ࡱ> OQNy /bjbjEE *F'''dd8,4SSiiiDDDMOOOOOO$hs'DD''sii'iiM'Mi<(90f f f D"f~DDDssDDD''''f DDDDDDDDDd m:  Somerset LMC Discussion Paper on a possible Health Community Response to Choosing Health Background In 2004 the Government issued a white paper Choosing Health which identified a number of areas in which public health could be improved. This paper suggests a possible response for the health community in Somerset. The paper identifies a number of fields in which peoples can be encouraged to make lifestyle changes to better their health. The LMC thinks that there area with the greatest potential gain is in developing a co-ordinated programme across the whole health community aimed at encouraging the population to improve their dietary habits. Reasons for Choosing Diet as the Programme Focus Diet affects outcomes in a large number of conditions including cardiovascular disease, diabetes, depression & cancer outcomes all of which are priority areas for the NHS as well as many others such as musculoskeletal disease, asthma, and eczema which also carry significant morbidity Other topics in the White Paper are either already the subject of work within the NHS, or are more matters for social and educational input . For example, there is already a successful campaign running to encourage smokers to quit which involves PCTs, community staff, and general practices. The general practice element of this is partly directly funded by PCTs, and partly supported through targets in the Quality and Outcome Framework. Likewise, the specific management of obesity is a more complicated matter as the health input it is likely to require more involvement from secondary care and a much higher level of clinical expertise directed at specific overweight individuals. Also, experience suggests that low key interventions are generally not very productive for this patient group. On the other hand, changing the attitude of the general population towards their diet is likely to be an incremental process that can be supported by a number of simple initiatives which between them should produce a significant change in peoples eating habits. Rationale There is an impression that there is a change in the publics perception of food and the importance of healthy eating. A recent survey suggested that the high level of salt in processed food is now regarded as the number one hazard in food by shoppers, and the increase in popularity of organic produce and fat restricted items suggests that there is a desire amongst people to eat more healthily. The considerable interest in the Channel 4 television series Jamie Olivers School Dinners also reflects this great public interest. We think it would be possible to design a relatively inexpensive programme of activities covering the whole of the NHS that would encourage more people to eat better. In particular this needs to be targeted at hard to reach groups, notably single men, families living on benefit, and the elderly living on limited pensions. Objectives Such a programme should have two sets of objectives 1 Negative objectives that is a reduction in the amount of fat, sugar and salt consumed, 2 Positive objectives - an increase in the amount of fresh fruit and vegetables along with specific nutrients such as Omega 3 fatty acids. The ultimate objective, of course, is to improve health and well-being and reduce morbidity. The Programme Outline For maximum impact the programme should cover every population group and be fully integrated. We suggest that the financial cost of this could be quite modest but the staff and skills investment required is significant. To make best use of the available resource we foresee a programme board, possibly at SHA level, the critical members of this would be the DSHA Communications department, public health, a nutritionist/dietician, a general practice representative, and PCT based health promotion staff. Work Programme The project needs to run for long enough to have a real impact on the population. We suggest at least two years. Activities should cover the greatest possible range of patient contacts. Because the GP practice is the most frequently consulted NHS organisation by just about every patient group, it is logical that this should be at the centre of the programme. It is important that programme materials are identified as such and that the same format and logo is used throughout. This will obviously require considerable input from Communications and a certain amount of financial investment in producing good quality material. Programme elements might include: 1 More dietary information in the ante-natal period. Pregnancy packs could include more nutritional information and ante-natal classes, which already cover some of this area, could have it emphasized. A visual display of the amount of fat, salt and sugar in different commercial baby products would be valuable, specialist dietetic training for health visitors and midwives would enhance their ability to give really up to date information, and access to subsidized cookery classes, particularly directed towards young mothers on a low income, could be considered. 2 Enhanced dietetic advice from health visitors. New mothers are generally grateful for the support they receive from their health visitors. There is an opportunity here to encourage families to consider preparing their own weaning foods rather than using pre- packaged ones, to continue the work done during the ante-natal period, and to run competitions or other activities which might include offering a free sample pack of locally produced vegetables. 3 Pre-school Activities. This work could be extended into the pre-school period when parents are taking children to nurseries or play school. Publicity displays at pre-schools, children and parent activities looking at healthy eating, short sessions for parents at the beginning or end of the pre-school session and targeted work with the most deprived families could all pay dividends. There is a perception amongst lower income families that healthy eating is expensive and this needs to be dispelled. Also, a significant number of younger mothers have low self-esteem and there would be positive psychological benefits as well as physical health improvements to be gained by helping them to develop food preparation skills to give their children the best start that they can. 4 School Age Activities. Much of this would depend on Education Authorities engaging with the programme but primary school age children are likely to respond well to activities to do with food preparation, taste trials and competitions. Again, this might be a group where offering a pack of free fruit or vegetables along with some simple recipes that the children can use at home with their parents might be a way of expanding their horizons. 5 Secondary Age. The burger and chips teenager will need a more subtle approach. Schools can be encouraged to at least reduce the fat and salt content of convenience foods, and specific material for teenagers could pick up on the benefits of healthy eating, particularly in respect to obesity for this group of young people who are becoming very body conscious in relation to themselves, and also the opposite sex. 6 Young Single Adults. Young single men living alone are a considerable challenge. Material showing that eating well does not need to be complicated or time consuming and some sort of outreach using fairly light-hearted methods could prove to be possible ways of reaching them. It has been suggested that a poor diet is related to suicidal ideation, so the extent of possible benefits in reaching health targets is considerable. 7. Involving Families. Displays and activities in public places, work to encourage family meals, initiatives to help shoppers identify good, value for money food purchases, and using the school lactivities of children to positively influence shopping habits should be considered. 8 Helping the Elderly. Whilst many older people eat well, there is a group,usually living on a limited pension and in relative isolation, whose nutritional intake is very poor. This has considerable health implications from obesity at one end to susceptibility to infection and delayed healing from malnutrition at the other. Most such patients do make contact with their GP or the practice nurse on at least a periodic basis and whilst habits are hard to change for older people, specific advice from the doctor or nurse is a powerful tool. If some resource were available for the patients at greatest risk to have a simple nutritional assessment using a standard tool administered by a practice or community nurse, then professional input could be targeted effectively. We foresee that this work could be contracted for as a simple enhanced service. Maintaining Momentum Project materials need to be refreshed at a regular interval and the main focus of the programme could vary through the different population groups at different times. A display in GPs surgeries, community hospitals, outpatient departments and other places where there is a lot of foot traffic can have an impact - particularly striking is visual display showing the recommended daily intake of salt, compared with the salt content of different natural and processed foods. This would be which is simple and inexpensive to prepare. Similar displays can be prepared using fat and sugar content. Not only would this programme have a direct impact upon people exposed to the material, but it should also have an indirect impact on health professionals who will become more aware of the need to enquire about nutrition and who will be more likely to make offering nutritional advice part of their routine work pattern. Conclusion Somerset LMC believes that real improvements in diet are possible for the local population at relatively little cost using a campaign that covers a range of patient groups and is based on well prepared and designed visual information. Harry Yoxall V2 March 2005      PAGE 4   ijkv! ) [ f r y z  ! % g E I z ɾɰɧ}ujbhd-CJaJh1h1CJaJh1CJaJh15CJaJh\5CJaJh[CJaJh\CJaJh W\CJaJh W\5CJaJh\h;+5>*CJaJh\5>*CJaJh\h W\5>*CJaJh\h;+>*CJ OJQJh\h;+>* h;+CJh;+jh;+U& jkvP Q "#,-7PQ$G&$4&#$+D/0$a$ *%&#$/ {(+,-67Nru!*OP9:<T+@A>LuefϾϾ𔤔hM0v@` @A258e&367y 9!N!####$d$e$y$$$$%%m&n&r&&'ƾưưƨƨΠΊ|ttith56CJaJhCJaJhha56CJaJhaCJaJhh,z56CJaJh,zCJaJh<CJaJhh56CJaJh1CJaJhCJaJhd-CJaJh) tP(XGN@u7Qm`ՁV Y8z1@kYK3yLϦ,ΑUл;7N8 L&ed(6;!ُMR1DE 4U^Tä֯}lWN9_ ='L48cPfic-MiCn` KHI4B\O!7гAJޕ0D$nHFz942%W%l4C6:Y81@~p `8dHي18yEꎣ`Gڕ\z/r^!-YXE%~1a]k^C4˛/9EރCHzz7B.@4χЂ'_Թ/>}z-\$r&xR#$SR81c3)I,9dlZ8Egh9=".8-]T>p:l3N-ՠPe<l.H?VQvyQ/EhTo8h}x20[)#[gyFGQ{p=3, gC RtxW̜|{@K&:({KN#b5bv5܇+΃N{w0{Pԁ!%\ YzO C@VgW?V&kzmQo3ae sʀƸv) > hµuZw01ȫX.)tM J@9Px[Pk{X} )p U]sWs#'7݁jEh&(kRJ6Pml_H PqY P]` j.@|C1^(S c8c<j-b8ߛ4t tw: sYCJjwfg~8Mu>ў7w=IWkx/@6-Df@-_(({([xuϷ"jik즽8^lNh0f#XVC4a짾8/! L-m$.\OINFxxzzZN86.ٳ^81R}AxGiuZ ԝǣmr!gZB7BJk_tG]}~2u3גz]sZ@ў [N@sYVؤxN3Ѯ҈eY> aNW]Y{J/&4s,?|DT9WhZ@_m\I[dֳxvW -.z&62a[\=ٻH3L@10ԡՁV{HMwzZ/yeI@JADk=J`7;k],V6aj m\ ;{fQ@ O_& .AvxpF!6Enf_@OU/ -ܡ̔,Z}oȿʤaqGG/H8ͨлӗSO"ĨӀ8}` nM}y։"yzս}:_߹P pd6:8IsTO]y@&Ge[U{a(s5@ >( CGe]tYOI󥩏eI<ȤlSy66Yl;ُrPRTFm^h4Cr5;b<ՙ6ќC,^)+ԟ<^us<il2PWY+;3"L w y Po׹S 4W4}ΎusQVB*-?K&m@3WD7@D%!nI 9S9/>9hi .X68KŘ$#)@˼lKެp&rs-Y.j2 *$=9tV]h>:sxV\ hnxYRy<ϠO6‡)@FXf/TsF(Ѫ)z(ܞ3#q5;6@ۛhy!;п$P+bҟ lRkE<1'7h>iPKv9{X_FHx"*![peG4}*[5=Q^\ gۉ^%vյMP #@D qY$ gMݷ Krg"@-.ߪ{f_G*K?Erg>.O ?3uRԬw~SIE/͛AfAX(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X&l IENDB`^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH NN  Heading 5$$0$@&a$5CJ OJQJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 0U0 Hyperlink>*B*44 Header  9r 4 @4 Footer  9r PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 'F  '//!x! *// "!8@0(  B S  ?'\'FF'NN'8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsplace 6+43>''''''''''''''''''''oy]jl $ V X 27x} CKz FN[a9<{ Q\)- KPHN!gk;?~] i ;!@!!!!!""Y"["""""$$''''''''''''''333333333333333333333333333333333333333333333333333333333333 2'''''''''''''''''''''''''[/<R "Xw";$d-DocumentSummaryInformation8FCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q