ITEM NO.
REPORT OF THE LEAD MEMBER FOR HEALTH
CABINET
Date: 24th January 2006
TITLE :
Improving Health and Well-Being and Reducing Health Inequalities IN
Salford - a consultation document
RE RECOMMENDATIONS:
1. Cabinet is asked to note the contents of the attached paper entitled ‘Choosing Health IN
Salford’ prepared by the Director of Public Health along with officers of the city council
2. Cabinet is asked to refer to the thirteen recommendations contained at Item 4 within the
document
3. Cabinet is primarily asked to agree to a period of consultation with members, Community
Committees, Partners and trade unions following which the results of that consultation
will be presented to Cabinet
EXECUTIVE SUMMARY:
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Salford suffers health inequalities in comparison with the national average
Life expectancy in Salford is lower than the national average
There are also inequalities identifiable within the city itself
In May 2004 the Health Inequalities Strategy was agreed by Cabinet and by the
Primary Care Trust Board
The city has challenging targets to meet by the year 2010
Health has been identified as a Cabinet priority and performance against health
inequalities is included in CPA and District Audit assessments
Salford City Council has a responsibility to improve the well-being of the people of
Salford
Salford Primary Care Trust has a responsibility for improving health and reducing
health inequalities in Salford
Delivery of our targets is a corporate responsibility – partnership working is
essential and all directorates have a contribution to make
Coordinated programmes of work, city-wide and community based, provide the
most effective means of delivery
The Healthy City Executive, through the Director of Public Health, reports on
progress to the Local Strategic Partnership and the PCT Board
BACKGROUND DOCUMENTS:
‘Choosing Health’ Government White Paper (DH 2004)
Salford’s Health Inequalities Strategy
Cabinet Report ‘Improving Health and Well-Being and Reducing Health Inequalities IN Salford
(June 2005)
CONTACT OFFICER: Dr Julie Higgins, Director of Public Health, Salford. 212 4819
Brian Wroe, Assistant Director, Community Services, tel. 793 2287, e mail
brian.wroe@salford.gov.uk
WARD (S) TO WHICH REPORT RELATE (S): Citywide
PURPOSE OF REPORT
The purpose of this report is set out in the attached paper.
BACKGROUND
In May 2004 Salford’s Health Inequalities Strategy was ratified by Cabinet and
the Primary Care Trust Board. Priorities for action were agreed as
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Under 5’s
Over 50’s
Tobacco Control
Healthy Eating and Physical Activity to reduce obesity
Ambitious and challenging targets have been set and the city must reduce
inequalities in health outcomes by 10% as measured by infant mortality and life
expectancy at birth. Other challenging targets have also been set. Health has
been adopted as a Cabinet priority and health inequalities are included in CPA
and District Audit assessments.
The Director of Public Health in Salford, assisted by officers of the city council,
has produced a comprehensive paper (attached) which details the position of
Salford and what must be done to reduce health inequalities in the city. The
paper outlines the local, regional and national position in relation to health
inequalities. It is stressed that Health Inequalities are a corporate responsibility.
Effective partnership working is essential and all directorates have a contribution
to make.
Coordinated programmes of work are recommended as being the most effective
way of achieving lasting results.
Our response is led by the Director of Public Health who reports to the Local
Strategic Partnership by way of the Healthy City Executive.
This document is brought together following a meeting held in November 2004
between Cabinet and board of the Primary Care Trust when this subject was
discussed in detail.
CONSULTATION
Detailed discussion has previously taken place between
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Director of Public Health
(Former) Deputy Director of Public Health
Lead Member for Health
Director, Community, Health and Social Care
Assistant Director, Community Services
The Health Inequalities Strategy was presented to the Cabinet and to the PCT
Board in May 2004. A further paper was presented on 14 June 2005 when
Cabinet was asked to note the structures and partnership arrangements in place
and to endorse the programmes of work which were underway across the city.
The first recommendation in this paper suggests a period of 6 weeks for
consultation with members, Community Committees, Partners and trade unions
following which the results of that consultation will be brought back to Cabinet.
DETAIL
Full detail is contained in the attached paper entitled ‘Choosing Health IN
Salford.’
RESOURCE IMPLICATIONS
Resource implications remain unclear at the present time however there will be a
need for additional finance and staff time to deliver some of the targets.
Nonetheless, it is felt that the long-term cost of taking no action would be far
greater in terms of health care, absenteeism etc. Furthermore, many of the
actions can be undertaken at no cost simply by changing working practice or by
the demonstration of firm leadership by the city council and PCT.
CONCLUSION
Salford suffers disproportionately from health inequalities in comparison with the
national picture. There are also health inequalities across the city itself.
Challenging targets have now been set which the city must achieve by the year
2010. Furthermore, the performance of the city council and PCT in addressing
health inequalities forms part of CPA and District Audit assessment. Firm and
decisive action needs to be taken in order to reduce those inequalities. Key
partners and each directorate of the city council have a role to play and Cabinet
is now asked to endorse the paper prepared, with others, by the Director of
Public Health so that action can be taken in order to improve the health of the
people of Salford.
Appended: ‘Choosing Health IN Salford.’
Choosing Health IN Salford
SALFORD CITY COUNCIL’S ACTION ON SMOKING AND OBESITY
The purpose of this paper:
Section 1
1. To summarise what health inequalities are and describe a method for addressing them –
programmes of work
2. To outline how action on these issues will help us work towards meeting targets on health
inequalities, a cabinet priority/pledge and CPA and District Audit assessments
3. Outline the structures and co-ordinating arrangements in place to monitor and deliver
action on reducing health inequalities
4. To give an overview of Choosing Health, the Departments of Health’s strategy for
reducing health inequalities
Section 2
5. To focus the Cabinet on two key areas for action – smoking and obesity, by describing
the scale of the problem, current work and what can be done
Section 3
6. To highlight for Cabinet that to reduce health inequalities requires a corporate approach –
every directorate can contribute and partnership work is essential. Leadership is placed
with the Director of Public Health – a joint appointment with the Primary Care Trust
7. To identify key considerations and immediate actions that the City Council can take
o In Directorate business plans
o At a corporate level
Section 1: What are health inequalities, and what methods should we use
to address them
1.1 HEALTH INEQUALITIES IN SALFORD
GOOD HEALTH IS IMPORTANT FOR EACH PERSON IN SALFORD, ENABLING THEM TO
PARTICIPATE FULLY IN THEIR EDUCATION, EMPLOYMENT OR RETIREMENT AND WITH
THEIR FAMILIES AND COMMUNITIES. ON THE OTHER HAND, HEALTHY SALFORD
CITIZENS ARE AN EQUALLY IMPORTANT RESOURCE FOR SALFORD’S ECONOMIC
PROSPERITY.
HEALTH IN SALFORD HAS IMPROVED DRAMATICALLY IN THE LAST CENTURY,
HOWEVER, SALFORD PEOPLE ARE STILL MORE LIKELY TO EXPERIENCE ILL HEALTH
AND TO DIE EARLIER THAN THE AVERAGE PERSON IN ENGLAND. WITHIN SALFORD,
PEOPLE IN THE EAST OF THE CITY ARE MORE LIKELY TO BE UNHEALTHIER THAN
THOSE IN THE WEST OF THE CITY.
NEVERTHELESS, WE MUST INTERPRET THIS CAREFULLY. FOR EXAMPLE, WHILST
THERE IS RELATIVE GOOD HEALTH IN SWINTON, AS COMPARED TO ORDSALL, THE
PEOPLE OF SWINTON STILL EXPERIENCE WORSE HEALTH THAT THE NATIONAL
AVERAGE AND THERE ARE EXCEPTIONS; RESIDENTS IN WORSLEY, BOOTHSTOWN
AND PARTS OF WALKDEN EXPERIENCE BETTER HEALTHY THAT THE NATIONAL
AVERAGE.
INEQUALITIES IN HEALTH ARE CLOSELY ASSOCIATED WITH INEQUALITIES IN WEALTH.
CENTRAL SALFORD BEARS THE BURDEN OF DISADVANTAGE AND ILL HEALTH, BUT
THIS IS REPLICATED IN OTHER LOCATIONS THAT ALSO HAVE POCKETS OF
DISADVANTAGE.
1.2 Health Inequalities Targets
Reducing health inequalities is a priority for this government. Ambitious national floor targets
have been set. Local Government, NHS and our partners have fundamental roles to play. The
national target for health inequalities is, by 2010, to reduce inequalities in health outcomes by
10% as measured by infant mortality and life expectancy at birth. This national target will be
achieved by local co-ordinated action. Recognising this, Government has focused on the 88 most
challenged local authorities and has chosen them to ‘spearhead’ developments. They also have
‘stretched’ targets. Salford is a ‘spearhead’ community.
Further national targets for health that address inequalities have also been set, focussing on
disadvantaged groups relating to teenage conception rates, smoking, breast feeding,
immunisations such as flu and death rates from coronary heart disease and cancer (Appendix 1)
Meeting the health inequalities national floor targets is proving to be very challenging both
nationally and locally. Because of this they have gained a much higher profile nationally,
health is identified as a cabinet priority/pledge and health inequalities are included in
comprehensive performance assessment (CPA) and District Audit assessments. Key lines
of enquiry in CPA relate to partnership working and action on smoking, diet and physical
activity and their relationship to reducing health inequalities.
1.3 The Health Improvement Challenge – programmed work
It is generally accepted that many factors such as poverty, employment and the funding of
services determine whether a person or community experiences good or poor health. Many of the
factors are local, including access to good quality housing, decent education and effective health
services. Focusing on the well being of individuals and their families – a well-established duty for
us as a City Council - can also bring about long-term changes. Supporting vulnerable people is of
particular importance. There are also many actions that can be taken to improve the health of
local people by working with children. The Dahlgren and Whitehead model (figure 1) captures the
different levels of influence, and underscores the roles we have in the City Council working with
partners. Improving health and well-being is a complex business. Success is achieved when the
City Council, the NHS, the police and others take action upon the many factors that affect health
through coordinated action. These actions fall into two broad areas:
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Activities, which seek to improve health by increasing access to money, decent
housing and education; improving safety; increasing participation; and
Interventions focusing on changing health-related behaviours, like smoking, exercise,
eating and drinking.
Figure 1: (Dahlgren and Whitehead, 1991)
Effective initiatives to improve health and associated life chances should be co-ordinated within
programmes of work that raise awareness, educate, provide support, support behavioural
change or make policy changes (societal/environmental).
For example, increasing knowledge about nutrition is only helpful if families and individuals: 1)
know how to cook food; 2) are interested in cooking, and feel confident; 3) have the right
utensils and equipment; and 4) are able to access affordable and nutritious food. Action on
one of these areas alone will bring limited success. Greater impact is achieved if all four
areas are developed together.
Programmes of work are made up of coordinated actions, undertaken by relevant partners. At
root, the ‘programmed’ approach recognises that action on any one part of the system is
unlikely to have significant impacts, unless it is tied to work happening elsewhere.
Research and examples of good practice demonstrate this conclusively. Linking to the
Dahlgren and Whitehead model – figure 1 above, co-ordinated action is required at each
point:
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Individuals: awareness raising, changing behaviours, building knowledge and
confidence;
Families: building skills, developing networks, offering support;
Communities: releasing capacity, developing groups, building networks
Organisations, workplaces and schools: developing workplace policies,
regulating access to unhealthy food, and
Environment: improving housing, reducing poverty, promoting inclusion
(Example in Appendix 2)
The programmed approach also enables leadership to be at the right level with appropriate levels
of subsidiarity. This translates into programmes at both city and community committee levels –
with both corporate and directorate responsibility. This means we develop action plans that:
o Have a ‘golden thread’ of activity within city-wide and community based programmes,
with each Directorate taking responsibility for defined pieces of work
o Are undertaken by relevant agencies (for example, PCT, City Council Directorates,
Police, University);
o Are driven by residents themselves; and
o Are measured in terms of immediate and long-term effect.
1.4 Leadership and structures for delivery
1.4.1 Leadership
Salford City Council is charged with improving the well-being of the people of Salford. Salford
Primary Care Trust is charged with improving health and reducing health inequalities in Salford.
These two objectives are inextricably linked and the two organisations have appointed a joint
Director of Public Health. The Director of Public Health will lead, working closely with the
Strategic Director of Community Health and Social Care, in co-ordinating activity to ensure
delivery of the health inequalities targets for both organisations and on behalf of the Local
Strategic Partnership. Health inequalities will sit within the portfolio of the lead matters for health.
1.4.2 Reporting Structures
The Healthy City Forum Executive is comprised of executive directors of the City Council and
PCT. It is the service delivery group under the local strategic partnership, through which the
Director of Public Health reports progress on delivering the Inequalities Strategy and targets to
both the Local Strategic Partnership and the PCT Trust Board. It is proposed that this executive
group reports through the Director of Public Health to Cabinet and that an annual review of
progress be presented to Cabinet to coincide with the annual Business Plan production cycle. A
number of partnerships sit under the Healthy City Forum Executive.
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The newly formed Tobacco Control Partnership. Chaired by the Regulatory Services
Manager, and co-ordinated by the Health and Well-being Manager who is jointly
managed by the Director of Public Health and the Regulatory Services Manager of
Environmental Services Directorate. Member leadership is provided by Cllr Lea
A Food and Physical Activity Partnership was launched in the summer. It is chaired by
the Director of Public Health, and co-ordinated by the Health and Well-being Manager. .
Councillor Sheehy will be Lead member for this Partnership.
Other topics are linked into the Healthy City Forum Executive’s business including
children’s well-being, sexual health, including teenage pregnancy, alcohol prevention,
promoting mental health and well-being
Another role is to ensure that the well-being strategy for older people, the forth coming
mental health commissioning strategy for Salford, the children and young peoples plan
and the drug and alcohol strategy address health inequalities.
These partnerships oversee the multi agency programmes that are being developed to eliminate
the health inequalities in Salford. All Council Directorates have an important role to play and their
potential actions are set out in section 3.2.
The Director of Public Health is lead for Greater Manchester Obesity Working Group and links
into the Greater Manchester Tobacco Alliance. Through the Strategic Health Authority there are
links to Regional Task forces relating to Tobacco Control, obesity and Physical Activity. These
are all under review in light of changes in NHS strategies. The Director of Public health as a
representative of the Healthy City Forum Executive links into these forums.
1.4.3 Overview and Scrutiny
Whilst the City Council has every confidence in the local NHS structure delivering good quality
health services, the City Council has a role in ensuring health services remain at a high standard.
Whilst working in partnership with Salford Primary Care Trust, the Health and Social Care
Scrutiny Committee will maintain a proactive and vigilant role in scrutinising local NHS services.
This will include scrutinising:
 Standards and appropriateness of health care services
 Equitable distribution of health care services
 Prevention services and those that address health inequalities
1.5 CHOOSING HEALTH
Our lower life expectancy rates reflect lifestyles and environments that people lived in forty to
eighty years ago. Historically, most effective public health successes have come from social and
economic improvements. Salford has been at the forefront on some of these great public health
achievements – first City to have smokeless zones and first City to introduce health visitors. It is
clear that improvements in the determinants of health such as education, housing and poverty will
improve the health of Salford people but we can take actions to enable people to live healthier
lifestyles that will improve life expectancy now.
Choosing Health, Making Healthy Choices Easier (DH, 2004) describes actions that can be taken
to increase life expectancy, improve quality of life and narrow the gap in health levels between
richer and poorer communities. It supplements the National Service Frameworks concerned with
clinical care of Coronary Heart Disease, Diabetes, Older People, Mental Health, Children’s and
Long Term Conditions. It aims to
“inform and encourage people as individuals, and to help shape the commercial and
cultural environment we live in so that it is easier to choose a healthy lifestyle “ (page
3).
Key to this approach is the opinion that lifestyle decisions are personal ones and that people do
not want this responsibility to be taken away from them. People act as consumers and require
information, advice and personalised help to support healthy lifestyle choices. This is described
as a shift from ‘advice from on high to support from next door’. On the other hand, Government
can act in areas where personal choice can affect another person’s health and take additional
steps to protect children and young people’s health through support for parents and healthy
‘whole school’ approaches.
The lifestyle issues targeted are:
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Reducing smoking
Improving sexual health
Reducing obesity
Improving diet and nutrition
Increasing physical activity
Sensible drinking
Improving mental health
Our local policy on health inequalities, Salford’s Health Inequalities Strategy, was ratified at both
City Cabinet and Salford’s Primary Care Trust Board in May 2004.
Although the actions described in this document relate largely to lifestyle, they sit within a set of
City Council policies that address the determinants of these lifestyle choices. Examples of these
are:
 Healthy workforce strategies
 Agenda 21
 Health plans for people with learning disabilities
 Green transport policies
 Procurement strategies e.g. buying local food
 Clean air policies
 Affordable warmth strategy
 Anti-poverty measures
 Improving the health of children looked after
 Safer communities initiatives
 Road accident prevention
 Affordable and decent homes
It is the complex inter-relationships of these broad policies and the context of the way people live
their lives that bring about positive changes in health in Salford.
To provide focus, it is proposed that the two major lifestyle factors that affect Salford people’s
health – smoking and obesity are targeted and the key actions the City Council can take to
address these issues are outlined.
The next sections of this paper will:
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Outline the size of the problem of smoking and obesity in Salford
Describe what we are currently doing and what actions can be taken to tackle these
issues
Describe specific actions the City Council can take, within the context of partnership work
o At a directorate level
o At a corporate level
Section 2: Focus on smoking and obesity
2.1 Smoking IN Salford
2.1.1 SIZE AND SCALE AND THE PROBLEM
Smoking is the biggest preventable cause of death in the West. Half of those who smoke will die
from their habit. It is a major risk factor for coronary heart disease, respiratory illness and cancer.
Smoking related diseases kill 120,000 people a year in this country. No other legal product
causes mortality on this scale. Smoking is also a principal cause of a range of diseases, in
particular circulatory and respiratory disease and lung cancer. Although smoking rates have
reduced greatly in past decades to 25% (from nearly half the population), prevalence in Salford
remains high at around 35%. Smoking is responsible for 500 deaths a year in Salford.
Exposure to second hand smoke is now also known to be an important cause of death and ill
health. Although the impact is far less than that of smoking itself, regular exposure to second
hand smoke can increase the risk of lung cancer and heart disease and middle ear infection and
asthma in children. Those most at risk are children, pregnant women, those with existing
respiratory illness and those exposed through work, (particularly in the hospitality industry).
Second hand smoke kills over 600 workers a year, and more than 10,000 through domestic
exposure.
2.1.2 Solutions to Reducing Smoking
Solutions for taking effective control of tobacco must be found at both individual and the
environmental level. However, it is crucial to acknowledge that these levels interact.
For example, smoke free workplaces, have been shown to have an impact on individuals by
encouraging smokers to cut down, quit or not start in the first place.
The table below illustrates some of the different contributions played by individuals, local
government and national government.
Examples of actions required to address wider issues of tobaccos control
Individual level
Quitting smoking
Not smoking in the home
Not smoking around children
Environmental
National
Taxation
level
Legislation – smoke free workplaces and public places
Raising awareness regarding the dangers of second hand
smoke
Reducing smuggling of counterfeit tobacco
Anti-poverty measures
Local
‘Smoke free Salford’
Adopting an exemplar role
Promotion of stop smoking services
Support to staff who wish to quit
Raising awareness/education regarding dangers of smoking
and second hand smoke
Reducing underage sales
Reducing sales of counterfeit tobacco
2.1.3 Legislation
The Government is introducing legislation to restrict smoking in workplaces and public places.
Consultations have shown that the above has overwhelming public support. As it currently
stands, all workplaces would be smoke free by 2007, and those which do not serve food (‘wet
pubs’) being exempted from the legislation entirely, apart from restricting smoking at the bar. The
proportion of pubs serving food is relatively low in Salford, which means that many public houses
(often those in the most deprived areas) would escape the ban. This would have a detrimental
effect on health inequalities in the city.
2.1.4 A SMOKE FREE CITY
Liverpool City Council has introduced a private members bill to promote a local act of parliament
making the city smokefree by 2008. If successful this would mean that the current legislation
would be extended to cover current exemptions from Government plans i.e. pubs which do not
serve food and members associations. Manchester is currently considering a similar route.
2.1.5 STRATEGIC OBJECTIVES
Action by the City Council should be directed at achieving the following strategic objectives:
Reducing the incidence of smoking related diseases in Salford by
 reducing the prevalence of smoking by supporting smokers who wish to quit
 reducing uptake of tobacco use by young people
 reducing exposure to environmental tobacco smoke (second hand smoke)
 strengthening control over the illegal supply of tobacco
2.1.6 CURRENT ACTIVITY
In 2004, the Health and Social Care Scrutiny Committee scrutinised tobacco control and made a
series of recommendations that have been progressed by the appointment of two City Council
staff, with funding from the PCT. Although they have a corporate role they have concentrated
their actions in Environmental Services, working closely with Environmental Health Officers to
increase the number of workplaces with smoke free policies (case study 1) and smoke free
restaurants scheme (case study 2).
The Salford Tobacco Control Partnership has been developed to coordinate a wider, strategic
approach to this work, focusing on prevention and cessation with young people and adults, and
reducing the health effects of second-hand smoke. In partnership with the PCT, lunchtime
smoking cessation sessions are being offered to City Council staff in some locations. Work is
being developed with young people in a range of settings, and work being planned to develop
and progress the number of families signing up to being smoke free or agreeing not to smoke
around their children (‘Smoke free Homes Initiative’).
Case study 1: Environmental Health Officer intervention - tobacco control
Environmental Health Officers (EHOs) are now making a key contribution to improving the health
of those who work in Salford by helping to increase the number of smokefree venues and
protecting staff from the known harmful effects of exposure to second-hand smoke. Since April
2005, all EHOs who are involved in Health and Safety or Food safety inspections now investigate
the smoking status of all businesses they inspect and intervene where appropriate. This
intervention is followed by more intensive input from the Tobacco Control Officer in supporting
businesses who agree to adopt 100% smokefree policies. Along with work to encourage seven
additional cafes and restaurants to go smokefree, taking our total to over fifty, recent successes
with businesses has included Worsley Golf Course and GM Fire Service.
Worsley Golf Course
Balloted its members on a smoking ban – members voted in favour of the ban and it will be going
smokefree in January 2006
GM Fire Service
The headquarters of the above are in Salford. Following our intervention, the Fire Service will be
going smokefree in January 2006.
Case study 2: Smiths restaurant
Smiths restaurant in Eccles was one of the first restaurants in Salford to agree to go smokefree
following an intervention from Health and Wellbeing staff. Staff visited the restaurant in February
2005 and the owners agreed to introduce a 100% smokefree policy from March 2005. One
partner in the restaurant is now an active member of the Tobacco Control Partnership. She
reports that whilst one or two customers have reported they will no longer use the restaurant, she
has gained many more. A customer survey produced overwhelmingly positive responses,
focusing on the positive effect of the new smokefree environment on the health of customers and
staff alike. A small selection are shown below.
‘… we want to say how wonderful it is to have a non-smoking restaurant in Eccles. As a staff
team, we have had many meals at Smith's and the fact that it is non-smoking is a real plus as
many of us, myself included, really object to smoky atmospheres and smelling of other people's
smoke. We also have some staff members who are asthmatic and cannot cope with smoke at all.
We were all really delighted when you became non-smoking and are pleased to lend you our
support in forging the way forward for other establishments.’
‘…Speaking as one who suffers from breathing trouble (probably brought on by smoking some
years ago) I think it must be much better for the staff.'
‘As almost weekly diners at Smith's, we feel that the already high standards have been enhanced
since the introduction of the no smoking policy. Maureen has sinus problems and even small
amounts of ambient smoke has an unpleasant effect on her. We were prepared to put up with this
as yours is our favourite restaurant. The change has been an added bonus.’
2.2 BEING OVERWEIGHT AND OBESE IN SALFORD
2.2.1 SIZE AND SCALE OF PROBLEM
The prevalence of people being overweight and obese is steadily rising; it is recognized as a
serious public health issue and is a national priority. More children and adults are overweight
than ever before. This obesity epidemic has the potential to be of equal importance to smoking
as a determinant of future health. Obesity is one of the most important preventable challenges to
health leading to a range of diseases including coronary heart disease, cancer, and type 2
diabetes.
Several national surveys give us an indication of the problem in Salford. For a definition of
obesity please see Appendix 3.
%
Male
Female
Overweight
43.2
32.6
Obese
22.2
23.0
Morbidly obese
Total
1.0
66.4
2.9
58.5
Health Survey for England 2003
This means that over 2/3rds of men and half of women are overweight or obese. This equates to
30,000 obese people and a further 140,000 who are overweight. Obesity in women is related to
deprivation, an association not seen in men or children. Our children are also getting fatter.
Why are we getting fatter?
We are getting fatter because our diets are not good, but more so because we are not physically
active enough.
Compared to our forefathers we have less daily calories, but they are energy dense, and we
expend significantly less too with lower levels of active daily living. Car ownership and television
watching are strong predictors of the rise in obesity.
Unhealthy choices related to food and physical activity have two consequences:
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We put weight on because we take in more calories than the energy we use
An unbalanced diet leads to ill health in itself, e.g. eating 5 fruit or vegetables a day can
reduce the risk of coronary heart disease by 20%
The quality of our diet – on the whole – is not good. Characterised by high calories, saturated fat
or sugar, high levels of salt and insufficient consumption of fruit, vegetables and fibre.
o
Overall, adults in England are eating:
 50% more saturated fat than the maximum recommended
 around 50% more than the maximum amount of salt recommended
 half the fruit and vegetables recommended
 insufficient amounts of fibre which are up to a third less than recommended
 half the fish recommended
Children’s diets have changed:
 Breast feeding and weaning on to poor diets which are low in fruit and vegetables
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Children graze more eating extra confectionary and snack on sweets, crisps and
savoury snacks
Television viewing is linked to unhealthy, high fat food habits
60% of energy consumption by British teenagers comes from fat with added sugars
Consequently, the causes of the epidemic are complex.
In relation to food, they include the rise of the fast food restaurant; the relative ease of access to
unhealthier ‘energy dense’ options compared to healthy options, which, it is hypothesised, may
make us more prone to weight gain; the perceived and often real cost of healthier options
compared to fast food; confusion over (and lack of) food labelling and the decline of cooking
skills. Also we cannot separate out the complex relationship individuals have with their food,
using it as ‘treat’ or for comfort and the family and society environment we have all learnt our
eating habits within. Some groups (widowers and older people, especially those on low incomes,
living independently and with impaired mobility) have limited exposure to a wide range of fruit and
vegetables. This relates to affordability and accessibility to healthy foods not knowledge. There
are also cultural differences that affect diet. Furthermore, alcohol adds unneeded calories to our
diet.
In relation to physical activity, increased sedentary workplaces and home lives, reduced walking
opportunities and a culture in schools and society that makes it more likely to be sport spectators
than participators, long working hours, the impact of rising concerns with crime and anti-social
behaviour on traditional ‘games’ for children and the rise of competing, home based cultures have
contributed to lower calories burned by people.
These complex causes require complex solutions. Above all, it requires partnership working
between those who have a role to play in encouraging easily accessible healthy food and
opportunities to be active in the workplace, in the community and in the school.
2.2.2 SOLUTIONS TO REDUCING OBESITY
Solutions for taking effective control of obesity must be found at both individual and the
environmental level. However, it is crucial to acknowledge that these levels interact. For
example, encouraging people to become more active will have limited impact if the environment
in which they live and work is not conducive to being active.
The table below illustrates some of the different contributions played by individuals, local
government and national government.
Examples of actions required to address and control obesity
a) Energy in
Individual level
Breast feeding
Eating a healthy balanced diet –‘ 5 A day, low salt/fat/sugar,
high fibre
Ensuring dependents eat a healthy diet
Environmental
National
Taxation on unhealthy foods
level
Advertising controls
Restrictions on food production and provision companies
Farming policies
Education
Local
Long term, behavioural change programmes aimed at food and
physical activity:
o
Promoting good access to healthy food
o Promoting affordable healthy food
o Promoting good knowledge and understanding of food
o Developing cooking skills
Healthy procurement policies
Obesity care pathways
Health promotion interventions in workplace
b) Energy out
Individual level
Environmental
Achieving recommended minimum standards for weekly
moderate intensity or greater exercise (e.g. 5 x 30 mins per
week for adults; 5 x 60 mins per week for children)
National
Environment policy
Transport policy
Culture, media, sport
Education
Cultural shift
Local
Safe, good quality environment
Affordable leisure facilities
Long term, behavioural change programmes aimed at food and
physical activity to promote an increase in active daily living
by increasing habitual activity
Range of opportunities for physical activity
Transport policies which encourage walking and cycling
Obesity care pathways
2.2.3 Strategic Objectives
Action by the City Council should be directed at achieving the following strategic objectives:
1. Within long term, behavioural change programmes aimed at food and physical activity to:

Increase access to good quality affordable supplies of fruit and vegetables in areas of
greatest need

Promote the ‘5 fruit and vegetables a day’ message to increase consumption, particularly
where levels are low

Encourage a healthy diet by promoting ‘the Balance of Good Health’ (Appendix 4)

Promote strategies to increase physical activity to recommended minimum standards for
weekly moderate intensity or greater exercise (e.g. 5 x 30 mins for adults; 5 x 60 mins for
children)
2. With Salford Primary Care Trust, develop obesity care pathways 1
1 Provide weight loss therapy (weight loss advice, calorie controlled diets and behaviour therapy) consistent with
increased physical activity for overweight and obese people: Those on BMI 25-30 should be managed in Primary Care;
Those with BMI >30 should be managed in specialist services, based on the community, supported by secondary care.
This service should make recommendations for drug therapy and surgery; Weight therapy for children who are overweight
should be provided but giving priority responsibility for the behaviour changes to the parents; Anti-obesity drugs and
surgery for morbid obesity should be prescribed following National Institute for Clinical Excellence guidance.
3. Promote active daily living and physical activity with supportive culture, sport, transport and
workplace policies
2.2.3 Current Activity
A Food and Physical Activity Partnership was launched in July 2005 and will be developing a
strategy to address those factors that impact upon obesity in Salford. The strategy will take a
‘population approach’ focussing on primary prevention which has been shown to have a greater
impact than focusing purely on those with existing weight problems.
Case Study 1
Somerville Primary School
Somerville Primary School in Salford has embraced an inclusive approach to healthy eating
which has gone beyond simply replacing existing food with healthier options and taken a ‘whole
school’ approach. Within weeks of her appointment the Head Teacher exhibited leadership. She
introduced a breakfast club, stopped the sale of crisps and unhealthy snacks on the premises,
prevented sugary drinks from being consumed at the school, supported a healthy lunch box
scheme and enhanced healthy choices. She also ensured that water was provided throughout the
day, refurbished the school refectory and enabled a school allotment scheme. The school is an
active member of the Healthy Schools scheme and has been supported by the 5 A Day Project.
The children enjoy their healthy eating programme and behaviour in the school has improved
significantly. They have had national recognition for their efforts.
Case Study 2
School Smart Cards
A pilot scheme to reward children for making healthy choices has been introduced in one school.
Pupils at Swinton High school have been issued with swipe cards and a cashless system
introduced. As well as reducing queuing time, this removes the need for children to carry cash at
school, ensures that lunch money is spent on lunch and dissuades young people from leaving
school at lunchtimes to spend lunch money elsewhere. The card can be programmed with dietary
information to assist parents in promoting healthy eating (ie chips allowed only once a week) as
well as track the choices their child is making when they purchase food at school.
The next section of this paper will describe specific actions the City Council can take, within the
context of partnership work
o At a directorate level
o At a corporate level
Section 3: Focus on action
3.1 Corporate Actions
The large changes required to tackle obesity and smoking will come through national public policy
relating to:



Farming, food production and food marketing and taxation
Transport policies that promote physical activity and raising the importance of active daily
living and sports
Smoke-free places legislation and taxing of tobacco products.
These will set a context that promotes healthier choices and enables people to make these in
their local environments.
For the City Council, this means that it can take action:




By working with partners to ensure information, advice, personal support and
opportunities in places for local residents to make healthy choices.
By providing local leadership to bring concerted and integrated local action on health
To support healthy consumerism
By acting within strong leadership
- strong ‘health only’ choice in our policies relation to smoking and obesity
- strong leadership for ‘health only’ choice with our partners e.g. tobacco policies in
local schools
- being a supportive employer, maximising ‘health only’ choice
- using our enforcement powers
- sales, licensing
There are three corporate actions



strong leadership using our Exemplar role to the full
a broad lifestyle campaign
understanding the financial consequences of no action on health inequalities to the City
Council and understanding where cost benefits can be made
3.1.1 EXEMPLAR ROLE
3.1.1.1 What does it mean to be an exemplar?
As an exemplar, the City Council will be a role model for showing how easy the healthy choice is
to make. In doing this, it will not take responsibility away from people as consumers but neither
will it provide obstacles for personal choice. Key to this approach is the opinion that lifestyle
decisions are personal ones and that people do not want this responsibility to be taken away from
them. People act as consumers and require information, advice and personalised help to support
healthy lifestyle choices. What it will mean is that in the public’s gaze the City Council will
actively promote the healthy choice. This does not mean that it will be telling its staff and the
members what to do, but where the City Council money is being spent, it is only on healthy
things. Central to the exemplar role is the City Council as a good employer maintaining their
personal responsibility for healthy choices but will facilitate this as much as it can.
As an exemplar, the City Council can act in areas where personal choice can affect another
person’s health and take additional steps to protect its citizens e.g. healthy ‘whole school’
approaches.
3.1.1.2 TOBACCO
It is proposed that each adopt a revised smoking policy that aims to





Ensures that all council buildings are smokefree
Stops smoking breaks
Remove all smoking from the public’s gaze
Ensure all council events are smokefree. This include public events such as the Mayor’s
Ball
Support staff who wish to access smoking cessation services
Smoking cessation support will be provided to staff by the PCT’s workplace Cessation Officer and
by occupational health. Consideration should be given to staff being given time off in work time to
attend. The City Council may choose to provide Nicotine Replacement Therapy to each person
seeking such support2.
3.1.1.3 OVERWEIGHT AND OBESITY
The City Council will move towards a ‘ Healthy Choice’ Policy with targets to demonstrate
improvements over time. This will include:



‘only healthy choice’ buffets. This is important as most buffets provide 37% of daily
energy and 75% of total daily fat content (appendix 5)
‘predominant, healthy choice’ meals in our schools
access to nutritional advice training for staff and their families (i.e. 5 A day training).
To ensure ‘buy-in’ of staff, this will be developed involving staff at all levels in the organisation.
Champions from the councillors will also be developed.
The City Council will adopt an Active Daily Living Policy for staff and councillors. This will bring
together elements of HR policy (e.g. Well Workforce) and the green transport policy by



increasing opportunities for physical activity by providing better facilities (showers, bicycle
storage) and promoting lunchtime activities
actively promote physical activity pre-post work and lunchtimes by enabling staff to visit
local Fit City centre as part of their induction
Reward staff for being active i.e. via travel plans – introduce cycle/walking mileage
3.1.2 LARGE SCALE PUBLICITY CAMPAIGNS
3.1.2.1 Being Healthy IN Salford
Building upon the IN Salford brand and smokefree café and restaurant initiative, the Salford brand
will incorporate strong health messages relating to



2
being smokefree
eating five portions of fruit and vegetables a day, reducing salt, fat and sugar intake
Promoting an increase in physical activity to recommended minimum standards for
weekly moderate intensity or greater exercise (e.g. 5 x 30 mins per week for adults; 5 x
60 mins per week for children)
Nicotine replacement therapy costs approximately £13/week. The City Council could choose to subsidise this – for 1
week or for a 10 week course
This will include logos on stationary; permanent website features; permanent changes made to
messages on answer machines/call waiting facilities; signposting caller to smoking cessation
services and weight therapy services; extension of the ‘smoke free’ café and restaurant
programme to include healthy eating.
Part of this branding will include the ‘exemplar’ role of the City Council.
3.1.3 FINANCIAL BENEFITS TO SALFORD
The national cost of smoking in relation to visits to the GP, NHS bed days, social care
expenditure and sickness is vast. In 2003/4, the impact on Greater Manchester for hospital beds
alone was more than £37million.
The national audit office in 2001 reported that obesity places a considerable economic burden in
England. In 1998 its consequences included:
o Over 18 million days of sickness costing £1.3 million in lost earnings;
o Over 30,000 deaths in England (6% of all deaths that year)
o £480 million direct costs to the NHS (1.5% of total NHS expenditure that year)
o £2.1 billion indirect cost to the economy in terms of lost output due to sickness or death of
workers;
o A total estimated cost of £2.6 billion.
A PIECE OF WORK WILL BE CONDUCTED TO ESTABLISH THE FINANCIAL COSTS TO
THE CITY COUNCIL AND ITS PARTNERS ON THE FINANCIAL COST OF SMOKING AND
BEING OVERWEIGHT AND OBESE IN SALFORD. IT WILL ALSO LOOK AT THE COST
SAVINGS OF SPECIFIC INTERVENTIONS TO DEMONSTRATE THE HEALTH ECONOMIC
BENEFITS OF PREVENTING ILL HEALTH FROM THESE LIFESTYLES.
3.2 Directorate Actions
All Directorates have an important role to play in reducing health inequalities by focusing on tobacco and obesity. Below is a range of potential
actions. These require a general sign-up by Cabinet so that Directorates can finalise details and add these to their business plans. An annual
review of individual Directorates contribution to the reduction of health inequalities via their business plans should be monitored by the Healthy
City Forum Executive with regular reports to Cabinet
3.2.1 Tobacco
Housing & Planning
Suggested Action
Possible Target
Develop checklist for Supporting People review officers, to ensure all
supported housing schemes provide advice and information to
residents on smoking prevention and cessation services.
Checklist developed by 31 December 2005
Raise awareness of need for supported housing providers to provide
advice and share access to literature and promotional materials by
presentation and stalls at provider events.
Supporting People Strategy Launch – October 2005
Develop and deliver training for Supporting People officers to advise
providers and monitor level of compliance.
Supporting people officers trained by 31 December 2005
Review what actions could be provided through the ‘Affordable
Warmth Strategy’ recognising that fuel poverty may be linked to poor
health and tobacco use.
Report on appropriate actions and targets – end October 2005
(quarterly meeting of the Affordable Warmth Strategy Group)
Use staff newsletter to raise awareness and generate ideas of how
the Directorate could further support smoking prevention and
cessation.
Article in Houseplan Brief – December 2005
Minimum 3 ‘new’ ideas/generated targets
Promotion of the Smoke Free Homes Scheme and logo to Accredited
Landlords to raise awareness in particular regarding fire safety within
the private rented sector.
An article in the Landlords Newsletter by April 2006 to reach 500
landlords
Investigate the potential of promoting smoke free homes to raise
awareness of the dangers of secondhand smoke in the private rented
sector
Information provided to 4,000 tenants of Accredited Landlords by
April 2006
Develop a protocol to influence partner contractors' customer care
packages to raise awareness of the dangers of secondhand smoke
and to deter smoking in clients' homes.
Raise within the current structures and protocols for the
management arrangements of construction partners under the
Rethinking Construction Framework by Jan 2006
Raise awareness of the dangers of secondhand smoke with the
contractors applying for and included on the Housing Services Listed
Scheme for Contractors working within the private sector
Information supplied to all current and potential Housing Services
Listed Contractors by Jan 2006
Promote awareness with housing providers of the dangers of
secondhand smoke and to encourage them to influence their
contractor partners to develop protocols and to include within their
customer care packages
Present a briefing note to Salford Housing Partnership by Jan 2006
to raise awareness and Registered Social Landlords Strategic
Issues Forum.
Contribute as a directorate to raising the profile of tobacco control
work in Salford under the banner of ‘Smokefree Salford’

Inclusion of relevant publicity in mailings

Adaptation of stationery to include ‘Smokefree Salford’ logo

Appropriate links (ie to Smokefree Homes and Stop Smoking
Service) to be made available on website
Customer and Support Services
Suggested Action
Possible Target
Dispatch smoking cessation literature with annual council tax bills
No. of households reached through marketing mail shots
Continue to provide signposting advice in respect of smoking
cessation as part of call handling/debt advice service
Number of people provided with advice on smoking cessation
Number of front line staff who have been given smoking cessation
awareness training
Provision of customer advice facilities for smoking cessation
development work
No. of face to face visitors dealt with through customer service
locations
Development of smoking consultation development work as part of
Customer Services consultation development work
No. of customer surveys undertaken
Participate in the lung cancer awareness health promotions campaign
incorporating the PCT (Little Hulton) and undertake benefits take-up
advice
No. of marketing mail shots dispatched
No. of face to face visitors attending Advice sessions
Continued promotion of smoking cessation opportunities for staff
within managerial pledges
Co-ordinate appropriate marketing information around smoking
cessation campaign including web developments
No. of staff attending smoking cessation awareness training
Customer web activity
No. of +ve press articles
Children’s services
Suggested Action
Possible Target
Promote the Healthy Schools Scheme – focus on areas of greatest
health need
% of schools in areas of greatest health need actively engaged with
Healthy Schools Scheme
Continue, through the Drugs Education Officer, to offer training to
schools in promoting smoking cessation
% of schools receiving specific training from Drugs Education Officer
Offer training to Governing Bodies in Drugs Education
Number of governors / schools represented
Promote, through Personal, Social and Health Education, advice and
positive approaches to tackling smoking from an early age
% inclusion of drugs awareness (including tobacco) in PSHE policies
for under 7’s
Monitor Sure Start smoking cessation activities
Sure Start targets
Promote, through Citizenship curriculum, awareness of the health and
legal risks associated with buying and smoking cigarettes
% of schools accessing specific training related to tobacco use /
misuse
Monitor drugs awareness via Youth Service activity
Administer ‘baseline’ questionnaire for smoking activity in all high
schools and monitor outcomes
Proportion of school population against number of smokers tracked
and showing decrease
CPD offered to all schools annually and to Community Nurses to
become accredited PSHE ‘teachers’
By 2010 every school to have a PSHE accredited ‘teacher’
CHIEF EXECUTIVE
Suggested Action
Monitor/ review Tobacco Control scrutiny report
Possible Target
Ensure national targets are applied to local strategies/ action plans
Continue delivery of Re-Energise (NDC) healthy living project
Ensure project outputs contribute towards project outcome – number
of people from community involved/ participating
Continue delivery of Drug and Alcohol Action (NDC) project
Ensure project outputs contribute towards project outcome - number
of people from community involved/ participating
Promote Tobacco Control programme to regeneration funded
regimes
% of regeneration funded regimes delivering Tobacco Control
programmes
Oversee monitoring/ review of Tobacco Control programme via
Community Plan
% of LSP organisations delivering Tobacco Control programmes
Community, Health and Social Care
Suggested Action
To ensure community plans include smoking cessation advice at
Mother and Toddler groups
To ensure community plans promote ‘Just Quit’ groups within
community / resource centres
Establish lunchtime ‘Just Quit’ group for council employees
Provide information and advice on smoking cessation linked to
 Library services
 Debt advice
Work with Salford Community Leisure to link physical activity with
smoking cessation
Possible Target
Number of adults ‘smoke free’ for x number of days
 Number of groups established
 Number of adults ‘smoke free’ for x number of
days
Number of council employees ‘smoke free’ for x number of days
Can be target for whole council if agreed, however the directorate
could set its own internal target


Numbers advised
Number of leaflets etc distributed
Number of people ‘smoke free’ for x number of days
Environment
Action
Target
Mainstream Health & Well Being Manager
Secure funding to extend post
Support continued development of smoke-free workplaces in advance
of legislation



Support smoke-free eating establishments
Continue to support Tobacco Control Partnership
Number of cafes/restaurants going smoke-free
Development of Tobacco Control Strategy
Visits to retail premises by Trading Standards to detect offences



No. of premises visited
No. of premises complying with law
No. of prosecutions / warnings / cautions
Visits to retail premises with Customs & Excise to detect excise
avoidance


No. of premises visited
No. of prosecutions / warnings / cautions
Advertising at point of sale
No. of premises complying with law
No. of interventions with workplaces
No. of workplaces going ‘smoke free’
No. of premises given advice
3.2.2 Obesity
Housing & Planning
Suggested Action
Possible Target
Provide shower and changing facilities for staff to promote walking,
cycling and physical activity.
Provision of shower/changing facilities built into accommodation
plans
March 2006
Use staff newsletter to raise awareness and generate ideas of how
the Directorate could further support reductions in obesity by
promoting healthy eating and increased physical activity.
Article in Houseplan Brief – December 2005
Minimum 3 ‘new’ ideas/generated targets
Implement the published Cycle Strategy - example action: complete
the city’s cycle route network.
Completion by 2012
Produce school travel plans which include practical measures to
increase walking and cycling.
Travel Plans in all Salford schools by 2010. % of schools with plans.
Organise ‘Walk to School Weeks’
October and May. % of pupils participating
Customer and Support Services
Suggested Action
Possible Target
Continue to provide signposting advice in respect of diet/physical
activities as part of customer service offerings
Number of people provided with advice
Number of front line staff who have been given appropriate
awareness training
Development leisure consultation development work as part of
Customer Services consultation development work
No. of customer surveys undertaken
Continued promotion of healthy living opportunities within managerial
pledges eg. health walks, flu-jab vaccination programme
No. of staff participating in such activities
2005/06 programme to be developed further to include



Healthy eating /slimming clubs at lunch times for staff
Lunchtime Tai Chi taster sessions
Stress busters – massage /relaxation for staff
Continue to improve access for vulnerable families to free school
meals
Customer transaction levels-free school meals service
Develop integrated working between Salford Community Leisure and
Benefits Service to promote access to the Passport to Leisure
scheme
Future possibility
Children’s Services
Continue to promote the Healthy Schools Scheme
% of schools actively engaged with Healthy Schools
Continue to promote partnership between schools and City Wide
service in shared development of ‘healthy eating’ options
% of schools engaged in Citywide’s Healthy Options programme
Continue development of the Schools’ Sports Coordinator programme
roll-out
All planned phases completed within timescale
Continue promotion of work of Salford Community Leisure in terms of
sports development in schools
% of schools / numbers of children and young people engaged in
SCL – led activity programmes such as Fitbods
Promotion of broad and balanced curriculum including ‘Excellence
and Enjoyment’ at primary level, with target time spent on physical
activity
Schools’ compliance with target curriculum time for physical activity
Cookery and ‘Grow Your Own’ clubs established in schools under
healthy schools remit
% increase of schools participating in programmes
Provide easy access to water for all learners
% increase in schools providing easy access to fresh drinking water
for learners
Chief Executive
Suggested Action
Monitor/ review Obesity scrutiny report
Possible Target
Ensure national targets are applied to local strategies/ action plans
Continue delivery of Re-Energise (NDC) healthy living project
Ensure project outputs contribute towards project outcome - number
of people from community involved/ participating
Continue delivery of Community Sports and Activity Programme
(NDC) project
Ensure project outputs contribute towards project outcome - number
of people from community involved/ participating
Continue delivery of Community Sports Development Programme
(NRF) project
Ensure project outputs contribute towards project outcome - number
of people from community involved/ participating
Continue delivery of Chapel Street Arts Programme for Older People
(NRF) project
Ensure project outputs contribute towards project outcome - number
of people from community involved/ participating
Continue delivery of Detached Youth Service Programme (NRF)
project
Ensure project outputs contribute towards project outcome - number
of people from community involved/ participating
Promote Obesity programme to regeneration funded regimes
% of regeneration funded regimes delivering Obesity programmes
Community, Health and Social Care
Suggested Action
Possible Target
To ensure community plans include Health Walks and Cookery Clubs
on neighbourhoods based upon ‘what works’ and centred upon
community / resource centres, schools and other public buildings




Number of Health Walks undertaken
Number of people taking part
Number of cookery clubs established
Number of people taking part
Promote ‘Healthy Hips and Hearts’ and Tai Chi sessions for older
people


Number of sessions held
Number of people attending
Produce Healthy Cookery Book aimed at young people


Successful production of book
Number of copies distributed
Promote Breakfast Clubs for children based upon healthy eating


Number of Breakfast Clubs established
Number of children attending
Ensure healthy eating and dietary advice in all day centres and
intermediate care homes
Promote healthy eating, health walks and ‘Healthy Hips and Hearts’ in
public libraries
All meals to offer healthy option and to contribute to 5-a-day fruit and
vegetable campaign
 Good promotional advice available in all public
libraries
 Library staff trained to deliver advice?
Environment
Continue to support Food and Physical Activity Partnership
Development of obesity strategy
Intervene with workplaces offering staff canteens to promote healthy
food
No. of healthy eating awards issued
No. of workplaces showing improvements
City wide to improve on an ongoing basis the nutritional content of
food to promote healthy eating programme

Continuation of Healthy option programme ( H.O.P. scheme) in
conjunction with Salford Community Leisure to promote the
importance of a healthy diet linked with regular exercise




No. of meals meeting standards and accredited as healthy
and nutritious.
No. of schools meeting or exceeding all Government
nutritional guidelines
No. of salad bars introduced into schools
No. of schools taking part in pilot
No. of children taking part in HOP project
No. of HOP cards completed
Continue to support the delivery of Health Walks in partnership with
Salford Leisure


No. of health walks
No. of people taking part
Deliver Stepping Stones walks
(longer walks for those wishing to progress from health walks)


No. of stepping stones walks
No. of people taking park
Support the Cycling for Health project in partnership with Salford
Community Leisure and North West Cycling Project




Establish 3 cycle pods on sites across the city
No. of groups using cycle pod facilities
No. of cycle rides supported
No. of participants
Deliver practical conservation activities in green spaces


No. of activities delivered
No. of people participating
Promote opportunities for physical activity and well being in green
spaces


No of activities delivered
No of people participating
Improve facilities and quality of parks to promote physical activity


No of playgrounds improved
No of playing fields improved



No of new facilities provided
Retain Green Flag status of Blackleach and Victoria parks
Improved provision of looplines/ walkways for walking and cycling
No of metres of looplines/walkways improved
Develop Salford Ranger team to provide increased presence in city
parks
Promote opportunities to grow own food
Successful funding and appointment of Park Rangers
Working with schools to promote sustainable healthy food ie via
composting, ‘Grow your own’, 5 A DAY, promotion of Eco schools


No of allotment tenants
No of vacant plots


No of schools signed up to healthy schools initiative
No of schools signed up to Eco Schools
4 Recommendations
1. This paper to go out to further consultation for a 6 week period to Members of the
Council, Community Committees, Partners and trade unions for comment. A report
outlining the results of the consultation to be brought to Cabinet with findings,
recommendations, targets
2. Officer leadership for Health Inequalities should rest with the Director of Public Health.
Health inequalities should sit within the portfolio of the lead member for health
3. Performance on reducing health inequalities should be monitored by the Healthy City
Forum Executive with regular reports to Cabinet, including an annual review of individual
Directorates contribution via their business plans
4. The City Council should focus its actions on smoking and obesity, in the first instance
5. The City Council should fully embrace its ‘exemplar’ role – that is it should act as a role
model showing how easy the healthy choice is to make, spending its money only on the
healthy things and maximising its role as a good employer (section 3.1.1.1 for definition).
6. The City Council should consider taking action, like Liverpool and Manchester, in
becoming a ‘smoke free city’ to extend smoking bans into the current exemptions in
proposed Government legislation
7. A new smoking policy should be developed in 2006 with staff that considers greater
support for cessation (including time out and NRT), stop smoking breaks and ban
smoking from all City Council events e.g. the Mayor’s Ball
8. A Healthy Choice Policy to be developed with staff outlining how, by 2008, Citywide would
serve predominantly healthy food and describe access to nutritional advice for
staff/members
9. The current HR, cycling and transport policies to be enhanced with development of Active
Daily Living Policy to promote more cycling/walking to work/between meetings, staff
taking exercise before/after/during work
10. The City Council should support a large publicity campaign – being Healthy IN Salford.
This will build on the IN Salford brand and focus on key messages related to stopping
smoking, eating healthily3 and promoting recommended weekly moderate exercise
standards4
11. A piece of work to be conducted to establish the financial costs to the City Council and its
partners on the financial cost of smoking and being overweight and obese in Salford. It
will also look at the cost savings of specific interventions to demonstrate the health
economic benefits of preventing ill health from these lifestyles.
12. For Cabinet to support the potential actions of Directorates (section 3.2) so that
Directorates can finalise details and add these to their business plans. An annual review
of individual Directorates contribution to the reduction of health inequalities via their
business plans should be monitored by the Healthy City Forum Executive with regular
reports to Cabinet
13. With PCT, to jointly fund a corporate Health and Well-Being Team comprising lead
manager and officers for tobacco control; food and physical activity; mental health and
well-being provision
3
4
5 fruit and vegetables a day, reducing salt, fat and sugar
5 x 30 mins per week for adults, 5 x 60 mins per week for children
APPENDIX 1
Ambitious national floor targets have been set. As first glance, they appear to relate to the
work of the NHS, however, evidence shows that to make real impact, local authorities have
fundamental roles to play. The national target for health inequalities is, by 2010, to reduce
inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at
birth.
There are two supporting targets:
1. Starting with children under one year, to reduce the gap in mortality by at least 10%
between ‘routine and manual groups’ and the population as a whole, by 2010. This
represents approximately 2 fewer infant deaths per year in Salford children aged less
than 1.
2. Starting with local authorities, to reduce the gap by at least 10% between the fifth of
areas with the lowest poorest life expectancy at birth, and the population as a whole,
by 2010. Therefore, to reduce the gap by 10% we need to increase life expectancy by
106 days for men and by 88 days for women by 2010.
Further national targets for health that address inequalities have also been set, focussing on
disadvantaged groups:

By achieving agreed local conception reduction targets, to reduce the national
under 18 conception rate by 15% to 2004 and 50% by 2010, while reducing the
gap in rates between the worst fifth of wards and the average by at least a
quarter. By 2010 we would therefore need to prevent around an extra 120 women
aged 15-17 a year becoming pregnant and by 2004 we need to prevent
approximately an extra 35 conceptions a year.

Reduce smoking rates among manual groups from 32% in 1998 to 25% by 2010,
800,000 smokers from all groups nationally successfully quitting at the 4-week
stage by 2006. We have ambitious targets for quitting in Salford; we are currently
exceeding those targets.
In addition, there are a number of targets being developed in relation to the LPSA (2) and
forthcoming Local Service Agreements.
Additionally, there are a number of other targets, which will contribute to reductions in health
inequalities:

Cutting the number of women who smoke in pregnancy by 1 per cent a year

Increase the national breast-feeding initiation rate by 2% a year, focussing on women
from disadvantaged areas.

Contributing to the national reduction in death rates from coronary heart disease in
people under 75 by at least 25% by 2005

Contributing to the national reduction in cancer death rates of at least 12 % in people
under 75 by 2005

Achieving a 70% uptake in influenza immunisations in people aged 65 and over,
targeting populations in 20% of areas with lowest life expectancy.
PROGRESS AGAINST NATIONAL TARGETS TOWARDS MEETING NATIONAL
TARGETS IN SALFORD HAS BEEN UNEVEN:



OVER THE PAST TEN YEARS, RATES OF DEATH HAVE FALLEN IN A NUMBER
OF PRIORITY AREAS, INCLUDING A 28% DROP IN CIRCULATORY DISEASE
SINCE 1993.
HOWEVER, DEATH RATES HAVE FALLEN FASTER ELSEWHERE IN THE
COUNTRY. FOR EXAMPLE, DEATH RATES FOR CIRCULATORY DISEASE
REMAIN 25% GREATER THAN THE NORTH WEST AND 50% HIGHER THAN IN
ENGLAND AND WALES.
LONG TERM LIMITING ILLNESS RATES REMAIN HIGHER IN SALFORD THAN
FOR ENGLAND AND WALES – AND HAVE INCREASED IN THE PAST TEN
YEARS.
APPENDIX 2
Example Programme: Tobacco Control
In developing city-wide programmes, work is mapped across the five key levels:





Individuals: behaviours/lifestyles, relating to knowledge and awareness (e.g. smoking
cessation advice).
Family-focused interventions (e.g. smoke free homes; supporting vulnerable parents,
helping expectant mothers to quit);
Community-based activities (e.g. community ‘quit smoking’ campaigns, engaging local
people in focused events, developing support groups);
Organisational, work place and school settings (e.g. smoke free workplace policies;
smoking prevention/cessation work in schools); and
Environmental and socio economic contexts (e.g. quality of the environment; smoke free
public places);
For work in neighbourhoods, programmes will focus mainly on levels 1-3, with input into
school and work-based (Level 4) and regeneration activities (Level 5) where appropriate.
APPENDIX 3
Standard BMI Classification
Obesity is defined by a calculation of Body Mass Index (BMI)
BMI = Body weight (KG)/(height ²)
BMI range (kg/m²)
<17
17 - <20
20 - <25
25 - <30
30 - <40
>40
Malnourished
Underweight
Normal weight
Overweight
Obese
Morbidly obese
Appendix 4
The Balance of Good Health
People are more likely to be at normal body weight with healthy fat distribution if they have


Been breast fed for the first 4 months of life
A healthy diet has an average daily energy intake of approximately 2300 calories for
men and 1600 calories for women.
Carbohydrates starch or sugar should provide fifty percent of total energy intake, fat should
provide 35% of energy intake and protein 15% of energy intake. ‘The balance of good health’
(see diagram below) summarises the government’s nutrient-based dietary recommendations
and provides a guide to the proportions of food from each group that needs to be consumed
on a regular basis to form a healthy diet. The five main food groups are:
 Bread, other cereals and potatoes
 Fruit and vegetables – 5 portions a day
 Milk and dairy foods
 Meat, fish and alternatives
 Foods containing fat, and foods and drinks containing sugar.
Appendix 5
Buffets and their nutritional value
The balance of good health diet recommends a balanced diet with carbohydrates providing
50%, fat 35% and protein 15% of total energy intake. Meals should be balance and varied
with low salt and 5 fruit and vegetables a day. Food should be consumed over 3 balanced
meals and a couple of healthy snacks a day.
The buffets we access can contribute positively or negatively to our diets.
Buffet 1:
A traditional style buffet incorporating 1 small pork pie, 1 sausage roll, crisps, tea, or coffee
provides a total of 920kcals and 68g fat. For the average man requiring 2500kcals and 90g fat
/ day this constitutes 37% of energy, but 75% of total fat intake respectively.
Buffet 2:
1 Sandwich (chicken and tomato/cucumber), low fat yogurt, 1 banana, 1 glass of
unsweetened orange juice, provides 574 kcals and 15g fat. For the average woman requiring
2000kcals and 70g fat this constitutes 27% of energy and 21% of total fat intake respectively.