Impact of community led intervention on reducing health inequalities relating to physical activity & healthy eating Siu-Ann Pang and Judy Kurth, NHS Stoke on Trent Gemma Hurst, Graham Smith, Rachel Davey and Sarah Grogan, Staffordshire University Wednesday 21 October 2009

Context - Drivers WHO Healthy City Phase 5 status Health Inequalities Strategy Local Agreement Targets: adult physical activity and obesity

Common themes Need to address wider social determinants more systematically Impact of where we live/ the environment influencing and impacting on our ability to choose and adopt healthier lifestyles Community engagement – communities as agents for change - Ecological Approach - - Community Participatory Research -

My Health Matters CDW for Health – pilot in 3 areas in Stoke (Bentilee, Burslem South and Meir North) 3 Year Targets: individuals engaged, increase in physical activity to 3x30min over a 4-week period, increase of at least 1 portion of fruit and vegetables per day.

Programme Objectives Use community participatory research to build effective community partnership & strengthen community “engagement” in their own health, Based on partnership consensus, identify, prioritise and design intervention(s) related to specific health disparities (and their relevant determinants, mediators), Recruit local residents to help with the delivery and sustainability of the target intervention(s), Establish systems for ongoing monitoring and evaluation and overall impact on social capital and health inequalities.

Programme Phases Phase I: Baseline mapping (GIS) - built environment integrated with community postal survey. Phase II: Develop effective partnerships. Phase III: Community intervention mapping: identify, prioritise and design pragmatic intervention(s) to address wider environmental determinants. Phase IV: Evaluate intervention(s) and determine impact (follow up GIS, survey & focus groups).

Outcome Measures Indicators will include; Change in levels of physical activity, healthy nutrition and better health. Number of environmental barriers identified and addressed, change in neighbourhood perceptions and social capital. Number of community and voluntary sector organisations that have increased awareness and understanding of the relationship between healthy lifestyles and the urban environment. Number of staff trained in participatory methodologies across the Local Strategic Partnership.

Phase 1; Baseline Findings Neighbourhood Mapping; Study Areas Data Collection Summary of Findings Community Survey; The Questionnaire Positive Neighbourhood Characteristics Negative Neighbourhood Characteristics Physical Activity and Healthy Eating Summary of Findings

Neighbourhood Mapping; E.g. Burslem South Neighbourhood Mapping across 4 out of 8 Lower Super Output Areas within the ward. 1,132 residential addresses mapped. Neighbourhood environment measured around each address. Lower Super Output areas have a population of approximately 1,500.

Data Collection – GIS Indices Residential Population – address location and density Physical Activity Facilities / Green Space Commercial Outlets – Food Outlets (by type) Roads and Pathways (street connectivity) Land Use mix Road Traffic levels Road Accidents (especially pedestrians) Crime and Anti-Social Behaviour

Area defined within 1km of the residential addresses mapped within the study area. All environment data collected and mapped within this area. Data Collection Area; E.g. Burslem South

Neighbourhood Mapping; Findings Selected GIS Indices; Access to Green Space Commercial Outlets – Food Outlets (by type) Access to Physical Activity Facilities

Access to Green Space Green Space mapped by: - Size - Access - Purpose - Quality Green Space Access Points mapped. Walking distance measured from every residential address to every green space access point.

Access to Green Space Summary of Results Overall there is a high level of access to green space across Burslem South, Bentilee and Townsend, and Meir North study areas. 96.1% (Burlsem South), 67% (Bentilee and Townsend) and 76.5% (Meir North) of households are within 300m of green space with unrestricted access. 43.6% (Burlsem South), 4% (Bentilee and Townsend) and 0% (Meir North) of households are within 300m of ‘excellent quality’ green space.

Access to Shops and Services Shops and services mapped by type. Food outlets mapped by: - Food eaten on premises - Food eaten off premises (fast food) - Food Retail (including fresh food) Walking distance measured from every residential address to every shop/service.

Access to Fast Food / Fresh Food (500m) Summary of Results Burslem South 98.6% of households within 500m of a fast food outlet. Only 21.3% are within 500m of a fresh food retail outlet. Bentilee and Townsend 79.9% of households within 500m of a fast food outlet. Only 32.6% are within 500m of a fresh food retail outlet. Meir North 68.8% of households within 500m of a fast food outlet. ‘None’ are within 500m of a fresh food retail outlet.

Access to Physical Activity Facilities Physical Activity facilities mapped. Includes locations where activity currently takes place & locations which have the potential to facilitate physical activity Walking distance measured from every residential address to every facility.

Access to PA Facilities within 1km Summary of Results Burslem South 89.5% of households are within 1km of between 2 and 4 known physical activity facilities. (100% for at least 1). Bentilee and Townsend Only 22% of households are within 1km of between 2 and 4 known physical activity facilities. (92% for at least 1). Meir North A very low 3.2% of households are within 1km of between 2 and 4 known physical activity facilities. (53% for at least 1).

Key Findings – GIS mapping Lack of access to fresh food outlets, Relatively large areas of green space – but lack of quality, functionality and properly “maintained/managed” green space, PA facilities are within walking distance for some, but most are not within walking distance. PA facilities need to be better utilised.

Baseline Community Survey General Health (SF12v2) – including Physical & Mental Health, Neighbourhood Environment Walkability (ANEWS) – including land use mix, street connectivity, infrastructure and safety for walking, aesthetics, traffic hazards, crime, lack of parking, lack of cul-de-sacs, hilliness & physical barriers, Social Capital – investment in the local community, including, enjoyment, trust and reciprocity & participation, Physical Activity (IPAQ) – including the contribution of different domains to total weekly physical activity (work, active transport, garden & domestic, & leisure), Healthy Eating – Fruit & vegetable consumption.

Positives; Land-Use-Mix 30 minutes walk Bus stop Convenience store Fast-food restaurant Local park 54.8% 49.6% 33% 29.6% Workplace / place of study Gym / leisure centre Post office Large supermarket 26.1% 25.2% 20.9% 18.3% 30 minutes walk Bus stop Convenience store Fast-food restaurant 49% 46.7% 33.3% Non fast-food restaurant Gym / leisure centre Local park 57.3% 47.3% 16.7% 30 minutes walk Bus stop Convenience store School 55.1% 42.3% 39.7% Local park Gym / leisure centre Large supermarket 61.5% 56.4% 34.6%

Negatives; Aesthetics

Physical Activity; Domains

Physical Activity; Recommendations International Physical Activity Questionnaire (IPAQ) (Categorical Scoring); Moderate Physical Activity; > 5 days of moderate-intensity activity or walking of > 30 min / day. 33% (Burslem South), 30% (Bentilee and Townsend) and 24.4% (Meir North) of respondents were participating in moderate physical activity. ~70% of the population are not meeting recommended level of PA.

Key Findings – Survey (1) General Health (SF12); - Lower than average physical and mental health scores. Neighbourhood Environment Walkability (ANEWS); - Positive characteristics; Land-use-mix (access & diversity), infrastructure and safety for walking, - Negative characteristics; Aesthetics, traffic hazards & crime. Social Capital; - Three-quarters enjoyed living in their area with individuals on average living in the area for over 20 years, - Low perception of trust and reciprocity, - One-third participated in groups or organisations, - Perceived access to leisure facilities is poor, - Perceived problems with teenagers and vandalism in the area.

Physical Activity (IPAQ); - Sixty-percent of total weekly PA, for each ward, comes in the form of work-related PA. - One-quarter of total weekly PA from garden and domestic activities, - Active transport and leisure time PA accounted for the lowest contribution to weekly PA, % of respondents were taking part in moderate weekly PA. Healthy Eating ; - Approximately 70% of respondents were not meeting the recommendations for daily consumption of fruit and vegetables. Key Findings – Survey (2)

Next Steps Use Community Intervention Mapping to address key areas of the environment that can be modified, for example; 1.Increase access to fresh produce (community allotments, fruit and vegetable door-to-door delivery, social enterprise) 2.Improve quality and functionality of green space and facilitate PA for segmented groups i.e. families and youths 3.Optimise use of local community venues for PA/exercise and provide more local provision for PA 4.Look at traffic calming measures in key areas Overall aim is to create built and natural environments that support healthy behaviour.

Acknowledgements Stoke Primary Care Trust Area Implementation Teams – Stoke City Council Stoke-on-Trent Healthy City Partnership Transport Planning Stoke City Council VAST and Changes – voluntary sector Local Strategic Partnership