Or in this case a city: the city of Amsterdam.
Obesity Action Scotland has recently returned from a study trip to Amsterdam where our hosts were the public health department of the city of Amsterdam. Amsterdam is the first area in the world to see a decrease in rates of childhood obesity across all socio-economic groups. A unique and inspiring achievement given that in Scotland we are seeing a widening inequalities gap.
What is the secret of their success? What did we see while we were there?
Well, the scale of investment is significant. 5 million euros and a team of 25 dedicated staff (plus another 75 linked staff) to solve this issue in a city where 27,000 children were classified as overweight or obese.
The health system they operate within is different to the Scottish one. They identified that there are 13 moments that children have their weight and height measured between the ages of 0 and 4.
One pillar of their success is a strong political champion within the Council who was and is prepared to be brave and outspoken but who also understands it is a long term effort.
There are lots of small, unique aspects to their approach - but what about some of the bigger principles?
Healthy weight is a collective responsibility. This was a recurring theme and they were very clear that everyone was needed and that messages needed to be consistent. While each professional will have a different role to play, the message from the doctor, nurse, teacher, and politician must all be the same. They invested in training and awareness across all professionals.
Target and achievements had to be set and measured appropriately. They identified that this was a long term investment, that it would take time and patience to achieve goals but that they could set some interim targets to demonstrate success along the way and to ensure the appropriate achievement was made within political cycles. Therefore, the long term mission is for all young people in Amsterdam to be of healthy weight by 2033 but the first interim measure of success is for all 0-5 year olds to be a healthy weight by 2018.
The approach they take is unique. Whilst JOGG is the national Netherlands approach to tackling childhood obesity and is based on the French EPODE model, Amsterdam would readily admit that they have not adopted all aspects of the JOGG approach. They support and implement the JOGG framework but not necessarily the detailed methodology. Amsterdam have adopted it and made it unique. They avoid the commercial partnerships that are taken forward in other JOGG/EPODE models, in fact they lobby strongly for action on advertising and marketing of junk food. They keep ensuring that marketing of unhealthy foods and the food choices available are strictly controlled at events subsidised by Amsterdam Municipality.
They have a “health in all policies” approach that embraces decision making on everything from playgrounds to tackling poverty. They specifically target their efforts and resources to the heaviest neighbourhoods and schools with specific and unique programmes for certain schools, ethnic groups, neighbourhoods, parents. It is a complex mix of programmes based on three rules of thumb – healthy food and drink, active lifestyle and good sleep. It focuses on prevention but has a strong comprehensive care programme for those who are already overweight or obese.
What struck us most during our visit? Pride and ownership. We met a variety of people from a school head teacher to a local fishmonger and all of them had pride and ownership of their role in helping children improve their diet and grow up healthy.
What can we learn from this? Obesity Action Scotland is working hard to ensure we change the environmental conditions that surround us every day and that influence our food choices. This includes lobbying for action to control price promotions and advertising and marketing of unhealthy foods. Those changes, as important as they are, are only one part of the jigsaw. We must also see the local approach that we witnessed in Amsterdam. An approach where every professional and many community members understood what their role was in influencing healthy lifestyles. There are numerous examples of local led approaches in Scotland . Scotland has enthusiastic and clever individuals who want to make in change in their communities. It is time to harness, strengthen and develop that local work and focus on improving our village.