January 2016 Sarah Heathcote – HoS Child Health Improvement Addressing variation in impact of smoking & obesity – Wiltshire perspective

Why is obesity an issue?

Trend in the prevalence of obesity and excess weight Children aged 2-15 years; Health Survey for England Patterns and trends in child obesity Child excess weight BMI ≥ 85 th centile, child obesity BMI ≥ 95 th centile of the UK90 growth reference. 95% confidence intervals are displayed on the chart

Obesity prevalence and deprivation National Child Measurement Programme 2013/14 – Year 6 children 5 Patterns and trends in child obesity Child obesity: BMI ≥ 95 th centile of the UK90 growth reference Local authorities in England

Obesity prevalence by deprivation decile National Child Measurement Programme 2013/14 6 Patterns and trends in child obesity Child obesity: BMI ≥ 95 th centile of the UK90 growth reference

Obesity prevalence by region National Child Measurement Programme 2013/14 7 Patterns and trends in child obesity Child obesity: BMI ≥ 95 th centile of the UK90 growth reference Children in Year 6 (aged years)

Wiltshire 471,000 residents recorded in the 2011 census 93.4% population ‘White British’ 3.4% population ‘Black and Minority Ethnic’ Nearly 19% of population is over 65 years Life expectancy is 80.4 years for men and 83.9 years for women Life expectancy is 6.1 years lower for men in the most deprived areas of Wiltshire than in the least deprived areas

Child overweight and obesity in Wiltshire Overweight and obese 1 in 5 (22.1%) of Reception pupils 1 in 3 (29.7%) of year 6 pupils Obese 9% of Reception pupils (aged 4-5 years) 16.6% of Year 6 pupils (aged years)

Obesity in Wiltshire School Health and Wellbeing Survey % Eat 5 or more portion of fruit and veg a day 24% never or not often eat breakfast 31% want more support with cooking skills 30.7% want more support with losing weight 51.9% report doing 6 or more hrs of exercise per week, compared to 45.6% of free-school meal children

Inequalities and Obesity The local analysis from the National Child Measurement Programme (2013/14) highlights inequalities between genders, deprivation quintiles, Community Areas and Children centre areas. Girls are less likely to be overweight or obese in reception year and year 6 The most deprived quintile for both reception and year 6 has significantly higher percentages overweight and obese children than the Wiltshire average In 2013/14, the inequalities gap between the most and least deprived areas of Wiltshire for excess weight in reception stood at 7.2% and at 7% in year 6 Melksham Kings Park, Tidworth windmill and Trowbridge Longfield children centre have significantly higher percentages of obese or overweight reception children

OBESITY IS AN INTERGENERATIONAL PROBLEM If a child has obese parents, then he or she is over 50% more likely to suffer from obesity as an adult. In order to give children the best start in life work needs to focus on pre- pregnancy, pregnancy, infancy, early childhood to age 5 and families as critical stages for interventions to prevent obesity and weight related health inequalities

Obesity in Wiltshire Prevalence of adult obesity Obese 22.3% of adults are classified as obese Overweight and obese 61.6 % (6 out of 10) of adults are either overweight or obese Deprivation Obesity prevalence is estimated to be over 8% higher in the most deprived population quintile compared to the least deprived 17.4% of pregnant women in Wiltshire are estimated to be obese at first booking with maternal services

The challenge: Obesity is complex

The challenge: Obesogenic environments

What we are doing

Maternal and Child Health Baby Steps Specialist healthy lifestyle in pregnancy services Breastfeeding Peer Support Scheme (Mum2Mum) Healthy Start Scheme SHINE Wiltshire/weight management ABC Cook Wiltshire Food in School Active Travel Adult Health Stop Smoking The Health Trainer Programme Active Health Leisure Service Diabetes prevention Obesity management Slimming on Referral NHS Health Checks Behaviour Change Training Health Promotion Campaigns Work in Wiltshire: Core services

Pregnancy and Early Years Maternal and infant health pathway Healthy Child Programme (0-5 years) – Commissioned by Local Authorities from October 2015 Better integrated working – e.g. children’s centres and maternity, integrated year old check Key public health messages - injury prevention, healthy eating, immunisation and screening

Children and Young People School Nursing Service Healthy Schools Programme SHINE weight management programme (7-11 years) Safe Active Travel Wiltshire Food in School Emotional wellbeing – inputting into CAMHS Transformation Plan School Health Behaviours Survey (n = 6912)

Developing a life course obesity strategy Draft Strategic Priorities 1. Maximise universal prevention across the life course 2. Give children the best start in life 3. Promote effective self-care, early intervention and treatment 4. Take steps towards reversing the ‘obesity promoting’ environment where people live, play, learn, work and retire Life course approach: Preconception to Early years (0-4years old) Children and Young People (5-17years old) Adults (18-64 years old) Older People (65+)

Preventing drinking, smoking and substance misuse from harming the unborn child Modifiable risk factors that can cause serious pregnancy- related health problems. Babies are also more prone to illness in infancy and childhood; those born to mothers who drink more alcohol than recommended can be born with fetal alcohol syndrome which can cause lifelong learning difficulties; behavioural problems; physical disability and emotional and psychiatric problems. Prevalence: Smoking prevalence is higher in routine and manual groups and amongst those out of work and those with mental health issues. Smoking during pregnancy is more common in lower socio- economic groups and in younger mums-to-be

Smokefree Homes

Smokefree Cars Legislation % of those who smoke started before they were 18 years old 80% of cigarette smoke is invisible and is harmful to health (opening a window does not remove harmful effects of smoke) 01 October 2015 – illegal to smoke in an enclosed vehicle with passengers under 18 years of age present Aims to reduces child exposure to second hand smoke Both driver and smoker can be fined £50 Legislation applies to all vehicles

Smoke free – the good news Smoking in homes and around children has declined in recent years significant reduction in emergency hospital admissions for children Smokefree cars legislation is hoped to reduce child exposure further Implementing BAAF recommendations Reduction in smoking in pregnancy rates in Wiltshire and across England as a whole. Since the national Tobacco Plan (2011) set out the government ambition to reduce smoking in pregnancy to 11% by the end of 2015, smoking in pregnancy rates in Wiltshire have dropped from 14.2% (2011/12) to 12.2% (2014/15) and more recently to 9.9% (Q2 2015/16), below the England average of 10.5%.

Wiltshire Specialist Healthy Lifestyle Services in Maternity Service It is projected that 50% of our population will be obese by 2050 (Foresight, 2011) and up to 22% of women in England are estimated to be obese at the beginning of their pregnancy (Heslehurst, 2010). SFT began in May 2016, RUH in October (still in discussions with GWHT) Focus is on healthy lifestyles – including maternal obesity and smoking Current referral criterial is women with BMI≥30 and smokers Group based or 1:1 support model

Community Engagement Child Poverty Profiles for each community area, highlighting significant issues to prompt local action In % of children in Wiltshire in poverty Significant variation within Wiltshire -pockets of high deprivation found in particular localities and significant deprivation across some vulnerable groups Country Life: Tougher To Make Ends Meet report found people living in rural communities need to spend 10-20% more that those in urban areas to reach a minimum acceptable living standard while pay levels are frequently lower than urban areas.

Impact of smoking on children Rolling out smoke free signage support the de-normalisation of smoking reduce the risk of exposure to second hand smoke reduce smoking-related litter and the threat of cigarette butts, which are non-bio-degradable and toxic to children, wildlife and the environment reduce the risk of fire offer the potential for increased use of parks and recreation areas

Remember……. Any questions..?

ACTIVITY! (last one….)

Activity Get into groups focused on smoking/substance misuse or obesity (can consider multiple risk factors/issues if you like) Discuss the following: Is the evidence base accessible and being implemented in YOUR local area? Share examples of good practice Feedback Common themes in relation to opportunities and challenges? What will make the biggest difference? Any requests of PHE?