Table Of Content49
The role of public 51
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Growing levels of obesity (including among children), continued harmful consumption of alcohol,
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and the growing threat of antimicrobial resistance (AMR) are some of the greatest contemporary G
health organizations
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challenges to the health of European populations. While their magnitude varies from country to ys
N ce
country, all are looking for policy options to contain these threats to population health. IZ olieri
A in addressing public PS
It is clear that public health organizations must play a part in any response, and that intersectoral T h
t
action beyond the health system is needed. What is less clear, however, is what role public health IO al
organizations currently play in addressing these problems. N health problems in Europe He
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This is the gap that this volume aims to fill. It is based on detailed country reports from nine N
European countries (England, France, Germany, Italy, the Republic of Moldova, the Netherlands, D
F
Poland, Slovenia and Sweden) on the involvement of public health organizations in addressing
I The case of obesity, alcohol
N
obesity, alcohol and antimicrobial resistance. These reports explore the power and influence of
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public health organizations vis-a-vis other key actors in each of the stages of the policy cycle N and antimicrobial resistance
(problem identification and issue recognition, policy formulation, decision-making, implementation, C
I
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and monitoring and evaluation). Country Reports
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A cross-country comparison assesses the involvement of public health organizations in the nine O
countries covered. It outlines the scale of the problem, describes the policy responses, and explores F Online Appendix
P
the role of public health organizations in addressing these three public health challenges. U
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This study is the result of close collaboration between the European Observatory on Health Systems L Edited by:
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and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It C
Bernd Rechel
accompanies two other Observatory publications: Organization and financing of public health services H
E Anna Maresso
in Europeand Organization and financing of public health services in Europe: country reports.
A
L Anna Sagan
T
H Cristina Hernández-Quevedo
The editors
S
Erica Richardson
E
Bernd Rechelis Research Officer at the European Observatory on Health Systems and Policies,
R
Elke Jakubowski
based at the London School of Hygiene & Tropical Medicine. V
I
C Martin McKee
Anna Maresso is Research Officer at the European Observatory on Health Systems and Policies. E
S Ellen Nolte
Anna Sagan is Research Officer at the European Observatory on Health Systems and Policies, I
N
based at the London School of Economics and Political Science.
E
Cristina Hernández-Quevedois Research Officer at the European Observatory on Health Systems U
R
and Policies, based at the London School of Economics and Political Science. O
P
Erica Richardsonis Research Officer at the European Observatory on Health Systems and Policies, E
based at the London School of Hygiene & Tropical Medicine.
C
Elke Jakubowskiis Senior Advisor for Policy and Strategy at the Division of Health Systems O
U
and Public Health for the WHO Regional Office for Europe, based in Copenhagen. N
T
Martin McKeeis Professor of European Public Health at the London School of Hygiene & Tropical R
Y
Medicine and Research Director at the European Observatory on Health Systems and Policies.
R
E
Ellen Nolte is Professor of Health Services and Systems Research and was previously hub P
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coordinator for the London hubs of the European Observatory on Health Systems and Policies.
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Health Policy Series No. 51
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© World Health Organization 2018 (acting as the host organization for, and secretariat of, the European
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Policies or any of its partners.
The role of public health
organizations in addressing
public health problems in Europe:
Obesity, alcohol and
antimicrobial resistance
Country reports
(online appendix)
European
on Health Systems and Policies
a partnership hosted by WHO
Contents
page page
1 England 3 5 The Netherlands 114
Obesity John Middleton 3 Obesity Hans Maarse, Maria Jansen,
Mariëlle Jambroes and Dirk Ruwaard 114
Alcohol John Middleton 13
Alcohol Hans Maarse, Maria Jansen,
Antimicrobial resistance John Middleton,
Mariëlle Jambroes and Dirk Ruwaard 117
Ellen Bloomer 24
Antimicrobial resistance Hans Maarse,
Maria Jansen, Mariëlle Jambroes and Dirk Ruwaard 121
2 France 36
Obesity Michel Chauliac, Laurent Chambaud,
6 Poland 124
Cristina Hernández-Quevedo 36
Obesity Michał Brzeziński 124
Alcohol Nicolas Prisse, Laurent Chambaud,
Cristina Hernández-Quevedo 45 Alcohol Aleksandra Kuich, Łukasz Balwicki,
Anna Sagan 131
Antimicrobial resistance Pascal Astagneau,
Laurent Chambaud, Cristina Hernández-Quevedo 55 Antimicrobial resistance Jadwiga Wójkowska-Mach,
Tomasz Bochenek, Anna Sagan 137
3 Germany 64
7 Republic of Moldova 150
Obesity Klaus Plümer 64
Obesity Galina Obreja 150
Alcohol Klaus Plümer 71
Alcohol Marcela Tirsea, Angela Ciobanu,
Antimicrobial resistance Klaus Plümer 79
Jarno Habicht 157
Antimicrobial resistance Stela Gheorghita 164
4 Italy 88
Obesity Elena Azzolini, Walter Ricciardi 88
8 Slovenia 172
Alcohol Andrea Poscia, Walter Ricciardi 96
Antimicrobial resistance Kerstin Vesna Petrič 172
Antimicrobial resistance Daniele Ignazio La Milia,
Walter Ricciardi 105
9 Sweden 179
Obesity Bo Burström, Cristina Hernández-Quevedo 179
Alcohol Bo Burström, Anna Sagan 185
Antimicrobial resistance Bo Burström,
Cristina Hernández-Quevedo 193
England 3
England
Obesity
John Middleton
The scale of the challenge
The National Child Measurement Programme for The recognition of obesity as a national problem in
2014/15 found that around one in 10 children in school England emerged in the late 1990s. Public interest in
reception year (aged 4–5 years) in England was obese obesity accelerated, as indicated by the volume of press
(boys 9.7%, girls 8.8%). By year 6 (aged 10–11 years), stories on the subject, from the end of the 1990s (HM
around one in five children was obese (boys 20.4%, girls Government, 2004: 11). Reasons given for obesity
17.4%), where child obesity is defined as a body mass rates have included genetic theories, the obesogenic
index (BMI) ≥ 95th centile of the UK 1990 growth chart environment (Egger and Swinburn, 1997) and the
(National Obesity Observatory, 2016). There are stark “calories in – calories out” line exemplified by the Fore
inequalities in levels of child obesity, with prevalence sight report. Foresight also highlighted the obesogenic
among children in the most deprived areas of England environment, the lifecourse component and the
being double that of children in the least deprived areas generational dimension, with parental obesity being a
(National Obesity Observatory, 2016). predictor of childhood obesity. The most significant
predictor of childhood obesity was identified as parental
Treating obesity and its consequences is currently obesity, which increased the risk of childhood obesity by
estimated to cost the National Health Service (NHS) 10% (Foresight, 2007).
6.1 billion pounds sterling every year. It is one of the
risk factors for type 2 diabetes, which accounts for The “calories in – calories out” model has been helpful
spending of 8.8 billion pounds sterling a year, almost to industries selling highsugar products, as they have
9% of the NHS budget (House of Commons Health been able to maintain the line that there are “no bad
Committee, 2015). The wider costs of obesity to society foods only bad diets”. More recently, in England, there
are estimated to be around three times this amount. By has been a resurgence of interest in sugars as a causal
contrast, the UK spends only around 638 million pounds factor for obesity. Under this theory propounded by John
sterling on obesity prevention programmes (Health Select Yudkin (1972) and resurrected by Lustig and others, not
Committee, 2015). all calories are equal – although sugary foods may not
be as high calorie as fats, their effect on obesity may be
In 2007 the government’s Foresight report charted the profound through their impact on insulin sensitivity
rapid rise in obesity in the UK. It showed that by 2050 as they have a high glycaemic index (Lustig, 2014).
over half of the UK adult population could be obese. This interest has encouraged systematic reviews of
By 2050 the costs to the NHS were projected to double the role of sugar in obesity and diabetes (Te Morenga,
to 10 billion pounds sterling per year, while the wider 2013) and a report by Public Health England on the
costs to society and business were estimated to reach evidence for action (Tedstone et al., 2015). In England,
49.9 billion pounds sterling per year (at 2007 prices) the government has recently (2015) accepted the
(Foresight, 2007). Scientific Advisory Committee on Nutrition’s (SACN’s)
recommendations and revised national dietary guidelines
4 The role of public health organizations in addressing public health problems in Europe: Obesity, alcohol and antimicrobial resistance
on carbohydrate and health for the first time in 20 years aim was to halt the yearonyear increase in obesity rates
(SACN, 2015). among 11yearolds by 2010 in the context of a broader
strategy to tackle obesity in the population as a whole.
“Choosing health” also introduced the new public health
Policies and programmes staff group: “health trainers”. The idea drawn from the
private sector was for a “personal trainer” for everyone
The first English health improvement strategy, Health
with “lifestyle problems”, particularly supporting those in
of the Nation (1992), had five priorities – coronary heart
poorer communities who would never be able to afford
disease reduction, cancer prevention, accident prevention,
such services otherwise.
suicide prevention and HIV/AIDS and sexual health.
Obesity hardly featured. By the time the Public Health
The Foresight report (Foresight, 2007), as mentioned in
Green Paper, “Saving Lives: Our Healthier Nation”
The scale of the challenge section, raised the profile of
(OHN) appeared in 1999, obesity had been recognized
obesity as a national health problem even further and
as a new priority.
modelled scenarios of the growth of obesity and diabetes,
through to 2050. It mapped the complexities of factors
OHN argued for a whole generation approach from
causing obesity and went into detail on obesogenic
pregnancy through childhood, adulthood and later life.
environments and sedentary lifestyles. This prompted
It saw the need for combined actions by individuals, local
the Department of Health initiative on Healthy Towns
communities and government to improve health, and
in 2008, focusing on healthy town planning, encouraging
proposed healthy schools and healthy workplaces. In this
active travel and accessible physical activity (Cross
approach, a whole generation is needed to reduce the
Government Obesity Unit, 2009). In 2008, there was
impact of such factors as smoking, poor nutrition, obesity
also an ambitious crossgovernment strategy for England
and physical inactivity. Fundamentally it recognized the
called “Healthy Weight, Healthy Lives”, which set out to
inequalities in the distribution of adverse behaviours and
reverse increasing prevalence of obesity and overweight
the need to tackle the underlying social, economic and
in the population by ensuring that everyone was able
environmental conditions (HM Government, 1999). The
to achieve and maintain a healthy weight. The initial
link between obesity, health variables and socioeconomic
focus was on children, with the target of reducing the
inequality was further highlighted in the Wanless Report
proportion of overweight and obese children to 2000
(2002) which contributed to the debate and development
levels by 2020 (Department of Health, 2008).
of policy in this area.
In April 2007, broadcasting restrictions to significantly
In the 1990s, there was split responsibility for nutrition
reduce the exposure of children to television advertising
in government – the Food Standards Agency, an
of foods high in fat, saturated fat, salt and sugar were
independent government department, had a significant
introduced. The Food Standards Agency worked across
role in diet and nutrition surveillance, policy, research
government and with academics, industry, and non
and service delivery, including supporting the voice of the
governmental organizations (NGOs) to develop the
consumer around dietary health; their Nutrition Division
nutrient profiling model which was implemented from
was moved into the Department of Health only in 2010
2010. This model is a tool to differentiate foods which
to consolidate policy and programme delivery in England
are high in fat, saturated fat, salt or sugar and can be used
(Blackshaw, 2016).
by the media and communications regulator (Ofcom)
to regulate the advertising and promotion of foods to
By 2004, obesity was centre stage in the government
children (Department of Health and Social Care, 2011a).
White Paper “Choosing health: making healthy choices
easier” but the emphasis was on supporting individuals
Under the coalition government (in place in 2010–2015)
to change their behaviours and on (primary care trusts’)
any central government pressure to control irresponsible
role in reducing inequalities, whereas OHN put in
fast food advertising dissipated. Organizational change
place a raft of supporting structures and initiatives to
created further uncertainty with regard to investment
improve health – Health Action Zones, Healthy Living
in obesity programmes, culminating in the transfer
Centres, expert patients. The 2004 White Paper also set
of public health departments to local authorities
out a Public Service Agreement (PSA) on child obesity
from 2013. For many involved in the organizational
and included measures to improve school meals and the
upheaval, it became difficult to plan and develop new
development of the Healthy Schools Programme. The
England 5
services, or advocate for national policy changes, such Public Health England (PHE) published its physical
as the regulation of marketing of fast food to children. activity evidence base and strategy in late 2014 (Public
Furthermore, under the Health and Social Care Act Health England, 2014). This comprehensive review
2012, certain public health services were mandated to described levels of inactivity and inequalities and set out
be provided or commissioned by local authority public four domains for getting society to be more active (Public
health services. However, obesity prevention and weight Health England, 2014):
management were not among the mandated services.
• active society: creating a social movement;
More recently, the major national health policy effort
• moving professionals: activating networks of
with regard to food and, to a lesser extent, physical
expertise;
activity and alcohol was wrapped up in voluntary
agreements with industry in the form of the “Public • active environments: creating the right spaces;
Health Responsibility Deal” (Department of Health,
• moving at scale: interventions that make us active.
2011). Introduced in 2011 after publication of the public
health White Paper and with reforms moving towards the
Another noteworthy initiative is NHS England’s Healthy
Health and Social Care Act of 2012, the Responsibility
New Towns which aims to promote the building of new
Deal was intended to be a partnership between
healthy environments from scratch, with 10 demonstrator
government, industry and public health organizations to
housing developments across England in 2016 (NHS
agree interventions by industry which would demonstrate
England, 2016; Leeds Beckett University, 2015).
their corporate social responsibility and promote health.
However, the homepage (https://responsibilitydeal.dh.gov.
The NHS Commissioning Board produced commis
uk/) praises relatively marginal action by industry, such
sioning guidelines for weight management in 2013
as new formulations of ultraprocessed food or small
(NHS Commissioning Board, 2013). Its successor body,
changes in alcohol marketing practices, while providing
NHS England, along with Public Health England, in
industry with a platform to gain credibility and free
2014 produced advice on commissioning obesity services
advertising. There was an overarching Responsibility
(NHS England, 2014). Both documents refer to the
Deal forum chaired by a senior civil servant and specific
Tiers Model for obesity management. Tiers 1 and 2
Responsibility Deal forums dealing with alcohol, food,
are seen as the preventive and early intervention tiers,
physical activity and health in the workplace. Researchers
generally through services funded by local authorities.
from the London School of Hygiene & Tropical Medicine
Tier 3 involves clinical, nonsurgical interventions,
were commissioned to evaluate the initiative. They
such as behavioural psychology and dietetics, and tier
noted at the outset how the disparate and wideranging
4 is bariatric surgery which is NHSfunded. However,
pledges suggested by industry presented a complex set of
in practice there is scope to locally determine sources
interventions of which it would be all but impossible to
of funding and whether to establish pooled budgets.
assess the effectiveness (Petticrew et al., 2013). They also
Buoyed by findings of the Lighten Up study (Jolly et al.,
reviewed 47 evaluations of previous voluntary agreements
2011), weight management services provided by Weight
with industry and concluded that effective voluntary
Watchers, Rosemary Conley and other commercial
agreements are based on clearly defined, evidencebased
providers are also being commissioned by local authority
and quantifiable targets, which require partners to go
public health departments.
beyond “business as usual”, and include penalties for not
delivering the pledges (Bryden et al., 2013).
The UK’s first food labelling regulation came into force
in 1996. Frontofpack nutrition information was first
Many public health lobby organizations did not take part
introduced by the food industry in the UK in 2005.
in the Responsibility Deal; more left the initiative in 2013
To date, two systems have been used, Guideline daily
when it became clear that government commitments
amounts (GDAs) and Trafficlight colour coding. As part
to legislate on plain packaging for cigarettes and on a
of the Responsibility Deal, in June 2013 standardized
minimum unit price for alcohol were sidelined and that
frontofpackage labelling developed by the Food
behindthescenes lobbying by industry was preventing
Standards Agency was introduced by those companies
meaningful interventions by government, such as
that had signed up to the voluntary pledge, including
effective legislation, taxation and regulation.
a trafficlight coding scheme for energy, salt, sugar and
6 The role of public health organizations in addressing public health problems in Europe: Obesity, alcohol and antimicrobial resistance
fat. With the voluntary scheme, the UK has gone beyond In January 2018, PHE launched the Change4Life
European Union (EU) harmonized nutrition labelling, campaign. The campaign addresses the problem that,
which does so far not provide for interpretative systems on average, half of children’s sugar intake comes from
such as colour coding. unhealthy snacks and sugary drinks. The Change4Life
campaign encourages parents to look for “100 calorie
The national Office of Communications (Ofcom) is snacks, two a day max!” to help them purchase healthier
the independent regulator of television, radio, tele snacks than the ones they currently buy.
communications and wireless communications services
in the UK and sets standards for television advertising.
Its regulatory objectives include the protection of children Problem identification and issue
under the age of 16 from the overconsumption of high recognition
fat, salt and sugar foods. Since 2006, Ofcom does not
The Secretary of State for Health and the Department of
allow TV advertisements for such foods to be shown in or
Health are responsible for setting public health policy for
around programmes specifically made for children (which
England. PHE is the national public health body charged
includes preschool children) or in or around programmes
with policy formulation and implementation; it advises
of particular appeal to children under 16. The UK’s
the Department of Health on what policy should be
statutory ban on television advertising of foods high in
taken and provides advice to local authorities, the NHS
fats, sugar and salt during children’s programming was
and others, on implementation. In 2013, PHE sought
a world first. It broke new ground for imposing more
the views of the Directors of Public Health on what the
stringent conditions on the food and drink industries.
priorities should be for PHE to tackle obesity in local
communities; the output of this work helped to inform
PHE produced their evidence for action on sugar
the PHE obesity workplan mentioned in the Policies and
reduction in November 2015 (Public Health England,
programmes section (Public Health England, 2014). PHE
2015). In March 2016, the Chancellor of the Exchequer’s
also published advice on early approaches to tackling
budget statement launched a surprise introduction of a
obesity (Public Health England, 2013).
tax on sugarsweetened drinks, which has been welcomed
by the public health community. The revenue raised is to
The Scientific Advisory Committee on Nutrition
be committed to more physical activity in schools.
(SACN) is an advisory committee of independent experts
which provides scientific advice on, and risk assessment
An action plan on tackling childhood obesity, “Childhood
of, nutrition and related health issues. It advises the
obesity: a plan for action”, was adopted in August 2016,
governments of all four UK countries.
covering the period 2016–2026. Its key anticipated
actions include the introduction of a levy on the soft
Other UK government departments have key roles to
drinks industry and the encouragement of the foods and
play in obesity policy, including the Department for
drinks industry to voluntarily reduce the sugar content
Education, the Department of Culture, Media and Sport
of their products. The overall emphasis on voluntary
(physical activity and control of advertising/marketing
action and the failure to include further restrictions
standards), the Department for Communities and Local
to advertising aimed at children in the action plan
Government, and the Department for Environment,
were criticized by public health experts and attributed
Food and Rural Affairs.
to sustained lobbying by industry against regulatory
measures. While PHE supported a sugar tax and
Local authorities are the lead body responsible for
reductions in the sugar content of foods, it had argued
forming statutory Health and Wellbeing Boards which
that banning pricecutting promotions of junk food
comprise local authority cabinet members for public
in supermarkets, banning the promotion of unhealthy
health, children and adult’s social services, GP members
foods to children in restaurants, cafes and takeaways,
of the local Clinical Commissioning Group, the local
and further restricting advertising of unhealthy food to
HealthWatch patient’s rights organization, and other
children on TV, social media and the Internet were more
healthrelated interests agreed by local partners. Priorities
effective measures of tackling childhood obesity. These
for Health and Wellbeing Boards are determined locally,
measures were lacking in the action plan (Boseley, 2016).
but a survey of senior local government members in 2015
indicated that childhood obesity remained a priority
England 7
and that more needed to be done (Local Government Policy formulation
Association, 2015).
In the area of obesity, the Department of Health is in
charge of policy development at the national level, with
Local authority public health departments are responsible
PHE responsible for helping to inform national policy
for assessing the level of need with regard to obesity and
and for supporting delivery through the local public
for advocating effective interventions at the local level.
health and health system. NHS England is now taking a
They hold the budget for services for healthy public
greater interest given the expectations for preventing ill
policy interventions, including obesity prevention and
health in their Five Year Forward View. PHE and NHS
early intervention. It is up to local authorities to decide
England both see obesity as a major priority (Public
how well programmes are funded and what interventions
Health England 2014b; NHS England, 2014b) and both
are chosen, on what evidence, and relative to other
are leading organizations in policy formulation. PHE
competing local needs.
develops, translates and assembles evidence, prepares
policy advice and oversees surveillance data for England
Local authorities (unitary, metropolitan councils and
on all aspects of obesity. The chief medical officers
district councils within counties) are also the lead
of the UK’s four countries have written guidance on
agency for food safety and inspection, the provision and
physical activity (Department of Health and Social Care,
commissioning of leisure services, and town planning.
2011b) and on alcohol consumption (Department of
Local authority departments for environmental health
Health, 2016). The Chief Medical Officer for England
and trading standards oversee some aspects of consumer
called for a discussion of a sugar tax in 2013. However,
protection, but have been subject to severe cutbacks in
all the agencies and organizations identified above
recent years as part of austerity policies. In some local
(see the Problem identification and issue recognition
authorities, there have been efforts to move food hygiene
section) are involved in the formulation of policies. Local
and safety inspection towards food quality inspection to
authorities, through their Health and Wellbeing Boards
address obesity and coronary heart disease (Saunders et
and public health departments, are charged with local
al., 2014; Middleton and Saunders, 2015).
needs assessment and local policy formulation. The
Fingertips information system managed by PHE is a
NGOs play a strong role in lobbying, policy advocacy
major intelligence resource for local authority public
and services on food, fitness and healthy environments.
health (http://fingertips.phe.org.uk/search/obesity).
One of the longest established actors is the National
Obesity Forum, a charity formed in 2000, with the remit
of raising awareness of obesity in the UK and promoting
Decision-making
ways in which it can be addressed. This includes public
initiatives and the training of clinicians and health The Secretary of State for Health, the Department of
professionals on how to identify and address weight Health and PHE set obesity health policies for England,
management issues and obesity (National Obesity Forum, but it is anticipated that the National Obesity Strategy
2016). The Obesity Health Alliance is a relatively new will be crossgovernmental and be owned by the Cabinet.
body seeking to coordinate policy lobbying. It is hosted Local authorities are free to determine local policies,
by the Royal College of Physicians. To date, it comprises based on needs.
principally health professional bodies and some NGOs.
The Department of Health and PHE are seen as leaders
The industry and the private sector is also involved in a of obesityrelated policy at the national level. However,
number of initiatives. Change4Life (http://www.nhs.uk/ the delay in bringing forward a National Obesity Strategy
change4life), the national lifestyle health advice website is thought to be due to the necessity of securing support,
and supporting resources, was established in 2008. It and action, from all government departments for the
comes with a contribution from private sector industries, strategy and for ownership of the strategy from the
but is now managed by PHE. Commercial weight Cabinet and primeministerial level.
management services such as Weight Watchers and
Rosemary Conley are increasingly being commissioned
by local authority public health services, instead of or
alongside NHSprovided services.
8 The role of public health organizations in addressing public health problems in Europe: Obesity, alcohol and antimicrobial resistance
Policy implementation second tier councils within large county authorities.
The district council portfolio includes town planning,
At the local level, local authorities are free to implement
housing, environmental health and trading standards
local policies. Local government seeks to manage obesity
and leisure and therefore will have a strong interest in
related problems through its management of public
obesity. Health and Wellbeing Boards have the potential
health services, environmental licensing, consumer
to deliver joint programmes on obesity, through policies,
protection and social care and through its partnerships
as well as directly managed or commissioned services.
with health and community organizations. Since 2013,
the responsibility of local authorities for public health has
meant that they provide or commission client services,
Monitoring and evaluation
including weight management and local preventive
campaigns and services. Public health agencies are PHE has a role in the overall monitoring of obesity
vital, but their ability to act and be accepted in local prevalence and other important lifestyle factors, including
partnerships is variable, depending on how their host dietary habits, through the National Diet and Nutrition
councils view their importance and whether they view Survey (NDNS) (https://www.gov.uk/government/
obesity as a priority. statistics/nationaldietandnutritionsurveyresultsfrom
years1to4combinedoftherollingprogrammefor
Local authorities have a progressively declining influence 2008and2009to2011and2012).
on schools, which are now directly funded from central
government as well as from local authorities. Many The National Child Measurement Programme (NCMP)
schools have moved entirely out of local authority control measures the height and weight of children in school
and authorities have been forced to divest themselves of reception year (aged 4–5 years) and year 6 (aged 10–11
many advisory functions, and of support services such as years) to assess overweight and obesity levels in children
school meals. in primary schools. Children’s heights and weights are
measured and used to calculate a BMI centile. These
Local authority funding to obesity services has not kept data can be used to support local public health initiatives
pace with the level of need. For example, there are over and inform the local planning and delivery of services for
1.2 million people in England with a BMI of over 40, but children. Child obesity data from the NCMP 2006/2007
only about 8 000 bariatric procedures per year. However, to 2014/2015 are now available online as a child obesity
with levels of obesity and overweight at more than 60% data tool for local authorities. The tool presents trend
of the adult population, it is clear that individual and data and enables easy comparison of local authority
therapeutic interventions will not be sufficient to solve data, allowing users to compare regional neighbours
the challenge of obesity. Faced with funding cuts, many and local authorities with similar characteristics. The
local authorities are looking at obesity services as a tool now includes inequalities data (by sex, deprivation
likely area to cut. Weight management services, often and ethnic group) by local authority and information on
provided by private sector organizations, look particularly the density of fast food outlets. These data are collected
vulnerable. Birmingham has already announced that it and analysed by the National Obesity Observatory. The
will stop funding for weight management services. National Obesity Observatory is now part of Public
Health England’s knowledge and intelligence function,
Local authorities (in charge of public health, as well which helps to assimilate evidence into relevant and
as adult and children social care) and NHS Clinical useful analytical and evidential tools for the local system,
Commissioning Groups are able to collaborate including the dataset for local authorities known as
through the Health and Wellbeing Boards, and Fingertips (Public Health England, 2015).
through recommendations for the annual report of the
Director of Public Health and the joint strategic needs There are also Public Health Outcomes Framework
assessment. Different Health and Wellbeing Boards profiles for the nine regions of England which collate
may have different membership based on the different local authority indicators for breast feeding rates, physical
configuration of local services and may consider different activity, fruit consumption, life expectancy and diet
partners relevant to their decisions, e.g. the food industry related cancers (http://www.phoutcomes.info/search/
and agricultural interests may be relevant in some obesity#page/0/gid/1/pat/15/par/E92000001/ati/6/are/
areas. Some Health and Wellbeing Boards do include E12000005).
representation from district councils – the socalled
Description:Alcohol Bo Burström, Anna Sagan respectable public face (Room, 2004; McCambridge, the advice and information it provides (McCambridge,.
