Miércoles 26 de Noviembre de 2008, Ip nº 256

A sneak preview of the towns of the future
Por John Naish

“It won't work around here,” says Jim, a Portsmouth paramedic in his fifties, at news of the city winning government millions to become a Healthy Town. “Step outside the caff and I'll explain.” Portsmouth is one of nine English councils to share an award of £30million this week to encourage locals to exercise, eat well, live better and, above all, curb obesity. Will these pilot projects pave the way to solving Britain's burgeoning health crisis or are they, as critics, argue, another political gimmick?

Jim lights a cigarette outside the café and says: “I don't know whether anything would make a difference. You just have to see the binge-drinking on Friday and Saturday nights. We have community health paramedics with a specific role in advising people who've drunk far too much. But it doesn't really make a dent.”

He squints in the morning sunlight and adds: “Jogging and healthy eating are fine for people out in the nice parts. But on the city estates? There's tons of caffs and burger bars, but I've never seen any healthy eating.”

Along with Portsmouth, deprived areas such as Dudley, Middlesbrough, Tower Hamlets and Tewkesbury are to divide the cash. The Hampshire city is emblematic of anytown Britain: there's a Seventies shopping centre, restored heritage bits and city-centre sink districts. Sure, there are some grossly overweight people about, but it doesn't look gravely beyond today's porky norm. Civic pride was outraged last year when Boris Johnson, the Mayor of London, wrote in GQ magazine that Portsmouth was “too full of drugs, obesity, underachievement and Labour MPs”. Out of fairness, I forego the grim estates for the pretty waterfront, to talk to breakfast fry-up customers at the Big Wheel Café - the very people targeted by the new initiative.Jim (not his real name - NHS trusts hate staff talking to reporters) says: “Maybe it's because I tend to see the bad side of this place, but I have to wonder how you tackle generations of really terrible behaviour. I encounter kids as young as 8 walking the streets late at night. How are you going to persuade the heads of families like that about the benefits of healthy living?”

Among the other Big Wheel customers, John Parker, 20, sits with his face buried in a mobile phone having just finished a plate of omelette, beans and tinned tomatoes. “Yeah, I do all that stuff anyway. Healthy eating and exercise. The scheme won't make a difference to me,” he mumbles. Parker, who cooks at a nearby restaurant, adds: “My restaurant serves organic stuff. But I only cook it. I prefer to eat here.”

While there's little evidence of popular clamour at the Big Wheel, the council is delighted at the funding, which it has earmarked for ten projects, including boosting access to cycling with new routes, bike rental and refurbishment schemes. School dining rooms are to be revamped, residents will be encouraged to convert gardens into allotments or create rooftop gardens on blocks of flats. A network of community cafés selling affordable good food is planned.

Urban design “encourages” obesity

Many of the newly approved Healthy Towns plans centre on making changes to the urban environment that encourage people to exercise and eat better. A growing body of research shows that modern “obesogenic” townscapes are contributing to the obesity epidemic because they make it difficult and dangerous to walk around but easy to find junk food. The hope is that redesigned streets can help us to stay slim.

Statistically, Portsmouth has size problems: 52per cent of adults are overweight, compared with the English average of 45 per cent. A third of primary school-leavers weigh too much and three-quarters of residents do not exercise regularly. Susie Waller, Portsmouth City Council's head of health improvement, says that the new money is “a fantastic opportunity to have real impact”. But sceptics such as Norman Lamb, the Liberal Democrat health spokesman, have declared the initiative “at risk of being another time-wasting gimmick”.

That might be mere political opportunism, but there is a real danger of Healthy Towns joining the list of failed and forgotten Labour social initiatives. And who knows which health interventions work? There is a dearth of follow-up, says Ann Oakley, a researcher at the University of London's social science research unit.

Community health involves a mass of disparate factors, and teasing out which changes make a difference is a huge challenge. For example, Sheffield City Council, another winner of Healthy Towns funds, will use the cash to try to boost breast-feeding rates, as these are linked to less child obesity. It seems a sensibly intuitive idea. But perhaps the statistical link is caused by affluent, lifestyle-conscious, middle-class mums being more likely to feed their babies this way.

Officials recognise the challenge

Waller acknowledges the difficulty, but says that Portsmouth's approach is based on the best available evidence. “Outcome data around public-health improvement is in its infancy, but Nice [National Institute for Health and Clinical Excellence] has been doing good work developing our knowledge over the past two years.” She adds that the Healthy Towns projects will be monitored to get more data on which programmes seem to work.

Carefully targeted support is vital, cautions Kerri McPherson, a health psychologist at Glasgow Caledonian University. “People can become so bombarded by advice that they close their ears,” she says. “There are an awful lot of mixed messages around, with conflicting information from government and food advertisers.”

Families are even sorely confused about whether their own weight is unhealthy. Only one in nine parents of obese or overweight children believes that his or her child has a weight problem, reports a Department of Health survey of nearly 1,200 parents this week.

Is there a danger of Britons suffering a surfeit of well-meaning words? Steve Field, chairman of the Royal College of General Practitioners, takes a pragmatic approach. “Obesity is the biggest problem we face and health campaigns are the only real option we have for trying to change behaviour,” he says. “We've got to start somewhere and this is the best place to start.”

But what of the sceptics back at the Big Wheel café? Professor Field wants the mass media to play a role in reaching those who most need to heed health advice. “We need to ban smoking on Coronation Street and see disadvantaged people on EastEnders adopting better behaviours,” he says. “Those would be the best way of getting to millions of people.” Perhaps we need to add two more places to the Healthy Towns list: Walford and Weatherfield.

Five steps to a fitter town

Tax the traffic London's congestion charge has delivered a small but noticeable health improvement, says a study in occupational and environmental medicine. Scientists from two London colleges calculated that since 2003, 1,888 extra years of life had been saved among the city's seven million residents.

Bike for breasts City of York Council has tried to get more women on their bikes by promoting a report which claims that regular cycling can help to guard against breast cancer. The German study of nearly 1,300 women, published in The Journal of Epidemiology, says that three hours of moderately intensive cycling over a week could help to reduce incidence of breast cancer by 34 per cent.

Create book clubs Dr Robin Reesal, a clinical associate professor of psychiatry at the University of Calgary, reports how several studies show that reading or “bibliotherapy” as he calls it, can help to reverse the symptoms of depression. He says that reading activates the frontal lobes of the brain, which are involved in processing and applying information. Population health could be raised if everyone joined a book club, he adds.

Reintroduce rationing The restricted diet of people during the Second World War may have health benefits for middle-aged women, says the Cancer Research Campaign. It reports that women who were children in the early 1940s benefited from the “war diet”, when meat, sugar and dairy products were restricted, and orange juice and cod liver oil provided vitamins A, C and D. These are now recognised as important elements of an anti-cancer diet.

Healthy planning in cities

Portsmouth Signage to help walkers, runners and cyclists time their progress Dudley Transforming parks into family health zones

Halifax Grow-your-own fruit and veg scheme

Manchester Rewards for exercising

Middlesbrough Urban farms and junior trainer programmes

Sheffield Making the city breastfeeding-friendly

Tewkesbury Urban garden to help people keep fit

Thetford Encouragement to cycle more

Tower Hamlets Award scheme for businesses to sell healthy food

Source: Department of Health

  15/11/2008. Times Online.


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