consultant in Public Health for Lincolnshire County Council