Activating London’s communities to stay well
London has the highest rate of childhood obesity compared with the rest of the UK and to any peer global city. Presently, almost one in four children in reception and more than one in three children in year six are either obese or overweight, and children in more economically deprived areas are twice as likely to be obese than those in more affluent areas. Treatment of childhood obesity is estimated to cost up to £195m per year. If growth in childhood obesity continues at the current rate over half the children in the UK will be obese or overweight by 2020.
This is clearly a significant challenge to the ambitions set out by the London Health Commission in their Better Health for London Report. Healthy London Partnership (HLP), established in 2015, set out to implement the key findings from The NHS Five Year Forward View (FYFV) and Better Health for London (BHfL), with an overarching aspiration to make London the world’s healthiest global city. The HLP Prevention Programme is one of 13 core programmes within HLP and has a strong focus on supporting the childhood obesity agenda in London.
In 15/16, we teamed with the prevention programme to work with three Boroughs across London to address the growing levels of childhood obesity in their regions. These were the Boroughs of Haringey, Hackney and Tower Hamlets.
What was needed?
The aim of the work in 15/16 was to gain a deep understanding of the local factors, both behavioural and environmental, that affect people’s choices around healthy living in each of the three boroughs. We worked intensively with each of the local communities to better understand their local needs and challenges, the engagement with and impact of existing interventions, and to coproduce ideas for new or improved interventions.
What we did
The Design Council’s Double Diamond process was used to guide the project. This consists of four stages:
A review of existing evidence and research was conducted to frame existing knowledge on obesity. This was followed with observational site visits to each of the three communities to gather rich, first-hand insights. A series of interviews with policy makers, school staff, and community leaders were conducted Ethnographic interviews were also carried out with parents and children in their own homes and in the community. Over 100 children completed a food and activity diary where they recorded everything they ate and all the physical activity they did for a week.
In the define phase, a number of synthesis tools, informed by behavioural science, were used to analyse data and reframe the problem. These included the ISM model, the COM-B model and behavioural segmentation. Through the COM-B model, co-design briefs were built based on the individual, social and environmental factors that could increase the capability, motivation or opportunity for families to engage in a healthier lifestyle. 13 opportunity areas were identified to guide innovation in the develop stage, the most relevant of which are described below:
Making food – How might we better involve children in the preparation of healthy food?
Joint effort – How might we connect up and enhance health activities already out there to maximise reach and impact?
Food shopping – How might we motivate parents to prioritise health alongside their other food buying priorities (e.g. taste and ease)?
Role models – How might we support local role models to become health agents of change and and inspire families around them?
Healthy skills – How might we help parents develop holistic healthy living skills?
A series of co-design workshops were held with over 50 parents, children, community and council stakeholders at each site. During these workshops the insights gathered during the discover and define phases were shared to inform the generation of ideas on how best to encourage healthy lifestyles within each community. The ideas were subsequently prioritised using a gaps analysis. They were also validated with site leads and cross referenced against primary and secondary research and existing interventions.
A set of transferable principles (or idea lenses) were identified and developed from the insight gathering that were considered to have the potential to make existing interventions more impactful. In total six lenses were developed: Activating spaces, Schools on board, Inclusivity, Personalised signposting, Co-production and Right time, Right place. Each of the proposed ideas incorporates at least one of these idea lenses.
A refined set of solutions were prototyped through the use of storyboards to help communicate and get feedback on the ideas with a diverse group of 43 residents and stakeholders. The prototyping wheel of desirability, viability and feasibility was applied to evaluate the appetite and sustainability of the ideas.
The project, involving over 100 residents and 30 other stakeholders across the three sites, has determined local factors that community members have identified as key challenges to healthy living. Environmental factors that encourage obesity include proximity to cheap, fast-food and lack of access to affordable, healthy options. Our analysis of behavioural factors found that inactive parents often do not prioirtise exercise for their children and within some cultures education is prioritised over a healthy lifestyle. In addition, traditional methods of cooking were often favoured over healthy alternatives within some communities. It was also found there was a lack of parental education about the health implications of children being overweight, and a concern from parents about the psychological implications of addressing weight issues with a child.
It has also enabled the development of a series of locally generated initiatives; three of which have been put forward to be fully developed, piloted and formally evaluated in the three sites. These are;
Healthy Tuck shop
Healthy tuck shops are situated at school gates and provide healthy low cost snacks and food as well as providing a social meeting place for parents and school children. They are supported by schools but are run and stocked by local businesses who sell healthy alternatives. They aim to tap into the Right time, Right place idea lenses by providing healthy food options in a location that is convenient and attractive to parents and children, thereby breaking unhealthy habits of snacking on fatty, innutritious food after school.
Info Scouts are well-connected parents who are supported to spread information about local healthy activities through their networks. They don’t just signpost, they do whatever it takes to help other parents take that first step towards making a healthy change. Info Scouts tap into personalised signposting to make use of pre-existing formal networks (such as social prescribing) as well as informal networks (organic friendship circles). This will help sections of the community that may not otherwise be reached, to become aware of, and take that first step towards engaging in healthy activities.
Healthy Recipe Packs
Healthy Recipe Packs, distributed to the community, offer a simple recipe and fresh ingredients to create a quick, low cost but healthy meal. They can be sold outside schools (at Healthy Tuck Shops or canteens), in housing estates, local food shops or even GP surgeries. They provide a compelling alternative to easy takeaways and cheap ready meals. This initiative aims to address the issue of families not having the time or knowledge to cook a healthy meal in the evenings and will encourage healthy cooking at home.
These ideas aim to link with and/or build on existing local initiatives in order to make them more impactful. Uscreates is currently working with local community organisations, business and entrepreneurs to pilot the delivery of these ideas and build their self-sustaining business models.
Working with three sites across London with the most challenging levels of childhood obesity has given us a real insight into the complexities of this problem at a community level. The communities in which we have engaged, including schools, mosque leaders, local businesses and parents and children, are excited and motivated to take back control to tackle this challenge locally. A series of innovative ideas have been co-produced with the communities which will eventually be led by the communities to make local initiatives the most impactful they can be. In turn, we hope to empower local communities to support their children (and themselves!) lead healthier and happier lives.