Annual Congress X – Health, Happiness & Wellbeing

Shaleen Meelu – Public Health and Nutrition Specialist, Public Health Birmingham

Do you believe that everyone is entitled to healthy, nutritious food? What role can/do you play in the development of a healthier food environment? What support can you give to Public Health Professionals? What support do Public Health professionals need to give you?

The philosophical nature of the first question alone gives an indication as to some of the challenges outlined by the speakers during this workshop; at the very least, the challenge inherent in articulating where responsibility for a healthy food environment lies when professional and public beliefs around the subject are not necessarily aligned.

Shaleen began by stressing the need for joined up thinking when tackling the current issues around obesity in the UK. The mix of public, private and personal components in the following diagram from the Lancet demonstrates just how complex the picture is.

The projected cost of obesity in Birmingham by 2050 will be £2.6 billion per year (equal to 13.5 new Birmingham libraries). By school year six, 40% of children are either overweight or obese and levels are on the rise most sharply in Birmingham’s inner, more deprived wards.

Internationally, the World Health Organisation has recently changed its strategy from a focus on lessening obesity to merely trying to halt the rising levels. Birmingham however has adopted an ambitious target to reduce levels to the core city average across all wards. Childhood obesity is one of the 10 priorities of the Birmingham Health and Wellbeing Board, bringing together the City Council, Clinical Commissioning Groups, the NHS, Healthwatch and the voluntary sector. This type of group approach is perhaps not new but the 5-year strategy produced by the group seeks to incorporate the critical voices and opinions at the key points where their input can make a difference.

Taking Einstein’s view that ‘insanity is doing the same thing over and over again and expecting different results’, Charlene explained how the strategy focuses on three concurrent strands; environment, behaviour and opportunities. The fabric of the urban environment can be altered to increase healthy food availability, encourage active transport and limit unhealthy food near schools, whilst planning obligations from new developments can be used to optimise health benefits. Altering behaviour is a complex process of changing hearts and minds but by working closely with schools and voluntary groups, the strategy aims to encourage interventions for healthier eating and increased physical activity across the city. This also ties in with increasing opportunities for access to healthy foods (for instance in schools) but alongside a strategy of making it more attractive to children modelling healthy food behaviour and by increasing access for children to grow food themselves.

Crucially from an urbanist point of view, the strategy is seeking to engage with built environment professionals and the planning system. Public health professionals in Birmingham recently produced a Supplementary Planning Document (SPD) aiming to reduce an existing 10% cap on hot food takeaway units in shopping centres down to 5%. The SPD also introduces a levy to deter new businesses from opening and to restrict hot food takeaways within an 800m radius of schools.

This is a great example of non-planners interacting with the planning system to bring about positive change however an SPD is only a material consideration in determining planning applications. Shaleen observed that they had ‘missed the boat’ in terms of enshrining obesity legislation within the Local Plan due to a lack of understanding about how and when they needed to interact with the planning system to incorporate creative changes. This was a theme I heard repeated several times throughout the congress; the complexity of the planning system makes it difficult for professionals from other disciplines to contribute and help bring about positive change. There is perhaps an onus therefore on planners to make sure the relevant voices are heard, which may require an element of thinking outside the box as to who these voices may belong to and when they should be heard.

Development Management professionals (along with the public, schools, Government etc.) need to be brought into conversation to ensure that the overarching aims of the policy are understood in a holistic manner. Shaleen identified the ideological battle they were facing to overcome the perception that obesity prevention lies purely in the community and therefore should not be the responsibility of the public sector.

There were also battles inherent in producing the SPD and Shaleen gave an indication of the sorts of issues that had been raised by planners prior to producing the document. For example, there is not enough capacity in the planning team to regulate and monitor the policy, fear of legal appeals, hot food takeaways provide employment opportunities and the fact there is clearly demand for them. The workshop group gave a range of answers from their professional points of view, which the public health team noted for future use.

In neighbouring Sandwell, the approach being taken is to develop a community agriculture strategy and focus on local food production at a regional level. There are economic and social reasons to fight the commodification of food and in Sandwell; the approach focuses on local knowledge transfer to create small ‘spaces of hope’ in the urban area. These spaces can then be occupied by community members to keep the local food growing movement visible, accessible and at a human scale. Angela expressed the same sadness however at the lack of cohesion between planning documents; produced at different times and lacking the common threads needed to really support the interventions.

Discussion:

Using the opening questions above as a framework, the presenters opened the floor for discussion within the group. The first point raised was that every arrow in the Lancet diagram moves from the Government towards other groups. Where therefore is the feedback mechanism to allow central Government to learn and move forwards?

An interesting discussion followed about the increasing use of automated processing in the food industry and how primarily private companies to make larger profits on food use it. Could this instead be a creative alternative to food banks? Technology will be increasingly important in a future that will almost certainly involve food insecurity for more people. What implications will this have for planning professionals and how should food be incorporated into future policy?

In sharing the challenges faced, the presenters received valuable input from the group and individuals were able to share best practice with each other and take inspiration from the local initiatives identified in Birmingham. Tackling obesity is undoubtedly a huge challenge but in order to make a start, the extent of the cross-professional approach required must be understood and each relevant profession must be prepared to think creatively about the scope for a truly multi-disciplinary strategy.

Words by Young Urbanists