Havering Healthy Weight Strategy 2024-2029: Everybody’s Business

The vision for Havering is that within 20 years’ childhood obesity will

have been eradicated, that the Borough will have become a healthier

place to live, work and play, and a place where communities have

come together to make the healthier choice the easier choice

London Borough of Havering

Havering Healthy Weight

Strategy 2024-2029:

Everybody’s Business

A whole systems approach to reducing overweight and obesity

London Borough of Havering

1/17/2024

Document Control

Include document details, version history, approval history, and equality analysis record.

Document details

Name

Havering Healthy Weight Strategy 2024-2029

Version number

Draft v 1.0

Status

First draft

Authors

Elaine Greenway, Assistant Director Public Health, London Borough

of Havering (LBH)

Jack Davies, Public Health Specialist, LBH

Victoria Stokes, Public Health Programme Manager, LBH

Thomas Goldrick, Senior Public Health Analyst, LBH

Lead Officer

Mark Ansell, Director of Public Health

London Borough of Havering

Approved by

Scheduled review

date

Version history

Version

Change

Date

Dissemination

Draft

Equality & Health Impact Assessment record

Title of activity

Havering Healthy Weight Strategy 2024-29;

Everybody’s Business: A whole systems approach to

reducing overweight and obesity

Type of activity

A new strategy

Scope of activity

This document sets out the local strategic approach

for addressing high levels of overweight and obesity in

the Borough, through a “whole systems place-based

approach”. This will support the longer term vision for

the Borough; within 20 years’ childhood obesity will

have been eradicated, and that the Borough will have

become a healthy place to live work and play, and a

place where communities have come together to make

the healthier choice the easier choice.

There is sound evidence that shows where we live

influences how and what we eat, and how active we

are. The system (the conditions that affect how we

live) can shape the choices that we make. There are

over 100 causes of overweight and obesity in the

system that are pushing us towards unhealthy

choices.

A whole systems approach to obesity prevention

means addressing all the different causes of obesity

and being aware of the potential health implications of

actions taken, and working towards making the

healthier choice the easier choice.

A whole systems approach takes a long time to

embed. Once embedded, it takes many years for rates

of obesity to fall.

During the five-year lifetime of this strategy, we will (a)

embed changes through an all systems place-based

approach for the whole Borough, (b) introduce an

enhanced and targeted neighbourhood-level place-

based approach to address inequalities (starting with

the neighbourhood of Gooshays and Heaton wards).

By 2029 we expect to see:

 An improvement in healthy weight levels in

reception aged children across the Borough,

compared to the England average.

 An improvement in measures of excess weight

among year 6 children in the targeted

neighbourhood of Gooshays and Heaton wards

compared to statistical neighbours.

 The development of the Borough as a place

that promotes healthy weight and where the

healthier choice is the easier choice; enabling

people to eat healthily and be active.

Are you changing, introducing a

new, or removing a service,

policy, strategy or function?

Yes

If the answer to

any of these

questions is ‘YES’,

please continue to

question 5.

If the answer to

all of the

questions (4a, 4b

& 4c) is ‘NO’,

please go to

question 6.

Does this activity have the

potential to impact (either

positively or negatively) upon

people (9 protected

characteristics)?

Yes

Does the activity have the

potential to impact (either

positively or negatively) upon

any factors which determine

people’s health and wellbeing?

Yes

If you answered YES:

Please complete the EqHIA in Section 2 of this

document. Please see Appendix 1 for Guidance.

If you answered NO: (Please

provide a clear and robust

explanation on why your activity

does not require an EqHIA. This is

essential in case the activity is

challenged under the Equality Act

2010. )

Please keep this checklist for your

audit trail.

Date

Completed by

Review date

01. 09. 23

Jack Davies

Executive summary

Obesity rates in Havering are very high for both children and adults, either similar or above

the London and England averages, and they look set to get worse. The problem of

overweight and obesity is cutting lives short, and negatively impacting the quality of life of

Havering residents. Prevention is a key priority for Havering Council and the NHS, as set out

in the Havering Corporate Plan,

the Havering Health and Wellbeing Board’s Health and

Wellbeing Strategy 2019/20–2023/24 and the Havering Place Based Partnership’s Interim

Health and Care Strategy.

It is a common misconception that individuals are completely in control of their own weight

and that an overweight problem is entirely the result of personal choices. Over recent years it

has become increasingly evident that obesity is a much more complex issue, and one that is

caused by multiple factors that interact with each other; the modern-day changes in the

circumstances where we live, work and play that now make us more likely to opt for

unhealthy options of foods and less likely to be physically active. In short, it is largely the

circumstances where we live, known as ’the system’, that has resulted in the increasing rates

of overweight and obesity.

The scale and complexity of the problem means that the Council, the local NHS, and

stakeholders must work together to change the system.

Over 100 local partners came together for two healthy

weight summits to identify the system-wide factors that are

contributing to overweight and obesity in Havering, and to

consider the solutions. The work from these summits

contributed to the development of this five-year healthy

weight strategy on taking a whole systems approach, and a

twenty-year vision for the Borough.

Over the lifetime of this strategy the Council and NHS, with

partners will

 deliver a Borough-level whole systems approach that makes the healthier choice the

easier choice and supports individuals to achieve and maintain a healthy weight

 introduce an enhanced and targeted neighbourhood-level whole systems approach to

address inequalities, starting with Gooshays and Heaton wards initially, and

expanding to other neighbourhoods in the future

By the end of this five-year strategy we expect to see

 The development of the Borough as a place that promotes healthy weight, where the

healthier choice is the easiest choice; with foundations laid to achieve the twenty-year

vision of eradicating childhood obesity

 An improvement in healthy weight levels in reception aged children across the

Borough, compared to the England average

 An improvement in measures of excess weight among year 6 children in the targeted

neighbourhood of Gooshays and Heaton wards, compared to statistical neighbours

The shared vision for Havering

is that, within 20 years,

childhood obesity will have

been eradicated, and that the

Borough will have become a

healthy place to live work and

study and a place where

communities have come

together to make the healthier

choice the easiest choice.

Joint Foreword between Mark Ansell, Director of Public Health, and

Councillor Gillian Ford, Cabinet Member for Adults and Wellbeing

Welcome to Havering’s draft Healthy Weight Strategy.

We share an ambition for the Borough to be a place where residents achieve the very best

for their health and wellbeing. Sadly, we know that this isn’t happening; levels of overweight

and obesity in the local population are among the highest in the country, which means that

too many people living in Havering are at greater risk of poor health. Even more worryingly,

too many children in the Borough are overweight or obese and set on a path of experiencing

lifelong illnesses that were once only seen in adults. As rates of overweight and obesity have

increased over the years, and are projected to increase still further in the future, the reality is

that obesity is cutting too many lives short and, unless we take urgent action, the problem will

only get worse.

The Council, the NHS, and our partners are determined to tackle the problem. We have so

many fantastic assets in the Borough; beautiful green spaces and parks, excellent leisure

and sporting facilities, and good schools. But along with the rest of the UK and other

developed countries, Havering is host to conditions that stand in the way of good health and

wellbeing; the food environment, the way that we work and other circumstances that favour

inactivity, are all pushing the population in the direction of overweight and obesity.

As this draft strategy sets out, we propose adopting an approach which is proving to be

effective in other cities. Known as a ’whole systems approach’, the Council, the NHS and

other partners will work together to address the over 100 factors that are contributing to the

problem of growing rates of overweight and obesity.

We share the vision that Havering will become a place where the healthier choice will be the

easier choice, with childhood obesity eradicated within 20 years.

Whether you live, work, or visit the Borough, we encourage you to consider the Obesity

Health Needs Assessment chapter on obesity that has informed this strategy’s approach,

and comment on the draft strategy itself.

Mark Ansell

Director of Public Health

London Borough of Havering

Councillor Gillian Ford, Deputy

Lead of Havering Council and

lead member for Health

Support for the Health Weight Strategy

“I am seeing more cases of fatty infiltration of liver and Type 2 diabetes in children and young

people, which are a direct result of higher numbers of obesity. Fatty infiltration of liver is a

precursor to Liver cirrhosis leading to liver failure. Type 2 diabetes in children and younger

population is a much more aggressive condition and leads to both kidney failure and heart

disease at an early age.

“The NHS can’t deal with increasing rates of obesity by itself; it is important for all local

partners to work together.”

Diabetes Specialist Paediatric Consultant

Barking, Havering and Redbridge University Trust

‘

“Everyone Active fully supports this strategy and is committed to playing our part in

supporting local residents to achieve a healthy weight.’

Area Contract Manager

Everyone Active

“As the independent voice of people who use health and social care services in Havering, we

know how overweight and obesity can affect the day to day lives of local people. We fully

support this strategy, and as an organisation, pledge to play our part in preventing

overweight and obesity.”

Senior Manager

Healthwatch Havering

“Schools are seeing increasing numbers of children who are overweight and obese. As a

head teacher, I welcome this strategy, and want my school to play a full part in achieving the

vision for a healthier Borough.”

Head teacher,

Harold Hill Junior School

Introduction

Preventing overweight and obesity and the health issues caused by overweight and obesity

are priorities for Havering Council and the NHS, as set out in the Havering Corporate Plan,

the Havering Health and Wellbeing Board’s Health and Wellbeing Strategy 2019/20–2023/24

and the Havering Place Based Partnership’s Interim Health and Care Strategy.

This draft five year Havering Healthy Weight Strategy 2024-2029 summarises the scale of

the problem of overweight and obesity, why it is a concern and what causes obesity. It sets

out how residents, the Council, the NHS, schools, leisure centres, the voluntary and

community sector and local businesses must work together on delivering a ‘whole systems

approach’

to achieve a healthier population. This document should be considered alongside

the new Havering Obesity Health Needs Assessment.

The development of this strategy has been led by the Council and has involved elected

members, including the Leader of the Council and Lead Member for Adults and Wellbeing,

as well as relevant service areas, and NHS partners. In total, over 30 stakeholder

organisations have been engaged in its development, including representatives from

schools, local businesses and the voluntary and community sector. The focus is on upstream

prevention; stopping increasing rates of obesity in the local population, whilst recognising

that help and support should be available for those individuals who want to lose excess

weight.

Work started on this strategy during 2022 by bringing together information about overweight

and obesity in the local population, evidence about the causes of and solutions for tackling

obesity, a review of national strategy and published research on what has worked in the UK,

and the achievements that have been made to address overweight and obesity in other cities

around the globe.

This information was presented at two healthy weight summits, which

were attended by over 30 stakeholder organisations.

The discussions from those workshops and ongoing engagement with

stakeholders informed the content of this strategy, the twenty year

vision for the Borough, the guiding principles for development and

implementation, and the process for implementing a whole systems

approach.

OHID and the Department for Health and Social Care (DHSC) defined a local whole systems approach as a

response to “complexity through an ongoing, dynamic and flexible way of working. It enables local stakeholders,

including communities, to come together, share an understanding of the reality of the challenge, consider how the

local system is operating and where there are the greatest opportunities for change. Stakeholders agree actions

and decide as a network how to work together in an integrated way to bring about sustainable, long-term systems

change

The publication What Good

Healthy Weight for all Looks

Like provided the guiding

principles for the

development and

implementation of this

strategy, and for future

assessment (see appendix

Figure 1: Six step model for implementing a whole system approach to tackle obesity

Source: OHID Whole Systems Approach Guide

Phases 1 to 4 of the six step model guided the development of this strategy during 2022-

2023. Phases 5 and 6 will commence when the strategy is agreed.

Prevalence of overweight and obesity

Rates of overweight and obesity have been increasing and are expected to increase further

in the future.

The latest data for children is for the 2022/23 school year

which shows that for Havering:

 22.2% of children aged 4 – 5 years old (school year

reception) were overweight or obese. Havering is similar

to the London and England averages (which are high).

 40.1% of children aged 10-11 (school year 6), were

overweight or obese. Havering is similar to the high

London average and above the England average.

Obesity rates in Havering for children aged 10 – 11 (school

year 6) has increased by 20% over the last 15 years from

32.9% to 40.1%.

The most recent data for adults is from the 2021/22 Active

Lives Adult Survey which shows that for Havering:

 60.3% of adults aged 18 – 64 years old are estimated to be overweight or obese. Trend

data shows that Havering consistently has one of the highest proportion of adult

overweight and obesity in London and is above the high England average.

 24.9% of adults aged 18 – 64 years old are estimated to be obese. Trend data shows

Havering is consistently above the London average and is following the rising England

average.

The prevalence of overweight and obesity is expected to continue to rise:

 The proportion of adults who are overweight or obese has risen in England from 52.9% in

1993 to 64.3% in 2021, and the proportion of those people who are obese has risen from

14.9% in 1993 to 26.0% in 2021.

 In 2022, Cancer Research UK suggested that 36% of the population would be obese by

2040.

If overweight and obese trends continue then the combined prevalence of

overweight and obesity may reach 71% of the population by 2040.

Inequalities

Health inequalities are the systematic, unfair, and avoidable differences in health between

different groups of people.

There are inequalities associated with overweight and obesity, which mean that some groups

of people are affected more than others.

National evidence is that rates of obesity are highest in areas of greatest disadvantage.

Children growing up in these areas are more at risk of obesity. Children who are obese are

more likely to be obese in adulthood.

FACT BOX 1: What is a healthy weight?

Healthy weight for both adults and children is

determined by Body Mass Index (BMI).

For adults, a BMI between 18.5 and 24.9 is

considered healthy. BMI is calculated by dividing

body mass by the square of the body height, and

is expressed in units of kg/m²

For children, age and gender is also taken into

account when calculating BMI and the result is

then compared to national datasets of children’s

BMI to assess whether they are a healthy

weight. Children with a BMI between the 2

and

centiles are a healthy weight. Children

above the 85

centile are overweight and above

centile obese.

Excess weight is classified by the NHS as an

adult living with overweight, obese or severe

obesity. With a BMI ≥25kg/m2.

Figure 4: Map of Havering wards showing the English Indices of Deprivation 2019

Data Source: Ministry of Housing, Communities & Local Government. 2019

As figures 2 and 3 above show, the highest rates of excess weight among children in

reception year (ages 4-5) are in Gooshays, Heaton, South Hornchurch and Rush green &

Crowlands wards. For children in year 6 (ages 10-11), the wards with the highest rates of

excess weight are Beam Park, Rainham and Wennington followed closed by Gooshays and

Hacton. The maps illustrate the association between higher levels of excess weight and

wards of greater disadvantage as presented in figure 4.

Data Source: National Child Measurement Programme (NCMP) 20 - 23 OHID.

Figure 3: Percentage of excess weight

among children aged 10-11 by ward,

2019/20-2022/23

Figure 2: Percentage of excess

weight among children aged 4-5

by ward 2019/20-2022/23

As set out in the Obesity Health Needs Assessment chapter on obesity, overweight and

obesity is also higher in particular population groups such as in some ethnic groups, people

with physical and learning disabilities, people with severe mental illness, and people of

middle age. Men are more likely to be overweight compared to women, but women are more

likely to be obese compared to men.

Why is overweight and obesity a problem?

Overweight and obesity is affecting the quality of life of Havering residents and cutting lives

short.

Children are beginning to develop diseases previously seen only in adults, such as type 2

diabetes, high blood pressure, high cholesterol, liver conditions, and bone and joint

problems.

Overweight and obesity could also be affecting children’s life chances as there

are higher rates of school absence among children who are overweight, compared with

children of healthy weight,

and there is emerging evidence of an association between

obesity and poorer educational attainment.

Being obese can result in stigma and bullying

which has been found to result in lower self-esteem and can impact emotional and

behavioural development.

In adults, overweight and obesity is the second biggest preventable cause of cancer after

smoking.

Obesity reduces life expectancy by an average of three years or by eight to ten

years with severe obesity.

Being overweight or obese increases risk factors for

cardiovascular disease, such as high blood pressure, high cholesterol and type 2 diabetes.

People who are obese are a third more likely to develop dementia compared to those of a

healthy weight.

Maternal obesity rates doubled from 7.6% in 1989 to 15.6% in 2007. Pregnant women who

are obese are more likely to experience complications in labour, and their children have

increased risk of health conditions such as heart disease, diabetes and asthma.

Children

born to obese mothers are more likely to develop obesity themselves

and obesity in

childhood is more likely to lead to overweight and obesity in adulthood.

This is resulting in

an added problem in that overweight and obesity is increasingly being handed down through

generations. Breastfeeding is associated with lower chances of children becoming obese.

Obesity significantly increases the risk of hospitalisation, and morbidly obese individuals

make significantly more visits to GPs and to hospital.

Multiple studies have estimated that

the NHS spends approximately £6 billion on obesity-related health care each year.

A 2022

study estimated obesity costs the UK around £58 billion per year through NHS cost of

treating the associated illnesses, provision of social care, as well as to the individual in

regards to quality of life, and to business due to loss of workplace productivity.

Obese individuals are three times more likely to need adult social care than people of a

healthy weight.

A 1 kg/m² increase in BMI is associated with a five per cent rise in the

odds of need for help with social care.

When social care is required for people who are

obese, this can often mean costly housing adaptations and additional carers. It is estimated

that the yearly cost of local authority funded community-based social care for an individual

with severe obesity and a BMI of 40, would be £1,086, nearly double the cost for a person

with a BMI of 23, which is in the healthy range.22

The causes of obesity

It has been a common misconception that the answer to addressing the problem of obesity

lies in education, food labelling, and individual willpower.

Most people know what is a

healthy lifestyle. More than 90% of us know that we should limit our consumption of foods

that are high in fat, sugar and salt. Almost everyone (99%) knows that eating fruit and

vegetables is important for a healthy lifestyle.

The majority (75%) of people know what a

healthy diet is, 78% understand that diet has an impact on their health and 87% think it is

important to eat a healthy diet.

However, as Table 1 below shows, similar to the rest of the

UK population, the majority of Havering residents do not have a healthy lifestyle.

Table 1: Average ‘5 a day’ consumption and physical activity levels in Havering, London and

England

Area

The number

of children

(aged 5 - 15)

eating ‘5 a

day’*

The number of

children meeting

physical activity

guidelines**

The number of

adults (16+)

eating ‘5 a

day’***

The number of

adults meeting

physical activity

guidelines***

Havering

not available at

borough level

42.9%

31.0%

61.2%

London

Region

not available at

regional level

46.1%

31.5%

66.8%

England

18.0%

46.8%

32.5%

67.3%

Sources:

* NHS England 2019 Health Survey for England (Data for year 2018)

** OHID 2023 Based on Active Lives Children and Young People Survey, Sport England (Data for year 2021/22)

*** OHID 2023 Based on the Active Lives Adult Survey, Sport England (Data for year 2021/22)

Achieving a healthy lifestyle isn’t solely the combination of individual knowledge and

willpower. Eating healthily and being physically active is largely influenced by the

circumstances where we live, work and play.

Changes in modern day living have

resulted in high streets and dining options that have become saturated with unhealthy food,

and infrastructure and cultural attitudes that have led to fewer opportunities to be physically

active.

The impact of these changes in modern day living is a system of circumstances and factors

that encourage us to eat more foods that are high in fat, sugar and salt and to be physically

inactive, so that it has now become easier to become overweight or obese.

Turning the tide on obesity through a whole systems approach

The influential Foresight Project Report Tackling Obesities:

Future Choices describes over 100 interacting factors that

influence individual choices.

The Foresight Report makes the case that these over 100

factors are so inter-related that they create a very complex

system. Focusing on single initiatives will not achieve the

scale of change needed to reduce levels of obesity.

Instead, broad action is needed that address the wide-

ranging factors across the whole system.

Turning the tide on obesity through a whole systems

approach means responding to the complex and inter-

related factors that are driving increased rates of

obesity. It requires the Council and NHS working

with other partners and stakeholders to identify

local factors that are influencing decisions about

diet and physical activity, and developing a local

plan to change the local system and so make healthier choices the easier choices.

In 2019, Public Health England (now office for Health Improvement and Disparities (OHID))

with Leeds Becket University and the Local Government Association (LGA) published the

‘Whole Systems Approach to Obesity: a guide to support local approaches’.

The guide was

based on evidence appearing from Amsterdam and Australia about the success of

implementing whole systems approaches to address overweight and obesity.

A number

of local authorities in the UK are now testing and embedding systems thinking, with early

evidence appearing to show positive impacts.

To be effective, a local whole systems approach needs an extensive range of local

stakeholders to work together to understand and tackle the different parts of the system.

Figure 5: Example of whole systems working 1: healthier food environment

Healthy food options need to be conveniently available in the places where we live, work and play.

No one organisation is responsible for all of these settings, so partners must work together to

change the whole food environment. This is an example of a whole system approach, with

stakeholders and partners sharing a common vision, and then working together to make change

happen across the whole system.

Factors that influence

individual choices range from

the external environment, to

social culture, behaviour,

psychology and biology; many

of which are outside individual

control but heavily influence

decisions about diet and

physical activity. These factors

continuously interact and result

in a very complex system that

promotes overweight.

A system is a collection of interdependent

parts. Where there is change in one part of

the system, this will affect other parts.

Figure 6: Stakeholders recommended to develop a whole system approach to obesity

Source: OHID Whole Systems Approach Guide

Developing the Havering whole system

approach

Over 150 stakeholders representing the many parts of the

local system (as per figure 6) took part in two Havering

Healthy Weight Summits to map the local causes of obesity

and develop the local response.

Participants at Summit 1 identified over 120 local features

that impact on maintaining a healthy weight. Figure 7 was

produced as a result; a system map that captures the

features, their interdependencies and their interconnections.

At Summit 2, participants used the system map below

(figure 7) to identify where they could take action to deliver a place-based whole systems

approach for the Borough, taking into account national and regional initiatives.

OHID and the Department for Health

and Social Care (DHSC) defined a

local whole systems approach as a

response to “complexity through an

ongoing, dynamic and flexible way of

working. It enables local

stakeholders, including communities,

to come together, share an

understanding of the reality of the

challenge, consider how the local

system is operating and where there

are the greatest opportunities for

change. Stakeholders agree actions

and decide as a network how to work

together in an integrated way to

bring about sustainable, long-term

systems change”’

ICB

Health

& care

Figure 7: The Havering Obesity System Map 2022: the causes of obesity in Havering

To use the map, identify any cause and follow the direction of the arrows to see the relationship between the cause

and how it relates to diet or physical activity. The direction of the arrows indicates the nature of the relationship.

National and regional initiatives

This strategy will complement and influence action at regional and national levels including

the following initiatives:

 In 2020 Government announced a new national strategy to introduce legislation to restrict

the placement of less healthy products in large retailers, both in store and online, to

reduce the likelihood of impulse purchases. From 2025, there will be a ban on multi-buy

promotions such as “Buy One Get One Free” and a ban on advertising less healthy

products in the media.

 In 2021 the London Childhood Obesity Taskforce, chaired by the Mayor for London,

developed a 10 point plan for addressing childhood obesity, which includes policies that

restrict the advertising of products high in fat, salt and sugar across all Transport for

London estate in London boroughs and supports food businesses to sell healthier

options.

Table 3: National, regional, and local healthy weight initiatives

National

Regional

Local

UK Government Tackling

Obesity Strategy 2020

 Introduce legislation to

require large out of home

food businesses to include

calorie information

 Legislate to prevent

supermarkets selling high

fat, sugar and salt foods

next to supermarket tills

 Ban advertising of high

fat, sugar and salt

products being shown on

TV and online before 9pm

 Fund the expansion of

weight management

services and a campaign

to support individuals to

take steps to move

towards a healthier weight

 Legislate to end the

promotion of foods high in

fat, sugar and salt by

restricting volume

promotions such as buy

one get one free

The London Plan 2021

 Recognises that

Londoners’ physical and

mental health is largely

determined by the

environment in which they

live, work and play

 The plan includes policies

on developing a healthy

city to enable health to

flourish

London Child Obesity Taskforce:

2021

The taskforce set 10 ambitions, and

works with the GLA to provide

content for local authorities to

implement locally whilst doing

research and influencing policy at a

London region level.

1. End child poverty

2. Support women to

breastfeed

3. Skill up early years

professionals

4. Use NCMP to better

support parents

5. Ensure all nurseries and

schools are enabling

health for life

6. Make free ‘London water’

available everywhere

7. Create more active, playful

streets

8. Stop unhealthy marketing

9. Transform fast-food

businesses

10. Fund good-food innovation

Healthy weight is a priority for the

Council and Havering Place Based

Partnership (HPBP) which includes

BHRUT, NELFT, NEL Integrated Care

Board

 Vision for Havering “The

Havering you want to be part

of”

 Havering Health and

Wellbeing Board Strategy

 Havering Place-Based

Partnership Board priority

Havering Healthy Weight strategy is or

will be aligned with relevant Council

and partner strategies and plans. This

will include the Council’s:

1. Havering Corporate Plan

2. Havering Local Plan

3. Havering Climate Change

Action Plan

4. Havering Community Safety

Partnership Plan

5. Havering Infant Feeding Plan

6. Havering Housing Strategy

7. Havering regeneration plan

8. Parks Strategy

9. Havering Active Travel

Strategy

10. Sports and Physical Activity

Strategy

11. Early Help Strategy

12. Havering Advertising Policy

Assets and activities

The Borough already has many community assets

that contribute to making Havering a healthy place to

live:

 Safe and clean green areas with 16 parks

achieving green flag status

 Five leisure centres

 69 schools achieving Healthy School London

accreditation

 Offer of healthy school meals

 Planning restrictions to limit the number of

new takeaways within 400m from schools

 Thirteen school streets operating to help

children travel safely to school and achieve

the recommended daily 60-minute physical

activity

 Over 45 schools achieving accreditation with

the TfL Sustainable Travel: Active Responsible and Safe (STARS) programme which

supports children to travel sustainably around the Borough.

 116 early years’ settings achieving the Healthy Early Years London accreditation

 The introduction of the UNICEF breastfeeding accreditation scheme in key places

such as early years’ centres, maternity settings and health visiting services to ensure

residents get the knowledge they need from public services about breastfeeding

 Over 22 venues achieving breastfeeding welcome status which helps support families

to feel confident breastfeeding when visiting local cafés, restaurants and venues.

 Buggy walk and talk sessions to help new parents to be active

 Adult weight management services, including a specialised offer for adults with a

learning disability

 An exercise referral scheme which provides subsidised gym access for those with

certain health conditions

 Healthy start vouchers being available for those who need them, giving those most in

need the opportunity to buy discounted fruit and vegetables

 50 business signed up for the water refill scheme

 Two community pantries in Harold Hill and Rainham to help people access affordable

healthy food

 Free swimming for children in the school holidays

While a great deal is already happening to make the Borough a healthier place to live, work

and play, clearly these actions and activities are not enough to hold back the rising rates of

obesity.

Harrow Lodge Leisure Centre

Moving forward

Developing this strategy has brought together the Council, the local NHS and other partners

and stakeholders who are committed to working collaboratively to address the root causes of

obesity and reduce inequalities.

The vision for Havering is that within 20 years’, childhood obesity will have been

eradicated, and that the Borough will have become a healthier place to live, work and

play, a place where communities have come together to make the healthier choice the

easier choice.

Changing from an obese-promoting system to one that promotes healthy weight requires

action across the whole system and will take the lifetime of this strategy (or longer) to

achieve. It is unlikely that there will be reductions in measures of overweight and obesity

during the first few years of this strategy. What we will see in the first few years are changes

to the system; creating the conditions that will eventually lead to improvements in rates of

overweight and obesity.

By the end of this five-year strategy, we will have set in place firm foundations for achieving

the twenty-year vision of eradicating childhood obesity.

Figure 8: Extract from the Havering Obesity System Map 2022 with examples of actions to

be taken

Aims

This strategy has two strategic aims;

The first aim is to implement a Borough-level

place based approach. This will build a firm

foundation to support the twenty-year vision of

eradicating childhood obesity, with the Borough

becoming a place where the healthier choice is

the easier choice. Developing a response which

covers all the different causes of obesity and

ensure support is available for people looking to

lose weight.

Residents will see tangible differences in the Borough; changes that result in healthier foods

being more accessible and available, opportunities for active travel being safer and more

appealing and public spaces that encourage physical active, and opportunities to get

involved in actions that contribute to the creation of a healthier Borough.

The second aim is to develop an intensive neighbourhood-level place-based approach to

address inequalities in Gooshays and Heaton Wards which will identify changes needed for

relevant services and the public realm, informed and prioritised by engagement with local

communities.

Achieving the two aims depends on the continued commitment of and collaboration between

partners. Achieving the twenty-year vision means maintaining that commitment for the long

term. The governance structure set out below shows where progress will be monitored.

Objectives

This strategy’s aims will be delivered through eight objectives, grouped into three themes:

 Theme one is concerned with ensuring that the whole system is engaged and works

together on the many drivers of obesity

 Theme two is concerned with the Borough becoming a place that promotes healthy

weight; recognising that the places where people live, work and play shape the type

of foods they eat and how physically active they are.

 Theme three recognises the importance of a life-course approach, and ensuring that

individuals are supported to achieve a healthy weight.

All objectives will take into account inequalities described in this strategy and in the Obesity

Health Needs Assessment. Progress will be monitored against outputs described in the

table below. Outputs described for Havering apply to all wards in the borough, and will be

further amplified in Harold Hill alongside additional outputs.

FACT BOX: What does it mean for childhood obesity to be

eradicated in Havering within 20 years?

In 2021/22, it was estimated that, in Havering, 10.4% of

reception aged children (4-5 years old) and 25.8% of year 6

children (aged 10-11 years old) were obese.

The UK government set an ambition in 2018 to ‘halve childhood

obesity by 2030’. At that time, the obesity rate in Havering for

Reception aged children was 9.5% and for year 6 aged children

was 20.1%.

Havering is looking to go further and eradicate childhood obesity

by 2044. This means that by 2044, less than 5% of Havering

children will be obese.

Themes and outputs for delivering objectives

Theme 1: Engaging the whole system to work together on the many drivers of obesity

Objective

Outputs – Havering

Outputs – Harold Hill

Objective 1: We will embed a whole

systems approach across Havering

which will be the foundation for

addressing healthy weight. This will

enable the introduction of policies

and practices that have an

influence on healthy weight.

 A steering group formed, jointly

led by the Council and NHS

 A network formed comprising

system partners.

 Network partners to commit to a

detailed action plan and

contribute to monitoring its

delivery. The action plan will be

transformative and co-ordinated

across a broad range of

disciplines and stakeholders.

 A training programme that covers

whole systems approach and

wider influences on health will be

developed for Council key and

non-key decision-makers

 Local healthcare professionals

trained to discuss healthy weight

with their patients

 Engage a wide variety of

system partners local to

Gooshays and Heaton

wards as part of the

consultation on the

healthy weight strategy

 Host a workshop to

design an enhanced and

targeted neighbourhood-

level place-based

approach for Gooshays

and Heaton wards

 Network formed

comprising system

partners from across

Gooshays and Heaton

wards

 A detailed action plan

specific to Gooshays and

Heaton wards with

network partners

committed. Ongoing

monitoring in place

Objective 2: We will develop

partnerships which lead to effective

community engagement into

addressing healthy weight

 A healthy weight alliance is

formed and one meeting held per

year.

 Residents and businesses will

take a central role in shaping the

approach and delivering actions

 Establishing a healthy food

partnership to strengthen the

local food system.

 Production of a digital intelligence

dashboard containing key

statistics on weight and updated

annually to inform the strategic

approach.

 Councillors, residents

and businesses in

Gooshays and Heaton

wards involved in

shaping and the

designing the approach

Theme 2: Becoming a borough that promotes healthy weight

Objective

Outputs – Havering

Outputs – Harold Hill

Objective 3: We will develop

communities in Havering which

promote and provides access to

healthy, nutritious and

sustainable food for all; enabling

a healthy diet to become the

easier option.

 Public sector food premises in the

Borough will promote healthy and

affordable food and beverages,

leading the way for a change in the

food environment.

 Private sector food retail offers are

supported to become healthier food

retail offers working to achieve the

healthier catering commitment.

 Enhancement on the restrictions in

place on the availability of fast food

outlets.

 Identify local enablers

and barriers to

consuming a healthy diet

in Gooshays and Heaton

wards

 Public sector business in

Harold Hill to provide and

promote healthy and

affordable food and drink

beverages

 Identify key food

business in Harold Hill to

be involved in the healthy

 Changes in advertising policy to

support promotion of healthier

products.

 Encouraging healthier retail offers

through the Havering business

awards scheme.

weight strategy and

assess food offers

 Introduce public water

fountains and ensure a

healthy food retail offer

as part of regeneration

plans

Objective 4: We will provide

leadership to further shape the

Borough as a place where rates

of physical activity increase and

residents enjoy the benefits that

physical activity provides.

 The development of active travel

interventions including

enhancement of the street scene.

 The expansion of school streets

where appropriate.

 Public sector organisations

demonstrate system leadership in

approaches to active travel.

 Havering parks continue to be safe

and clean and provide opportunities

for residents to be physically active.

 Review health impact assessments

for large developments undertaken

by developers & leverage

opportunities to promote and

support healthy weight.

 Identify enablers and

barriers to physical

activity for children and

adults in Gooshays and

Heaton wards

Theme 3: Taking a life-course approach to enabling people to achieve and maintain a healthy weight

Objective

Outputs - Havering

Outputs – Inequalities

Objective 5: We will support

healthy pregnancies and help

families achieve the best start to

life for their babies and young

children. (pre-conception – 5

years old)

 Those contemplating pregnancy are

supported to optimise their health

and wellbeing prior to conception to

improve pregnancy outcomes and

give their child the best start in life.

 Introduce the forthcoming

government standards on healthy

weight from maternity.

 Develop further support options and

environments that enable those

mothers who wish to breastfeed.

 Early years settings are supported

to achieve the ‘Healthy Early Years

London’ award.

 Identify enablers and

barriers for young

families achieving a

healthy weight

Objective 6: We will support

children and young people (5

years old to 18 years old), along

with their families to achieve a

healthy weight

 Schools are supported to achieve

the ‘Healthy Schools London’ award.

 The family support programme is

available for those who wish to learn

about healthy behaviours.

 Through the national childhood

measurement programme, identify

children and families who may need

extra support.

 Provide a children’s weight

management support to those who

are eligible for the programme that

enable individuals to achieve a

healthier weight.

 Identify enablers and

barriers for young

children achieving a

healthy weight in

Gooshays and Heaton

wards

 Further promote the

children’s weight

management service to

eligible families in

Gooshays and Heaton

wards

Objective 7: There will be greater

opportunity for adults to achieve

and maintain a healthy weight,

 Public and private sector workplaces

and community settings enable

 Identify enablers and

barriers for adults

achieving a healthy

including information / support to

lose excess weight and maintain

a healthy weight (18 years old

+).

good health by achieving the Good

Work Standard.

 Promote national tailored

information campaigns which have

been informed by behavioural

science and provide trustworthy up

to date and consistent advice.

 Provide weight management

support to those who are eligible for

the programme that enable

individuals to achieve a healthier

weight.

weight in Gooshays and

Heaton wards

 Identify key workplaces in

Harold Hill to participate

in the development of a

neighbourhood-level

approach

Outcomes

The following outcomes should be achieved over the five-year lifetime of the strategy:

 The development of the Borough as a place that promotes healthy weight, where the

healthier choice is the easiest choice, with foundations laid to achieve the twenty-year

vision of eradicating childhood obesity

 An improvement in healthy weight levels in reception aged children across the

Borough, compared to the England average

 An improvement in measures of excess weight among year 6 children in the targeted

neighbourhood of Gooshays and Heaton wards, compared to statistical neighbours

Indicators

The following indicators will be monitored periodically:

1. Breastfeeding at 6-8 weeks

2. Child excess weight in 4-5yrs old (reception age)

3. Child excess weight in 10-11yrs old (year 6 age)

4. Number of children meeting physical activity guidelines

5. Number of adults eating ‘5 a day’

6. Number of adults meeting physical activity guidelines

7. Percentage of adults classed as having excess weight

8. Percentage of adults classed as obese

9. Effective partnership working, including an annual assessment of the system response in

accordance with the ‘What Good Looks Like’ guide

Delivering the strategy

A steering group will be formed that will be jointly led by the Council and NHS. The steering

group will be accountable to the Health and Wellbeing Board, the Place-based Partnership,

and Council Cabinet.

The steering group will oversee implementation of the place-based Borough-level whole

system approach, by:

 ensuring that a detailed action plan is produced that captures actions proposed by

partners and stakeholders

 monitoring progress against the action plan

 periodically assessing the state of the local system

 producing an annual report for the Havering Health and Wellbeing Board, the Place

Based Partnership, and Cabinet. The report will be published on the Council’s

website

The Steering Group will oversee the

 setting up of a multi-agency system-wide Havering Healthy Weight System Network

with a broader membership comprising those organisations responsible for actions

 development of a Healthy Weight Alliance; giving residents and organisations

opportunity to shape further action and be part of the solution to addressing obesity

The Steering Group will oversee the approach for developing an intensive place-based

neighbourhood level whole system approach for Gooshays and Heaton wards, including

 governance

 detailed action plan

Figure 9: Governance Structure for the delivery of the healthy weight strategy

Havering System Network: a forum of organisations that are responsible for actions to implement the place-based whole system

approach for the Borough

Havering Healthy Weight Alliance: a group of residents and community groups who are committed to addressing the problem of

obesity

Consultation

This healthy weight strategy has been drafted in collaboration with partners and

stakeholders. A wide public consultation on the draft strategy will take place during January

to March 2024; inviting views and comments of residents and stakeholders in the Borough,

including businesses, the voluntary and community sector, and the workforces of statutory

agencies.

The consultation will take the form of online engagement which will include a social media

campaign and online information sessions. Health champions will also raise awareness of

the consultation through face to face engagement with communities, with a particular focus

on those groups where rates of obesity and overweight are higher. As part of the

consultation, the following documents will be published: this draft Healthy Weight Strategy,

the Obesity Health Needs Assessment which has informed the strategy, and the Equality and

Health impact assessment.

At the conclusion of the consultation period, a report will be produced that summarises

consultation responses and the changes that have been made to the final draft strategy in

response to the consultation. The final draft strategy will be presented to the Havering Health

and Wellbeing Board and the Havering Place based Partnership for endorsement, and

subsequently to Havering Cabinet for approval and adoption.

Appendix 1: Acknowledgements and thanks

Havering Council led the development of this strategy, working closely with partner agencies

and wider stakeholders. The Council thanks the representatives from the many organisations

who took time to attend summits and participate in discussions, and further thanks them for

their commitment to future action.

Age UK Redbridge, Barking and Havering

Barking, Havering and Redbridge University Hospitals NHS Trust

Cranham Health Centre

Drapers Maylands Primary School

Engayne Primary School

Everyone Active

Havering Adult College

Havering Crest Primary Care Network

Havering Diabetes UK Network

Havering Disabled Sports Association

Havering Marshall Primary Care Network

Havering MIND

Having North Primary Care Network

Havering South Primary Care Network

Havering Volunteer Centre

Kent Community Health

London Sport

My Health Matters

North East London Foundation Trust

North East London Integrated Care Board

North East London Local Pharmacy Committee

Outdoor Classroom

Romford Business Improvement District

St Edwards Medical Centre

Sanders Draper School

Squirrels Heath Infant School

Tigers Football Club

Transport for London

University College London

Appendix 2: Principles of a whole system approach

The principles that have guided the development of this strategy, and which will continue to

guide its implementation, are set out by the Association of Directors of Public Health (ADPH)

and OHID in What Good Healthy Weight for all Looks Like, a document that provides a high-

level framework for a local approach to promoting healthy weight.

A corresponding self-

assessment matrix enables local systems to assess the progress in these areas.

The table below summarises the principles, outlining what success looks like. The Havering

system will be assessed annually using these principles.

Systems leadership

Anchor organisations will work in a way that exemplifies the approach. Local

system leaders including politicians, Council leaders, Director of Public Health

and NHS leaders will prioritise and champion achieving a healthy weight for the

Borough.

A long-term whole

system approach

The Borough will develop an approach which is long-term, where local

stakeholders work together using all available policy levers across the system

in combination with systems thinking.

A health-promoting

environment

The response focuses on addressing the environments in which people live,

play and work to stop the excess calorie consumption and encourage active

lifestyles.

Community Engagement

& Partnership

Local communities will be given the opportunity to be at the centre of decision-

making, engaged in the whole system approach and drive local solutions. The

Borough will work as one to address obesity.

Focus on inequalities

There are marked inequalities in the drivers of obesity such as access to

healthy food and overall rates of obesity. The approach will work to address

those deep rooted system causes and those most in need.

A life course approach

The work will target those most in need or those at highest risk at every age

group with a focus on maximising prevention and early intervention. The

approach will include working collaboratively with specific life course settings

such as maternity services, early years, schools, workplaces and services for

older people.

Monitoring, evidence,

evaluation and innovation

Evaluating actions and approaches, continuous improvement and sharing data

and good practice across the local system to inform decisions and practice.

Appendix 3: Glossary

Anchor organisations: large organisations that are unlikely to relocate and have a significant

stake in their local area. They have sizeable assets that can be used to support their local

community’s health and wellbeing and tackle health inequalities, for example, through

procurement, training, employment, professional development, and buildings and land use.

Place based approach: understanding the issues, interconnections and relationships in a

place and coordinating action and investment to improve the quality of life for that

community.

Shared vision: A clear and aspirational statement of what the whole systems approach is

trying to achieve.

Statistical neighbours: Areas that have similar characteristics.

System: A system is a collection of interdependent and interconnected parts. If something

happens to one part of the system, other parts of the system will be affected.

System mapping (for obesity): A process to identify and visually represent how the local

causes of obesity are linked.

System network: A broad set of stakeholders from the local place, from both within and

outside of the local authority, responsible for the sustained implementation, adaptation

and refinement of the whole systems approach and action plans.

Systems thinking: A way of looking at, learning about, and understanding complex

situations

Whole systems approach: A local whole systems approach responds to complexity

through an ongoing, dynamic and flexible way of working. It enables local stakeholders,

including communities, to come together, share an understanding of the reality of the

challenge, consider how the local system is operating and where there are the greatest

opportunities for change. Stakeholders agree actions and decide as a network how to

work together in an integrated way to bring about sustainable, long term systems

change.

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