Norfolk County Council has worked with a voluntary sector group to run a project aimed at tackling obesity among pregnant women and new mothers. It is a bottom-up community-driven approach which has seen women in one of the county’s most deprived areas given training to help create sustainable change.
Why bottom-up solution is the answer
Health behaviours run in families and pregnancy is a critical time to promote healthy eating and physical activity to give children the healthiest start in life. It is also important for the mother’s health as being overweight in pregnancy can increase the risk of gestational diabetes and pre-eclampsia.
Obesity rates in young children in Norfolk are high in the town of King’s Lynn. In 2020-21, nearly 25 per cent of reception-age children were living with obesity, compared to 22.5 per cent of children nationally.
The data prompted the council to look at ways to address the issue. It opted to work with the social enterprise C3 Collaborating for Health which has designed a programme called Community Health Engagement Survey Solutions (CHESS).
Advanced Public Health Officer Dr Sara Karrar, who led the work with C3, said: “We all know collaboration is good in principle, but it is much more difficult in practice. We, in the local authority, have benefitted from insights gained through collaboration with academics and practitioners including the benefits of using community members as citizen scientists to tackle problems in their neighbourhoods.”
CHESS is aimed at empowering communities by putting them in charge of investigating their health and local built environment. It uses a mobile survey tool that is used by community members on a walk around their neighbourhood, equipping them to identify and map the barriers to making healthy choices with respect to four risk factors – food, physical activity, tobacco, and alcohol.
After this data collection, community members come together to interpret findings and co-design recommendations for change. Importantly, these ideas are often simple and low-cost, such as healthy food tasting sessions for babies to promote healthy eating, but also minimise food waste and reduce costs for families.
Public Health Expert Adviser Professor Andy Jones said: “In public health we cannot be in every community all the time, but members of the public are – that is why a community driven approach is very important.
“The approach used by C3 was particularly attractive as it equips local people with the skills they need to drive the change themselves as the participants receive training in how to use the mapping tool and what to focus on. They are accompanied on the walk by staff from C3, but very much as support. It is the residents who take the lead.”
The ‘walk and talks’
Two “walk and talk” sessions were run in South Lynn and North Lynn in early summer 2022. A total of 16 new mothers and family members took part, equipped with a tablet with the CHESS mapping tool.
A North Lynn mother who was involved said: “I was told about something they were doing here where they were going for a little walk and look around different things. I came and joined. It really helped.”
Professor Jones said: “What we found was there are often healthy opportunities available, but sometimes they are not as accessible as they should be. In shops, healthy food may be tucked away and not promoted well or not easily accessed. That is something that can be rectified by talking to the owners.
“Or a green space may not be usable because of a broken step, broken gate or lack of step-free access. Another issue is people may feel intimidated about using a space because of anti-social behaviour, such as drug use.
“Some of these things can be fixed by the community themselves with help. We have a team of public health locality officers – there is one in each district – who can work with the communities to find solutions and even access funding where needed. They work very closely with the district councils which have a strong understanding of local communities and an ability to support change. You need to work in partnership in two tier areas like ours.”
Dr Sara Karrar said work is now ongoing with the local community to act on what was found. “Many well-meaning public health interventions fail in the feed-back to the community. With CHESS we had the opportunity to bring back the participants and share the findings, facilitate a discussion and support ideas for activities that are appropriate for those specific communities.
“Our area locality officer is now working with the community in King’s Lynn to draw up an action plan to tackle some of the more entrenched issues. And once we have completed the work in King’s Lynn, we will look at what lessons can be learnt and how we can apply this to other areas. Pregnancy and the early years are so important as they set the foundations for the rest of people’s lives.”
Dr Sara Karrar, Advanced Public Health Officer, Norfolk County Council: firstname.lastname@example.org
Professor Andy Jones, Public Health Expert Adviser, Norfolk County Council: email@example.com