Minutes:
The Board received a presentation from Paul Lindley OBE, Chair – London Child Obesity Taskforce and Professor Corinna Hawkes, Vice Chair – London Child Obesity Taskforce, providing the context behind the existence of the Taskforce, its work and call to action, and a summary of its next steps.
The Chair of the London Child Obesity Taskforce noted that they were aware that child obesity had been a priority for the Bromley Health and Wellbeing Board in recent years, and the changes made to residents’ lives through its actions had been life changing. They hoped to learn from this, and receive any thoughts of what could add to the work they were currently undertaking.
The London Child Obesity Taskforce had been established nearly two years ago, as part of the Mayor of London’s Health Inequalities manifesto commitment. Other stakeholders included Guy’s and St Thomas’ Charity, Public Health England, the Association of Public Health Directors – London and the Association of London Directors of Children’s Services, plus additional independent volunteers. The Taskforce had been asked to recommend actions that would change the trajectory of the lives of this generation children of living in London, which was a very broad remit.
London was in the unenviable position of being at the bottom of the world cities league for healthy weight children. On average, 12 children in each Year 6 class (nearly 40%), and 22% of children in Reception classes, were not at a healthy weight. Unfortunately, for the majority of these children, they were likely to live at an unhealthy weight throughout the rest of their lives. It was highlighted how we are shaped by our buildings; by our city; and by our environment. London was beautiful, but it could be a very hard place to live, especially if you lived in an area of deprivation. In areas of deprivation, the environment was subject to a tide of unhealthy food advertising, and was flooded with fast food restaurant. The places that London’s children lived their lives, shaped their lives. Therefore the Taskforce aimed to unleash a transformation in London so that every child had a chance of growing up: eating a healthy diet; drinking plenty of water; and being physically active.
Over the last two years, the Taskforce had worked around five core values, or truths. The first was the environmental challenge to secure a healthy weight, as London was an obesogenic environment for its children. Pictures were displayed showing what London was like today for children that grew up there – flooded with traffic; waves of people using escalators, with very few choosing to walk. There was a deluge of opportunities to buy more and more unhealthy foods, and the encouragement to get more than was wanted.
The flood gates had opened on the growth of fast food restaurants, especially in areas of deprivation, with over 9,000 now in London. This was an increase of more than 40% in less than a generation. The Mayor of London had been working to ensure that no new fast food restaurant could open within 400 metres of a school across the city, and last year, Transport for London had banned all high fat, salt and sugar advertising across its network.
It was highlighted that even inside stores, there was an environment of being overwhelmed and drowning in unhealthy products. Supermarkets would sell only about 20% of their space, but made us feel like it was much more by the way their shelves were set out, and encouraged us to buy. Food was everywhere – with the opportunity to eat, and eat unhealthily, everywhere and at all times.
Poverty was the second truth, and another factor highly correlated to child obesity. Children were almost twice as likely to have an unhealthy weight if they grew up in the most deprived boroughs of London, versus the most affluent.
The Chair of the London Child Obesity Taskforce noted they were aware that there was no “silver bullet” to the problem, and the third truth was that a whole system approach would be required. As a result of the call to action, ten ambitions and twenty specific courses of action for across London had been created.
The fourth truth was that there was lots of great stuff already happening, with fantastic programmes, initiatives and commitments that were really impactful. It was known that childhood obesity was at the centre of nearly every borough’s Health and Wellbeing Strategy. It was hoped that the London Child Obesity Taskforce could use its position to scale, connect, amplify and celebrate the good things that were already happening across London.
The fifth truth was that the London Child Obesity Taskforce had put families and children at the centre of its work, as they were the experts. All these five truths were built into their theory of change and approach. This was so the transformation could be built on six pillars (media; home; schools and nurseries; civic spaces; retail; and streets), representing where children spent their lives. These pillars were built on the foundations of opportunities for their lives to be improved, by scaling up and amplifying what exists; applying minimum standards; incentivising with fun and motivation; building capacity for better impact; and learning from place-based activity.
There were 1.5 million children across London, and just over half of them (56.2%) ate the recommended five pieces of fruit and vegetables per day. In the richest city of the fifth richest country in the world, nearly one in five children (17%) were on free school meals, which was usually their only hot meal of the day. Across London, only 12% of 15 year olds took the NHS recommended amount of physical activity each day, compared to the national average of 22%, and 20% of teenagers self-reported that they ate ‘take away’ food twice every day.
The Chair of the London Child Obesity Taskforce shared some examples of real stories of children in London:
- Two boys supported the same football team, but if one came from Brent and the other from Richmond, one was likely to live over eight years longer than the other – purely through the chance of where in the same city he was born.
- Two girls that sat next to each other in class – if one happened to have an obese parent, she was three hundred times more likely to become obese than her friend.
- Two siblings in the same household, and one happened to watch high fat, salt and sugar adverts on TV every day, whilst the other did not – the TV watching sibling was twice as likely to become obese that the other.
All of these examples were incredibly unfair, and the core principal of the London Child Obesity Taskforce was to put children at the centre of their work. They had mapped out a day in the life of a child in London in 2019, to really understand: where they go; why; with whom; and for how long. The Vice Chair of the London Child Obesity Taskforce noted that this had been extremely insightful in helping understand how the different determinants of health overlapped.
In September 2019, the London Child Obesity Taskforce had published their call to action in London – ‘Every Child a Healthy Weight – Ten Ambitions for London’: http://www.london.gov.uk/sites/default/files/every_child_a_healthy_weight.pdf
These were ten ambitions, which together, would unleash the proposed transformation:
1. End child poverty in London
2. Support women to breastfeed for longer
3. Skill up early years professionals
4. Use child measurement to better support parents
5. Ensure all nurseries and schools are enabling health for life
6. Make free ‘London water’ available everywhere
7. Create more active, playful streets and public spaces
8. Stop unhealthy marketing that influences what children eat
9. Transform fast-food businesses
10. Fund good-food innovation and harness the power of investment
They were presented through the eyes of children, starting at the beginning of their life, and worked through the different stages of childhood. Each of these ambitions then had two specific calls to action.
It was noted that some of Taskforce’s work, priorities and actions had changed in recent months due to the COVID-19 pandemic. It had been clear that like child obesity, the pandemic had affected the lives of those living in poverty more acutely than the more affluent. For children across London, lockdown had changed behaviours, especially around what they were eating and when. Just a day previously, BiteBack 2030 had published their research findings on how children’s lives had changed. More water had been consumed by children during lockdown, as the opportunity to go out and buy sugary drinks had been reduced.
There were four ‘next steps’ that the Taskforce were committed to being taken forward:
- Involving children, young people and families;
- Using our voice to tell the story;
- Learning our way to the future; and
- Mobilise others to take action.
However it was noted that, as the Taskforce had no statutory power or budget, they were not in a position to deliver them. These areas would be taken forward by working with leaders and partners across London, which was especially important at borough level. For 2020, three specific areas had been prioritised:
1. a London Vision for health and social care;
2. making free ‘London water’ available everywhere; and
3. creating more active, playful streets and public spaces.
The Vice Chair of the London Child Obesity Taskforce highlighted that partnership work across London, and between boroughs, was needed. The offers and asks of the Taskforce included for boroughs to review the call to action and see where they could act, continue to act or act further. The Taskforce were also drafting a list of actions taken by Councils (as well as other stakeholders) aligned with each of their twenty actions, which allowed the progress of implementation to be tracked. The communication plan would focus on championing actions already being taken, and boroughs were being asked to consider if there anything else that they would like the Taskforce to include. The Health and Wellbeing Board were also asked to consider if its work supported any of the Taskforce’s three priorities for 2020, especially around Water Only Schools and more playful streets in Bromley.
The LBB Director of Public Health thanked Paul Lindley OBE and Professor Corinna Hawkes for their presentation. It was noted that quite a lot of work had been undertaken relating to childhood obesity in Bromley, as it was one of the priority areas of the Health and Wellbeing Strategy. A small working group had been established, however its work was currently paused due to the COVID-19 pandemic. It was suggested that a further action plan, led by the obesity group, be developed to consider what further support could be offered.
A Board Member considered that a peer-led approach and social media engagement campaigns could be a powerful way to help shift behaviour. The Chair of the London Child Obesity Taskforce agreed that this was the most effective way, as the young listened most to other young people. The Greater London Authority (GLA) had a group of ambassadors from every borough, and the Taskforce had also been working with BiteBack 2030, which was a national organisation. It was noted that they would be happy to connect any groups already established in the borough with the GLA ambassadors, and introduce them to the BiteBack 2030 group too. The Vice Chair of the London Child Obesity Taskforce echoed that they wanted to pull together the different youth-led groups to work with them on their communications campaign. The Chairman suggested that the Taskforce may wish to engage with the Bromley Youth Council, which was extremely active.
A Board Member suggested that conversations could also take place with the Children and Young People’s Forum, who had been very active during lockdown, engaging with a number of groups within the community. The Vice Chair of the London Child Obesity Taskforce said that they would welcome links to work with these two groups.
A Board Member noted that they were aware of the successes of horticultural education, and encouraging people to eat vegetables which they would not usually do so because they had been involved in the grow process. It was considered that a small area within a park could be allocated, and sponsorship sought, as there were likely to be a number of volunteers with the skills to run something similar. People who did not have gardens, or children who wanted to do something a bit different, could be targeted, to get them into food which could help to change lives.
Another Board Member noted that there were 51 allotments in the Borough, a number of which had links with local primary schools. The children were able to see that the vegetables they ate came from the under the ground, and not from a cellophane bag. It could be a cumbersome process, with a number of teachers needed to supervise and all allotment holders required to be DBS checked, but it was extremely rewarding. The Chairman noted that this was something that could be built on, possibly in partnership with the allotment group.
The Chair of the London Child Obesity Taskforce informed Board Members that one of their volunteers was a primary school Headteacher in Greenwich. The school had created an allotment on the school site, and the gardener and chef were involved in lessons to help engrain food within the whole curriculum. The children were then able to grow, see, feel and taste their own food, which increased their interest. It was suggested that the Headteacher may be able share their experiences, or invite representatives from Bromley to see the work being undertaken.
The Borough Based Director – South East London Clinical Commissioning Group (SEL CCG) echoed the need for multiple approaches to be taken to tackle child obesity. The influence of parents and adults was highlighted, and it was considered that during the pre-natal and anti-natal period, there was an almost captive audience and therefore the possibility of a more robust intervention. There could also be the opportunity for brief intervention with adults when they attended A&E or outpatient departments. The Chair of the London Child Obesity Taskforce responded that in terms of engaging parents more, one of their ambitions was to support women to breastfeed for longer. Another way in which they sought to engage with parents was through the national child measurements programme letter. This was sent to parents when their child reached the end of Reception and Year 6, and was currently neutral and impersonal, telling them that their child was not at a healthy weight. The Taskforce aimed to add more value to this letter by offering more advice and information about what local services were available to help them address this issue.
In response to a question, the Chair of the London Child Obesity Taskforce said that the BiteBack 2030 research had highlighted that there were some good thing, and some bad things, happening in terms of food choices which amplified the social and economic divide. 60% more children were eating home cooked meals, but the 40% consuming more snacks were unlikely to be the same children.
The Chairman thanked Paul Lindley OBE and Professor Corinna Hawkes, on behalf of the Board for an excellent presentation. It was suggested that they be invited to return to the Health and Wellbeing Board to provide an update in twelve months’ time.
RESOLVED that the presentation be noted.