London Journal of Primary Care 2008;1:106–7
# 2008 Royal College of General Practitioners
Commentary – Alma Ata
Healthier happier children Elizabeth Dunsford Regional Coordinator for Healthy Schools, London, UK
London has 1.72 million children and young people – nearly a quarter of its total population. It has 2433 schools. It also faces major health challenges: 41% of those children (over 650 000) living below the poverty line, which is significantly higher than the national average of 28%. Childhood obesity is significantly higher than in the rest of England, with 20.8% of 10–11 year olds obese compared with 17.5% nationally and 11.3% of reception year children, compared with 9.9% nationally. In at least two London boroughs the prevalence of obesity in 10–11 year olds is 25%. Children in London also spend notably fewer hours on physical activity than children in most other regions. There are huge gaps between the best and worst of health across more or less affluent boroughs. For example, in City and Hackney 16% of children are obese at reception age, whereas in Richmond and Twickenham that figure falls to just 7.7%. By Year 6, in Southwark figures are at 27.1%, whilst in Richmond and Twickenham this is 13.1%. Teenage pregnancy has fallen slightly since 2006, but this overall figure masks the fact that many boroughs have the highest rates in the country. The National Healthy Schools Programme (NHSP) is a joint Department of Health (DH) and Department for Children, Schools and Families (DCSF) initiative which is helping schools to make the link between health and achievement. Working with a comprehensive network of local and national partners, it provides schools with a framework for supporting children and young people by giving them the skills and knowledge to make improved life choices. The 41 criteria that result in ‘National Healthy School Status’ include things such as good canteen food and free drinking water, lifestyle advice for things such as sexually transmitted diseases and physical activity, and parental education and support, reminding about simple things like eating together or how to cook a healthy meal. In London 97% of schools are participating and 67% of schools have already achieved National Healthy School Status. Kevin Ward Head Teacher from Holmleigh Primary School in Hackney explains that the NHSP helps to
create an environment that has a holistic, subtle affect on overall health: ‘When you’re in a healthy school you can ‘‘feel’’ the difference. There will be healthy values and a healthy ethos running throughout the whole school, and the impact of this will be evident everywhere.’
Partnerships with primary care trusts and general practice Although most Healthy Schools Coordinators in Greater London are employed by the local authority and are based in education departments, one of the keys to the programme’s widespread popularity and success is in the collaboration it promotes between schools and PCTs. In London, this partnership takes place via representation in local steering groups, through joint funding and through the employment of PCT personnel as part of the Healthy Schools Team such as specialist sexual health workers, drugs advisors, or dieticians. Hugh Annett, Director for Public Health at Bristol PCT, says: ‘From a public health perspective, I think Healthy Schools is a great way of shaping the opinions of young people around many important public health issues, including obesity, sexual health, substance misuse, emotional health and wellbeing, healthy eating and exercise. Where better to do this than through schools? I’m absolutely convinced that the messages children learn during the school day can have a direct impact not just upon them, but also upon their entire family and community.’
Closer involvement of PCTs is helping the NHSP to succeed. For example, PCT involvement helped the London Borough of Bexley to become the first authority in England to achieve National Healthy Schools Status amongst 100% of it’s schools, nearly a year ahead of national targets. Local Healthy Schools Coordinator for Bexley, Tricia Oates says: ‘As a PCT, we took a very practical ‘‘hands on’’ approach in working with our schools, encouraging close working
A practical guide to the diagnosis and management of insomnia in a general practice consultation
between schools to enable the sharing good practice, and provided high quality training and resources to make the process of gaining accreditation as easy and smooth as possible. We also ran a series of policy days where schools worked with us in sessions to develop new school policies on issues such as school food and child protection.’
The Bexley success story has also involved GPs. For example Dr Daniela Mo, from Plas Meddyg Medical Surgery in Bexley has been working with the programme locally on the issue of obesity. She recently participated in a local healthy eating conference and has contributed to the borough’s new healthy packed lunch policy. The combined efforts of schools, healthcare workers and many other partners, is now having a marked impact on lifestyle. Most children are now doing at least two hours of high quality physical activity each week. There are plenty of opportunities for primary care practitioners and managers to get involved – from delivering training for teachers or health promotion to pupils and parents, to delivering healthcare services within the school environment or helping to shape and steer policies. Merely showing that you know about the programme helps. For example if you see a child that is overweight, you can encourage the parents to see how the school can help. If a child or young person comes to you with emotional health concerns, you can ask if there is a school counsellor, or peer mentors. For older children, do they have school nurse or sexual health drop in service which they can be pointed towards for more advice? The Healthy Schools Programme is promoting ‘health as a citizen issue’ in the way envisaged by Alma Ata. It encourages broad participation in health
107
promoting activities. Collaborative working is essential, because sharing the load it does not involve extra work. One of the most helpful things a GP can do, you do already – reinforcing the message ‘look after yourself, your family and your community; and remember to laugh and smile’. So this is a message equally important for adults too. It’s easy to forget to do simple things that improve our social and emotional health, like playing and having fun. Actually, it is too easy to forget how to be like a healthy child. To find out more about the Healthy Schools in your borough, please contact your Local Healthy Schools Coordinator whose details can be found at www. ealthyschools.gov.uk or contact the London Regional Healthy Schools Coordinators by emailing: elizabeth. [email protected] or alison.staff[email protected]. gov.uk Figures taken from the following sources: National Child Measurement Programme 2006/7; APHO Indications of Public Health in the English Regions, 5: Child Health, 2006 The State of London’s Children Report, Greater London Authority, 2007. ADDRESS FOR CORRESPONDENCE
Elizabeth Dunsford Regional Coordinator for Healthy Schools, London, UK Directorate of Children and Learners 10th Floor, Riverwalk House 157–161 Millbank London SW1P 4RR UK Tel: +44 (0)20 7217 3207 Email: [email protected]
# 2008 Royal College of General Practitioners
Commentary – Alma Ata
Healthier happier children Elizabeth Dunsford Regional Coordinator for Healthy Schools, London, UK
London has 1.72 million children and young people – nearly a quarter of its total population. It has 2433 schools. It also faces major health challenges: 41% of those children (over 650 000) living below the poverty line, which is significantly higher than the national average of 28%. Childhood obesity is significantly higher than in the rest of England, with 20.8% of 10–11 year olds obese compared with 17.5% nationally and 11.3% of reception year children, compared with 9.9% nationally. In at least two London boroughs the prevalence of obesity in 10–11 year olds is 25%. Children in London also spend notably fewer hours on physical activity than children in most other regions. There are huge gaps between the best and worst of health across more or less affluent boroughs. For example, in City and Hackney 16% of children are obese at reception age, whereas in Richmond and Twickenham that figure falls to just 7.7%. By Year 6, in Southwark figures are at 27.1%, whilst in Richmond and Twickenham this is 13.1%. Teenage pregnancy has fallen slightly since 2006, but this overall figure masks the fact that many boroughs have the highest rates in the country. The National Healthy Schools Programme (NHSP) is a joint Department of Health (DH) and Department for Children, Schools and Families (DCSF) initiative which is helping schools to make the link between health and achievement. Working with a comprehensive network of local and national partners, it provides schools with a framework for supporting children and young people by giving them the skills and knowledge to make improved life choices. The 41 criteria that result in ‘National Healthy School Status’ include things such as good canteen food and free drinking water, lifestyle advice for things such as sexually transmitted diseases and physical activity, and parental education and support, reminding about simple things like eating together or how to cook a healthy meal. In London 97% of schools are participating and 67% of schools have already achieved National Healthy School Status. Kevin Ward Head Teacher from Holmleigh Primary School in Hackney explains that the NHSP helps to
create an environment that has a holistic, subtle affect on overall health: ‘When you’re in a healthy school you can ‘‘feel’’ the difference. There will be healthy values and a healthy ethos running throughout the whole school, and the impact of this will be evident everywhere.’
Partnerships with primary care trusts and general practice Although most Healthy Schools Coordinators in Greater London are employed by the local authority and are based in education departments, one of the keys to the programme’s widespread popularity and success is in the collaboration it promotes between schools and PCTs. In London, this partnership takes place via representation in local steering groups, through joint funding and through the employment of PCT personnel as part of the Healthy Schools Team such as specialist sexual health workers, drugs advisors, or dieticians. Hugh Annett, Director for Public Health at Bristol PCT, says: ‘From a public health perspective, I think Healthy Schools is a great way of shaping the opinions of young people around many important public health issues, including obesity, sexual health, substance misuse, emotional health and wellbeing, healthy eating and exercise. Where better to do this than through schools? I’m absolutely convinced that the messages children learn during the school day can have a direct impact not just upon them, but also upon their entire family and community.’
Closer involvement of PCTs is helping the NHSP to succeed. For example, PCT involvement helped the London Borough of Bexley to become the first authority in England to achieve National Healthy Schools Status amongst 100% of it’s schools, nearly a year ahead of national targets. Local Healthy Schools Coordinator for Bexley, Tricia Oates says: ‘As a PCT, we took a very practical ‘‘hands on’’ approach in working with our schools, encouraging close working
A practical guide to the diagnosis and management of insomnia in a general practice consultation
between schools to enable the sharing good practice, and provided high quality training and resources to make the process of gaining accreditation as easy and smooth as possible. We also ran a series of policy days where schools worked with us in sessions to develop new school policies on issues such as school food and child protection.’
The Bexley success story has also involved GPs. For example Dr Daniela Mo, from Plas Meddyg Medical Surgery in Bexley has been working with the programme locally on the issue of obesity. She recently participated in a local healthy eating conference and has contributed to the borough’s new healthy packed lunch policy. The combined efforts of schools, healthcare workers and many other partners, is now having a marked impact on lifestyle. Most children are now doing at least two hours of high quality physical activity each week. There are plenty of opportunities for primary care practitioners and managers to get involved – from delivering training for teachers or health promotion to pupils and parents, to delivering healthcare services within the school environment or helping to shape and steer policies. Merely showing that you know about the programme helps. For example if you see a child that is overweight, you can encourage the parents to see how the school can help. If a child or young person comes to you with emotional health concerns, you can ask if there is a school counsellor, or peer mentors. For older children, do they have school nurse or sexual health drop in service which they can be pointed towards for more advice? The Healthy Schools Programme is promoting ‘health as a citizen issue’ in the way envisaged by Alma Ata. It encourages broad participation in health
107
promoting activities. Collaborative working is essential, because sharing the load it does not involve extra work. One of the most helpful things a GP can do, you do already – reinforcing the message ‘look after yourself, your family and your community; and remember to laugh and smile’. So this is a message equally important for adults too. It’s easy to forget to do simple things that improve our social and emotional health, like playing and having fun. Actually, it is too easy to forget how to be like a healthy child. To find out more about the Healthy Schools in your borough, please contact your Local Healthy Schools Coordinator whose details can be found at www. ealthyschools.gov.uk or contact the London Regional Healthy Schools Coordinators by emailing: elizabeth. [email protected] or alison.staff[email protected]. gov.uk Figures taken from the following sources: National Child Measurement Programme 2006/7; APHO Indications of Public Health in the English Regions, 5: Child Health, 2006 The State of London’s Children Report, Greater London Authority, 2007. ADDRESS FOR CORRESPONDENCE
Elizabeth Dunsford Regional Coordinator for Healthy Schools, London, UK Directorate of Children and Learners 10th Floor, Riverwalk House 157–161 Millbank London SW1P 4RR UK Tel: +44 (0)20 7217 3207 Email: [email protected]
