Healthy Communities

cyllidwyd gan Lywodraeth Cynulliad Cymru. Cynulliad Lywodraeth gan cyllidwyd

(Anghydraddoldebau Iechyd), (2002 - 2008), - (2002 Ceredigion Iechyd), (Anghydraddoldebau A toolkit to help organisations and

Seiliedig ar brofiad prosiect "Calon Lân" Lân" "Calon prosiect brofiad ar Seiliedig groups in Ceredigion promote healthier lifestyles

yng Ngheredigion i hybu dulliau iachach o fyw o iachach dulliau hybu i Ngheredigion yng Based on the experience of the "Healthy Heart"

Pecyn cymorth i helpu sefydliadau a grwpiau cymunedol grwpiau a sefydliadau helpu i cymorth Pecyn (Inequalities in Health) project, Ceredigion (2002 - 2008),

funded by the Welsh Assembly Government. Cymunedau Iach Cymunedau

Argraffwyd ar bapur wedi'i ailgylchu ac ddefnyddio inciau argraffu llysieuol. llysieuol. argraffu inciau ddefnyddio ac ailgylchu wedi'i bapur ar Argraffwyd

www.zodshopdesign.co.uk amgylchedd i'r cyfeillgar dylunio zodshop l l

helen.jones@nphs..nhs.uk [email protected]

01570 424107 01570 01970 633395 01970

Llanbedr Pont Steffan SA48 7HA 7HA SA48 Steffan Pont Llanbedr SY23 2NL 2NL SY23 Aberystwyth

Y Bryn, Heol y Gogledd, Gogledd, y Heol Bryn, Y 15-17 Ffordd Portland Portland Ffordd 15-17

Tîm Iechyd Cyhoeddus Ceredigion, Ceredigion, Cyhoeddus Iechyd Tîm Ymlaen Ceredigion, Ceredigion, Ymlaen

Cysylltwch â: Cysylltwch

Alan Whittick, Swyddog Datblygu Cymunedol Datblygu Swyddog Whittick, Alan

Ymlaen Ceredigion: Ymlaen

Rhian West, Gweithiwr Hybu Iechyd Hybu Gweithiwr West, Rhian

Tîm Iechyd Cyhoeddus Ceredigion: Cyhoeddus Iechyd Tîm This Toolkit has been prepared in partnership with Ymlaen Ceredigion Prosiect: y Swyddogion

and the Ceredigion Public Health Team.

Ymlaen Ceredigion a Thîm Iechyd Cyhoeddus Ceredigion. Cyhoeddus Iechyd Thîm a Ceredigion Ymlaen Project Officers: ag partneriaeth mewn hwn Cymorth Pecyn y Paratowyd

Ceredigion Public Health Team: Rhian West, Health Promotion Practitioner

Ymlaen Ceredigion: Alan Whittick, Community Development Officer

Contact: Ceredigion Public Health Team, or: Ymlaen Ceredigion, Y Bryn, North Road, 15-17 Portland Road, SA48 7HA Aberystwyth SY23 2NL 01570 424107 01970 633395 [email protected] [email protected]

Designed by zodshop ● environmentally sensitive design ● www.zodshopdesign.co.uk Printed on 100% recycled paper using vegetable based inks. Toolkit Contents:

2 Organisations and groups who took part.

3 Who we are. 4 Aim of the Toolkit. 4 What do we mean by "health"? 5 Why promote healthy lifestyles? 6 Why are community organisations well placed to promote healthy lifestyles?

7 Getting started…key principles. 9 The key facts about food. 11 Types of projects - food. 14 The key facts about physical activity. 16 Types of project - physical activity. 19 The key facts about smoking 21 Types of project - smoking. 22 The key facts about stress. 23 Types of project - stress.

24 Overall good practice.

26 Help! 26 Resources, training and help (Ceredigion). 29 Resources, training and help (National).

32 Service Level Agreements 34 Policy

35 Evaluation 37 Self-assessment

38 Acknowledgements. 2 HEALTHY COMMUNITIES TOOLKIT

Organisations and groups who took part in the Healthy Heart programme in Ceredigion: l Ceredigion Local Health Board l Surestart l Ceredigion County Council l Homestart l Ceredigion Health Alliance l Flying Start l Ceredigion Association of Voluntary Organisations (CAVO) l Women's Aid, Aberystwyth l Area 43 (Youth support and information centre) l Family Centre l Primary Health Care Teams in Aberystwyth l Residents of Golwg y Castell and Ridgeway, (Ystwyth Medical Practice, Church Surgery, Padarn Cardigan Surgery) and in Cardigan (Ashleigh Surgery) l Cardigan Toy Library, Maesglas l Ceredigion Healthy Schools Scheme l Penparcau Youth Club l National Smoking Cessation Service l Jigso - Children's Centre, Cardigan l University of Wales (Dept. of Sport and Exercise Science l Cardigan and Aberystwyth after schools Clubs and Dept. of Leisure) l Ceredigion Pupil Referral Unit l Communities First, Aberystwyth l Plascrug Leisure Centre l Ceredigion Social Services l Finch Square Café, Cardigan l Ceredigion Youth Offending Team l Camau Bach (MYM) l Ceredigion Pupil Referral Unit l Canolfan Padarn (Day Centre) l Ceredigion Training l Cardi Cardiacs l Age Concern, Ceredigion l Crazy Fruit Club l Ceredigion WI l Crymych Leisure Centre l Cantref Housing Association l Aqua Serena Country Club l Ceredigion Local Agenda 21 l Aberystwyth Mind l Children and Young People's Partnership l Small World Theatre l Pfizer UK

l and the lead organisations - Ceredigion Public Health Team (National Public Health Service) and Ymlaen Ceredigion (a not for profit organisation promoting sustainable community development).

Small World Theatre - Riverside Festival, healthy food theme, Cardigan. WHO WE ARE 3

Who We Are: The Ceredigion Healthy Heart programme was established in April 2002. Originally a three year programme funded by the Inequalities in Health fund Ceredigion Healthy Heart Programme of the Welsh Assembly Government, it was subsequently extended and is now due to finish in March 2008. It is one of 62 Inequalities in Health projects in Wales.

The overall aim of the fund was to target areas of inequality and reduce the risk of developing coronary heart disease in ways that could be sustainable.

The Ceredigion Healthy Heart programme worked in the communities of Aberystwyth and Cardigan. Our aim has been to reduce the risk of serious illness by promoting healthy lifestyles. This meant focusing on healthy eating, physical activity and issues relating to smoking and stress.

The programme has worked with individual groups and organisations to identify ways which would make it easier for their members to either eat healthier food, increase physical activity or deal with stress and smoking issues

Within the two towns, 52 projects emerged.

Activities chosen by the participants included, fruit snacks, provision of healthy meals, recipe swaps, cooking skills, training on healthy eating, production of resources such as a Cardigan step and calorie map, production of an exercise video, community gardens, physical activity sessions, classes and equipment, awareness raising discussions and events, environmental improvement, personal mentoring, smoking cessation support and residential and other intensive programmes aimed at young people at risk.

The best results came when community leaders were able to work with both their members and their staff to bring about positive changes in lifestyles.

It was important to do this in a way which could be sustained after the project had finished and into the long term future. 4 HEALTHY COMMUNITIES TOOLKIT

The healthy heart programme showed conclusively What do we mean by health? that community organisations, given initial support and a modest level of investment from our fund, were The World Health Organisation defines health as: pleased to promote healthy lifestyles. "a state of complete physical, mental and social well-being and not merely the absence of disease Community organisations felt that the introduction of or infirmity". the healthy lifestyles agenda, especially where related to food, produced a positive response from both staff In the light of this definition, many community and members. Social interaction and communication organisations will recognise that they already make a increased and raised confidence which in some significant contribution to the health and well-being of cases led to other healthy lifestyle initiatives, such as their members. For example: group activities (e.g. walks) or smoking cessation. Many community organisations support vulnerable and hard-to-reach members of the community. They Some initiatives have had such a positive response engage with them and listen, offering advice, that participants have agreed to contribute to the reducing stress and providing a safe, positive social cost to make the initiative sustainable for the long- environment. term. Indeed, some of these organisations have health issues at the centre of their agenda, for example those supporting people experiencing mental health The Aim of the Toolkit problems.

The aim of the toolkit is to encourage and support It is important therefore for everyone to recognise that community organisations and groups to promote community organisations are already likely to be healthy lifestyles by: contributing to the health and well-being of their members in some way. l Clarifying the meaning of health Health is also about the individual staying healthy. l Identifying the potential of organisations to This includes, having access to information, making influence healthy lifestyles informed choices about health and well- being and having the confidence and self esteem to make l Identifying the benefits of promoting healthy changes. lifestyles to both organisations and members Adopting a healthy lifestyle is one of the ways of l Providing information on healthy lifestyle improving your health by enjoying healthy food, taking messages enough exercise, stopping smoking and tackling stress issues. l Providing information about resources, training and support networks, both locally and Community organisations have the opportunity to nationally. adopt an "holistic" approach to health which can be particularly effective, as it considers the whole person The Toolkit is based on the experience of the healthy and the situation in which they find themselves. heart programme's work with community It is an approach which values rather than labels the organisations. individual and identifies root causes of problems, rather than just symptoms. We hope that it will inspire you to take up the promotion of healthy lifestyles. "We will focus on health and wellbeing, not illness by using every avenue to promote healthy communities (and by) empowering individuals to take responsibility for their own health." "Designed for Life" - Health and Social Care in Wales in the 21st Century WHO WE ARE 5

Why promote healthy lifestyles?

Most people would benefit from increasing their We know that those members of the community physical activity, eating a healthy balanced diet, suffering the most disadvantages have the greatest avoiding too much stress and of course, not smoking. risk of ill health. Organisations that access this target group are particularly well placed to support changes There are immediate benefits to adopting a healthier in their lifestyle. lifestyle and being more active. Physical activity and a balanced diet help people feel better not only in Promoting healthy lifestyles fits well with many of the themselves, but about themselves. key policies and strategies which inform the development of our services and our communities here Even for those people facing particularly difficult and in Wales. This may be helpful when seeking funding. challenging circumstances, changing to a healthier lifestyle is something positive which they can achieve These include: for themselves and for their family. The Assembly Government's consultation document ‘Well Being in Wales’ which emphasises that Small changes can significantly increase our chances everyone in Wales shares responsibility for health. of avoiding illness, such as heart disease, some Government's role is to help create the conditions cancers, obesity or diabetes. necessary to help people to improve their health.

Teachers and parents consistently report better 'Health Challenge Wales' is the Welsh Assembly's behaviour and better concentration levels from children challenge for the nation. It asks organisations in the who have eaten regular, balanced meals, especially voluntary sector to do as much as they can to help breakfast and from children who have avoided some of the people who use their services and their own the additives found in fizzy drinks and sweets. employees, to improve their health.

Evidence shows that people feel better after taking The Welsh Assembly Government has developed a some form of physical activity such as a walk in the nutrition strategy called ‘Food and Well-being’ which open air. Even this modest level of activity promotes outlines the actions required to improve the diet of mental health and can help combat depression. people in Wales.

Plascrug Leisure Centre - cycling in the woods, near Aberystwyth. 6 HEALTHY COMMUNITIES TOOLKIT

The Review of Health and Social Care in Wales 2004 A wealth of local knowledge and insight about their (known as the Wanless Report) states that the members and their community which can help the demands on health care services are unsustainable in depth of engagement necessary to bring about long- the longer term and that greater emphasis on term change. preventing ill health in the first place is essential. The opportunity to bring about change, not simply by "Designed for Life" is the ten year strategy outlining telling and informing but by allowing the client group how National Health Services should look by 2015. to experience change, through seeing, doing, or "Life Long Health" is one of the Three Design Aims. tasting something new. Again, such experiences can The aim is to focus on health and well being not significantly influence change in the long term. illness by: A unique position outside the health service with its l Using every avenue to promote healthy current emphasis on treating ill-health, where communities members of the community can access advice and support on healthy lifestyle issues. l Empowering individuals to take responsibility for their own health. The Benefits to your organisation: The Ceredigion Health, Social Care and Well-being Healthy Lifestyle issues provide a focus for discussion Strategy is part of "Ceredigion 2020" which is the and activities that is beneficial to both staff and Community Strategy for the county. This is the basis clients. for developing services and is the key vehicle for taking forward the Health Challenge Wales agenda in Discussions provide an opportunity to share thoughts Ceredigion. and experiences, making clients feel included and valued.

Why are community organisations Healthy lifestyle initiatives prompt greater participation well placed to promote healthy and the opportunity for greater engagement with the client group. lifestyles? Learning new skills increases the confidence and self Community Organisations offer: esteem that is so essential for long term change. A safe and trusted environment that accesses some Staff may also appreciate being supported to live a of the most vulnerable members of the community. healthier lifestyle and they in turn can subsequently Such an environment is favourable to influencing become role models for members. change.

A relationship with the client group that allows for open discussion which is non-judgemental. This environment and relationship provide a unique platform that can significantly influence changes in lifestyle issues. GETTING STARTED 7

Getting started... Promoting healthy lifestyles is about an organisation looking at the factors that influence health and taking up those that best suit the organisation and its members. This may be healthy eating or physical activity, stress or smoking. In our experience healthy eating has been a popular issue with which to start. It has helped organisations and their members develop their confidence and subsequently go on to introduce other aspects of healthy lifestyles.

Reflect on your own organisation… what health messages does your organisation give? For example: Do you offer fruit as a snack option? Do you provide healthy meals? Does a health initiative have a place in the future aims of your organisation?

How do you see a health initiative possibly benefiting your organisation, its staff and its members?

Look at different types of projects either from the experience of the"Helthy Heart Project" (See "Projects") or use the websites and their links to other networks for further ideas (See "Resources").

Support of staff Assess the level of interest and commitment from your staff for a health initiative. Their support is crucial for its success.

Assess the resources available amongst your staff; their level of knowledge, skills and confidence.

Identify what you need to take the initiative forward e.g. training, resources, information, support, guidance etc .See "Resources" re what is available. 8 HEALTHY COMMUNITIES TOOLKIT

Support of Members Is it Working?... Evaluation It is important for the success of an initiative that you This will involve identifying the changes your initiative talk with the people who could benefit from taking has made on the organisation and the members. action on healthy lifestyles How you evaluate needs to be considered at the beginning. There is a section in this tool kit on the Your project is more likely to succeed if your members process of evaluation. This process is particularly are involved from the start in deciding what to do and important where you need to seek future funding. how to do it. Everyone will bring with them some knowledge and experience. This needs to be Making it a part of your organisation… Policy respected and used as a baseline and a resource from A policy can help identify to your staff and trustees which to move forward. It's important to start from what you are doing and why. It shows that good where people are and offer the information and practice is embedded within your organisation. This support in a way that is acceptable and promotes tool kit contains an example of what you may wish to confidence and self esteem. include in a policy.

All this can seem daunting, but remember the Funding incentive for change is there - no-one is likely to Funding is not always needed to start an initiative.You regret feeling and looking better. may wish to relocate existing funding or come to an agreement with the members to introduce payment Furthermore, improving their lifestyle is often eg. 10p for a piece of fruit something which is within their control, even when The healthy heart programme had an operational they are facing a range of serious problems and fund that gave financial support to the various challenges elsewhere in their lives. projects. This fund ends in March 2008. Organisations needing to access sources of funding Taking the Time should contact Ceredigion Association of Voluntary Some initiatives take time to 'bed in'. Even positive Organisations (CAVO) who have up to date changes can face pockets of resistance. This is why information on sources of funding. the support of staff and members for the initiative is Details of CAVO and other sources can be found in crucial. Holding firm is important, giving people the the Resource section. time to adjust to the change Organisations should also be mindful of the latest government initiatives on healthy lifestyles. These are Working with Others...Partnership and Networking promoted via the media and in policy documents. If It may be worth considering whether it would be your work supports government objectives, it is more beneficial to work in partnership or simply linking with likely to attract funding. another local group or organisation to share resources, support and experience. The Resource Writing Down the Detail for Funders… section lists various network web sites where ideas Service Level Agreements (SLA) and experience can be shared. If you are receiving or giving funding to improve lifestyles, you may find that a Service Level How to keep it Going… "Sustainability" Agreement helps clarify in detail what the funder and Whatever initiative you choose you need to consider the deliverer are trying to achieve. An example of the ways of making it sustainable. Training a member of outline SLA we used appears at the end of this toolkit staff rather than depending on outside skills, (page 33). resources such as books, kitchen or sports equipment are all good investments with a long term effect. Organisations often found that following initial funding, members felt so positive about the initiative they were prepared to pay towards keeping it going. Where sustainability is not possible, it will help to collect evidence of success (see "Evaluation"). This can then be used to back up any future funding application. FOOD 9 Key facts about… Food

l A third of the nation's children are now The eight guidelines for a healthy diet are: overweight or obese. l enjoy your food; l Compared to those with a healthy diet, l eat a variety of different foods; malnourished children are 51% more likely to l eat the right amount to be a healthy weight; exhibit antisocial behaviour at 17. l eat foods rich in starch and fibre; l Two in every three Britons who are overweight l eat plenty of fruit and vegetables; have a potentially life-threatening health problem l don't eat too many foods that contain a lot of fat; as a result. l don't have sugary foods and drinks too often; l Poor diets cost the NHS £6 billion a year l if you drink alcohol, drink sensibly and limit the in ill-health. amount.

The balance of good health There are no bad foods, only bad diets, say most experts. That means it is important to eat a wide Fruit & vegetables Bread, other variety of foods and include a good amount of cereals and fruit and vegetables. When it comes to healthy potatoes eating, little things can make a big difference.

Here are a few tips on healthy eating

l Try low-fat alternatives to dairy products, such as low-fat spreads instead of butter, and skimmed or semi-skimmed milk. (Skimmed or semi-skimmed milk contains a bit more calcium - good for healthy bones - than the full-fat variety). l Trim the visible fat from meat. l Grill or oven cook rather than fry. l Get out of the habit of adding salt to your food - taste it first. l Add salad to sandwiches, and choose fruit for Meat, fish & Milk snacks. alternatives & dairy foods l Check the labels. You would be surprised what Foods containing fat. some foods contain - and many 'convenience' meals Foods and drinks containing sugar are loaded with fat and salt. Use this handy guide

The balance of good health aims to give people a A lot A little practical message about healthy eating and is based Sugars 10g 2g on the 8 guidelines for a healthy diet. It shows the Total fat 20g 3g types and amounts of different foods that should be Saturated fat 5g 1g eaten to achieve a well balanced, healthy diet. Fibre 3g 0.5g The balance of good health applies to most people. Salt 1.5g 0.3g It applies to vegetarians, people of all ethnic origins Sodium 0.6g 0.1g and people who are a healthy weight for their height, as well as those who are overweight. However, it does not apply to children under two years of age Look at the fat, sugar and calorie content per 100g. How because they need full fat milk and dairy products. do they compare to the guidelines in the table above? 10 HEALTHY COMMUNITIES TOOLKIT

You should be aiming for more products that fall into What counts as fruit and vegetables? the 'little' category, only eating products that fall into l Fresh, frozen, chilled, canned, 100% juice and the 'lot' category sparingly. smoothies all count, as do dried fruit and A small amount of fat helps keep you healthy but you vegetables. need to be careful about how much you eat. This is l Fruit and vegetables don't have to be eaten on especially true of saturates, which are found in butter their own to count. You can also include any and lard as well as cakes, biscuits and pastries. vegetables found in soups, stews, sandwiches and other dishes. As the balance of good health chart shows, a healthy l Fruit and vegetables contained in convenience diet is based on starchy foods such as bread, pasta foods like ready meals, pasta sauces, soups and (particularly whole grain varieties) and potatoes, and puddings, also contribute to your 5 A DAY. at least five portions a day of fruit and vegetables. l However, these ready-made foods can be high in Add to this, small amounts of milk and dairy salt, sugar and fat, which should only ever be products, meat (or vegetarian alternatives) and fish, eaten in moderation, so it's important to check the and a little of foods containing fat and sugar. nutrition information on the labels and packaging. l Dietary supplements like vitamins and minerals do A healthy diet also contains about two litres (3.5 pints not count towards 5 A DAY. This is because many or 6-8 glasses) of fluids a day. Everything counts - dietary supplements don't have the same water, milk, and hot drinks - but not alcohol. nutritional benefits as fruit and vegetables. l Potatoes do not count. This is because they are Getting your 5 a day classified as a starchy food. They contribute to Eating at least five portions of fruit and vegetables a your healthy balanced diet, but not to your daily day is an essential part of a healthy, balanced diet. By portions of vegetables. following the 5-a-day guidelines, you could reduce the risk of cancer, heart disease and other conditions.

What is a portion? A general rule, easy to remember, is that one handful is a portion, so this means smaller portions for children who will have smaller hands.

A portion is about 80g of fruit or vegetables. This is roughly equal to: l an apple, orange, banana, or similarly-sized fruit l two plums, nectarines or similarly-sized fruit l a handful of grapes or berries l a slice of melon, pineapple or large fruit l one tablespoon of raisins or other dried fruit l two serving spoons of cooked vegetables, e.g. broccoli or carrots l a dessert bowl of salad l two serving spoons of beans and pulses l a 150ml glass of fresh fruit juice or smoothie Penparcau Family Centre - healthy snacks, Aberystwyth. FOOD 11 Types of Projects: Food

1. Fruit Snacks 2. Healthy Meals Fruit offered at break time, instead of biscuits. A healthy meal (e.g. breakfast or lunch) provided on a regular basis at low cost. Key Features l Simple and effective way of introducing healthy Key Features lifestyles. l Provides a healthy meal once a week or every day. l Low cost funding . l Can be run by volunteers or paid staff. l Both parents and children respond well. l Members should be encouraged to participate and learn about preparing and eating healthier foods. Benefits l Participation leads to the sharing of cooking ideas, l Encourages children to try fruit they may not eat at recipes, shopping and budgeting issues. home. l Requires commitment from designated members l Introduces fruit as a snack option. of the organisation to prepare and plan meals l Children ask parents to buy fruit. l Staff will have to go through the correct food and l Raises awareness and discussion about healthy hygiene training. eating l May need funding to cover the cost of food initially. l Parents proud to see their children eating fruit. l Charges for meals to fund cost of food, may vary l Parents prepared to pay to keep the fruit snacks. between asking for a minimum donation to one l Easy to keep going---sustainable based on a waged and unwaged price. l Organisations encouraged by the positive l Change of existing meals to healthy options, with response have gone on to start other health no significant cost to the organisation. initiatives. l Staff have gone on to request training on healthy Benefits eating. l Provides opportunity to taste a variety of healthy l Supports the "5 a day" initiative and the Health food. Challenge Wales directive. l Increases skills and knowledge about healthy cooking. Remember l Increases confidence to try and to buy different l Change takes time. Keep offering, as some food. children may initially be reluctant to accept fruit as l The sharing of recipes encourages clients to cook an alternative to crisps and biscuits. at home. l The initiative needs firm but supportive leadership l Prompts discussion about shopping on a budget from the organisation from the start. and where to buy. l Provides a basis to engage with the client group and helps identify other client needs. "The fruit tuckshop has been a great success from l Provides the opportunity to engage positively with the very beginning." the client group - through sitting with members to (Cardigan Family Centre Annual Report.) enjoy the food clients often become more relaxed to talk about other issues. "I'm proud that my child eats fruit. I never thought l Increases social interaction/ fun. about giving it before." l Leads to the organisation wishing to take up (Parent, Penparcau Family Centre.) further health initiatives, such as yoga classes, group walks, swimming sessions and the provision of a smoking cessation service. 12 HEALTHY COMMUNITIES TOOLKIT

Remember 4. Food Co- Ops l Success depends on the skills, attitude and A food co-operative is a group of people organising approach of the session leader. to buy fruit and vegetables in bulk direct from l Staff will need to be given the time, support and wholesalers or farmers. training to undertake the initiative. l Meals need to be available on a regular basis e.g. Key Features every Wednesday, to gain the support of members. l Increases access to fruit and vegetables. This requires commitment from the staff. l Reduces cost l Run mainly by volunteers "Provision of healthier food options on a regular, l Funding needed to buy equipment e.g. weighing consistent basis proved a springboard for scales, knife and initial float. engaging clients in other matters relating to l Continuing costs include transportation, hire of healthy living." premises and payment of volunteers' expenses. Healthy Heart Project report to Welsh Assembly Govt. l Legally, co-operatives must be a membership organisation usually run on a modest annual fee of "Coming here and having a good breakfast is the between 50p and £2 best thing that's happened to me. I've stopped drinking and just got my own flat. Thanks." Benefits (MIND client). l Increases consumption of fruit and vegetables. l Cheaper fruit and veg. 3. Training and Cooking Skills l Can provide a setting for exchanging recipes and Developing basic skills in food preparation and information about healthy eating. cooking. l Social benefit. People working together for their own community. Key Features l Volunteers can gain new skills e.g. book keeping l Participation builds confidence and develops skills. and improve their chances of employment. l Opportunity to educate about budgeting and the preparation of low-cost meals. Remember l Delivery needs to be appropriate and sensitive to l The food co-op will need consistent support and your group. commitment from volunteers. l A member of staff or external person may be used l It may require quite a lot of work and possibly to deliver programme. financial skills. l To find a reliable supply of good quality produce Benefits and suitable storage. l Practical experience in a supportive environment l It helps to have access to a supportive co-op gives the confidence to try new cooking skills at network. home. l Raises self esteem. 5. Using Arts and Crafts l Training a member of staff provides a resource for Relaying health messages to your group, using art the long-term. and craft activities as an attractive way of getting people involved. Remember l You may need to recruit or train a suitable Key Features instructor. l Popular activity can be themed around the health l For training on cooking skills and healthy eating, message. you can contact Ceredigion Public Health Team in l Everyone can be involved in these activities Lampeter. l Many organisations will already have the necessary materials. "The cooking course gave me confidence to try out new ideas and made me aware of healthy options." (Family Centre parent). FOOD 13

Benefits 6. Buying of resources l Stimulates discussion about healthy eating. The buying of equipment and materials to support l Children influence parents' choices. health initiatives. l Participation allows for greater social interaction and feeling of involvement. Key Features l Most organisations are able to supply materials l Organisations often need support to promote without significant cost. healthy eating by purchasing equipment or materials e.g. ovens, fridge freezers, basic cookery Remember books etc. (See "Resources" for funding) l You may wish to talk to or involve your local community theatre or a "Theatre in Education" Benefits company. l Food bought in bulk saves both on cost and l Funding may be needed to work with other staff time. community/theatre groups. l Ovens allow for participation / demonstration in food preparation. Small World Theatre (Cardigan) worked with residents l Books stimulate discussion about cooking and of Golwg y Castell and Ridgeway, using giant exchange of recipes. puppets and models of food options, engaging the l Books may be provided on a loan scheme to participants and the general public in identifying encourage cooking at home. healthier food choices. l Such initiatives are sustainable.

Remember l Staff will need the correct food and hygiene training before cooking with client group. l There are rules about health and safety relating to equipment and food handling-but don't be put off - these are not difficult to comply with. See Resources - Environmental Health.

Small World Theatre working with Cardigan residents at a local arts and crafts event. 14 HEALTHY COMMUNITIES TOOLKIT Key facts about…Physical Activity

Modern life is making us increasingly inactive and this gradually, you'll soon feel the difference. is proving hazardous to our health. Being active will make a difference to your quality of life. Once you start, the benefits will become obvious. Physical Inactivity l Is a serious health problem. 7 in every 10 women You'll experience: and 6 in 10 men in the UK are not active enough l Improved health to benefit their health. l More energy - you'll be able to cope with your l Is a major cause of some of the UK's biggest daily routine and have energy to spare killers - heart disease, stroke, diabetes and bowel l Reduced stress - you'll relax more easily and feel cancer better about yourself l Contributes to overweight and obesity in adults l Stronger bones and muscles and increasingly in children l Better balance, strength, suppleness and mobility l Increases frailty, dependence, falls and fractures in l More independence in later life - you'll be able to the elderly Estimated cost of physical inactivity cope with daily tasks more easily (through disease and disability) in England & Wales l Improved sleep is more than £8.2 billion l Better maintenance of a healthy weight l More social opportunities - you'll meet other Recommendations people who enjoy being active Any increase in activity will benefit your health but l A sense of achievement experts agree that: l Increased enjoyment - activity can be fun and it's something you could do as a family. l Adults need to do at least 30 minutes of physical activity that makes you slightly out of breath on at TAKE CARE! least five days a week. If you have had heart trouble, high blood pressure, a l Children and young people should aim for 60 bone or joint problem that could be made worse by minutes. You can add together separate periods of exercise, or have any worries about becoming more activity to get the total. active, talk to your family doctor. Don't suddenly l If you use a pedometer to measure how far you take up very vigorous or competitive exercise like walk, 10,000 steps a day would qualify as "active". badminton or squash without medical advice. Try to do at least 5,000. l The aim is to make physical activity part of your everyday life. Health or Fitness You can build up slowly and do it in 10 minute Some people are put off becoming more active "bursts". because they think they have to work out at a high intensity, compete with others or wear a designer Why be more active? tracksuit. None of these things are necessary. Physical activity improves your physical and mental If you want to feel better and reduce the risk of ill health. It is one of the most important factors in health you should be physically active. To achieve the maintaining a good quality of life. health benefits it doesn't require the same intensity of The heart is simply a muscle, but it's the most training as becoming fit. You can simply build important muscle we've got, and it needs exercise to physical activity into your daily routine, either as a keep fit so that it can pump blood efficiently with form of 'active commuting' (walking or cycling, each heart beat. Your health risks will decrease as perhaps) or in the comfort of your home or a health soon as you start to do more. You don't have to be club. The main message is... fit to start with - build up your level of activity 'it doesn't have to be hell to be healthy.' PHYSICAL ACTIVITY 15

Tips for becoming more active l There are lots of small changes you can make to l It can be free...doing enough physical activity your lifestyle: doesn't have to cost money. l You don't have to join a gym or buy any special l Take the stairs instead of the lift equipment. l Walk part (or all!) of your journey to l You don't need to be thin or fit to make a start. work or school l Moderate activity includes brisk walking, l Go for a walk in your lunch break gardening, housework and playing with children. l Walk to the shops l Don't use the remote control to change TV channels

Medwyn Williams helping with plans for the Toy library garden, Maesglas, Cardigan 16 HEALTHY COMMUNITIES TOOLKIT

Tips on overcoming the barriers to activity. People may say that they would like to increase their activity levels but there's a barrier to doing so…

Barrier Solution

Lack of Knowledge and information Provide leaflets/education Lack of exercise partner/social support Check community schemes or organise group activity Not the 'sporty type' Emphasise the activity, not "sport" or "exercise" Financial constraints Walking is the best activity and it's free Lack of available facilities Facilities are not always necessary Lack of motivation and willpower Think about developing a buddy system where you encourage each other to be active together Fear of injury, fear of embarrassment Walking is the safest and simplest activity Don't enjoy it Try from a variety of activities and find what you like Fear of doing too much activity Start very slowly and gradually build on current levels of activity

Jigso launching the Cardigan calorie map PHYSICAL ACTIVITY 17 Types of Projects: Physical Activity

1. Group Walks 2. Taster Sessions Walks led by organisational member. May include, yoga sessions, swimming/ gym sessions at local leisure centre, use of exercise videos Key features eg. salsa dancing. l No funding required. l Walks can be varied according to age and ability Key features of group. l Type of activity may be chosen by the participants l Pedometers can be used where available. according to the interest and skills of the group l If required, training for walk leaders is available free and local facilities available. of charge through the "Walking the Way to Health" l Encourages participation. scheme. l Women, in particular, may value group support to undertake physical activity. Benefits l Funding may be required for tuition and equipment. l Feel Good factor-lifts mood. l Leisure facilities may operate reduced fees for l Pedometers increase awareness of the amount of certain groups.. walking needed to reach the recommended daily Benefit target. l Group members value the time to focus on l A varied programme of walks can be developed themselves. where the number of steps per walk can be l Increases sense of well being counted to create a group step-map. l Improves group cohesion l Participation - improves social interaction within the l Increases awareness that physical activity can group. make you feel better l Identifies walks to share with friends and family. l Can lead to other initiatives such as making your l Increases awareness of environment, local own exercise DVD. features, nature. Remember Remember l Choose a suitable activity, bearing in mind, for l Be aware of safety issues relating to suitability of walk example, that people may be sensitive about their for your group including identification of any hazards. physical appearance. l Government policy supports the funding of physical activity initiatives in the community. ( See Resources ) l On going costs means that an evaluation process needs to be in place if you want to support future funding proposals (see "Evaluation".)

"The physical activity project had the greatest influence because it helped establish routines." (Head of Pupil Referral Unit.) 18 HEALTHY COMMUNITIES TOOLKIT

3. Grow Your Own! 4. Buying of resources Creating or adapting gardens to produce fruit and The buying of equipment and materials to support vegetables. physical activity.

Key features Key Features l Involves local people in decision making l Organisations and individuals often need and planning. encouragement and support to take up physical l Brings together individual gardeners to provide activity. It may help to purchase materials such as advice and guidance. pedometers, exercise mats, sports equipment, l Area may be a plot of land, raised beds in a yard exercise videos, etc. and to pay for some tuition, or a few containers/grow bags. (e.g. Yoga) at least to start up an activity l Tools provided may be shared with other such (See "Resources" for funding). initiatives. l Organiser needs to have a good knowledge of Benefits growing and be able to relate well to people of all l Activity in a group setting helps give mutual backgrounds. support and motivation and spreads the message. l Funding may be needed for tools if donations are l Offers a variety of resources to allow the group to not available from local gardening enthusiasts. choose their starting point. l Is a good tool for increasing social interaction Benefit within the group. l Encourages people to try different vegetables l Involves people of all ages and abilities. Remember l Produce can be shared, given away or sold. l You can work with others... l Sense of achievement The Cardigan step map pictured l Raises self esteem here was produced by the l Working together Healthy Heart project in l Growing herbs can encourage people to try new partnership with the University flavourings and use less salt. of Wales, Aberystwyth and l May complement school curriculum. local residents. l Combines participation in growing food with physical activity.

Remember Ridgeway residents help make a local map l Insurance may be necessary if setting up a new showing steps taken and calories burned garden (See Resources, 14.) l A local garden centre or gardening club may know where to buy reasonably priced equipment / plants etc. and may also know of an enthusiastic gardener to act as a volunteer adviser.

The Healthy Heart programme worked with the Toy Library in Cardigan, Ysgol Ceredigion in and Felinfach and with residents of the Ridgeway, Cardigan to establish gardens to grow fruit and vegetables.

Growing vegetables, Ridgeway Garden, Cardigan SMOKING 19 Key facts about…Smoking

l Smoking is the single greatest cause of l Tar - a sticky black residue made up of thousands preventable illness and premature death in the UK. of chemicals that stays in the smoker's lungs and causes cancer. l Just over a quarter - 26 per cent - of adults in Wales are smokers. But 27 per cent of adults in Nicotine is very addictive. But it is the tar and other Wales are ex-smokers. chemicals in cigarettes that cause cancer. Other harmful chemicals found in cigarettes include: Reasons to quit There are lots of good reasons to quit. Everyone's l Acetone - used in nail varnish remover motivations to stop will be different. Here are some l Ammonia - used in dry cleaning fluids health benefits to quitting. l Arsenic - used in pest control and insecticides The sooner you give up smoking the better. l Benzene - used in chemical manufacture l Cadmium - used in batteries After: l Formaldehyde - used to preserve dead bodies. l 20 minutes - your blood pressure and pulse return to normal Low Tar Cigarettes l 8 hours - nicotine, carbon monoxide and oxygen 'Low tar' cigarettes are just as harmful for you as levels in your blood begin to return to normal regular brands. When people smoke 'low tar' l 2 days - your lungs start to clear and your sense cigarettes they breathe in much harder, to get the of taste and smell begin to return amount of nicotine their body craves. These l 3 days - breathing is easier and your energy levels cigarettes may be carefully designed to taste weaker increase. but they are probably doing your body just as much l 2-12 weeks - circulation improves and exercise damage as the 'stronger' brands. gets easier l 3-9 months - breathing problems, coughing, Giving up shortness of breath and wheezing improve Giving up is the best thing a smoker can do to l 5 years - risk of having a heart attack falls to about improve their health. Most smokers say that they half that of a smoker would like to give up if they could. But for some, l 10 years - risk of lung cancer falls to about half stopping isn't simple. that of a smoker. You have the same risk of a heart attack as someone who has never smoked. Questions to ask before setting a quit date. l Why do I smoke? Improve your health, whatever your age. l Why do I want to stop smoking? Giving up smoking at any age will increase life l Is this the right time to stop smoking? expectancy. l When am I most likely to give in to cravings? l What can I do to overcome these cravings? l Who can support me whilst I'm giving up? What is in a cigarette? l How can I reward myself for giving up? The three main components of cigarette smoke are: l When would be a good quit date? l Nicotine - a fast-acting drug that makes smokers crave cigarettes Once you've thought about all these issues you may l Carbon monoxide - a poisonous gas that reduces need some support with quitting for good. oxygen in the blood stream causing breathing problems 20 HEALTHY COMMUNITIES TOOLKIT

Professional help Withdrawal symptoms There are professionals available to help you give up. There are several products on the market to help The NHS has a range of services on offer. These control withdrawal symptoms. Many are free on include: prescription from your GP. l The national Smoking Cessation Service in Wales Nicotine Replacement Therapy (NRT) offers various options for support, including NRT helps by reducing your nicotine cravings. It has individual or group sessions - been shown to double the chances of successfully contact 0800 085 2219 quitting. It is also less addictive than smoking and l The national Smokers Helpline is also there to offer doesn't cause cancer. NRT is available on friendly advice and support - prescription or over the counter as gum, patches, contact 0800 169 0 169 tablets, lozenges, nasal spray or inhalers. You usually take a 10-12 week course.

Staff and volunteers, Aberystwyth Mind drop-in centre SMOKING 21 Types of Projects: Smoking

Supporting the no smoking policy within 2. Smoking Counsellor organisations and the training of a member of your Support over a period of time, 1:1 or in a group, staff as a smoking cessation counsellor. to give up smoking.

1. Support Key Features l Needs specialist training input. Key Features l Uses either existing staff or the Smoking l Organisation supports clients with information about: Cessation service. l The national smoking cessation service. l An "advanced" intervention. l The effects of passive smoking. l The cycle of quitting Benefits l Major reduction of risk of serious illness. Benefits l Timely intervention as new law impacts on l Supports the national health message social activities. and legislation. l Responds to the wish of the majority of l Staff and clients work in an improved atmosphere smokers to give up. l Instigates discussion and information l Sets smoking cessation in a context where clients about quitting. feel safe, supported and comfortable. l Produces measurable results which can be used Remember for evidence for future funding. l Staff attitudes need to be supportive. l Smoking cessation represents a Remember significant challenge. l Consider the availability either of a suitable l May stimulate a demand for staff training on member of staff for training or of the Smoking 'brief intervention' work (see Resource section). Cessation Service. l Cost of training and staff time. l Funding would be needed for the specialist training and salary of a smoking cessation counsellor. l The cost could be taken up by the national smoking cessation service where evidence shows its effectiveness. l Might follow on from other simpler healthy lifestyle interventions which have engaged clients with, for example food. 22 HEALTHY COMMUNITIES TOOLKIT Key facts about… Stress

l Half a million people in the UK experience work- Ten tips to tackle stress related stress at a level they believe is making them ill. l Make the connection. Could the fact that you're feeling under-the-weather be a response to too l Twelve million adults see their GP with mental much pressure? health problems each year. l Take a regular break. Give yourself a brief break whenever you feel things are getting on top of you Stress means different things to different people. - get a soft drink or take a brief stroll. A situation that is intolerable to one person may be l Learn to relax. Follow a simple routine to relax stimulating to another. What you feel is determined your muscles and slow your breathing not just by what is going on around you, but how you l Get better organised. Make a list of jobs; react to it. The important point is that you learn to tackle one task at a time; alternate dull tasks with recognize how you respond to stress and if interesting ones necessary that you develop skills to deal with it. l Sort out your worries. Divide them into those that you can do something about (either now or soon) Are you under too much stress? and those that you can't. There's no point in How you may feel: worrying about things that you can't change. l Tired l Change what you can. Look at the problems that l Breathless can be resolved, and get whatever help is l Sweating necessary to sort them out. Learn to say 'no'. l Difficulty in sleeping l Look at your long-term priorities. Step back and l Depressed examine what it is about your life that's giving you l Irritable too much stress. What can you off-load, or l Neglected change? How can you introduce a better balance l Fearing you are ill between work, social life and home life? Is it time l Dreading the future to reassess your priorities? l Dreading failure l Improve your lifestyle. Find time to eat properly, l Taking no interest in life get plenty of exercise and enough sleep. Avoid l Believing you are bad or ugly drinking and smoking too much. However much l Lacking interest in others you believe they can help you to relax, they'll have l Losing your sense of humour the opposite effect. l Having no-one to confide in. l Confide in someone. Don't keep emotions bottled up. l Focus on the positive aspects of your life.

How you may behave: Learn to relax l Difficulty making decisions l Close your eyes and breath slowly and deeply. l Inability to show true feelings l Locate any areas of tension and try to relax those l Problems concentrating muscles; imagine the tension disappearing. l Avoiding difficult situations l Relax each part of the body, in turn, from your feet l Denying there's a problem to the top of your head. l Frequently crying. l As you focus on each part of your body, think of warmth, heaviness and relaxation. l After 20 minutes, take some deep breaths and stretch your body. STRESS 23 Types of projects…Stress

Unlike the food and physical activity projects, stress Benefits by its very nature was not taken up as a specific l The involvement of clients who found project by the organisations. However the food and communication difficult was helped by their joining physical activity projects, with their emphasis on in with activities. participation did much to raise self esteem and l Health initiatives helped the group focus away from improve social isolation which in turn helped to difficult issues and enabled them to see that a alleviate stress. The following aspects of stress have healthy lifestyle is something that can not only therefore been identified by analysing the take up of make them feel better but is also within their projects by participants. control. l Discussion with the group members about a Key Features health initiative showed not only that the group l Recognising that stress means different things to valued their health but also their views and ideas, different people. thereby increasing feelings of self worth l Providing time to listen to peoples' concerns and l Provision of a healthy meal was one initiative that worries is an important factor in alleviating stress. was found to give clients a reason for attending l Talking about healthy lifestyles made people more the group. Without the provision some clients comfortable to discuss other personal issues with would not have had the courage to attend and members. ultimately receive the support they needed. l A healthy lifestyle - physical activity and a balanced diet - helped greatly in dealing with stress. Remember l Participation improved skills, self esteem and l Professional help is always available through the social isolation. GP.

Young people biking in the hills above Aberystwyth 24 HEALTHY COMMUNITIES TOOLKIT

Overall Good

Practice… This is a community organisation's own description of how, with modest financial support and advice, they were able to promote healthy lifestyles right across the organisation in a positive and effective way.

"Jig-So Children's Centre initially started with a small grant from the Healthy Heart Project in 2003.This money helped start up a Fruit Tuck Shop. In consultation with users, a very important part of any project that we do within the centre, we tried to sell the fruit at a nominal cost to encourage children and adults to increase their daily intake of fruit. However, we quickly realised that our grant money was disappearing fast and the provision of fruit would not therefore be self sustaining.

During a user group meeting all users agreed that it was currently too cheap and it was suggested that the price be increased in order to keep the project running indefinitely. As a result, the fruit now retails at 15p per item and the project is self sustaining. In consultation with the Health Team, we felt that we would like to encourage further healthy lifestyle options and set up healthy cooking and food sessions, one day per week. This involved training for staff, a grant for equipment and extensive consultation with the users, management and all involved. We recognize that learning by trial and error is fine. We recognize we are not perfect and it encourages others to try.

Many things have changed. We operate an equal opportunities policy and therefore wanted to make sure people were not excluded on cost grounds. We ask for a donation of £1 per family for meals and most donate. Again it is now self sustaining and we have requests to increase the number of days - something to think about for the future. OVERALL GOOD PRACTICE 25

These sessions have prompted many comments: Grants were applied for and received (our service is "but I always cook my Sunday chicken from frozen!" free.) and though we've encountered a variety of to: "you don't have to use fatty ingredients to have hurdles: poor attendance (at first), pools closed etc. a tasty meal". with perseverance, communication and a willingness We use simple achievable recipes such as soups, to change and respond to the need, we have just pasta etc. finished a complete year of physical exercise "I used all the recipes at home, followed your advice combined with our healthy food programme. and the kids really enjoy themselves." Users are already requesting more and we look forward to the next few years of promoting and We photocopy recipes, use questionnaire sheets and supporting healthy lifestyles! constantly talk to all involved in the process. If something isn't working we ask for suggestions and Thank you to everyone who enabled us to take talk our way around the problem. Staff and users are these first steps. enthusiastic and requested further healthy lifestyle initiatives: Yoga, Swimming, Gym sessions, and Walking (pedometers and refreshments encourage participation!). A "Health Fun Day" was organised, which included the launch of the Cardigan Steps Debra Davies-Russell, map and fun aerobics and late last year we organised Jigso Children’s Centre, a Health, Safety and Wellbeing Day for the general 2 Pont y Cleifion, public. This incorporated all aspects of health, including Diabetes, Stroke, Language, Dental and Cardigan Diet and attracted all ages . [email protected]

Jigso Children's Centre - family walk, Cardigan 26 HEALTHY COMMUNITIES TOOLKIT

Help!

Resources: Including information, Support within Ceredigion funding & training… 1. Ceredigion Public Health Team (CPHT). (Funding, support, training, resources) CPHT is part of the National Public Health Service (NPHS) for Wales. The aim of the team is to deliver health improvement locally. The team work in partnership with and in support of other organisations both locally and nationally to co ordinate action within Ceredigion. They can therefore provide information on, local initiatives, resources and sources of funding. The team are responsible for the following areas of work: Community development, physical activity, healthy food, healthy schools, accident and injury prevention, workplace health, diabetes and cancer prevention, sexual health, substance misuse and tobacco control. They also co ordinates the following project funded work: Community Healthy Food Programme, Inequalities in Health and Mind your Heart Programmes. The Food Programme has developed a healthy eating training course for community group leaders called ' Train the Trainer'- this is a free one day course. They are currently developing a 'Cooking Skills' training programme. Contact: Ceredigion Public Health Team, First Floor, 9 Bridge St, Lampeter, SA48 7HG Tel. 01570 424105 [email protected]

2. Ceredigion Council for Voluntary Action. CAVO (Funding, training.) Funding: Provides information on sources of funding both at a local and national level and holds the latest major funding directories. It also has the two computer programmes 'FUNDER FINDER' and 'GRANT FINDER' for up-to-date searches. Administers the GOOD HEALTH GRANT SCHEME which aims to provide one off grants up to a maximum of £5,000 to voluntary organisations operating in Ceredigion. HELP! 27

Training: CAVO provide a variety of training Bodies of Sport and organisations such as the courses throughout the year. A list of courses is Urdd. Administers sport grant applications. available to all members and on request. Contact: Contact: Leisure Services, County Offices, 'Bryndulais', Marine Terrace, Aberystwyth SY23 2DE 67 Bridge St., Lampeter,SA48 7AB. Tel. 01970 633588 Tel. 01570 423232 www.ceredigion.gov.uk www.cavo.org.uk (c) Department of Education Dragon Sport (Resources) 3. Ceredigion County Council This is a Sports Council for Wales initiative (a) Environmental Health Department designed to offer 7-11 year olds fun and enjoyable ( Food and Safety) (Support and training) sporting opportunities. It supports the Aim to educate, advise and assist individuals and development of After School and Community organisations. It is a legal requirement that you Sports Clubs. The web site has downloadable contact the department and register if you are information on activities, game rules and more. setting up an initiative handling food. They provide To find out more, please contact: up to date advice on current food and hygiene Bryn Evans, Ceredigion's Dragon Sport regulations and provide information on the Co-ordinator on 01970 633695. availability of Food and Hygiene Training course in Or: the county. Dept of Education and Community Services, The department organise the CURIAD CALON County Office, food awards presented to qualifying organisations Marine Terrace, Aberystwyth,SY23 2DE providing healthy food. Tel.01970 633600 Contact: www.dragonsport.co.uk Environmental Health (Food and Safety) , Aberaeron SA46 0AP 4. Walking the Way 2 Health (WW2H) Tel 01545 572151 (Training and resources) www.ceredigion.gov.uk This is a national initiative that aims to improve people's health and well being by promoting (b)Leisure Services (Includes: Ceredigion Sports regular walks. They lead regular walks in Development Team). (Advice and funding) Aberystwyth, Cardigan, Aberaeron, Treagaron, Work with other agencies to provide additional Lampeter and . Maps of the walks are resources and opportunity for sport and recreation. available through Age Concern offices. One day Contact: training for walk leaders is available for volunteers Education and Community Services, or anyone wishing to lead their own group Department of Tourism and Leisure, Contact. County Offices, Marine Terrace Aberystwyth Tel.01970 615151 Aberystwyth SY23 2DE. Cardigan. Tel. 01239 615777 Tel.01970 633600 www.ww2h.org.uk/

The Ceredigion Sports Development Team is employed by Ceredigion County Council to actively improve participation in sport and health related exercise within the county. It works closely with the Sports Council for Wales, National Governing 28 HEALTHY COMMUNITIES TOOLKIT

5. Smoking Cessation Service It is hosted by the Small Woods Association in (Support) partnership with the Forestry Ccommission and Ceredigion has two smoking cessation counsellors the country Side Council for Wales. for north and south Ceredigion. They provide www.coedlleol.org.uk support on an individual or group basis. Some GP surgeries offer smoking cessation clinics. 10.Rural Regeneration Brief intervention training day can be arranged. (Support, training) For further information The Community Food Co-operative Programme in Contact: Wales enables people to access fresh fruit and Mid and West Wales Smoking Cessation Service vegetables on a weekly basis at wholesale prices. Tel. 01267 225039 The average £2 bag of vegetables and £2 bag of fruit can help a family achieve the recommended 5 6. MIND Aberystwyth a day. If you think that your community would (Support) benefit from having its own food co-op, or would Provides a smoking cessation counsellor like further information, then contact the rural specifically trained to support those experiencing regeneration unit: mental health problems. A drop in centre offering West Wales low cost healthy meals is available twice a week. Maria Davies Support is provided through group activities which 01269 823888 include: - Art and crafts, yoga, swimming and [email protected] organised walks Mid Wales Contact: Jenni Moorhouse The Mill, Mill St. Aberystwyth. [email protected] Tel 01970 626225 Wales Mark Jones 7. Area 43 01492 660263 or 07717 734406 (Support and training) [email protected]. The Cardigan Youth Project, Drop-In and Information Shop, is a registered charity set up to To find your nearest fruit and vegetable food give help and support to all young people in the co-op, visit the Community Food Initiatives Cardigan and surrounding area. Area 43 is also a Database. recognised Open College Network training centre. Contact: 11. SUBSTANCE AND ALCOHOL MISUSE 1 Pont Y Cleifion, Cardigan, (The Healthy Heart Project did not undertake Ceredigion, SA43 1DW. projects related directly to substance and alcohol Tel. 01239 614566 misuse. However, community leaders may find the www.area43.co.uk following contacts useful if their members' physical or mental health is affected by these issues:) 8. Health Visitors (Advice and support) Prism is a local charity working to promote safer or Health visitors are based with GP practices and non use of alcohol. Workers are available across can help with advice and support on lifestyle West Wales and the service is free and issues for people of all ages. confidential. They also have a service for under Contact: Local GP surgery 18's called SUDDS. Ceredigion contact: 9. Coed Lleol 01570 422555 (Advice and Support) www.prism-online.info Aims to help more people enjoy and care for Welsh woodlands. If you would like to know about DAN 24/7 is a national, confidential service the health benefits of spending time in the woods providing 24 hour advice to drug and alcohol users Coed Lleol will give you relevant information and and anyone wanting information on substance contacts. misuse. The helpline number is: 08006 33 55 88 HELP! 29

12.SEXUAL HEALTH Publications include:- (The Healthy Heart Project did not undertake l Eat Well-8 tips on healthy eating projects related directly to sexual health. However, l Salt--Facts for a Healthy Heart community leaders may find the following contacts l The balance of Good Health useful if their members' physical or mental health is affected by this issue:) 2. British Heart Foundation. BHF (Information, advice and resources) Ceredigion Family Planning Clinics give free BHF is a registered charity that funds research, contraception, pregnancy testing and advice on education, care and more in its fight against heart sex and relationships. They are based in disease. The foundation provides pamphlets on Aberystwyth, Aberaeron, Cardigan and Lampeter. healthy eating, physical activity and smoking. GUM clinics offer emergency contraception, These are available free of charge or for a small treatments and testing of sexually transmitted donation. Some can be downloaded and all can infections (STI's) and HIV testing. be ordered online. The website offers a smoking They are based in Aberystwyth and Cardigan. micro site, providing information, advice and online All can be contacted on 01545 571224 support to those wishing to stop smoking. Publications (see websites) include: Support Nationally l So You Want To Lose Weight……For Good. l Healthy Eating 1. Food Standards Agency: FSA l Staying Active www.bhfactive.org.uk (Information, training and sources of funding) l Get Kids on the Go The FSA carries out a varied programme of work l Smoking and How to Give Up on nutrition including practical initiatives. www.bhf.org.uk/smoking/ Their web site is informative. Under 'Nutrition' find 'Community'. This section is for people working in Contact: the' Community,' containing details of how you 14 Fitzhardinge St. .W1H 6DH. can help people learn more about food and gain Tel. 020 7935 0185 cooking skills through local nutrition initiatives www.bhf.org.uk The agency produces a wide range of publications for the public and food industry many are available 3. Big Fat Problem - free of charge. Some titles can be downloaded. (Information, advice.) Information, news and advice about healthy eating l A ' Get Cooking' training pack, provides trainers and exercise from the BBC. with a tool kit to teach young people broadly www.bbc.co.uk/bigfatproblem between the ages of 14-25 some basic cooking * FOOD DIARY (your record of what you eat and skills in a community setting. how you exercise) and other practical advice from: l Also available is a pack on 'Funding for Initiatives bbc.co.uk/health/healthy_living/your_weight/ on Nutrition and Diet'. reaching_diary.shtml

Contact: 4. British Nutrition Foundation - 11th Floor, South Gate House, Wood St. (Information, resources) . CF10 1EW This site provides healthy eating information, Tel. 02920 678999 resources for schools, news items, recipes and www.food.gov.uk healthier packed lunches, plus details of the work undertaken around the UK/EU. EAT WELL Contact: The FSA has a link web site 'eatwell', for High Holborn House, 52-54 High Holborn, consumer advice and information. The site is London. WC1V 6RQ. packed with practical healthy eating and food Tel.020 7404 6504 safety tips. www.nutrition.org.uk www.eatwell.gov.uk Publications l Healthier Packed lunches 30 HEALTHY COMMUNITIES TOOLKIT

5. Nutrition Network For Wales 9. Mind (National Association for Mental Health) (information, successful initiatives) (Information, advice, resources) Provides a 'one stop shop' where a range of The leading mental health charity, works to create healthy eating information can be found. Also a better life for everyone with experience of mental holds a database of community initiatives. distress. Contact: Mind info line-offers confidential help on a range of Wales Centre for Health, 14 Cathedral Rd. mental health issues. Cardiff CF11 9LJ. Call 08457660163 from anywhere in the UK for Tel 029 2022 7744 the cost of a local call. www.nutritionnetworkwales.org.uk Rural minds---aims to improve the mental health of people in isolated rural areas. 6. 5 A Day (resources and information) Publications include: Packed with information, downloadable resources, l 'Understanding---' series of, booklets covering, recipes, fun and games. depression, anxiety etc. Contact: l 'How To" series promotes ways of coping with, The Department of Health, Richmond House, family life, loneliness, etc. 79 Whitehall,London,SW1A 2NL. l 'Mind Guide to Managing Stress.' Tel 0207 210 4850 www.5aday.nhs.uk Contact: Mind, 15 - 19 Broadway, London E15 4BQ 7. The Physical Activity Network for Wales.(PANW) Tel: 020 8519 2122 (Networking) www.mind.org.uk The Network links with individuals and organisations in Wales providing support and the Food And Mood Project, funded by Mind. Provides sharing of information with the aim of increasing information, advice and support on how foods the physical activity levels of the people of Wales. affect our mental and emotional health. Contact: Wales Centre for Health,14 Cathedral Rd. Publications include: Cardiff. CF11 9LJ. l Mind Guide to Food and Mood Tel 029 2022 7744 l Food and Mood Workshop Pack www.panw.org.uk Contact: The Food and Mood Community Interest 8. Sports Council for Wales - Company. PO Box 2737, Lewes, (Information and resources) Sussex.BN7 2GN. The Sports Council for Wales is the national [email protected] organisation responsible for developing and www.foodandmood.org promoting sport and physical activity: in particular it is concerned with creating sporting opportunities When you're preparing a bid for funding what for children in schools and in the community and about including funding for healthier food options? to increase participation in sport. Contact: 10. National Smoking Cessation Service in Wales Sophia Gardens ,Cardiff CF119SW (Support and resources) Tel. 0845 045 0904 Free phone number 0800 085 2219 .The service www.sports-council-wales.co.uk offers an appointment with a local counsellor and six week support following a quit date. Information relating to smoking, the facts and techniques of quitting are available free of charge. HELP! 31

11. The National Smokers Helpline 15.British Trust for Conservation Volunteers. BCTV (Support and resources ) (Information, resources ) Free phone number 0800 169 0169. Supports groups that take practical action in their Offers individual advice from a counsellor, packs local community.eg garden projects. Provides a for adults or youths wishing to quit and access to good information pack, ideas, insurance and the smoking cessation service. more… for garden projects. Contact: 12. Cancer Research UK BTCV. Sedum House, Mallard Way, Potteric Carr, (Resources and information) Doncaster,DN4 8DB. Easy to access information, good links with Tel. 01302 388 888 downloadable resources, recipes and healthy www.bctv.org.uk lifestyle tips. Contact: PO. Box 123, London WC2A 3PX. Tel. 020 7121 6699 www.cancerresearchuk.org.uk

Publicity poster 13. Big Lottery Fund for the project. (Funding) Lottery grants available from £500 upwards to support local projects. Provides advice on how to apply. Contact: 2nd Floor. Ladywell House, Newtown Powys.SY16.1JB Tel. 01686611700 www.biglotteryfund.org.uk

14. Health Challenge Wales (Ideas, overall view) Health Challenge Wales is the national focus of efforts to improve health and well-being. It recognises that a wide range of factors - economic, social and environmental - have an impact on health, so that action in all these areas can help create a healthier nation. The Key Themes are: smoking, food and fitness, accidents and injuries, alcohol and other substance misuse, infections and mental health and well-being. A free Action Pack provides ideas on how you can respond to the Challenge by taking some simple steps to improve your health. www.healthchallengewales.gov.uk 32 HEALTHY COMMUNITIES TOOLKIT

SERVICE LEVEL

AGREEMENTS… Where a funder is arranging for an organisation to undertake some work on the healthy lifestyle agenda, it can be useful for both parties to have a Service Level Agreement to help clarify the details and purpose of the work.

What a Service Level Agreement (SLA) might look like: SERVICE LEVEL AGREEMENT 33

SERVICE LEVEL AGREEMENT 4. Length of Agreement: INEQUALITIES IN HEALTH The programme will be funded from (start date) to (end date). The Healthy Heart Programme- CEREDIGION 5. Funding and Payment: 1. Memorandum of Agreement: The total allocation is £XXX , This is broken down This agreement is made between: as follows: (Funder) and (Organisation). l Facilitators and trainers fees (planning with participants, 3 days, design and preparation of 2. Conditions of Agreement: activity, 8 days, 22 sessions x half a day, 2 staff), The purpose of the Inequalities in Health £XXX. programme is to work with the people of l Catering Costs, £XXX. Ceredigion to reduce their risk of developing l Materials and equipment, £XXX. Coronary Heart Disease by promoting physical l Travel (40p per mile), £XXX activity and healthier food and reducing smoking l Expenses, subsistence and childcare, £XX. and stress levels. l Admin. and office overheads, £XXX. To this end your Organisation will use the funding to: l Positively engage with the target group on the Amount payable by invoice; issue of healthy lifestyles, using… Made out to: l Train and support XXX to cook healthy lunches for Name, address and contact number of funder. participants. l Explore existing knowledge and perceptions of 6. Variation of Agreement: healthy lifestyles amongst the target group and Any variation of this Agreement must be agreed in support participants to make positive choices writing by both parties. about their own lives. l Produce evidence that the intervention is effective 7. Organisational Responsibilities: and contributes to the process needed for positive Your Organisation must at all times follow all legal change relating to lifestyles. requirements and accepted good practice within your field of work, for example with regard to 3. Evaluation Health and Safety, child and vulnerable adult Evaluation is an important part of this programme. protection, insurance, financial matters, equality of We need to know: opportunity, confidentiality. l What happened and what changed as a result of this project? l Was it worth the money and the effort? 8. Signatures: l If you did it again, what would you do differently? l Were there any "spin offs" - i.e. unintended Organisation: benefits? So the sort of information you may need to record is: Funder: l How many people took part? l Do you have feedback from them? For example Signed: from one or more of the following: questionnaires, individual or group discussion, a detailed account Name: of one or two experiences (case study), quotations etc. Position:

Date: 34 HEALTHY COMMUNITIES TOOLKIT

Policy. Some community organisations may wish to consider having a written policy on promoting healthy lifestyles. This does not need to be a long document and is simply intended to help reach agreement and clarity on what you are doing, how and why.

Why have a policy? l It informs everyone connected with your organisation and other agencies that you consider healthy lifestyles to be important. l It makes sure everyone shares the same understanding. l It makes it clear how everyone is involved.

It's important to make sure your policy actually leads to good practice. l An "action plan", listing aims, objectives, responsibilities, timescale and outcome, helps turn good intentions into definite action. l In order to know whether you're succeeding or not, it may help to set targets and monitor your progress and achievements against those targets.

What might a policy include? A statement for clients / service users, explaining: l Why promoting and supporting healthy lifestyles is important. l How you will inform, consult with and involve service users and other stakeholders (people who have an interest in your work). l The details of what will be done, how and by whom. l How the results will be measured.

A statement for staff: l A mission statement - an explanation of what you are trying to achieve, expressed in one statement. l How policy will be implemented. l Whose responsibility is it? l How results will be measured. l How staff will be supported to live healthier lifestyles and act as role models. (This doesn't mean being perfect!) EVALUATION 35

Do you have clearly defined outcomes for the work EVALUATION and proper systems in place for measuring the success (or not) of these?

So how do we know if its working? What is an outcome? Some basic principles of evaluation: An outcome relates to the aim of what you're doing. Generally, it's something that happens in the longer term. e.g. Your aim is to help people choose healthier food options.

To help achieve this, you organise a series of cooking demonstrations for cheap, healthy food. Lots of people turn up and clearly enjoyed the sessions. That may be a positive and helpful response, but it's not an outcome.

Your aim was to change their choice of food, so that in the future they will regularly buy and cook healthier options. So to measure the outcome, you need to know whether they did (you may also wish to know to what extent they changed and why some didn't change).

The key questions are therefore: l What are the changes or difference you want to make? (changes in the community, in people, in services, in policies…) l How will you know if you have achieved these changes? l What information will you need (e.g. Did you reach your target group?) and how will you collect and analyse it?

You may also wish to know… l Would anyone else benefit from knowing what was and wasn't successful? l Were there any unintended benefits (spin-offs) from the work?

If you want more detail about how to evaluate these sorts of activities, we recommend "Evaluating Your Community Development Activities", available free from: Community Development Cymru, Plas Dolerw, Milford Road, Newtown, Powys SY16 2EH (01686 627377) [email protected] 36 HEALTHY COMMUNITIES TOOLKIT

Some of the advice given in this document is reproduced here:

KEY EVALUATION QUESTIONS… AND FINALLY… just two words of evaluation jargon explained… 1. Is your activity successful? (i) Are you achieving what you set out to achieve? QUALITATIVE: (ii) How do you know the intervention is working? Concerned with measuring quality, expressed in (iii) What new things / change has occurred? words rather than numbers, for example: how people (iv) Did it make things better, the same or worse? feel.

2. What is the value of your work? QUANTITATIVE: (i) Is it worth the time? Concerned with amount or quantity, expressed in (ii) Is it worth the effort? numbers, for example the number of people (iii) Is it worth the money? attending an event or the percentage increase in people using a service. 3. What will you do differently if you do it again? (i) What worked well? (ii) What didn't work well and why not? (iii) What have you learned? Spinbikes - Aberystwyth Day Centre.

HOW MIGHT YOU COLLECT EVIDENCE? l Your own or others' monitoring records and reports l Observation l Case studies l Meetings, workshops and events l Mapping l Interviews l Focus groups / group discussions l Oral histories / tapes, photos or films l Questionnaires, surveys, feedback forms

PLANNING YOUR EVALUATION (KEY QUESTIONS): l Why are we evaluating - who is it for? l What resources do we need / what resources do we have? l Who will be involved in the evaluation? l What are we evaluating? l What is our starting point? l What information will we need and how will we get it? l When are we going to do the evaluation? l What does the information show? l How will we use the results? l How will we reflect on (evaluate) the evaluation? SELF ASSESMENT 37 Self-Assessment:

HOW WELL DOES YOUR ORGANISATION PROMOTE HEALTHY LIFESTYLES? l Do you offer fresh fruit as a snack? l Do you provide buffets? o Yes? o No? o Yes? o No? Comment: Comment: l Do you offer water and juice options instead of l Do you provide healthy options? tea and coffee? o Yes? o No? o Yes? o No? Comment: Comment: l Do you provide opportunities for physical activity l Do your members have access to information on in your programme? healthy lifestyles? (e.g. group walks, swimming, yoga etc.) (Healthy eating, physical activity, avoiding stress, o Yes? o No? not smoking, alcohol and substance misuse, Comment: healthy sexuality…) o Yes? o No? l Are there barriers to you providing opportunities Comment: for physical activity in your programme? o Yes? o No? l Do you provide meals? Comment: (e.g. what are the barriers to you o Yes? o No? providing these opportunities?): Comment: l Do you help those members who want to give l Do you provide healthy options? up smoking? o Yes? o No? o Yes? o No? Comment: Comment: (e.g. what would you want and need to do so?) l Do you provide snacks? o Yes? o No? l Do you have ways of supporting members who Comment: feel under stress and want help? o Yes? o No? l Do you provide healthy options? Comment: (are there any barriers to you providing o Yes? o No? this support?) Comment: 38 HEALTHY COMMUNITIES TOOLKIT

AND IF YOU WANT TO MAKE THINGS MORE FORMAL… l Do you have a policy, strategy and/or an action plan to promote health and well-being? o Yes? o No? Comment: l Is promoting health and well-being referred to in your mission statement, in your promotional literature and/or on your website? o Yes? o No? Comment: l Is health and well-being mentioned in staff job descriptions? o Yes? o No? Comment: l Is health and well-being regularly discussed and reviewed? o Yes? o No? Comment: l Do staff understand how promoting health and well-being fits with major strategies and policies? o Yes? o No? Comment:

ACKNOWLEDGEMENTS:

The work of the healthy heart programme and its findings would not have been possible without the support and commitment of: l Welsh Assembly Government l Communities First, Aberystwyth l National Public Health Service / Ceredigion Local l Ceredigion County Council Health Board l Ceredigion Health Alliance l Ymlaen Ceredigion l Opinion Research Services, Swansea l Community groups in Aberystwyth and Cardigan l Welsh Institute for Health and Social Care l Ceredigion Association of Voluntary Organisations l University of Wales, Aberystwyth