Health Matters: Whole systems approach to obesity – Interview with Prof Jim McManus

Health Matters: Whole systems approach to obesity – Interview with Prof Jim McManus


So the whole systems approach to obesity is an attempt to take systems science, that works and it’s been used
elsewhere and translate it into a context where local government and their
partners can actually make changes on obesity, not just at the individual behavioural level but at some of the kind of system level things like food availability, food
culture, the types of food that are available in our organisations, making
self-propelled transport second nature that kind of thing, so it’s an
attempt to give them an umbrella approach and a series of things that they
can consider and sense check how to implement. The Association of Directors of public health and Local Government Association have been in since the
beginning, we worked with PHE on the concept for the programme, we worked with
PHE on procurement exercise, we’ve been on the steering group, we helped to find
local authorities to pilot and then to test and we’ve kind of journeyed along
side them for the last four years of the programme. I think there’s probably several bits of
advice I’d give local authorities if they’re going to use it for a whole systems
approach and the first thing is before you do anything sit down and read the
route-map and toolkit and really think through it, so it’s worth the day of your
time just investing in that and get your head around the systems approach. The
second thing is use it as the sense check to say well we’re doing this, we’re
not doing that, what could we do more of, what could we stop doing, what should we
prioritise and the third thing is get together a gang of the partners relevant
to whichever priorities you choose, to kind of build the approach and then
start writing your action plans once you’ve got the understanding I think of the route-map. I think there’s several ways in which
local authorities have contributed to the guide into the resources, the first
of all of course is those four pilot sites that went before anybody else they
did a huge amount of work and there was a District, a County, a London Borough,
a Unitary and they did some great work and then after the learning that they
brought out of it, came a second round of authorities testing it, and we were one
of them and so we contributed back and this works, this doesn’t, we don’t
understand this, what do you mean by that, we could do with the guide better, and
we spent a lot of time inputting collectively into the guide, and then
there was a whole learning community of local authorities that came together for two or three layers
and they contributed by trying the stuff out, sense checking it, in fact I can
remember Paul Gately from Leeds Beckett standing in front of an audience of a
hundred people working them through bits of the toolkit and saying what works, what
doesn’t so I think local authorities have been through this and in in this all
the way along since the beginning. So in Hertfordshire we were lucky enough to be
part of the kind of community of learning that’s been going along around
this and we also became one of the second stage test sites if you like, so
we worked with one borough then two boroughs, to kind of implement that so we
worked with East Hertfordshire district council, which is one of our ten
districts and boroughs looking at an approach, then on top of that we’ve
actually just taken our report through our cabinet to say that we’re going to
use this all across Hertfordshire and the principles, and we’ve got members to sign up to the protocols, and we now have a deputy cabinet member whose focus is going to
be on bits of the whole obesity systems work. So we think we’re building the
leadership to do that and we’ve got a list of things from the very clinical,
right up to the kind of whole systems planning infrastructure from our whole
systems work, so we’ve got enough work to keep us going. I think it does it by first taking the
systems approach, so for me the big thing lacking in health and all policies is a
systems approach to using system science. So how do you build healthy older ageing,
through future housing planning for example, is one area for health in all
policies, well the obesity questions the same. I think the second thing that it
does is it actually enables us to get partner agencies to look at everything
they can do and act on it, so is the food choice in our hospital shops unhealthy,
if that’s the case what can the NHS do about it.
Can we actually build in activity and standing throughout the day, can we
build in healthy food choices in all our canteens, so I think it’s a perfect
focused example of health in all policies. I think you need a collective vision
for obesity, that goes far beyond public health for several reasons, first is if
this just falls on the Director of Public Health it won’t happen. Transport, planning, school catering,
libraries, elected members, the planning of local takeaways, they’ve all got a big
contribution to make to obesity and healthy weight and so teams right
across the council in all they do need to be part of that so and actually
you need to have a collective vision for what you could achieve if you’ve got
these disparate groups we need to all know what it is we’re aiming at, and the whole
systems approach can help us because it gives us a framework for that collective
vision and actually identifying well my bit of this jigsaw puzzle is this, so
it’s a way of unifying the jigsaw puzzle and getting us all on the same page as it where. So my own view is local authorities rule
in implementing this and leading this is firstly through political leadership this
is something that elected members can do par excellence because
they are the democratically elected leaders of place, so they are the people
who are front and centre leading this. Secondly the Director of Public Health
can bring the expertise of her or his team to this, and that’s really
importantly but thirdly all the place functions of local authorities like
planning and everything else are absolutely crucial to this. So I
think local authorities have that wider overview of place that if it were led by
the NHS, I’m not saying it wouldn’t be good but it would have to focus on things
the NHS can do and that’s one bit of the jigsaw, but you need that much wider
approach. So I think if you want to work with
other stakeholders like the NHS to do this the first thing to do is start
with the first principles conversation, what are we both trying to achieve, what is
the system science behind this tell us what we need to do, then right fine,
where are the policy hooks in the Long Term Plan and in your CCG business plan or
your trust business plan that will help us implement this and how can we work
together and what is your job, and I like to come out of these things with an
agreement of right here’s the jigsaw, this is your better bet, we really
want you to do it well this is what your going to focus on brilliant, thank you very
much. I think there’s one other thing the NHS can do which is the NHS is an anchor
institution, making the health of its staff that very best it can and that’s a
really important contribution. So if you’ve already got local plans in
place, the first thing I’d say is don’t ditch them, just park them, keep going, then go and sit down read the toolkit work out
what you need to do and then once you’ve done that, make an appraisal of whether these
are right or fit for purpose, higher priority or lower priority and then just rearrange and reshuffle them in, but don’t just kind of scrap things for starters
because, I will bet that you will find some of the stuff you’ve got is
absolutely spot on and some of it maybe needs a bit of adjustment, and some of it
could be done later and then you develop an order of things, that’s what we found. First actually have a seminar for our
elected members on what it is, so they can get their head around it, we’ve already
done one of offices and stakeholders, we’ve taken a report through cabinet
that says we’ll adopt this approach on obesity and will start
to do it, we’re in the phase of trying to do the action plan with all ten
districts and our NHS partners and everybody else at the minute. We’re
continuing with some of the actions we’ve already identified, so we’ve
already identified early work on planning and early work on transport,
physical activity legacy and then we’re going to use it in mental health, because
we started using it in mental health two years ago, so we’ve got a 20
pillar approach in mental health for a whole systems approach to mental health and we’re refreshing that and using it and once we’ve done it in mental health
we’re actually then going to try doing it on children’s health, of what does it
look like for a child to reach adulthood healthy and well-adjusted. So I’m a bit of a system science geek anyway, I’m a complete anorak about it, so I find it
really really helpful, so to me it’s kind of bread and butter. I realise other people might be a wee bit sceptical about it, and I think use
it in obesity, if you can’t work with obesity then there’s no harm in trying
it and another area and then coming back to obesity.

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