1. CHESS™ - engaging communities in their health & wellbeing
Christine Hancock | The 2018 Wellbeing Symposium

2. Our vision
A world where there are no preventable deaths from non-communicable diseases (NCDs) because people find it easier to live healthy lives.

3. The 3FOUR50 message 3 risk factors Four chronic diseases
Over 50% of the disease burden worldwide
cardiovascular diseases
type 2 diabetes
cancers
chronic lung disease
Tobacco use
Lack of physical activity
What we eat and drink

4. We can prevent much of the burden…
40%
80%
80%
type 2 diabetes cases
Heart disease
and stroke cases
some cancers cases
Source: WHO, Chronic Disease: A Vital Investment (2005)

5. …by addressing the risk factors
No tobacco
Increased physical activity
Healthier diet

6. 2x ~50% Smoking 3 months among low SES groups
as likely to have a heart attack
~50%
3 months
life expectancy lost for every year of smoking
of all smokers will be killed by their addiction
The risk factors
after age 35–40
Source: HSCIC: Statistics on Smoking, England 2015

7. £450m 1 in 10 1 in 6 Physical inactivity
contributes to
Physical inactivity
1 in 10
premature deaths from coronary heart disease
£450m
contributes to
1 in 6
cost to NHS in England annually
The risk factors
premature deaths from any cause
Source: Public Health England

8. 40% 10.8% Unhealthy diet of illness in UK
of NHS resources spent dealing with illness caused by poor diet
The risk factors
Source: Public Health England

9. Our mission & work areas
C3 fosters multi-sector Collaboration to catalyse action in the global community, to promote 3 behaviour changes:
Improving diet and avoiding harmful alcohol use
Stopping smoking
Increasing physical activity
C3 works with businesses, workplace health, communities and health professionals.

10. Communities
Engaging communities – the experts in their own health needs  – is the best way to break down environmental barriers to living a healthy life, and generate sustainable change.
- Why C3 works with communities

11. CHESS™ (Community Health Engagement Survey Solutions)
Developed out of international research
Tablet-based mapping tool, and also a process
Community members play active role in investigating their environment
Enables greater understanding of whether an area is conducive to good health (or not!)
Arms the community with an argument for change + evidence for proposed solutions
Our community engagement process is based on a process & app called CHESS

12. 1. What condition is the footpath in?
Street assessment
1. What condition is the footpath in?
2. Is it possible for pedestrians to cross this street safely?
3. Is there street lighting?
4. Are there dedicated cycle lanes on the street?
5. Are there trees or greenery (grass or flowers) along the street?
6. Is the neighbourhood generally free from litter?
Example CHESS scan, Picture: Girvan

13. In one community, teenagers refused to play at a nearby park
In one community, teenagers refused to play at a nearby park. When asked why, they reported,
‘There are signs that say “No drugs or alcohol allowed.” That must mean drug dealers use that park. We don’t want to play there.’
A sign that was meant to be helpful was instead inhibiting use of the park.
Example of why it’s important to engage community through insight sessions to figure out why resources in community are being used or not

14. C3’s community engagement
London boroughs 8
UK communities 2

15. Healthy Communities project
Why Halifax (Ovenden)?
In Halifax, deprivation is higher than average and about 20.1% (8,200) children live in poverty. Life expectancy for both men and women is lower than the England average.
Why Girvan (Glendoune)?
Girvan performs badly on income, unemployment, health, crime levels, and rate of emergency hospital admissions.
2-year ( ) project funded by Nestlé UK & Ireland
Why Nestlé?
C3 believes in a ‘whole- of-society’ approach to tackling chronic disease. This includes being a critical friend to big influencers, such as the food industry.
Nestlé: great workplace health programme but realising their staff don’t live at work, wanted to help the communities from where their staff came.
C3 selected Halifax & Girvan as 2 of the most health challenged environments among Nestlé’s 6 factory sites in UK.

16. Healthy Communities project timeline

17. Using CHESS™ in Ovenden & Glendoune
We assessed 5 aspects of the community’s built environment:
Streets
Shops
Restaurants
Outdoor physical activity spaces
Indoor physical activity spaces
69 total assets examined

18. What did community members say?
The roads and parks are not safe for our children – they can’t play there.
All the junk food is in the eye line!
Alcohol, sweets, crisps – we buy it because it’s cheap and it’s there!
Communities can exercise more control if availability is better.
It’s hard to know what is going on locally – especially if you are not comfortable using the Internet.
There aren’t enough activities for families to do together.

19. ‘The healthier stuff is not on offer, only chocolates and meal deals.’
‘Children are used in advertisements for unhealthy foods.
Children might be influenced by this and tell their parents that they want it!’

20. Food environment: Most significant findings
Girvan
No fruit or veg sold at the local Asda
All shops (chain and independent) with signage promoting unhealthy diets over healthy options
Alcohol at shops very visible
Community shops with mostly unhealthy food and drink options
Ovenden
Shop selling almost only unhealthy food across the road from a school
Only 1 of 9 shops had healthy foods at checkout
Children used in ads
How visible & promoted junk food is at most of the shops

21. Physical activity environment: Most significant findings
Girvan
Only community centre on housing estate disintegrating physically & figuratively
Multi-use games area in poor condition with lots of rubbish
Streets felt unsafe to cross
Very limited options for cycling
Difficult to find information for outdoor activities
Different parts and activities of Girvan not linking up
Ovenden
Significant amounts of litter & dog excrement in streets & parks
Lack of accessible information about local sport centres

22. Community members engaged
Interventions: Ovenden
32% of Ovenden’s population engaged with the project
Morrisons moved healthy options to near the till, and today has extended the number of tills with healthy options
A local café now runs a healthy supper club
Community clean-up day
Creation of community gardens & family gardening club
Dance & sport sessions
Cooking, wellbeing classes
To add to sustainability the interventions were organised through existing services, and were funded by the £10,000 community can-do grant. Local project manager Lisa reported that “It was the best part of the project ringing organisations up and asking them if we could support. One lady cried with thankfulness…that an organisation was willing to give them money.”
4,000 community members engaged with the project in the end - ~32% of Ovenden’s total population!
Pictures: (top) Willing contestants for the human fruit machine and (bottom) indoor activities at the local activity centre
4,000 18
Community members engaged

23. Community members engaged (30% Glendoune’s population)
Interventions: Girvan
Community centre repaired, including new fridge, cooker and kitchen units to enable a focus on healthy eating
Re-enthused Community Association and newly elected Chair who calls the work ‘inspirational’
Drop-in group for the young and old to help with issues of social isolation
175 summer picnic boxes for disadvantaged school-aged children
Classes through local restaurants about healthy food preparation
Community clean-up
Local Asda now sells fruit & veg
1,000
Story from Roddy: also identified some authentically hungry children over the Summer holidays. They came mostly to our Friday afternoons. And we gave them food to take home. They asked to also eat some of the food before they went home as their parents would take the food from them. A real eye opener in Scotland 2017.
Picture: the community litter pick
Community members engaged
(30% Glendoune’s population)

24. Our impact
“PD is a 14 year old girl who is on the autism spectrum and she came along to the Grow Your Own Food course, she has been bitten by the growing bug and has started growing more things at home. This is having a positive effect on the whole family – her mother has a disability and she is spending more time outside in the open air with her daughter.”
“The Healthy Communities project is just what Glendoune and the Community Association (GCA) need to jumpstart the whole community. This project has re-energised a tired and flagging Community Association.”
Picture: Happy customer with her donut peaches

25. £2m
14k 2
Healthy meals for children provided by Morgan Stanley in east London
Based on C3 and the community’s recommendations using CHESS™
Playgrounds co-designed by local parents, including transforming a disused carpark
Based on recommendations using CHESS™
Awarded to local communities to implement interventions
Thanks to the strength of evidence collected by CHESS™
Overall impact from our community engagement

26. (Healthy Communities project participant)
What are the implications of CHESS™ and community engagement for a wellbeing strategy?
‘The health of Girvan matters and each one of us who lives here needs to look and absorb the reality of our lives – our health, our strengths, and weaknesses – so that Girvan can be changed from the inside out!’
(Healthy Communities project participant)
For this slide, discuss the importance of engaging community members in their own wellbeing strategy. Too often public health interventions are imposed on communities. By equipping communities with a tool like CHESS they’re able to investigate their environments, draw on their own stories & determine the wellbeing strategy they want & need (guided by C3’s public health expertise). Ensures sustainability

27. www.c3health.org | christine.hancock@c3health.org
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