Agenda Document Pack - Community Planning Board - 11/02/2026
Moray Council · 11 February 2026
Back to Community Planning Board — 11 February 2026 and its agenda
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Community Planning Board Wednesday, 11 February 2026 NOTICE IS HEREBY GIVEN that a Meeting of the Community Planning Board is to be held at Committee Room, Council Office, High Street, Elgin, IV30 1BX on Wednesday, 11 February 2026 at 14:00. BUSINESS 1. Sederunt 2. Minute of the meeting held 26 November 2025 5 - 12 3. Whole Systems Approach - Physical Activity (Update) and Healthy Weight (New) Report by Executive Director Education Housing and Communities, and Consultant in Public Health, NHS Grampian 13 - 126 4. Update on Poverty in Moray Report by Elizabeth Robinson, Consultant in Public Health, NHS Grampian 127 - 142 5. Director of Public Health Annual report 2024-25 Report by Professor Shantini Paranjothy, Director of Public Health 143 - 146 6. Place Director and Community Planning Partnership Charter Report by Chief Executive, Moray Council 147 - 150 7. Health and Transportation Action Plan (2024-2029) Report by Timothy Mackay, Service Manager Transportation 151 - 158 8. Wildfire Update Verbal Update by Head of Operations and Environment, Moray Council 9. AOCB Page 1
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THE MORAY COUNCIL Community Planning Board SEDERUNT Councillor Kathleen Robertson (Chair) Councillor Amber Dunbar (Depute Chair) Ms Connie Calvo (Member) Ms Karen Greaves BEM (Member) Councillor Sandy Keith (Member) Councillor Scott Lawrence (Member) Ms Jackie Maclaren (Member) Councillor Marc Macrae (Member) Mr Grant Moir (Member) Ms Shantini Paranjothy (Member) Mr David Reid (Member) Mr Dennis Robertson (Member) Chief Superintendent Kate Stephen (Member) Councillor John Stuart (Member) Ms Caroline Webster (Member) Mr Andrew Wright (Member) Councillor Bridget Mustard (Outside Body Appointee) Gp Capt Sarah Brewin (Non-Voting Member) Ms Sarah Medcraf (Non-Voting Member) Lt Col James Walker (Non-Voting Member) Clerk Name: Lindsey Robinson Clerk Telephone: 07966 120593 Clerk Email: committee.services@moray.gov.uk Page 3
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Minute of Meeting of the Community Planning Board Wednesday, 26 November 2025 Committee Room, Council Office, High Street, Elgin, IV30 1BX PRESENT Ms Connie Calvo, Councillor Amber Dunbar, Ms Karen Greaves, Councillor Sandy Keith, Councillor Scott Lawrence, Councillor Marc Macrae, Councillor Bridget Mustard, Ms Shantini Paranjothy, Mr David Reid, Mr Dennis Robertson, Councillor Kathleen Robertson, Chief Superintendent Kate Stephen, Mr Andrew Wright. SUBSTITUTES Sarah Riley-Evans (Community Development Officer, RAF Lossiemouth) attended on behalf of Group Captain Sarah Brewin. Sarah Kane (Barrack Staff Officer, 39 Engineers, Kinloss) attended on behalf of Lieutenant Colonel James Walker. Gavin Miles (Director of Planning and Place, Cairngorms National Park Authority) attended on behalf of Grant Moir. APOLOGIES Group Captain Sarah Brewin, Ms Jackie Maclaren, Ms Sarah Medcraf, Mr Grant Moir, Councillor John Stuart, Lieutenant Colonel James Walker, Ms Caroline Webster IN ATTENDANCE The Executive Director Economy, Enterprise and Operations; Executive Director Education, Housing and Communities; Chief Officer Moray Integrated Joint Board; Head of Growth, Planning and Climate (Chief Planning Officer); Head of Operations and Environment; and Lindsey Robinson, Committee Services Officer, all Moray Council, and the Place Director for Moray, Scottish Government. 1. Chair Councillor Kathleen Robertson chaired the meeting. 2. Minute of meeting held 20 August 2025 The minute of the meeting of 20 August 2025 was submitted and approved as an accurate record of the meeting. Item 2. Page 5
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3. Proposed Schedule of Meetings for 2026 and 2027 The meeting had before it a report by the Executive Director Education, Housing and Communities, Moray Council, inviting the Board to agree the schedule of meetings for 2026 and 2027. Following consideration, the Board unanimously agreed the meeting dates for 2026 and 2027 as undernoted: • Wednesday 11 February 2026 • Wednesday 3 June 2026 • Wednesday 19 August 2026 • Wednesday 2 December 2026 • Wednesday 10 February 2027 • Wednesday 9 June 2027 • Wednesday 1 September 2027 • Wednesday 24 November 2027 4. 2025-26 Quarter 2 LOIP Performance Monitoring Report The meeting had before it a report by the Executive Director Education, Housing and Communities, Moray Council, informing the Board of the performance against the Local Outcome Improvement Plan (LOIP) for the period to 30 September 2025. During consideration, Councillor Robertson sought assurance that the current indicators would show outcomes and not just actions. In response, the Executive Director Economy, Enterprise and Operations, Moray Council, advised that some outcomes had a lot of activity, and the indicators were a good way to show the activity happening on the ground. She further advised that it was not always easy to link back to the outcomes. The Executive Director Education, Housing and Communities, Moray Council, added that the long-term indicators often had factors out with our control. She further added that can lead to tracking outputs rather than outcomes but that it would be focused on further for the next LOIP. The Interim Director of Public Health, NHS Grampian, was of the opinion that the report needed to show an indication of progress towards specific targets and asked if this could be picked up in future reports. This was agreed. Councillor Keith sought clarification on whether the focus of the childcare development was primarily on the hard-to-reach groups. In response, the Executive Director Economy, Enterprise and Operations, Moray Council, advised that it was a targeted approach towards supporting those not in work to find employment. The Chief Executive, Moray Council, added that more childcare places would be made available through different providers and childminder flexibility. Page 6
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Following consideration, the Board unanimously agreed to note progress reported in the templates hyperlinked to the report. 5. Wildfires - Notice of Motion The meeting had before it a report by the Executive Director Economy, Enterprise and Operations, Moray Council, inviting the Board to consider the actions arsing from the Notice of Motion relating to Wildfires submitted to a meeting of Moray Council on 27 August 2025 and agree the next steps. Councillor Robertson advised that the draft letter included at Appendix 1 should be edited by partners and responses collated before the letter is sent to remove any political slant. The Board joined the Chair in thanking the Scottish Fire and Rescue Services (SFRS) and other agencies for their work during the wildfires. Area Commander Wright welcomed the work done by the Cairngorms National Park Authority (CNPA) but sought clarification on how the by-laws would be policed. In response, the Director of Planning and Place, CNPA, advised that policing of the by- laws would be at priority, high visitor areas, as they could not be everywhere. Chief Superintendent Stephen added that policing the by-law would be a geographical challenge and would require the public and CNPA rangers to report it to Police Scotland. The Head of Operations and Environment, Moray Council, was of the opinion that the benefits to the by-laws were clear, but enforcement would be difficult. She added that to form an action plan there would need to be commitment from partners to the action points raised in the notice of motion. Councillor Robertson advised that the action points should be taken in order to get an idea of where partners were on each of them. She added that action 1 should be looked at by partners and also include Scottish Land and Estates (SLE), renewable energy companies, RAF, and Army, and should be viewed form Moray as a whole. The Scottish Government Place Director for Moray was of the opinion that a summit discussing local issues was a good starting point. He advised that debriefs were happening at Government level with the SFRS and other agencies and that would feed into a national Wildfire Strategic Plan. He further advised that prevention was key and that the feedback from the public awareness campaigns and wildfire summit could be feedback into the local summit. Councillor Robertson and the Chief Executive, Moray Council, advised the Board and the Scottish Government Place Director for Moray that Moray Council had not been invited to any of the Scottish Government wildfire discussions. The Scottish Government Place Director for Moray advised that he would take that back to the team involved. Page 7
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The Director of Planning and Place, CNPA, stated that although CNPA were the first to introduce by-laws, they would have liked to have seen a national approach. He added that it was a bigger regional issue rather than just local. The Head of Operations and Environment, Moray Council, stated that it was an issue that affects us on a local, regional and national level but action needs to start somewhere and suggested that the Scottish Government provide an update as to the national plan, as the agenda for any local summit would be informed by the direction of the Scottish Government. Area Commander Wright was of the opinion that a summit in early spring would be more beneficial to allow work to get underway before the warmest of the weather began. He was also of the opinion that the letter being sent should be delayed until after the Scottish Government update has been received. The Chief Executive, Moray Council, invited the Scottish Government to attend the summit and present their plan and speak to local partners. The Scottish Government Place Director for Moray stated that he was happy to support what had been suggested and would provide an update for the clerk to circulate. The Interim Director of Public Health, NHS Grampian, advised that public and environmental health could feed into the summit by supporting any communication on prevention and providing psychological support for those affected by the wildfires. The Area Manager Moray and Orkney, Skills Development Scotland (SDS) sought clarification on whether learning had been looked at from other local authorities. The Director of Planning and Place, CNPA, advised that Moray was the first local authority to look at this. Area Commander Wright added that Aberdeenshire Council have asked questions around it but have not tested anything yet. Councillor Lawrence was of the opinion that prevention should be a large part of the strategy and that every agency should be working on a communication strategy. The Chair of the Moray Integration Joint Board (MIJB) suggested that Dumfries and Galloway could share their experiences of the wildfires with us and that he agreed that the summit should be held earlier in the year. The Chair of the MIJB left the meeting at this juncture. The Scottish Government Place Director for Moray advised that it was colleagues in environment and justice who were taking this forward, but he would ask the question. The Chief Executive, Moray Council, asked the Head of Operations and Environment, Moray Council, to also check with her networks. The Director of Planning and Place, CNPA, advised that they had employed a communications agency to look at how their communication was dealt with and he added that he would give an update at the summit. Page 8
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Following lengthy consideration, the Board unanimously agreed to: i. note the notice of motion; and ii. support and deliver actions 1 and 2 within the Notice of Motion to hold a summit by Spring 2026 with all stakeholders affected by the recent wildfires including private and public agencies to develop an Integrated Wildfire Management Plan for Moray, and to work with the Park Authority to learn from the work underway in the Cairngorms; iii. delay action 3 until after the summit has taken place; and iv. all partners editing the draft letter and comments being collated before the letter is sent from the Board Chair, as described in action 4. 6. Highland and Islands Regional Economic Partnership - Recent Strategic Developments The meeting had before it a report by the Executive Director Economy, Enterprise and Operations, Moray Council, outlining the progress with delivery of the Highlands and Islands Regional Economic Strategy (RES) and also providing a short update on governance changes at Moray Economic Partnership. It was agreed that this paper would be heard in conjunction with item 7 “Regional Transformation Opportunities” as this report concerned raising awareness amongst Board members of Regional Transformational Opportunities (RTOs) that have the potential to drive economic growth in Moray and consideration of the role of the Board and its members in realising these opportunities. The Depute Chair of the MIJB left the meeting at this juncture. During consideration, Councillor Lawrence sought clarification on how we see the community benefit as most investment in the area is in infrastructure not people. In response, the Executive Director Economy, Enterprise and Operations advised that the infrastructure needs to be in place to help the community and will provide a lasting impact of creating more jobs and industry support. The Head of Growth, Planning and Climate (Chief Planning Officer), Moray Council, advised that there would be a paper to committee early next year showing the link to the Local Development Plan. The Area Manager Moray, Highlands and Islands Enterprise (HIE) was of the opinion that the new RTOs were good, but the existing developments also need to be looked after. He advised that conversations between partners were needed to ensure that Moray was a competitive area in its own right so that we can keep people here. He further advised that there were a lot of unknowns when looking at structure and process, but the conversations needed to start. He was further of the opinion that anything undertaken should be a public/private collaboration that linked into the community wealth building agenda and futureproofed. Page 9
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Councillor Robertson advised that community wealth building was on the agenda for the next Convention of the Highlands and Islands (CoHI) meeting and that the Moray Council community wealth building plan needs to be embedded into the wider partnership. The Chief Executive, Moray Council, was of the opinion that the Council community wealth building plan needs to be expanded to include all partners do that there is one partnership plan. The Area Manager Moray (HIE) suggested a session on community wealth building as a subject in its own right as each partner will have its own definition. He added that all partners would be bound by their own governance structures but there should be areas that everyone could agree on. The Interim Director of Public Health, NHS Grampian advised that she would get her team to make the connection between community wealth building and different NHS strategies and she would feed back to the Board. Councillor Robertson advised that North Ayrshire Council had a video about their experience and would see if it could be shared with the Board. Following consideration, the Board unanimously agreed to: i. note the progress to date with the Regional Economic Strategy Delivery Plan; ii. note work on going in Moray Economic Partnership and recent governance changes; iii. note Highlands and Islands Regional Transformational Opportunities (RTOs) and what could be realised in Moray; iv. consider the part each member can play in helping to maximise these opportunities; and v. support the Skills Summit for Moray on 4 December 2025. 7. Moray Pathways Energy Skills and Workforce Summit The meeting had before it a report by the Regional Skills Planning Lead, SDS, providing an update on the planned Moray Pathways Energy Skills and Workforce Summit to be held on 4 December 2025 at UHI Moray, in partnership with the Moray Pathways network and wider stakeholders. The summit is being organised as a place-based approach to embedding the Highlands and Islands specific Workforce North project – an action from the May 2025 Convention of the Highlands and Islands (CoHI) in response to the Regional Transformational Opportunities (HIE, 2025). During consideration, Councillor Lawrence sought clarification on whether state pensionable age was the defining age it used to be with regards to stopping work. He questioned whether people stop work completely or do they go part time or change jobs. Page 10
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In response the Area Manager Moray (HIE) advised that it was a bit of everything, and people do keep working longer. The jobs that will come into the area would be driven by industry but their needs to be the right curriculum and choices in place to make people want to come to the area, but working from 16 to 65 is no longer the norm. The Area Manager Moray and Orkney (SDS) stated that the population was aging so the care sector would need to be looked at and also that the population in the area was declining so partners need to look at how we get people into the area and keep them here. The Chief Executive, Moray Council, was of the opinion that public and private sector will be competing for the same people, so we need to look into attractive options such as part time and flexible working. She further stated that young people were no longer looking for a job for like, they were looking for opportunities around on the job training. The Area Manager Moray (HIE) advised that we need to sell the opportunity not just the job. He further advised that to keep people we need to look at people moving within our organisations and support the upskilling of staff. Following consideration, the Board unanimously agreed to: i. note the purpose, structure, and focus of the Moray Skills Summit 2025; ii. recognise the Summit as a key action in responding to the Regional Transformation Opportunities within Moray and the Workforce North Project established via the Convention of the Highlands and Islands; and iii. support ongoing collaboration through the Moray Workforce Group and partners to deliver agreed outcomes and ensure alignments with regional and national workforce planning framework. 8. AOCB Councillor Robertson stated that a report on the partnership approach to attainment for young people and how the Board can work together to support our young people will be brought to a future meeting. Page 11
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REPORT TO: COMMUNITY PLANNING BOARD ON WEDNESDAY 11 FEBRUARY 2026 SUBJECT: WHOLE SYSTEMS APPROACH – PHYSICAL ACTIVITY (UPDATE) AND HEALTHY WEIGHT (NEW) BY: EXECUTIVE DIRECTOR EDUCATION HOUSING AND COMMUNITIES & CONSULTANT IN PUBLIC HEALTH, NHS GRAMPIAN 1. REASON FOR REPORT 1.1 To provide the Board with an update on the development of the Systems Based Approach to Physical Activity in Moray and ask Community Planning Partner leadership teams to embed the priorities of this approach into relevant local and regional strategies and provide capacity within their teams to support the practical delivery of this approach. 1.2 To provide the Board with information on a new Whole Systems Approach model for Healthy Weight in Moray and request support and endorsement for this approach. 1.3 To set these programmes within the context of the Scottish Government and COSLA Population Health Framework for Scotland, published in 2025. 2. RECOMMENDATION 2.1 It is recommended that the Community Planning Board; Item 3. Page 13
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i. Continues to recognise the importance of these programmes in creating and maintaining good health and preventing ill health, focussing support on the people and communities who need it the most, and changing systems and environments to support individuals to stay healthy. ii. notes the progress made in relation to the Systems Based Approach to Physical Activity (which will be branded Active Moray), scrutinise the plan and strategy content to ensure alignment with strategic outcomes for Moray; iii. embed the priorities from the strategy into relevant local and regional strategies of community planning partners and provide capacity within their teams to support the practical delivery of Active Moray; iv. raise awareness of Health and Social Care Moray’s commitment to lead and progress a Whole Systems Approach to Healthy Weight; and v. endorse the collaborative intentions of the 2 approaches whilst acknowledging the separate working groups to drive forward the distinct actions. 3. BACKGROUND 3.1 At the meeting of the Community Planning Board on 23 October 2024 the Board agreed the following (paragraph 7 of the minute refers); i) note the progress made in relation to developing the Systems Based Approach to Physical Activity in Moray; ii) that Officers would consider looking at a more holistic approach to include healthy eating and obesity; iii) scrutinise the emerging themes and high-level actions to ensure alignment with strategic outcomes for Moray; and iv) encourage and liaise with partners to ensure this approach is embedded within relevant strategies and plans to ensure a whole system contribution. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Scotland’s Population Health Framework (PHF) 2025–2035 is a ten-year plan, produced by the Scottish Government and COSLA to improve life expectancy and Page 14
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reduce the life expectancy gap by 2035, emphasizing prevention, a whole-system approach, and cross-sector actions to create healthier food environments and tackle social determinants of health. Local partners are expected to use the PHF priorities and actions to inform the development and delivery of their Local Outcome Improvement Plans. Improving healthy weight is one of the two initial priorities for the Population Health Framework. This involves: • developing legislation to improve the food environment • increasing the availability and affordability of healthy foods • adopting evidence-based interventions for tackling overweight and obesity • supporting innovation to improve the health of people affected by obesity-related conditions, including type 2 diabetes • supporting wider government priorities such as Good Food Nation, Scottish Dietary Goals, food security, malnutrition and the just transition to net zero to support reducing inequalities A second action is to support the implementation of evidence-based physical activity policy actions as outlined in the National Physical Activity for Health Framework. This will involve: • strengthening collaborative leadership and accountability to actively champion our vision of a more active Scotland through a whole systems approach • creating active environments, policies and opportunities across all places of learning • prioritising active travel infrastructure and support and encouraging active travel behaviour • strengthening access and ensure sustainability of good quality public and green spaces, green networks, recreational spaces, play and sports amenities • embedding the provision of appropriate physical activity opportunities and programmes between NHS Scotland, health practitioners and physical activity providers • integrating communications and public education into both national and local strategies for physical activity • ensuring that sport and active recreation opportunities target people and communities where the need is greatest, whilst supporting those who are already active to remain so • working towards ensuring that everyday physical activity is supported in workplaces in Scotland Page 15
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4.2 Since the initial endorsement from the CPB of the Systems Based Approach to Physical Activity in Moray back in February 2024 and the update report presented in October 2024, stakeholders have continued to develop the emerging themes and high-level actions into a tangible action plan. The culmination of this continued work is the final draft action plan which is available as Appendix 1. 4.3 Since the last update report, the new Physical Activity for Health framework for Scotland has been launched with system partners including COSLA, Scottish Government, sportscotland, Public Health Scotland, Community Leisure UK, Paths for All, Transport Scotland, and Nature Scot. This framework aligns exactly to the approach being taken in Moray which will ensure both local and national synergies and strengthen the potential of success. 4.4 The action plan has been populated through a stakeholders perspective based on evidence, research, and local knowledge. It is acknowledged that the content of the plan is not ideal for public consumption and therefore it was concluded that a strategy document highlighting the key priorities of the action plan be the recommended document for publishing into the public domain. For ease of reference and for national consistency it has been determined to classify this strategy and plan as ‘Active Moray’ moving forward. The strategy document is available as Appendix 2. 4.5 In January 2026 the working group have started to engage and connect with the public on the new strategy through various video reels via support from the Council’s Communications Officer. The action plan is already underway in regard to implementation across the various stakeholders. This plan will be an evolving document that will be reviewed and updated regularly based on stakeholder feedback and public engagement. Healthy Weight 4.6 A Steering Group has been guiding this work locally, and progress has been made following the Leeds Beckett Whole Systems Approach to Obesity method. The Local Levers for Diet and Healthy Weight Report is another guiding document being used by the steering group and is available as Appendix 3. 4.7 The first workshop was delivered in June 2025 where stakeholders began to map the perceived local causes of obesity, exploring the complex and interconnected social determinants of health. A second workshop was delivered in September 2025 focusing on mapping current actions to support healthy weight within the system. A summary of the progress of the healthy weight approach is captured in Appendix 4. Page 16
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4.8 We are now preparing for the next Action Planning Workshop, with the aim of co- designing a Healthy Weight Action Plan that reflects shared priorities and drives meaningful change. 4.9 The Whole Systems approach to healthy weight is governed through the NHS Grampian Public Health Directorate, however, it is important for the local CPB to be aware of this new approach. The draft action plan will be brought back to CPOG/CPB in due course for noting and final endorsement. Collaborative intentions 4.10 As is noted in Appendix 3 physical activity is one of the seven local levers for diet and healthy weight in Scotland. To avoid duplication, it has been agreed that the Active Moray action plan will be the reference point of any physical activity components within the Healthy Weight Action Plan for Moray. A number of stakeholders sit on both the Active Moray working group and the Healthy Weight steering group so awareness of both approaches will be monitored. 4.11 A national Good Food Nation Plan will be published in due course and local authorities, and NHS trusts are required to lead and support the development of local Good Food Nation Plans. Cognisance of the Healthy Weight Action Plan for Moray will be required when developing this plan to ensure alignment and avoid duplication. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) Corporate Plan; Tackle poverty and inequality Build thriving, resilient, empowered communities LOIP: Building a better future for our children and young people in Moray Empowering and connecting communities Improving wellbeing of our population (b) Policy and Legal Improving the health and wellbeing of the Moray community through the creation of an environment that supports healthy eating and physical activity is an integral part of the local vision, and a national priority. Page 17
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(c) Financial implications None arising directly from this report. (d) Risk Implications and Mitigation Failure to endorse and prioritise these whole system approaches will result in continuing pressures on the economy, sickness absence levels, public services and our NHS system due to obesity, long-term medical conditions such as diabetes and coronary heart disease. Our poverty and health inequalities gap will continue to worsen. (e) Staffing Implications None are arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact The report identifies the importance that physical activity and healthy eating places on equalities, social inclusion, and impact on our economy. These recommendations aim to further strengthen our service direction across these 3 priority areas. (h) Climate Change and Biodiversity Impacts None arising directly from this report. 6. CONCLUSION 6.1 The Community Planning Board is asked to; i. Continue to recognise the importance of these programmes in creating and maintaining good health and preventing ill health, focusing support on the people and communities who need it the most, and changing systems and environments to support individuals to stay healthy. ii. notes the progress made in relation to the Systems Based Approach to Physical Activity (which will be branded Active Moray), scrutinise the plan and strategy content to ensure alignment with strategic outcomes for Moray; iii. embed the priorities from the strategy into relevant local and regional strategies of community planning partners and provide capacity within their teams to support the practical delivery of Active Moray; Page 18
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iv. raise awareness of Health and Social Care Moray’s commitment to lead and progress a Whole Systems Approach to Healthy Weight; and v. endorse the collaborative intentions of the 2 approaches whilst acknowledging the separate working groups to drive forward the distinct actions. Author of Report: Kim Slater (Leisure & Culture Service Manager – Moray Council), Lisa Taylor (Health Improvement Team Lead, Moray Health & Social Care Partnership) and Elizabeth Robinson (Consultant in Public Health, NHS Grampian) Background Papers: Appendix 1: Active Moray Action Plan Appendix 2: Active Moray Strategy Appendix 3: Local Levers for Diet and Healthy Weight Appendix 4: Reflecting on 2025 progress on Healthy Weight approach Page 19
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Active Moray Action Plan 2025-2035 Tasks highlighted in green are short term 2026 priority actions Tasks highlighted in orange are long term priority actions 1. Active System Objective: Collaborative actions established, enabling a whole systems approach to physical activity. Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base: Create and strengthen leadership, governance, and accountability for physical activity strategically across the system. 1.1 Strengthen leadership, governance and accountability in relation to physical activity 1.1.1 Active Moray Strategy & Action Plan is created and approved by Moray Community Planning Partnership (CPP) as the oversight governance document to the systems based approach Leisure & Culture Service Active Moray Working Group & Stakeholders Making Recovery Real in Moray Partnership Number of adults in Moray participating in sport or physical activity in the previous 4-week period: Including Walking: 87% (National 82%) Excluding Walking: 56% (National 51%) Baseline data for participants with disabilities. 1.1.2 Active Moray Action Plan is adopted by partner agencies. All 1.1.3 Active Moray Action Plan is reported against every 6mths to CPP. Leisure & Culture Service Manager Bi-annual CPP report produced. 1.1.4 Identify internal and external funding streams that could support successful delivery of All Funding streams and investment identified. Item 3. Page 21
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areas within systems based approach – collective investment/resource 1.1.5 Utilise the Actify platform to access tools, resources, best practice and share best practice relating to Active Moray All Moray content on Actify. 1.1.6 Conduct an Integrated Impact Assessment on the Active Moray strategy and plan Leisure & Culture Service Manager (with input from all partners) Integrated Impact Assessment completed. Evidence Base: Establish collaborative ways of working via multisectoral partnerships as a mechanism to maximise the impact of resources and enable the coordinated implementation of action to increase physical activity and reduce sedentary behaviour. 1.2 Strengthen cross policy/partner cohesion, maximising the impact of resources 1.2.1 Strategic Champions identified to oversee and challenge the Active Moray working group and delivery of the action plan and champion the cross-policy benefits of physical activity to identify policies/strategies/plans where physical activity has an evidenced role and seek opportunities to integrate this over time. Leisure & Culture Service Manager Active Moray Working Group & Stakeholders Strategic Champions identified. 1.2.2 Collaborate on any cross over synergies with the whole systems approach (WSA) on healthy weight for Moray. Merge relevant sections across both system approaches for physical activity/healthy weight. Health Improvement Team Active Moray Working Group & Stakeholders Evidence of collaboration between the WSA to healthy weight and Active Moray. 1.2.3 Scottish Disability Sport (SDS) to support the embedding of inclusion for participants with disabilities across all sub-systems of this approach SDS 1.2.4 Engage and connect with the COSLA Sport and Physical Activity Network and Special Interest Group as required to ensure national and local developments are working in synergy Leisure & Culture Service Manager and Local Elected Member representative Evidence Base: Utilise national and local data and evidence to identify priority populations and enable data driven decision making. Page 22
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1.3 Develop a stakeholder map to understand who is involved in the physical activity system and the connections between stakeholders including outcomes, actions and performance indicators. 1.3.1 Use A Local Information System for Scotland (ALISS) as the platform to assist with this stakeholder map. Sport & Leisure/Physical Activity asset map produced to promote/showcase opportunities available in Moray Active Moray Working Group Locality Network 1.4 Develop and utilise data/evidence to better effect to improve physical activity levels 1.4.1 Research group established to look at physical activity levels in Moray, identify social value and develop consistent data for ongoing monitoring. Moray Council NHS National Partners Scottish Government Evidence Base: Strengthen policy cohesion and finance mechanisms that enable opportunities aimed at increasing physical activity and reducing sedentary behaviour. 1.5 Explore how physical activity could be integrated into participatory budgeting. 1.5.1 Identify opportunities for PB involvement connected with physical activity Moray Council Third Sector Page 23
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2. Active Health and Social Care Objective: Physical activity embedded into routine NHS health care and social care services. Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base: Integrate the NHS Physical Activity Pathway into routine healthcare and existing clinical pathways as part of treatment and rehabilitation for people diagnosed with long term conditions e.g., heart disease, stroke, diabetes, cancer, and mental health conditions, as well as into the care and services for pregnant women, people with disabilities and older adults. 2.1 Integrate physical activity into all relevant clinical settings including primary and secondary care 2.1.1 Social Prescribing models embedded in clinical settings and Making Every Opportunity Count (MEOC) Physical Activity Toolkits circulated as relevant to raise awareness of local activities Health Improvement Team Community Wellbeing and Development Team 2.1.2 Adopt the principles of the Activity Inclusion Model within the pathway SDS NHS 2.1.3 Ensure people with disabilities and those living with long term health conditions have interventions in place to engage in the pathway when involved in clinical services SDS NHS 2.2 Develop partnerships and co-location opportunities with health care and physical activity providers 2.2.1 Link SDS member branch with the NHS PA Pathway to ensure joined up provision/standards SDS NHS 2.2.2 Explore co-location opportunities in Moray for delivery of health and wellbeing services through community hub model. Consideration of public and voluntary location options. As required Moray Council NHS Asset Owners 2.3 Utilise the research, learning and development of the Digital Health & 2.3.1 Promotion and population of Community connections Moray website and associated products – ensuring it becomes a well-recognised guide for all Moray citizens DHI Page 24
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Innovation (DHI) programmes 2.3.2 Expand the Heart of Moray programme wider across the Local Authority area – engaging with all relevant partners DHI Moray Leisure Centre (MLC) Moray Council NHS Evidence Base: Develop partnerships with NHS Scotland and physical activity providers across Scotland to embed the provision of appropriate physical activity opportunities and programmes for different patient populations. 2.4 Apply the PHS Tiered Model of Physical Activity Interventions to review, design and deliver appropriate physical activity services across Moray. 2.4.1 Use the Community Wellbeing Development Team as part of the referral pathway to access re- ablement health groups ran by the community for the community. Distribute the activity programme to wider networks. Utilise ALISS tool Community Wellbeing & Development Team Health and Social Care Moray (HSCM) 2.4.2 Ensure a range of appropriate opportunities are available to meet the needs of people with disabilities and long-term health conditions by adopting the principles of the Activity Inclusion Model SDS Evidence Base: Integrate physical activity into pre-service and in-service training for all healthcare and social care staff and associated roles, which is medics, nurses and allied health professions, healthcare support workers employed by NHS Scotland and all social care staff governed by the Care Inspectorate. 2.5 Develop and deliver physical activity learning to the health and social care workforce 2.5.1 Deliver Grow Well Choices Early Years training to Nursery Nurses and Early Years establishments Health Improvement Team Education Active Schools 2.5.2 Identify Physical Activity champions or volunteers in all Health & Social Care settings to undertake health walk leader training Health Improvement Team Walk Moray Project 2.5.3 Learning and development opportunities for allied health professions around physical activity and inclusion delivered by Scottish Disability Sport (SDS) to ensure equality and inclusion underpins all areas of work SDS NHS Page 25
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Evidence Base: Implement the learning from the Care Inspectorate Care About Physical Activity Improvement Programme to enable social care providers to build physical activity into the daily lives of those they support within care settings, residential care homes and care at home. 2.6 Design and deliver physical activity referral services 2.6.1 Work with organisations, such as SDS, to provide clarity on the standards and requirements to achieve these. SDS are currently part of referral programme within NHSG and can support people with disabilities to be active – enable and promote this across Moray SDS 2.6.2 Embed the referral standards within all processes connected to physical activity referral services All 2.6.3 Create and establish connections with care settings and providers to identify physical activity opportunities All through a single conduit within working group Page 26
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3. Active Sport & Recreation for All Objective: Active participation in sport and active recreation increased across the life course through equitable and inclusive access to appropriate places, spaces and services Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base: Provide universally, welcoming, inclusive, affordable, accessible programmes and mass participation events for people of all ages and abilities across multiple settings; urban and natural environments, community recreation and sports facilities, schools, workplaces and healthcare settings. 3.1 Provide inclusive, accessible and sustainable programmes and events 3.1.1 Active Schools (AS) team continue to offer a universal programme of free activity sessions for school aged pupils across Moray, complimented by events calendar. AS Team 39% of Moray School roll involved in 2023/24 programme (national average 40%) 3.1.2 Moray Council Sport and Leisure Team and Moray Leisure Centre continue to provide activities including swimming, gym and fitness classes via their Fit Life Membership scheme. Sport & Leisure Team MLC Fit Life Memberships 3.1.3 Community participation events such as Parkrun and Junior Parkrun are supported and progressed. Park Run Committee Active Schools & Community Sport Team Park run usage stats 3.1.4 Moray Council Club Accreditation scheme progressed to include all local sport clubs, promoted via Sport in Moray website. Leisure & Culture Service 30 clubs accredited as of July 2025 Evidence Base: Prioritise the least active individuals in Moray 3.2 Prioritise the least active individuals in Moray 3.2.1 Moray Disability Sport Hub Project plan created and delivered to improve opportunities for all Moray residents with disabilities to increase physical activity levels. Community Sports Hub Officer SDS, Grampian Disability Sport, UHI Moray, Outfit Moray SDS national survey - 73% of participants would like to take part in more physical activity. Page 27
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3.2.2 Mental Health Accreditation for Sport project developed to ensure individuals experiencing mental health challenges are supported by club coaches. Community Sport Hub Officer 11 coaches from 9 clubs accredited 2024 3.2.3 Further exploration and development of poverty and sport projects All 3.2.4 Further develop Moray Pride Inclusion Sports Hub project with UHI Moray UHI Community Sports Hub Officer and Clubs 3.2.5 Create Equality, Diversity and Inclusion Map for Active Moray partners – utilising template from Active Schools and Community Sport All 3.3 Support community based interventions 3.3.1 Walk Moray (collaboration between HIT and Walking Scotland). Health Walks available for all population groups across Moray – elderly, pregnant, families, school children Health Improvement Team (HIT) 16 Health Walks currently operating Evidence Base: Build workforce capacity; enhance the knowledge, skills and competency of the workforce to engage, motivate and enable, inclusive and equitable opportunities. 3.4 Build workforce capacity; enhance the knowledge, skills and competency of the workforce to engage, motivate and enable, inclusive and equitable opportunities. 3.4.1 UHI Moray to offer courses from level 5 to degree level in Sport & Fitness. CPD opportunities to be offered in Sports Psychology and Nutrition. UHI Moray UHI Moray stats 3.4.2 Active Schools & Community Sport Team to co- ordinate coach education programme open to school staff, volunteers, young leaders and community club coaches. AS & CS Team Sport National Governing Bodies UHI Moray 30 courses delivered in 2023/24 academic year, with 340 participants. 3.4.3 Provide volunteer and paid workforce with inclusive learning and development opportunities to support embedding of inclusion in practice (i.e. Disability Inclusion Training) AS & CS Team Sport National Governing Bodies Page 28
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4. Active Workplaces Objective: Everyday physical activity enhanced through the workplace Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base - Provide leadership by implementing workplace health initiatives to support employees increase physical activity and reduce sedentary behaviour, particularly through increasing incidental physical activity during the working day 4.1 Engage employers to take on a leadership role to adopt a healthy workplace model - that encourages a holistic approach and culture to inclusive physical activity in the workplace. 4.1.1 Encourage workplaces to sign up to walk at work award and NHSG Step Count Challenge All Employers Paths for All Chamber of Commerce Moray Federation of Small Businesses 4.1.2 Support through NHSG Workplace team to be explored Health Improvement Team 4.1.3 Develop the cycling culture at workplaces through the Cycle to Work Scheme, provision of staff pool bikes (and bike maintenance). Provide staff training and deliver led rides. Council Travel Planning Group All Employers Chamber of Commerce Moray Federation of Small Businesses 4.1.4 Workplaces adopt the principles of the Activity Inclusion Model to ensure employees with disabilities access physical activity and sport opportunities SDS Chamber of Commerce Moray Federation of Small Businesses Page 29
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Evidence Base – Develop and disseminate guidance and promote implementation of workplace health programmes aimed at increasing physical activity, reducing sedentary behaviour and promoting incidental physical activity during the working day for employees, in different occupations and settings, with a priority focus on the least active. 4.2 Develop a Moray workplace health programme with tools and resources available 4.2.1 Identify and collate tools and resources to support a workplace embed physical activity All Chamber of Commerce Moray Federation of Small Businesses 4.2.2 Populate an online platform for Active Workplaces on guidance, tools and resources to access as required All Chamber of Commerce Moray Federation of Small Businesses Evidence Base – Create workplaces that are designed to enable employees and visitors to be physically active in and around the buildings, and access by pedestrians, cyclists and public transport. Page 30
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5. Active Travel Objective: Active travel behaviour influenced and infrastructure for walking, wheeling, and cycling organised across Scotland Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence base: Continue to prioritise investment in walking, wheeling and cycling infrastructure that enables access to destinations and services, as well as actions that influence active travel behaviour to encourage modal shift. 5.1 Support delivery of the Moray 5 Year Active Travel Strategy. 5.1.1 Further develop the Active Travel (AT) network by increasing the Active Travel network with an extra 5% infrastructure over the next 5 years Sustainable Transport Officer National/local partners Increase the AT network with an extra 5% infrastructure over the next 5 years 5.1.2 Develop Active Travel Masterplans for key settlements over 1,200 in population across Moray Sustainable Transport Officer Transport Development and Traffic Teams Strategic Plans and Development Team) Completion of masterplans for all communities over 1,200 population 5.1.3 Embed Active Travel opportunities within new developments through applying Local Development Plan policies to ensure that residential streets are designed to encourage walking and cycling over the use of the private car by providing well connected, safe and appealing routes Scottish Government Transport Development and Strategic Plans and Development Team Sustainable Transport Officer 5.1.4 Encourage and facilitate walking and cycling as leisure and tourist activities to provide benefits to health and the local economy through continued Local and National Partners Sustainable Transport Officer Numbers of participants at events and promotional activities. Cycle Page 31
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partnership working with local organisations such as Outfit Moray, NHS Grampian and Cycling UK. Moray to organise events and activities to trial electric bikes, pedal bikes etc. to promote the health benefits of cycling and walking to residents and visitors to the area. count data from permanent count sites. 5.1.5 Provide new/improved cycle parking at key destinations and transport interchanges in Moray Sustainable Transport Officer HITRANS 5.1.6 Work with local employers (including Moray Council) and their staff to encourage more walking and cycling to and from work. Sustainable Travel Officer Staff Travel Plan Working group National Partners Local Employers Results of Moray Council staff surveys 5.1.7 Work with students and school pupils, staff and parents to encourage more walking, cycling and scooting to and from school/further education through a program of work including Bikeability, School Travel Plans, Daily Mile and School Route Audits. Sustainable Transport Officer Outfit Moray Living Streets Education Team UHI Number of schools/ further education sites with an up-to- date Travel Plan, School Route Audit and Bikeability delivery numbers. Results of HUSS and Travel Tracker 5.1.8 Continue to seek funding from existing sources such as Transport Scotland, HITRANS and Cycling Scotland to Identify new funding opportunities as they emerge to secure funding for Active Travel interventions, as appropriate. Sustainable Transport Officer Local and National Partners Level of funding received through grant applications for new/improved active travel infrastructure Page 32
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and behaviour change programmes. Evidence Base: Engage communities in urban and rural transport planning processes to enhance the design of connected and walkable communities. 5.2 Address issues of transport poverty across Moray. 5.2.1 Work with M.Connect service to ensure residents can travel and access leisure and recreational facilities across Moray as required within opening hours or alternatively use M.Connect to transport individuals/groups to events Transportation Leisure & Culture Evidence Base: Accelerate implementation of policy actions to improve road safety and the implementation and enforcement of traffic speed restrictions (for example 20 mph in residential areas and 30 mph on urban roads). 5.3 Utilise tools and partners to inform Active Travel infrastructure 5.3.1 All new and existing infrastructure schemes to be scored through the Active Travel Prioritisation Tool Sustainable Transport Officer Evidence base: Upskill local authority transport and planning workforce to create inclusive and equitable active travel infrastructure. 5.4 Provide learning opportunities for the transport and planning workforce connected to active environments 5.4.1 Ensure individuals with lived experiences are part of these discussions Sustainable Transport Officer 5.4.2 Disability Inclusion training delivered on a needs- based approach SDS Page 33
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6. Active Places of Learning Objective: Whole school approach to physical activity adopted by all places of learning Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base: Whole School Approach to Physical Activity 6.1 Strengthen physical activity provision within the curriculum 6.1.1 Involvement, promotion, embedding and input in the Moray Physical Education Activity & Sport Health & Wellbeing Learning, Teaching and Assessment Framework Quality Improvement Officer Active Schools Local Partners 6.1.2 Create policies to strengthen commitment to physical activity in schools as significant factor contributing to attainment and achievement such as including physical activity within Moray Education Improvement Plans and individual school plans Active Schools Education Local Partners 6.1.3 Lobby national bodies to support the reintroduction of specialist PE in Primary Schools and explore locally how this could be achieved (or suitable alternative ensuring skilled providers to develop agility, balance, co-ordination skills and core introduction of individual and team sports/activities) Active Moray Working Group CPP 6.1.4 Explore the continued rollout of Active Play training through CALA across early years and primary schools to promote physical activity to support emotional, social and cognitive development Early Years Service Manager 2 schools and 1 nursery to date in Moray 6.2 Ensure the delivery of 2hrs quality PE per week in all schools in Moray. 6.2.1 Undertake an audit (and true baseline) of PE provision across all Moray Primary and Secondary Schools based on the national guidelines (for all pupils) Leisure & Culture Service Education Page 34
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6.2.2 Identify and implement support mechanisms to ensure quality PE is provided Quality Improvement Officer Education Scotland 6.2.3 Re-establish a PEPAS group for Moray (PE, Physical Activity & Sport) that will focus on Moray wide objectives such as 2hrs quality PE, Daily Mile/Walking initiatives, Bikeability etc Active Schools Education 6.2.4 Inclusion training delivered to support the delivery of PE to pupils with disabilities SDS 6.3 Maintain and enhance physical activity opportunities before, during and after the school day. 6.3.1 Re-establish and promote the Daily Mile (or suitable alternative) commitment across all schools – supported by HMIe Education The Daily Mile Foundation 6.3.2 Work with Early Years/Education to implement Play on Pedals programme (funded through Cycling Scotland) Early Years Service Manager 6.3.3 Encourage all Primary and Secondary Schools to work towards the sportscotland School Sport Award Active Schools Education 6.3.4 Active Schools delivery in all Primary and Secondary Schools across Moray (ensuring inclusive opportunities are available for pupils with disabilities by adopting the activity inclusion model) Active Schools Education 6.3.5 Encourage internal and external partners to apply to be a delivery partner within the Flexible Framework (alternative curriculum) and be promoted on community asset map Leisure & Culture Education Evidence Base: Whole of campus approaches to physical activity in colleges and universities 6.4 Enhance opportunities within higher/further education settings 6.4.1 Ensure individuals with lived experiences are part of these discussions UHI 6.4.2 UHI Moray to work with local industries to coordinate volunteering and work experience for students. All UHI Moray Sport staff Page 35
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*Senior Phase developing leadership: 10 hours leading in community *2 x 6-week projects for HNC sports coaching students *To provide FE level 5 & 6 sport and fitness students with 30 hours of volunteering. 6.4.3 To provide CPD opportunities at HNC level to upskill volunteers, and current workforce. All UHI Moray Sport staff 6.4.4 To offer PT/FT courses from Further Education, Higher Education to Degree to develop a workforce of sport, health and fitness professionals. Link to all courses at UHI Moray: Subjects - Sport and Fitness All UHI Moray Sport Staff 6.4.5 To support the delivery of Active Schools and NGB programmes, for example: SDS para sport event All UHI Moray Sport Staff Active Schools 6.4.6 To work with Moray Justice System and NHS to provide physical activity and sport sessions at UHI. Student and staff led sessions. Curriculum Team Leader Moray Justice System NHS 6.5 Active Campus Co- ordinator acts as key conduit for working with partners on opportunities through co-ordinated approach. 6.5.1 Work closely with community sports hub to create opportunities for marginalised students. This is being completed through the Moray Pride Hub for LGBT students and community members providing opportunities to become more active. Active Campus Co-ordinator Community Sports Hub Officer 6.5.2 UHI Inter-Campus sports festival providing students the opportunity to compete against their fellow UHI students on other campuses. Active Campus Co-ordinator 6.5.3 Sport and physical activity for participants with a disability – SFL students participating in various governing body led initiatives such as curling 360 and tartan touch rugby. Partnership formed with Active Campus Co-ordinator SDS Page 36
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local groups for disabled adults to participate in boccia festival, and disability sport festival. 6.5.4 Duke of Edinburgh for Level 5 students – Encouraging local volunteering opportunities, and outdoor activity with Council DofE Officer. Provides secondary award for students on top of their level 5 Active Campus Co-ordinator Council DofE Officer 6.5.5 UHI Moray active travel improvements – working with Outfit Moray, Cycling UK, Cycling Scotland and HISA to make students aware of active travel to and from campus. Events such as bike fayres have been organised with key partners. Active Campus Co-ordinator 6.5.6 Partnership delivery with Active Schools – Curling sessions and festival held at Moray UHI Active Campus Co-ordinator Active Schools 6.5.7 CLD summer programme – Support CLD summer programme with organised activity for new students. Active Campus Co-ordinator Evidence Base: Preservice and in-service workforce development for teachers; enhance knowledge and teaching skills on the value of active play, physical education, adaptative physical activity, fundamental movement skills and physical literacy, and on how to include people with disabilities and the least active. 6.6 Develop and deliver physical activity learning for the education workforce 6.6.1 Inclusion training delivered as part of in-service days SDS 6.6.2 Provision of training, coach education and in- service sessions to support all school/teaching staff to embed physical activity and sports opportunities as part of learning Active Schools Education Scotland Evidence Base: Develop and implement design guidelines for education and childcare facilities; create accessible and safe environments for children and young people to be physically active. 6.7 Create education and childcare facilities that are active places and spaces by design. 6.7.1 Utilise the Out to Play practical guidance document (which focusses on outdoor play) from Inspiring Scotland/Care Inspectorate and Scottish Government when creating/changing space Learning Estate Programme Manager Early Years Service Manager Page 37
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6.7.2 Strategic group representatives act as consultees and involved in the design of physical activity places and spaces Learning Estate Programme Manager 7. Active Places & Spaces Objective: Places and spaces are appropriately designed, created, and maintained to enable people to be physically active in their community Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base: Integrate urban design and land-use policies; to enable and promote walking, cycling and other forms of physical activity by creating connected, walkable communities, with equitable and inclusive public space, as well as pedestrian access to a range of local amenities for daily living. 7.1 Create connected, walkable/wheelable communities that support healthier lifestyles 7.1.1 The Moray Local Development Plan will set out policies and site requirements to create walkable, connected communities to support local living and healthier lifestyles. Masterplans will be prepared for strategic growth areas (e.g. new neighbourhoods). Strategic Planning & Development The Moray LDP Delivery Plan will measure progress of policy implementation. Evidence base: Strengthen access to good quality public and green open spaces, recreational spaces, play spaces and sports amenities through spatial design and community engagement. Ensure equitable and inclusive access to places and spaces to help reduce inequalities. Ensure places and spaces enhance active play to support healthy growth and development in early childhood and adolescents. 7.2 Strengthen access to good quality public open spaces, green networks, recreational spaces (including blue spaces such as river and coastal areas), play spaces and sports amenities 7.2.1 Undertake a Play Sufficiency Assessment (PSA) and prepare an updated Open Space Strategy (OSS) as part of the preparation of the new Moray Local Development Plan which can be used as evidence for developer requirements and to inform other Council services. Strategic Planning & Development Robust evidence base to inform LDP policies and proposals and identify priority areas for improvement/investment across Council Services. 7.2.2 Develop a Leisure/Recreational Facilities and Sports Pitch strategy to identify gaps and priorities for future planning and investment to support healthier lifestyles and economic growth. Leisure and Culture Service SDS Outfit Moray Robust evidence base to inform LDP developer requirements and Council Capital Plan Page 38
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Ensure engagement and consultation with SDS on place and space changes/developments 7.2.3 Work with community groups to develop proposals such as those identified in LPPs and funding bids to improve open space and play provision. Community Support Unit Successful funding bids/projects delivered by community groups. Support the delivery of the core paths plan 7.2.4 Review delivery of Core Paths Action Plan 2023- 2026 and develop proposals for a new Core Path Action Plan to support prioritised actins for maintenance and removing barriers to access on Moray’s Core Path network Open Space team Moray Local Outdoor Access Forum Approval of Core Path Action Plan review and development of new Core Path Action Plan (though Committee). Maintain play areas to a suitable standard 7.2.5 Undertake monthly condition inspections to Moray Council managed and maintained play areas to ensure play areas are safe for use; and carry out an annual independent condition inspection to help prioritise investments in renewal of provision or replacement equipment (subject to capital funding being available from relevant asset owners). Open Space team Asset Managers in Learning Estate, Housing and Open Space teams Overall Play Area Condition Scores Evidence Base: Develop and or apply design guidelines for public amenities; schools, health care, sports and recreation facilities, workplaces and social housing, designed to enable people to be physically active. 7.3 Design public sector facilities to enable people to be physically active. 7.3.1 Cross-service working by public sector organisations to co-ordinate investment to co- locate facilities. Community Planning Partnership Co-ordination of planning and investment in public facilities Evidence Base: Co-locate local services and destinations e.g. schools, healthcare, workplaces, shops and leisure. 7.4 Support the co- location of services and facilities to promote local living 7.4.1 As part of Council transformation of leisure service/estate identify co-location opportunities to support sustainability Leisure & Culture Service Strategic Planning & Development 7.5 Support the third sector to acquire, 7.5.1 Moray Council Sport & Leisure team to support, as required, opportunities for the third sector to Sport & Culture Service Estates and Community Page 39
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asset transfer or develop new amenities that can support physical activity opportunities. submit expressions of interest for community asset transfers Support Team (Moray Council) Evidence Base: Increase the knowledge and skills of planners, transport engineers and architects to create inclusive active environments. 7.6 Increase the knowledge and skills of planners, transport engineers and architects to create inclusive active environments 7.6.1 Engage with the Public Health and Sustainable Transport Partnership Group to utilise training, knowledge and information sharing for all employees Active Moray Working Group 8. Active Communication & Public Education Objective: Communications and public education established as an integral component of a systems-based approach to physical activity in Scotland. Ref Emerging Action Ref No. Tasks (How will it be achieved?) Lead Support Indicator Evidence Base: Follow the ‘best practice principles’ for physical activity communications to develop and implement a physical activity for health communications plan that operates alongside the proposed actions identified across physical activity system. 8.1 Create a communications strategy and plan for Active Moray 8.1.1 Create communications strategy – ensuring demystifying what a systems based approach is. Work with national partners. Ensure strategy considers appropriate ways to engage people with disabilities (e.g. often starts with socialisation as a catalyst to activity). Consider multiple and intersecting barriers to meet the communication needs of people with disabilities. All All PR teams (Moray Council/ NHS/UHI etc) Page 40
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Ensure strategy considers appropriate ways to ensure protected characteristics can access communications where relevant 8.1.2 Utilise the Moray Engage platform to ensure we continually engage the community with Active Moray and listen and embed their feedback in priority areas Leisure & Culture Service PR Team (Moray Council) 8.1.3 Utilise local case studies to bring this approach to life – generates human interest Sport & Culture Service All PR Teams 8.2 Create central platform for physical activity for all 8.2.1 Audit of current platforms and identification of most efficient and effective single source (considerations include Sport in Moray website, ALISS, Community Connections, Discover Pathways to Wellbeing in Moray) All 8.2.2 Create/Refine identified platform to act as that single source and promote accordingly All 8.3 Public education campaigns for physical activity 8.3.1 Ensure messaging uses consistent, inclusive languages and appropriate imagery – nationally and across Local Authorities to ensure the public can relate to this approach regardless of where they reside/visit. Create consistent branding. SDS to share best practice, language, terminology and imagery as appropriate. National and local groups Page 41
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Active Moray Strategy 254559 Item 3. Page 43
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Contents Introduction 5 Our Strategic Priorities 10 Priority 1 – Active System 12 Priority 2 – Active Health and Social Care 13 Priority 3 – Active Sport and Recreation for All 14 Priority 4 – Active Workplaces 15 Priority 5 – Active Travel 16 Priority 6 – Active Places of Learning 17 Priority 7 – Active Places and Spaces 18 Priority 8 – Active Communication and Public Education 19 3Page 45
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Introduction What/Where? Active Moray is the comprehensive physical activity strategy designed for the residents of Moray. This strategy focusses on a holistic approach, connecting physical activity with various aspects of daily life, including travel, work, recreation, learning and community spaces. With constraints to budgets, resources and capacity it is more important now than ever that to improve physical activity levels in Moray we need to do this through collaboration. Creating a more active Moray through the places where we live, work, learn, care and play. – Our Vision 5Page 47
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Why? Public Health Scotland identifies physical inactivity as a leading cause of premature death and a significant risk factor for diseases such as coronary heart disease, Type 2 diabetes and certain cancers. Public Health Scotland estimate that over 3,000 deaths in Scotland per year are attributable to physical inactivity and approximately 47 of these occur in Moray. The 2024 Scottish Health Survey reported that 62% of adults in Scotland met the guidelines for moderate or vigorous physical activity. The proportion of adults meeting the recommended levels decreased as area deprivation increased. 68% of children were reported to meet the recommended levels of physical activity – meaning 32% of children are not meeting the daily recommended levels. Older children were less likely to meet the physical activity guidelines. Being physically active is a fundamental to our overall health and wellbeing. 6Page 48
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Being physically active is a fundamental to our overall health and wellbeing. Engaging in physical activity offers numerous benefits including; • Reducing the risk of chronic disease • Improving cardiovascular health • Manage weight • Strengthening bones and muscles • Reducing stress, anxiety and depression • Improve mood and self-confidence • Enhancing cognitive function • Improving sleep pattern • Increasing energy levels • Fostering social connections • Providing enjoyment • Reducing sick days • Supporting the economy Based on national health data – approximately 60-65% of adults in Moray meet the recommended physical activity guidelines, this drops to between 45-40% for children and young people. 21% of Primary 1 children in Moray were classified as at risk of being overweight of obesity. A range of factors influence physical activity levels in Moray including socio economic status, geography, cultural factors and infrastructure. Some of the barriers include transport, health conditions (ageing population), socioeconomic constraints and lack of awareness of opportunities available. 7Page 49
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Elements of this plan include strengthening colleague and citizen engagement to improve health. 8Page 50
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When/How? This strategy aligns to and contributes to other key policy drivers in Moray such as the; Moray Local Outcome Improvement Plan – in particular the priority areas of building a better future for our children and young people in Moray, empowering and connecting communities and improving wellbeing of our population. Moray Health and Social Care Strategic Plan (Partners in Care) – in particular focussing on prevention and tackling inequality. The plan also aims to continue to build communities where people are safe and care for each other. NHS Grampian Delivery Plan – elements of this plan include strengthening colleague and citizen engagement to improve health, creating the conditions for sustainable change and improving preventative and timely access to care. Local Development Plan – help shape future land use and development across Moray. The key principles that underpin this strategy are: • Addressing inequalities • Equality, diversity and inclusion • Sustainability • Partnership working and collaboration • Taking an evidence-based approach This strategy will be implemented between 2025-2035, with annual review periods. A plan accompanies this strategy, and this plan will evolve and change over time dependant on community need, strategic priorities and capacity. A working group of key stakeholders across the public, private and third sector with a responsibility for physical activity, in its widest sense, have been involved in the creation and development of this plan and strategy. This working group will be responsible for the delivery of this plan and will meet regularly to review and update the plan and ensure timelines are being achieved. The Moray Community Planning Board will have oversight of this plan and strategy. The plan will be monitored on a 6 monthly basis with evidence of progress reported to the Moray Community Planning Board (facilitates agreement from key partners on strategic priorities for Moray and scrutinises performance). 8 9Page 51
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Our Strategic Priorities Active System Establish collaborative actions to enable a whole system approach to physical activity in Moray Active Health & Social Care Integrating physical activity into routine NHS health and social care services Active Sport and Recreation for All Participation in sport and recreation throughout life via equitable and inclusive access to appropriate places, spaces and services Active Workplaces Everyday physical activity enhanced through the workplace 10Page 52
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Active Travel Encourage active travel and influence the infrastructure for walking, wheeling and cycling in Moray Active Places of Learning Universal approach to physical activity adopted by all places of learning Active Places and Spaces Places and spaces are designed, created and maintained to enable people to be physically active in their community Active Communication & Public Education Ensure that communications and public education is an integral part of highlighting the importance of physical activity in Moray and ensuring the public are aware of the opportunities 11Page 53
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Priority 1 – Active System Objectives • Strengthen leadership and accountability in relation to physical activity • Strengthen cross policy/partner cohesion, maximising the impact of resources • Develop and utilise data/evidence to better effect to improve physical activity levels Aim • To ensure everyone involved in getting more people, more active, more often work collectively to make a positive impact to the people of Moray and help influence positive change as a strategic force. 12Page 54
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Priority 2 – Active Health and Social Care Objectives • Integrate physical activity into all relevant clinical settings including primary and secondary care • Develop partnerships and co-location opportunities with health care and physical activity providers • Utilise the research, learning and development of the Digital Health and Innovation (DHI) programmes • Develop and deliver physical activity learning to the health and social care workforce • Design and deliver physical activity referral services Aim • Ensure physical activity is embedded into routine NHS health and social care services in Moray. 13Page 55
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Priority 3 – Active Sport and Recreation for All Objectives • Provide inclusive, accessible and sustainable programmes and events • Prioritise the least active individuals in Moray • Build workforce capacity • Support community based interventions Aim • Ensure all ages and abilities can participate in sport and recreation equitably through places, spaces and services in Moray. 14Page 56
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Priority 4 – Active Workplaces Aim • Work with employers to embed physical activity opportunities through the workplace across Moray. Objectives • Engage employers to adopt a healthy workplace model • Develop a Moray workplace health programme 15Page 57
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Priority 5 – Active Travel Objectives • Connect the existing cycling infrastructure in Moray • Provide learning opportunities for the transport and planning workforce connected to active environments • Utilise tools and partners to inform Active Travel infrastructure Aim • Support the delivery of the Moray 5yr Active Travel Strategy 16Page 58
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Priority 6 – Active Places of Learning Aim • Ensure physical activity is a core component of lifelong learning within early years, schools and further/higher education Objectives • Strengthen physical activity provision within the curriculum • Maintain and enhance physical activity opportunities before, during and after school • Enhance opportunities within higher/further education settings • Develop and deliver physical activity learning for the education workforce • Create educational facilities that are active spaces by design 17Page 59
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Priority 7 – Active Places and Spaces Objectives • Create connected, walkable/wheelable communities that support healthier lifestyles • Strengthen access to open and recreational spaces and sports amenities • Support the delivery of the core paths plan • Design public sector facilities to enable physical activity • Support co-location of services to promote local living • Support the third sector to acquire, asset transfer or develop new amenities Aim • Create environments that enable all ages and abilities to be physically active in Moray 18Page 60
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Priority 8 – Active Communication and Public Education Objectives • Create a communications strategy and plan for physical activity in Moray • Create central information platform for physical activity for all • Public education campaigns for physical activity Aim • To ensure communications and public education is consistent and co-ordinated and highlights the importance of physical activity and the opportunities available across Moray. 19Page 61
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The Moray Community Planning Partnership is a collaboration between Moray Council, Police Scotland, NHS Grampian, Moray College UHI, • Scottish Fire & Rescue Service, Highlands & Islands Enterprise, HITrans, Skills Development Scotland, and tsiMoray. Page 62
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REPORT LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT TOP EVIDENCE-BACKED OPPORTUNITIES August 2023 Item 3. Page 63
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LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT TABLE OF CONTENTS Foreword 5 Abbreviations 6 Introduction 7 1. Restrict food advertising 11 2. Utilise planning to improve food environments 15 3. Strengthen public food procurement and provision standard 18 4. Work with the out of home sector to reduce calories on the menu 21 5. Improve uptake of school meals 25 6. Promote and support physical activity 29 7. Protect, promote, and support breastfeeding and healthy diets for children 32 References 37 Appendix. List of documents reviewed for intitial local lever list 40 Page 65
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5 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT FOREWORD From 2019 to 2023, Obesity Action Scotland (OAS) has been delighted to support the early adopter phase of a Whole Systems Approach (WSA) to Diet and Healthy Weight in Scotland. OAS recognise that the levers to change our food system exist at local and national level and that actions across the whole system will be required to deliver healthy weight for all in Scotland. This report is one of a series of outputs designed to share learning from the early adopter phase and inform and support future WSA work across Scotland. In considering Local Levers for Diet and Healthy Weight, this report has reviewed the evidence in finding and recommending seven measures which can be utilised as part of a place-based approach to addressing diet and healthy weight. Whilst individual-based interventions remain popular, it is population-level change which have the most impact on health. The various levers described in this report are those that exist at local level that are likely to have the greatest benefit on the largest number of people living in Scotland. They should be used first and foremost in our local authorities and health boards, whose remit includes promoting the health of their populations. But some of the interventions in the report also should be considered, where relevant, by voluntary and private sector organisations who wish to support their staff, their communities and their customers. Lorraine Tulloch Programme Lead Obesity Action Scotland For areas who wish to take a WSA to Diet and Healthy Weight, it is recommended that these levers are used to inform your approaches and help guide you in your action planning. I would thank Professor Lindsay Jaacks, University of Edinburgh for her expertise in preparing this report and together we hope that this report can provide guidance and support to those working to make a difference locally. Together we can all shape our food and physical activity environments to support healthy weight and protect and improve the health of the Scottish people. Page 67
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6 HFSS High in fat, sugar, or salt HRS Healthcare Retail Standard NEC National Entitlement Card NHS National Health Service NICE National Institute for Health and Care Excellence NPF4 National Planning Framework 4 OECD Organization for Economic Co-Operation and Development SIMD Scottish Index of Multiple Deprivation SYP Scottish Youth Parliament WHO World Health Organization ABBREVIATIONS Page 68
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LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 1 Throughout this report, “unhealthy food and drink” primarily refers to food and drink high in fat, sugar, or salt. 7 The circumstances and environments in which we live, work, learn, play and socialise shape our health and wellbeing. To improve health in Scotland, we must address the social and commercial determinants of health. Education and willpower are no match for the flood of unhealthy food and drink1 options we are faced with every day. We know environmental interventions work for other commercial determinants of health. The 2006 smoke-free legislation resulted in a 39% reduction in salivary cotinine (a marker of exposure to smoking) among both adults and children living in Scotland within just one year (1, 2). Furthermore, following implementation, support for smoke-free policies increased, including among smokers (3). Building on the success of smoke- free legislation, in 2013, the Scottish Government announced an ambitious aim for a tobacco-free generation by 2034 (4). INTRODUCTION Social determinants of health include poverty and deprivation; the built environment including food outlets, transport systems, leisure centres, and green space; cultural norms around eating and drinking as well as breastfeeding; and schools. Commercial determinants of health include the marketing and sale of unhealthy food and drink; and the marketing of infant formula. As we did with tobacco, we need to focus our efforts on transforming our local environments to stem the tide of unhealthy food and drink, and put healthy food and drink options in reach. “ Page 69
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8 Social and economic factors like income also influence our health. Over the past decade, the association between income and health has potentially grown stronger in Scotland. A recent independent review of health inequalities in Scotland published by the Health Foundation attributed this to three underlying factors: (i) the accumulation of severe multiple disadvantage; (ii) a lack of improvement in living standards; and (iii) austerity (5). The cost-of-living crisis is likely to exacerbate these inequalities. The recent Health Foundation review highlighted the health and experiences of infants and children in their early years as one of three areas of particular concern, citing widening inequalities in risk of obesity at the start of primary school (5). Twenty years ago, 76% of primary 1 children had a healthy weight in both the most and least deprived areas of Scotland (see Figure 1) (6). However, since then, the health of children living in these areas has diverged. Today, children living in the most deprived areas of Scotland are much less likely to have a healthy weight compared to children living the least deprived areas: 70% versus 81% (6). Figure 1 Trends in the percentage of primary 1 children with a healthy weight in Scotland from 2001/2002 to 2021/2022. SIMD, Scottish Index of Multiple Deprivation. 80.0% 85.0% % Prim ary 1 children with a healthy weight School Year 75.0% 70.0% 65.0% 60.0% 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18 18/19 19/20 20/21 21/22 SIMD Quintile 1 (Most Deprived) SIMD Quintile 2 SIMD Quintile 3 SIMD Quintile 4 SIMD Quintile 5 (Least Deprived) Page 70
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LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 9 Whilst outside the scope of this report, it is important to emphasise that actions taken to address child poverty are likely to have beneficial effects for diet and healthy weight. “ We refer to relevant Scottish Government guidance published elsewhere for local levers for tackling child poverty (see resources). When it comes to diet and healthy weight, no one action is going to result in huge benefits. A package of synergistic actions, each having a small effect on their own, and together having a larger effect, is needed. We suggest prioritising the implementation of actions in this report, monitoring progress, celebrating successes, and adapting to strengthen what works and drop what doesn’t work. Committing to an iterative process of implementation, evaluation, and adaptation is key. The scientific consensus is that the rise of obesity has largely been driven by changes in food consumption rather than changes in physical activity (7). However, physical activity can help people maintain a healthy weight and has many health benefits independent of any impact on body weight. The role of place is also recognised within this document. The places where people live, work and play can have an impact on their health and are shaped by many factors including but not limited to national and local policy. If we want to create places that enable health and realise the full potential of communities, we must take action to make them health supporting, health enabling places. In order to identify local levers for diet and healthy weight, several documents were reviewed, as summarised in the Appendix. An emphasis was placed on documents published in the past 5 years with the exception of National Institute for Health and Care Excellence (NICE) guidelines for working with local communities on obesity, which were published in 2012. From this document review, a long list of effective actions for diet and healthy weight was created. From this long list, many actions were excluded because they were beyond the scope of local areas. For example, fiscal measures such as taxation. Other actions were excluded because they focused on individual behaviour change. For example, the World Health Organisation’s (WHO) best buy, “Nutrition education and counselling in different settings to promote healthy diets.” Ultimately, seven actions remained on the list. For each of these local levers, a separate web search was conducted to identify evidence specific to the UK / Scottish context. Tackling Child Poverty “Best Start, Bright Futures: tackling child poverty delivery plan 2022 to 2026” “Developing a local child poverty action report: guidance”Policy Toolkit” Policy Toolkit” Page 71
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10 The seven local levers for diet and healthy weight2 in Scotland are: 1. Restrict food marketing 2 . Utilise planning to improve food environments 3. Strengthen public food procurement and provision standards 4. Work with the out of home sector to reduce calories on the menu 5. Improve uptake of school meals 6. Promote and support physical activity 7. Protect, promote, and support breastfeeding and healthy diets for children. In the chapters that follow, we outline how to take each local lever forward, why each lever is important in the Scottish context, and evidence of effectiveness particularly in the UK or Scottish context, when available. There are significant opportunities to shape our food environments including the implementation of the Good Food Nation (Scotland) Act 2022 and associated Good Food Nation plans and the National Planning Framework 4 (NPF4) and associated local development plans. It is possible to halt the rise in obesity in Scotland and achieve a healthy weight for all. No one of the local levers alone will have a huge impact, but with continued evaluation and improvement, together they can. Local levers for diet and healthy weight are actions available at the local level – for local authorities, health boards and schools, as well as the private and third sectors – to support community health by ensuring everyone can get affordable, healthy food and drink, and integrate safe and enjoyable physical activity into their daily lives. 2 Not in priority order. No one of the local levers alone will have a huge impact. As many of the levers as feasible should be considered for local implementation to maximise impact. Page 72
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11 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 3 For example, Lothian Buses Ltd is owned by the City of Edinburgh Council (through Transport for Edinburgh Ltd), Midlothian Council, East Lothian Council, and the West Lothian Council. See Consolidated Financial Statements for the year ending 31 December 2019: https://www.lothianbuses.com/ wp- content/uploads/mdocs/200622_Consolidated_Financial_Statements.pdf. However, further evaluation of Arm’s Length External Organisations such as Lothian Buses Ltd is needed to understand the feasibility and likely impact of HFSS advertising restrictions. 4 HFSS is based on the UK Nutrient Profiles Model. The council adopted the idea of “no brand is banned,” meaning that products, rather than companies, were directly affected by the policy. 5 These restrictions include a 9pm watershed for HFSS products and restrictions on paid-for advertising of HFSS products online. HOW TO TAKE THIS LOCAL LEVER FORWARD 1. Restrict advertising of products high in fat, sugar, or salt (HFSS) by local authorities themselves. 2. Restrict HFSS product advertising on transport networks owned by local authorities.3 3. Restrict HFSS product advertising by third parties on council-owned spaces, assets, and events. RESTRICT FOOD ADVERTISING1 These actions are aligned with those taken by Bristol City Council, which prohibits HFSS product4 advertising for all advertising generated by the Council and advertising and sponsorship by third parties on council-owned spaces, assets, and events. The Bristol policy also prohibits the advertising of a food or drink brand where no food or drink product is featured directly. The policy did not apply to local sponsorship deals such as sports teams. An estimated 30% of all advertising space in Bristol is council-owned (8). We suggest starting with HFSS food and drink, but allowing the list to expand in the future based on emerging evidence regarding the impacts of, for example, brands that sell predominantly unhealthy food and drink. Ultimately, people – especially children – should be protected from any advertising of unhealthy food and drink as well as brands that primarily sell unhealthy food and drink. WHY IT’S IMPORTANT IN SCOTLAND New restrictions on the advertising of HFSS food and drink will not come into effect in the UK until 1 October 20255. Moreover, these new restrictions only cover TV and online; outdoor advertising is excluded. Therefore children will continue to be exposed to HFSS product advertising on buses, bus shelters, billboards, and at sporting events. Indeed, exposure to outdoor marketing is likely to increase once the new restrictions on TV and online marketing come into effect in 2025. A modelling study by Kantar Page 73
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12 estimated that this displacement from TV and online to outdoor marketing will be about 26% (9). This is concerning because outdoor marketing has been shown to be effective: repeated exposure on the way to school or work promotes the purchase of products from that brand. A study by researchers at the University of Glasgow used Google Street View to identify 9,701 bus stops across the Central Belt of Scotland, 1,845 (19%) of which had advertisements, and linked this to accelerometer data from a subset of children in the Growing Up in Scotland study (10). The most commonly advertised products were fast food (15% of advertisements) and confectionary (7% of advertisements) (10). Children living in more deprived areas and in urban areas had greater exposure to unhealthy food and drink advertisements because they had greater exposure to bus stops (10). Similar results were observed in an Edinburgh-specific evaluation of bus stop advertising (11). Taken together, these findings suggest that advertising restrictions that target the transport network may help to address health inequalities. In addition, no current or proposed advertising regulations restrict brand advertising. Some research has shown that advertising by unhealthy brands alone – regardless of the product advertised – is enough to promote unhealthy behaviour. For example, one study conducted by researchers at the University of Liverpool found “exposure to adverts for ‘healthy’ meal bundles did not drive healthier choices in children, but did promote liking for fast food” (12). With regards to the scale of local authority owned and/or controlled outdoor advertising spaces, a 2021 report by Obesity Action Scotland and East of Scotland Partnership and funded by Scottish Government evaluated this for four local authorities: The City of Edinburgh Council, Scottish Borders Council, Fife Council, and West Lothian Council (13). The scale varied widely across local authorities, though many unknowns remained, particularly with regards to phone boxes, wayfinders, fleet advertising, and real time passenger transport information (see Table 5 in the report adapted below in Table 1). All local authorities planned to expand the scale of their current advertising and expressed some concern regarding restricting the content of their owned outdoor advertising spaces due to potential revenue losses. Box 1 - Resources Restrictions on the advertising of less healthy food and drink on television programme services, on-demand pro- gramme services, and online services: “Health and Care Act 2022, Schedule 18: Advertising of less healthy food and drink” “Nutrient Profiling Technical Guidance” from the Department of Health and Social Care (2011) Existing restrictions on advertising and promotion of infant formula and follow- on formula: “The Foods for Specific Groups (Infant Formula and Follow-on Formula) (Scotland) Regulations 2020” Bristol City Council Advertising and Sponsorship Policy Sustain’s local government guide for restricting unhealthy food advertising: “Healthier Food Advertising Policy Toolkit” Page 74
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13 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 6 The London Underground was also among the first public places to ban smoking, in 1987, decades before it was banned in all workplaces. See “Smoking in Public Places Investigative Committee. Scrutiny of Smoking in Public Places in London.” London: Greater London Authority; 2002. Table1 Scale of local authority owned and/or controlled outdoor advertising spaces across four local authorities in Scotland (13). Billboards Bus shelters Taxis Public transport Events / sponsorship City of Edinburgh 2 large hoardings, 4 digital screens coming soon 29 digital 6-sheets Licensing agreements Controlled by Arm’s Length External Organisations Roundabouts, parks and green spaces, events: Oktoberfest, Christmas and Hogmanay, Edinburgh Festival Fife None 6 owned by Fife, 153 owned by Clear Channel Only signage relating to taxi business is allowed None Roundabouts - mainly for local business sponsorship West Lothian Unknown 69 owned by Clear Channel 431 without advertising Licensing agreements None Unknown Scottish Borders Insignificant outdoor advertising, owned by local authority or otherwise. Planned expansion to refuse vehicles and possibly bins, primarily for signposting and local business promotion. EVIDENCE OF EFFECTIVENESS The Transport for London restrictions on advertising of HFSS products came into effect in February 2019. Restrictions covered the London Underground6; rail network; some buses, trains, taxis; bus stops and land outside train stations. Researchers at the London School of Hygiene & Tropical Medicine looked at trends in household HFSS purchases for 36 pre-restriction weeks and 44 post-restriction weeks in London and, for comparison, North of England (where such a restriction had not been implemented) (14). They found a relative reduction in average weekly household energy purchased from HFSS products of 1,001 kcal (7%) in London compared to North of England (14). Significant relative reductions in average weekly household purchases of fat (58 g), saturated fat (26 g), and sugar (81 g) were also observed (14). It is important to point out that these relative reductions were in the context of increasing HFSS purchases. This means that the restrictions were associated with a reduced rate of growth of HFSS purchases in London compared to North of England rather than an absolute reduction in purchases. Changes were largely driven by reductions in chocolate and confectionery and puddings and biscuits rather than sugary drinks, sugary cereals, or savoury snacks (14). This could be because sugary drinks, sugary cereals, and savoury snacks have non- HFSS substitutes (e.g., low or zero calorie drinks). No differences were observed across population subgroups, but given the small sample size (977 households in London and 993 households in North of England), subgroup results should be interpreted with caution (14). Page 75
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14 These reported changes are larger than those reported following the implementation of the UK Soft Drinks Industry Levy (average weekly household purchases of sugar declined by 30 g) (15). This suggests that restrictions on the marketing of HFSS products across transport networks has the potential to be a highly effective intervention. A modelling study estimated that the policy likely resulted in ~95,000 fewer individuals with obesity (16). And, the good news for local authorities is that advertising revenue was shown to increase by £1 million in the first quarter following the restrictions, not decrease (17). The Bristol City Council HFSS advertising restrictions did not come into effect until April 2022, and so only results of the baseline, pre-implementation survey (conducted between January and March 2022) are currently available for Bristol and the comparator area of South Gloucestershire (8). In the week prior to baseline survey completion, 41% of respondents (53% in Bristol and 31% in South Gloucestershire) reported noticing advertisements for HFSS products (8). Younger respondents were more likely to report noticing advertisements for HFSS products than older respondents: 73% in 11-34 year-olds versus 42% in 65+ year-olds in Bristol; 45% in 11-34 year-olds versus 27% in 65+ year-olds in South Gloucestershire (8). In Bristol, respondents living in less deprived areas were less likely to see advertising for HFSS products, but this area patterning was less consistent in South Gloucestershire (8). Of the 836 advertisements on display in Bristol, 21% were on foods and 4% on non- alcoholic drinks. Thirteen percent of advertisements would be subject to the new Advertising and Sponsorship Policy (which restricts not only HFSS but also alcohol, gambling, and pay-day loans – though no current advertisements were on alcohol or pay-day loans and just 0.1% were on gambling, so most of the advertisements affected would be HFSS foods) (8). What does this mean for Scotland? The results are likely to be smaller than those observed in London considering that 68% of London participants in the above- mentioned study typically used public transport (14) whereas just 26% of workers in Edinburgh report taking the bus to work (the highest proportion in Scotland), according to the 2011 Census (18). However, those walking to work or school may also be exposed to outdoor HFSS advertisements including on bus shelters; in 2021, 16% of working adults in Scotland travelled to work by walking and 56% of children travelled to school by walking (19). Page 76
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LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 15 HOW TO TAKE THIS LOCAL LEVER FORWARD Apply the National Planning Framework 4 (NPF4) approach to the food environment, which includes food growing, retail and non-retail outlets, promoting a town centre first approach and consideration of clusters of outlets that may be affecting community wellbeing. NPF4 was adopted in 2023, and alongside local development plans, forms the development plan for the area. Local development plans will be reviewed in light of NPF4 within 5 years of its adoption. Local development planning guidance has been published to support the implementation of NPF4 and should be referred to in the preparation of local development plans. The following table (continued on the next page) summarises relevant principles from NPF4. 2 UTILISE PLANNING7 TO IMPROVE FOOD ENVIRONMENTS Box 2 - Resources Scottish Government commissioned research project, “To Explore the Relationship Between the Food Environment and the Planning System” “National Planning Framework 4” Local Development Planning Guidance 7 This local lever focuses on planning given existing evidence has largely related to planning. Local Authorities also have licensing powers covering some aspects of food premises, e.g. late hours catering and mobile street traders. There is potential for an improved licensing system to be part of the solution to improve local food environments but more work is required to understand this lever and how it could be used.Page 77
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16 Table 2: Relevant Principles from NPF4 Policy 23 ‘Health and safety’ • Spatial strategies to seek to tackle health inequalities particularly in places experiencing the most disadvantage • Create healthier places including through opportunities for healthier lifestyles, land for food growing and allotments Policy 27 ‘City, town, local and commercial centres’ • Support sustainable futures for city, town and local centres • Consider where clusters of non- retail outlets may be adversely affecting community wellbeing • Consider where drive-through facilities may be acceptable in relation to local living principles and sustainable travel Policy 28 ‘Retail’ • Consider where there may be need for further retail provision • Identify areas where healthy food and drink outlets can be supported Policy 14 ‘Design, quality and place’ Development proposals will be supported where they are consistent with the six qualities of successful places, including ‘healthy’ Policy 15 ‘Local living and 20 minute neighbourhoods’ Consider the level and quality of interconnectivity including local access to opportunities for food growth and allotments Policy 23 ‘Health and safety’ Supporting development proposals likely to have positive effects on health and not supporting those that are likely to have a significant adverse effect on health Policy 27 ‘City, town, local and commercial centres’ • Supporting proposals that enhance and improve the viability of city, town and local centres • Not supporting further provision of non-retail development proposals where that would undermine the health and wellbeing of communities, particularly in disadvantaged areas, and including takeaways (which can include permanently sited vans) Policy 28 ‘Retail’ Support development proposals for retail in existing city, town and local centres or edge of centre areas or commercial centres if allocated for new retail development in the local development plan For local developm ent plan preparation For decision m aking on proposed developm ents Page 78
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17 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT WHY IT’S IMPORTANT IN SCOTLAND One in six adults in Scotland eat out at least once a week according to a survey conducted by Food Standards Scotland in January 2023 (1,764 respondents 16+ years of age) (20). However, the food environment encompasses more than just the out of home sector.8 The food environment is all food available to people in their surroundings. Limited data have been published on the built food environment across Scotland, which includes the number and density of all places where people can access food in their community.9 An unpublished systematic review of studies of the UK food environment found only 21 recent (i.e., past decade) studies in Scotland that described the local food environment or evaluated the association of local food environments with diets, overweight and obesity. Nearly all studies have focused on Glasgow. One study mapped all food outlets in Viewpark, east Glasgow in 2009 (21). They found very high availability of fast food (18 fast food outlets in an area of 11.69 sq km) as well as high availability of fresh fruits and vegetables (a majority of the nine stores in the area sold apples, oranges, bananas, onions, potatoes and tomatoes) (21). In a convenience survey of 94 residents of Viewpark, 91% reported that their main supermarket was a large supermarket outside Viewpark (21). More recently (data collected in 2018 and 2019), a University of Edinburgh PhD student thesis mapped the food environment in Whitewood, Glasgow, finding one-third of outlets were takeaways, fast food outlets and convenience stores (22). Another study in Glasgow found clustering of quick service restaurants in more deprived areas looking at data from 2012 (23), but a fourth study in Glasgow did not find clustering of these outlets looking at data from 2003 (24). An analysis of all of Scotland using data on the locations of four popular quick service restaurants in 2005 found evidence of clustering of these outlets in more deprived areas (25). We were not able to identify more recent published data on this topic. EVIDENCE OF EFFECTIVENESS Given its recent publication (in February 2023), the implementation and impact of NPF4 has yet to be evaluated. Nonetheless, it is well recognised that the built food environment influences people’s access to both healthy and unhealthy food (26, 27), and that planning is an upstream tool that can be used to influence the built food environment over the long-term (28, 29). 8 The out of home sector typically includes quick service restaurants, full service restaurants, cafes and coffee shops, pubs and bars, and bakery and sandwich shops. 9 The Food environment assessment tool (Feat) allows for detailed exploration of the geography of food retail access in Scotland but is currently offline.Page 79
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18 3 STRENGTHEN PUBLIC FOOD PROCUREMENT AND PROVISION STANDARDS HOW TO TAKE THIS LOCAL LEVER FORWARD The following should be considered in all facilities owned and/or operated by local authorities and health boards including, for example, leisure centres and National Health Service (NHS) premises providing non-patient food and drink. 1 . Increase the proportion of healthy food and drink on offer to at least 75%.10 2 . Offer price promotions on healthier options. 3 . Reduce the calorie content of foods on offer – either through reformulation or smaller portions. Consider a mandatory calorie cap per item sold.11 4 . Provide free drinking water. It is important to take into consideration the taste of healthy food and drink on offer to ensure that the above-mentioned actions do not negatively impact uptake of meals in these settings. This local lever is closely linked with local lever #4, Work with the out of home sector to reduce calories on the menu, and actions mentioned for that local lever should also be considered by facilities owned and/or operated by local authorities and health boards. 10 Further research is needed to confirm 75%. This number comes from a small online choice experiment of 159 Scottish adults that found when 75% of product options were healthy, 58% of participants selected a healthy option compared to just 41% of participants selecting a healthy option when only 50% of product options were healthy. See Allan et al. Nutr Health. 2021;27(3):321-7. Box 3 - Resources Existing NHS food regulations: “Criteria for the Healthcare Retail Standard” Food Standard Scotland’s Healthier Catering Guidance covering seven specific sectors: children’s menus, Chinese, chip shops, Indian and South Asian, Italian, Pizza, and sandwich shops (available in multiple languages) Scottish Government’s Out of Home Action Plan and forthcoming voluntary Eating Out, Eating Well Framework which will include a Code of Practice for Children’s Menus Food Standard Scotland’s MenuCal – a free tool for food businesses to provide information about the calories and allergens in their dishes Page 80
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19 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 11 George Eliot Hospital in England has set a calorie cap of 250 kcal for confectionery and sweets and 400 kcal for pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, and pasta salads). WHY IT’S IMPORTANT IN SCOTLAND Annual public sector expenditure on food and drink in Scotland is nearly £150 million (30). With the passing of the Good Food Nation (Scotland) Act in 2022, local authorities and health boards have a significant opportunity to use this public spend to promote healthy diets and support healthy weights. The health and social care workforce in particular represents one of the most important opportunities to lead by example when it comes to diet and healthy weights. Over 400,000 people across Scotland are employed in NHS, Social Care and Social Work (31) and can both benefit from healthier workplace food environments and play an import role in demonstrating the benefits of healthier food environments in general. Significant progress has been made in recent years in Scotland towards implementing positive changes on NHS premises that improve the healthfulness of food and drink on offer. In 2015, the Healthcare Retail Standard (HRS) was introduced in Scotland and sets mandatory requirements for all retail outlets in NHS premises, including that at least 50% of available foods meet nutritional standards (32). EVIDENCE OF EFFECTIVENESS An observational audit of 13 outlets immediately before HRS implementation (July to November 2016) and after (July to November 2017) found that the mean number of chocolate confectionery products on offer declined, as did the number of promotions for these products (33). All hospital retail sites are required under the terms of their contract to adhere to the HRS criteria and sites are assessed by Scottish Grocer’s Federation Healthy Living Programme. It is important to not just increase healthier options, but to tackle the abundance of less healthy options. Changes in the availability of less healthy options may have a greater effect on choice than comparable changes in healthy options (34). Making healthy food the easier, more obvious option, is critical. If 50% of food options are healthy and 50% are less healthy, people will tend to choose the less healthy option. In contrast, if 75% of options are healthy, and just 25% are less healthy, they may tend to choose the healthy option. A small online choice experiment of 159 Scottish adults found that when 75% of product options were healthy, 58% of participants selected a healthy option compared to just 41% of participants selecting a healthy option when only 50% of product options were healthy (35). An audit of HRS adoption across NHS Scotland Page 81
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20 found that only three outlets had more than 70% of food on offer meeting HRS nutritional standards (36). This may help explain why a majority of purchased snack items between January and May 2017 in Aberdeen hospital food outlets were not healthy options (35). As stated by the authors of that study, “Despite equivalence in the number of healthy and unhealthy (individual) products available across each retail unit as a whole, within the single-serve snack category, only 30% of unique product lines were healthy options. This indicates that consumers intending to purchase just a snack are not presented with equivalent numbers of healthy and unhealthy options; rather, they must select from a range where there is a greater variety of unhealthy options.” Many customers continue to purchase less healthy items, even when healthy alternatives are available, suggesting further interventions may be required to tip the balance towards healthier options as the norm. A systematic review of food environment interventions to improve the healthfulness of diets of healthcare staff published before May 2017, commissioned by the behavioural insights team at Public Health England, concluded (37): » Labelling is unlikely to be effective on its own. » Offering a smaller size of the main meal of the day is effective – no compensatory purchasing was observed or decline in sales of the smaller- sized meal. » Making healthier options more accessible than unhealthy options is effective. For example, putting healthier options at eye-level and putting lower-calorie options at the front in the most accessible positions. Page 82
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21 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 12 In a survey by Food Standards Scotland conducted in January 2023 (1,764 respondents 16+ years of age), 74% of adults agreed slightly (42%) or strongly (32%) that “food establishments should offer the option of smaller portion sizes.” In that same survey, half of respondents agreed that “food businesses have a responsibility to encourage people to eat more healthily” and that they would be more likely to choose a food establishment that offered healthier choices. 13 The emphasis is on reducing fat given the higher energy density of fat compared to carbohydrates and protein. A modelling study found that a 20% reduction in fat across both manufactured and out of home food in the UK could reduce average calorie intake by 67.6 kcal/d/person, resulting in a reduction in average body weight of 2.7 kg over 5 years. See Roberta Alessandrini et al. Am J Clin Nutr 2021;113:1312-1321. HOW TO TAKE THIS LOCAL LEVER FORWARD 1 . Work with the out of home sector to calculate and display the calories of menu items. 2 . Encourage the out of home sector to reduce the default portion size offered.12 3 . Work with the out of home sector to encourage the use of lower-calorie versions of standard ingredients such as lower fat mayonnaise and tinned tuna in water instead of oil.13 4 . Work with the out of home sector to encourage the adoption of healthier cooking practices such as “shake bang and hang technique” for fried food and draining food on kitchen roll before service. 5 . Work with wholesalers to enable supply of smaller portion sizes (e.g., smaller takeaway boxes and smaller fish fillets or beef burgers). Efforts to reduce calories should be careful not to increase salt in order to increase consumer acceptability. Interventions should not have a noticeable impact on palatability, should not reduce sales, and, where possible, should try to minimise the need for special skills / training /equipment or more time than current practices. A Takeaway Masterclass offered to the out of home sector including both takeaways and restaurants is one approach of working with these stakeholders that has been shown to be acceptable in northern England (38). This local lever is closely linked with local lever #3, Strengthen public food procurement and provision standards, and actions mentioned for that local lever could also be considered in the private sector. 4 Box 4 - Resources Food Standard Scotland’s Healthier Catering Guidance covering seven specific sectors: children’s menus, Chinese, chip shops, Indian and South Asian, Italian, Pizza, and sandwich shops (available in multiple languages) Scottish Government’s Out of Home Action Plan and forthcoming voluntary Eating Out, Eating Well Framework which will include a Code of Practice for Children’s Menus Food Standard Scotland’s MenuCal – a free tool for food businesses to provide information about the calories and allergens in their dishes Guidance for local authorities, schools, retailers, caterers and other partners on what they can do to influence the food environment around schools: “Beyond the School Gate - Improving Food Choices in the School Community” WORK WITH THE OUT OF HOME SECTOR TO REDUCE CALORIES ON THE MENU Page 83
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22 14 This includes all food and drink consumed outside the home and from takeaways consumed inside the home. 15 Included restaurant/pub/night club, fast food outlet, coffee shop/cafe/deli/sandwich bar. WHY IT’S IMPORTANT IN SCOTLAND In 2021, people in Scotland, on average, took three out of home food14 trips per week (39). Quick service restaurants, particularly fish and chip shops and Chinese takeaways, make up a large proportion of these trips (39). The taste, ease, and quickness of eating out of home are the main motivators (39). However, out of home food tends to have larger portion sizes, resulting in greater caloric intake when eating out of home more frequently as compared to in the home (40). Even for the same brand, portion sizes are larger in out of home settings versus at the grocery store (41). An analysis of the National Diet and Nutrition Survey, combining years 2008-2014, found that food outlets15 accounted for 26% of calories in adults 19-34 years, 24% of calories in adults 34-49 years, and 23% in adults 50-64 years (42). Since the start of the pandemic, the percent share of out of home trips that were takeaways (including deliveries) has more than tripled, with burgers, chicken meals, Chinese, fish, and pizza the top five purchased products from takeaways (39). Thus, the proportion of calories coming from these outlets is likely to be even higher today. In an evaluation of major UK restaurant chains, the average calorie content of a fast food restaurant meal was 751 kcal and the average calorie content of meals at full service restaurants was 1,033 kcal, both higher than the recommended 600 kcal per meal for lunch and dinner (43). A more recent study found that there has been a very slight, non-significant downward trend in calorie content of restaurant meals, but, on average, calorie content remains too high (44). Thus, both takeaways and full service restaurants have lots of scope for reducing calories and helping communities achieve a healthy weight. EVIDENCE OF EFFECTIVENESS Evidence suggests that menu labelling can support food businesses in reformulating their products or reducing the portion size sold in order to reduce the calorie content (45). In addition, FSS has reviewed the global evidence of the impact of calorie labelling on the number of calories purchased or consumed (46). Whilst the evidence base is mixed, overall it shows a reduction in the number of calories purchased or consumed when calorie information is present (46). The Scottish Government published a consultation on mandatory calorie labelling in the out of home sector in April 2022 (47). In England, from April 2022, businesses with over 250 employees are required to display the calorie information of all items prepared and sold for immediate consumption. Page 84
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23 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 16 Values are standardised mean difference, which is the size of the intervention effect relative to the variability in that effect. Many takeaway owners currently offer a large portion size out of a desire to offer customers “value-for-money” but there is a higher profit margin for smaller portion sizes offered at the same price. One study worked with a fish and chip shop wholesaler supplying more than 2,500 shops across northern England and Scotland to offer a smaller portion size option (48). The impact evaluation was limited, but data from seven of eleven shops that provided sales information showed that the proportion of all meals sold which were a smaller portion increased from 14% to 21% over six weeks’ intervention (48). Importantly, the wholesale supplier and shop owners were broadly willing to introduce – and promote using posters (see below) – a smaller portion size option (48). The following figure, showing data from Cadario and Chandon (49), compares the size of effect16 on selection or consumption of a given food or drink according to different types of interventions (299 effect sizes were included). It clearly shows that providing nutrition information is less effective than physical changes – for example, providing pre-sliced fruit, placing healthier options in the “grab and go” section, using smaller takeaway boxes, or making a smaller portion the default option. To put the effect sizes in perspective, cognitive-oriented nudges like providing nutrition information result in, on average, a reduction of calories of 64 kcal whereas behaviour-oriented nudges like making the default option a smaller portion result in, on average, a reduction of calories of 209 kcal (49). Examples of promotional posters for smaller portion sizes offered at select fish and chips shops in northern England. Reproduced without modification from (48). Licensed under CC- BY by Louis Goffe et al. Page 85
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24 0 0.2 0.4 0.6 0.8 Size of Effect Smaller portion size of unhealthy options Physically easier to select healthy options Encourage healthy options Increase visibility of healthy options Smaller portion size of unhealthy options Colour-coding nutrition information or special logos Nutrition information Figure 2 Size of effect of varying intervention types (49) Page 86
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25 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 17 And continue the planned roll out of free school meals to P6 and P7 as soon as local and/or national resources allow IMPROVE UPTAKE OF SCHOOL MEALS HOW TO TAKE THIS LOCAL LEVER FORWARD 1 . Continue to provide free school lunches to children in primary 1 to 5 (P1-5).17 2 . Continue to provide and encourage uptake of free school lunches to eligible pupils in Primary 6 to Secondary 6. 3 . Remove barriers to uptake, for example, reduce queuing times. For a flavour of what is working to improve uptake of school meals across Scotland, readers are referred to the 2021 report for the Poverty and Inequality Commission, “Tackling Food Insecurity in Scottish Schools: Case Studies of Strengthening Free School Meal Provision In Scotland.” WHY IT’S IMPORTANT IN SCOTLAND Overall, only 50% of pupils in Scotland eat meals (free or paid for) provided by their school, and this percent continues to decline year on year (50). The percent is substantially higher in primary school pupils (60%) compared to secondary school pupils (36%) (50). There is also substantial variability between schools, ranging from 0-100% of pupils eating meals (free or paid for) provided by their school, and between local authorities (Figure 2) (50). 5 Box 5 - Resources Existing school food regulations: “Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2020” Statutory guidance supporting the implementation of the Nutritional Requirements: “Healthy eating in schools: guidance 2020” Page 87
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26 East Lothian Clackm annanshire City of Edinburgh South Ayrshire Dundee City W est Lothian Renfrewshire W est Dunbartonshire Glasgow City 1 Angus East Dunbartonshire Stirling Fife M oray East Ayrshire M idlothian Perth & Kinross South Lanarkshire North Ayrshire Inverclyde Aberdeen City Scottish Borders Falkirk Highland Argyll & Bute Aberdeenshire North Lanarkshire Dum fries & Galloway Na h-Eileanan Siar Orkney Islands East Renfrewshire Shetland Islands 40.0 50.0 60.0 70.0 80.0 90.0 Percentage of P1-7 pupils taking school m eals (Free or paid for) on census day in 2022 30.0 20.0 10.0 0.0 Figure 3. Percentage of P1-7 pupils taking school meals (free or paid for) by local authority in 2022. Data are from the Healthy Living Survey, Supplementary Table 9. Promoting uptake of school meals is important because analyses of UK-wide data (Scotland- specific data are not yet available)18 show that children and young people who consume school lunches are more likely to meet minimum recommendations for vegetables, protein- rich foods, and fibre compared to those consuming packed lunches (51). They are also less likely to exceed recommendations for salt and savoury and sweet snacks (51). Ongoing work to assess the diets of children and young people aged 2-15 years living in Scotland will provide up-to-date information on diet quality of school lunches versus packed lunches specifically in the Scottish context. While recent evidence (i.e., post-COVID19) is not available, before the pandemic, the purchase of unhealthy food at lunchtime “beyond the school gate” was common among pupils in Scotland (52, 53). Page 88
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27 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 19 The survey was completed by 15,582 pupils in more than 200 secondary schools in November- December 2021. 20 A total of 846 young people aged 12-26 years (93% were aged 12-17 years) responded to the survey across 26 local authorities. The question asked: “If every secondary school pupil in Scotland was given a free school meal at lunchtime in school, would you use it? If you have left school, think back to what you would have done.” EVIDENCE OF EFFECTIVENESS Research in Scotland suggests that long queuing times, poor food quality, an unwelcoming dining environment, staffing (i.e., presence of teachers in the dining area), and set dining times for each year group are some of the barriers to school meal uptake (54, 55). “Fuelled in School? A nation-wide survey of secondary school pupils’ opinion on school meals in Scotland,” published in 2022,19 confirmed that these continue to be barriers to uptake in secondary schools across Scotland, particularly the long queuing times and short lunch breaks. A briefing by NHS Health Scotland on interventions to prevent childhood overweight and obesity within schools found that improving the aesthetics of school dining areas and encouraging positive social interactions in school dining areas may encourage uptake of school meals (56). However, what interventions are effective at improving the aesthetics and social interactions in school dining areas remains unclear. A Food Active report, “Free School Meals: What are the barriers to uptake among primary and secondary school children?” (57), cited many of the barriers to uptake mentioned above and gave the following recommendations for schools: 1 . Create a pleasant dining environment. 2 . Protect time for lunch. 3 . Implement a staggered lunch time system to avoid long queues. 4 . Involve pupils in the development of menus. 5 . Adopt a system that enables pupils to obtain free school meals in a dignified and discrete way. Several evaluations in Scotland have demonstrated that making free school meals universal increases uptake (58, 59). An evaluation of universal free school meals for P1-3 pupils in Scotland following their introduction in January 2015 found an increase of overall school-meal uptake (both free and paid) among primary pupils from 53% in 2014 to 65% in 2015 (59). The author of the evaluation concluded this overall increase was due to increased uptake of free school meals among P1-3 pupils: 79% of P1-3 pupils took a free school meal compared with 53% of P4-7 pupils (both free and paid) (59). Page 89
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28 21 Restricted to members of the Organization for Economic Co-Operation and Development (OECD) A study conducted in Scotland of the 2007-08 free school meal pilot (P1-P3) suggested that peer-group take-up of school meals reduced non-participation by 29-35%, by reducing stigma and signalling that the school meal is a desirable option (58). This remains important today because while the Education (Scotland) Act 1980 states that educational authorities must take reasonable steps to ensure that the fact that a pupil receives school lunches free of charge remains private, stigma remains a barrier to uptake among young people in Scotland according to a survey conducted by the Scottish Youth Parliament (SYP) in October and November 2022 (60). More than 80% of respondents to the SYP survey said that if universal free school meals were extended to secondary schools, they would make use of it on a regular basis (41%) or sometimes (42%)20 (60). Around three- quarters (76%) of young people who responded to the SYP survey said free school meals would make them more likely to eat lunch at school (60). An international systematic review21 identified 47 studies that evaluated universal free school meals (61). Nearly all studies found positive effects on school meal uptake and that the increases in uptake tended to be largest among students who previously did not qualify for free school meals (61). Most studies also found improvements in pupils’ diet quality, particularly when mandatory nutritional standards for school food and drink were present (61). Of the small number of studies that evaluated associations with body mass index, results were mixed with some finding that universal free school meals reduced the risk of obesity and others finding no significant effect (61). Space limitations in secondary schools make logistics of increasing uptake of school meals a major challenge in some parts of Scotland. This is why a linked- up, long-term approach is needed, including utilising planning to improve food environments (local lever #2) and working with the out of home sector to reduce calories on the menu (local lever #4). Page 90
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29 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT PROMOTE AND SUPPORT PHYSICAL ACTIVITY HOW TO TAKE THIS LOCAL LEVER FORWARD In 2022, Public Health Scotland published a report, “A systems-based approach to physical activity in Scotland. A framework for action at a national and local level,” which presents a seven-stage evidence-based process “designed to enable practitioners and policy makers to take forward a systems-based approach to physical activity in Scotland” (62). In order to ensure alignment with this existing guidance, here we present verbatim the strategic delivery outcomes and associated actions from that report (see Figure 5b on pages 20 & 21) (62). Those interested in adopting this local lever should refer to that document for all other elements associated with delivery. 6 Strategic delivery outcomes Associated actions Active travel • Upskill transport and planning to enhance active travel infrastructure. • Walking, wheeling and cycling infrastructure. • Engage communities in transport planning. • Road safety and traffic restrictions. • Strengthen walking data. Active places and spaces • Integrate urban design, transport and land use policies. • Design guidelines for public amenities. • Workforce development for planners, transport engineers and architects. • Develop guidance for National Planning Framework 4 (NPF4). • Access to quality green and open space, green networks, blue space, active recreational space, play spaces and sports amenities. Page 91
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30 Active workplace • Seek opportunities through health board workplace teams to provide leadership for workplace policies. • Develop national standards for workplace physical activity. Active place of learning • Health promoting universities framework. • Accessible activities in schools, colleges and universities. • Physical education. • Initial teacher training and in-service training. • Active classrooms and outdoor learning. Sport and active recreation • Enable authorities to fulfil their statutory duties, in the ‘adequate’ provision of active recreation and sport. • Prioritise public funds to target the least active, as well as to retain existing and returning participants. • Strengthen access to community assets – places, spaces, facilities and services across the public sector. • Maximise the public health contribution of community sport clubs. • Enhance the knowledge, skills and competencies of the sport and active recreation workforce. Active systems • Research, evidence and evaluation. • Data and intelligence. • Local delivery plans. • National delivery plans • Capacity. • Systems-based approach. • Financial mechanisms. • Accountability. • Leadership. • Physical activity as a human right. Page 92
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31 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 22 At least 150 minutes of moderately intensive physical activity or 75 minutes vigorous activity per week or an equivalent combination of both. 23 At least 60 minutes of activity on average per day. WHY IT’S IMPORTANT IN SCOTLAND In 2021, 69% of Scottish adults self-reported meeting physical activity guidelines,22 continuing an upward trend since 2012 (63). The percent is similar for children with 71% meeting the physical activity guidelines (again, according to self-report).23 Adults living in the most deprived areas of Scotland are least likely to meet the recommendations – 57% versus 77% among adults living in the least deprived areas (63). EVIDENCE OF EFFECTIVENESS The evidence to support each of the eight strategic delivery outcomes in the table above is summarised in Appendix 2 of the report, “A systems-based approach to physical activity in Scotland. A framework for action at a national and local level” (62). Box 6 - Resources Public Health Scotland: A systems-based approach to physical activity in Scotland. A framework for action at a national and local level Active health and social care • Physical activity established as a core component of a world class public health system. • Apply learning from Care About Physical Activity. • Integrate physical activity into pre-service and in-service training of medics, nurses, allied health professionals and social care workers. • Engage and support the Movement for Health. • Integrate NHS Physical Activity pathway into routine care and clinical pathways. • Partnerships between NHS and physical activity providers. Communications and public education • National physical activity communications subgroup to coordinate targeted campaigns. • Adopt best practice principles for communications and public messaging. • Integrate communications and public education into the Active Scotland Delivery Plan. Page 93
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32 PROTECT, PROMOTE, AND SUPPORT BREASTFEEDING AND HEALTHY DIETS FOR CHILDREN 7 HOW TO TAKE THIS LOCAL LEVER FORWARD Improving nutrition of infants and in early childhood is key for ensuring a healthy weight as they grow into adults. This involves (i) protection, promotion, and support for breastfeeding, as well as (ii) the appropriate and timely introduction of complementary foods, and (iii) ensuring a wide and varied healthy diet throughout early childhood.24 With regards to (i) breastfeeding, “Becoming Breastfeeding Friendly Scotland: report,” published by the Scottish Government in 2019, includes a priority list of eight recommendations, almost all of which have relevance to local areas (pasted verbatim from the report): 1 . Develop and implement a breastfeeding advocacy and promotion strategy which brings together and builds upon activity happening at local, regional and national levels, in order to build awareness of and support for breastfeeding at multiple levels from community to government. This will include building a cohesive network of Scottish advocates and developing a coordinated events calendar building on existing activity. (page 11) 2 . To gain and maintain support from policy officials as well as other influential officials (for example, councils and the relevant Royal Colleges) in order to collaborate and formalise efforts for legislative change and advocacy for breastfeeding. (page 17) 3 . Provide guidance to employers and inform mothers and families about their rights. (page 27) 4 . Scottish Government Ministers, officials, and all public sectors employees should adopt the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA resolutions principles within their work place and in dealings with the public and private sector through a Code of Conduct. (page 32) 24 This local lever covers children up to their third birthday in order to align with the Framework for Improving Maternal and Infant Nutrition. Scottish Government advice is that there are nutritional benefits for infants to be breastfed for up to 2 years of age and so the scope should go beyond infants (which is up to 1 year). Moreover, as discussed in the Framework, nutritional requirements of children vary between 1-3 years and 4-6 years, and so a practical decision was made to limit the scope to up to 3 years. Page 94
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33 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 25 Over the period April 2020 to June 2021, 23% of eligible people had not claimed the benefit. 5 . There are nationally coordinated, consistent learning outcomes for all groups who care for mothers and babies, both in service and pre- registration, and also volunteers and lay supporters. These outcomes are based on a competency framework for each group and underpinned by training and mentorship, supervision and monitoring; together these will ensure consistency for each group and appropriate, quality assured and standardised provision. (page 35) 6 . Women have equitable access to high quality, evidence-based models of care through sufficient coverage, spread and awareness of audited and registered core, peer and specialist support providers. Well developed and maintained referral structures are in place to ensure women receive the right information and support where and when they need it. (page 41) The “Improving Maternal and Infant Nutrition: A Framework for Action,” published in 2011, highlighted that although there has been a national and international focus on breastfeeding, there has not been the same focus on nutrition of young children beyond milk feeding. A review published in 2019 by NHS Greater Glasgow and Clyde provided an update on any new and relevant studies published since 2011, and came to a similar conclusion regarding the lack of evidence on effective interventions to promote nutrition of young children beyond milk feeding (64). Therefore, with regards to (ii) the appropriate and timely introduction of complementary foods and (iii) ensuring a wide and varied healthy diet throughout early childhood, local areas should: 1 . Continue activities under the Framework to encourage the introduction of healthy complementary foods at around six months of age and to gradually increase the amount and variety of foods such that by 12 months, food rather than milk is the main part of an infant’s diet. 2 . Continue to promote Best Start Foods.25 Box 7 - Resources Scottish Government’s recommendations for actions which can be taken by NHS Boards, local authorities, and others to improve the nutrition of pregnant women, babies, and young children: “Improving maternal and infant nutrition: a framework for action” Scottish Government’s recommendations for the continued protection, promotion, and support for breastfeeding: “Becoming Breastfeeding Friendly Scotland: report” Best Start Foods payments that can be used to buy healthy food and drink like milk or fruit Public Health Scotland’s nutritional guidance and food standards for early years childcare providers: “Setting the Table” Public Health Scotland’s “Fun first foods: An easy guide to introducing solid foods” (available in multiple languages) First Steps Nutrition Trust’s “Eating Well Sources” Parent Club Resources Page 95
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34 WHY IT’S IMPORTANT IN SCOTLAND The percentage of babies born in Scotland who are breastfed has increased steadily over the past 20 years (65). In 2021/22, 65% of babies were breastfed for at least some time after their birth (65). However, there are important disparities in breastfeeding rates: babies born into the most deprived areas of Scotland are substantially less likely to be breastfed (40%) compared to babies born into the least deprived areas of Scotland (73%) (65). With regards to appropriate and timely introduction of complementary foods, Scottish Government policy recommends that complementary foods should be introduced to infants around six months of age (66). Some infants may be introduced to complementary foods earlier than six months for a variety of reasons, however, current recommendations state that this should never happen before four months (66). The 2017 Scottish Maternal and Infant Survey (67) found that 96% of respondents reporting waiting until four months to introduce complementary foods and 46% reporting waiting until six months or later. Respondents who lived in the most deprived areas were less likely to wait until six months or later (44%) than respondents who lived in the least deprived areas (50%). The use of commercial baby foods (for example, pouches, snacks, jars, tubs, bars, etc.) is common in Scotland: 41% of respondents reported giving these items to their infant five days or more per week. Respondents Exclusive Breast Mixed Breast and Formula Formula SIMD 4 SIMD 5 (Least Deprived) SIMD 3 SIMD 2 SIMD 1 (Most Deprived) 0 20 40 60 80 100 Percent of babies in Scotland 2021/22 Figure 4. Disparities in Breastfeeding Rates in Scotland Page 96
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LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 1 Throughout this report, “unhealthy food and drink” primarily refers to food and drink high in fat, sugar, or salt. 35 who lived in the most deprived areas were more likely to give commercial baby foods to their infant on a daily basis (38% versus 25% in the least deprived areas) and less likely to give fruit (61% versus 76%, respectively), vegetables (44% versus 61%, respectively), and dairy (33% versus 44%, respectively). Treats (for example, chocolate buttons, ice cream, crisps, or cheese puffs) were given to their infant on a daily basis by 29% of respondents. Respondents who lived in the most deprived areas were more likely to report giving treats to their infant on a daily basis (39%) than those who lived in the least deprived areas (18%). EVIDENCE OF EFFECTIVENESS Studies, including in the UK, have shown that children who are breastfed have a slightly lower risk of developing obesity in childhood. For example, an analysis by the Office for Health Improvement & Disparities found a small inverse association between the percent of children breastfed in a local area and the prevalence of children living with obesity and overweight at ages 4-5 years (68). This was independent of other factors such as deprivation, maternal age, and health behaviours during pregnancy (68). These findings are consistent with 26 previous studies, which together found that one month of breastfeeding was associated with a 4.0% decrease in risk of obesity among children aged 2-6 years (69). Evidence from the Millennium Cohort Study also suggests that infants who receive complementary foods before four months are more likely to be overweight at 3 years of age (70). In addition to the timing of introducing food, the type of foods and drinks given to infants is also important for later health and establishing eating habits. A Cochrane review published in 2017 identified 73 trials of breastfeeding support (71). They concluded that providing extra organised breastfeeding support to women significantly increases the duration and exclusivity of breastfeeding (71). The effectiveness of programmes is higher in places with high initiation rates (71). Characteristics of effective support included: offered as standard by trained professionals or lay/peer supporters or a combination of both during antenatal or postnatal care, ongoing scheduled visits so women can predict when support will be available, face-to-face support, and tailored to the needs of the population group (71). The aforementioned 2019 review by NHS Greater Glasgow and Clyde concluded “Evidence from the literature and learning from local models suggest that the most effective, evidence-based strategy is a combination of health professional and trained volunteer delivering support to women from the antenatal period through hospital stay and into the postnatal weeks at home” (64). Page 97
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36 26 It should be noted that given the nature of the data collected, findings are based on the participants’ perceptions of impact, rather than objective measures of impact and may not be generalisable to all Best Start Foods recipients. The effectiveness of interventions to improve infant and young child feeding practices has been mixed. Two recent systematic reviews evaluated the evidence for interventions to improve diets and prevent overweight and obesity in children under 2 years of age (72, 73). They concluded, “Improving dietary intake at this age appears challenging based on a relatively limited number of studies” (72) and that early benefits on child’s body mass index are not sustained (73). This stage of life is a good opportunity to promote whole family healthy eating habits (64). Evidence from the Southampton Women’s Study suggests that the quality of an infant’s diet at six and 12 months is determined by the quality of the mother’s diet (74), thus interventions that improve mothers’ diets could have an impact on infant diets. However, more research is needed to understand “what works.” Best Start Foods, which replaced the UK Healthy Start Vouchers in Scotland from August 2019 with the transition complete by March 2020, was designed to provide financial support for low income families with young children to access nutritious food. It is one of a range of Scottish Government policies set out in the Tackling Child Poverty Delivery Plan. An evaluation involving 33 in-depth interviews with Best Start Foods recipients across Scotland conducted between December 2021 and February 2022 found that the programme has enabled mothers and children to eat more healthy foods (75).26 “For example, recipients purchase healthier snacks for their children, instead of processed foods like crisps, and some use payments to experiment with new healthy recipes. Recipients also say the benefit gives them more freedom to let their children try a greater range of healthy foods without worrying about wasting money or food” (75). Continued evaluation of Best Start Foods will help establish its impact on infant and young child diets and healthy weight. Page 98
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37 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT REFERENCES 1. Akhtar PC, Currie DB, Currie CE, Haw SJ. Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ. 2007;335(7619):545. 2. Haw SJ, Gruer L. Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ. 2007;335(7619):549. 3. Hyland A, Hassan LM, Higbee C, Boudreau C, Fong GT, Borland R, et al. The impact of smokefree legislation in Scotland: results from the Scottish ITC: Scotland/UK longitudinal surveys. Eur J Public Health. 2009;19(2):198-205. 4. Scottish Government. Creating a Tobacco-Free Generation. A Tobacco Control Strategy for Scotland. Edinburgh: Scottish Government,; 2013. https://www.gov.scot/ binaries/content/documents/govscot/publications/ strategy-plan/2013/03/tobacco-control-strategy-creating- tobacco-free-generation/documents/creating-tobacco-free- generation-tobacco-control-strategy-scotland/creating- tobacco-free-generation-tobacco-control-strategy-scotland/ govscot%3Adocument/00417331.pdf 5. Finch DW, Heather; Bibby, Jo. Leave no one behind. The state of health and health inequalities in Scotland. London: The Health Foundation; 2023. 6. National Statistics. Primary 1 Body Mass Index (BMI) statistics Scotland. School year 2021 to 2022 Edinburgh: Public Health Scotland; 2022 [Available from: https:// publichealthscotland.scot/publications/primary-1- body-mass-index-bmi-statistics-scotland/primary-1- body-mass-index-bmi-statistics-scotland-school-year- 2021-to-2022/#:~:text=Marked%20socioeconomic%20 inequalities%20in%20child,in%20the%20least%20 deprived%20areas 7. Harper HH, Michael. Counting Calories. 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Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis. PLoS Med. 2022;19(2):e1003915. 15. Pell D, Mytton O, Penney TL, Briggs A, Cummins S, Penn- Jones C, et al. Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: controlled interrupted time series analysis. BMJ. 2021;372:n254. 16. Thomas C, Breeze P, Cummins S, Cornelsen L, Yau A, Brennan A. The health, cost and equity impacts of restrictions on the advertisement of high fat, salt and sugar products across the transport for London network: a health economic modelling study. International Journal of Behavioral Nutrition and Physical Activity. 2022;19(1):93. 17. Reynolds J. 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38 23. Macdonald L, Olsen JR, Shortt NK, Ellaway A. Do ‘environmental bads’ such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate in more deprived areas in Glasgow City, Scotland? Health & Place. 2018; 51:224-31. 24. Macintyre S, McKay L, Cummins S, Burns C. Out-of-home food outlets and area deprivation: Case study in Glasgow, UK. International Journal of Behavioral Nutrition and Physical Activity. 2005;2. 25. Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation—substitution or concentration? Appetite. 2007;49(1):251-4. 26. Atanasova P, Kusuma D, Pineda E, Frost G, Sassi F, Miraldo M. The impact of the consumer and neighbourhood food environment on dietary intake and obesity-related outcomes: A systematic review of causal impact studies. Soc Sci Med. 2022;299:114879. 27. Mah CL, Luongo G, Hasdell R, Taylor NGA, Lo BK. A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies. Curr Nutr Rep. 2019; 8(4):411-28. 28. Ironside Farrar. Research Project: To Explore the Relationship Between the Food Environment and the Planning System. Edinburgh: Scottish Government; 2018. 29. Bird EL, Ige JO, Pilkington P, Pinto A, Petrokofsky C, Burgess- Allen J. Built and natural environment planning principles for promoting health: an umbrella review. BMC Public Health. 2018;18(1):930. 30. Soil Association, editor Food systems change through public procurement: Scottish experiences. Northern Real Farming Conference; 2021; Online: Soil Association. 31. Government CS. National Workforce Strategy for Health and Social Care in Scotland. Edinburgh: Scottish Government; 2022. https://www.gov.scot/publications/national-workforce- strategy-health-social-care/documents/ 32. Population Health Directorate. Criteria for the Healthcare Retail Standard Edinburgh: Scottish Government; 2016 [Available from: https://www.gov.scot/publications/criteria- healthcare-retail-standard-9781786525673/pages/7/ 33. Stead M, Eadie D, McKell J, Sparks L, MacGregor A, Anderson AS. Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets. BMC Public Health. 2020;20(1):132. 34. Pechey R, Marteau TM. Availability of healthier vs. less healthy food and food choice: an online experiment. BMC Public Health. 2018;18(1):1296. 35. Allan JL, Duthie S, Heddle M, McKenzie F, Webb S, Johnston M. Healthy snacks in hospitals: Testing the potential effects of changes in availability. Nutr Health. 2021;27(3):321-7. 36. Shipton D. Evaluation of the implementation and impact of the Healthcare Retail Standard in Scottish hospitals and other NHS facilities in 2017. Edinburgh: NHS Health Scotland; 2019. 37. Al-Khudairy L, Uthman OA, Walmsley R, Johnson S, Oyebode O. Choice architecture interventions to improve diet and/ or dietary behaviour by healthcare staff in high-income countries: a systematic review. BMJ Open. 2019;9(1):e023687. 38. Hillier-Brown F, Lloyd S, Muhammad L, Summerbell C, Goffe L, Hildred N, et al. Feasibility and acceptability of a Takeaway Masterclass aimed at encouraging healthier cooking practices and menu options in takeaway food outlets. Public Health Nutr. 2019;22(12):2268-78. 39. Kantar. Out of home - Scotland 2021. Aberdeen: Food Standards Scotland; 2022. https://www.foodstandards.gov. scot/publications-and-research/publications/out-of-home- scotland-2021 40. Goffe L, Rushton S, White M, Adamson A, Adams J. Relationship between mean daily energy intake and frequency of consumption of out-of-home meals in the UK National Diet and Nutrition Survey. International Journal of Behavioral Nutrition and Physical Activity. 2017;14(1):131. 41. Davies S. Time to Solve Childhood Obesity. An Independent Report by the Chief Medical Officer, 2019. Professor Dame Sally Davies. London: Department of Health and Social Care; 2019. https://www.gov.uk/government/publications/time-to- solve-childhood-obesity-cmo-special-report 42. Ziauddeen N, Almiron-Roig E, Penney TL, Nicholson S, Kirk SFL, Page P. Eating at Food Outlets and “On the Go” Is Associated with Less Healthy Food Choices in Adults: Cross-Sectional Data from the UK National Diet and Nutrition Survey Rolling Programme (2008-2014). Nutrients. 2017;9(12). 43. Robinson E, Jones A, Whitelock V, Mead BR, Haynes A. (Over) eating out at major UK restaurant chains: observational study of energy content of main meals. BMJ. 2018;363:k4982. 44. Huang Y, Theis DRZ, Burgoine T, Adams J. Trends in energy and nutrient content of menu items served by large UK chain restaurants from 2018 to 2020: an observational study. BMJ Open. 2021;11(12):e054804. 45. Rincón-Gallardo PS, Zhou M, Da Silva Gomes F, Lemaire R, Hedrick V, Serrano E, et al. Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research. Nutrients. 2020;12(6). 46. Garden LW, Laura; Davidson, Lyndsay; Milne, Anne Rapid Evidence Review: How Effective is Calorie Labelling in the Out of Home Sector? Aberdeen: Food Standards Scotland; 2022. https://www.foodstandards.gov.scot/publications-and- research/publications/rapid-evidence-review-how-effective- is-calorie-labelling-in-the-out-of-home-sector 47. Scottish Government. Mandatory calorie labelling in the out of home sector in Scotland. Edinburgh Scottish Government; 2023. https://consult.gov.scot/population-health/mandatory- calorie-labelling/ 48. Goffe L, Hillier-Brown F, Hildred N, Worsnop M, Adams J, Araujo-Soares V, et al. Feasibility of working with a wholesale supplier to co-design and test acceptability of an intervention to promote smaller portions: an uncontrolled before-and- after study in British Fish & Chip shops. BMJ Open. 2019;9(2):e023441. 49. Cadario R, Chandon P. Which Healthy Eating Nudges Work Best? A Meta-Analysis of Field Experiments. Marketing Science. 2019;39(3):465-86. 50. National Statistics. School Healthy Living Survey statistics 2022. Edinburgh: Scottish Government; 2022. https:// www.gov.scot/publications/school-healthy-living-survey- statistics-2022/ Page 100
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39 LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 51. Haney E, Parnham JC, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J, et al. Dietary quality of school meals and packed lunches: a national study of primary and secondary schoolchildren in the UK. Public Health Nutr. 2022:1-12.). 52. Crawford F, Mackison D, Mooney JD, Ellaway A. Observation and assessment of the nutritional quality of ‘out of school’ foods popular with secondary school pupils at lunchtime. BMC Public Health. 2017;17(1):887. 53. Macdiarmid JI, Wills WJ, Masson LF, Craig LCA, Bromley C, McNeill G. Food and drink purchasing habits out of school at lunchtime: a national survey of secondary school pupils in Scotland. International Journal of Behavioral Nutrition and Physical Activity. 2015;12(1):98. 54. Wills W, Backett-Milburn K, Gregory S, Lawton J. The influence of the secondary school setting on the food practices of young teenagers from disadvantaged backgrounds in Scotland. Health Educ Res. 2005;20(4):458-65. 55. Wills W, Danesi G, Kapetanaki AB, Hamilton L. Socio- Economic Factors, the Food Environment and Lunchtime Food Purchasing by Young People at Secondary School. Int J Environ Res Public Health. 2019;16(9). 56. Martin L. Evidence for environmental interventions to prevent childhood overweight and obesity within schools. Edinburgh: NHS Health Scotland; 2017. 57. FoodAct!ve. Free School Meals: What are the barriers to uptake among primary and secondary school children? . Liverpool: FoodAct!ve; 2022. https://foodactive.org.uk/ new-school-food-resources-school-food-update-barriers- to-free-school-meal-uptake/ 58. Holford A. Take-up of Free School Meals: Price Effects and Peer Effects. Economica. 2015;82(328):976-93. 59. McAdams R. Evaluating universal infant free school meals, Scotland: second monitoring report of school-meal uptake. Edinburgh: NHS Health Scotland; 2016. https:// www.healthscotland.scot/publications/universal-free- school-meals-second-monitoring-report 60. Scottish Youth Parliament. Young People’s Right to Food. Edinburgh: Scottish Youth Parliament,; 2023. https://syp. org.uk/right-to-food-report-launch/ 61. Cohen JFW, Hecht AA, McLoughlin GM, Turner L, Schwartz MB. Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review. Nutrients. 2021;13(3):911. 62. Public Health Scotland. A systems-based approach to physical activity in Scotland. Edinburgh: Public Health Scotland,; 2022. https://publichealthscotland.scot/ publications/a-systems-based-approach-to-physical- activity-in-scotland/ 63. National Statistics. The Scottish Health Survey. 2021 Edition. . Edinburgh: Scottish Government; 2022. 64. NHS Greater Glasgow and Clyde. Maternal and Infant Nutrition Framework (MINF) Evidence Review Glasgow: NHS Greater Glasgow and Clyde; 2019 [Available from: https://www.stor.scot.nhs.uk/bitstream/ handle/11289/580041/MINF%20Literature_Review. pdf?sequence=20&isAllowed=y 65. Public Health Scotland. Infant feeding statistics. Financial year 2021 to 2022 Edinburgh: Public Health Scotland,; 2022 [Available from: https://publichealthscotland.scot/ publications/infant-feeding-statistics/infant-feeding- statistics-financial-year-2021-to-2022/#:~:text=Almost%20 two%20thirds%20(65%25),some%20time%20after%20 their%20birth 66. Public Health Scotland. Fun first foods: An easy guide to introducing solid foods Edinburgh: Public Health Scotland,; 2022 [Available from: https://www. healthscotland.com/documents/303.aspx 67. Scottish Government. Scottish maternal and infant nutrition survey 2017 Edinburgh: Scottish Government,; 2018 [Available from: https://www.gov.scot/publications/ scottish-maternal-infant-nutrition-survey-2017/ 68. Office for Health Improvement & Disparities. Small area associations between breastfeeding and obesity. London: Office for Health Improvement & Disparities,; 2022. https://assets.publishing.service.gov.uk/government/ uploads/system/uploads/attachment_data/file/1079224/ Small-area-associations-between-breastfeeding-and- obesity.pdf 69. Qiao J, Dai LJ, Zhang Q, Ouyang YQ. A Meta-Analysis of the Association Between Breastfeeding and Early Childhood Obesity. J Pediatr Nurs. 2020;53:57-66. 70. Hawkins SS, Cole TJ, Law C, Group atMCSCH. An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study. J Epidemiol Community Health. 2009;63(2):147-55. 71. McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews. 2017(2). 72. Butler ÉM, Fangupo LJ, Cutfield WS, Taylor RW. Systematic review of randomised controlled trials to improve dietary intake for the prevention of obesity in infants aged 0–24 months. Obes Rev. 2021;22(2):e13110. 73. Koplin JJ, Kerr JA, Lodge C, Garner C, Dharmage SC, Wake M, et al. Infant and young child feeding interventions targeting overweight and obesity: A narrative review. Obes Rev. 2019;20(S1):31-44. 74. Robinson S, Marriott L, Poole J, Crozier S, Borland S, Lawrence W, et al. Dietary patterns in infancy: the importance of maternal and family influences on feeding practice. Br J Nutr. 2007;98(5):1029-37. 75. Scottish Government. Best Start Foods: evaluation Edinburgh: Scottish Government; 2022 [Available from: https://www.gov.scot/publications/evaluation-best-start- foods/ Page 101
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40 APPENDIX LIST OF DOCUMENTS REVIEWED FOR INITIAL LOCAL LEVER LIST 1. UNICEF (2019). “UNICEF programming guidance. Prevention of overweight and obesity in children and adolescents.” Available from: https://www. unicef.org/media/92336/file/Programming-Guidance-Overweight- Prevention.pdf 2. WHO (2022). “Draft Updated Appendix 3 of the WHO Global NCD action plan 2013-2030.” Available from: https://cdn.who.int/media/docs/default-source/ ncds/mnd/2022_discussion_paper_final.pdf?sfvrsn=78343686_7 3. WHO (2022). Science and Technology in childhood Obesity Prevention (STOP) series of policy briefs. Available from: https://www.stopchildobesity. eu/policy-briefs/ 4. Chief Medical Officer (2019). “Time to solve childhood obesity: CMO special report. An independent report by former Chief Medical Officer (CMO) Professor Dame Sally Davies.” Available from: https://www.gov.uk/ government/publications/time-to-solve-childhood-obesity-cmo-special- report 5. Arnot, Julie (2019). “Scottish Public Health Network (ScotPHN). An Overview of Local Authority Powers Relating to Public Health.” Available from: https:// www.scotphn.net/wp-content/uploads/2019/09/2019_09_09-LA-Powers- Final-Draft.pdf 6. National Institute for Health and Care Research (NIHR) (2022). “How can local authorities reduce obesity? Insights from NIHR research.” Available from: https://evidence.nihr.ac.uk/how-local-authorities-can-reduce-obesity/ 7. NICE (2012). “Obesity: working with local communities.” Available from: https://www.nice.org.uk/guidance/ph42 8. Public Health Scotland (2022). “A systems-based approach to physical activity in Scotland. A framework for action at a national and local level.” Available from: https://publichealthscotland.scot/publications/a-systems- based-approach-to-physical-activity-in-scotland/ 9. Obesity Health Alliance (2021). “Turning the Tide. A 10-year Healthy Weight Strategy.” Available from: https://obesityhealthalliance.org.uk/turning-the- tide-strategy 10. Hawkes, Corinna; Walton, Stephanie; Haddad, Lawrence; Fanzo, Jessica (2020). “Centre for Food Policy Research Brief. 42 policies and actions to orient food systems towards healthier diets for all.” Available from: https:// researchcentres.city.ac.uk/__data/assets/pdf_file/0011/583517/42-Actions- v5-ALT-updated.pdf Page 102
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LOCAL LEVERS FOR DIET AND HEALTHY WEIGHT | REPORT 41 11. Holmes, Jonathon (2021). “Tackling obesity. The role of the NHS in a whole-system approach.” Available from: https://www.kingsfund.org.uk/ publications/tackling-obesity-nhs 12. Bagnall, Anne-Marie; Radley, Duncan; Jones, Rebecca; Gately, Paul; Nobles, James; Van Dijk, Margie; Blackshaw, Jamie; Montel, Sam; Sahota, Pinki (2019). “Whole systems approaches to obesity and other complex public health challenges: a systematic review.” Available from: https://bmcpublichealth. biomedcentral.com/articles/10.1186/s12889-018-6274-z 13. Theis, Dolly; White, Martin (2020). “Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992-2020.” Available from: https://onlinelibrary.wiley.com/doi/10.1111/1468- 0009.12498 14. Daniell, Shaun; Coffey, Tom; Ashrafian, Hutan; Darzi, Ara (2021). “Systematic review into city interventions to address obesity.” Available from: https:// www.sciencedirect.com/science/article/pii/S2589537020304545?via%3Dihub In addition to the above-mentioned documents, we reviewed Food Active position statements and whole-systems approach to obesity case studies from England and Scotland published by the Local Government Association, Public Health England, Obesity Action Scotland, Public Health Scotland, and the National Children’s Bureau. Page 103
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44 www.obesityactionscotland.org Twitter - @obesityactionsc E-mail - info@obesityactionscotland.org Obesity Action Scotland 232-242 St Vincent Street Glasgow G2 5RJ This report was compiled and published by Obesity Action Scotland, Royal College of Physicians and Surgeons of Glasgow in conjunction with University of Edinburgh Global Academy of Agriculture and Food Systems Page 106
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Reflecting on 2025 :Progress in Moray’s Whole Systems Approach to Healthy Weight Item 3. Page 107
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In This Issue What you will find in this reflection includes but not limited to the following; • Understanding Whole Systems Approach • Why it's important- national context • Why it's important -local context • What we did • What we achieved together • Partner spotlight • Next steps- Looking ahead to 2026! • Appreciation from the Core Working Team Page 108
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Key Highlights • Stakeholder Engagement Workshops: We successfully hosted three workshops bringing together partners across sectors to Identify perceived causes of overweight and obesity in Moray, map existing actions, identify gaps, and co-create solutions. These sessions strengthened local partnerships and produced system causal map. • Action Mapping & Gap Analysis: Through collective effort, we identified factors reinforcing overweight and obesity locally and prioritised actions (draft) that address both the environment and individual lifestyle factors. for example the Google map produced through student placement activity showed the connection between the built environment and unhealthy weight ( Asset Map) - Click this link Here for more information. • Community-Centred Actions: Several proposed actions focused on improving access to healthier food options, promoting active lifestyles, and supporting wellbeing in workplaces and communities. • Data-Driven Insights: Improved use of local insights has informed decision-making, ensuring that our draft action plan is evidence-based and tailored to Moray’s unique needs. Page 109
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• Shared Vision for 2026: We’ve laid the groundwork for a comprehensive draft action plan that will guide our efforts in the coming year. • Previous workshop report click this link-Here Page 110
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In Moray, Food Insecurity is significantly lower than the Scottish average This suggests that people in Moray generally have better access to food resources than the national average, possibly due to local economic conditions? community support? or food supply system?. However, lower food insecurity does not necessarily mean better diet quality, as data shows, fruit and vegetable uptake among children is still low. This highlights that affordability and access might not be the only barriers; cultural preferences, habits, and convenience also play a role. So, while basic access to food may be less of a problem as shown in the SHS, diet quality and healthy eating habits remain key challenges. Source: Scottish Health Survey 2024 See below Family and School community engagement briefing. Click link for full evaluation report Here Page 111
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What we did? Page 113
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Identified perceived causes of overweight and Obesity in Moray Page 114
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Identified Key themes Page 115
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Mapped current actions against identified causes Produced Draft Vision Statement “Our vision is a Moray where healthy choices are easy, appealing, and accessible for everyone - a place where communities, organisations, and workplaces connect to create healthy lives, and where collective leadership drives collaboration, accountability, and shared action.” Page 116
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Action Planning Workshop -Tuesday 2nd December Page 117
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Produced Draft Action Plan 2026 Vision board Page 118
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Next step Refine Vision Statement click the link Heathy Weight Moray Voices from Our Stakeholders “The workshops gave us a platform to align our efforts and think beyond traditional health interventions. It’s about creating environments where healthy choices are easier.” “Collaboration has been key. By working together, we’ve identified gaps and opportunities that no single organisation could tackle alone.” ''As it was the first of such workshops which I have attended I was heartened by meeting other participants from different organisations. It was good to connect with and hear the ideas and testimonies of the other participants''. Page 119
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‘’How interactive it was, seated exercises, table conversations’’ Page 120
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Partner Spotlight • Moray Council: Led efforts to merge the Whole Systems Approach (WSA) to Physical Activity Plan with the WSA to healthy weight , The transport team supported our Page 121
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student placement in mapping transport links in Moray, this information encourage considerations into local planning and transport strategies. • Free venue for future workshops and meetings- Elgin Library • Schools & Youth Groups (Elgin Youth Café): Delivered engagements on healthy eating, and mental wellbeing through the Snack-Tember Campaign in September empowering young voices and families in decision-making. • Third Sector Organisations: TSI Moray links and active promotion of the WSA work at the Health and Wellbeing Hub • Local Businesses: Moray Leisure Centre provided delicious spread for lunch and led on seated exercise session at our last workshop supporting healthier food options and active breaks. • Elgin Sports Community Trust- Offer of free venue for future workshop and meetings Thank you to all partners, stakeholders, and community members who have contributed to this journey. Together, we are building a healthier future for Moray. Page 122
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Thank you for a productive year! Wishing You and Yours a Healthy Christmas and New Year! WSA Core Working Team Page 125
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Contact Us Report Produced by : Nonye Agbaza Area Public Health Coordinator- HEAL / WSA Health Improvement Team, Health and Social Care Moray Visit us on - Facebook Page 126
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REPORT TO: COMMUNITY PLANNING BOARD ON WEDNESDAY 11 FEBRUARY 2026 SUBJECT: UPDATE ON POVERTY IN MORAY INCLUDING CHILDREN IN LOW INCOME FAMILIES (CILIF) AND CHILD POVERTY 2023-24 – NATIONAL AND LOCAL ANALYSIS BY: ELIZABETH ROBINSON, CONSULTANT IN PUBLIC HEALTH, NHS GRAMPIAN IAIN SNEDDON, RESEARCH AND INFORMATION OFFICER, MORAY COUNCIL 1. REASON FOR REPORT 1.1 To update the Board on Child Poverty Data for Moray and progress towards a new strategic approach to child poverty reduction. 2. RECOMMENDATION 2.1 It is recommended that the Community Planning Board (CPB) consider and note the latest Child Poverty Data for Moray and the development of a Lived Experience panel and Delphi method to build a consensus set of 3–5 priority anti-poverty interventions for Moray (short-, medium-, and longer-term). 3. BACKGROUND 3.1 Every year the lives of children and their parents across the UK are cut short by poverty. The harm that poverty causes to the health of individuals also affects: • our economy, by reducing people’s ability to work and contribute fully • public services, such as healthcare, education, housing and social care Item 4. Page 127
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• government budgets, through increased spending on welfare and reduced tax income 3.2 The Scottish Budget 2026 includes a commitment to increasing the Scottish Child Payment, funding for breakfast clubs and activity clubs, employability and childcare. 3.3 A priority of the Moray Community Planning Partnership (CPP) is to reduce Child Poverty. The Board receives an annual update on progress towards this target. As noted in a paper of July 2025, while individual agencies continue to deliver activity to tackle poverty in Moray, and recognising the commitment to national action, we are not yet reversing the trend. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Child poverty in Scotland is due to causes, or drivers, partially or wholly outside parents’ control and always outside of children’s control. These drivers include: • income from employment • cost of living • income from social security and benefits in kind 4.2 Solutions therefore include: • improving employment rights, including better access to paid parental and carers leave, and more flexible working options • raising the National Living Wage to match the Real Living Wage and extending it to younger parents • creating good jobs in areas with the highest levels of poverty, using targeted investment and economic development • embedding fair work principles in public sector contracts and spending, ensuring parents have access to well-paid, secure jobs 4.3 To support this we are working with a Lived Experience Panel and a Delphi method to build consensus across Moray of 3–5 priority anti-poverty interventions (short-, medium-, and longer-term), which will then be brought back to the Poverty Event already committed to by the Moray CPB. 4.4 A Delphi method is a systematic interactive way of gaining opinions/forecasts from a panel of independent experts (i.e. people with lived experience) over 2 or more rounds. It is a type of consensus method which does not require face to face Page 128
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meetings, recommended by Healthcare Improvement Scotland and will be used in conjunction with existing community engagement methodologies being utilised within Moray. 4.5 Outputs of this session will include: • A costed action plan with owners, timelines, equality impact assessment (EqIA), and measurable indicators. • A Lived Experience Advisory Panel (LEAP) embedded in CPP governance for ongoing monitoring. • A data & insight baseline and draft public dashboard for accountability. 5. CONCLUSION 5.1 The Community Planning Board is asked to note and continue to provide support for the local child poverty data for Moray and the activity being undertaken to support a local strategic action plan. Author of Report: Elizabeth Robinson (Consultant in Public Health, NHS Grampian) Background Papers: Appendix 1: Children in Low Income Families (CILIF) and Child Poverty 2023-24 – National and Local Analysis Delphi Model: Navigating policy complexity: a Delphi method approach | Nesta Page 129
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1 Children in Low Income Families (CILIF) and Child Poverty 2023-24 – National and Local Analysis AUTHOR: Iain Sneddon, Research & Information Officer, Moray Council INTRODUCTION On March 27, 2025, the Department for Work and Pensions (DWP) published the most recent UK-wide Children (aged 0-15) Living in Low Income Families (CILIF) dataset for 2023/24, detailing the proportions of children in low-income families across all UK Local Authorities. While numerical data is also available for individuals aged 0–19, due to changes within the 16–19-year-old cohort, DWP does not provide proportional data for this age group. It is important to note that CILIF statistics, though foundational for deriving ‘Child Poverty’ figures, are distinct from the official measure of ‘Child Poverty’ due to differences in methodology. The CILIF dataset reports the number and proportion of children living in both relative and absolute low income1 before housing costs (BHC) at the small local area level2. In contrast, the recognised measure of Child Poverty is based on after housing costs (AHC)3, which generally results in higher reported rates of children in poverty. In June 2025, updated UK-wide Relative Child Poverty4 data was released (End Child Poverty 2023/24), providing a resource commonly used by all UK local authorities. Unless otherwise specified, all references to ‘Poverty’ in this report pertain to ‘Relative Poverty’. Furthermore, child poverty data encompasses a wider age range, including children aged 0-15 as well as those aged 16-19 who are engaged in full-time non-advanced education5, thereby maintaining eligibility for Child Benefit and the Child Element of Universal Credit for their parents or carers. Previous two editions of this report incorporated data from the Scottish Index of Multiple Deprivation (SIMD 2020), alongside information from Moray Council and partner agencies, to provide additional context. This year, SIMD data has not been included. At five years old, SIMD 2020 is now considered too dated to add meaningful insight. The delay of Scotland’s Census has postponed the release of new SIMD data until late 2026. Previous analysis has shown that including local data makes little difference to the overall picture of poverty levels in Moray. While useful, the extra time and resources required to incorporate local data cannot be justified for this report. Small area population estimates are released less frequently than mid-year estimates. The current analysis is based on 2022 estimates—the latest available—as the National Records of Scotland (NRS) will not publish figures for 2023 and 2024 until winter 2025. Figures, proportions, and related calculations may change when the new data becomes available. Comparisons of mid-year estimates for Moray between 2022 and 2024 for the 0-15 and 0-19 cohorts show no significant statistical variation affecting 1 The ‘Income’ measure used is ‘Net Income’ (Gross Income + Benefits – Tax, National Insurance & Pension contributions). 2 Intermediate Zone (24 in Moray), Data Zone (126), Output areas (799) & Local Authority. 3 Housing Costs (Rent or mortgage interest payments, water rates, structural insurance payments and ground rent and service charges) 4 Relative Poverty / Child Poverty – described as: People / Children living in households whose equivalised income is below 60% of UK median income in the same year after housing costs (AHC). 5 Non-advanced Education – 12 hours or more/week in educational programs below university degree level. Item 4. Page 131
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2 findings at the Local Authority level; however, greater fluctuations may occur within specific intermediate zones, which could influence calculated proportions at that scale. This report is likely to be the last directly comparable with previous years. Since 2011, Moray has comprised 126 data zones, each containing approximately 750 residents. As residential development progresses, population distribution shifts, necessitating the redrawing of geographical boundaries to maintain balance. Previously conducted every decade, this process was delayed in 2021 due to the COVID-19 pandemic, but resumed during 2024-25, resulting in an increase to 138 data zones for Moray. SCOTLAND AND UK Scotland's child poverty rate in 2024 was 23%, lower than England and Wales (both 31%) and slightly below Northern Ireland (24%). Scotland and the East of England had the lowest rates among UK regions in 2023/24. Over the past decade, child poverty rose by 3.4% in England and 1% in Scotland, was stable in Wales, and fell by 1% in Northern Ireland. Recently, only Scotland has seen a decline. The Scottish Child Payment is expected to cut child poverty in Scotland by about 4 percentage points from 2020–23 to 2024/25, according to the Joseph Rowntree Foundation: “The introduction of the Scottish Child Payment (SCP) and the reforms to how disability benefits are delivered show initial steps to an improved system. With that in mind we predict that the SCP could reduce child poverty in Scotland by around 4 percentage points between 2020–23 and 2024/25.” Joseph Rowntree Foundation, Poverty in Scotland 2024, October 2024 MORAY AND SCOTLAND CILIF data shows a reduction in the number of children aged 0–15, from 2,652 in 2022/23 to 2,478 in 2023/24, representing a 1% fall to 15.9%. Relative child poverty also records a similar decline in the proportion of children aged 0–19, from 23.9% (4,182) in 2022/23 to 23% (3,942) in 2023/24. Considered in isolation, these figures are encouraging, indicating a fall in the number of children affected by low incomes and poverty. However, compared with most other Scottish local authorities, Moray does not perform as well. The median change in poverty levels across Scottish local authorities, between 2022/23 and 2023/24 (-1.8%), is twice the rate of Moray. In relative terms, poverty in Moray has worsened when compared with the most other local authorities, with the ranking shifting from 20th highest in 2014/15, to 16th in 2022/23, and 13th in 2023/24. Long-term data also paints an unfavourable picture, with poverty in Moray rising by 2.2% over the past decade, while the Scottish median shows a smaller increase of 1%. Within its comparator authority group, Moray has recorded the second highest rise in poverty levels between 2014 and 2024, and in 2024 holds the third highest level of poverty overall. The data suggests that although poverty levels in Moray are currently moving in the right direction, they are not keeping pace with the average reductions seen across Scotland. Figures 1 & 2 show poverty levels within all Scottish Local Authorities, Moray’s relative position and the change in levels between 2014/15 and 2023/24. In both figures Moray and comparator authorities have been highlighted. Additional illustrations of local authority comparisons can be found in Table 6 and Figures 4 & 5 in Appendix 1. Page 132
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3 Figure 1 Figure 2 The average gross full-time hourly pay (earnings by place of work) in Moray in 2024 at £16.526, is significantly less than Scotland (£19.17) and ranks Moray 32/32 (lowest) of Scottish local authorities, a decline of four places from 2023. Unlike most other Scottish local authorities, in Moray full-time female workers earn more per hour (£16.49) than their male counterparts (£16.43), although the gap has closed since 2023 (F=£16.09, M=£15.55). Calculations based on weekly wage data, for all employed in Moray, shows an average working week of 38.9hrs, compared with the Scottish average of 37 hrs/week. Even by working more hours/week, the average full-time weekly pay in Moray (£688.80) is significantly less than the national average (£739.70). Moray's low wage economy makes it less resilient to increases in the cost of living compared to other Scottish local authorities. This may partly explain why Moray is not keeping pace with the national reduction in poverty rates. To compound the income challenges faced by Moray; as wages rise so will the median average wage on which poverty measures are based, resulting in a rise of the poverty ‘Threshold’. If wages in Moray fail to keep pace, reducing poverty in Moray will prove more difficult. In Scotland between 2021 and 2024 it is estimated that three quarters of children in relative poverty live in ‘Working Households’. In 2012-15 this figure was significantly lower at 59%. In contrast both adults and children living in ‘Workless households’ have witnessed decreases in poverty over the same period. This may be indicative of low wages having more of an impact than benefit awards, or perhaps decisions have been made to direct more resources towards workless households, with the assumption being they are more in need. Either way this is an increasing and concerning trend. As poverty is defined as an income- based measure it is clear that not all work pays enough to ensure the household is above the poverty 6 NOMIS – Official Census and Labour Market Statistics 2024 Page 133
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4 threshold. With a low wage economy and the lack of senior and professional job roles in Moray it is difficult to see how changes in poverty levels can keep pace with elsewhere in Scotland. Children living in ‘Priority Groups’7 are at a far greater risk of being in ‘Relative Poverty’. Across all priority groups poverty levels are higher among Scottish households, with those with three or more children reaching 41% in 2021-24. In all other groups, levels were greater than 26%. Households where the household head is aged 16-24 have been consistently more likely to be in relative poverty compared to older households. In 2021-24, 37% of these households were in relative poverty compared to 18% - 21% for other age groups. In 2024 17% (120) of the 690 live births in Moray were to mothers under the age of 25, this compares with 14% nationally. Other societal groups in Scotland do not experience poverty to the same levels as children. Scottish Government figures (2021-24) show that 20% of working-age people and 15% of pensioners were living in poverty. METHODOLOGY OF LOCAL ANALYSIS Most nationally published data is unable to show any insight into levels of poverty within Local Authorities unless available at smaller geography level, which is uncommon. CILIF data is available in smaller geographies and can therefore be aggregated to show data at Data Zone and Intermediate Zone. Unfortunately, poverty data is not available to the same detail. Analysis of data from the past 10-years makes it possible to identify the average proportional increase from CILIF to relative child poverty. By using the average proportional increase and applying an algorithm to CILIF data, levels of poverty can be estimated to a high degree of accuracy within smaller geographies. This method was tested on several previous years data to determine accuracy, prior to the publication of official Local Authority poverty data. The testing established accuracy to within 0.2% at Local Authority level. In future years it may be possible to estimate poverty levels prior to publication of national data. The 2023/24 CILIF publication estimated 3,052 Moray children, aged 0-19, were living in low-income families. ‘End Child Poverty’ data estimates the number of children living in relative poverty to be 3,942, representing an increase of 29.2%. Figures calculated for smaller geographies using this method assume that the increase from CILIF to Relative Child Poverty is consistent, which may not account for local variations or unique circumstances affecting certain communities. At the smallest of geographical levels, more data is redacted to maintain anonymity. To provide the most accurate data analysis for smaller geographies Intermediate Zone Level data has been used. WITHIN MORAY Moray is classed as a rural Local Authority. Nationally 17% of the population live in rural locations, in Moray the figure is significantly higher at 41.6%. Long-term trend analysis shows the Urban/Rural population demographic has remained stable. The costs of living rurally tend to be higher, often due to food, fuel and travel costs. While it might be expected that poverty levels would be higher in rural areas due to increased living costs, the available data for Moray does not support this assumption. This may be due to higher incomes in rural areas of Moray. However, there is currently no detailed income data available for rural Moray to support this premise. Whilst the data shows that poverty appears lower in 7 Households where there is/are: 3 or more children, Disabled member(s), Youngest child is under one, Minority ethnic, Single parent and Mother under the age of 25. Page 134
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5 rural areas of Moray, it may be, where there is poverty, the severity is higher. 40.1% of children aged 0-15 live in rural locations, indicating a lower population density for this age group. Almost two thirds (63.6%) of children aged 0-15, living in poverty, reside in urban areas of Moray . This suggests that, despite a lower overall population density of children in urban areas, child poverty is disproportionately concentrated there compared to rural areas. Table 1 shows the population distribution for urban and rural areas of Moray. Table 1 Urban / Rural Population Demographics in Moray (0-15) Population 0-15 Population Data Zones Location of Poverty Number % Number % Number % Number % Urban 55,098 58.4% 9,366 59.9% 75 59.5% 2,085 63.6% Rural 39,202 41.6% 6,280 40.1% 51 40.5% 1,190 36.4% TOTALS 94,300 15,646 126 3,282 CHILDREN IN LOW INCOME FAMILIES (CILIF) Prior to calculating poverty for small geographies, a full analysis of CILIF data was undertaken. An emerging trend between 2021/22 and 2023/24 is a significant change in the proportion of children within age groups, as shown in Table 2. There is a clear movement of proportions from the younger to older groups, indicating that poverty is becoming more acute in the older age groups, and particularly the 16-19 group. In relation to the 16-19 group a possible reason may be due to entitled parental benefits. According to HM Revenue and Customs (HMRC), parents of children in this age group are not effectively claiming benefits for their children, with the rules for continued claims, especially what constitutes ‘approved education or training’ not being well-understood, leading to the assumption that benefits cease when the child reaches the age of 16. Targeted outreach or policy adjustments may be necessary to ensure families with older children are aware of their entitlements, to potentially reduce poverty rates in this group. Regardless of reason, it is a concerning and increasing trend. Table 2 % Age distribution of children in Low Income Families 0-4 5-10 11-15 16-19 2021/22 25.07% 30.99% 28.05% 15.88% 2022/23 23.93% 30.30% 28.62% 17.15% 2023/24 23.66% 28.93% 28.60% 18.81% Difference -1.42% -2.06% 0.56% 2.92% CILIF data can be broken down by household demographic. Single parent households are one of the ‘Priority’ poverty groups. Scotland’s Census 2022 estimates that in Moray 21.5% of all households with dependent children are ‘Lone parent’ families, nationally the figure is 26.4%. In Moray 61.6% (1,879) of CILIF in 2023/24 were within single parent households - a 9% increase from 2021/22. Both Moray and Scotland show rising trends, however national proportions are lower (53% in 2021/22 & 57% in 2023/24). There is strong correlation, at intermediate zone level, between single parent households and levels of poverty, but it is not always the case that higher proportions of CILIF for single parent families leads to higher poverty levels. Table 5 in Appendix 1 shows the proportions of children in single parent households and CILIF in these households along with the links between the rankings for single parent households and estimated poverty at intermediate zone level. There is only one major outlying intermediate zone (Rural Keith and Strathisla) which ranks 9th for poverty and 22nd for single parent households, this suggests that for couple families in this zone the effects of poverty are more acute. Page 135
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6 In Moray 71.5% (2,180) of CILIF are living in ‘Working Families’, higher than the national figure of 66.3%. As mentioned earlier in this report, the Scottish government estimates 75% in poverty are within ‘Working Families’. If the same increase were to be applied to Moray, it would indicate levels of child poverty in ‘Working Families’ would be in the region of 80%. ESTIMATED CHILD POVERTY IN SMALLER GEOGRAPHIES The data in Table 3 shows the number and proportion of Moray children, aged 0-19, living in poverty in 2023/24 at Intermediate zone level. To allow for comparisons 2021/22 & 2022/23 data has been included. The table has been ranked from highest to lowest in 2023/24. Estimated proportions of poverty are shown for every zone. This data has also been aggregated into Quartiles to show on a larger scale how average levels have changed over the period. It is estimated that almost 40% (1,557/3,942) of children living in poverty in Moray are within Quartile 1 (highest levels of poverty), in comparison with 19% (752/3,942) in Quartile 4 (lowest levels of poverty). In 2023/24 seven from the top 10 Intermediate zones are within urban areas. There is little ranking change between 2021/22 and 2023/24 within the Quartile 1. Whilst individual zone rankings have changed, five of the top six in 2023/24 appear in both 2021/22 and 2022/23. From 2021/22 to 2023/24, place rankings for seven zones remain unchanged. Five of these are the top five within Quartile 1, all of which have witnessed reductions in poverty levels. Level reductions in Quartile 1 are however not consistent with four zones showing rises between 2022/23 and 2023/24. Nine zones have seen increases in ranking, with poverty proportions also increasing. In eight zones, rankings have decreased, with seven showing reductions in poverty levels. Zones within Quartile 2 have witnessed both the highest ranking and proportional poverty increases. The most significant positive ranking changes are within Quartiles 3 & 4. Between 2021/22 and 2023/24, positive changes in poverty levels are most significant for Quartile 1 (- 2.4%) and Quartile 4 (-5.3%), showing that children living in the Quartile with the lowest levels of poverty (Quartile 4) benefiting more than those living in the Quartile with the highest levels (Quartile 1). This indicates that the gradually reducing levels of poverty in Moray is more so due to these levels falling in the areas with the least poverty than those with the most. Investment of resources to reduce poverty has traditionally been directed to the ‘Poorest’ areas; however for Moray, data may suggest this investment hasn’t made the differences required to bring about significant positive change and that current intervention strategies are less effective in areas with entrenched poverty, highlighting a need for tailored approaches or additional support. The most significant negative changes are witnessed within Quartile 2 which increased by 5.4% between 2021/22 and 2023/24. The data indicates a movement in the levels of poverty from both the highest and lowest Quartiles into the centre two Quartiles, which has resulted in a reduction in the gap between the most and least in poverty from 42.2% in 2021/22 to 33.8% in 2023/24. Direct comparisons can be made as the most and least Intermediate zones are identical in both periods. Whilst this reduction is encouraging, we must be cognisant of the changing geographical poverty demographic in Moray and consider whether changes in the delivery of interventions and areas targeted need to be made. A outlier in the table is the Findhorn, Kinloss and Pluscarden Valley Intermediate Zone which ranked significantly higher in both 2021/22 and 2022/23. Further analysis of CILIF data over the period 2021/22 to 2023/24 shows a 23% reduction in the number of children in low-income households over the period. This zone takes in the MOD camp at Kinloss which has a transient population that may have a bearing over the population data used in calculating figures. Page 136
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7 Table 3 No in Poverty (0-19)* % 0-19 in Poverty* RANK Quartile % Poverty No in Poverty (0-19)* % 0-19 in Poverty* RANK Quartile % Poverty No in Poverty (0-19)* % 0-19 in Poverty* RANK Quartile % Poverty 1 New Elgin East 309 41.6% 1 368 48.4% 1 370 48.3% 1 2 Elgin Cathedral to Ashgrove and Pinefield 280 40.2% 2 266 37.2% 2 313 43.9% 2 3 Keith and Fife Keith 258 35.4% 3 228 30.5% 6 271 36.3% 3 4 Cullen, Portknockie, Findochty, Drybridge and Berryhillock 273 34.1% 4 258 31.6% 4 291 35.4% 4 5 Forres South West and Mannachie 270 30.7% 5 304 33.7% 3 310 34.3% 5 6 Elgin Bishopmill East and Ladyhill 167 30.1% 6 165 29.0% 7 153 27.0% 8 7 Buckie Central East 198 30.1% 7 209 31.0% 5 200 29.8% 6 8 Fochabers, Aultmore, Clochan and Ordiquish 127 27.5% 8 106 22.4% 13 124 25.9% 10 9 Rural Keith and Strathisla 115 24.7% 9 116 24.3% 11 116 23.9% 11 10 New Elgin West 159 24.4% 10 147 21.9% 14 123 18.4% 16 11 Forres Central East and seaward 107 24.3% 11 118 25.7% 9 74 16.1% 21 12 Lossiemouth West 202 23.5% 12 246 27.9% 8 233 26.4% 9 13 North Speyside 121 22.2% 13 106 19.1% 17 103 18.3% 17 14 South Speyside and the Cabrach 123 19.8% 14 150 23.6% 12 150 23.6% 12 15 Mosstodloch, Portgordon and seaward 115 19.6% 15 124 20.6% 16 115 19.0% 15 16 Lhanbryde, Urquhart, Pitgavney and seaward 149 19.2% 16 144 18.2% 18 144 18.2% 18 17 Findhorn, Kinloss and Pluscarden Valley 138 18.9% 17 184 24.4% 10 206 27.3% 7 18 Lossiemouth East and Seatown 80 17.1% 18 79 16.3% 19 102 21.0% 13 19 Burghead, Roseisle and Laich 178 17.0% 19 155 13.9% 23 135 12.0% 23 20 Heldon West, Fogwatt to Inchberry 213 15.1% 20 228 15.8% 21 217 15.0% 22 21 Buckie West and Mains of Buckie 136 14.6% 21 154 16.2% 20 160 16.6% 19 22 Rafford, Dallas, Dyke to Dava 105 12.4% 22 180 20.7% 15 180 20.7% 14 23 Elgin Bishopmill West and Newfield 83 12.4% 23 102 14.9% 22 113 16.4% 20 24 Elgin Central West 37 7.8% 24 47 9.4% 24 31 6.2% 24 MINIMUM 37 7.8% 47 9.4% 31 6.2% MAXIMUM 309 41.6% 368 48.4% 370 48.3% DIFFERENCE 272 33.8% 321 39.0% 339 42.2% 3,942 23.0% 4,180 23.9% 4,226 24.1% * The cohort of 16-19 year-olds changes anually, %'s are based on the 0-15 population + 16-19 year-old cohort, hence why reducing numbers in poverty do not always equal reducing %'s TOTAL 35.4% 25.7% 19.5% 14.0% 37.8% 20.3% 18.6% 19.3% RELATIVE CHILD POVERTY (0-19 Years) 2021-2024 (Sorted Highest - Lowest 2023-24) 2021-222023-24 2022-23 35.2% 23.1% 19.1% 18.1% Intermediate Zone Page 137
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8 Whilst SIMD2020 data has not been used in this analysis, SIMD methodology has been used to show the internal deprivation of Moray. Using the SIMD data zone rankings internal deprivation can be established by ranking each of Moray’s 126 data zones from 1 to 126 and placing them into deciles, similar to SIMD (1- 10, high to low deprivation). Table 4 & Figure 3 show the 0-19 population8, the number of children in poverty and the percentage of children in poverty per Moray decile. Figure 3 shows a clear link between poverty and deprivation with the percentage of poverty decreasing as deprivation decreases. Table 4 details the levels within deciles showing that half of children living in the most deprived 13 data zones are in poverty. Children living in the most deprived 40% (deciles 1-4) account for 36% of the 0-19 population but 59% (2,311) of all children in poverty. In contrast almost half (48%) of the 0-19 population live in deciles 7-10 (least deprived 40%), yet only account for 25% (1,005) of all Moray children in poverty. This concentration of poverty in more deprived areas highlights significant inequalities within Moray, Table 4 Deciles 0-19 Population* % of 0-19 population No in Poverty % in Poverty 1 1,071 6.3% 541 50.5% 2 1,747 10.2% 737 42.2% 3 1,724 10.1% 568 32.9% 4 1,636 9.6% 473 28.9% 5 1,322 7.8% 337 25.5% 6 1,371 8.0% 281 20.5% 7 1,549 9.1% 313 20.2% 8 2,374 13.9% 337 14.2% 9 2,555 15.0% 250 9.8% 10 1,696 10.0% 105 6.2% TOTAL 17,045 100.0% 3,942 23.0% * Children aged 0-15 + 16-19 if in non-advanced education Figure 3 8 Children aged 0-15 + 16-19 if in non-advanced education 50.5% 6.2% 0% 10% 20% 30% 40% 50% 60% - 500 1,000 1,500 2,000 2,500 3,000 1 2 3 4 5 6 7 8 9 10 Deciles % Poverty & population by decile 0-19 Population* No in Poverty % in Poverty Page 138
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9 CONCLUSION Local authorities are limited by external factors in efforts to reduce poverty. Inflation and rising fuel costs are factors out with the control of authorities, tackling these issues in more rural authorities are likely to be more challenging. Although poverty in Moray, amongst the 0-19 age group, has decreased over the past three years (1.1%), the ten year average (22.7%) would indicate it as plateauing. The physical numbers of children living in poverty have increased between 2014/15 and 2023/24, whilst the population of the same age group has decreased, showing no progress has been made in the numbers of children affected. Moray isn’t keeping pace with other Scottish local authorities. When ranked against all other authorities Moray’s position has declined, from being placed 20th in 2014/15 to 13th highest in 2023/24. With ‘Poverty’ being an income-based measure, it is probable that the low wage economy and the lack of senior and professional job roles continues to hinder progress. It is positive to see the number and proportion of children aged 0-10 living in low-income families declining but, at the same time it is concerning to see the consistent increase in numbers and proportions for those aged 11-19. Where can a difference be made? Simplistically, with the measure of ‘Poverty’, whether that be ‘Relative’, ‘Absolute’ or ‘Persistent’, being income based, the only way to reduce poverty is to increase incomes. To do so requires either wage growth, increasing benefits and/or ensuring that all people who are entitled to benefits can access them. Increasing wages in Moray is challenging given the range and quantity of higher paid work while raising benefits requires changes in government policy. Increasing access to benefit entitlement however is achievable locally. Services and resources directed at helping families in poverty cope with the effects will not reduce poverty, they will only help mitigate the impact. It is the authors opinion that investment in income maximisation services to ensure that families receive benefit entitlements are where the biggest differences can be made; particularly if these services are focussed towards families with children aged 16-19. Page 139
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10 APPENDIX 1: ADDITIONAL FIGURES AND TABLES Table 5 % of single parent households with dependent children* % CILIF in Single Parent Families Single Parent Household Rank Poverty Rank Elgin Cathedral to Ashgrove and Pinefield 35.7% 61.1% 1 2 New Elgin East 34.0% 68.4% 2 1 Forres South West and Mannachie 30.2% 57.4% 3 5 Buckie Central East 28.4% 66.0% 4 7 Keith and Fife Keith 27.8% 66.0% 5 3 Fochabers, Aultmore, Clochan and Ordiquish 25.9% 48.5% 6 8 Cullen, Portknockie, Findochty, Drybridge and Berryhillock 25.1% 62.3% 7 4 Mosstodloch, Portgordon and seaward 24.7% 55.4% 8 15 Elgin Bishopmill East and Ladyhill 23.0% 54.5% 9 6 Lossiemouth West 22.4% 66.9% 10 12 Lhanbryde, Urquhart, Pitgavney and seaward 22.1% 71.4% 11 16 New Elgin West 22.1% 68.6% 12 10 North Speyside 20.0% 58.5% 13 13 Lossiemouth East and Seatown 19.9% 67.8% 14 18 Forres Central East and seaward 19.9% 55.3% 15 11 Findhorn, Kinloss and Pluscarden Valley 18.7% 51.9% 16 17 South Speyside and the Cabrach 18.6% 44.8% 17 14 Burghead, Roseisle and Laich 16.7% 56.3% 18 19 Rafford, Dallas, Dyke to Dava 15.2% 54.8% 19 22 Heldon West, Fogwatt to Inchberry 14.2% 66.5% 20 20 Buckie West and Mains of Buckie 14.2% 75.2% 21 21 Rural Keith and Strathisla 14.0% 52.9% 22 9 Elgin Bishopmill West and Newfield 13.7% 76.7% 23 23 Elgin Central West 12.1% 44.8% 24 24 MORAY 21.5% 61.6% * Children aged 0-15 + 16-19 if in non-advanced education Proportion of children in single parent households (2023/24) Page 140
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11 Table 6 Figure 4 Ranking 2023/24 2022/23 2014/15 Scotland 23.0% Scotland 24.0% Scotland 22.0% 1 Glasgow 36.1% Glasgow 32.9% Glasgow City 27.1% 2 Clackmannanshire 28.5% North Ayrshire 29.2% North Ayrshire 24.8% 3 Dundee 26.1% Clackmannanshire 29.2% East Ayrshire 24.4% 4 West Dunbartonshire 25.2% Dundee 28.2% Clackmannanshire 24.2% 5 Falkirk 25.1% West Dunbartonshire 28.0% North Lanarkshire 23.9% 6 Fife 25.0% East Ayrshire 27.9% Dundee 23.8% 7 North Lanarkshire 24.9% North Lanarkshire 26.9% Fife 23.6% 8 Midlothian 24.6% Dumfries and Galloway 26.9% West Dunbartonshire 23.4% 9 North Ayrshire 24.3% Fife 26.6% Dumfries and Galloway 23.3% 10 West Lothian 24.1% Falkirk 26.2% Falkirk 22.7% 11 Angus, Scotland 24.1% Inverclyde 26.1% South Ayrshire 22.7% 12 East Ayrshire 23.6% South Ayrshire 25.0% East Lothian 21.9% 13 Moray 23.0% Angus, Scotland 24.9% Midlothian 21.8% 14 Edinburgh 22.8% West Lothian 24.6% South Lanarkshire Council 21.5% 15 Dumfries and Galloway 22.7% Renfrewshire 24.0% Highland 21.4% 16 Inverclyde 22.4% Moray 23.9% West Lothian 21.3% 17 Highland 22.1% Scottish Borders 23.6% Angus, Scotland 21.1% 18 East Lothian 22.1% South Lanarkshire Council 23.6% Inverclyde 20.9% 19 Scottish Borders 21.5% Argyll and Bute 23.5% Scottish Borders 20.9% 20 Argyll and Bute 21.2% Highland 23.3% Moray 20.8% 21 Renfrewshire 21.0% Midlothian 23.2% Argyll and Bute 20.7% 22 South Ayrshire 20.7% Aberdeenshire 21.8% Orkney 20.3% 23 Stirling 20.4% Perth and Kinross 21.7% Perth and Kinross 19.9% 24 Na h-Eileanan Siar 19.7% East Lothian 21.3% Stirling 19.6% 25 South Lanarkshire Council 19.5% Stirling 20.8% Renfrewshire 19.3% 26 Perth and Kinross 19.2% Edinburgh 20.4% Aberdeen 18.7% 27 Aberdeen 19.1% Orkney 19.3% Edinburgh 18.6% 28 Orkney Islands 18.6% Na h-Eileanan Siar 18.5% Na h-Eileanan Siar 17.5% 29 Aberdeenshire 15.0% Aberdeenshire 16.5% Aberdeenshire 15.6% 30 East Dunbartonshire 14.9% Shetland 16.4% East Dunbartonshire 15.2% 31 Shetland 14.5% East Dunbartonshire 15.7% East Renfrewshire 15.0% 32 East Renfrewshire 12.0% East Renfrewshire 14.0% Shetland 13.3% Figure 5 Page 141
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12 APPENDIX 2: MEDIAN HOUSEHOLD INCOME EXPLANATION Determining the Income threshold by which poverty is measured is a complex procedure. The Households Below Average Income (HBAI) data set is the source used by the Uk government to identify UK average incomes. The median income is the income where half of all households have more, and half have less. The government uses the median value from the HBAI data for each year as the official measure for determining poverty. A household is considered to be low income if their equivalised net disposable income is below 60% of the median. Equivalisation standardises household income to account for different household composition, making it possible to compare different households. Income thresholds can be calculated both before and after housing costs, for poverty the After Housing Cost (AHC) measure is used. For 2023, 60% of the median income for households below average income (HBAI) data was approximately £17,300 after housing costs. Different government reports may provide slightly different figures depending on their specific scope, methodology, and the exact period they are reporting on, however it is widely accepted that the ‘Poverty’ threshold ranges between £17K & £17.3K. NATIONAL SOURCES 1. Scotland’s Census 2022 2. National Records of Scotland (NRS): Mid-year population estimates by Data Zone, 2022 3. National Records of Scotland (NRS): Small area household estimates by Data Zone, 2022 4. Department of Work and Pensions (DWP) Stat-Xplore: Children living in Low Income Families, 2023/24 5. End Child Poverty, 2023/24 6. Households Below Average Income (HBAI) 2023 7. HM Revenue & Customs 8. Official Census and Labour Market Statistics (NOMIS), December 2024 Page 142
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REPORT TO: COMMUNITY PLANNING OFFICERS BOARD ON WEDNESDAY 11 FEBRUARY 2026 SUBJECT: DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT 2024/25 BY: PROFESSOR SHANTINI PARANJOTHY, DIRECTOR OF PUBLIC HEALTH 1. REASON FOR REPORT 1.1 It is usual practice for the Director of Public Health (DPH) to provide an annual report. The DPH annual report for this year is focused on children and is presented to the Board for information, along with an accompanying appendix that provides an updated overview of population health data for Grampian. 2. RECOMMENDATION 2.1 It is recommended that the Community Planning Board: i. Reflect on how we continue to incorporate the voices of children and young people into decision making and planning of services; and ii. Note the commitment to the production of comprehensive population based needs assessments for children and young people in Grampian during summer 2026 to inform the development of plans for Children’s Services, Child Poverty, Corporate Parenting and Children’s Rights. 3. BACKGROUND 3.1 The focus on Children in this year’s DPH annual report is in recognition of the importance of the early years on health and wellbeing during the life course. Children’s experiences during this formative time are a key driver of inequalities in population health outcomes. The report has been informed by engagement with children and young people across Grampian. Community engagement groups across Grampian were contacted with a view to organise focus groups with young people. Due to the number of already scheduled events in Aberdeen City and Moray, focus groups were held in four locations across Aberdeenshire. Participants (aged 12-17) were asked about how they feel now, what they would like to keep and what they needed for the future. In addition to these engagement activities in Aberdeenshire, this report incorporates insights from recent Item 5. Page 143
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consultations with children and young people in Aberdeen City and Moray. These conversations have collectively helped us to examine the four threats to population health that were described in the previous DPH reports through the lens of children. The Children’s Services Board in Aberdeen City, Getting it Right for every Child (GIRFEC) Strategic Group in Aberdeenshire and GIRFEC Leadership Group in Moray were also engaged in to inform the production of this report. 3.2 Overall, children in the most deprived communities face significantly shorter lives than those in the least deprived. In Aberdeen City, boys born in the most deprived areas can expect to live 9 years less than their peers in the least deprived areas; for girls the gap is over 8 years. Aberdeenshire tells a similar story, with a 6.5 year gap for males and a 5 year gap for females. Even in Moray, where outcomes are slightly better overall, boys in the most deprived area still live 6 years less than those in the least deprived areas. This difference is 2 years for girls. 3.3 The report covers four themes - growing up in poverty, inequalities, mental health and neurodiversity, and climate change. Under each theme, we present what children and young people said, contextual information relevant to the theme including data and examples of work that is underway to address these issues. 3.4 Whilst there are many examples of good practice highlighting where we are making a positive difference to the health and wellbeing of children, there are also areas where inequities persist and further action is needed. These include breastfeeding, maintaining healthy weight, oral health, HPV vaccinations and teenage pregnancies. 4. NEXT STEPS 4.1. Through our work with health and social care partnerships and our contribution to community planning partnerships we have the opportunity to ensure a whole system joined up approach to reduce inequities and provide the best quality of services for children and families. The following sets out the actions that will be taken to progress this: 4.1.1 Within NHS Grampian we will progress work to look at how we can ‘poverty proof’ our health and care services, using the learning from the Health Equity Learning Project that was highlighted in the report 4.1.2 We will develop an innovative whole-system pathway to provide early identification, assessment, and tailored support for children with neuro- developmental differences. The developmental aspects of this work will be supported by NHS Grampian Charity funding, with a clear plan embedding this into usual practice to ensure the change is sustained in the longer term. 4.1.3 We will continue to progress ongoing work to address inequities in breast feeding drop-off rates, oral health, HPV vaccinations and teenage pregnancies, and supporting children to maintain healthy weight. Page 144
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4.1.4 The Child Health strategy for Grampian will be reviewed and refreshed for publication during summer 2026. 4.1.5 The Public Health team will continue to work with partners in the Integrated Children’s Services Board in Aberdeen City, to develop and use comprehensive population based needs assessments for children and young people in each area to inform the development of plans for Children’s Services, Child Poverty, Corporate Parenting and Children’s Rights. These will also be published during summer 2026. 5. CONSULTATION This report has been prepared with input from Public Health and wider NHS colleagues and Partners, and engagement on early drafts with the Integrated Children’s Services Board in Aberdeen City, Getting it Right for every Child (GIRFEC) Strategic Group in Aberdeenshire and GIRFEC Leadership Group in Moray. Author of Report: Shantini Paranjothy (Director of Public Health) Background Papers: DPH Annual Report 2024/25 director-of-public-health-dph- annual-report-2024---children-and-young-people.pdf DPH Annual Report Data Appendix 2024/25 dph-annual- report-2024-data-appendix.docx DPH Annual Report 2024/25 video DPH Report Page 145
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REPORT TO: COMMUNITY PLANNING BOARD ON 11 FEBRUARY 2026 SUBJECT: PLACE DIRECTOR / COMMUNITY PLANNING PARTNERSHIPS CHARTER BY: CHIEF EXECUTIVE, MORAY COUNCIL 1. REASON FOR REPORT 1.1 To raise awareness of the work undertaken by Scottish Government and COSLA to develop a Place Director Charter, setting out expectations and how they will be supported by Community Planning Partnerships (CPP). 2. RECOMMENDATION 2.1 It is recommended that the Board – (i) Consider and provide endorsement in principle for the draft charter. 3. BACKGROUND 3.1 Scottish Government and COSLA have been working to refresh their Shared Priorities Plan, which sets out how they will work with partners to enhance community planning. The Plan includes a review of Place Directors to maximise their role as ambassadors to Community Planning Partnerships (CPP). 3.2 Development of a Place Director Charter sets out expectations of Place Directors, and how they will be supported by CPP partners. Engagement with key stakeholders at a national level on the Charter has been positive. 3.3 CPP were invited for feedback over ten days in December, feedback was unanimously supportive for the principle of having a Charter in place, with the final draft presented (Appendix 1). Item 6. Page 147
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3.4 The aim is to launch the Charter with COSLA and key stakeholders at an event in late March to reconfirm the Scottish Government’s commitment to CPP and community planning. 4. SUMMARY OF IMPLICATIONS 4.1 There are no direct financial, workforce, equalities, policy or legal issues from this report. 5. CONCLUSION 5.1. The Community Planning Board considers and endorses in principle the Place Director Charter. Author of Report: Louise Marshall, Strategy and Performance Manager Background Papers: Ref: Page 148
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APPENDIX 1 Page 149
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REPORT TO: COMMUNITY PLANNING BOARD ON 11 FEBRUARY 2026 SUBJECT: HEALTH & TRANSPORT ACTION PLAN (2024-2029) BY: TIMOTHY MACKAY, SERVICE MANAGER TRANSPORTATION 1. REASON FOR REPORT 1.1. The purpose of this report is to update Board members regarding the review of the Health & Transport Action Plan (HTAP) (2024-2029) and implementation of new structures to support action-focussed delivery of objectives. 2. RECOMMENDATION 2.1. It is recommended that the Board: i. Note the contents of this report and the new Health & Transport Action Plan 2024-2029; ii Note the ongoing work of partners to ensure all partner organisations are engaged and committed to the new HTAP; and iii. Support the delivery of actions agreed by the HTAP Steering Group. 3. BACKGROUND 3.1. In the Grampian region there has been an established partnership between health and transport partners since 2008. The purpose of HTAP is: “to enable providers of transport, health and social care services to work together in a more co-ordinated manner in order to improve outcomes and efficiency of service delivery, both in reducing the adverse impacts of transport choices on public health and in improving access to health and social care.” 3.2. Since the time of the first review in 2014, there have been a number of significant challenges and changes. These changes necessitated the need to undertake a review of the HTAP and the priorities for Grampian partners. Item 7. Page 151
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3.3. During 2023 the Programme Manager led a review of the HTAP, supported by a group of partners providing advice. Extensive stakeholder engagement, evidence review, and consultation has taken place. Effort has been made to seek alignment with existing and emerging strategies across organisations. 3.4. The new, refreshed HTAP was launched on the 3rd of February 2025. Action Plan launched to address health and transport challenges | Nestrans 3.5. Partners have been meeting to develop the Governance Structure, the Terms of Reference and Priority Projects. 3.6. It has been agreed that a slimmer governance structure will be adopted. The two themed Sub-Groups will be replaced by a single Reference Group formed of liaisons to each partner organization. As well as supporting the delivery of the agreed Projects, the Reference Group will serve to support the HTAP network generally and feed into the Steering Group. 3.7. A summary of the new Governance Structure and priority projects is shown in Appendix A as a supporting document. The background papers will be uploaded as additional meeting documents. 3.8. In lieu of an annual report, this paper serves as the update on HTAP to partners. 3.9. In addition to finalising the review, its creation and launch, partners have continued to bring together local partners to exchange information, provide THInC and THInC in the City, presenting to the Public Health Scotland conference in November 2024 and supporting the local delivery of Public Health Scotland and SCOTS (Scottish Collaboration of Transport Specialists) in person event in Aberdeen on 5th of February 2025. 4. SUMMARY OF IMPLICATIONS 4.1. Since the 2014 review of the Plan there have been a number of challenges and changes that have presented themselves and required a review of the plan and it’s priorities. The result of which is the updated Plan, revised Governance Structure, Terms of Reference and Priorities, and the replacement of the two Sub Groups with a single Reference Group, that will continue to feed into the Steering Group. 5. CONCLUSION 5.1. It is hoped that review of the HTAP and implementation of new structures to support action-focussed delivery of objectives will lead to further collaboration, engagement and exchange of information between health and transport partners. Author of Report: Andrew Stewart, HTAP Programme Manager (post jointly funded by NHS Grampian and Nestrans). Page 152
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Background Papers: HTAP Annual Report 2022-23 HTAP Terms of Reference HTAP Project Plans Ref: Page 153
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1 Appendix A Next Steps, Deliverables & Delivery Structure Discussion Paper The new HTAP was launched on the 3rd of February 2025. The new HTAP Governance Structure The HTAP Steering Group has agreed a new structure to promote delivery of projects, new Terms of Reference and priority projects. Three core project groups, reporting through a reference group that is comprised of members of the previous two subgroups. The Reference Group would then report to the Steering Group: Key Considerations 1. A need to be both efficient and effective 2. A need to demonstrate collective ownership and delivery. 3. A need to retain our network of members and contacts but reduce the burden on time for key partners. 4. A wish to drive motivation and engagement through successful completion of simple, tangible deliverables. HTAP Steering Group Reference Group Project Group 1 Project Group 2 Project Group 3 Overarching Purpose: “To enable providers of transport, health and social care services to work together in a more co- ordinated manner in order to improve outcomes and efficiency of service delivery, both in maximising the health promoting aspects of the transport system and reducing the adverse impacts of transport choices on population health and in improving access to health and social care.” Item 7. Page 155
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2 The HTAP partnership will focus on four elements: 1. A Centre of Excellence for Health & Transport; 2. A co-ordinating role; 3. Delivery of exemplars; 4. Strategic Alignment The specific projects proposed are: Group Project Title Focus Project 1 Sustainable Model for Community Transport a) Improving Current Systems • Raising visibility of THInC to patients • Improving NHSG travel webpages b) Developing a New Model • Influencing change across the system – appointment times flexibility, reimbursement of travel costs. • Adapting community transport to address gaps in provision (Volunteer driver recruitment, working with third sector to develop a funding application to the NHS Grampian Charities Fund. • Co-ordinating role • Delivery of exemplars Project 2 Creating a Centre of Excellence • Short life group focused on co-producing the best practice steps needed to make the HTAP group Centre of Excellence. • Coordinating role • Centre of excellence Project 3 Health & Transport Data Sharing Group • Did Not Attend data gaps – evidence needed to support funding transport for health. • Strategic alignment Page 156
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3 • Whole system thinking requires more data sharing. • Collation of lived experience work on transport poverty. • Co-ordinating role Any questions: Andrew.Stewart@aberdeenshire.gov.uk Page 157
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