change for life

1. CHANGE4LIFE comparative study an analysis and

2. OUTLINE OF PRESENTATION • Current trends in Britain and the Department of Health’s plans • DefiningChange4Life • Analysingit using determinants of behavioural change and evaluating its • Effectiveness • Comparative study with Singapore’s programmes

3. CURRENT TRENDS. defining . analysing . evaluating . comparing • Studies • Annual increase in obesity related deaths between 2000 and 2006. (University of Oxford) • More than 190 people under 65 had direct obesity-related deaths compared with 88 in 2000.

4. current trends. DEFINING. analysing . evaluating . comparing • Change4Life • A societal movement, the social marketing part of "Healthy Weight, Healthy Lives", the cross-governmental strategy for England. (broad based strategy, not top-down) • Alifestyle revolution to change people's behaviour and prevent obesity (preventative campaign, not remedial) • Started in January 2009 • Mission: to encourage people to eat well, move more and live longer

5. current trends. DEFINING. analysing . evaluating . comparing • What Change4Life is based on Change4Life Behavioural Change Model

6. current trends. DEFINING. analysing . evaluating . comparing • Target Group • Focused on families with children aged 5-11, greatest risk of becoming overweight or obese • grouped into clusters (income) with 5 being high-risk • Pregnant mums and families with babies aged 0-2 (Start4Life) • Ethnic minority communities - Pakistani, Bangladeshi and West African (TV commercials and advertorials in key ethnic titles) • Recently: middle-aged adults

7. current trends. defining . ANALYSING. evaluating . comparing • Made up of • Grassroots supporters • NHS and local government staff • Commercial sector partnerships • Non-government organisations • To spread messages with the help of • Schools • GP surgeons • Community centres • Supermarket

8. current trends. defining . ANALYSING. evaluating . comparing • Support • Health charities: Cancer Research UK, Diabetes UK, British Heart Foundation • NGO: Natural England and Sustrans • Business: free gym access, money off fruit/vege, low cost bikes • National Partners: Kellogg's, Nisa, SPAR, TESCO

9. current trends. defining . ANALYSING. evaluating . comparing • Provides practical tips, helpful information • E.g. 8 Healthy Behaviours • Provides a coordinated campaign for health promotion nationwide • E.g. Facebook updates on events in the local community • Subgroups • Let's Dance with Change4Life • Bike4Life • Walk4Life • MuckIn4Life • Play4LifeSwim4 • Lifeadvertisements: • http://www.youtube.com/watch?v=dyvfSmB0YOQ • http://www.youtube.com/watch?v=i3xXK1BcMB4&feature=relmfu • http://www.youtube.com/watch?v=Nb0fLYdPEPM&feature=relmfu

10. current trends. defining . ANALYSING. evaluating . comparing • Bike4Life • Promoting: Cycling, whether its a day to day activity, or an occasional adventure, is a great way to help keep you and the rest of the family healthy. Getting on our bikes more often can help us on the way to making the small changes that can bring short and long term benefits to your health, the environment and your purse. • Encouraging kids to cycle from an early age and getting them to take their Bikeability test will equip them with a skill for life. • Singapore context: do not think it will work, because not bike friendly, many bikes accidents etc. 

11. current trends. defining . ANALYSING. evaluating . comparing • Swim4Life • Similar to UH: 4 swims with the 5th free! • Similar to Singapore • Compulsaryfor schools to have swimming lessons to make sure students are equipped with fundamental survival skills • By Primary 4, students must be able to tread water and swim 50m, • Good life skills plus it encourages students to excercise more 

12. current trends. defining . ANALYSING. evaluating . comparing • Change4Life • Creating an environment that better supports people in developing and sustaining healthy eating and activity habits • On a social level - culture, people, lifestyle • ie. through messages, posters, activities (see people moving about), influences • Interactions with family and friends • Includes institutions in the local community

13. current trends. defining . analysing. EVALUATING. comparing • Effectiveness • 85% of mothers agreed that the Change4Life advertising made them think about their children’s health in the long term • 81% agreed it made them think about the link between eating healthily and disease • 83% agreed that is made them think about the link between physical activity and disease 

14. current trends. defining . analysing. EVALUATING. comparing • Key Determinants • Life history / impact of life transitions --> starting from young, good! (an age when behavior change is the easiest!)  • Awareness of role models --> parents , good! but... actual effectiveness, questionable. beyond the reach of Change4Life, it's personal... (correct target audience, effectiveness is questionable because whether parents will implement it? when children kick up a big fuss, will they give in?)  • Complex issues of perception of sport ability and self-confidence --> more can be done on this front. talks etc.

15. current trends. defining . analysing. EVALUATING. comparing • Key Determinants • awareness of opportunities is also a key determinant and that Change4Life did well with its widespread publicity. (but need to think better where their posters are placed! - ie at the bus stop? after the counter in the cafeteria?)  • social networks - friends and family involvement will aid the effectiveness of the campaign. the approach of Change4Life, not top down but with the authority spread to others such as community volunteers enabled it to gain a better outreach. --> good! • economic reasons - such as financial incentives from asda and tesco is helpful, good! more can be done on this front but it requires the commitment of more corporate partners who are profit-oriented.

16. current trends. defining . analysing. EVALUATING. comparing • Empowerment • In control of the behaviour change and that it is not forced from ‘outside’ • Lawson (2005) focuses on the issue of power, who holds it and how it can be used

17. current trends. defining . analysing . evaluating . COMPARING • Comparison with Singapore’s health promotion efforts

18. current trends. defining . analysing . evaluating . COMPARING • Demography • Population of 5.18 million • Land area of 778 km² • Second most densely populated country in the world • Health Department • Health Promotion Board (HPB)

19. current trends. defining . analysing . evaluating . COMPARING • Life expectancy at birth (as of 2011) • Males: 79.5 • Females: 84.9 • Average: 82.14 Source: CIA World Factbooks 18 December 2003 to 28 March 2011

20. current trends. defining . analysing . evaluating . COMPARING • Causes of Death Source: Ministry of Health Singapore, 28 Oct 2011

21. current trends. defining . analysing . evaluating . COMPARING • Eating habits

22. current trends. defining . analysing . evaluating . COMPARING • Physical Activity

23. current trends. defining . analysing . evaluating . COMPARING • Smoking

24. current trends. defining . analysing . evaluating . COMPARING • Barriers to eating healthily • Easy access to a large variety of food • Preference for unhealthy food • Low cost of food

25. current trends. defining . analysing . evaluating . COMPARING • Easy access to food • It is quite hard not to see food around you…

26. current trends. defining . analysing . evaluating . COMPARING • Preference for unhealthy food • Unhealthy food = Good food

27. current trends. defining . analysing . evaluating . COMPARING • Low cost of food • Cheap food = Buy more food

28. current trends. defining . analysing . evaluating . COMPARING • Low cost of food • Cheap food = Buy more food

29. current trends. defining . analysing . evaluating . COMPARING • Barriers to physical activity • Consumed with family and work commitments, hence there is little time set aside to exercise • The misconception that “I am not obese so I am healthy” – a link between obesity and health • Urban setting which discourages preferred forms of exercise prevalent in other countries e.g running and cycling

30. current trends. defining . analysing . evaluating . COMPARING • Barriers to physical activity • Consumed with family and work commitments, hence there is little time set aside to exercise • The misconception that “I am not obese so I am healthy” – a link between obesity and health • Urban setting which discourages preferred forms of exercise prevalent in other countries e.g running and cycling • Highly efficient and dense network of transport systems including public transport and traffic network • Eliminates the need to walk long distances • “Why walk when I have a car?”

31. current trends. defining . analysing . evaluating . COMPARING • Singapore has a relatively low obesity rate at 10.8% as of 2011 • Thus, despite all the barriers to ensuring a healthy lifestyle, something is going right…

32. current trends. defining . analysing . evaluating . COMPARING • National Service • All males have to enlist in the conscripted armed forces at the age of 18 • Serve a national service liability which runs for 2 years • After service, the individual is still liable up to the age of 40 and is required to undergo an annual physical proficiency test up till that age • Individual Physical Proficiency Test (IPPT) • Incentives and Disincentives

33. current trends. defining . analysing . evaluating . COMPARING • Health Promotion Board • Two-pronged approach • Healthcare system • Health promotion programmes

34. current trends. defining . analysing . evaluating . COMPARING • Healthcare System Source: AARP International

35. current trends. defining . analysing . evaluating . COMPARING • Taking responsibility for your own health • Absence of socialised models of social security • Compulsory pension system • Employees typically pay 20 percent of their wages into the Central Provident Fund (CPF), while employers pay 13 percent • The money in these fund is then used for future healthcare costs

36. current trends. defining . analysing . evaluating . COMPARING • Health promotion programmes • The “Healthier Choice” programme The Healthier Choice Symbol (HCS) on packaged food products indicates that they are healthier options, and this helps consumers to make informed food choices when grocery shopping.

37. current trends. defining . analysing . evaluating . COMPARING • Health promotion programmes • Healthy Eating in Schools Programme (HESP) • Enhance the availability of healthier food and beverage choices in schools through an integrated programme involving teachers, canteen vendors and students • 10 guidelines e.g • sale of drinks and desserts with less sugar • sale of deep-fried food and preserved food on only one specified day a week • As of 2009, 87% of schools in Singapore have achieved the Healthy Eating in Schools award

38. current trends. defining . analysing . evaluating . COMPARING • Health promotion programmes • Healthy Eating in Schools Programme (HESP) • Enhance the availability of healthier food and beverage choices in schools through an integrated programme involving teachers, canteen vendors and students • 10 guidelines e.g • sale of drinks and desserts with less sugar • sale of deep-fried food and preserved food on only one specified day a week • As of 2009, 87% of schools in Singapore have achieved the Healthy Eating in Schools award

39. presented byGrace Chua . Rachel Shong . Darren Nin