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? Low adherence to a healthy diet for learning disabled people. ? Ability to feed and drink unaided. Barriers. Barriers to undertaking physical activity for

Equality Impact Assessment

Corporate Proforma and Guidance

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Equality Impact Assessment


Step One identification and scope

    1.0 The title of this assessment

    EqIA of the Draft Glasgow City Council Healthy Weight Action Plan 1.1 Date assessment completed

    th14 April 2009

    1.2 Responsible officer

Susie Palmer

    1.3 Contact details

City Chambers, Rm 40, Corporate Policy

    1.4 This is an assessment of a new policy.

    1.5 These are the aims and objectives of the policy/function and the scope of the assessment:


    The Healthy Weight Action Plan will be a key means to improve the health and well

    being of the population of Glasgow by 2012. This will be achieved by the co-ordinated activities of Glasgow City Council and its partner agencies working toward a

    sustainable, comprehensive and integrated range of services, plans and evidence-based interventions to help Glasgow citizens maintain a healthy weight. Objectives of the Plan

    ? KEY OBJECTIVE 1: To develop policy and service development solutions that

    address health inequalities and work across policy areas with the aim of

    achieving a corrective population-wide shift in overweight /obesity trends.

    ? KEY OBJECTIVE 2: To both encourage and empower the population of

    Glasgow to make healthy lifestyle choices through awareness-raising activities,

    education, community engagement and knowledge and skills development.

    ? KEY OBJECTIVE 3: To improve the environment in order to make healthy

    choices easy choices; accepting that environmental interventions must coexist

    to support and facilitate behaviour change.

    ? KEY OBJECTIVE 4: To record and analyse information on the weight, health

    and lifestyle choices (including access to healthy food and physical activity

    opportunities) of adults and children in Glasgow in order to plan/monitor

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    Addressing evidence and gaps relating to specific actions which aim to remove barriers

    faced by equalities groups in tackling healthy weight was integrated into the development of the Plan.

    Stakeholder consultation process

    Relevant stakeholders from a variety of GCC services and arms-length companies were individually consulted on the development, delivery and the future monitoring of the Plan‟s actions, which were designed to collectively help to reduce inequalities in

    health and wellbeing within the city.

    The following services were consulted:

    ? Cordia LLP [formerly DACS]

    ? Glasgow City Council, Development and Regeneration Services

    ? Glasgow City Council, Education Services

    ? Glasgow City Council, Land and Environmental Services

    ? Culture and Sport Glasgow

    ? Social Work Services

    ? Community Health and Care Partnership (Evelyn Boreland on behalf of all 5


    ? NHS Greater Glasgow and Clyde & Glasgow City Council -Health at Work Team

    ? Community Planning

    ? NHS Greater Glasgow and Clyde

    ? Glasgow Centre for Population Health

    Other consultees out with Joint Officer’s Group on Health Improvement membership included:

    ? Glasgow Community Safety Services

    ? University of Glasgow

    ? Health Scotland

    During the consultation period, the evidence on tackling healthy weight was presented and considered by services in the development of specific actions for the Plan. In this

    regard, the GCC Equalities Team advised that forming an „impact assessment team‟ would not be necessary for this Plan, since equalities considerations had been

    mainstreamed during the development of the policy. It was however felt that a desk top

    EqIA would be useful for the development of this policy.

    This plan aims to develop existing actions found within local plans and policies that

    were previously subject to community consultation. Therefore, the Council will take a

    leadership role in implementing the plan and provide information to communities on the proposed service developments.

    Through colleagues within Glasgow Community Planning Partnership, we will

    determine exactly how best to reach and engage with local communities.

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Step Two research and consultation

These are the sources of evidence used and the key facts that informed the assessment

    of the policy or function


2.1 Age and gender

    The proportion of the NHS Greater Glasgow and Clyde population either overweight or

    obese has increased rapidly over the last decade. In 2003, the Scottish Health Survey revealed that more than 346,000 (60%) of Glaswegian adults and 115,000 (20%) of

    Glaswegian pre-school children were classed as either overweight or obese.

    Importantly, obesity is a problem affecting the entire population and it can be

    demonstrated that the entire weight distribution of the population is shifting upwards. The Scottish Health Survey (1995) showed, at a national level, that Mean BMI increased with age in both sexes, although in men it rose more steeply in earlier ages and

    plateaued in the older age groups. Mean BMI was lower in men than in women in the

    youngest and oldest groups but was higher in the other age groups. In all age groups

    except the youngest, the proportions who were overweight were higher in men than

    women. The proportions who were obese were similar between the sexes for age

    groups 25-34 and 45-54, but in the youngest and oldest groups women were

    significantly more likely than men to be obese.

    The health benefits of weight control are less clear-cut in elderly age groups, with the relative increase in risk associated with excess weight declining with increasing age.

    Nevertheless, applying both absolute and relative measures of risk showed that heavier

    men and women have an increased risk of death at all ages.

    The Foresight Report on tackling obesity suggests that preventing obesity is a lifelong challenge and that focusing solely on children would miss the opportunities to improve

    the health of adults and reduce the impending epidemic of diabetes in the short to

    medium-term. Therefore, interventions targeting both children and adults are essential.

2.2 Disability

    Obesity appears to be more common among people with learning disabilities. Health checks have shown that people with learning disabilities have a higher rate of obesity than the general population.

Overweight/Obesity Levels

    A research study of 945 adults conducted by Glasgow University (2007) found that overall, 39.3% of women and 27.8% of men with learning disabilities were obese,

    compared with 25.1% of women and 22.7% of men in the comparison general

    population. The mean BMI of women with intellectual disabilities was significantly greater than the mean BMI of men with intellectual disabilities, and women (with intellectual disabilities) were more likely to be obese than men. The risk of overweight and obesity reduced as the severity of intellectual disabilities increased, and Down

    syndrome was associated with an increased risk of overweight and obesity.

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There are no population-level datasets on obesity prevalence in people with physical

    disabilities for the City of Glasgow. Monitoring of obesity and overweight in people with

    physical disabilities can be problematic due to practical difficulties with weighing and


Risk Factors

    Risk Factors for those with learning disabilities include:

    ? Genetic syndromes such as Down syndrome

    ? Demographic factors such as gender, age, level of learning disability,

    geographical location and living situation

    ? Low adherence to a healthy diet for learning disabled people

    ? Ability to feed and drink unaided


    Barriers to undertaking physical activity for those with learning disabilities include:

    ? lack of activity choices

    ? poor accessibility of leisure and exercise facilities

    ? an individual‟s understanding, motivation and mood

    ? whether people are supported and encouraged to be more physically active

    ? learning disability service resourcing

    ? transport and staffing constraints

    ? risk assessment issues

    ? lack of clear policies, staff training and support

2.3 Race

Overweight/Obesity Levels

    There is evidence to suggest that certain minority ethnic groups, and principally females

    from those groups, may have more pressing needs than the majority population, in relation to excess weight problems. Black Afro Caribbean, Black African and South Asians appear to have higher obesity prevalence rates this has been associated with adverse adolescent dietary behaviours.

Diet Related Diseases

    ? Coronary heart disease mortality is higher in South Asian men and women when

    compared to the rest of the UK population

    ? Stroke mortality rates are higher in South Asians and black Caribbean men and

    women and in West African men when compared to the rest of the UK population

    ? There is consistent evidence that adults born in the Caribbean, Africa and South

    Asia have a higher prevalence of diabetes than the general population in the UK

    It is still not clear what causes the health inequalities described above (e.g. genetic factors, lifestyle factors, social conditions, social isolation, poverty etc) or whether these health risks are transmitted across generations.

Ethnic Variations in Diet

    There is considerable variation in eating habits between minority ethnic groups. Bangladeshi men and women tend to eat more red meat and fatty foods, and less fruit,

    than any other minority ethnic group. Pakistani men and women have the lowest

    vegetable consumption of minority ethnic groups. Chinese men and women eat the

    most fruit and vegetables. The practice of adding salt to cooking is almost universal

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among South Asian and Chinese groups and is more common in black Caribbean adults

    than in the general population.

Physical Activity Levels

    There is less reported physical activity and sport among minority ethnic groups than in

    the majority population, which may contribute to negative health implications including higher levels of obesity.


    Cultural barriers to undertaking sport and physical activity include:

    ? Modesty: One of the key cultural issues for Muslim school-aged children

    particularly girls.

    ? Negative attitudes of ethnic minority parents towards their children‟s involvement

    in sporting activity e.g. sporting activities are seen to lack academic credibility.

    ? A lack of awareness of others from their ethnic minority community participating

    in sport.

    ? Fear of personal safety / racial discrimination

    ? Perceived lack of ability

    ? Lack of confidence

    ? Lack of awareness of „appropriate‟ sporting environments

    ? Access: Cost / opening hours

    ? Initiatives/facilities don‟t meet the needs of ethnic minority groups e.g. lack of

    privacy in changing areas, lack of single gender provision, dress code.

    ? Cultural differences that may make more general approaches inappropriate e.g.

    certain sports or activities are inappropriate, which could influence uptake.

2.4 Socio-Economic Group

    Evidence of a relationship between area deprivation and obesity in childhood remains mixed. For general and central measures of obesity, there tends to be increasing

    prevalence with increasing deprivation, though the relationship with deprivation is

    generally stronger in women than in men, and in adults rather than children.

There is however considerable evidence that social inequalities and social exclusion

    contribute not only to lower physical activity but also to poorer health outcomes in

    general, all creating a cycle of disadvantage transmitted to the next generation.

In the case of socio-economic status, evidence suggests that universal public

    awareness campaigns may actually increase health inequalities and that mainstream

    messages and interventions may not reach certain vulnerable groups.

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Step Three assessing the impact

    Based on your evidence, outline the positive, negative and neutral impacts the

    policy/function has, or may have, on the following groups:

3.1 Black and ethnic minority people

    There is evidence suggests that in the long term the needs of minority ethnic groups will

    either be similar to or less than those of the general population.

We conclude that this Strategy does not discriminate against equality groups, although

    in the future more could be done to target specific vulnerable populations. Its aim is to

    redress inequalities and promote equal opportunities, particularly for disadvantaged


3.2 Disabled People

    The evidence suggests that there is a high prevalence of obesity in people with learning disabilities although there is an absence of evidence around differences in obesity prevalence for people with physical disabilities.

    It is appreciated that some of crosscutting actions within the Plan (taken from existing or forthcoming city plans) will have a differential effect on disabled and non-disabled people e.g. cycling, actions linked to employee health. However, there has been considerable thought within the Healthy Weight Action Plan into ways of ensure that a widening of health inequalities is mitigated. In this light, the following actions which it is hoped will impact positively on this group include:

    ? Target Paths to Health activities to specific groups e.g. minority ethnic groups,

    young people, older people, disabled people

    ? A research study into the effectiveness of a NHS Board-wide weight loss

    approach for obese adults with learning disabilities.

    ? Map the accessibility of health improvement initiatives, across the NHS GG&C

    area, to disadvantaged groups (including disabled people)

    ? Hold a series of events aimed at ASL children and their carers/parents to

    provide information on the range of physical activity opportunities across the city

    as well as highlighting the broad health and wellbeing benefits of physical

    activity and healthy food consumption.

    ? Physical Activity Pricing Strategies: Continue to develop target free or low-cost

    physical activity initiatives for vulnerable groups with appropriate support

    ? Use the redesign of learning disability day services as a key opportunity to

    increase physical activity opportunities and healthy eating/food literacy for social

    work clients

    ? Outcome focussed evaluation of Scottish Disability Sport's model for promoting

    access to mainstreamed leisure facilities.

3.3 Women/Men

    The Plan recognises that whilst a life course approach for children is imperative in terms

    of maintaining a healthy weight, it is also important that, in time, the needs of adults who

    are overweight or obese are considered and more support is provided to those who wish to move towards a healthier weight. It is hoped that the following measures will benefit

    all groups.

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    ? Monitor adult overweight and obesity through the Glasgow Health and

    Wellbeing Survey (e.g. questions about height, weight, lifestyle choices) and

    utilise this information to develop local interventions according to need.

    ? Physical Activity Pricing Strategies: Continue to develop target free or low-cost

    physical activity initiatives for vulnerable groups with appropriate support

    ? Raise awareness among Social Work clients about local physical activity and

    healthy eating services ( e.g. as part of support to engage in meaningful activity)

    ? Promote the opportunities for physical activity including local parks, leisure

    centres etc

    ? Develop & deliver a series of presentations for schools & local community

    events to promote the opportunities for physical activity (e.g. walking, cycling


    ? Roll out NHSGGC 50% healthier vending policy across all 5 CHCP sites

    ? Roll out of Healthy Lifestyle Brand Café‟s to Bellahouston Leisure Centre,

    Tollcross Leisure Centre, Tramway Leisure Centre, Gorbals Leisure Centre,

    Scotstoun Leisure Centre, Mitchell Cafe Bar.

    ? Develop stronger links between planning policy and health and well being in

    Glasgow‟s development plans and planning frameworks

    ? Development and approval of the GCC Travel Plan

3.4 Lesbian/Gay/Bisexual/Transgender people

    There were no specific implications identified for this group, other than benefiting from

    the Strategy overall.

3.5 Older people

    Whilst action, that is referenced in the Plan, relating to employers promoting wellness

    amongst staff health as well as action targeted at educational settings are not likely to be beneficial to the elderly population, other general actions (mentioned above in

    Women/Men) include actions that should benefit all age groups. Also, actions targeted

    at disabled people may also benefit elderly people who find themselves with mobility issues.

    Specific action in the plan targeted at benefiting older people includes:

    ? Target Paths to Health activities to specific groups including older people

    ? Raise awareness among Social Work clients about local physical activity and

    healthy eating services ( e.g. as part of support to engage in meaningful activity)

    In developing the plan it was clear that there are already some physical activity initiatives in place across the city that target older age groups including the Silverdeal and Active8 exercise programmes as well as concessionary discounts in culture and

    leisure services for 60+. However, recent mapping exercises across the NHSGGC

    region have suggested significantly fewer opportunities for older people and the frail elderly.

3.6 Younger People

    Whilst the evidence suggests that prevalence of excess weight is higher in adults than in children, it also supported prioritising a focus on children and early years age groups as

    the starting point in taking a „life-course‟ approach aimed at long-term prevention of excess weight in individuals.

    On the basis of this evidence and the opportunities for long-term prevention in children through school and early years settings there are a series of actions on tackling

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early prevention of excess weight problems.

    Whilst these policies are intended to benefit children primarily, some are also likely to support parents and families in understanding the importance of healthy weight and

    making healthier choices in relation to diet and physical activity.

These actions include to:

    ? Hold a series of events aimed at ASL children and their carers/parents to provide

    information on the range of physical activity opportunities across the city as well

    as highlighting the broad health and wellbeing benefits of healthy food & physical


    ? Develop a childhood obesity intervention programme

    ? Fully implement The Infant Feeding Strategy & Action Plans ? Develop a pilot project in selected secondary schools where first year pupils are

    maintained on school premises at lunchtime in order to eat school lunch ("The

    Big Eat In")

    ? Improve access to indoor/outdoor places for play and recreational activities and

    identify barriers to use

    ? Development of Plans to improve the monitoring of childhood BMI measurements

    ? Target Paths to Health activities to specific groups including young people

    ? Introduce "fast food" exclusion zones around educational establishments and to

    monitor the impact of this initiative

    ? Develop a healthy in-house tuck policy to cover all educational settings, including

    "after school clubs" (pre-school through to secondary)

    ? Develop a set of recommendations aimed at carers and parents to educate and

    encourage them to prepare healthier based packed lunches / snacks, including

    advice on portion sizes. Each school to monitor compliance using an annual


    ? Physical Activity Pricing Strategies: Continue to develop target free or low-cost

    physical activity initiatives for vulnerable groups (including low income families,

    disabled people) with appropriate support

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Stage Four taking action

    Detail the actions you will take to remove or mitigate any actual or potential negative

    impacts identified, and to build on positive impacts. Include timescales and


    The role of diet and physical activity in improving health and wellbeing must be considered alongside the beliefs and attitudes which underpin health behaviour in

    different groups, and the design of culturally-appropriate programmes to promote the

    adoption of optimal eating patterns and improving physical activity levels.

We must collectively ensure that any intervention strategy considers the need for

    information, skills training, motivation, social support and development of positive social

    norms, which will vary between the identified groups.

4.1 Black and ethnic minority people: Gaps/Action

    ? There is enormous diversity in culture, traditions and food habits both between

    and within different ethnic minority groups and even within a single family. When

    producing interventions relating to food, the importance of having culturally

    appropriate dietary information for particular ethnic minority groups will be

    stressed to those actioned to do this.

    ? Develop and promote a range of sporting/physical activity initiatives targeted

    at BME communities (both community based and integrated into existing

    facilities) and consult fully with the target communities prior to development and

    implementation of such initiatives.

    ? Ensure that services recognise and address the issue of racial discrimination.

    Responsible Services for Action: Cordia LLP, GCC Education, GCC Procurement

4.2 Disabled People: Gaps/Action

    ? Concessionary discounts for CSG leisure services currently cover those with

    disability working allowance, disability living allowance and those with disabled

    person‟s railcard.

    ? Discounts are also available for those with learning disabilities as well as their

    carers but continued and increased promotion of these discounts is essential.

    ? There needs to be increased provision for the monitoring of the health

    inequalities experienced by disabled people.

    Responsible Services for Action: CSG, CHCP, NHSGGC

4.3 Older People: Gaps/Action

    ? Partners should consider more opportunities for physical activity for older

    people and the frail elderly.

    ? The main emphasis of this strategy was tackling obesity and overweight.

    However, given the Strategy‟s broader remit of “healthy weight”, there are

    potentially more opportunities for action around promoting better elderly

    nutrition and protect the vulnerable in this area. Such actions should be

    considered during the development of the Council‟s forthcoming food policy an

    action highlighted within the Staff Health Action Plan. Whilst there are actions

    around connecting with elderly people through Social Work Services and through

    adopting planning procedures that take food access and access to opportunities

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