A community-led intervention to reduce health inequalities related to physical activity and healthy eating EXECUTIVE SUMMARY BASELINE REPORT “My Health Matters”

Rachel Davey and Gemma Hurst Centre for Sport, Health & Exercise Research, Faculty of Health, University.

Graham Smith Institute for Environment, Sustainability & Regeneration Faculty of Sciences, .

Project Leads at NHS Stoke: Siu-Ann Pang, Senior Lead for Obesity and Judy Kurth, LSP Strategic Co-ordinator.

Acknowledgements

The My Health Matters project is funded by NHS Stoke-on-Trent PCT.

We would like to thank the following people and organisations for their help with this project:

Siu-Ann Pang, NHS Stoke-on-Trent Primary Care Trust, Senior Lead for Obesity. Judy Kurth, NHS Stoke-on-Trent Primary Care Trust, LSP Strategic Co-ordinator.

Gill Jones, My Health Matters, Community Development Worker for Meir North for help collecting data on commercial premises and physical activity facilities. Lisa Tomkinson, My Health Matters, Community Development Worker for Bentilee and Townsend for help collecting data on commercial premises and physical activity facilities. Marvin Malloy, My Health Matters, Community Development Worker for South for help collecting data on commercial premises and physical activity facilities. Dave Wheat, Chief Executive Officer, Changes.

John Nichol, Transport Planning Manager, North Staffs Regeneration Partnership for allowing access to Transport Planning data sets. Chris Oakley, North Staffordshire Regeneration Partnership, Stoke-on-Trent City Council for providing Transport Planning data sets on road traffic counts. David Wood, North Staffordshire Regeneration Partnership, Stoke-on-Trent City Council for providing Transport Planning data sets on road accidents.

Paul Rushton, Information Management Officer for Stoke-on-Trent and North Staffs Police Divisions, for arranging access to crime and anti-social behaviour­ data sets.

Christine Dover, for administrative support including the distribution of the community survey and preparing data sets for further analysis. Rosemary Duncan, for the design of this publication.

For further information or to obtain a full copy of the report contact:

Professor Rachel Davey E: [email protected] Telephone: 01782 294019

Ms Gemma Hurst E: [email protected]

Graham Smith E. [email protected]

November 2009 Executive Summary

“My Health Matters”

A community-led intervention to reduce health inequalities related to physical activity and healthy eating

Background levels and healthy eating in targeted areas within Stoke on Trent. There is growing recognition that the rising incidence of obesity is being driven by The project is based on evidence that environmental factors that affect individuals’ increasing levels of physical activity and physical activity and dietary choices. healthy eating will help to raise the low levels of life expectancy experienced The environments and neighbourhoods in by the population of Stoke on Trent. It which we live, and with which we interact, acknowledges that the voluntary and have become ones that encourage lifestyle community sector are best placed to reach choices that decrease physical activity the often ‘unseen’ and ‘unheard’ people in and encourage over consumption of food our communities that we specifically wish to stuffs. Recent research in the area related engage with in terms of promoting a desire to obesity signal a simple, evolutionary shift and motivation for improved health. away from individually orientated theories to broader, more environmentally based “My Health Matters” project approaches for understanding and altering the wider environmental determinants of The project aims to develop and to evaluate health behaviours. a community-led intervention to reduce health inequalities by increasing physical There is a strong link between the built activity and promoting healthier eating as environment, health outcomes and defined by community members themselves. inequalities in health. Elements of the The project will focus on areas within three built environment can negatively impact deprived wards in Stoke on Trent (Burslem upon levels of physical activity and healthy South, Weston & Meir North and Bentilee eating. & Townsend), each is similar with regards to socio-economic status (i.e. in the bottom The “My Health Matters” project has 40% of the Index of Multiple Deprivation been designed specifically to help build 2007). The project will be conducted in four partnership with statutory healthcare phases over a 3 year period; some phases providers, the local voluntary and will be ongoing and may overlap; community sector to help meet the challenge of increasing physical activity

1 These measures describe aspects of the Phase I: Produce a detailed baseline environment that can either have a positive map of the built environment in each or negative influence on health behaviours of the three wards using Geographical and health outcomes. All GIS measures have Information Systems (GIS) at the level of been calculated around every residential Lower Super Output Area and integrate address within the targeted study areas. this with information obtained from a

community postal survey. A postal community survey of randomly selected addresses from the publicaly Phase II: Develop effective partnership available Postcode Address File across the between Staffordshire University, key three target areas was undertaken between professional stakeholders in health July and September 2009. and the community in order to design neighbourhood interventions and to Overall, the response rate to the engage local community residents questionnaire was low (12.3%), however, through community health forums respondents were representative of the designed to strengthen community study population in terms of gender, socio- involvement and participation. economic status and ethnicity. The following were included in the survey; individual’s Phase III: Based on the partnership socio-demographic details, including, consensus, identify, prioritise and design gender, age, ethnicity, marital status, pragmatic intervention(s) that address household characteristics, employment specific environmental disparities related status, education level and vehicular to physical inactivity and healthy eating. access.

Phase IV: Pilot the intervention(s) in Validated measures of perceived health order to test process, implementation were measured (SF12 health survey) and the and effects of this approach to increasing Neighbourhood Environment Walkability physical activity/healthy eating. Scale was used to assess residents’ perceptions of their neighbourhoods related The Executive summary presents key to physical activity and environmental findings from Phase 1: GIS mapping of characteristics i.e. proximity to and ease of the built environment and the community access to retail stores, shops, restaurants, postal survey. local amenities, street connectivity; footpaths, aesthetics; traffic safety; and The environmental factors which have safety from crime. been mapped included; convenience and proximity of physical activity spaces, Social Capital questions were taken from greenspace/leisure facilities from resident’s the Health Survey for , 2002 and homes, neighbourhood connectivity and included; trust and reciprocity, participation walkabilty, land use mix and population in community organisations, access to density, traffic, safety and crime, food services, satisfaction / enjoyment of living in outlets and restaurants. the local area, length of residence in area /

2 neighbourhood, perceptions of anti-social 300m walk of ‘excellent quality’ green behaviour. space e.g. Meir North and the Grange respectively. Levels of physical activity were assessed • 43.6% (Burlsem South), 4% (Bentilee by the International Physical Activity and Townsend) and 0% (Meir North) Questionnaire (IPAQ) – recommended by of households were within 300m of the World Health Organisation. ‘excellent quality’ green space.

In addition, daily fruit and vegetable Access to local amenities and consumption was used as a proxy measure services of healthy eating. This was measured in • Overall there were a high proportion terms of the percentage of respondents of households within 500m walking eating the daily recommended level of 5 distance of shops, services and portions of fruits and vegetables per day. amenities (ranging from 83-90%) across the three areas.

A. Key findings from the GIS Access to fast food and fresh food mapping of the built environment. outlets Burslem South In general the environments of all three • 98.6% of households were within 500m areas were not supportive of healthy living, of a fast food outlet. did not facilitate physical activity and did not • 21.3% were within 500m of a fresh food help to promote healthy eating. There was retail outlet. a lack of local access to fresh food outlets and a large number of fast food outlets. Bentilee and Townsend There were a large number of residents • 79.9% of households were within 500m within 300m walking distance of large areas of a fast food outlet. of green space, but these spaces were of • 32.6% were within 500m of a fresh food poor quality e.g. poorly maintained, no retail outlet. facilities on them, not functional or properly maintained/managed. Physical activity Meir North facilities were within walking distance for • 68.8% of households were within 500m some of the population but some areas had of a fast food outlet. very few within walking distance. • ‘None’ were within 500m of a fresh food retail outlet. Access to Green Space • Overall there was a high level of local Access to physical activity facilities access to unrestricted green space • Some areas such as Bentilee and across the three wards ranging from Townsend had reasonably good access 76%-96% of households within 300m (67% of houses within 300m walking walking distance. distance) to local physical activity • However this varied when the quality facilities e.g. leisure centres, gyms, of greenpace is considered; some areas church halls and community centres, had 0% and 3% of households within

3 whereas in other areas there was poor • Negative characteristics included; access e.g. Meir North (3% of houses Aesthetics (e.g. lack of trees, attractive within 300m). areas to walk), traffic hazards (e.g. volume, speed and traffic accidents) Road traffic and road accidents and crime. • The level of road traffic on major roads across all three areas was high (over Social Capital 5000 vehicles per day). • Most people surveyed enjoyed living in • There are areas with higher road their area with individuals on average accidents e.g. around Bucknall and living in their neighbourhood for over Townsend Estate and Lyme Road 20 years. (Meir). • Across all three areas, there was low perception of trust of others. Crime and anti-social behaviour • One-third of survey respondents • Crime and anti-social behaviour was participated in groups or organisations highest in Bentilee and Meir North. (e.g. church groups, social clubs). • Perceived access to local leisure and physical activity facilities was low. B. Key Findings from the • Many perceived problems with Community Survey teenagers and vandalism in the area.

General Health (SF12) Physical Activity (IPAQ) • Overall self-reported health was lower • Approximately 70% were sedentary than average compared to England. and not reaching 30 minutes of accumulated moderate physical activity Healthy Eating on 5 days of the week. • In all three areas the majority of • Active transport and leisure time the population were not eating the physical activity accounted for the recommended portions of fruit and lowest contribution to weekly activity. vegetables (e.g. Burslem South; 79.1% • Most physical activity reported was < 5 portions per day, Bentilee and related to work. Townsend; 74% < 5 portions per day, Meir North; 69.2% < 5 portions per References: day). Brazier JE et al. The estimation of a preference-based measure of health from the SF-12. Med Care Perception of the Neighbourhood 2004; 42(9):851-859. Department for Communities and Local Government. Environment for Walkability Index of Multiple Deprivation 2007. London: (ANEWS) Department for Communities and Local Government. • Positive characteristics included; Land International Physical Activity Questionnaire. August use mix (access & diversity of local 2004 http://www.ipaq.ki.se/. Neighborhood Environment Walkability Scale (NEWS) – amenities/services), infrastructure and Abbreviated [http://www.activelivingresearch. safety for walking (e.g. pavements, org/files/NEWS_Abbreviated.pdf]. Office for National Statistics (ONS)www.statistics.gov.uk/ paths, road connectivity). socialcapital

4 Recommendations for • for traffic calming measures and community consultation and speed enforcements on key roads. action Taking a transformative approach Directions for policy change - targeted local area programmes involving the community which address • Local government and business can specific problems identified in each of partner to sponsor clean up and maintenance of parks, green space. the three areas (Burslem South, Bentilee/ Townsend and Meir North). • Local procurement – work with local shops and cafes (and subsidies rent/tax) in the provision of fresh food produce • Raise the profile of the “My Health such as fruit and vegetables. Matters” project and actively engage • Policy-makers can engage in public- key community members in project private partnership with developers to development and implementation. identify areas of land to be developed • Offer training opportunities for local for small scale grocery retail. residents/volunteers in community • Offer incentives to local stores that sell consultation, design and delivery of fresh produce – fruit and vegetables. identified interventions. • Government officials can provide • Develop areas of local green space guidance and technical support in improving quality, functionality and helping to establish social enterprise implement low cost interventions that schemes such as door-to-door fruit/ reach a large number of the target vegetable delivery, “grow your own”, populations. “garden-to-home” schemes, cafes and • Identify green spaces that can be used “soup kitchens” linked to the growing for community gardens/allotments. of local produce. • Explore opportunities for community • Develop a pedestrian and bicycle collectives and social enterprise around master plan that assesses the local ”mobile markets” for fresh fruit environment for pedestrians/cyclists and and vegetables. provides infrastructure improvements to enhance safety and walkability. • Optimise use of local physical activity facilities by providing appropriate • Local planners to identify the balance activities, advertising widely and of green grocery stores and take away utilizing church halls, community fast food outlets – use zoning policies venues, libraries, school facilities (out of to ensure that the density of fast food school time and in school holidays). outlets is limited. • Raise levels of awareness of existing • Create public-private partnership with physical activity classes/groups running local gyms, leisure centres to provide in the area and develop capacity to greater access to facilities at lower increase the number and range of costs. activities provided. • Develop joint-use agreements of local • Local supervision: target crime venues such as community centres, prevention and street security – public places, schools for use of community policing and increase facilities after school hours and in opportunities for organized Youth school holidays. Activities/Groups.

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