Complexity & Challenges in Public Health Interventions by Dr Sonia Ahmed

2025-12-01 15:08:18 UTC

Obesity is a complex issue, with many contributing factors, including the “obesogenic” environment, which can lead to excess calorie consumption and physical inactivity (1). There is no one solution to tackle such an ingrained problem and local action to promote healthy weight across the life course requires a coordinated collaborative approach to support change

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The disproportionate impact on individuals and families living in more deprived areas means that the status quo on obesity is no longer acceptable

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At a local level, there is the opportunity to build on this momentum, to tackle key local environmental drivers of obesity and support people living with obesity, aligning with actions at a national level

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BUILD SUSTAINABLE EATING HABITS

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A whole systems approach to obesity epitomises a ‘Health in All Policies’ approach, drawing on local authorities strengths, supporting their key priorities and recognising that they can create their local approaches better and more effectively by engaging with their community and local assets

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A whole systems approach can add value by providing the opportunity to engage stakeholders across the wider system to develop a shared vision and actions that tackle the more upstream drivers of obesity, that are outside the realms of public health.

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effect of collective actions is greater than the sum of the individual actions – identifies, implements and aligns actions that have wider impact across the local system

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supports a community centred approach to tackling health inequalities – involving local communities, in particular disadvantaged groups, can better reflect the local realities, help improve health and wellbeing and reduce health inequalities

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Obesity is complex with no one single solution. It needs to become everyone's business to tackle obesity, requires prioritisation.

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The causes of obesity exist in the places where we live, work and play, where the food and built environment often makes it difficult to make healthier lifestyle choices.

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Conversely, obesity systems are complex with many changing interrelationships. This can be clearly seen in the Foresight Tackling Obesities Future Choices – Project Report systems map (1) which is made up of a series of interconnected ‘sub-systems’: societal and cultural influences, food production, food consumption, biological factors, individual psychology, individual activity and environmental factors. This type of system is a social system because people are involved in, and influence, all aspects of the system. Social systems are always complex and largely unpredictable. Complex issues such as obesity, tend to require long-term, systemic approaches. Senior leader buy-in and a change of mindset may be required to support this new long-term way of working

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Co-production essential. Whole systems approach required. Foresight report - Tackling obesities: future choices - project report (2nd edition)

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maximises all the assets in the local area, including community assets – recognising and identifying local assets can help build on the particular strengths of communities

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develops transferable workforce skills and capacity – relevant and applicable for other complex issues

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recognises the potential of all partners to contribute – NHS organisations, local authority departments and the education, business and voluntary sectors all have a significant role to play in improving the population’s health

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Approach to obesity needs to be agreed collectively by local stakeholders to reflect the local context. This is key to using a Whole Systems approach.

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societal and cultural influences, food production, food consumption, biological factors, individual psychology, individual activity and environmental factors

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Consider the resources needed to establish and run the system network in terms of strategic input, the CWT roles (including administrative support) and governance. This should be considered at the start of the process to ensure adequate resources are identified and allocated.

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Recognised that adopting a WSA is a new way of working for some local areas - requires commitment, energy, drive and importantly local political and senior level buy-in. Requires sustained and systemic action and buy-in from systems leaders. This is essential to support implementation and enable local authorities to work differently and test new approaches.

2025-12-01 15:20:00 UTC

Political implications come from the need for government and local authorities to allocate resources and support to implement and sustain the whole systems approach. This includes funding for public health services, partnerships with local businesses, and community engagement initiatives.

Business implications focus on the economic benefits of reducing obesity rates, which can lead to improved productivity, reduced healthcare costs, and a healthier workforce. Additionally, promoting healthy weight can enhance the reputation of businesses and attract more customers.

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The ethical implications of a whole systems approach to obesity involve ensuring that all stakeholders, including individuals, families, communities, and public health professionals, are involved in the decision-making process. This approach requires a commitment to equity and justice, ensuring that all communities have equal access to resources and support for healthy weight.

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• progress – What progress has been made with the approach and actions? • risk – What risks are associated with delivering this approach? How will these be mitigated? • inequalities – What is the likely health impact of actions on inequalities? Are inequalities impact assessments being undertaken and monitored? • critique – What could be done better? How could this be achieved? • community ownership – Is there community representation, engagement, trust and ownership across the approach? (further detail below)

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Examples Rooftop gardening was trialled to improve local access to fresh vegetables for vulnerable families in a Chicago neighbourhood. Whilst the gardens did not bring about the anticipated improvements in fruit and vegetable intake, the trial did lead to the widespread adoption of rooftop gardens because landlords discovered that they improved the insulation of older apartment buildings. The tenants also enjoyed getting to know each other while tending the gardens.

2025-12-01 15:21:43 UTC

It is clear that no one organisation has all the answers or has all the responsibility for tackling obesity and promoting a healthy weight. It is ‘everybody’s business’. A whole systems approach enables local leadership, across stakeholders and communities, and helps deliver local ownership to make a difference to how obesity and its causes are tackled.

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individuals and communities who want to engage, have the capability, opportunity and motivation

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wider determinants of health- poverty, housing, education,

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A systems approach encourages distributed leadership within a local authority (8). Leaders should be skilled in bringing people together, facilitating discussions, making sure differences are considered and that everyone is heard (22, 23). This leadership style generates buy-in from a wide range of partners, enables understanding and can lead to better use of local assets and resources through aligning actions. It also enables flexibility and helps maintain momentum to sustain the project

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Other people's livelihoods depend on people buying fast food, jobs, employment investment in the area.

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business rates from fast food chains and independent outlets

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A person has freedom of choice as to how they want to live, what they want to buy

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income generation form advertising