Sarah Hickey, childhood obesity Programme Director, Guy’s and St Thomas’ Charity
Sep 20, 2019
At the heart of our childhood obesity programme is the aim to make sure all children can grow up healthy, no matter where they live. With that in mind – two and a half years into our programme – how have we identified our goals, what do they mean in practice, and how do we track and measure our impact?
When we started the childhood obesity programme, our first question was ‘what are we talking about when we talk about childhood obesity? Secondly, what’s our role as an urban health foundation in supporting a place to tackle this issue?’
To answer this, we continually look at evidence from three equally important angles: data and academic literature; the experience of experts already working on the issue; and the perspective of children and families themselves.
First, data in Lambeth and Southwark demonstrated that rates of childhood obesity tracked extremely strongly with an area’s average income. This is an extreme example of our national picture which shows that where you grow up strongly influences your chances of being overweight and obese, and this correlation has only got stronger over time.
This evidence has guided our programme from the outset, and we believe that by designing interventions around families on the lowest incomes, they are likely to work for everyone.
This shaped our programme’s ten-year goal: to close the childhood obesity inequality gap by bringing the high rates of childhood obesity in neighbourhoods with the lowest incomes down to the level of the more affluent ones.
In practice, this means much of the activity that we support is focused in the areas with lower average incomes, where childhood obesity rates are highest.
Spending time with local children and families helped us understand what was happening beneath this data. Families are up against a flood of unhealthy food options, and reduced financial resources limit healthy options even more.
Across the world, approaches to childhood obesity have been most successful when they have focused on re-designing the spaces where children and families spend their time, particularly in urban areas.
This shaped our programme approach: to make sure all children have healthy food options and places to run and play by redesigning the spaces where children and families spend their time. We weight more heavily towards food, as we think this has the largest impact.
Our programme’s projects and activities focus on three areas to make sure children and families can live healthy lives:
There is international consensus that tackling childhood obesity requires a whole-system approach.
What’s unique about our approach is our focus on a goal and a place, working across the entire system to make change happen in Lambeth and Southwark. Everything that we do in our programme is in partnership with others. We see our role as a charitable foundation as bringing convening power and support to help tackle this issue through lots of different approaches, organisations and people.
We work at different scales to increase the flow of healthy options for children and families. Some levers for change exist locally and some involve national or international partnerships. Equally, some involve using detailed insights from our work in inner-city London to influence national policy and practice.
To measure our progress across our homes, schools and streets strands, we developed an outcome framework to define specific goals, track progress and test assumptions from our theory of change. We believe that no single intervention can tackle childhood obesity alone, so we use measurement and evaluation to track the cumulative impact of a portfolio of projects.
When it comes to most partners, we don’t actually ask them to measure their impact on childhood obesity. Rather we ask that they rigorously assess their impact on a factor within their control that contributes towards tackling childhood obesity. For example, a project that supports schools to change their food environment tracks what changes have occurred within the schools, and how many unhealthy food options have been removed.
While our core strategy remains the same as when we launched our programme nearly three years ago, we’ve made significant progress in strengthening what underpins our thinking. Ultimately, we need to reach as many children as possible and re-design our food system and local places to create neighbourhoods with healthy options and opportunities to run and play.
My colleagues at the Charity will be sharing more detail on what we’ve learned so far through our programme strands to reshape our streets, schools and homes – as well as the types of projects we’re keen to partner with in future – so keep an eye out for more in the next few weeks.
Programme Director: Sarah Hickey
30 June, 2020
Our Programme Director, Sarah Hickey, shares how we’re collaborating with the commercial sector to tackle the inequality that prevents children from accessing nutritious food.