"Newham's Food Nutrition"
Newham’s N e w h a m ’s F o o d & Nutrition Food & N u t r i t i o n Strategy Strategy Prepared by: Supported by: F o re w o rd The London Borough of Newham is a place with an incredible diversity of food cultures reﬂecting the great diversity of its residents. With over 150 languages spoken in the Borough’s schools it is probably one of the most diverse places on the face of the planet. As a borough of Greater London Newham is also a part of one of the world’s most extraordinary food systems. London attracts produce from every corner of the globe, it contains some of the world’s top restaurants, and yet its food system is also responsible for more than 1/3 of the Capitals total ecological footprint1. Food is a hugely important part of our lives. It sustains us – giving us the energy to function on a day to day basis. It provides employment – from production, cultivation, and transportation to processing and catering. It is the basis of many of our most important social and cultural activities. And, importantly, it can play a huge role in our short term and long term health. However, amongst the apparent abundance of London’s food system there also exist many inequalities. For one, the ability to access a healthy and nutritious diet is not equal for all Londoners. Low income, physical and geographical boundaries, lack of skills and knowledge and the failure of the retail market all inhibit people’s ability to access a healthy diet. This has serious consequences which are borne out in the levels of health inequalities in areas where these problems exist. The London Borough of Newham is one area faced with rising levels of health inequalities – the existence of which may be linked to the prevalence of poor nutrition amongst many of its 250,000 residents. There is an urgent need for these problems to be tackled requiring a coordinated but community driven response to improve the current situation. Newham must build on the strengths of its communities to help create a borough where the beneﬁts of a healthy diet are available to all. It is with this aim that I am proud to present Newham’s Food and Nutrition Strategy. Cllr Neil Wilson – Chair Newham Food Access Partnership 1 Ecological footprint. This is the land and water area, measured in global hectares, that is required to support indeﬁnitely the material standard of living of a given human population. 1 Newham Food Access Partnership The Newham Food Access Partnership (NFAP) is a borough-wide umbrella group that aims to take a coordinated approach to tackling food and health related issues within the borough. The NFAP works on strategic issues affecting diet-related health and supports providers of food access projects. Key partners include Newham Primary Care Trust, London Borough of Newham, Community Food Enterprise, Aston Mansﬁeld and East Thames. If you are interested in the work of the Newham Food Access Partnership please contact:- Strategic Manager Newham Food Access Partnership c/o East Potential 3 Tramway Ave Stratford E15 4PN T: 020 8536 8882 E: firstname.lastname@example.org www.nfap.org.uk Acknowledgements NFAP have led on the process of developing the Food and Nutrition Strategy for Newham with the support of partners and funding from Newham Primary Care Trust and London Borough of Newham’s Culture & Community Grant Programme. NFAP would like to thank the many individuals who contributed to this document and the London Borough of Newham’s Social Regeneration Unit for additional support during the development of the strategy. 2 Contents INTRODUCTION 4 1: PREGNANT WOMEN AND CHILDREN 0-5 YEARS 9 2: SCHOOL-AGED CHILDREN & YOUNG PEOPLE (16-25) 11 3: PEOPLE WITH ADDITIONAL NEEDS, DIET-RELATED CONDITIONS AND OBESITY 14 4: INCREASING KNOWLEDGE, AWARENESS AND SKILLS FOR HEALTHY EATING 16 5: OVERCOMING PHYSICAL BARRIERS TO FOOD ACCESS 18 6: RETAIL ECONOMY AND FOOD CULTURE 20 7: FOOD GROWING AND ENVIRONMENTAL SUSTAINABILITY 22 IMPLEMENTATION – TAKING THE STRATEGY FORWARD 24 APPENDICES Appendix A 25 Key partners of Newham Food Access Partnership London Food Strategy Links to other local strategies Public Service Agreements Appendix B 26 Links to other strategies and government PSA targets Appendix C 28 Newham Food and Nutrition Strategy - Policy Statement Appendix D 29 Example of Implementation Plan Appendix E 29 Determinants of Health Model Appendix F 30 Organisations contributing towards strategy development 3 I n t ro d u c t i o n Why is food an issue in Newham? Newham has the lowest life expectancy for females and the fourth lowest for males in London. Infant mortality is the fourth highest in London and death rates from cancer and 1 circulatory disease are higher than the London and England averages . Poor diet is a key risk factor for major killers such as cardiovascular disease (CVD) and many 2 cancers. Poor maternal nutrition is also a risk factor for infant mortality . In addition an estimated 20% of adults in Newham are overweight and a further 35% are obese, which is of concern as being obese increases the risk of developing diabetes, coronary heart disease (CHD) and some cancers. Tracked trends at a national level suggest this situation is set to worsen unless action is taken. Food and dietary issues are a contributing factor to health inequalities; research has shown that people on a low income are more likely to have poor diets or suffer food poverty 3 and therefore experience diet related disease . Newham is a borough with high levels of deprivation and this situation is compounded by local food access issues. In 1999 Newham was identiﬁed as having the worst food access situation in East London in a study undertaken by the East London and City Health Authority. The factors behind a person’s choice of food are complex and include global issues such as exposure to advertising, local issues including the types of retail outlets within easy reach, and individual issues such as cost, preference and understanding how diet affects health. These factors working together in Newham have created a local environment which perpetuates a poor diet and therefore increases the risk of developing obesity or diet-related conditions. This is not just the picture in Newham but is a worrying trend throughout the country. In England the average adult eats 50% more saturated fat, about 50% more salt, and half the 3 fruit and vegetables of a recommended diet and the typical diet is worse for children and people on low incomes. Nationally it has been recorded that poor nutrition contributes to 4 almost half of coronary heart disease and 33% of all cancer deaths . The cost of these issues is not only high in terms of quality of life and years of life lost but it has also been estimated 5 that the cost to the NHS of treating diet-related ill health is at least £4 billion per year . 1 London Health Observatory, (February 2006) 2 Nutrition and food poverty: a toolkit. National Heart Forum and Faculty of Public Health 3 National Diet and Nutrition Survey, (2004) 4 Faculty of Public Heath Food Poverty and Health brieﬁng statement 5 Choosing Health. Choosing a Better Diet: a food and health action plan 4 Why do we need a Food & Nutrition Strategy? Concern over food access, poverty and health issues has led to an array of community-based projects within Newham including breakfast clubs, social food outlets and lunch clubs. Many of these local food projects have had positive impacts on individual and community life and received national acclaim. Even so there is still more to be done to ensure that everyone in the Borough has the access and knowledge they need to be able to make informed food choices. At a Borough level the Newham Food Access Partnership (See Appendix A for key partners) exists to coordinate and provide strategic direction on food and health issues. NFAP has highlighted the need for a Food and Nutrition Strategy for Newham to ensure partnership work continues and is targeted at areas and groups in most need. The document has been shaped around the needs, experiences and knowledge of people living and working in Newham. It sets out to build on the strengths of the local food system, resolving its problems and keeping the borough at the forefront of improvements to tackle diet-related health inequalities. This strategy has been developed within the context of national and regional policy agendas and targets (see Appendix B), in particular the Public Service Agreement (PSA) ﬂoor targets around life expectancy, infant mortality and childhood obesity. Many of the PSA and other targets for Newham are inﬂuenced by food and diet and therefore this strategy will contribute to reaching these targets and improving the health and wellbeing of people in the Borough. In particular, this strategy plays a large role in addressing the key priority of reducing obesity. Headline Targets ◆ By 2010: - Halt the year on year rise in obesity in children under 11 - Decrease mortality rate from heart disease and strokes by 40% - Reduce mortality from cancer by 20% - Reduce health inequalities by 10 % as measured by infant mortality and life expectancy at birth National Public Service Agreement targets ◆ To increase the percentage eating at least 5 portions of fruit and vegetables per day by 1% per year for 5 years from 2006 baseline LB Newham Corporate Plan Delivery Plan ◆ By 2020 Newham’s health will be as good as other Londoners, and that by 2012 premature deaths from cardiovascular disease will have been signiﬁcantly reduced. Local Strategic Partnership’s vision ◆ To increase health in England by reducing the prevalence of diet related disease and illness and reduce obesity in England Choosing Health Food & Health Action Plan 5 This strategy also supports government messages around ‘5 A DAY’ in the context of a balanced diet and recommendations in the Choosing Health Food and Action Plan. In addition to the impact of food on health, there is also recognition of the signiﬁcance of food in the local economy and global environment. This has been seen nationally through the development of the Food Industry Sustainability Strategy (FISS) and regionally in the London Food Strategy. While the Newham Food and Nutrition strategy cannot deal directly with global inﬂuences it can make a local impact by setting out how Newham can act as a responsible neighbour, create sustainable retail economies and reduce the negative impact of its food system on the environment. Finally, food has great cultural signiﬁcance and is often used to bring people together, celebrate different occasions and can be a tool for community cohesion. In a Borough as diverse as Newham it is important that the value of food in this context is recognised and opportunities to promote the cultural heritage and diversity of the population, through food, are utilised. How was the strategy developed? The process was launched in January 2005 by Newham Food Access Partnership (NFAP) with a consultation event resulting in a Policy Statement for the strategy, with a vision and objectives (see Appendix C ). Seven subsequent public consultation meetings were held based on the priority areas highlighted at the ﬁrst meeting. Around 200 members of Newham’s community (both residents and professionals) attended these meetings across the borough. Overall Vision for 2012 To create a borough where the beneﬁts of a healthy diet are available to all by working in partnership with the community, statutory bodies, the voluntary sector, private and social enterprise, and other interested parties Aims ◆ To maximize equitable access to affordable, safe healthy foods ◆ To contribute towards the reduction in health inequalities and halt the rise in obesity amongst the Newham population by improving consumption of healthy food ◆ To increase knowledge and awareness of the links between food and health among Newham residents, and support the development of skills to put the knowledge into practice. ◆ To link the national, regional and local agendas on food and health to the lives of local people ◆ To develop a food supply chain that is economically and environmentally sustainable and is capable of meeting the cultural and nutritional needs of Newham’s diverse population ◆ To develop a food culture where the provision and consumption of food is an enjoyable experience and which promotes healthy individuals and sustainable communities 6 Priority Themes & Groups During consultation with key stakeholders a number of priority groups and themes emerged on which action should be focussed to achieve the overall vision and aims. It is these themes and groups which form the structure of the strategy. They are: i. Pregnant women and children 0–5 years ii. School aged children and young people (16–25 years) iii. People with additional needs, diet-related conditions and obesity iv. Increasing knowledge, awareness and skills for healthy eating v. Overcoming physical barriers to food access vi. The retail economy and food culture vii. Food growing and environmental sustainability Each section is set out with a vision for the future based on community priorities and expert views, plus a description of the current situation. Together these show the direction of change and gaps where action and improvements should be focused. The detail of how we get from the current situation to the vision will be developed in an implementation plan, with costed and prioritised actions (see example – Appendix D ). Brief information on current good practice within Newham is contained within each chapter. These are followed by targets and performance indicators (PIs) to enable progress towards the vision to be measured. These measurement tools, where available, have been taken from other documents to ensure this strategy ﬁts into the wider picture to improve the borough. Where these targets and PIs do not currently exist they have been created for this strategy. 7 Resources In order to move towards a borough where the beneﬁts of a healthy diet are available to all, resources have to be considered. Tackling health issues through food and nutrition is a priority and resources have already been allocated. For example national government has targeted funding to improve food in schools and at a local level Neighbourhood Renewal Funding has been allocated to address food and nutrition issues. In addition it is hoped that the allocation of future resources will be guided through the priorities set out in this document and that funding for particular projects will be sought both by NFAP and its partners. There are also numerous opportunities to achieve improvements without additional resources and through quick wins. Having the strategy in place means that Newham can make the best use of existing and mainstream resources and create a structure to respond to funding opportunities. The detail of resourcing these actions will be covered in the implementation plan and will also be a factor in prioritising the actions that are taken forward. Timescale of Strategy This strategy sets out a vision to guide work on food and nutrition until 2012. This will be monitored annually by Newham Food Access Partnership. 8 1 : P re g n a n t Wo m e n a n d c h i l d re n 0 - 5 y e a r s 1a. Vision ◆ More women will breastfeed their children from birth up to 6 months, exclusively ◆ Nurseries will provide healthy food for under 5s ◆ More parents and women of child bearing age will be aware of the importance of and have access to healthy foods 1b. The current situation From conception to 5 years is a crucial stage in a child’s development and nutrition is a key part of this. Poor nutrition during pregnancy can lead to lower birth weight and increase the risk of obesity, diabetes and cardiovascular disease in adulthood. Newham also has one of 1 the highest infant mortality rates in the country , which poor antenatal nutrition contributes to. Infant mortality is highest amongst babies born to women of Pakistani origin, followed by 2 those born to Africans and West Indians and national data shows incidence to be higher in 3 babies born to older women and teenage mothers . It is important to target those groups at most risk of infant mortality with services to raise awareness and improve nutritional health as part of wider initiatives to reduce infant mortality in Newham. Post-natally, the diet of mother and baby has been shown to have long term health implications. Breast milk is the best food for babies, reducing infections and protecting them against allergies, asthma, the onset of juvenile diabetes and risk of obesity later in life. 4 Current initiation of breastfeeding is around 69% within Newham , but there is a need to ﬁnd ways to support and encourage mothers to sustain breastfeeding up to the government recommendation of six months. Weaning and early years are crucial stages in relation to the growing concern around children’s diets, which on average are too high in saturated fat, sugar and salt and contain half the daily recommendation of fruit and vegetables. Children in the lowest income groups, which make up a high proportion of Newham’s population, eat about half of the fruit and 5 vegetables of those in the highest income groups. Newham is also reported as having the highest percentage in North East London, of children aged ﬁve with untreated advance 6 dental decay . This is associated with high sugar diets and consumption of acidic drinks. Early Start and the Birth and Breastfeeding Support project (BABs) operate within the Borough and are working to promote breastfeeding and healthy eating at local level. They have identiﬁed a number of factors contributing to poor diets and are seeking to address these. They also recognise the need to ensure their services reach out to the hardest to reach 7 groups in the Borough . 1 ONS 4 Newham mortality & births data (1990-2003) PCT Figures (2005) 2 Macfarlane 5 National et al, FIDEL Report (2005) Diet and Nutrition Survey (2004) 3 Dittani N. Mortality in children aged under 4. 6 North East London Health (2004) Health Statistics Quarterly (1999) 7 Food for Thought – Diet in Early Years (2006) 9 1c. Examples of good practice: Birth and Breastfeeding Support Project (BABs) – trains local women to support women from vulnerable communities with advice on nutrition and breastfeeding. This project is supported by Newham University Hospital and Newham Primary Care Trust and is funded through Neighbourhood Renewal Fund. Early Start Community Nutrition Service – offers a variety of services around diet and nutrition for expectant mothers, breastfeeding women, and parents/carers of children 0-5 years old. Community Food Enterprise Home Delivery Service – delivers low cost fruit and vegetables to pregnant women and those with children under 4 years. 1d. Targets and Performance Indicators Below are targets and performance indicators (PIs) taken from other documents to enable progress towards the vision to be measured. New targets and PIs have been created where relevant targets do not exist. TARGET SOURCE i. Increase life expectancy at birth and reduce infant Public Service Agreement (PSA) mortality Target ii. To increase by 10% numbers of parents/carers Early Start Service Level Agreement attending Early Start Community Nutrition Service by March 2007 and to increase by 10% the numbers accessing the services on referral iii. Newham General Hospital to be accredited as a * Baby Friendly hospital under the Baby Friendly Initiative run by UNICEF PERFORMANCE INDICATOR SOURCE iv. Percentage of new mothers known to have PSA Indicator & Public Health initiated breastfeeding at birth Performance Management Indicator (PHPMI) v. Percentage of mothers still breastfeeding at 6 Currently measured by PCT weeks and 6 months vi. Numbers of families with children under 5 using * social food outlets vii. Percentage of children with active dental decay PSA & PHPMI *Created for the Newham Food & Nutrition Strategy 10 2 : S c h o o l - a g e d c h i l d re n & young people (16-25) 2a. Vision ◆ Schools will provide healthy food and an environment which encourages healthy eating for pupils and supports the local food economy ◆ Parents will be encouraged and given support and opportunities to provide healthy food for their families ◆Healthy food choices for young people will be actively marketed and provided in settings which are relevant for young people ◆ There will be efforts to limit the marketing to and access of school-aged children to unhealthy options 2b. The current situation Newham has one of the youngest populations in Britain with 40 percent under the age of 25. Diets of children and young people in Britain have been shown to be inadequate in terms of a low intake of fruit and vegetables and a high intake of snacks containing large amounts of sugar, salt and fat. Locally the RELACHS Community Health Survey (2001) in East London found that 22.3% of young people (11-14 year olds) were obese and another 15.6% were overweight. Nearly a third of young people in the study went to school each day without eating breakfast. A Young Peoples Diet, Physical Activity and Health (DPAH) Strategy is being developed for the borough as part of the work to address childhood obesity. This will reinforce and link with the vision and delivery of this strategy around diet and health issues for school-aged children and young people. i) School Aged Children 1 There is currently very limited data on obesity in children under 11 in the Borough . The Newham Household Panel Survey suggests that around 25% of 11-15 year olds are either “at risk of overweight” or “overweight”. Nationally this is an area of grave concern and halting the rise in obesity among under 11’s is a key PSA target for the Borough and, as mentioned earlier, has led to the development of the DPAH strategy to tackle childhood obesity in the Borough. Parents have a primary role in providing a healthy diet for their children; however it is a challenge to ﬁnd ways to inﬂuence the choices made within the home. As a result much of the work to inﬂuence children and parents has taken 1 Local data will become available in future years as the Primary Care Trust begins to implement government guidance on collecting height and weight data for under 11s. 11 place within schools, which are in a key position to inﬂuence and educate children and families on the importance of a healthy diet. Schools are important providers of food particularly for the most vulnerable children, who tend to eat less (and poorer quality) food outside of school. The extended schools agenda also means that children may be eating a greater proportion of their daily food intake at schools. For these reasons, schools have a responsibility to ensure that food provided by them is of a high standard within budget constraints. Many schools in Newham supported through the Newham Catering Service have made great improvement to the quality of school food. These improvements are set to carry on as Newham continues its school cooks training and Food in Schools programme. They will also be implementing new compulsory national standards for school food from September 2006. This work is supported by the Healthy Schools Programme which all Newham schools are aiming to be accredited with by 2012. This requires a whole school approach to food and nutrition including the development of school food policies and encouraging curriculum links to food. b ii) Young People (16-25 years) Newham has one of the youngest populations in Britain with nearly 17 percent aged between 16 and 25. Young people of this age are often semi independent, predominantly low income, many with child care responsibilities but often lacking essential life skills. Despite the abundance of unhealthy foods available to this age group they are often overlooked as a target audience for healthy eating initiatives. There is a need to coordinate and support the work that already exists, to learn from best practice, and to develop new and innovative ways of communicating the connection between food and health to this audience. 2c. Examples of good practice: Central Park Primary School Healthy Eating Tuck Shop - sells fresh fruit and vegetables such as washed carrots and celery sticks as well as water, fruit juice, and dried fruit at break times. School Meal Improvements – characterized by committed and enthusiastic staff and a supportive board of governors a number of schools in Newham have gone beyond the standards required of their school meals to ensure that pupils receive the most nutritious food possible. Newham’s Children and Young People’s Services have employed a Chef trainer to work with school cooks to help them improve the nutritional standards of the meals. Breakfast Clubs – there are numerous breakfast clubs in schools in Newham. Breakfast clubs can provide a nutritious start to the day for children who would otherwise not receive a breakfast. Work is now happening to see how these can be mainstreamed or sustained. Focus E15 Foyer – this foyer for young people aged 16 – 24 runs life skills programmes that include teaching residents to cook healthily and on a budget. They also run healthy living events at which they promote healthy eating. Meals on Wheels for After School Clubs Since 2005 Aston Mansﬁeld have been delivering healthy meals to 7 after school clubs in Newham. 12 2d. Targets and Performance Indicators TARGET SOURCE i. Halt the year on year increase in child obesity PSA Target among under 11s by 2010. ii. 100% of schools in Newham to be working Dept for Education and Skills (DFES) towards Healthy Schools standard by 2008 (this includes a range of criteria on healthy food) iii. 54 % of schools in Newham to be accredited with healthy schools status by March 2007 and 71% by March 2008 iv. All Newham schools to meet the Government’s DFES/ Dept of Health new food-based standards for school lunches, produced by School Food Trust, by September 2006 v. Decrease the proportion of 11 – 15 years olds who Corporate Plan Delivery Plan are overweight or at risk of being overweight from 25% in 04/05 to 20% in 09/10 vi. Decrease the proportion of 16 – 19 years olds Corporate Plan Delivery Plan who are overweight or obese from 18% in 04/05 to 13% in 09/10 PERFORMANCE INDICATOR SOURCE vii. Percentage of children with active dental decay Public Health PMI (London Health Observatory/ Dept of Health Basket of Indicators 13 3: People with additional n e e d s , d i e t - re l a t e d conditions and obesity 3a. Vision ◆ Initiatives will be in place to address any additional barriers people may face in accessing and understanding the importance of a healthy diet ◆ Informal and formal carers and care services will encourage healthy eating and where relevant will provide healthy food choices to their clients ◆ Initiatives will exist to improve the health of those with diet-related illnesses 3b. Current Situation There are particular groups who may face additional barriers when trying to access a healthy diet. The barriers may be connected to mobility, income, access to information or a combination of these factors. Those most likely to experience barriers or suffer food poverty include: ◆ people with physical and sensory impairments ◆ people with learning disabilities ◆ people with mental health needs ◆ older people, particularly those living in residential homes, nursing homes or sheltered accommodation. ◆ members of BME communities and refugees and asylum seekers ◆ people on low incomes In a Borough with a diverse community and a focus on social inclusion it is important that food access work seeks to actively include these groups and address the barriers they may face. To date various groups have been targeted through community-based schemes such as social food outlets, operated by Community Food Enterprise and lunch clubs, but there is a need to ensure schemes are reaching those with additional needs. Another important target group is those with obesity; the rise in obesity caused by a lack of physical activity and poor diets, is of growing concern within Newham. Most sections in this strategy will have a long-term impact on the prevalence of obesity but there is also a short-term need to support those at current risk or who are obese, as outlined within the Governments Choosing Health White Paper. There is also a need to target those people with conditions that are directly affected by diet, (e.g. diabetes and cardiovascular disease) in order to reduce the health impact of these conditions. 14 3c. Examples of good practice in Newham Lunch Clubs for older people – exist in many areas across the borough. Those that provide transport for users, are wheelchair accessible and provide additional activities and services are especially successful. Newham Fit Club – free to join, it provides health MOTs and healthy eating advice through the Newham Lifestyle Journal. It plans to offer “slimming on referral” in 2007.. Hamar Agar sheltered housing and Subco day centre for Asian Elders – which both run healthy cooking classes for older people Greenhill Centre café – provides healthy food for visitors to their day centre and training opportunities for disabled people. Food for a Penny – offers food at a minimal price to refugees and asylum seekers depending on their need 3d. Targets and Performance Indicators TARGET SOURCE i. See 1d for Early Start target for engaging families in services ii. Obesity care pathway will be implemented Choosing Health White Paper iii. Caroline Walker Trust guidelines on nutritional * standards will be implemented in nursing homes, residential homes and sheltered accommodation iv. For disabled people: Newham Disability Strategy Increase the number of disabled people eating 5 a day Establish nutritional standards for meals provided in care homes. v. Basic food and health training provided for carers and personal assistants who cook or prepare food PERFORMANCE INDICATORS vi. Number of people participating in Healthy Start * Voucher Scheme vii. Number of people who may have additional * needs (listed in 3b) using social food outlets. viii. Number of people with diet-related conditions * using social food outlets ix. Number of borough strategies and action plans * addressing food and nutrition issues *Created for the Food and Nutrition Strategy 15 4 : I n c re a s i n g K n o w l e d g e , Aw a re n e s s a n d S k i l l s f o r Healthy Eating 4a. Vision ◆ People living or working in Newham will be aware of the beneﬁts of a healthy diet and have opportunities to increase their knowledge and skills relating to healthy eating 4b. Current Situation The factors behind a person’s choice of food are complex and include global issues such as exposure to advertising, local issues including the types of retail outlets within easy reach, and individual issues including cost, preference and an understanding of the impact of diet on health. These inﬂuences have created a local environment which encourages a poor diet and therefore provides a higher risk of developing diabetes, cardiovascular disease and other diet-related illnesses. Nationally the Food Standards Agency is working with food manufacturers to ensure healthy choices are easier to make. There is also a focus on educating children through the Healthy Schools agenda. At a local level there has been a lot of progress to empower people to be able to make those choices. This has included the National Training Programme for Community Food Workers, which has already had 100 graduates this year. There have also been various cook and eat activities throughout the Borough run through Early Start, Food in Schools and other community based organisations. Work is needed to ensure existing programmes and learning opportunities continue and that they target a range of audiences. There is also a need to ensure that where there is an unmet need, new programmes are developed to give local people skills and keep Newham at the forefront of work in this area. 4c. Examples of good practice National Training Programme for Community Food Workers – developed in Newham by Community Food Enterprise, the National Training Programme was developed to help build the skills of local people in Newham to address the food and health issues faced by their families and communities. Trafﬁc light system – Newham Catering Services have introduced this system to school meals. It indicates to pupils the healthiest options on the dinner menu (see Priority Two). Cook & Eat – various courses around the borough that teach people how to prepare healthy meals on a budget. For example Early Start currently run a programme targeted at parents with children under 5 as part of the Community Nutrition Service Healthy Eating in the Workplace – East Thames currently provides free fruit for employees to promote healthy eating amongst employees. This is supplied by Community Food Enterprise who, in partnership with East Thames, are looking at other ways to promote healthy eating to employees. 16 4d. Targets and Performance Indicators TARGET SOURCE i. 150 people living or working in Newham to achieve Community Food Enterprise pass on National Training Programme for Community Food Workers annually ii. 75% of people attending Early Start cook and Early Start Service Level Agreement eat sessions reporting an increased conﬁdence in providing a healthy diet for themselves/their families by March 2007 and 20% of parents/carers report a change in eating behaviours following immediate completion of a “Cook & Eat” project. iii. All schools to be working towards Healthy Schools Corporate Plan Delivery Plan Standard by 2009 (which include a requirement for training for staff to deliver healthy eating and teaching pupils to plan and prepare healthy food) iv. 50 individuals and organisations to be registered * to food and nutrition network by 2007 1 v. 30 Communities of Health will be accredited * with a diet-related outcome including 6 business communities of health PERFORMANCE INDICATOR SOURCE vi. Number of school staff including cooks and * midday meal supervisors receiving training on food awareness and nutritional education *Created for the Food and Nutrition Strategy 1 Communities of Health is a pilot initiative being delivered in Newham PCT to accredit local groups and organisations who promote ways to improve health to their members and employees 17 5 : O v e rc o m i n g P h y s i c a l Barriers to food access 5a. Vision ◆ Affordable and nutritious food will be available through a diverse and culturally appropriate retail sector covering town centres, residential areas and places of work ◆ Areas of poor access to food will be addressed by long term strategies and policies ◆ Projects and business outlets that improve access to good quality and affordable healthy food will be supported within the Borough 5b. Current Situation The ability to physically access healthy affordable food is essential to maintain a healthy diet. This is not the only factor that affects people’s choices but studies have shown it can impact 1 on food choices . Physical barriers can include poor access to shops or markets but also factors like transport to shops, shop opening hours, physical access into shops, major roads, and the ability to carry and store food. As described in Chapter 3 this is an even greater obstacle for certain groups of people. In 1999 a report on food access in East London stated that Newham had the lowest concentration of affordable fruit and vegetable retailers in East London, with 2.9 affordable fruit and vegetable retailers per square mile, compared to 8.9 in Hackney and 7.7 in Tower 3 Hamlets . The local issues with access to food retail (often referred to as ‘food deserts’), highlighted in this report has contributed to the increase proﬁle and understanding of food issues within Newham. Food access is also of particular concern when combined with other factors such as deprivation, as it is likely to increase food poverty and create additional barriers to healthy eating. 4 A recent study into the local food access situation found that the situation had improved, although there are still areas with low provision of affordable fresh fruit and vegetables within the Borough. Social food outlets (SFOs) can and are relieving this situation but often rely on grant funding and volunteer support and are open for limited periods so are not necessarily a sustainable solution. There is a need to ensure that the SFOs are targeted in the areas of most need and that work continues to support SFOs and other local food retail outlets to provide good access to affordable healthy food. 1 Wrigley N, Warm, D., Margetts, B. (2002) 2 White, M (2003) 3 J Freeze, (1999), Food Access in East London 4 NFAP (2006) Food Access Map Report 18 Other solutions to food access problems include use of the Internet which has enabled some groups, such as disabled people, to overcome the physical barriers they may face in accessing food. However, use of the internet for food shopping may be limited by factors such as access to computers, ownership of credit cards, high minimum spend values or delivery charges. Work needs to be done to see how this may be part of the wider solution to food access issues. 5c. Examples of Good Practice Food access projects – Community Food Enterprise manages numerous projects that improve peoples access to fresh fruit and vegetables. They run: 12 social food outlets; a mobile food store that covers 25 locations across the borough; and a free home delivery service for pregnant women, housebound and older people available via telephone and the Internet. 5 A DAY Retailers Study - the Newham Food Access Partnership has undertaken a study into the barriers small retailers face in selling fruit and vegetables in the Borough. The report recommended further support for the small retailer sector by utilising local planning tools; crime reduction strategies and the development of links between retailers and food access projects. 5d. Targets and Performance Indicators TARGET SOURCE i. Food Access Policy as part of Local Development Corporate Plan Delivery plan Framework by 2007 ii. To increase number of outlets in the borough * selling a good range of affordable fruit and vegetables and increase access to these outlets iii. Public buildings with eating facilities and staff * restaurants in statutory organisations to include and promote healthy choices *Created for the Food and Nutrition Strategy Links with other sections See section 6d for food access target relating to retail provision. See section 3d for food access target relating to social food outlets. 19 6: Retail Economy and Food C u l t u re 6a. Vision ◆ The Borough will have strategies & policies to support a diverse food retail economy and guide the retail sector to provide healthy choices to local populations ◆ Local retailers will play an active part in helping people to meet their ‘5 A DAY’ target and more healthy options will be available in restaurants, cafes and take-away shops ◆ There will be opportunities to buy local and Fairtrade produce throughout the Borough ◆ Social enterprise will be part of the food retail economy and will be supported to operate where there is a market failure to provide food access ◆ Newham will have a food culture where food is used to bring people together, celebrate diversity and contribute towards good health 6b. Current Situation London’s food economy is one of the most vibrant in the world. There are around 12,000 restaurants offering foods from over 60 nationalities, ﬁve wholesale food markets, and around 60,000 registered food businesses (approx. 2,000 in every borough). The food economy is a signiﬁcant part of London’s economy in terms of jobs and economic value. Newham’s food economy has many unique characteristics; the diverse population means that the food economy is equally diverse with retailers selling foods to meet the cultural tastes of the people who live here. This is a strength and should be seen as an important resource in the development of a healthier food culture. Unfortunately, other parts of the food culture in Newham that are not so healthy. Some of these are a direct result of the high levels of deprivation experienced by residents of Newham. This has resulted in a demand for cheap, ﬁlling food and has driven the prevalence of fast food shops within the Borough. These characteristics have also been driven by changes in modern life and working patterns, including the rise in convenience foods, the loss of traditional cooking methods and a lack of connection to the food chain. The Determinants of Health model on which this strategy is based (Appendix E) takes into account the wider impacts of social, economic, cultural and environmental conditions on community and individual health. When looking at the retail economy it can be seen that these cultural and environmental factors may be having a negative impact on health in Newham. Work to overcome this should focus on developing food retail which provides good quality but affordable produce. 20 It is also important that people understand and take ownership of the wider impacts of their food culture, for example its impact on the environment and communities, both here in Newham and across the world (see Chapter 7 for more detail). Nationally environmental and ethical issues are increasingly becoming a factor in the choices people make when buying 1 food . However the majority still make their choices according to price and in Newham there may be more challenges to encourage people to make these more expensive choices, due to high levels of deprivation. Newham has a changing population and as existing and new residents gain more buying power they will also start to inﬂuence the direction of future retailing developments and food culture. The challenge of developing Newham’s retail economy will be to meet the range of needs of Newham’s current and future residents, through a diverse and ﬂexible food retail economy. 6c. Examples of good practice Community Safety Network – an initiative between the police and the local authority. This seeks to increase safety amongst small retailers in an area and to reduce anti social behaviour. CSN have given two way radios to small shop owners in Manor Park and Canning Town. Increased communication between shop owners has helped them bring down crime in their area and improve the climate for their business. 5 A DAY Retailer Study –undertaken by NFAP in partnership with the PCT and the Food Unit that sought to understand the issues facing small retailers in the borough and to develop ways in which to help them become better points of access for 5 A DAY 6d. Targets & Performance Indicators TARGET SOURCE i. Food Retail Strategy developed(as part of Local London Food Strategy Development Framework) ii. 20 restaurants and small businesses will be involved * in a healthy food related accreditation scheme by 2007 iii. Newham application made for Fairtrade Borough * status by December 2008 iv. Directory of retail outlets created to indicate where * Fairtrade and affordable fruit and vegetables can be purchased within the Borough v. Food retail issues referenced in Local Development * Framework (core policies and/ or background papers) and any strategy or action plan relating to Section 106 money allocation *Created for the Food and Nutrition Strategy 1 FISS (2006) Dept Environment, Food and Rural Affairs 21 7 : F o o d G ro w i n g a n d E n v i ro n m e n t a l Sustainability 7a. Vision ◆ A range of allotments and growing spaces will be available and used to educate and re-connect people with food and health issues ◆ The environmental sustainability of the food chain in Newham will be improved; in particular 1 there will be an increase in local food use to reduce food miles and more composting of food waste. ◆ Food businesses will minimise their environmental impact ◆ Statutory organisations will use their procurement power as a driver for change by purchasing local and fairtrade goods which contribute to a more sustainable food system. 7b. The current situation As discussed in the Chapter 6, certain aspects of the food culture in Newham do not necessarily encourage healthy eating and can have signiﬁcant negative environmental impacts both in terms of waste and transport. Typical income levels in Newham mean that people’s ability to choose foods with less negative environmental impact (e.g. organic, fairtrade and locally produced) is reduced as they are often more expensive. It is difﬁcult to measure the direct impact of food on the environment at a local level but a 2 report into the environmental impact of London indicated that food is responsible for 41 3 per cent of London’s ecological footprint . Improving the sustainability of the food chain through increasing use of local produce to reduce food miles, reducing use of processed foods and improving recycling of food waste and packaging will also provide opportunities to increase understanding of the link between what we eat and the health of individuals, communities and the environment. This area of activity would also support efforts to increase the recycling rate within Newham. The need for Newham to be ‘a good neighbour’ through reducing its impact on the environment both in the UK and across the world is reinforced by the Food Industry Sustainability Strategy. This document highlights the range of ways the food industry can reduce negative and improve positive impacts on society and the environment, many of which 1 Food Miles is a term used to demonstrate the distance food has travelled by the time it is consumed and indicates the environmental impact of different sources of food. 2 City Limits (2002) A resource ﬂow and ecological footprint analysis of greater London 3 See deﬁnition on page 1 22 are relevant at a local level. There is also recognition of the role of the statutory sectors to inﬂuence this through their buying power and procurement policies. This is also highlighted in the ‘Good Corporate Citizen’ guidelines developed by the Sustainable Development Commission for the NHS. Food growing projects can play a crucial role in the development of a healthy and sustainable food system in the Borough, by providing an opportunity to reconnect people with the food chain and learn about growing and eating healthy, local produce. Growing projects can also make a contribution to improving the sustainability of the food system as a source of local, unprocessed food. In addition food growing gets people physically active which together with a healthy diet can help tackle obesity. 7c. Examples of good practice: Growing Schools Initiative – DfES initiative to encourage food growing in schools was piloted in a number of sites around Newham. Children taught about social, environmental and health aspects of food through interaction with the food garden. Allotments – with over 500 plots around the borough, allotments provide healthy food and exercise for those lucky enough to get a plot. In addition there are also community growing projects such as BreakinGround & Greenhill Horticultural Project which provide training and employment opportunities for disabled people and include the growing of healthy food. The Mushroom Farm, Manor Park – Agridutt International grow mushrooms on a commercial scale at their farm situated under the A406 Ilford ﬂyover. 7d. Targets & Performance Indicators TARGET SOURCE i. To increase number of shops promoting and * selling local food as a way to reduce food miles ii. Establish local food procurement policies in the * statutory sector and increase amount of local food used iii. To increase number of children and adults * involved in food growing projects iv. To increase the amount of food waste which is * recycled or composted *Created for the Food and Nutrition Strategy Links with other sections See section 6d for food access target relating to Fair Trade foods. 23 Implementation – t a k i n g t h e s t r a t e g y f o r w a rd This strategy has been developed using a partnership approach and has involved over 200 hundred different participants. However, the process of developing the strategy is just the beginning of the journey. The most challenging work is yet to come – changing Newham’s food system to “create a borough where the beneﬁts of a healthy diet are available to all”. Taking the vision forward will require input from a wide range of organisations, from large statutory bodies to small voluntary sector organisations and many in between. The Newham Food Access Partnership is committed to supporting this process and ensuring that the Strategy becomes a useful and working document. Next Steps ◆ To support the implementation of the strategy detailed implementation plans will be developed for each area of the strategy. The following twelve months will be most crucial in the success of the strategy. Funding for new initiatives will need to be secured and work on their development started. ◆ NFAP are committed to helping partners identify and secure this funding as well as working alongside them to help them develop these new work streams. ◆ Some of the areas covered in the strategy required further facilitation to develop ways forward. NFAP have committed to run four consultation events over the course of 2006 to identify and move forward speciﬁc priority areas. ◆ NFAP will also develop a monitoring process to ensure that the vision of the Strategy is being implemented through action and that this is being measured. ◆ If certain areas for actions are not taken forward it will be NFAP’s responsibility to identify why this is the case, to investigate if the action is still a priority, and if so to develop a process by which action will be achieved. ◆ NFAP will be responsible for producing an annual monitoring report which will assess the progress made towards implementing the recommendations of the strategy. 24 Appendices Appendix A Key Partners of Newham Food Access Partnership Newham Food Access Partnership Aston Mansﬁeld Strategic Manager Durning Hall c/o East Potential Earlham Grove 3 Tramway Avenue London Stratford E15 4PN E7 9AB T: 020 8536 8882 www.aston-mansﬁeld.org.uk Email: email@example.com www.nfap.org.uk Community Food Enterprise Ltd Unit 4a Thameside Industrial Estate Newham Primary Care Trust Factory Road Public Health Directorate London 3rd Floor Francis House E16 2HB Barking Road www.community-food-enterprise.org.uk Plaistow T: 020 7511 9014 E13 9PJ www.newhampct.nhs.uk East Thames Culture, Arts, Sport & Health London Borough of Newham 3 Tramway Ave Social Regeneration Unit Stratford 3 Nelson Street London E15 4PN London T: 020 8522 2000 E6 6EQ www.newham.gov.uk 25 Appendix B Links to other strategies and government PSA targets The development of Newham’s Food and Nutrition Strategy was a locally initiated undertaking. However there are several government directives that speciﬁcally mention the usefulness of such an undertaking and recommend food and nutrition strategies as a way of addressing key government targets around levels of chronic illness. The following is a list of relevant Government documents: ◆ National Service Framework for Coronary Heart Disease (CHD) – 2000 ◆ National Service Framework for Older People – 2001 ◆ National Service Framework for Diabetes - 2001 ◆ The Cancer Plan – 2000 ◆ Nutritional Standards for school Lunches and other School Food – Autumn 2006 ◆ Choosing Health: Making Healthier Choices Easier – 2004 ◆ The Strategy for Sustainable Food and Farming 2002 ◆ Every Child Matters – 2003 ◆ National Healthy Schools Standard ◆ Diet and Health Action Plan ◆ Food Industry Sustainability Strategy – 2006 ◆ Good Corporate Citizen Guide - 2005 London Food Strategy Newham’s Food and Nutrition Strategy is placed ﬁrmly within the context of the Food Strategy for London. It has taken many of its leads from the London Strategy and both share a holistic approach to food and health. The vision, which incorporates the Mayor’s cross-cutting responsibilities of health, sustainable development and equalities, is translated into a series of objectives. ◆ to improve Londoner’s health and reduce health inequalities via the food they eat ◆ to reduce the ecological footprint and environmental impacts of London’s ◆ food sector ◆ to support a vibrant food economy ◆ to celebrate and promote the diversity of London’s food culture ◆ to develop London’s food security. 26 Links to other local strategies There are many local strategies which include recommendations around food and nutrition and this strategy is congruent with these. In particular, this strategy supports the following: ◆ Tackling Health Inequalities: a strategy for Newham ◆ LB Newham Corporate Plan Delivery Plan ◆ Children and Young People’s Plan ◆ Children and Young People’s diet, physical activity and health strategy ◆ Newham Disability Strategy (draft) ◆ Newham Older People Strategy (draft) ◆ Local Development Framework (draft) Although these strategies have different aims and cover different areas, they all in some way overlap with this food and nutrition strategy. Where this overlap occurs, they give the same message. Public Service Agreements There are a number of Public Service Agreement (PSA) Floor Targets that local statutory authorities are obliged to work towards with relevance to this document. Life expectancy - Substantially reduce mortality rates by 2010: ◆ From heart disease and stroke and related diseases by at least 40% in people under 75, with at least a 40% reduction in the inequalities gap between the ﬁfth of areas with the worst health and deprivation indicators and the population as a whole; ◆ From cancer by at least 20% in people under 75, with a reduction in the inequalities gap of at least 6% between the ﬁfth of areas with the worst health and deprivation indicators and the population as a whole. (PSA1) Health inequalities - Reduce health inequalities by 10% by 2010 as measured by infant mortality and life expectancy at birth. (PSA2) Halt the year-on-year rise in childhood obesity amony children under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole. The following are indicators which local statutory authorities are also required to monitor: ◆ The percentage of new mothers known to have initiated breastfeeding ◆ The percentage of children with active dental decay 27 Appendix C Newham Food and Nutrition Strategy - Policy Statement This policy statement sets out the vision, aims, process and priorities for the creation of a Food and Nutrition Strategy for the London Borough of Newham. Newham is an East London Borough with a rapidly growing population which is both young and culturally and economically diverse. Newham is recognised as one of the most deprived boroughs in the country and is faced with increasing health inequalities, within Newham and between Newham and elsewhere. The prevalence of social and health inequalities poses a signiﬁcant challenge to local statutory agencies. However, these agencies cannot tackle these problems alone, nor should it be their responsibility to do so. This policy statement is a commitment from those engaged in the development of a Food and Nutrition Strategy to work in partnership to address the issues surrounding food and health that contribute to the continuance of social and health inequalities within the borough. Vision To work in partnership with the community, statutory bodies, the voluntary sector, private and social enterprise, and other interested parties, to create a borough where the beneﬁts of a healthy diet are available to all. Aims To maximise equitable access to the affordable, available, safe provision of healthy foods To increase the level of knowledge, skills and awareness of the links between food and health within the whole population To link the national, regional and local agendas on food and health to the lives of local people To map current levels of provision and identify gaps leading to the development of strategies for addressing these To develop a food supply chain that is both economically and environmentally sustainable and which is capable of meeting the cultural and nutritional needs of Newham’s diverse population To develop a food culture where the provision and consumption of food is an enjoyable experience and which promotes both healthy individuals and sustainable communities NB: these were amended as part of the consultation process 28 Appendix D Example of Implementation Plan Action Measure of Lead/ Resources Stage of success partners development/ Priority Appendix E Determinants of Health Model – Dahlgren & Whithead Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute of Futures Studies, 1991. 29 Appendix F Organisations contributing towards strategy development Healthy Schools Newham Catering and London Food Link Programme Cleaning Services c/o Sustain Credon Centre 242 Fernhill Street 94 White Lion Street Kirton Road North Woolwich London Plaistow E16 2HZ N1 9PF E13 9BT Environmental Health Unit Greenwich Leisure Forward Planning and Alice Billings House Limited (GLL) Transport 2-12 West Ham Lane Atherton Leisure Centre LB Newham London 189 Romford Road Newham Town Hall annexe E15 4SF Stratford 330-354 Barking Road E15 4JF East Ham Canning Town and Custom E6 2RT House Regeneration Corporate Strategy Project Health Division Newham University Improvement Group LB Newham Hospital Trust – 20 Freemasons Road Newham Town Hall Department of Nutrition London Barking Road and Dietetics E16 3NA East Ham Newham General Hospital E6 2RP Glen Road Healthywise London Unit 121 Burford Business E13 8SL Centre 11 Burford Road Newham University London Hospital Trust – E15 2ST Maternity Services Newham General Hospital Birth and Breastfeeding Glen Road Support Project London Stratford Workshop E13 8SL Unit 327 Burford Road Stratford, London Client Catering Ofﬁce E15 2FP Children & Young People’s Services Early Start Community Broadway House Nutrition Service 322 High Street Play in Training Centre Stratford, E15 1AJ 1 Abbey Lane Stratford London 30 31 32