Director of Public Health Annual Report 2022: Preventing heart disease and stroke in Buckinghamshire

The health behaviours that increase the risk of cardiovascular disease are smoking, unhealthy eating, drinking too much alcohol and being insufficiently physically active. These risk factors increase the risk of cardiovascular disease but also contribute to the development of clinical risk factors such as high blood pressure, obesity, diabetes and high cholesterol that also increase the risk of cardiovascular disease. Addressing these risk factors holistically would also decrease the risk of many other diseases, including cancer and dementia, and improve many other aspects of life from birth to old age, increase economic productivity and contribute to a better quality of life for residents.

However, changing behaviours is hard and these behaviours do not occur in a vacuum. These behaviours are influenced by the social, economic, cultural and physical environment in which people live. For a person to change their behaviour they must have the Capacity (including knowledge, skills and ability), Opportunity and Motivation to perform the desired Behaviour – known as the COM-B model of behaviour change. For instance, it is hard to eat healthily if you do not have enough money. It has been shown that families from the poorest tenth of the population need to spend 75% of their disposable income to eat the recommended healthy diet. Likewise, if there are not safe places to play, safe walking or cycling routes to school, work or shops it is harder to build in the required level of physical activity into the day.

In addition, most health-related behaviours are shaped in childhood and adolescence and are influenced by a wide range of factors when we are an impressionable age. The health behaviours of young people are strongly influenced by the people they see around them, including parents, other adults and their peers. For instance, we know that children who have parents who smoke are more likely to become smokers themselves. The pricing, advertising and availability of food and alcohol affect consumption significantly and the food and alcohol industry spend many millions on advertising their products to influence cultural norms and consumption. The density of fast food outlets is higher in more deprived areas. For all these reasons the prevalence of health promoting or health harming behaviours varies across the population and over time. Changing behaviour requires much more than a focus on the individual and their behaviour but a whole system approach that supports the individual to make healthy choices and makes healthy choices the easy choices.

Stopping smoking is a good example of the variety of interventions needed to change behaviour: legislation creates ‘smoke free’ environments making it harder to smoke in public places, cigarettes are less affordable because of taxation, pictures on packaging show the real effect on people bodies, cigarettes are less visible within society due to a lack of advertising, and smoking cessation services support people develop skills to stop smoking.

To enable people to live healthy lives we must understand their barriers to making behaviour change and what would help them make a change. This differs for diverse groups of people. The best way to do this is to use co-design to involve people in shaping and testing and evaluating services and interventions that they will want to use. Co-production takes this process one step further where communities and individuals help deliver the service or intervention themselves. Effective behaviour change also requires that we understand people’s views on the wider environmental changes that would be necessary to enable behaviour change.

Evidence shows that interventions that alter our environments to promote health, such as structural changes that require little or no action from individuals, see the largest population health gains and gains in the most vulnerable communities compared to individual-based approaches. For example, more than 50% of the population are overweight or obese. A strategy that focuses solely on changing the behaviour of individuals one person at a time cannot reverse this epidemic. A whole system approach at population level is required that addresses a

wide range of factors such as food formulation, pricing, advertising, availability of healthy food and social norms.

Recognising the importance of effective behaviour change, we are training teams in the council, NHS and wider partners in the use of the COM-B model described above to co-design services with communities.

We are also rolling out the Making Every Contact Count programme to support behaviour change across the council and partners. Making Every Contact Count (MECC) is an evidence-based approach to behaviour change which uses the day-to-day interactions people and organisations have with others to cascade health and wellbeing messages and information, whilst supporting people to make plans and identify actions that will improve their health. MECC gives people the skills to have ‘healthy conversations’ with their friends, family and community which can help sow the seeds of change and improve health and wellbeing

Public Health and partners have trained 245 people in MECC, including people from several organisations including adult social care staff and social care providers, voluntary and community organisations, schools, food banks, housing trusts and parish councils.

We are also working with partners across Buckinghamshire to produce multiagency strategies and action plans on the four risk factors that consider the impact of the wider environment on health behaviours. This includes strategies and plans on:

• physical activity
• tobacco control
• whole systems approach to healthy weight
• The Buckinghamshire Drug and Alcohol Strategy is being reviewed and updated by the local multi agency partnership in 2022.

The next section looks at each of these behavioural risk factors in turn and highlights what we can do about them locally.

Smoking is a major cause of cardiovascular disease (CVD) and accounts for approximately one of every four deaths from cardiovascular disease nationally. Smoking is also the single biggest driver of inequality in death rates between the least and most deprived communities. Over half the difference in the risk of premature death between the least and most deprived is due to smoking.[1] Most smokers started smoking in their teenage years and the addictive nature of tobacco makes it more difficult to stop.

People who smoke are also 30-40% more likely to develop type 2 diabetes and need more insulin to regulate their blood sugar.[2] Dementia is also more likely to develop in smokers than people who have never smoked.[3]

The risk of cardiovascular disease increases with the number of cigarettes smoked per day and the numbers of years people have been smoking. Even people who smoke fewer than five cigarettes a day may show signs of early cardiovascular disease. People who smoke 20 cigarettes a day are six times more likely to have a stroke compared to non-smokers. Exposure to second-hand smoke can also cause heart disease, heart attacks and strokes in non-smokers.

Smoking rates have been falling nationally for many years and during the COVID pandemic in 2020, in England at least 300,000 people quit smoking successfully. Over two million people cut down on the number of cigarettes they smoke each day.[4] However, during the first lockdown in 2020, a study found that there was a 25% rise in 18 to 34-year-olds who smoke - resulting in more than 652,000 new smokers among this age group.[5]

In Buckinghamshire, it is estimated that about 11.3% of adults smoked in 2019. While the prevalence of smoking in Buckinghamshire has been falling and is lower than the national average, unfortunately our smoking rates have increased since 2017 when 9.6% of adults were smokers in Buckinghamshire.

The prevalence of smoking varies across residents in Buckinghamshire. Men have higher smoking rates than women. One in five people living in our most deprived areas are smokers compared to one in ten in our least deprived areas. Residents in routine and manual occupations are 2.5 times more likely to smoke in Buckinghamshire compared to people in managerial and professional occupations. Almost three in ten unemployed residents smoke compared to one in ten employed residents.

Residents with serious mental illness are three times more likely to smoke (three in ten smoke) compared to other residents (one in ten).

In England, residents from minority ethnic groups are less likely to smoke compared to residents from predominantly white ethnic groups (9.7% of black adults and 10.8% of Asian adults smoke compared to 14.7% of white adults). Within all ethnic groups, women are less likely to smoke compared to men - 15.9% of men in England smoke compared to 12.5% of women.[6] When looking at some minority ethnic groups the difference is larger. For example, 13.9% of Asian men smoke compared to 2.9% of Asian women.[7]

One in every 20 NHS hospital beds are occupied by someone with a smoking-related illness.

In Buckinghamshire in 2019/20 there were 3,085 hospital admissions attributable to smoking resulting in a rate of 957 per 100,000 which is lower than the England average of 1,398 per 100,000.[8] An audit in 2016 of admissions in the local hospital found that one in four were smokers but the majority were not asked if they would like to quit smoking. People who smoke are more likely to have complications after surgery, such as infections or delayed healing, and need to stay longer in hospital.

Evidence shows that smoking cessation interventions delivered as routine within hospitals could have a major impact on the number of smokers making a quit attempt.

The NHS Long Term Plan has set a goal to support people in contact with NHS services to quit smoking. This is based on an evidence-based model already implemented in Canada (Ottawa model) and Manchester (CURE model).

The model relies on health care professionals identifying patients who smoke at the time of admission. Patients then receive brief advice from that health care professional before being referred to a tobacco dependency advisor in the hospital. Patients receive appropriate nicotine replacement therapy and counselling to aid them to quit. The Ottawa Model can improve long-term quit rates by 11% and could save the NHS nearly 100,000 admissions by the end of 2023/24.

The CURE project is also estimated to save 30,880 bed days per year across England.

By applying the Ottawa Model outcomes to the that in Buckinghamshire population, the following benefits over five years:

• 284 lives saved
• 9,429 extra quitters
• net saving of £5,490,884

The best thing all smokers can do for their heart and general health is to quit smoking. Even long-term smokers can see rapid health improvements when they quit. Within one year of quitting smoking, the risk of a heart attack drops significantly. In addition, within five years of quitting smoking, smokers lower their risk of a stroke to almost that of a person who has never smoked.

People’s success at quitting smoking varies 44.5% of people under 18 years old report successful quitting compared to 61.4% of people aged over 60 years old.[9] Men are also more likely to quit successfully at 62% compared to women at 54%. Residents in the most deprived areas are just as likely to try to quit smoking, but they often find it harder to stop smoking compared to people in less deprived areas.[10] Data from ONS (Office for National Statistics) 2012 showed that of all those people who had ever smoked (current and ex-smokers), men and women in the most deprived fifth of areas were less likely to have given up smoking (46.5% and 48.5% respectively) than those in the least deprived fifth (74.0% and 76.0% respectively).[11] Ethnicity does not seem to impact on a person’s chances of quitting.

A wide range of partner organisations in Buckinghamshire, including public and voluntary sectors, are working together to help people to stop smoking and reduce the harm from tobacco. The Buckinghamshire Tobacco Control Strategy sets out our ambitions to achieve a smokefree future for residents. The three main aims of the strategy are to:

1. Continue to reduce smoking prevalence rates and inequalities caused by smoking for adults, children and young people.
2. Reduce the harms associated with second-hand smoke.
3. Reduce the supply and demand of illicit tobacco.

Partners are now working together as the Buckinghamshire Tobacco Control Alliance to implement the annual action plan against the four themes of the strategy: Prevention first, Supporting smokers to quit, Eliminate variations in smoking rates and Effective enforcement.

Work which is taking place to support this includes:

Buckinghamshire’s Stop Smoking Service, Live Well Stay Well, offers free stop smoking support to residents in Buckinghamshire. They have launched a new e-cigarette pilot so that clients can choose this method to support them to quit smoking.

Surgery waiting lists: Increase the number of patients on surgical waiting lists who quit smoking while waiting for their operation, including training staff in Making Every Contact Count (MECC).

NHS Long Term Plan – tobacco dependency services: A dedicated inpatient model that will ensure that all inpatients for acute, maternity and mental health services are screened for their smoking status, offered in-house support services to quit, including access to stop smoking aids such as nicotine replacement therapy, and then discharged into community services. Services must have a fully functioning service, with a trained workforce and appropriate IT systems and processes in place by 2023/24.

Dedicated campaigns: Promoting national campaign such as Stoptober, No Smoking Day and Better Health. Partners are encouraged to also share messages through their own channels. Smokefree Sidelines – a grass roots football campaign aimed at encouraging parents and spectators not to smoke around the pitch sidelines in front of children and young people.

Regular physical activity can reduce the risk of heart disease and stroke by 25%.[12] It also reduces the risk factors that lead to an increased risk of these diseases[13] such as high blood pressure and type 2 diabetes by one third. Regular physical activity can improve cholesterol levels by raising your HDL (‘good’) cholesterol levels and simultaneously lower your LDL (‘bad’) levels.[14]

Recommended levels of physical activity are at least 150 minutes a week of moderate-intensity physical activity or at least 75 minutes a week[15] of vigorous-intensity physical activity.

Physical inactivity (defined as less than 30 minutes moderate physical activity per week) increases the risk of high blood pressure, high cholesterol levels and increase the chances of being overweight or obese and having diabetes, all of which are risk factors for cardiovascular disease. Increasing levels of activity in inactive adults in England to just 30 minutes per week could increase overall life expectancy of inactive adults by three years.[14]

Sitting down for long periods also increases the risk of heart disease, high cholesterol, type 2 diabetes, obesity and even some cancers.16 Increased sitting time is associated with an increased risk of death regardless of physical activity levels, and therefore is now recognised as an independent risk factor in addition to lack of exercise.

In 2020 67.5% of people in Buckinghamshire said they met the recommended physical activity levels which is a slight increase over the last four years. However, studies show that people often overestimate the amount of activity they do. More than one in five adults are currently inactive and this has not improved over this period. The greatest health gains will be made by increasing activity levels in inactive people. If we increased physical activity levels from current 67.5% of adults meeting national guidelines to 71% of Buckinghamshire adults, 163 deaths could be avoided and 59 cases of diabetes prevented over five years (Source: Revised Health Impact of Physical Inactivity Model [2013], 2018).

National data show that men and women have similar activity levels with 62% and 60% respectively reporting that they meet physical activity guidelines.[3] Activity levels generally fall with age, the sharpest decrease coming at age 75+ years. Those who are long-term unemployed or have never worked are the least likely to be active (52%).15 There are also significant differences in activity levels based on ethnic background with 63% white adults, 52% black adults and 48% South Asian adults15 reporting that they meet the physical activity guidelines.

COVID and lockdown had a significant impact on activity levels and the impact has been greater on those with long term conditions, older adults and people from black, Asian and minority ethnic groups.15 The largest fall in activity levels was seen in those with the lowest activity levels initially and so the inequalities in physical activity have widened. Adult physical activity levels decrease as deprivation increases, and if you live within a deprived area, you are almost four times more likely to die early than someone in the least deprived area.[14]

A wide range of partners are working together to help people to increase their physical activity levels and have developed the Buckinghamshire Physical Activity Strategy 2018-2023. There is an annual action plan delivering the four pillars of the strategy: Active Environments, Active Communities, Skilled Workforce and Working Collaboratively.

Two subgroups focusing on older adults (Live Longer Better Alliance) and disabilities (The Sport and Physical Activity for All Network) have also been developed. Work which is taking place includes:

Skilled workforce: Active Medicine – free training for frontline workers and volunteers to improve knowledge, skills and confidence to promote physical activity and empower patients/residents to be more active. A total of 1,301 people have been trained via 68 training sessions.

Managing long-term conditions – providing specialist training for instructors to develop physical activity interventions to support residents to manage their long-term condition(s).

Active Communities and reducing sedentary behaviour: Active Movement is a whole school approach to inspire children and families to sit less and move more. The 12 month programme educates and empowers teachers to include movement into everyday class routines. Four Buckinghamshire schools took part in phase one, involving 1,579 pupils and two more schools joined in January 2022. Schools have reported benefits such as improved concentration levels and better engagement from pupils. For more details on how to implement this programme into your school, home and/or office contact the Public Health team.

The Active Communities pilot launched in May 2021 for wards in Aylesbury (Aylesbury northwest) and Wycombe (Abbey; Booker; Cressex & Castlefield; West Wycombe) to encourage residents to sit less and move more. The programme has been designed to take a whole community approach to help everyone make small changes to increase movement in our daily routine. Within the first six months the project has engaged with 2,777 residents, introduced four Active Park Walks with 575 walkers so far and has linked with over 50 different local services and organisations, which include doctors surgeries, pharmacies, care homes, nurseries, schools, faith settings and community centres. These settings have introduced a range of healthier changes.

Active Environments: Simply Walk – offering over 60 volunteer-led walks across the county, all walkers are welcome whether fit and active, require a walking aid or new to exercise. The service runs all year round, in all weathers, giving the opportunity for residents to meet new people improve physical activity levels and general wellbeing. All walks are led by trained volunteers and range from 30 minutes to over 90 minutes. Walkers can either book online or just turn up and complete a registration form with a walk leader.

Active Travel – multiagency working to increase the number of residents cycling and walking as part of the Active Travel Fund actions of Tranche one and two and supporting schools to achieve the mode shift award as part of the national school travel awards scheme.

Play Streets - implementing temporary road closures on residential roads, to allow for chaperoned children’s play and community connection on the street.

Working collaboratively: Increasing awareness of local activity opportunities – all partners supporting the use of the Bucks Online Directory and the Bucks Family Information Service to stakeholders and residents.

We are working together to support the Buckinghamshire leisure strategy and health based physical activity programmes across the county.

Figure 1: Eatwell Guide[15]

A healthy diet can reduce the risk of heart disease and stroke significantly. A poor diet is one of the biggest risk factors for preventable ill health in England.[17]

The Eatwell Guide (Figure 1) shows the different types of foods and drinks we should be eating – and in what portions to have a healthy balanced diet.[18] Foods high in salt, fat and sugar lead to conditions such as high blood pressure, high cholesterol and obesity, all of which are risk factors for cardiovascular disease.

Eating at least five portions of a variety of fruit and vegetables a day could reduce the risk of deaths from chronic diseases, such as heart disease, stroke and cancer by up to 20%,[19] with each increase of one portion of fruit or vegetables a day lowering the risk of coronary heart disease by 4% and the risk of stroke by 6%.[20] There are variations in fruit and vegetables consumption across communities and only 20% of adults meet the recommended five-a-day guideline in the most deprived areas.[21]

Currently, only 55.4% of adults in England eat the recommended five portions a day, with Buckinghamshire slightly higher at 58.4% (2019/20),[22] with fewer men than women meeting the guideline.23 However, other data sources put the figure even lower, according to Health Survey for England data only 28% of adults and 18% of children are eating the recommended five portions of fruit and vegetables per day, with fewer men than women meeting the guideline.[1]

Too much salt in our diet leads to high blood pressure, which is a major cause of heart disease and 69% of adults in England are estimated to be eating too much salt. For every gram of salt we remove from the average UK diet, we can reduce deaths from heart attacks and strokes and save 4,147 lives per year. Up to 75% of the salt we eat comes from processed foods (for example bread, cheese, meat products like bacon) and food eaten out of the home.[24]

More than one quarter of adults and one fifth of children in England are eating food from out-of-home food outlets (restaurants and takeaways) at least once a week.[25] These meals tend to have higher fat, saturated fats, sugar and salt, and lower levels of healthy nutrients. Often eating meals prepared away from home is linked with cardiovascular disease, with those regularly eating two meals or more per day prepared away from the home having a greater risk of death from cardiovascular disease and cancer.[26] Fast food outlets (including chip shops, burger bars and pizza places) account for more than a quarter of all eateries in England. More deprived areas tend to have higher concentrations of fast-food outlets, with five times more outlets found in these areas than in the most affluent areas.[27]

Food insecurity is when people cannot afford enough food to meet their basic needs.

The poorest 20% of UK households would need to spend 39% of their disposable income on food to meet the NHS Eatwell Guide costs and the poorest 10% would have to spend 75%. This is in contrast to just 8% for the richest 20%.[28]

COVID-19 has increased the number of people in food insecurity and the numbers of people using food banks. Pre-COVID 7.6% of the UK population were facing food insecurity, increasing to 9.9% (5.2 million adults) between February and July 2021.[29] The priority for people affected by food insecurity is to put food on the table that is filling, rather than focusing on the nutritional value of the food.

During the COVID-19 pandemic 40% of adults gained on average half a stone (one stone is the same as 14 pounds in weight).[30] Eating habits during the pandemic changed with a third of people reporting snacking on unhealthy food and drinks at least once a day (35%), an increase from 26% pre-pandemic. Sales data also showed an increase of 15% in take-home snack foods, such as crisps, sweets and biscuits. A quarter of alcohol drinkers also said their intake had increased since the second lockdown, with sales showing a 28% increase in shops compared to 2019.[31] In Buckinghamshire food bank use during the pandemic increased significantly compared to pre-pandemic levels. There are six food banks in Buckinghamshire with the number of food parcels distributed increasing from 16,158 in 2019 to 26,514 in 2021.

A healthy weight is defined using a measure called by a Body Mass Index (BMI).[32] A BMI of more than 25 is defined as being overweight and over 30 as being obese.

Obesity and being overweight is one of the leading risk factors for cardiovascular disease, particularly where people carry excess weight around their waist.[33] In the UK, around one in six heart and circulatory disease deaths are associated with being overweight.[34]

Obese people are also more likely to develop other risk factors for cardiovascular disease. They are more likely to develop high blood pressure and type 2 diabetes than those with a normal range BMI.[35] People who are obese are also 30% more likely to develop dementia than those with normal range BMIs.[36]

The risk of developing cardiovascular disease increases the more overweight a person is.[37] Waist circumference is also an important indicator of the risk of cardiovascular disease. Adults with a very high waist measurement (Men: more than 102cm. Women: more than 88cm) have an increased risk of cardiovascular disease compared to adults with the ‘ideal’ waist circumference (Men: less than 94cm. Women: less than 80cm).

Most adults in the UK are overweight or obese: almost seven in ten men and six in ten women are overweight or obese. Furthermore, 26% of men and 29% of women are obese. Unfortunately, during the COVID-19 pandemic 40% of adults gained on average half a stone in weight, of whom 21% gained a stone or more. [38], Children who are obese are more likely to be obese as adults. [39, 40] One in five children aged ten to 11 are classified as obese.[41]

In Buckinghamshire six in ten adults (63.1%) are overweight or obese, and the numbers who are obese has been increasing since 2017/18. Almost one in five (18.2%) of four to five-year-olds and almost one in three (31%) of ten to 11-year-olds are also overweight or obese. Childhood obesity has also increased since 2017/18 in children aged ten to 11 years.[42]

Both cardiovascular disease and obesity are strongly associated with health inequalities. Both adults and children in the most deprived areas have almost double the chance of being obese compared with the least deprived.[43, 44] In the ward of Micklefield in High Wycombe, one in four Reception age children are overweight or obese, increasing to two in five in Year 6. Likewise, in Southcourt one in five Reception age children are overweight or obese, increasing to two in five in Year 6. This is in comparison to the more affluent area of Greater Marlow where one in seven Reception age children are overweight or obese, increasing to one in five in Year 6. People of South Asian ethnicity also have an increased risk of cardiovascular disease and diabetes at a lower weight compared with white groups.[45]

Obesity is difficult to address, affected by a mixture of social, economic, biological and environmental factors that shape how we live and our individual behaviours. By creating healthier places to live and addressing other factors that affect our health and choices, such as education, employment and income, the quality and safety of the environment and the places we live and work in, it will help people maintain a healthy weight and improve overall health.

Whilst eating a healthy diet and maintaining calorie balance is down to individuals, the availability of food high in calories is now making it much harder for people to maintain healthier lifestyles. It is important the food environment supports people to improve their health. Improving the nutrient content of the food and drink we buy, cook and eat must be a priority at both a national and local level. We can take practical steps at a local level to enhance the healthy eating options available.

We also need to create an environment which provides people with the opportunity to be active and move more throughout their day. The built environment (for example housing, estates, workplaces etc.) can play a significant role in increasing the opportunities for people to be active and can impact on both physical and mental wellbeing. By protecting and enhancing green spaces for allotments, park runs and children’s play areas we can create an environment that helps to shape people’s preferences and behaviours to encourage activity.

Within Buckinghamshire we have recently started taking a ‘whole systems approach to obesity.’ This brings together partners from a wide variety of backgrounds, such as housing, planning, transport, leisure, schools and local communities, to develop and agree on a shared action plan to address obesity, looking at these wider environmental factors.

Food knowledge and environment – improving the food environment to support people to make healthier choices and improve food knowledge and understanding.

Transport – reducing sedentary behaviour and encourage communities to increase active transport and travel options to increase physical activity levels.

Physical activity – increasing physical activity uptake through promotion and increasing the range of activities offered.

Schools – enabling schools to contribute to children and young people achieving a healthy weight, creating consistent messages on food and physical activity for both pupils and parents.

Some examples of community projects we are delivering with communities and partners to increase people’s access to fresh fruit and vegetables, improve their knowledge to cook their own nutritious meals and try their hand at growing their own produce are included below:

Grow to Give encourages people to grow more food in their gardens and allotments and donate this surplus to food banks and community fridges in their local area to support people experiencing food insecurity. It was set up by residents Justine Hamer and Sheila Bees in Aylesbury and Wycombe in 2019. With support and funds from Buckinghamshire Council and Feedback the scheme has gone from strength to strength with 14 allotment sites and 200 community growers now participating.

In 2021 the community of growers donated 3.22 tonnes of produce for food parcels that supported over 600 families, that is the same weight as 403 baskets of fruit and vegetables, three giraffes or two family sized cars.

In 2022 the project will partner with five new allotment sites in the Chesham and Iver/ Wexham area in addition to the 14 existing sites in Aylesbury and High Wycombe. The project relies on the generosity of local food growers and champions at each allotment site, helping to keep the scheme running on the ground. We are also keen to expand to as many plot holders as possible so even more produce could be donated.

The project has also developed 20 recipe cards and videos to ensure people receiving the produce get healthy and simple recipe ideas to use the donated food. It also helped develop a community of eco-friendly growers and held eco-growing master classes to support growers get the most out of their site, engaging 100 people in the sessions.

Starting your own scheme is a simple, fun and healthy way to bring your community together while helping those in need. On the Grow to Give website there are free downloadable resources including a how to guide, posters to advertise the scheme at your allotment or in your local community.

Grow It, Cook It, Eat It brings communities together to create shared growing sites in their local area. Open to all, the sites provide a supportive area where people can develop their skills, knowledge and confidence to grow their own fruit and vegetables. There are currently four sites across the county in High Wycombe, Aylesbury and Chesham, with plans to develop a further two sites in the Iver and Buckingham areas. Each site is led by an experienced ‘Expert Gardener’ who is on hand to offer support and guidance as needed, with the aim being the local community will take ownership of the site and keep it going long-term.

During the set-up phase of the sites this year, many community members and local organisations have generously stepped forward offering workforce, tools, sheds, greenhouses and plants to help get the sites off the ground.

The project also has a cooking element which launched late 2021. Local community volunteers are trained to empower and inspire others to cook healthy and nutritious meals from scratch. Delivering a five-week cookery course, volunteers cover topics such as healthy meals on a budget, basic cookery skills and reducing waste.

For further details of each of the growing sites, and to register your interest in getting involved on a growing site and/or as a volunteer cookery tutor, please visit the Grow It Cook It Eat It webpages (healthandwellbeingbucks.org).

The veggies in containers project was developed to show people how easy it is to grow their own food regardless of the space they have available whether in the garden, on balconies, in window boxes and even indoors.

As part of the project Restore Hope (Chesham and Latimer), The Vineyard Foodbank (Aylesbury) and The Women’s Cultural Arena (High Wycombe) distributed a total of 251 growing kits to households who were currently using their services. Kits included containers, soil, seeds, equipment, and full instructions to allow people to try their hand at growing. Each kit also came with recipe cards enabling people to cook healthy and nutritious meals with the foods they have grown.

The project was well received by those involved with many stating they had increased confidence to try growing their own vegetables. Those with young children found the children really got engaged and provided opportunities for shared enjoyment with parents, but also provided educational value and introduced children to new foods.

Buckinghamshire Council commissions some weight management services through our integrated lifestyle service, Live Well Stay Well.46 Additional funding was received in 2021/22, for a one-year period, from the government to support weight management in groups with higher need of these services.

A review of current services and people accessing them in relation to need for weight management services identified three groups of people who were not attending services in the numbers expected: men, people from minority ethnic backgrounds and those with mild learning disabilities. Services were further targeted to areas with the highest rates of diabetes, and excess weight in adults which were Aylesbury and Wycombe.

We worked with the following organisations to help improve healthy eating and healthy weight in these groups:

A service for adults with a mild learning disability, based on developing the knowledge and understanding of food, nutrition, and weight issues. Taking a practical approach, they are educating people around shopping for the right food, reading food labels, cooking and trying new foods and selecting healthy foods, as well as including physical activity into everyday life.

A local community organisation will provide lifestyle advice and physical activity sessions that are culturally appropriate to the black and ethnic minority population of High Wycombe.

The charity of Wycombe Wanderers Football Club, using the appeal of football to deliver healthy weight services. Providing men and women only sessions across both High Wycombe and Aylesbury.

A community interest company working to improve the health of the people of High Wycombe through education and engagement in health fitness and mental wellbeing. Providing dedicated services for men and black, Asian, and ethnic minority groups, the Fitness Garden deliver services using both face to face contact and technology to keep people motivated and engaged in their journey to losing weight.

The UK’s largest male only weight loss programme. Based around a football league where all players want to enjoy football, lose weight and get healthier. The league is not just decided on goals scored, but also weight lost. Sessions start with dietary advice (and a weigh-in) followed by 28 minutes of football. Sessions run in both Aylesbury and High Wycombe.

We are currently reviewing the outcomes of each of the above programmes to help support future commissioning of services across Buckinghamshire.

Chronic alcohol consumption of more than 3.75 units per day (approx. 280ml wine or 660ml beer) is associated with an increased incidence of high blood pressure and of cardiovascular diseases, such as heart attack, heart failure and stroke.47 One unit is 8g of pure alcohol and a standard glass (175ml) of wine contains 2.1 units and a bottle (330ml) of beer contains 1.7 units. This calculator works out the number of units in a particular drink.

Global estimates indicate that the alcohol accounts for 16% of high blood pressure worldwide.48 Regular excess alcohol consumption also contributes calories which may lead to weight gain and abnormal heart rhythms can be exacerbated by alcohol consumption.

UK health advice is that, for both men and women, it is safest not to drink more than 14 units of alcohol a week to keep alcohol health risks to a low level. It is estimated that over one quarter (29%) of Buckinghamshire residents drink more than 14 units per week, compared to 26% nationally. This equates to 120,000 adults in Buckinghamshire drinking above recommended levels.

On average, people on low incomes drink less alcohol than people on higher incomes. However, people from deprived areas are more likely to die or suffer from a disease related to their alcohol use.[49]

Adults in ethnic minority groups are less likely to report drinking alcohol at a hazardous, harmful or dependent level compared to white groups.[50]

The Buckinghamshire Drug and Alcohol Strategy is being reviewed and updated by the local multi-agency partnership in 2022. The updated Buckinghamshire strategy will also take account of the new national drugs plan.

As part of the NHS Health Check simple questions are asked about people’s health. This includes how much alcohol people drink, enabling advice about alcohol to be offered. Further details are available on the NHS website.

Buckinghamshire Council commissions a range of services to support people with problematic alcohol use.