Agenda item

To present an update on work to promote healthier weight and good oral health amongst children in Blackpool.

Dr Arif Rajpura, Director of Public Health, Blackpool Council presented a report on the linked issues of young people’s healthy weight and oral health. He emphasised that these were serious issues in Blackpool and needed joined-up, long-term effort from all services.

Healthy Weight

Lynn Donkin, Consultant in Public Health, Blackpool Council explained that having a healthy weight protected people from a number of serious health conditions. Wider impacts included economic loss to businesses and increased financial pressures on the NHS for what was one of the health sector’s biggest challenges.

National strategy

She added that Government had agreed a national strategy imposing a financial levy on high sugar content products, principally soft drinks. National objectives included reducing sugar in food products, promoting healthier food in the public sector, minimum healthy food standards in schools and a voluntary healthy food ratings scheme in schools. Increasing physical activity in schools was the other strand.

Scale of challenges in Blackpool

Lynn Donkin explained that Blackpool had amongst the highest rates nationally for being overweight (obese). Figures for being overweight included over 1 in 4 (26.5%) of 4-5 year olds, over 1 in 3 (40%) of 10-11 year olds and 3 in 4 (74.5%) of adults. 40% of children moving from primary to secondary school were overweight and 84,000 adults (out of 140,000) were overweight. There was no simple solution and there were other impacts, e.g. on oral health with dental decay.

Food intake and calories

She explained that people were eating too much in terms of high calorie intake and needed to be encouraged to reduce calories and promote healthier food options. Modern lifestyles often equated to sedentary movement which heightened weight pressures.

Blackpool strategy

A Healthy Weight Strategy had been approved in 2016 by the Health and Wellbeing Board and had five key elements: increasing knowledge, skills and healthier food choices; reducing sugar; local environments offering healthier foods and physical activity; weight support services for young people; and focusing on young people.

Progress

Lynn Donkin referred to achievements.

Blackpool had become the first council in the country to create a Local Authority Declaration on Healthy Weight to support employees and residents. The Health and Wellbeing Board had suggested that other partner organisations needed to sign up so a Healthy Weight Summit was held in February 2017 resulting in another twenty local organisations adapting the Declaration. 

‘Give up Loving Pop’ (GULP) was a campaign to encourage young people to give up fizzy drinks for one month. This had gained national recognition. Further work would build on this success including featuring in the ‘Fit2go’ programme targeting younger children.

Physical activity

The Chairman made reference to a national initiative, the ‘Daily Mile’, which had had spread across the UK. This was a simple initiative promoting school classes to walk a mile as a group exercise during school time. Wider benefits included higher classroom performance.

Lynn Donkin referred to a similar initiative, the Living Streets ‘Walk to School’ project, led by a national charity (Living Streets) and funded by the Department for Education. Blackpool was the only area nationally with all its primary schools signed up. Schools were also promoting a range of diverse physical activities. She referred again to the ‘Fit2Go’ programme promoting activity and skills in Year Four children and involving their families.

The Chairman acknowledged the Living Streets project but noted that involvement was subject to parents’ commitment. The ‘Daily Mile’ was during school time so not dependent on parents and should be promoted within Blackpool schools. The Committee strongly supported the proposal and added that stronger personal responsibility messages could be made to parents.

Lynn Donkin explained that schools had their own programmes and would base decisions on available capacity to support activities. However, she would look into the option of the ‘Daily Mile’ initiative being promoted across local schools. Dr Rajpura echoed that there was a range of work being undertaken but the ‘Daily Mile’ would be considered. He advised that he would report back on whether it would be progressed locally to the Committee’s meeting in July 2017.

Key focus of strategy

Lynn Donkin added that reducing calorie intake needed to be the first priority exercise would not be able to negate high calorie intake. Dr Rajpura agreed that whilst physical activity was important, better nutrition was of primary importance. Initiatives such as the free school breakfast were proving effective. He cautioned that whilst there was good work during school term, there needed to be more effective work during holidays.

Tackling wrong messages

The Chairman referred to junk mail advertising fast foods. Dr Rajpura explained that planning policies could be used to reduce the number of takeaways. He added that healthy eating businesses could be promoted through awards and rating schemes. Food businesses also needed to be encouraged to develop healthy and low cost ‘fast foods’.

Information for residents - low-cost health eating options and cookery skills

Attendees agreed that it would be good to promote and distribute to residents, ‘quick-fire’ low-cost healthy menus with simple cooking instructions. Cllr Amy Cross, Cabinet Member for Health Inequalities suggested that she could work with Cllr Maria Kirkland, Cabinet Member for Partnerships, to target voluntary sector groups to support awareness raising and developing skills. Dr Rajpura added that a voluntary sector event had just taken place in the Winter Gardens with 40 organisations attending. He added that community facilities also offered opportunities. With reference to publicity for the Winter Gardens event, he explained that there would be another event in July 2017 and social media could be used to promote it more widely as a public event. The timing of the event (14.00-18.00) offered good scope for attendance.

Young people’s views

Young people attending the meeting made reference to trying to display healthy food in such a way that it was more exciting and appealing. They also felt that cost could be an issue so making healthy food more affordable would help. Helping promote cookery skills as part of wider ‘skills for life’ was important. Similar to making healthy food more attractive, it was suggested that physical activity could be offered through menu choices, i.e. bite-size options allowing people to make up their own physical activity package. This recognised that all children wanted to run as an exercise but would consider other options. 

Oral Health

Donna Taylor, Lead Nurse / Senior Public Health Practitioner, Blackpool Council explained that Blackpool residents suffered high levels of poor oral health. This correlated to deprivation including poor diet and nutrition as well as obesity. High sugar content food and particularly fizzy drinks were a significant factor in poor oral health.

Scale of oral health issues in Blackpool

She highlighted that 40% of local five-year old children had dental decay compared to 25% nationally, of which 8% had incisor caries decay compared to under 4% nationally and which stemmed from sugary content drunk from bottles ruining front teeth. Serious decay also resulted in extraction treatment under general anaesthetic.

Blackpool strategy and partnership working

The Council had developed an Oral Health Strategy and was working in partnership to deliver a number of initiatives. Partners included Better Start, NHS England (responsible for commissioning dentists’ services) and dentists.

She explained that the Strategy contained five broad elements. Public Health commissioned the Oral Health Improvement Service with key health improvement work taking place at the Hospital. Children’s centres promoted supervised tooth-brushing. Free toothpaste and toothbrushes were given away to support the ‘keep teeth clean’ message. Flouride in free milk had been introduced in schools late 2016 with nearly 80% take-up (6,500 children) using careful controls and monitoring. Public Health also commissioned mandatory oral health surveys.

Donna Taylor added that oral health was a complex area and referred to local work. Better Start supported families with children aged 0-5 years old with supervised tooth-brushing, oral health messages and developing local communities and workforces. She cited over 2,500 pre-nursery age children having regular supervised tooth-brushing. Oral messages helped dispel any urban myths e.g. that fruit was not good due to sugar content when it was actually smoothies that were not good due to distilled sugars, spitting out liquid after brushing was appropriate to help retain fluoride rather than rinsing out mouths.

Frontline opportunities through dentists

Donna Taylor referred to an important area of developing work. NHS England commissioned dentists who currently had little contractual remit to promote better oral health information and messages. However, it was hoped that NHS England would revise contracts so that dentists could promote oral health messages including having a local ‘champion’, work closely with other partners and, in particular, ensure all children received an oral assessment in their first year of birth. This would allow dentists to perform greater preventative work including working in community settings such as children’s centres.

She concluded her report highlighting that oral health was complex.

Fluoride and other areas

Members welcomed the good take-up of fluoride in milk and enquired if this could be extended to children of pre-school age (nurseries). They also enquired about having fluoride in water. It was explained that Public Health did want to do this but EU legislation would view this as a state aid subsidy requiring a significant budget cost to overcome the EU rule. Members felt that extra cost for the youngest children was worthwhile in view of future costs and damage. Dr Rajpura agreed and explained that fluoride in milk had been introduced as fluoride was not in water locally. He cited the West Midlands region as having fluoride in water and having much lower tooth decay but there were opponents. He added that drinking a lot of fluoride might cause some damage to teeth but this was a low likelihood and the only risk. Donna Taylor added that effective oral health messaging was paramount.

The Committee agreed that a report would be made at its July 2017 meeting concerning whether the ‘Daily Mile’ initiative would be progressing locally.