“It won't work around here,” says Jim, a Portsmouth paramedic in his fifties,
at news of the city winning government millions to become a Healthy Town.
“Step outside the caff and I'll explain.” Portsmouth is one of nine English
councils to share an award of £30million this week to encourage locals to
exercise, eat well, live better and, above all, curb obesity. Will these
pilot projects pave the way to solving Britain's burgeoning health crisis or
are they, as critics, argue, another political gimmick?
Jim lights a cigarette outside the café and says: “I don't know whether
anything would make a difference. You just have to see the binge-drinking on
Friday and Saturday nights. We have community health paramedics with a
specific role in advising people who've drunk far too much. But it doesn't
really make a dent.”
He squints in the morning sunlight and adds: “Jogging and healthy eating are
fine for people out in the nice parts. But on the city estates? There's tons
of caffs and burger bars, but I've never seen any healthy eating.”
Along with Portsmouth, deprived areas such as Dudley, Middlesbrough, Tower
Hamlets and Tewkesbury are to divide the cash. The Hampshire city is
emblematic of anytown Britain: there's a Seventies shopping centre, restored
heritage bits and city-centre sink districts. Sure, there are some grossly
overweight people about, but it doesn't look gravely beyond today's porky
norm. Civic pride was outraged last year when Boris Johnson, the Mayor of
London, wrote in GQ magazine that Portsmouth was “too full of drugs,
obesity, underachievement and Labour MPs”. Out of fairness, I forego the
grim estates for the pretty waterfront, to talk to breakfast fry-up
customers at the Big Wheel Café - the very people targeted by the new
initiative.Jim (not his real name - NHS trusts hate staff talking to
reporters) says: “Maybe it's because I tend to see the bad side of this
place, but I have to wonder how you tackle generations of really terrible
behaviour. I encounter kids as young as 8 walking the streets late at night.
How are you going to persuade the heads of families like that about the
benefits of healthy living?”
Among the other Big Wheel customers, John Parker, 20, sits with his face
buried in a mobile phone having just finished a plate of omelette, beans and
tinned tomatoes. “Yeah, I do all that stuff anyway. Healthy eating and
exercise. The scheme won't make a difference to me,” he mumbles. Parker, who
cooks at a nearby restaurant, adds: “My restaurant serves organic stuff. But
I only cook it. I prefer to eat here.”
While there's little evidence of popular clamour at the Big Wheel, the council
is delighted at the funding, which it has earmarked for ten projects,
including boosting access to cycling with new routes, bike rental and
refurbishment schemes. School dining rooms are to be revamped, residents
will be encouraged to convert gardens into allotments or create rooftop
gardens on blocks of flats. A network of community cafés selling affordable
good food is planned.
Urban design “encourages” obesity
Many of the newly approved Healthy Towns plans centre on making changes to the
urban environment that encourage people to exercise and eat better. A
growing body of research shows that modern “obesogenic” townscapes are
contributing to the obesity epidemic because they make it difficult and
dangerous to walk around but easy to find junk food. The hope is that
redesigned streets can help us to stay slim.
Statistically, Portsmouth has size problems: 52per cent of adults are
overweight, compared with the English average of 45 per cent. A third of
primary school-leavers weigh too much and three-quarters of residents do not
exercise regularly. Susie Waller, Portsmouth City Council's head of health
improvement, says that the new money is “a fantastic opportunity to have
real impact”. But sceptics such as Norman Lamb, the Liberal Democrat health
spokesman, have declared the initiative “at risk of being another
time-wasting gimmick”.
That might be mere political opportunism, but there is a real danger of
Healthy Towns joining the list of failed and forgotten Labour social
initiatives. And who knows which health interventions work? There is a
dearth of follow-up, says Ann Oakley, a researcher at the University of
London's social science research unit.
Community health involves a mass of disparate factors, and teasing out which
changes make a difference is a huge challenge. For example, Sheffield City
Council, another winner of Healthy Towns funds, will use the cash to try to
boost breast-feeding rates, as these are linked to less child obesity. It
seems a sensibly intuitive idea. But perhaps the statistical link is caused
by affluent, lifestyle-conscious, middle-class mums being more likely to
feed their babies this way.
Officials recognise the challenge
Waller acknowledges the difficulty, but says that Portsmouth's approach is
based on the best available evidence. “Outcome data around public-health
improvement is in its infancy, but Nice [National Institute for Health and
Clinical Excellence] has been doing good work developing our knowledge over
the past two years.” She adds that the Healthy Towns projects will be
monitored to get more data on which programmes seem to work.
Carefully targeted support is vital, cautions Kerri McPherson, a health
psychologist at Glasgow Caledonian University. “People can become so
bombarded by advice that they close their ears,” she says. “There are an
awful lot of mixed messages around, with conflicting information from
government and food advertisers.”
Families are even sorely confused about whether their own weight is unhealthy.
Only one in nine parents of obese or overweight children believes that his
or her child has a weight problem, reports a Department of Health survey of
nearly 1,200 parents this week.
Is there a danger of Britons suffering a surfeit of well-meaning words? Steve
Field, chairman of the Royal College of General Practitioners, takes a
pragmatic approach. “Obesity is the biggest problem we face and health
campaigns are the only real option we have for trying to change behaviour,”
he says. “We've got to start somewhere and this is the best place to start.”
But what of the sceptics back at the Big Wheel café? Professor Field wants the
mass media to play a role in reaching those who most need to heed health
advice. “We need to ban smoking on Coronation Street and see disadvantaged
people on EastEnders adopting better behaviours,” he says. “Those would be
the best way of getting to millions of people.” Perhaps we need to add two
more places to the Healthy Towns list: Walford and Weatherfield.
Five steps to a fitter town
Tax the traffic London's congestion charge has delivered a small but
noticeable health improvement, says a study in occupational and
environmental medicine. Scientists from two London colleges calculated that
since 2003, 1,888 extra years of life had been saved among the city's seven
million residents.
Bike for breasts City of York Council has tried to get more women on
their bikes by promoting a report which claims that regular cycling can help
to guard against breast cancer. The German study of nearly 1,300 women,
published in The Journal of Epidemiology, says that three hours of
moderately intensive cycling over a week could help to reduce incidence of
breast cancer by 34 per cent.
Get God involved A wealth of studies show that being involved in
religion boosts health and life expectancy. For example, a study published
in The European Journal of Ageing found that adults who attend synagogue
regularly live longer than their peers who do not. Professor Howard Litwin,
of the Hebrew University of Jerusalem, says that faith helps people to cope
with psychological pressure. He adds that people who go to synagogue
normally walk there and are, therefore, fitter.
Create book clubs Dr Robin Reesal, a clinical associate professor of
psychiatry at the University of Calgary, reports how several studies show
that reading or “bibliotherapy” as he calls it, can help to
reverse the symptoms of depression. He says that reading activates the
frontal lobes of the brain, which are involved in processing and applying
information. Population health could be raised if everyone joined a book
club, he adds.
Reintroduce rationing The restricted diet of people during the Second
World War may have health benefits for middle-aged women, says the Cancer
Research Campaign. It reports that women who were children in the early
1940s benefited from the “war diet”, when meat, sugar and dairy products
were restricted, and orange juice and cod liver oil provided vitamins A, C
and D. These are now recognised as important elements of an anti-cancer
diet.
Healthy planning in cities
Portsmouth Signage to help walkers, runners and cyclists time their
progress Dudley Transforming parks into family health zones
Halifax Grow-your-own fruit and veg scheme
Manchester Rewards for exercising
Middlesbrough Urban farms and junior trainer programmes
Sheffield Making the city breastfeeding-friendly
Tewkesbury Urban garden to help people keep fit
Thetford Encouragement to cycle more
Tower Hamlets Award scheme for businesses to sell healthy food
Source: Department of Health
[KEY TO GO WITH GRAPHIC]
1 Use of school fields by community outside hours, during holidays etc;
revamped canteen with healthier meals for pupils
2 Allotments; gardens turned into fruit and veg patches
3 Farmers' market
4 Fast-food outlets with healthy food options
5 Low-cost swimming pools
6 Measures to encourage cycling, including help with maintaining bikes
7 Urban farms
8 Cookery school in town centre
9 Outdoor gyms
10 Breast-feeding café
11 More green spaces
12 Takeaways farther away from school
13 Better town planning to promote walking
14 More cycle lanes
Sources: National Obesity Forum; International Association for the Study of
Obesity; NICE; DoH
