Sarah Hickey, Programme Director, Guy's and St Thomas' Charity
Jul 19, 2017
At the beginning of the year we announced a new area of programmatic focus. Over the next five-ten years, we plan to direct at least £10 million of our funding and activity towards tackling childhood obesity in the London boroughs of Lambeth and Southwark. Our aim is to make a step-change impact locally, working with anyone who can help us achieve this goal.
Over the last few months we’ve been talking to those working in the field and looking at the available evidence base. This was to help us fully understand the issue, why rates seem particularly high in our areas and where we can best play a role to help address this issue.
So, what have we learnt so far?
We’re not the first (or the 1000th) to work on this. In 2016, the World Health Organisation published a review of international evidence, drawing on information from over 100 countries about what’s been tried and tested in population-level approaches. We’ve learned from those involved in UK-wide efforts to support healthy food environments, such as the Government’s Childhood Obesity Action Plan, the Jamie Oliver Food Foundation, School Food Matters and Sustainable Food Cities. Locally, we’ve also learned from those leading the Lambeth and Southwark Councils’ childhood obesity strategies as well as London-wide initiatives such as the Healthy Schools Programme, and cross-sector networks including the Lambeth Food Partnership. To get a perspective from healthcare teams working with children and families I’ve also spent some time with colleagues from Guy’s and St Thomas’ NHS Foundation Trust including Evelina London’s Community Children's Nutrition and Dietetics Service. We’re keen to build on successes and lessons rather than start from scratch.
We’d like to focus our efforts on enabling healthy eating behaviour, as the strongest direct driver of obesity, as well as supporting an increase in physical activity. We know that the influence of these are complex. We were struck by a review of this area by The Behavioural Insights Team, who will be one of our programme partners. They found that eating behaviour is broadly habitual and influenced by the interaction of our own eating psychology and the food-related cues and incentives that surround us.
We think this means that we need to focus on healthy food and activity environments, rather than food education or weight management programmes alone.
We know that great ideas can come from anywhere, and combining them can be extra meaningful, as we move through a number of places throughout our day, including home, school and streets.
Across the UK, childhood obesity rates are twice as high in the most deprived areas compared to the most affluent. This difference is mirrored within our boroughs and there is a ‘childhood obesity corridor’ where wards with the highest rates track against the highest levels of deprivation. Whilst there is a vast array of evidence about ‘what works’ across the world, practitioners told us that replicating success only works if adapted to a particular context, in collaboration with the communities that initiatives seek to serve. This was echoed in conversations with the Stars Foundation, who adapted school nutrition model developed in the US to a Saudi Arabian context. It’s also the approach of many of our existing partners, such as Parents And Communities Together, who have developed an amazing programme to support the outcomes of children 0-5 with local families in Southwark. We’re keen to develop our childhood obesity programme in this way: co-producing local versions of approaches tested elsewhere, as well as backing home-grown initiatives. We’re particularly interested in how living somewhere urban and densely populated, hugely diverse and with high levels of deprivation affects an issue such as childhood obesity, for better or worse.
What have we learnt about the role of a charitable foundation in this area?
A message we heard loud and clear from everyone we spoke to was this is hard. Creating a ‘whole-systems’ approach to tackling childhood obesity takes time. It needs to be led by the priorities of residents in communities, and join up efforts across sectors. It also needs a willingness to take risk, to fail at times, and to put resource into evaluation. We think we can make a tangible contribution, as we plan on being around a long time. We are an independent charitable foundation and have resources that means we can take bets and assess whether our efforts have been successful.
There is huge diversity within Lambeth and Southwark. Within Southwark, Dulwich Village for example, is vastly different from East Walworth. Likewise Coldharbour Lane and Clapham Common in Lambeth are also good examples. We know there are different ways to approach this. But given success is dependent on a deep understanding of local context, we think the best approach is to focus in on a small number of areas, build up activity and learn. And then take these lessons broader. This will also help us to create the intensity of impact which is required for tackling childhood obesity.
I was inspired talking to the Robert Wood Johnson Foundation in the US, who have spent a decade building a strong coalition and huge evidence base around tackling childhood obesity. We’d like to learn from their approach, partnering with a range of organisations and tailoring our support to whatever is required to grow impact.
We’re looking to partner with others in three ways: to support initiatives developed locally, back new ideas and co-produce initiatives tried and tested in other cities.
So where do we go from here?
On our website is our draft Theory of Change; which sets out broadly where we think we could have the biggest impact and how.
We’re interested in finding out more about what communities - including families, schools and businesses - need to take their ideas forward; where we could focus; and what changes around physical spaces make the biggest difference to eating behaviour and physical activity. Over the rest of this year, we’ll be running some research and tester projects to explore some of the assumptions that we’ve made, based on the evidence that we’ve heard so far. We’re interested to hear from anyone who can provide us with further insights, either from data, experience as a practitioner, or from lived experience as a resident in Lambeth or Southwark.
I’ve found this first phase of the programme fascinating and am hugely grateful for everyone that’s generously shared their time and insights. Last week I shared a platform with a series of brilliant speakers at a Lambeth Council event looking back at almost a decade of work. As one of a handful of boroughs across the country whose child obesity rates have levelled, it was a privilege to hear about the drive and commitment that has produced a vast range of initiatives. Everyone I’ve spoken to knows that more work is needed, and we’re proud to play our part.
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