Kent Towards 2010
Food Champion application: Improving community diet and nutrition
This case study forms an overview of Kents strategy for health 'Towards 2010'. It is supported by case studies on the five pilot projects which took place in 2009.
In October 2005 Paul Carter was appointed Leader of Kent County Council (KCC). One of his priorities was to publish Towards 2010 which set out how Kent County Council would deliver on seven key areas:
- Increased prosperity for Kent through business growth and job creation
- Transformation in education
- Reduced traffic congestion
- Improved health and quality of life
- Quality homes in a well managed environment
- A safer Kent
- Continued improvements in services while keeping council tax down
Under the area of ‘improved health and quality of life’ Towards 2010 proposed a number of key actions. One was to: Encourage healthy eating by providing nutritious lunches through the “Healthy Schools” programme and launch a range of community-based healthy eating pilots. (Towards 2010, Number 51)
The target was taken in two parts. The first part ‘providing nutritious school lunches’ was a joint target for KCC Healthy Schools and Client Services who manage the school meal contracts. The second aspect around ‘healthy eating pilots‘ was led by KCC Healthy Schools in the Extended Services Team.
The following healthy eating pilots were developed:
Theme 1 – Improving community cooking skills - Pilot 1a Community chefs and cooking clubs - Pilot 1b Kent Cooks! – piloting a school based cookery competition
Theme 2 – Improving community access to fruit and vegetables - Pilot 2 Fruit and vegetable bag schemes
Theme 3 – Improving knowledge of healthy eating - Pilot 3 Developing and piloting a healthy eating training package
Theme 4 – School meals - Pilot 4 Increasing school meal uptake
Aims and Objectives
The aim of the healthy eating pilots was to improve healthy eating knowledge and awareness, and change attitudes and behaviour of families with the greatest health needs and so have an impact of the health and diet of the target groups and the communities in which the pilots would be delivered.
The pilots were evaluated qualitatively and quantitatively to understand which pilot or pilots would be the most effective at changing the healthy eating habits of the families. The pilots focused on families in communities in Kent with greater health needs. The pilots aimed to work with families but particularly parents and carers who are key influencers on the healthy eating knowledge, attitudes and behaviour of a family.
Parents and carers engagement was seen as critical to the long term success of these pilots. The pilots aimed to work with parents and children to understand the real barriers they face within the home, school and their local community and ensure they had the information, skills and access to support they needed to make informed choices that support a healthy lifestyle.
Objectives
The objectives of the Towards 2010 community-based healthy eating pilots were:
- To pilot community-based healthy eating pilots over three years in areas of Kent with families and communities at high risk of obesity and health inequalities with the aim of increasing knowledge and awareness, and changing attitude and dietary behaviour around healthy eating.
- To develop strong local strategic partnerships between the health, education and community sectors to facilitate the development of effective healthy eating projects across the county.
- To effectively disseminate ideas and experiences throughout the lifetime of the pilots and provide relevant resources.
- At the end of the pilots to produce a report detailing the most effective pilot/s and partnerships in increasing healthy eating knowledge and behaviour in the target communities.
Partners
Partners across the county were consulted extensively about the scope, design and location of the pilots. It was essential to involve partners from the outset as KCC would not have the capacity to deliver these pilots so needed to ensure future commitment from partners in delivering this work.
Partners included:
- Healthy Schools
- Extended Services
- Client Services
- Dietitians and Nutritionists
- Parent Support Advisor Project Manager
- PCT Health Promotion Managers
- Food Partnership Trainers
- Healthy Living Centre Managers
- Children’s Centres
- School nurses, Dental nurses
- MEND Coordinators
Partners were consulted through:
- Meetings with key partners and Strategic Groups
- The existing Kent Healthy Eating group which meets quarterly and is now used as a steering group for the Towards 2010 work
- A written consultation exercise of the Towards 2010 community-based healthy eating pilots background and update paper – first draft May 2007, second draft June 2007
Methodology
The development of the Towards 2010 community-based, healthy eating pilots involved:
- A review of Government healthy eating strategies and policies
- A literature review of guidance around setting up healthy eating interventions
- Using local data to identify appropriate locations for pilots
- Designing the pilots with partners.
Review of policies
As a first step the key Government strategies in place to improve public health, healthy eating and nutrition were reviewed to ensure that any pilots were relevant to Government priorities.
Policies and strategies considered included:
- Choosing health: making healthier choices easier (DH 2004)
- Delivering choosing health: making healthy choices easier (DH 2005)
- Choosing a better diet: a food and health action plan (DH 2005)
- Tackling health inequalities: a programme for action
- The Food Standards Agency’s Front of Pack Labelling Scheme
- Every Child Matters September 2003
- The Healthy Living Blueprint for Schools 2004
- The Healthy Schools Programme
- The Food in Schools Programme
- The School Fruit and Vegetable Scheme
- Nutritional standards for school lunches and other school foods.
- Food Standards Agency legislation around the promotion of foods to children in the form of a nutrient profiling model.
- The national weighing and measuring programme
- An Entitlement to Cook (now called Licence to Cook) DfES 2006
To help with the development of the pilots a literature review was conducted to understand patterns of healthy eating behaviour and to look at the evidence base for existing healthy eating projects and key learnings.
Some of the key aspects showed:
- It is essential to target healthy eating messages and interventions at children and young people as health related behaviour and attitudes towards food are formed in childhood
- Children are not eating enough fruit and vegetables (about 2 portions a day) and diets are high in salt, fats and sugar (The UK National Diet and Nutrition Survey of 4-18 year olds, DH, 2000).
- Childhood obesity is becoming a major problem in the UK. In the UK 16 per cent of boys and girls aged 2-15 years are obese and nearly thirty per cent are overweight or obese. This can cause both immediate and long term health problems.
- Parents influence the availability of food and act as role models for their children. They determine whether the family eats together, which in itself impacts on the quality of diet chosen. As children get older they tend not to eat with the family and have increased consumption of convenience foods and erratic eating habits that result in diets higher in saturated fats and sugar and poorer in micronutrients.
- One in three children in the UK lives in poverty, which is associated with poor nutrition.
- “Health” in itself is not a motivator for individual’s to change behaviour.
The Department of Health commissioned an evidence review to determine why some people make unhealthy lifestyle choices. The Department of Health ‘Healthy Living’ Social Marketing Initiative: A review of the evidence (MRC 2007) identifies barriers to lifestyle change within families.
These include: • Parents not recognising overweight/obesity in themselves or their child/children • Parents not embracing healthy lifestyles because they are perceived as – or are – too challenging. Parents perceive that there is a lack of time to eat healthily as healthy meals take too long to prepare and cook and getting children to try new things is too stressful. Parents also believe that other barriers to healthy eating are the cost, access and availability of healthier products, though research has shown these tend to be perceived barriers rather than actual barriers.
The role and nature of parental influence over the food choices of their children – children are often targeted by food and drink companies and often the products advertised are high in salt, fat and sugar. Advertising has been shown to have an effect on diet and can cause problems for parents encouraging healthy eating.
Children can also face peer pressure at school if bringing in healthy lunchboxes, and foods once considered as treats have become everyday norms. Children are more often deciding on what should be eaten at meals times and families are no longer taking the time to sit down and eat together due to busy social commitments, meaning a greater reliance on convenience foods.
The literature search found limited evidence for what works in changing people’s diet. Instead a number of reports have been published to provide guidance for health professionals in tackling diet, obesity and overweight. These include Obesity: the prevention, identification, assessment & management of overweight and obesity in adults and children (NICE, Dec 2006) and Lightening the load: tackling overweight and obesity (Faculty of Public Health and National Heart Forum, May 2006, updated March 2007).
The 5 A Day healthy eating programme has also identified key considerations for developing community healthy eating projects which are: • Base the intervention on a theoretical model • Adopt multiple strategies including making changes to the environment, providing training and information and working through a range of settings. • Involve everyone concerned as much as possible in both the planning and implementation of the project. • Make sure there are enough resources to run an intervention of sufficient intensity and duration. The pilots have been designed to address the barriers identified above, taking on board the recommendations for developing healthy eating projects and will be evaluated to provide a much needed evidence base.
Pilot locations
In Choosing a better diet: a food and health action plan, the Department of Health recognises that families living on a low income face particular difficulties with accessing a healthy diet and are often victims of food poverty.
Food poverty includes: • Limited income to pay for food • Lack of local availability of food • Lack of access to supermarkets • Lack of knowledge, skills and equipment to prepare healthy meals
When selecting the target areas for the pilots, local health inequality data was considered to ensure that the pilots were launched in areas where they were most needed. The Kent Health Profile produced by the Association of Public Health Observatories collates public health data to provide a synopsis of health in Kent (www.communityhealthprofiles.info).
The Health Profile covers life expectancy, teenage pregnancy, smoking, causes of early death, binge drinking as well as crime, income and benefits statistics. The 2007 report identified deprived communities in Kent which have the greatest health inequalities and increased risk to lifestyle related diseases and conditions such as coronary heart disease, stroke, diabetes and some cancers. Many members of these communities are also often at risk of overweight and obesity.
This data was used to determine the location of some of the pilots.
Partner consultation
Discussions took place with partners and colleagues across Kent and the region as well as a mapping exercise to identify existing healthy eating initiatives. A wealth of work was identified as taking place across Kent targeting children’s knowledge and experiences of healthy eating such as the Kent Healthy Schools programme and work by Sure Start Children’s Centres.
There are also various growing, cooking and healthy eating projects across Kent and many organisations actively promote healthy eating projects such as Primary Care Trusts and Healthy Living Centres. There is however no evidence base as to the effectiveness of these local pilots. Discussions with colleagues suggested that it was important to ensure that the pilots were developed in partnership alongside other established projects and organisations to ensure they complement existing work and were sustainable.
Following the discussions with local health and education colleagues and the Kent wide mapping exercise a number of community-based healthy eating pilots were developed, which would be relevant to the needs of local communities in Kent and the key areas for further development in the Department of Health’s Choosing a better diet: a food and health action plan:
- Healthy eating in a consumer society and how industry can help enable healthier choices, It was decided to address this by developing a pilot to work with local farmers to set up fruit and vegetable bag schemes
- Encouraging healthy eating behaviours in children and young people, pilots were developed to: • Work with school meals contractors to increase the uptake of school meals • Train Parent Support Advisors and Family Liaison Officers based in primary schools and staff at Sure Start Children’s Centres to work with and support families with healthy eating choices • Launch a cookery competition in schools
- Promoting opportunities for healthy eating in the communities where we live Pilots were developed to: • Set up community cookery clubs run by community chefs • Develop fruit and vegetable bag schemes
Promotion
General
- DVD – a DVD of the pilots has now been produced and widely distributed
- Press releases and launches – pilots were launched featuring the Leader or a Director from KCC, and local Councillors or Dignitaries. Local press was invited and press releases issued which has led to coverage in local media
- Evaluation reports – an evaluation report for each pilot is in the final stages of being signed off. There will also be an overall evaluation report showing key themes and findings across the pilots as a whole.
- Website – a website is currently being planned which will host the evaluation reports and resources developed from these pilots. Promotion to participants
- All children, parents, teachers, partners etc involved in the pilots were provided with a ‘Participation Information Leaflet’ explaining the context and content of the pilots
- Schools, Children’s Centres, community organisations involved in the pilots have promoted them through their own internal mechanisms such as websites and newsletters.
Partnership events – twice a year a partnership event is held for all partners involved in delivering the pilots. The event is organised by KCC and used to develop pilots further and feedback on progress of the pilots and evaluation.
The pilots are a standard agenda item at the quarterly Kent Healthy Eating Group Promotion to KCC Leader, Directors and Managers, KCC staff
Towards 2010 target monitoring – progress of the pilots and associated internal targets are regularly monitored by the Leader of the Councils Office. Monitoring reports are sent by the Action Plan Monitoring Group which are completed by the KCC Project Manager responsible for the pilots.
Annually progress is fed into the KCC Business Plans and also the Annual Reports . Regular briefings are prepared for Members and Directors covering emergent findings and key milestones. Progress is regularly fed back to the KCC Healthy Schools Strategic Group which includes the Managers and Directors of the Learning Group in which the work sits. Updates are provided at internal Team Meetings i.e. Extended Services and Healthy Schools.
Resources
A number of resources and reports have/are being developed for the pilots and will shortly be available to download from a website.
These include:
General
- Towards 2010 healthy eating pilots background and update paper
- Participant Information Leaflet & DVD
- Case studies and photos
- Overall evaluation report
- Guide to setting up cooking clubs
- Community chef pilot evaluation
- Guide to running a community cooking competition
- Kent Cooks! cookery book
- Kent Cooks! pilot evaluation
- Guide to setting up a fruit and vegetable bag scheme
- Poster
- Loyalty card
- Recipe cards
- Fruit and vegetable bag scheme pilot evaluation
- Running a healthier lunchbox workshop resource
- Healthy eating training pilot evaluation Increasing School Meal Uptake
- Increasing school meal uptake best practice guide
- Poster
- Increasing school meal uptake evaluation
Evaluation
KCC went through a tendering process and selected BMG to undertake the independent evaluation of the pilots. The projects were set up with the evaluation in mind and BMG had the opportunity to work alongside those developing and delivering the pilots.
Objectives of evaluation
- To evaluate the effectiveness of the Towards 2010 community-based healthy eating pilots individually in improving healthy eating knowledge, awareness, attitude and dietary behaviour in target groups and the communities in which the pilots are based and to identify common factors that contribute to the success of these pilots.
- To identify changes in levels of knowledge and awareness around healthy eating between the pre and post intervention periods of the pilots and to assess the impact of the intervention on knowledge and awareness of the target families and communities over a period of time.
- To identify changes in attitudes around healthy eating and also changes to dietary behaviour between the pre and post intervention periods of the pilots and to assess the impact of the intervention on attitude and behaviour of the target families and communities over a period of time.
- To provide recommendations for the implementation of effective future local healthy eating programmes based on the outcomes of Towards 2010 community-based healthy eating pilots.
Lessons Learned
See individual pilot case studies
Future Developments
Once the final evaluation reports are agreed by Easter 2010 the main focus will be on dissemination and promoting and publicising the pilots, findings and learnings. A website containing materials will be launched and opportunities for promotion locally, regionally and nationally will be explored including conferences and journal articles.
Contact Details
Contact Name: Joanne Condon
Job Title: Towards 2010 Project Manager
Phone: 01622 696598
Email: joanne.condon@kent.gov.uk
Organisation: Kent County Council
Address: Room 1.55, Sessions House, County Hall, County Road, Maidstone ME14 1XQ
Other Resources:
This case study was added 25/03/10