Jessica Attard, Portfolio Manager at Guy's and St Thomas' Charity, and Toby Green, Policy and Research Manager at RSPH, explain their work looking into how the public realm promotes or hinders healthy eating and activity.

As an urban health foundation, Guy’s and St Thomas’ Charity focuses on tackling a few and particularly complex health issues impacting people in its South London boroughs of Lambeth and Southwark, and well beyond.

The Charity runs a ten-year programme to help address childhood obesity in urban areas. A key part of this is understanding how environments impact on the ability of children and teenagers to keep a healthy weight. Our streets – how they’re designed and what they have to offer – make up for a large part of those environments and, to learn more about this, the Charity partnered with the Royal Society for Public Health (RSPH).

Together, we set out to find out more about how the public realm promotes or hinders healthy eating and activity, and specifically how local school children experience it. This included analysing the street environment across all 42 wards of Lambeth and Southwark, fieldwork in 13 of the key high street areas, and first hand interviews with 30 school children across the two boroughs.

A scale of obesity-promoting streets

Although much of the insight generated in this project came through focus group sessions, public polling and street interviews with young people, the starting point for our research was developing a scale to measure the obesogenic environment – that is, to what extent a space promotes obesity. This was based on a well-established approach by RSPH and looked at the key drivers of childhood obesity. It provided a measure of how unhealthy an urban area can be – taking into account elements like fast food takeaways and convenience stores, but also prevalence and quality of local parks and leisure centres. 

Looking ward by ward across Lambeth and Southwark, it was interesting to see where this obesogenic scale married up with childhood obesity rates – but also where it did not. While the general trend for high obesity rates in highly obesogenic environments showed up as expected, several outliers made it clear that we needed to look more closely at children’s lived experience of the streets. 

In essence, we are missing significant pieces of the puzzle if we look just at a child’s ward of residence. The ward level picture provides a useful overview of borough-wide trends but cannot capture the fluidity of young people’s lives and how far they travel to meet friends, play and, perhaps most significantly, go to school. In urban settings there are many spaces in a child’s life, and these are not always near a child’s home.

Context is key

One key message to emerge from this exercise is that the context in which a child experiences their environment really matters. For example, we found that the same shop can be more or less healthy depending on how much money a customer has available to spend.

The importance of context means that, among other things, we need to identify the crucial windows in a child’s day when they are most exposed to the obesogenic environment, and work out how to intervene in ways that provide healthier options and opportunities in those windows. A key example is the period of the day when children leave the school gates – with time to spare, change in their pocket, friends to follow, and a junk food offer within minutes on foot.

This came through most strongly in the focus groups and street interviews we did in Lambeth and Southwark. During these, children detailed all the reasons fast food outlets wound up as the most convenient, cheapest, and most popular after-school destination. In some cases, unhealthy fast food outlets have become de facto extensions of the school environment, with teachers on patrol outside and the school rules sellotaped to the window. This is all compounded by the commonplace ‘school kids discount’ at fast food shops – often advertised explicitly in shop front windows and offered to anyone in a school uniform. 

Lack of options

One thing that became increasingly clear was how aware children are of the fast food offer that clusters around their schools, and the ways that they are being targeted as consumers. As one child put it, “If you wanna go to a fried chicken shop you find the nearest secondary school, and then you know, there’s gonna be one there.” They also showed an awareness that they wouldn’t be getting the same treatment if they went to school in a more affluent part of town.

Ultimately, what really struck us about this work was the gap in provision for teenagers. We hear time and again that teenagers are attracted to fast food outlets as a safe and sociable space rather than for the food itself. For us, this all speaks to the need to provide a positive offer to kids on their way home from school – not just keeping fast food outlets away from the school gates, but offering attractive alternatives at the same time. 

Off the back of this joint research, the RSPH has published Routing out Childhood Obesity, a collection of calls to action across sectors to ensure everybody plays their part in creating healthier streets for our children.

To find out more about the work of the Charity on childhood obesity, visit www.gsttcharity.org.uk.