Prevention Needs A Whole System Approach… So That’s The Approach We Took

It comes as no surprise that nutritional issues in Scotland remain dominated by consideration of malnutrition in its two-faceted manifestations: under nutrition and over nutrition.  Under nutrition affects over 10% of free living adults over 65, and a third of hospital in-patients and care home residents are undernourished on admission.  At the other end of the spectrum, over nutrition affects a fifth of children at school entry and by adulthood it occurs in two thirds of the population.  Furthermore, there are variations within our populations with those living in deprived communities being at greatest risk.

Whilst malnutrition is largely preventable, the magnitude of malnutrition problems cannot be over emphasised and solutions necessitate public health nutrition approaches.  But what does that really mean?  There are many definitions of public health nutrition in the literature and this one resonates well with me:

“Public health nutrition applies population health strategy to the resolution of nutrition problems.  Its fundamental goal is to fulfil the human right to adequate food and nutrition.  It is in the interest of the public, involves participation of the public and calls for partnership with relevant sectors beyond health.”

Beaudry & Delisle (2005, Canada)

As we know, the underlying environmental and behavioural drivers perpetuating malnutrition exist in complex and multifaceted systems.  Tackling malnutrition effectively therefore requires the development of sustained ‘whole system’ approaches. This means joining up the many influences that impact on malnutrition, it also means promoting transformative, coordinated action across a range of sectors and agencies, many of which will be outside the NHS.  Working across multiple disciplines and agencies helps to identify opportunities to support individuals at key points throughout their lives and to reduce the occurrence and impact of malnutrition.  So where do we start?

This is the approach we have taken in Dundee to tackle the issue of over nutrition in the City.

In October last year our multi-agency Dundee Healthy Weight Partnership hosted a unique event in centre of the City.  We aimed to kick start a movement to help people to eat as well as possible and be as active as possible, in order to be a healthy weight.  Our campaign used a design-led approach to catalyse a first step and create a shared understanding of the benefits of a healthy weight.

GroupOver 100 people attended representing NHS, Dundee City Council, Dundee Health and Social Care Partnership, further education, voluntary and commercial sectors.  Members of the public were there too.

The event was introduced by Dr Drew Walker, Director of Public Health and wrapped up at the end of the day by me, Joyce Thompson.  The challenges and opportunities of achieving and maintaining a healthy weight were outlined by inspirational child healthy weight advocate and TV expert Professor Paul Gately, with our local expert Dr Laura Stewart, Weight Management Service Lead for NHS Tayside, outlining the picture in Dundee.  Scotland’s Chief Nursing Officer, Professor Fiona McQueen who has led by example by personally taking positive steps to achieve a healthy weight, contributed to the day along with a diverse range of public, private and voluntary sector organisations who shared ways of doing things differently.

SafariOn the day participants had first-hand experience of the challenges to eating healthily and being active in the City when they went on ‘street safari’ to carry out various tests in the ‘real world’. They also had the opportunity to learn in detail about a series of initiatives happening across the City and, connect themes and programmes around healthy eating and physical activity.

The outcome of the day was a first step in helping people to develop combined values, messages and practices that are owned and shared across the City.  It included over fifty individual and organisational pledges to further these aims and make them part of the culture of the City of Dundee.​

For more information, visit the website


Written by: Joyce Thompson, Dietetic Consultant in Public Health Nutrition 



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