Health Promotion Librarian
Ben Skinner BSc (Hons) MA*
Evidence based/Knowledge Management Librarian, KnowledgeShare
The Library, Audrey Emerton Building, Royal Sussex County Hospital, Brighton, UK
Britain is in the grip of an epidemic. Almost two-thirds of adults and one-third of children are either overweight or obese.
There is now widespread awareness of the signifi-cant threat that obesity and its attendant health im-pacts could pose to present and future generations. In particular, increasing obesity in children is likely to have profound effects on their social and emotional wellbeing, as well as their physical health and long-evity.
In 2004, the government took a step towards ad-dressing the growing prevalence of obesity in the UK with the Choosing Health white paper. This recognised the difficulty society has in achieving targets set by the Department of Health, when the environment we live in actively promotes unhealthy behaviour. It attempted to encourage the nation to adopt healthier lifestyles, increase levels of physical activity and eat more healthily.
Two years later this was followed up by the publi-cation of Lightening the Load, a toolkit designed to assist primary care trusts and local authorities in design-ing and implementing local overweight and obesity management strategies. This complemented the guidance on obesity set out by the National Institute for Health and Clinical Excellence (NICE) in 2006.
In 2007, a report by the Government Office for Science’s Foresight programme compared the scale and complexity of the obesity problem to that of climate change. The government’s response has been to set itself the target of being the first major country to reverse the rise of obesity and overweight in the popu-lation. An initial target has been set for reducing the proportion of overweight and obese children to 2000 levels by 2020.
Consequently, health promotion is high on the government’s agenda. Choosing Health recommended that addressing health promotion in children, and targeting the disadvantaged in society would help tackle the key public health problems including obesity.
Now in 2008, Healthy Weight, Healthy Lives is the first step in a sustained programme to support people’s attempts to maintain a healthy weight, focusing on:
• promotion of children’s health
• promotion of healthy food
• building physical activity into our lives
• supporting health at work and creating incentives for better health
• providing effective treatment and support when people become overweight.
Health promotion is the process of enabling people to increase control over and to improve their health. Whether in the form of screening programmes or guidance on behaviour and lifestyle choices, it is essen-tially about giving patients the advice and support that encourages them to maintain a healthy lifestyle. Effective health promotion in primary care plays an important role in preventing or delaying the progression of disease, and, according to the Royal College of General Practitioners’ curriculum statements, general prac-titioners (GPs) have a crucial role to play in promoting health.
This article highlights some of the most useful online resources available to help primary care workers carry out their health-promoting roles.
Public Health Specialist Library: www.library.nhs.uk/publichealth
Currently in the early stages of development, the new National Library for Public Health aims to provide a single source for access to high-quality, evidence-based information on all aspects of public health. It is being developed as a specialist library within the National Library for Health (NLH) as part of the Department of Health Information and Intelligence Strategy. Initial resources focus on obesity, tobacco and alcohol, with resources for the topics on the Choosing Health agenda, and eventually other public health categories, to be added later. While the target audience includes all those working in public health, a central objective of the library is to improve access to the evidence base for population-based commissioning so that it becomes a core resource for commissioners as set out in the Department of Health Commissioning Framework document.
There are two options for finding information within the library: using the search function or browsing through the subject areas. The subject areas are made up of: determinants, outcomes, management and inter-ventions, analysis and research, populations, and settings. In common with the other NLH specialist libraries, resources for each subject are subdivided into different categories, for example ‘guidance and pathways’ for clinical and service guidelines, ‘evidence’ for Cochrane reviews and other evidence-based research, ‘refer-ences’ for specialist websites, ‘education’ for learning materials, and finally ‘patient information’.
There are separate areas for ‘news’ and ‘events’, as well as a section that highlights and links to the latest public health stories from the BBC news website. The user also has the option to sign up to RSS feeds detailing major events and conferences relating to public health.
The Association of Public Health Observatories: www.apho.org.uk
The Association of Public Health Observatories (APHO) represents and co-ordinates the 12 regional public health observatories (PHOs) working across the UK to form a national network of knowledge in public health. PHOs support the work of public health pro-fessionals, local authorities and providers of health care by collecting and analysing data and intelligence on people’s health and health care. Each individual PHO acts as a resource for health-intelligence for its region, but also has responsibility for providing national leadership on a particular policy area.
The APHO website has recently been redeveloped and is a useful site for those involved in promoting health in their area. One of its main functions is to host tools and applications such as ‘health profiles’ – reports describing the health of local populations that enable comparison locally, regionally and nationally. Health profiles provide data and information on a variety of public health issues, for example they include regional obesity statistics. The Health Impact Assessment (HIA) gateway, providing access to documents and resources to help those commissioning HIAs, is another appli-cation accessible via the site.
APHO’s policy reports such as its series of ‘Indi-cations of Public Health in the English Regions’ are available to download under the ‘outputs’ tab, while the ‘resources’ tab allows access to additional useful material, including reports published by other organ-isations. The latest of these resources are easily located on the homepage of APHO’s site, along with infor-mation relating to training and events and news on topical health issues.
South East Public Health Observatory – Obesity and Overweight: www.sepho.org.uk/topics/obesity.aspx
As part of its commitment to partnership working, the APHO has taken each of the key public health topics and assigned them to the various regional observ-atories as ‘lead areas’. The idea is that each PHO will develop its expertise in these specific areas, and then share this expertise across the network. Obesity and overweight, as well as physical activity, have been assigned to the South East Public Health Observatory (SEPHO).
In addition to a small number of reports that are specific to the south east (because they describe regional prevalence and examples of local initiatives aimed at tackling the problem) there is a good selection of nationally applicable resources. This list of links con-tains pointers towards government policy on obesity, such as ‘Obesity: defusing the health time bomb’ from the Annual Report of the Chief Medical Officer in 2002, as well as the Department of Health’s own obesity topic page. There are a number of pieces of high-level evidence on primary care interventions for obesity, including two health technology assessments and a guideline from NICE. Also available are national stat-istics on obesity, physical activity and international Reference, for example from the World Health Organization.
National Obesity Forum: www.nationalobesityforum.org.uk
The front page of the National Obesity Forum (NOF) website provides regular updates on items of interest to healthcare professionals dealing with obesity. The forum is a UK charity that was set up to raise aware-ness of the problem, and to provide training, guidance and networking opportunities to clinical staff. It also acts as a lobby group, and has recently responded, for example, to the Healthy Weight, Healthy Lives obesity strategy.
An interesting, and relatively unusual, service that the NOF provides is to look out for newly published obesity-related research reports and summarise them on the site. The research is put into context and inter-preted by senior clinicians within the forum, making this more than the usual current awareness service. Their newsletter, which is published three times a year, provides a round-up of the latest news, views from opinion leaders, and examples of best practice. The site also holds a large selection of original content, for example a section on obesity in children that contains pieces on epidemiology, risk factors, assessment, man-agement options, parental responsibility and long-term effects. See also the area entitled ‘Healthcare profes-sionals’ for the full array of guidelines, care pathways, toolkits and other miscellaneous resources.
Patients and the public should be directed to the ‘Healthy approach to weight-loss’ section of the site, which guides people through the steps necessary to make a change in their lifestyle.
Association for the Study of Obesity: www.aso.org.uk
The Association for the Study of Obesity (ASO) has very similar goals to the National Obesity Forum: promoting professional awareness of obesity, educat-ing staff, and providing leadership within the UK. Like the NOF it alerts readers to new developments in the field, whether it is the publication of new guidance or an invitation to join a new obesity network. They also have an online ‘information centre’, with factsheets and ASO position statements, and of particular interest, a list of obesity strategies that have been submitted by various primary care trusts (PCTs). At the time of writing, 29 PCTs, from Bedfordshire to Wolverhampton, have added their strategies to the website – an extremely useful resource for anyone wanting to develop or update their own local approach to obesity management.
Another thing that sets the Association apart is its series of regular conferences and training events on aspects of obesity and overweight. Conference topics for 2008 have included ‘food pReference and appetite regulation’, ‘obesity and the built environment’, and in November, ‘obesity and cancer’. There is a charge to join the ASO, but doing so gives free entry to most conferences, and discounts on training.
International Association for the Study of Obesity: www.iaso.org
Members of the Association for the Study of Obesity automatically gain membership of the International Association for the Study of Obesity (IASO), an organ-isation that represents 56 countries worldwide. IASO is a registered charity and produces a number of schol-arly journals, as well as some free newsletters. It also runs international conferences on obesity, and hosts various task forces that take on specific areas of con-cern. The International Obesity Task Force, for example, focuses on advocacy and aims ‘to alert the world to the growing health crisis threatened by soaring levels of obesity’. Working closely with the World Health Organ-ization, it has groups of experts looking at prevention, childhood obesity, management and economic costs, and each of these working groups has its own collec-tion of resources available to download from the site.
There is also a Physical Activity Task Force and an Education and Management Task Force within IASO, although these do not have such a large array of links and documents associated with them. For those interested in gaining a recognised qualification relating to obesity management, IASO has developed SCOPE, the Specialist Certification of Obesity Professional Education. Details of professional development events, online courses, and opportunities to apply for fellow-ship, can be found on the site.
British Nutrition Foundation: www.nutrition.org.uk
The aim of the British Nutrition Foundation (BNF) is to promote the nutritional well-being of society by interpreting and disseminating evidence-based know-ledge and advice on the relationship between diet, physical activity and health. Much of its work involves producing literature and running conferences to dis-seminate the latest information concerning nutritional topics to health professionals in the UK and Europe. It also runs an information and consultancy service and has developed ‘Food – a fact of life’ – a food and nutrition education programme for schools. This programme, including a comprehensive collection of resources for promoting healthy eating to school chil-dren, is accessible via the website. BNF task forces address the problems of particular issues where the data may be uncertain or potentially misleading, as well as investigating public health problems linked to nutrition. Details of these and other projects or con-ferences being co-ordinated by the foundation are accessible here.
A large section of the website consists of printable fact sheets (found under the ‘Healthy Eating’ tab), and is dedicated to providing healthy eating information. The ‘Nutrition Basics’ contains literature detailing nutritional requirements, offers tips for healthier packed lunches and includes the brightly coloured ‘eatwell plate’, which clearly illustrates a balanced diet. ‘Nutri-tion through Life’ provides specific nutritional infor-mation for relevant stages of life, from infancy through to older adults and includes pregnancy. The topics of obesity and physical activity are covered in ‘Nutrition and Health’ where measuring body mass index (BMI), and the prevalence of obesity and associated health problems are discussed. A wealth of information on various foods and their nutritional values is easily accessible via the ‘Food Commodities’ section. Mean-while ‘Food Science/Labels’ discusses the science be-hind food in relation to additives, preservation, canning and organic food, amongst other topics, as well as providing an illustrated section explaining food label-ling. BNF leaflets and publications are available either to download or order via the website.
For further tips and advice on healthy eating the Food Standard Agency’s (FSA) ‘Eat well, be well’ website www.eatwell.gov.uk is a good place to explore. The ‘healthy weight’ section (found under the ‘healthy diet’ tab) hosts interactive resources aiming to help people manage their weight, including a BMI calcu-lator, height to weight chart, Ashwell shape chart, and a calorie calculator that can provide a rough idea of how many calories are burnt off by different physical activities. Obesity information can be found under the ‘Health Issues’ tab.
Sport England: www.sportengland.org.uk
Those wanting ideas on how to promote physical activity, and to understand the current trends in the nation’s physical fitness, should visit the website of Sport England. This is a governmental body that invests in community sport and promotes active living. As well as funding opportunities for projects aimed at getting people more involved in sport, there is a whole section for members of the public who need advice and encouragement about getting fit and healthy. Patients can be directed here to get suggestions about what sport is right for them, as well as details of a touring roadshow at which they can drop in and talk to advisors.
Health professionals should aim for the ‘Get Re-sources’ area of the website, and specifically the docu-ments listed under ‘Research’, which includes an analysis of data from national and regional surveys measuring participation in physical activity. Of par-ticular interest is a series of reports looking at what motivates or demotivates participation in sport. There is evidence on the benefits of sport, and case studies of what works to increase involvement, as well as re-search modelling the economic and health impact of increasing physical fitness.
Other useful evidence on physical activity can be found in: At Least Five a Week from the Department of Health (www.dh.gov.uk/assetRoot/04/08/09/81/04080981.pdf), Four Commonly Used Methods to In-crease Physical Activity from NICE (www.nice.org.uk/download.aspx?o=PHI002Guidance), and the ‘Staying Active’ area of the British Heart Foundation’s website (www.bhf.org.uk/keeping_your_heart_healthy/stayingactive.aspx).
In addition to the many useful resources available from these sites, you may well have an NHS-funded health-promotion library in your area that can supply leaflets, posters and models on a variety of subjects. To find a local health-promotion library search for ‘‘health promotion’’ (including the speech marks) in the Health Library and Information Services Directory (www.hlisd.org) or ask at your local NHS library.
Thanks to Kevin Burgoyne, Senior Library Assistant at Brighton and Sussex University Hospitals NHS Trust for his contributions.