Child healthy weight in Sefton: addressing the social determinants through whole systems working

It incorporates a whole-systems methodology, blending public health initiatives with partner and stakeholder engagement to address child obesity and is firmly rooted in the social determinants of health. 

The strategy leverages local partnerships and focuses on early intervention, education, and support services that are tailored to the unique needs of families and children in Sefton. This approach represents a significant shift from traditional weight management programmes, emphasising a comprehensive understanding of the ‘causes of the causes’ and fostering a supportive environment for sustainable lifestyle changes.

The context 

Sefton’s broad geography masks a gulf in inequality with stark differences in social mobility. Data across the borough is often sobering and illustrates the shocking and unacceptable levels of poverty faced by Sefton families. One in six children under the age of sixteen live in relative poverty, which has risen by 17.5 per cent over the last five years. 

Children and young people living in the most deprived areas of Sefton have poorer outcomes across a vast range of indicators including obesity, teenage pregnancy, educational attainment, and low birthweight, which continue across the life course and leads to poorer outcomes in adulthood. Twenty-four areas of Sefton are within the top five per cent most deprived nationally, of which five are in the most deprived one per cent.

The challenge

Sefton continues to face complex challenges in addressing child obesity, particularly in its most economically disadvantaged areas. Traditional approaches to weight management were not sufficiently addressing the complex social and economic factors contributing to obesity. 

There was a need for a more holistic strategy that not only focused on physical health but also considered the psychological and social aspects of child healthy weight.

The approach

Sefton's approach involves implementing targeted and integrated interventions, delivered with sensitivity and an understanding of the environmental and economic factors that influence choices people have to make.

One of the bespoke programmes is Happy 'n' Healthy Sefton, a targeted health and wellbeing hub that integrates all public health commissioned services for children and young people. Happy ‘n’ Healthy Sefton ensures that services work with children and families holistically across a broad range of public health themed areas (0-19, smoking, sexual health, mental health, healthy lifestyles or substance use), with the integrated model ensuring that all workforces consider the importance of healthy weight in their work with families and signpost into relevant support where needed. The programme entails:

• community engagement: working closely with schools, local organisations, and community groups to promote healthy lifestyles.
• education and awareness: implementing educational initiatives focusing on nutrition, physical activity, mental well-being and sustainable behaviour change.
• tailored support services: offering customised support for families and children, including dietary advice, physical activity programmes and wellbeing support.
• early intervention: focusing on early years to instil healthy habits from a young age.

Sefton’s whole system working covers comprehensive provision of healthy weight services across different age groups to promote understanding of healthy lifestyles throughout the life course. It is delivered through three workstreams:

1. Start Well: focusing on children and young people.
2. Live Well: focusing on the achievement of the healthy weight declaration.
3. Age Well: focusing on the adult weight management pathway.

The impact

The approach has seen positive outcomes. There has been a noticeable improvement in the awareness and understanding of healthy lifestyles among children and families, measured by the interest and engagement in services from local communities. The early intervention component is a good foundation to build on, promoting knowledge, awareness and confidence for families to be able to navigate support and advice to improve their health.

How is the new approach being sustained?

The sustainability of the ‘Start Well’ obesity work is anchored in its whole systems approach. Ongoing partnerships with local organisations and continuous community involvement ensure the programme’s relevance and adaptability. Engagement with these partners is maintained by ensuring the narrative underpinning the child healthy weight work aligns with the objectives and outcomes for their own work areas, for example, by adopting an outreach approach through commissioned services and working closely with the voluntary sector.

Social value is also integral to commissioning in Sefton, with encouragement that providers consider the social, economic and environmental benefits to communities, such as internships for children and young people leaving care, or improving opportunities in education, employment and living standards. Sefton are currently working with organisations to consider opportunities for bursaries and employment, whilst adopting the best working practices and conditions. 

Sefton also ensure that delivery is strategically aligned to all relevant agendas, including Sefton’s childhood poverty strategy, the Marmot led All Together Fairer agenda (2020), All Together Active (Cheshire and Merseyside’s Physical Activity Strategy), Sefton’s Health and Wellbeing Strategy and Core20Plus5 , as well as aligning to the Welfare Reform and Anti-Poverty (WRAP) agenda. All work is rooted in asset-based community development, which is a strengths-based approach supporting individuals and communities to build on sustainable solutions for increased wellbeing. 

Lessons learned

Key lessons from Sefton’s experience include the importance of system engagement and the need for a holistic approach to address child healthy weight. Addressing the social determinants through close engagement with partners across housing, NHS, education, children’s social care, early help, family wellbeing, 0-19, the voluntary community and faith sector, and local business is essential to promoting children’s healthy weight. Harnessing an organisations ownership and sense of purpose ensures that they can understand the vital role that they can play in tackling this sobering issue. 

Contact

Natalie Ashworth, Advanced Practitioner in Public Health 

[email protected]

Anna Nygaard, Head of Inequalities and Strategic Partnerships

[email protected]