2. 1 Part 1 Presented by Mavis Ames Portsmouth City Council

3. 2 Healthy Eating, exercise and dental health programme n Commissioned by the local Strategic Partnership. n Targeting children, young people and their families in areas of high deprivation. n Funded by Neighbourhood Renewal fund and Single Regeneration Budget.

4. 3 Focus Areas n Healthy Eating. n Access to Healthy Foods. n Dental Health. n exercise

5. 4

6. 5 Involvement from the community n Each area has a local health group to own the process and give directions to the work. n Local people involved in the recruitment and selection of care staff. n Local people trained and recruited to work as ‘community champions’. n Parents trained to set up and support breakfast clubs.

7. 6 Involvement from the community n Children and young people central to the whole process for example (1) slogan and logo competition (1) slogan and logo competition (2) animation video (2) animation video (3) collecting baseline data for breakfast (3) collecting baseline data for breakfast club club (4) interviewing for school meals providers (4) interviewing for school meals providers and breakfast club and breakfast club

8. 7 Value of community approach n Development of women in Health Group. n Expansion of Healthy Walks. n Support and encouragement from the community. n Developments of skills and confidence.

9. 8 Future Work n Joint initiative with Portsmouth football club. n Arts project - school dining areas. n Possible social enterprise project around food delivery. n Nutrition training for professionals. n Allotment for the Bangladeshi community

10. 9 What next n Mid term evaluation currently being carried out. n Sustainability audit. n Action Planning for year 2.

11. 10 Part 2 Presented by Nick Bishop Portsmouth City Council

12. 11 So why is it so important to engage people from the communities in the delivery of this project?

13. 12 In order to fully appreciate this I need to let you have a little background on health inequalities in Portsmouth.

14. 13 Poorer people get sick more often and die earlier. Social circumstances and the effects of childhood poverty are linked to overall health and life expectancy.

15. 14 Social inequality breeds health inequality and is passed down from generation to generation.

16. 15 In Portsmouth this means a difference in life expectancy of up to 8 years from one area to another within a radius of 5 miles. In Portsmouth this means a difference in life expectancy of up to 8 years from one area to another within a radius of 5 miles.

17. 16 But surely all that we need to do to tackle these inequalities is to run some hard- hitting campaigns in the inner city, telling people that they need to: n Smoke less n Drink less n Exercise more n Relax more

18. 17 Problem solved then? Not quite. The reality: n Excessive drinking n Smoking n Lack of exercise n Stress n Are inextricably linked to social circumstances, childhood poverty, access to services, housing conditions, income, gender etc.

19. 18 Unless we tackle the underlying causes of health inequalities, we will never break the cycle and will continue to have people in the same city with such unacceptable differences in terms of life expectation. Unless we tackle the underlying causes of health inequalities, we will never break the cycle and will continue to have people in the same city with such unacceptable differences in terms of life expectation.

20. 19 So what does this have to do with obesity and dental health? Doesn’t obesity affect everyone, rich and poor? To a certain extent this is true, but there is a very strong evidence to suggest that levels of obesity and certainly poor dental health are far higher in areas that historically suffer from health inequalities.

21. 20 Poor diet for example can very clearly be linked to the affordability and lack of access to fresh fruit and vegetables or a lack of knowledge about what is a good diet and skills in basic food preparation.

22. 21 A lack of exercise can again, in many cases, be directly linked to accessibility and affordability, and a basic lack of knowledge relating to the health benefits.

23. 22 Similarly, with dental health the picture in the inner city area is far worse than in other areas of the city, and in many cases the national average and in one school over 90% of the children have at least some decay.

24. 23 So how do we address the problem? Another hard-hitting campaign telling children and parents of the need to: n Eat more fruit and vegetables and less fatty food. n Exercise more. n Look after their teeth.

25. 24 That should do the trick and bring about huge improvement. Wrong again, I’m afraid. Health promotion campaigns, however “hard hitting” have achieved very little in terms of long term change in areas with above averagelevels of health inequalities that are linked to social circumstances and poverty.

26. 25 Unless we tackle the underlying determinants of health inequalities at the same time as tackling the inequalities themselves, we will never break the cycle.

27. 26 So how do we change things? There is a growing recognition of the unacceptability of health inequalities. National targets are now being set in relation to obesity and exercise. And attempts are being made to look at the fat and salt content of school meals

28. 27 Very good but tackling health inequalities Very good but tackling health inequalities such as these, also requires giving those who have responsibility for development at grass roots level, the freedom locally to decide how to do it. such as these, also requires giving those who have responsibility for development at grass roots level, the freedom locally to decide how to do it.

29. 28 The only way to bring about really sustainable change and improvement is to engage local people in the identification of local need and in the planning, delivery and monitoring of services. We have to see people as part of the solution rather than as the problem.

30. 29 This is what the Healthy Eating, Exercise and Dental Health project has done; it has, from the outset been community led and community owned.

31. 30 Local people have been engaged and empowered to work in partnership with the local authority, PCT and others and they have had a real role in developing the overall project, setting the priorities and monitoring the outcomes