healthy settings - innovative thinking for the real … bradford teaching hospitals nhs foundation...
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SETTINGSIssue 4, winter 2005
healthy
Access to Excellence
Healthy Settings Development Unit
In this issue:• Conference Highlights - A Four Page Pullout • News and Updates • Transport and Health •
• Choosing Health and Prisons • Nature and Health • Guidance for Healthy Catering • Stadia •
‘Settings at heartof Choosing Health’Settings are central to theChoosing Health WhitePaper on public health,said one of its architects,Department of HealthDeputy Chief MedicalOfficer Fiona Adshead.
The White Paper envisioned ‘awhole environment for health,’ shetold the second National HealthySettings Conference. Partnershipsfor Healthy Places: DeliveringWellbeing, Tackling Inequalities -Healthy Settings in Action was heldin September 2005 at UCLan.
‘Settings are at the heart ofChoosing Health. Where peoplelive their lives, how people live theirlives, and the society that shapesthat is absolutely critical.’
But society is about individuals, andgreat changes in society alwaysstart with individuals, she added.
‘This is about complex systemchange, changing a number ofthings in the way in which societyis structured, in the waycommunities and individuals livetheir lives - which is why settingsare so important.’
More than 100 people from theNHS, local authorities, thevoluntary sector, centralgovernment and further and highereducation attended a lively two-dayconference at the University ofCentral Lancashire in September.
The conference combinedchallenging keynote papers withinspiring practical case studies,workshops, a debate and aprovocative theatre performance.
Mark Dooris, director of theHealthy Settings Development Unit,organisers of the event, said: ‘Theconference was a big success. Itnot only offered tangible examplesof effective settings-based practice,but also provided a vision of whatjoined-up “healthy place-making”might look like. It was great to seepeople thinking laterally, movingaway from linear thinking andgetting fired up about the need tostrengthen links between publichealth, sustainable development,neighbourhood renewal andcorporate social responsibility.’
Conference papers are available onthe Healthy Settings DevelopmentUnit website:www.healthysettings.org.uk
See page 7 – 10 for conference articles . . .
Newnationalwork andhealthstrategyThe Department of Health, theDepartment of Work andPensions, and the Health andSafety Executive have joinedforces in a ground-breakingpartnership to improve thehealth and wellbeing ofworking age people –publishing an ambitiousstrategy: Health, Work andWellbeing - Caring for ourFuture.
Pulling together the different strandsof work going on withingovernment, the strategy not onlysets out government action, but alsoplaces real responsibility to deliverchange with employers, individuals,the healthcare profession andstakeholders. It aims to ensure thatthe topic gets the attention itdeserves, that work is recognised byall as important and beneficial, andthat healthcare services meet theneeds of working age people. WhilstBritain has one of the best healthand safety records in the world, 40million workings days are still lostevery year to occupational ill healthand injury and a third of those whostart claiming Incapacity Benefitcome directly from work.
Continued on page 11 . . .
Hospitals■ Bradford Teaching Hospitals NHS
Foundation Trust launched theirpublic health strategy in thesummer and also hosted a‘Healthy Foundations’ event forexisting and imminentFoundation Trusts. The HealthPromoting Hospitals network wasinvited to present some practicalexamples of how effective publichealth can be delivered throughsecondary care. Details should beavailable on the HSDU websitesoon, but in the meantime pleasecontact Denise Morris.
■ The final version of Essence ofCare ‘Promoting Health’ isexpected soon. This will providean excellent resource for trusts tohelp embed health promotingpractice within their trusts and tobenchmark with others.
■ A new resource outlines theevidence base for HealthPromoting Hospitals - HealthPromotion in Hospitals: Evidenceand Quality Management, editedby Oliver Groene and Mila Garcia-Barbero (WHO 2005). The book isavailable free to all memberhospitals, and is also availableonline at www.euro.who.int
■ The latest hospitals to join theEnglish HPH network are GreatOrmond Street Hospital,Ashworth Hospital, andGloucestershire Hospitals NHSFoundation Trust. Membership isfree of charge until October 2006.
■ The HPH database is beingupdated. If you are a memberhospital, and have lost orforgotten your password, pleasecontact Denise Morris, who canprovide you with a new one.
Contact: Denise MorrisNational Health Promoting HospitalsCoordinator01772 [email protected]
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SchoolsThe National Healthy SchoolsProgramme, sponsored by theDepartment for Education and Skillsand the Department of Health, nowhas two key national targets:
■ half of all maintained schools toachieve new healthy school statusby December 2006
■ all schools working towards beinghealthy schools by 2009.
Two thirds of all schools in Englandare now involved.
‘Choosing Health’ introduced a newset of minimum core criteria forHealthy School Status. FromSeptember 2005, this will entailmeeting criteria in all four core areas:
■ Personal, Social and HealthEducation (including sex andrelationship education and drugeducation)
■ Healthy eating
■ Physical activity
■ Emotional health and well-being(including bullying).
Schools currently registered on theNational Schools Database asachieving healthy school (level 3)status may need some boosting tomeet the new criteria.
Numbers of healthy schools is anindicator for Joint Area Review,requiring much greater localaccountability and strategic linkage.Good communication will be neededbetween Healthy School programmesand Children and Young PeopleStrategic Groups for targets to be metand more importantly, for theframework to be used so that schoolscan contribute to meeting the fiveoutcomes of Every Child Matters.
Contact: Ian Dixon Regional Co-ordinator, North Westand Yorkshire & the Humber07939 [email protected]
CollegesThe HSDU recently audited HealthySchools programmes working withcolleges across England. This founda number of Healthy Collegestandards being developed, linkinginto local Healthy Schools Standards,plus some individual collegesworking in partnership with PrimaryCare Trusts (PCTs).
Key findings
■ The National Healthy CollegeNetwork now has over 115members, an increase of 75 sincethe report was written, withapproximately 14 colleges pilotingthe Kirklees Healthy CollegeStandard. Some networkmembers, such as Wigan andLeigh College, are developingtheir own accreditation processesand standards for their area.
■ The Somerset Healthy CollegeStandard works with fourcolleges.
■ Telford College is developing ahealth promoting college strategywith its PCT, using jointly fundedworkers. Other colleges areworking with their PCTs under theworkplace agenda.
■ Some topic based projects arerunning in partnership with PCTs.
The audit report is available on theHSDU website:www.uclan.ac.uk/facs/health/hsdu/publications/reports/index.htm
Contact:Sharon Doherty, Healthy SettingsDevelopment Officer01772 [email protected]
Healthy College NetworkKate [email protected]
news and
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Healthy Care There are currently 70 Healthy Carepartnerships across the country using theNational Children’s Bureau (NCB) HealthyCare Programme materials to help ensurea high level of good practice ismaintained and developed, to improvethe health and well-being of looked-afterchildren and young people.
For those areas involved in Local AreaAgreements where looked-afterchildren have been selected as an areafor action, Healthy Care’s model ofmulti-agency partnership working andtargets provides a good framework.
NCB has secured a further two yearsof funding from DfES to co-coordinateand support a national Healthy CareNetwork, provide national andregional strategic development anddevelop and maintain a Healthy CareInformation and DisseminationService.
The National Healthy Care Networkwill promote the Healthy Care modelas a strategic approach for Children’sTrusts to meet the Public ServiceAgreements for looked-after children,deliver Change for Children andprovide opportunity for best practiceexchange.
Four Healthy Care publications weredisseminated in August:
■ Healthy Care briefings
■ Healthy Care, a health promotiontraining programme for fostercarers and residential socialworkers
■ Healthy Care ProgrammeHandbook
■ Carers Can! magazine for carers.
Contact: Helen [email protected],www.ncb.org.uk/healthycare
CitiesA strength of the World HealthOrganisation(WHO)’s European HealthyCities Network is the requirement todemonstrate political support.Liverpool’s current political championhas been at the forefront of the ‘SmokeFree Liverpool’ campaign and visitedNorth Karelia, Finland in September tolearn how political will led to changesin diet and nutrition that have cut heartdisease dramatically.
After a period of reduced visibility,Liverpool Healthy Cities is once againfirmly embedded within the LocalStrategic Partnership, and health is astrategic priority directed by LiverpoolFirst for Health and the Healthy CitiesPartnership.
Impact assessment tools support otherstrategic issue partnerships to identifytheir contribution to improving healthand reducing health inequalities, anddelivery is through settings. Populationgroups are targeted through settings.
Healthy Urban Planning is a majorPhase IV theme for all members of theEuropean Healthy Cities Network.Healthy Urban Planning supportsopportunities for physical activity andprovides access to affordable andsustainable healthier food optionssuch as fruit and vegetables. Effectivetransport planning will increaseopportunities for walking and cycling -essential for the effective delivery ofChoosing Health.
Contact: Julia TaylorLiverpool Healthy Cities Director 0151 [email protected]
PrisonsThe recognition that good prisonhealth is important has led 33countries in the European Region ofthe WHO to join a WHO networkdedicated to improving health withinprisons. This year, as part of the UKPresidency of the EU, the Projectcelebrated its tenth anniversary with amajor conference in London: Prisonsand Public Health, The Next Ten Years.
In the ten years of its existence, theProject has held annual meetings withaccompanying small conferences tocollect evidence and experiencesconcerning the major health problemsfacing prisons and to produce andpublish consensus statements ongood practice. The statementsproduced were:
■ Communicable diseases, jointlywith UNAIDS, 1998.
■ Mental Health Promotion inPrisons, with Mental HealthEurope, 1998.
■ Prisons, Drugs and Society, withthe Pompidou Group, Council ofEurope, 2002.
■ Promoting the Health of YoungPeople in Custody, with ScottishPrison Service, 2003.
■ Prison Health as Part of PublicHealth, the MoscowDeclaration, 2003.
■ Status Paper on Prisons, Drugs andHarm Reduction, with keypartners, 2005.
They include recommendations forproducing a prison health servicewhich can contribute to theprevention of the spread of life-threatening diseases. A PracticalGuide to Prison Health will bepublished by WHO HIPP in 2006.
WHO HIPP websitewww.euro.who.int/prisons
Contact: Paul Hayton, Director of theHealthy Prisons Project at UCLan andProject Lead for the WHO HIPPCollaborating Centre, DH, London01772 [email protected]
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Prisons and prisoners fit well into the tackling healthinequalities agenda and we are aiming to maximise theopportunities created by the Choosing Healthprogramme for prisoners, their families and those withinthe criminal justice system.
Prison Health, part of the Department of Health (DH), is working with other partsof the DH to incorporate prison health into their Choosing Health delivery plans.
Some current initiatives include:
■ Smoking Cessation: We are considering smoke-free wings or perhapssmoke-free prisons. Two juvenile prisons, Ashfield and Wetherby, havebecome smoke-free. There will be consultation over exemptions from theWhite Paper’s commitment to smoke-free environments in all enclosedpublic places and workplaces.
■ Health Trainers: Prison Health are to introduce an accredited programme,training staff and prisoners to become health trainers.
■ Physical Activity: A Walk the Way to Prison Health (WTWTPH) initiativehas been introduced in some establishments, encouraging prisoners tospend more of their day walking and training prisoners to become ‘walkleaders’.
■ 5-a-day and Water Pilots: A 5-a-day pilot is planned for prisons in Kent,and a pilot on providing water toimprove concentration in juvenileprisons is being considered. Bothinitiatives are part of developing anutritional standard for allgovernment agencies.
■ Mental Health: Colleagues in theNational Institute for Mental Healthin England (NIMHE) based in PrisonHealth are currently piloting mentalhealth projects in all eight NIMHEregions.
Prison Health is keen to hear of activitieslinked to the Choosing Health agenda.
Contact: Paul HaytonDirector of the Healthy Prisons Project 01772 895574
Choosing Health:delivering in prisons
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Talking balls at Thorn CrossTrainees at Thorn Cross Young Offenders Institution nearWarrington used drama to raise awareness of testicular cancer.The 15-minute play, Talking Balls, was written by Barrowplaywright John Kenneth Hall.The performance, by trainees for trainees, ran eight times overtwo days, followed by an open discussion led by Jamie Spencerfrom Macmillan Cancer Relief and Bill Ryder of the Lancashireand South Cumbria Cancer Partnership Group, both of whomhave had testicular cancer.
Contact: Katie Roberts, [email protected]
Case Studies from the Northwest
Mental Health radio projectEvidence of links between social exclusion and mental illhealth, and the positive impact of creative arts, was thestarting point for a partnership between HMYOI LancasterFarms and Headspace. The aim was to improve the selfesteem, communication and life skills of young offendersand juveniles. Representatives from Resettlement, Educationand Psychology departments were heavily involved in thedevelopment of a DJ workshop project, offering participantsthe opportunity to achieve an Open College Networkaccredited qualification in DJ Skills.
The project, Headspace, was offered to the most vulnerableyoung men, particularly those less likely to socialise and atrisk of isolation. Pam Eland, DJ facilitator and qualified youthworker, hosted the sessions, supported by prison officers andrepresentatives from Psychology, Education, OccupationalTherapy and other relevant departments. Eleven juvenilesand nine young offenders took part in taster sessions.
Evaluation of the tasters was very positive. The results of BHSindicated that the participants were mentally positive. Theatmosphere of the group was very altruistic with participantssupporting each other in learning new skills. The juvenilegroups in particular excelled themselves by creating someexcellent banners and working together on the decks.
A two day workshop was hosted in the same format as thetaster sessions, with seven juveniles and one young offendertaking part. The group dynamic again was very altruistic andsupportive and the workshop had an excellent impact on therelationship between the participants and the staff, creatinga real ‘buzz’ on the wings. All participants were successful inachieving the OCN Level 2 qualification.
Now the possibility of developing a radio station for the YOIis being explored, through an expanded partnership ofadditional departments with the YOI and Lancaster DistrictYMCA, which hosts the community radio station, DiversityFM. If the radio station goes ahead, content will be decidedby the young offenders and juveniles, who can work towardsanother qualification.
Headspace was funded by Morecambe Bay Primary Care Trust andCumbria Social Services.
Contact:
Vicky Putt, Headspace [email protected]
Jackie Jarvis, Deputy Head of [email protected]
HMP Haverigg works with YMCA on wellbeing
Lancaster and District YMCA have developed a ‘Wellbeing’ pilotat HMP Haverigg, near Barrow, funded by West Cumbria PCT.Participants have been challenged to identify their personalwellbeing issues and follow a 10 week interactive programme,exploring self awareness, anger and conflict resolution, mentalhealth, sexual health, prejudice and discrimination, relationships,testicular cancer, diet and exercise.
The sessions have been well attended by a constant group of 10men, of varying ages and literacy/academic levels, all of whomhave contributed much of themselves to the project.
Contact: Phil McGrath, Lancaster and District YMCA, 01524 32737 [email protected]
Hindley’s mental health teamA mental health team of six staff, employed by the 5 BoroughsNHS trust, aims to meet the mental health needs of young menat Hindley prison near Wigan.
Every young person entering the prison is screened by theprimary care team and from there they are referred toappropriate services, including the mental health team. Referralsare followed by an assessment, in liaison with GPs, communitypsychiatric nurses, social workers, Youth Offending Teams, theProbation Service and families.
The mental health team then provides patient-centredtherapeutic intervention and referral to a visiting psychiatrist ifnecessary. There is a purpose-built Mental Health Day Centre andthe team co-ordinates an ever-widening choice of individual orgroup therapeutic activities.
The team also works closely with wing staff as part of a multi-disciplinary team developing management plans for young menwith complex needs and disruptive behaviour problems.
Before release, the team works with families and outsideagencies to ensure a smooth transition.
Contact: Marie Hughes, Mental Health Team Leader at HMYOI [email protected]
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Heart of MerseyA coronary heart disease preventionprogramme, is building a Healthy Stadiapartnership with the top football andrugby league clubs across GreaterMerseyside, plus Aintree racecourse.In late July, the six sporting organisations, Aintree racecourse,Everton FC, Liverpool FC, St Helens RLFC, Tranmere FC andWidnes RLFC all pledged to work towards providing healthierstadia for their communities.
Keith Mercer, winner of the 2005 Scottish Grand National onJoe’s Edge, and originally from Formby, was at Aintree toofficially launch the scheme.
Keith said: ‘I am totally behind this and think it will be greatfor supporters and local communities.’
The project, supported by sanofi aventis, will focus on threeareas; Food & Nutrition, Smoke Free and Physical Activity(including sustainable and green transport). Each stadium willcommit to work on one of these areas with the support ofHealthy Stadia consultants and specialists from Heart ofMersey. This project will also build long-term networks withthe NHS and councils covering each stadium.
Contact:Emma HeesomCommunications ManagerHeart of Mersey0151 928 7829 [email protected]
North West Healthy StadiaProgramme As reported in the last newsletter, the North West is developing aprogramme of work on healthy stadia, defined as:
…those which promote the health of visitors, fans, players,employees and the surrounding community… places wherepeople can go to have a positive healthy experience playing orwatching sport.
Findings from the first two phases of the initiative – whichinvolved regional mapping and development work – werepresented at a stakeholder event in July 2005. These indicated awide variation in the range and depth of health-related activities,partnership working and community engagement. There was alsoa strong consensus that the setting of minimum standards wouldprove problematic.
With this in mind, the Department of Health has commissionedthe Healthy Settings Development Unit and the Federation ofStadium Communities to undertake a further phase of work withfour pilot stadia (Blackburn Rovers FC, Oldham FC, St Helens RLCand Blackpool FC). During this phase, a set of Healthy Stadiaprinciples will be refined and integrated into the production ofNorth West regional guidelines for stadia to ‘sign up to’. At thesame time, a toolkit will be developed to facilitate effectivecommunity engagement and partnership working by stadia.
With this third phase due to be completed by April 2006 and theOlympics coming to London in 2012, discussions are underwaywith a view to rolling out the learning across the region andbeyond, and to joining up the work with other sport and healthinitiatives.
Report of Phases I and II available at www.healthysettings.org.uk
Contact:
Linda Ratinkcx: [email protected] 01772 893404
Judy Crabb: [email protected] 01782 790606
Jackie Brennan: [email protected] 0161 952 4289
Stadia
Partnerships for healthy places: Delivering wellbeing, tackling inequalities, healthy settings in action
We need to lift our focus to the bigger picture, said Mark Dooris, directorof the Healthy Settings Development Unit, and ask what makes placesliveable and vibrant.‘Maybe we have to take the risk of leaving the explicit language of health to one side, but in doing so release theenergy to facilitate the innovative and creative change that can lead to more sustainable system-level wellbeing.’
New Local Area Agreements between local authorities, PCTs, private business and other key local players offered anexciting and potentially powerful way of doing this, Mark told the conference.
‘We need to focus on Choosing Health priorities, but retain our bigger vision and also engage with parallelGovernment strategies in areas such as sustainable development, regeneration and liveability.’
Retaining the ‘bigger picture’ was one challenge for the settings approach, he said. A second challenge, oropportunity, was the development of evidence for its benefits.
The settings approach is perceived as effective, but evidence is lacking because of the complexity of settings, thedifferent understandings of what the ‘settings approach’ actually is, and evaluation funding linked to specificdiseases and single risk factors rather than settings.
‘A possible way forward is to draw on the experience of "theory-based evaluation" as applied in complex initiativessuch as Health Action Zones, but this will require us to clarify the theory underpinning the settings approach; toengage with policy makers to ensure that the evidence is being generated for a purpose; and to secure "proper"long term funding.’
Mark concluded by highlighting the need to move away from linear reductionist thinking: ‘The 21st century issuesthat we face – whether a defined ‘health’ problem such as obesity or AIDS, or ever-present challenges such asglobal warming or ethical trade – are complex and are generated and developed within the complex systems thatmake up our society, and indeed, our world. The solutions to the problems are similarly complex and require us todevelop responses that recognise that complexity, and challenge the dominant paradigms within which we areworking.’
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Drop the healthlanguage, release the energy
Successful 2nd National HealthySettings ConferenceThe Partnerships for Healthy Places conference, held September 6 -72005, was heralded a success by delegates, speakers and organisers alike.The conference explored how healthy settings initiatives can work inpartnership to create healthy, vibrant and liveable places, and contributeto sustainable and integrated health improvement. The programme,abstracts, biographies and presentations are available on the HealthySettings Development Unit website www.healthysettings.org.uk
SettingsrequireskilledworkersThere is a shortage of workerscapable of developing healthysettings, warned Tony Elson, co-chair of the task group in charge ofdelivering the Choosing HealthWhite Paper.
He said: ‘Settings have huge implications for workforcedevelopment.
‘We need to develop people who are capable ofworking across professional boundaries and thinkinglaterally. Communication and interpretation are coreskills.’
Mr Elson, the Department of Health’s local governmentadviser on public health, also saw risks in the settingsapproach.
Boundaries between settings could become too rigid,thereby missing opportunities to exploit synergies acrossdifferent settings, and there was a danger of ‘losingsight of the big picture,’ he said.
HealthyCommunitiesCollaborativeset to expandA community-led approach that has
seen a 37% reduction in falls among
older people has been expanded to
tackle access to healthy diets.The Healthy Communities Collaborative works bysharing good practice, building teams of localresidents and professionals, and offering a simpleframework in which teams can try out and learnfrom new methods. The whole process is backedup by rigorous measurement.
The 62 teams working around the countryproduced a 20% increase in food outlets in theirfirst year of work on healthy diets, and an 18%increase in the quality of food outlets.
Maurice Wilson described how he and otherresidents of his community in Northamptonplanned and ran initiatives such as a ‘sloppyslipper’ event to replace worn slippers, persuadeda fishmonger to start selling fresh fish in his area,and taught widowers how to cook.
He said: ‘All of us volunteers have a much strongersense of community, and also it’s lots of fun. I justwish this had happened years ago - thecommunity being valued by the PCT.’
The Healthy Communities Collaborative will helpto deliver elements of Choosing Health in 20 newsites from next year, said Jenny Knowles, assistantdirector of the National Primary Care DevelopmentTeam, which runs the initiative.
Work-life balance as a wayin‘Work-life balance’ is a usefulstarting point to engage universityemployees in health promotion,according to Dr Margaret Hodgins,who conducted staff surveys andfocus groups at the NationalUniversity of Ireland, Galway.‘Work-life balance can be used to engage workers inwider debates about the impact of their workplacesetting on health,’ she said.
‘The need for ecological level interventions wasreaffirmed, as was the need to explore health in thecontext of organisational development.’
However, some people disliked the term ‘work-lifebalance’, feeling that it set work in opposition to life,while others were quite happy with an imbalance, sheadded.
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Partnerships for healthy places: Delivering wellbeing, tackling inequalities, healthy settings in action
Home zones good for healthReclaiming streets as social spaces can have a hugeimpact on health, said Peter Lipman, director of liveableneighbourhoods for Sustrans, a charity promoting foot,cycle and public transport.
Sustrans worked with residents of Dings, an inner city areaof Bristol, to plan and create a ‘home zone’ in which a newstreet layout cut traffic speeds and ‘redefined the streetspace as a social space’.
‘All the space dedicated to cars, which just sit there 23hours a day, can be used for children to play, and forpeople to sit and talk.
‘When people use the street as a social space, it creates ahealthy setting where there's a range of activity - peoplemake different contacts, speed drops, and it looks asthough serious crime is reduced.’
Parking spaces were placed to break up sightlines todecrease speeds and the home zone was linked to localamenities by new cycle paths and footpaths. Sustrans isnow working on ways to create home zones at lower cost.
Green campaigner Jonathon Porrittcalled on public healthprofessionals and sustainabledevelopment workers to join forces.‘The joint working has not been as much as it mightbe,’ said the former Friends of the Earth director whochairs the UK Sustainable Development Commissionand is programme director of Forum for the Future, theUK’s leading sustainable development charity.
Forum for the Future was trying to bridge this gap, hesaid, with recent work on NHS corporate citizenshipand health inequalities. He praised the Healthy SettingsDevelopment Unit for its vision of a ‘fully developedscenario’ in which a ‘whole systems’ way of working
made connections between people, environments andbehaviours.
Progress on health inequalities was hampered bycontradictions in government policy, such as lack oflocal powers, he told the conference, and the fact that‘local and national bodies run away from the kind ofparticipatory engagement that good settings require.’
But the main problem was the government’scommitment to consumption-driven economic growth,with its enormous costs to health and theenvironment.
‘Individual fulfilment is completely dependent on thesurrounding social capital. We should unapologeticallyopen up this whole debate about quality of life, valueswell-being and fulfilment.’
Porritt calls for links to sustainabledevelopment
Need for links toNeighbourhood RenewalNew government initiatives on neighbourhoodrenewal in small, self-defined communities couldoffer opportunities for ‘healthy communities’ work.
‘We recognise the role of neighbourhoods intackling health inequalities, they are a setting foraction on health improvement,’ said TonyArmstrong from the Neighbourhood Renewal Unit’shealth team in the Office of the Deputy PrimeMinister (ODPM).
‘The neighbourhood renewal strategy is really astrategy for public health, it covers all the widerdeterminants of health.’
His health team’s role was to ‘support andchallenge’ the Department of Health in itscommitment to reducing health inequalities, hesaid. The Government was committed to makingChoosing Health work.
‘But the difficulty in delivering this is that a lot of it isup to individuals, communities, PCTs and NHStrusts, there's no real clear direction to any localpeople on what exactly they should do.’
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Partnerships for healthy places: Delivering wellbeing, tackling inequalities, healthy settings in action
‘No settingsapproach inEngland’There is no such thing as a settingsapproach in England, declaredJane Wills, reader in public healthand health promotion at LondonSouth Bank University.
There were three possible reasons for this, she told theconference. First, the settings approach has somehowbeen bypassed by England’s ‘navel-gazing’ fascinationwith health promotion theory.
Second, while most countries cite the Ottawa Charteras underpinning their health promotion work, such asystemic approach does not fit England’s dominantpolitical ideology. And third, health promotion isdelivered through the NHS, putting the focus onindividuals and disease risk factors rather than settingsas social systems.
‘No surprise that the setting where work is most activeis schools, which are under local authority rather thanNHS control. Maybe we should align ourselves morewith social exclusion, rather than the current NHSagenda,’ said Dr Wills.
Insights are the keyto ‘evidence’‘Evidence’ should include moreinsights from practitioners and thepublic, and not just articles in peerreviewed journals, Jeff French toldthe conference.Dr French, a former director of the HealthDevelopment Agency, is now working with theNational Consumer Council to develop a new nationalsocial marketing strategy for the Department ofHealth.
He said: ‘Decisions about what action to take shouldbe influenced by a rounded review of as many possiblestreams of insight as possible. To risk stating theobvious, randomised controlled trials (RCTs) are onlyuseful where it is possible to randomise and controlthe variables.
‘Complex societal situations require much moresophisticated and developed approaches to evidenceand learning, that are able to draw on a multiple rangeof methods and approaches.’
A simple but uniform system for planning, evaluatingand recording interventions was needed, to gather andshare a broad range of insights.
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Partnerships for healthy places: Delivering wellbeing, tackling inequalities, healthy settings in action
The mobility forum of Eurocities, the networkof major European cities, looked at therelationship between health and transportfor the first time, when it met in Lancaster.
The forum, hosted by Lancashire County Council, heard fromspeakers including Prof John Ashton. North West EnglandDirector of Public Health, Phillip Insall from national walking andcycling charity Sustrans, and guests from Trondheim in Norway,Apeldoorn in Holland and Genoa in Italy, who presented casestudies of their work to improve accessibility of health services.
Stuart Wrigley, head of transport policy at Lancashire CountyCouncil, said the meeting was timely: ‘As we prepare for the nextLocal Transport Plan we are having to thoroughly consideraccessibility issues.’
New working groups on road safety and urban transport planslooked at issues such as public health, social exclusion andcasualty reduction.
A policy statement and presentations from the event are on theEurocities website.
www.access-eurocities.org
www.transportforlancashire.com/lancaster2005
www.transportforlancashire.com/europe
Eurocities focuses on health and sustainable mobility
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The new national strategy, Health, Work and Wellbeing -Caring for our Future1, is a crucial part of delivering on theGovernment’s commitment to improving the health andwellbeing of the working age population and is a centralelement of the wider welfare reform agenda that is set out inChoosing Health. It seeks to break the link between ill healthand inactivity, to encourage good management ofoccupational health and to transform opportunities forpeople to recover from illness at work while maintaining theirindependence and sense of worth.
The delivery of this ambitious agenda will be overseen by anew National Director for Occupational Health, with theoverall vision of supporting individuals to fulfil their potentialin contributing to society, enabling employers and theeconomy as a whole to gain from this potential, and ensuringequal rights and opportunity for all.
A North West strategy on workplace health came a stepcloser when representatives from more than 30 organisationsattended a stakeholder event in Preston, hosted by theRegional Workplace Health Co-ordinator and the North WestWorkplace Health Network.
Taking account of the issues identified by stakeholders andworking within the context of Choosing Health and Health,Work and Well-Being – Caring for our Future, theNetwork Group is currently finalising a draft strategy forwider consultation.This strategy will include an action planfocused on two priority areas:
Employment and health
Improve health through tackling worklessness, improvingaccess to employment and increasing diversity within theworkforce.
Improving working conditions
Maintain and improve health through ensuring a safe,healthy and supportive working environment, providingaccess to occupational health support and encouragingeffective workplace health promotion interventions.
In addition, the action plan will highlight a number of keycross-cutting themes, including:
■ building the capacity and competence of the wider publichealth workforce
■ developing and communicating the evidence base forworkplace health
■ developing corporate social responsibility.
One mechanism intended to deliver the action plan isWorkplace Health Connect, the subject of a successfulfunding bid to the Health and Safety Executive by ENWORKS,a North West environmental business support programme.The funding is specifically for projects focusing onoccupational health, safety and return to work.
Workplace Health Connect will help businesses with up totwo worksite visits, toolkits, an employee questionnaire andassistance with return to work.1 HM Government (2005) Health, Work and Wellbeing - Caring forour Future. London: Department of Work and Pensions,Department of Health and the and the Health and SafetyExecutive
Contact: Healthy Settings Development Unit:[email protected] 893765
Dan Aris, Enworks [email protected] 236 6348
Workplace health developments...continued from front page
A number of theories attempt to explain the relationshipbetween humans and nature. Of these, the Biophilia Hypothesis,developed by Wilson (1984) and expanded by others, is possiblythe best known. This states that, early in human evolution, therewas an evolutionary advantage in knowing about the naturalworld and that we continue to rely intellectually, emotionally,physically and spiritually on our affiliations with nature.
Nature and green space have the potential to enhance physical,mental, spiritual, social and environmental health. Evidence forthe benefits of nature for human health and well-beingdistinguishes between viewing, being in and interacting withnature (e.g. Maller 2002a, 2002b; Pretty et al 2005):
Viewing nature appears to improve recovery and healing, mentalhealth and self-reported wellbeing and decrease crime and fearof crime. Being in nature helps mental health, cognitivedevelopment and functioning, reduces attention deficit disordersymptoms in children, and enhances emotional recovery anddevelopment of self esteem, according to the research.Interacting with nature, from allotments to mountaineering,improves mental health, social interaction, community cohesionand perceived wellbeing and reduces risk factors forcardiovascular disease.
So, what are the implications of this for healthy settingsdevelopment? We can focus on nature as a setting, andmaximise opportunities to bring nature into settings.
Recent years have seen an increased focus on the role of parksand green space as settings for health, with research and actionon the health benefits of parks in Australia. In England, initiativessuch as ‘Walking the Way to Health’ and ‘Green Gyms’ have
highlighted the value of nature as a setting, supported by agrowing body of research.
Earlier this year, a concordat signed by the Countryside Agency,English Nature, the Forestry Commission England, Sport Englandand the Association of National Park Authorities pledged to makethe outdoors accessible and available to people for theirenjoyment and physical and mental wellbeing.
The importance of nature and green space within particularsettings has been highlighted by the research. This has confirmedmuch traditional wisdom about hospital gardens for recuperationand healing; prison gardens for increasing physical activity,contributing to biodiversity and developing skills, understandingand respect for the natural environment; and school gardens forholistic education and development. The WHO Healthy CitiesProject has also consistently prioritised green space in urbanplanning.
Despite all this, there is a continuing tendency to view nature asmarginal to public health. Ironically, it might well be the lack ofrespect for our planet that serves as the much-needed catalyst toreconsidering our priorities. The modern environmental crisis, ofdepleted natural resources, global warming and ‘natural’disasters, is viewed by many as symptomatic of a fundamentalrupture of the human relationship with the natural world – andrepairing this might prove to be one of the most urgent publichealth tasks.
Discussions are underway about convening a North WestEnvironment and Health Group - for further details, see contactsbelow.
Mark Dooris
The environment and health agenda has tended to focus on the negative impacts of the
environment on health, such as the effects of pollution. However, there is a growing body
of evidence for the positive contribution of green space and nature to health and wellbeing.
ReferencesMaller, C., Townsend, M., Brown, P. & St Leger, L. (2002a) Healthy Parks, HealthyPeople: The Health Benefits of Contact with Nature in a Park Context – A Review ofCurrent Literature. Melbourne: Deakin University.www.parkweb.vic.gov.au/resources/mhphp/pv1.pdf
Maller, C., Townsend, M., Brown, P. & St Leger, L. (2002b) Healthy Parks, HealthyPeople: The Health Benefits of Contact with Nature in a Park Context – AnAnnotated Bibliography. Melbourne: Deakin University.www.parkweb.vic.gov.au/resources/mhphp/pv2.pdf
Pretty, J., Griffin, M., Peacock, J., Hine, R., Sellens, M. & South, N. (2005) ACountryside for Health and Wellbeing: The Physical and Mental Health Benefits ofGreen Exercise. Sheffield: Countryside Recreation Network
Wilson, E (1984) Biophilia. Cambridge, Mass: Harvard University Press.
nature and health
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ContactsMark Dooris Tel: 01772 893760 [email protected]
Jackie Brennan Tel: 0161 952 4289 [email protected]
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Commissioning healthiercateringInvesting in a Healthy Workforce- guidance to help specify healthier catering
The food we eat has a major impact onour health. Eating a healthy and balanceddiet can help improve our health andwell being in both the short and thelonger term. Increasing fruit & vegetableconsumption is the second most effectiveprevention strategy for cancer, afterreducing smoking.
However, in a working environment, it is not always easy toachieve a balanced diet, due to limited choice of healthier foodoptions. All too often high fat, high salt and high sugar foods arethe norm, with very little availability of fresh fruit, vegetables orsalads.
As employers and hosts everyone has a role to play in ensuringthe health and well-being of employees, colleagues and guests.Those with the responsibility for provision of hospitality shouldensure that offering healthier food options at meal andrefreshment times is standard practice.
New Healthier Catering Guidelines have been written by theNorth West Food & Health Task Force. They are designed toensure that individuals responsible for organising any cateringprovided to staff, colleagues and visitors includes healthy options.The Guidelines can be applied or specified in various situationsincluding general catering, hospitality provision, meetingrefreshments and conference catering.
The specification for catering should always be for healthieroptions and all caterers should be able to offer a range fromwhich you can make your selection. If these options do notappear on standard menus, make specific requests for them anddo not be afraid to challenge caterers to offer a wider range ofhealthy options. Healthy options do not necessarily have to costmore than those offered as standard. Be prepared to challengeadditional costs which seem excessive.
Details of how to obtain a copy of the Guidelines will be postedon the NW Food & Health website by the end of October. Visitwww.foodandhealthnw.co.uk
Integrated transport in PrestonA sustainable transport pilot project willrun in Preston from 2005 to 2009,trialling alternative fuels, mobility andtraffic management, linked to similarwork in La Rochelle in France andPloiesti in Romania.Lancashire County Council will lead the Preston partnership inthe project, known as SUCCESS (Smaller Urban Communitiesin Civitas for Environmentally Sustainable Solutions), aresponse to the European Commission CIVITAS II programme.
Initiatives will include hybrid buses using biofuel, ‘clear zones’with improved traffic regulation, a new parking pricing policyincluding smart cards, more frequent bus services on 18routes, better passenger facilities and a central bus controlcentre.
Car sharing and car clubs will be promoted, goods distributionwill be better managed, plus travel plans for business andschools and telematics to improve management and publicinformation.
Contact: Richard S Clarke, Lancashire County Council,01772 532216, [email protected]
www.transportforlancashire.com
www.civitas-initiative.org
‘Healthier Inside’ is a two-year project run by the NationalChildren’s Bureau to support and develop innovative policy andpractice to meet the health and well-being needs of youngpeople in custodial settings. The project, funded by theDepartment of Health, aims to support the ‘whole prisonapproach’ to health promotion.
The first year has been taken up with a literature review, anational mapping exercise, and consultation with young peopleand staff at five sites.
Emerging findings highlight the many challenges faced by staff inmeeting the often complex health and well-being needs ofyoung people in this setting. But many of the young people feltthat going into custody provided them with positiveopportunities to improve some aspects of their health and well-being.
Key challenges identified by staff include meeting the highmental and emotional health needs of young people in custody,and in providing often large numbers of young people withsufficient levels of attention and one-to-one support. Scope toincrease young people’s participation in decision-makingprocesses and in the day-to-day running of establishments hasalso emerged as a central issue. This can help raise youngpeople’s confidence and self-esteem as well as ensure services areresponsive to their needs.
Common needs identified by young people were more time inthe fresh air, more ‘homely’ living environments and better food(‘they should do a thing like Jamie Oliver did in schools but foryoung people in prison’).
Young people said that they valued good relationships with staff.Staff and young people stressed the importance of ensuring thatany improvements to their health and well-being made incustody are supported and maintained when they make thetransition back into the community. Many young people raisedconcerns about the lack of suitable housing, personal supportand education and training opportunities available during thistransition.
Healthier InsideImproving the health and well-being of young people in custody
A report summarising the findings and recommendations fromthe first year of the project is now available. A national seminarto discuss the recommendations and plan how we will take themforward is also planned. One possibility is a framework or tool tosupport institutions to plan and implement holistic approaches toimprove the health and well-being of this vulnerable group ofyoung people.
Contact: Ellie Lewis Project Development Officer0207 [email protected]
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The National Institute for Mental Health in England (NIMHE) NorthWest Development Centre has match-funded the project, whichbegan in April 2005. Whilst the pilot has a number of defined‘project deliverables’ which include enrolment with the EuropeanNetwork for Health Promoting Hospitals and the delivery ofChoosing Health, the underlying objective is to set in place aframework to foster long term change.
Patients detained within High Secure Mental Health Services facesignificant barriers to health. The implications of mental disorderon health are well recognised as are the health inequalities forpeople with mental health problems, before we factor in acompulsory treatment order and life behind a five metre high wall.But Ashworth isn’t just the compulsory home to 250 malepatients, it is a workplace for more than 1500 employees, and forthose workers the hospital presents its own particular influences onhealth.
Ashworth Hospital is a complex setting: it is a home, a workplace(for staff and patients), a place for recreation and socialising, aneducation centre and of course a hospital where patients stay, onaverage, for eight years.
It would be optimistic to expect sweeping changes within the 12months of the pilot. However, changes to the hospital’s structuresand systems are beginning to show signs of progress.
A pilot steering group is established, led by Karen Howell, theHead of Secure Services in Mersey Care. Members include DeniseMorris, National Co-ordinator of the Health Promoting Hospitals
Network; Michelle Baybutt, Regional Healthy Prisons Co-ordinator;Jude Stansfield, NIMHE; and a patient.
Beneath the Steering Group sits the Health Promotion ActionTeam, which meets every month and has overarching responsibilityto deliver Choosing Health.
An application to the European Network for Health PromotingHospitals has been submitted, identifying patient wellbeing, healthin the workplace and tobacco as areas of collaboration.
The European Network’s ‘Self Assessment Toolkit’ was notintended for a mental health service, but has been used for thefirst stage of self assessment. Priorities have been identified and anaction plan is being finalised.
A key feature of the pilot is a health needs assessment for patientsand staff, undertaken with Edge Hill University’s Centre for HealthResearch and Evaluation. Dependent on consent, every patient willgo through a structured interview with their internal care co-ordinator and all employees will be given a questionnaire.
An Action Learning Set has been established and will sharelearning from the pilot across the eight mental health trusts in theNorth West.
As we enter the second half of the pilot’s 12 months, we are closeto knowing the work before us. The next six months will put thatknowledge to good use.
Contact: Stuart Eales, Co-ordinator Health Promoting Mental Health [email protected]
Promoting health in a high secure hospital
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Ashworth Hospital, which provides High Secure Services as part of Mersey Care NHSTrust, is now almost half way through its Health Promoting Mental Health Service pilot.
Acute and public health colleagues were challenged to discussand agree current public health priorities for acute healthcareproviders, and identify methods of support, at a recent regionalevent.
The challenges facing acute trusts in the North West in deliveringtheir public health mandate are commitment; capacity andcompetence, it was agreed.
An overarching goal was proposed, to establish every acute trustwithin the region as a health promoting organisation and toinvolve every trust employee in promoting health. This can onlyhappen in an organisation that is fundamentally committed tothe improvement of health, not only of its patients, but also itsstaff and the wider community.
A self assessment toolkit, developed by the WHO HealthPromoting Hospitals network, is available free of charge to allacute trusts, and is a useful first step in helping them to assesstheir public health commitment and capacity.
An independent secretariat for the HPH network has beenestablished at the WHO Collaborating Centre for Evidence basedHealth Promotion in Hospitals, Copenhagen, Denmark. It will beresponsible for administration, communication, a website,establishing a HPH library, developing the HPH database and forencouraging research.
Lancashire Teaching Hospitals NHS Foundation Trust andStockport Hospitals NHS Foundation Trust have joined in aninternational study examining the potential of coding healthpromotion activity within hospitals.
The 13th international conference of the WHO HPH network inDublin earlier this year, the largest ever, took empowerment as itstheme, covering empowerment of patients, staff and vulnerablegroups. Next year’s international conference, in Lithuania fromMay 24 to 26, will focus on the management of chronic disease.
Contact: Denise MorrisNational Health Promoting Hospitals Co-ordinator01772 [email protected]
Acute trusts challenged on public health
Healthy settings (general)Healthy Settings Development Unit: Marilyn Dobbs 01772 893765; [email protected]; www.uclan.ac.uk/hsdu
Cities, communities and neighbourhoodsHealthy Communities Collaborative: 0161 236 1566; [email protected]/scripts/default.asp?site_id=4
Liverpool Healthy City Project: Julia Taylor0151 285 2322; [email protected]
Manchester Joint Health Unit: Colin Cox0161 234 3391; [email protected];www.manchester.gov.uk/health/jhu
Neighbourhood Renewal [email protected]; www.neighbourhood.gov.uk
Clubs/NightlifeClub Health (Liverpool John Moores University): Karen Hughes0151 231 4384; [email protected]; www.clubhealth.org.uk
FoyersThe Foyer Federation020 7430 2212; [email protected]; www.foyer.net/mpn
Halton Foyer: Andy Guile 01928 591680; [email protected]
Further Education CollegesHealthy Colleges Network: Kate Birch01484 652341; [email protected]
Healthy Settings Development Unit: Sharon Doherty 01772 893761; [email protected]; www.uclan.ac.uk/hsdu
Healthy Care (Looked After Children)Liverpool Healthy Homes Initiative: Carol Murdoch0151 293 3528; [email protected]
Healthy Care Programme: Helen Chambers (NCB)0117 317 9606; [email protected]; www.ncb.org.uk/healthycare
Healthy Care (Older People)Lancashire County Council: Alex Sunderland01772 534449 [email protected]
Health and Social Care (Hospitals and Trusts)English National Health Promoting Hospitals Network: Denise Morris01772 893763; [email protected]
Lancashire Teaching Hospitals NHS Trust: Denise Morris01772 522627; [email protected]
Prisons and the criminal justice systemNorth West Healthy Prisons Network: Michelle Baybutt01772 893764; [email protected]
Healthy Prisons Programme, UCLan: Paul Hayton01772 895574; [email protected]
Prison Health (National): Paul Hayton; [email protected]/PolicyAndGuidance/HealthAndSocialCareTopics/PrisonHealth/fs/en
WHO Health in Prisons Project www.hipp-europe.org
SchoolsHealthy Schools Programme (North West): Ian Dixon 07939 [email protected]
National Healthy Schools Programme, Head of Unit: Sam Mellor 020 7972 [email protected]
WorkplacesNorth West Workplace Health Network Group: Charlie Kavanagh, Group Secretary0151 236 6608; [email protected]
Workplace Health Practitioners Network: Libby Sedgley, Regional Healthy WorkplaceCo-ordinator; 01772 893762; [email protected]
Healthy Workplaces – information, links and local contacts:www.uclan.ac.uk/facs/health/hsdu/settings/workplace.htm
Universities University of Central Lancashire: Sharon Doherty 01772 893761; [email protected]; www.uclan.ac.uk/facs/health/hpu
Contacts and links
AcknowledgementsThanks to:Kate Birch, Helen Chambers, Richard Clarke, Ian Dixon, Marilyn Dobbs,Sharon Doherty, Claire Drury, Phillip Insall, Dominic Harrison, Paul Hayton,Marie Hughes, Jackie Jarvis, Ellie Lewis, Phil McGrath, Denise Morris, Vicky Putt, Emma Reed, Katie Roberts, Emma O’Sullivan, Libby Sedgley,Jude Stansfield, Julia Taylor and anyone we’ve forgotten!
PhotographsMark Dooris, Sustrans
Produced in collaboration with the Department of Health
Printed on 75% recycled paper
Compiled by Michelle Baybutt and Mark Dooris
Edited by Andrew Hobbs
Designed by Nikki Moore, Printing Services, University of Central Lancashire
Further Details: Marilyn Dobbs, Healthy Settings Development Unit, Lancashire School of Health andPostgraduate Medicine, Faculty of Health, HA221, University of Central Lancashire,Preston PR1 2HE01772 893765 [email protected]; www.uclan.ac.uk/hsdu
The Healthy Settings Development Unit has received funding from the agencies below. Theviews represented in this newsletter are not necessarily the views of the funding bodies
Cheshire and Merseyside SHA
International conference on Health Promoting Universities
The University of Alberta hosted the 2nd internationalconference focusing on Health Promoting Universities, VitaminC for Health Promoting University: Communication, Culture,Creativity and Change, October 3-6, Edmonton, Alberta,Canada.
During the conference participants took part in shaping thecontent of the Edmonton Charter for Health PromotingUniversities and Institutions of Higher Education. This is yet tobe finalised and a draft can be accessed by going towww.healthyuconference.ualberta.ca, under ConferenceProceedings. This section also has copies of key notepresentations from the conference.
Sharon Doherty, from UCLan, attended the conference andpresented a workshop. A number of international contactswere established with a view to developing futurecollaborations.
The next conference will be in Mexico in 2007.