A Community Audit: The effects of school and local environments on childhood obesity rates in the Borough of Rushmoor

This audit aimed to understand local causes of obesity in the Borough of Rushmoor by identifying influences that are potentially contributing to the high childhood obesity levels in the borough, first through a questionnaire to schools to understand what they are doing to address this issue, and secondly, through a study of each school catchment environment.

The information collected was used to determine the characteristics and ratings of each catchment and school, which could identify opportunities to deliver meaningful interventions. The aims and objectives of the audit relate to the implementation of the NICE Quality Standard on physical activity and Quality Standard on community engagement to improve health and wellbeing.

Rushmoor Borough Council covers a population of nearly 100,000 people in the towns of Farnborough and Aldershot in North Hampshire, and the audit was confined to this population.

The NCMP data released in October 2017 identified that 25.5% of Rushmoor school children in Year R are obese or overweight, with this figure rising to 33.6% at Year 6 [1]. Year R percentages are higher than both the England (22.6%) and Hampshire averages (23.2%). Year 6 percentages are also higher than the Hampshire average (29.3%) but lower than the England average (34.2%). These figures highlight a continued increase in the number of children being overweight both nationally and locally.

Recent research in Hampshire has indicated that the family and community may have a greater impact on childhood obesity levels than the school environment. All 29 infant, junior and primary schools across Rushmoor were included in the audit, with a 100% return rate.

A survey was sent to schools asking for data around health and physical activity promotion, and services or schemes that they provide relating to outdoor space, extracurricular sports activities and active travel to school. Follow up calls to schools included specific questions about the provision of after school sports clubs. This was combined with data from Public Health England and the public health team at Hampshire CC.

The project method provides a case study of how the relevant NICE quality standards on physical activity and community engagement could be implemented.

A survey was sent to all 29 infant and junior schools in Rushmoor to collect data on schemes to promote physical activity, with a 100% return rate.

To get an indication of whether a school serves a deprived area, the Income Deprivation Affecting Children Index (IDACI) data was used from the 2017 schools’ budgets. This data is based on where pupils live and not school catchment areas. The audit is set against the backdrop of the 2017 local and national NCMP data that is available from Public Health England. Individual school data, however, was not available to the authors of this report due to data protection. In the absence of such data, 2017 Middle Super Output Area (MSOA) NCMP data was provided by Public Health at Hampshire County Council, with indications across each MSOA area reported under three categories of children’s weights: significantly higher; significantly lower; or not significantly different to the Hampshire average.

An environmental profile for each school catchment was created to determine the characteristics of the catchment, the outcomes of which have been reported in a ranked order. The data captured includes an assessment of the accessibility of open/green spaces, play areas, leisure facilities, sports clubs, school active travel rates and the number of takeaway food outlets in each catchment.

Results from the school survey indicate a wide disparity between schools in terms of what they are doing to promote and encourage healthy eating and physical activity. The survey suggested that out of 29 schools, only 15 (those with a plus score) were pro-active in encouraging healthy eating and physical activity.

• Two schools in particular scored exceptionally high in their delivery of programmes to address obesity, yet MSOA data indicated that children’s weights in those school catchments were above the Hampshire average, with the schools also serving catchments of relatively high deprivation.
• In addition to the impact of deprivation and the environment on the weight of a child, the school survey resulted in a number of key observations relating to the schools as summarised below:
• HC3S, which provides catering in many local schools, has occasionally offered a Cook and Eat programme, an educational practical course which encourages pupils and parents to eat more healthily by cooking with fresh and healthy ingredients. The survey highlighted that HC3S was not running any schemes in Rushmoor's schools, but that a small number of schools deliver their own sessions to pupils, and two schools to parents. Evidence on the effectiveness of the Cook and Eat scheme is weak, and this could be a reason why no schools are delivering this option. However, further evidence has shown that it is more effective to deliver schemes like this within the curriculum
• While many schools reported that they gave pupils the opportunity to choose lunches in advance, further investigation found that the HC3S-operated system only allowed for this choice to occur on the same day, and only then by the pupil. Is HC3S able to implement a new system that enables parents and children to make choices a week ahead, which could increase the number of healthier choices made?
• The survey highlighted that 22 of the 29 schools are not aware of NCMP data relating to their pupils. This could result in the schools not being able to recognise and target pupils who have been identified as being overweight, thereby limiting the school’s ability to address the issue. Hampshire County Council shares this data with all schools, so more work is needed to ensure that each school is aware of its data. - The survey highlighted that 15 of the 29 schools are not engaged with the Hampshire Schools Active Travel Team.

The study concluded that children in Rushmoor are more likely to become overweight if they are living in areas that have high levels of deprivation, irrespective of what schools are doing to address this issue. However, the study also concluded that the environment can have a positive effect in maintaining a healthy weight, by improving access to green space, local play facilities, sports clubs, routes to schools and by limiting fast food outlets.

It is recognised however, that improving the environment is far from simple, with the majority of school catchments being heavily urbanised and smaller in area than others. Nevertheless, Rushmoor Borough Council is continuing to identify opportunities to improve those environments where high levels of deprivation exist and work with Hampshire County Council to improve routes to schools.

The study identified possible causes for the higher levels of childhood obesity in Rushmoor, which can present opportunities to influence the local environments and communities. However, it is important to adopt a whole-systems approach in order to tackle this complex issue through the formation of a local action group made up of key stakeholders. As a result of the audit, a number of short term recommendations and actions were highlighted:

• Linking the Active Travel Team to those schools not signed up
• Encouraging all schools to sign up to The Daily/Golden Mile scheme or equivalent
• Helping those schools that have requested access to facilities that will promote physical activity
•  Providing survey outcomes to schools so that best practice can be widely shared, and that each school has an opportunity to implement any recommendations contained in each school summary
• Ensuring that each head teacher is made aware of their school's NCMP figures
• Encouraging schools to work towards a Healthy Schools rating The Council has also created a Local Action Group with other stakeholders to build on the Audit's findings.