Eat well Drink sensibly Exercise more 2015 Annual Public Health Report Annual Public Health Report Contents Chapter Title Page Introduction 6 Authors 8 Contributors 10 1.0 DIET 14 1.1 Maternal diet (pre-conception, pregnancy and postnatal) 16 1.2 Diet in the early years (0 - 5 years) 26 1.3 Diet for children and young people (5 - 18 years) 36 1.4 Diet for adults (18 – 65 years) 48 1.5 Diet in older age (65 years and over) 58 1.6 Food poverty and insecurity 68 1.7 School food 76 1.8 Food growing 82 1.9 Food establishments and healthy catering 90 1.10 References 96 2.0 PHYSICAL ACTIVITY 110 2.1 Maternal physical activity (pre-conception, pregnancy and postnatal) 112 2.2 Physical activity in the early years (0 - 5 years) 118 2.3 Physical activity for children and young people (5 - 18 years) 122 2.4 Physical activity for adults (18 – 65 years) 130 2.5 Physical activity in older age (65 years and over) 136 2.6 Green spaces 144 2.7 Sport in Kingston 148 2.8 Local leisure facilities 158 2.9 Active travel 164 2.10 Kingston mini-Holland programme 170 2.11 References 174 2 Contents Chapter Title Page 3.0 ALCOHOL 180 3.1 Alcohol in the pre-conception, pregnancy and postnatal periods 182 3.2 The impact of parental alcohol misuse on children 188 3.3 Alcohol and children and young people 192 3.4 Alcohol and adults (18 – 65 years) 198 3.5 Alcohol in older age (65 years and over) 214 3.6 Alcohol enforcement 222 3.7 Kingston town centre 226 3.8 Alcohol and crime 232 3.9 References 238 4.0 INTERPLAY 244 4.1 Social deprivation and links with diet, physical activity and alcohol 246 4.2 Diet, physical activity and alcohol consumption amongst 252 Black, Asian, minority ethnic and refugee populations 4.3 Healthy Schools Kingston 262 4.4 Diet, physical activity and alcohol at Kingston College and Kingston University 268 4.5 Workplace health 272 4.6 Food and alcohol in a sports culture 278 4.7 Planning and licensing 282 4.8 References 288 5.0 DEMOGRAPHY 294 5.1 References 326 Abbreviations 328 Glossary 330 3 Annual Public Health Report Introduction My ninth report on the health of people in Kingston focuses on diet, exercise and alcohol. Each of these lifestyle issues has a major impact on health and wellbeing but in addition the three interact with each other so increasing their effect. This report aims to set out the different ways these issues affect us throughout our lives, how we can make healthier choices and how the Council and local partners can act to enable us to make these choices. We have seen a huge rise in the proportion of What we eat is constantly in the news. In October people who are above a healthy weight with 2015 the World Health Organisation stated that red nearly two thirds of people in England now obese meat probably raises the risk of developing some or overweight. This not only has a huge financial cancers and processed meat does raise the risk of impact on the NHS (with direct NHS costs of colorectal cancer1. During the same month Public diseases related to overweight and obesity totalling Health England released a report highlighting the £15.4 billion nationally) and other services but also negative impact of sugar on weight gain and tooth means many more people will die early from the decay and recommending a range of measures illnesses associated with being above a healthy including a tax on high sugar soft drinks2. A helpful weight. The cause of being overweight or obese visual guide to what a healthy diet consists of is the is consuming more energy in the form of calories ‘eatwell’ plate (figure 1 on page 17). in food than is used by the body. The amount of energy used can be increased by physical activity. The report looks at the impact of diet across the So to achieve a healthy weight those of us who life course, commencing with pregnancy, the early are overweight or obese need to exercise more years and children and young people. In the last and eat well. of these the concerning rise in local children who are above a healthy weight between reception year (17.3%) and year 6 (28.5%) is highlighted. Dietary issues affecting adults and older people are discussed in chapters 1.4 and 1.5 and in the latter chapter the impact of malnutrition is noted, with 14% of all people aged over 65 being malnourished. Across the country malnutrition accounts for £18 billion in health and social care costs, which means that malnutrition in older people is a greater financial issue than obesity. Other chapters in this section examine food poverty, school food, food growing including allotments and healthy catering. 4 Introduction Taking sufficient physical activity – at least 150 Undertaking physical activity can be made easier minutes of moderate intensity activity a week for by having access to green spaces and providing adults – reduces the risk of a wide range of illnesses free opportunities for exercise such as outdoor including coronary heart disease, strokes, mental gyms and fitness trails. There are seven such sites health problems and some cancers. The way we in Kingston (chapter 2.6). Formal sports provision live our lives has changed radically, with a decrease locally has significant economic value (estimated in physical activity at work, much socialising taking at £68.6 million in direct economic value and nearly place online and many leisure activities now being 2,000 jobs) and information on over 100 sports sedentary so it is not surprising that many people clubs can be accessed via the Council’s website. do not now meet recommended activity levels. Other chapters in this section discuss local leisure facilities, active travel – which is one of the easiest It is vital to take exercise throughout one’s life. ways to build exercise into a regular routine – and This includes during pregnancy where many the exciting mini-Holland programme which aims common pregnancy symptoms can be improved to transform the cycling environment in Kingston by exercise (chapter 2.1). The importance of and so get many more people on their bikes like physical activity in helping to ensure the best start their Dutch counterparts. in life for young children is highlighted in chapter 2.2 as are the Department of Health guidelines for under fives which should be widely publicised. In older children, the extent to which girls take less exercise than boys is both a national and local issue that should be prioritised for action. The chapters on adults (2.4) and older people (2.5) highlight a range of ways in which people can be more active. These include the Get Active exercise referral programme for those with health conditions, Walking for Health (a national programme suitable for all the family) and Fit as a Fiddle which is focused on older people and has supported over 1,100 Kingston residents to increase their fitness. 5 Annual Public Health Report The section of the report dealing with alcohol also The interplay section looks at the interaction starts with a life course approach. It includes a between all three lifestyle issues. The impact chapter (3.2) dealing with the impact of parental of deprivation is discussed in chapter 4.1 whilst alcohol misuse on children which is estimated to chapter 4.2 focuses on Black, Asian, minority affect 1.3 million children aged under 16 across ethnic and refugee populations. A range of England. Young people also can misuse alcohol settings are then discussed – schools, Kingston directly and local information shows that year College and Kingston University and workplaces. 10 students who drink alcohol are much more likely The last of these notes the correlation between to have also smoked or taken illegal drugs (chapter all three lifestyle issues and productivity with 3.3). Although the majority of adults drink sensibly, physically active workers taking 27% fewer days 33% - which equates to 35,800 working age adults off sick, employees with a healthy diet having in Kingston – may be harming their health due to 25% higher job performance and alcohol related their level of alcohol consumption. Alcohol misuse illnesses causing 17 million working days to be lost in older people is a growing concern and it has each year. Chapter 4.6 discusses the relationship been estimated that up to 60% of older people between sports clubs and the food and alcohol admitted to hospital with diagnoses such as that is consumed there and notes the risk of confusion or recurrent chest infections may have inconsistent health messages being provided. unrecognised alcohol problems. Other chapters The section concludes with how planning and in this section deal with enforcement of the law licensing polices can assist in the promotion of with regard to alcohol sales, alcohol related issues eating well, exercising more and drinking sensibly. in Kingston town centre, and alcohol and crime. This report also includes a chapter on the demography of Kingston whilst the statistical annex, together with the update on progress against recommendations in last year’s report which focused on mental health and wellbeing can be accessed via: www.kingston.gov.uk/health_and_wellbeing I would like to thank all the authors and contributors to the report and give a special mention to the editorial team: Jo Lockhart, Iona Lidington, Christopher Rimington and Dr James Moore. As always I very much welcome both comments on the report and suggestions for future report topics which can be sent to me at [email protected] 6 Introduction References 1 World Health Organisation.