Introduction
This report will assess the health needs of Derbyshire via geographical profiling and needs assessment. Firstly, it will analyse characteristics of the population, health status, and different determinants which directly or indirectly impact health of the service users. Subsequently, the report will identify, highlight and analyze three primary health needs using an evidence-based approach. The physical and psychosocial impact of the needs will also be identified along with evaluating the economic influence on National Health Services (NHS). The three health concerns facing Derbyshire include obesity, diabetes and mental health which are largely due to rapidly deteriorating lifestyles of the people. Lastly, the report will prioritize one specific need, provide recommendation for a community-based intervention, and a work around to addressing one potent challenge to implementation of the proposed intervention which in this case is active participation of the community.
- Derbyshire Geographical Profile
Geographical profile of a particular area helps to identify the available resources, populations statistics, available opportunities and any lack thereof that might impede in the provision of necessities to people ensuring a standard quality of life.
Population characteristics of Derbyshire
The Derbyshire constitutes eleven parliamentary constituencies and 2 counties of Derbyshire County and Derby UA (Derbyshire Observatory, 2017). The borough comprises of 8 districts with a total geographical area of 78.03 km2 with 807,183 Derbyshire Observatory, 2022). Derbyshire is identified as one of the largest diverse regions in the United Kingdom with geographical and social diversity. The statistical data indicates that majority of White (97.5%) reside in town, followed by Asian (1.1%), mixed ethnicity (.9%), and Black population (0.4%) (City Population, 2022). Moreover, Derbyshire has slightly higher female population (50.8%) as compared to males (49.2%). Moreover, older people (50.9%) forms most of the Derbyshire population with lower young adults and adult population i.e., 19% and 21% respectively.
Factors Impacting Health
The deprivation in Derbyshire is relatively lower than the average UK (Office of National Statistics, 2022), and only 18 areas in the borough are ranked among 10% of England’s most deprived areas. The Unemployment in the town is also below the national average. However, Derbyshire County Council (2022) report that unemployment rates are double the national average in areas including Erewash and Chesterfield. The economic foundation of Derbyshire is its manufacturing sector, which produces about one fifth (18%) of the employment in the area, which is significantly higher than the England average of 8% (Derbyshire County Council, 2022). The growth rates of the manufacturing sector and increases in employment in the town indicate that town is no longer underrepresented and is comparable to the national average of 26%. However, the employees’ pay rates in the city are still lower than the national average, leading to deprivation. The monthly unemployment figures issued by Derbyshire Observatory (2022) show that around 14,120 individuals above 16 years in the county were unemployed, and the rate is currently stands at 2.9% which has decreased from 4.4% in January 2021.
The health status of the population
It is highlighted in the reports by Derbyshire Observatory (2022) that few regions of the county suffer from deprivation and high poverty levels because of increased cost of fuel, food and living. Similarly, the Multiple Deprivation (IDM) has indicated that twenty-two towns in the county are amongst the ten per cent of the most deprived areas in the country (Ministry of Housing, Communities, and local Government, 2019). Many of these town are located in Northeast of Derbyshire and the health profile is concluded and rated on thirty-nine indicators such as income education and skilled training, disability, deprivation, unemployment, crime, and poor housing facilities.
Moreover, in Derbyshire, childhood obesity is one of a major health issue with high prevalence rate which poses high health risks in adolescence and adulthood (Public Health England, 2022). The Body-Mass Index (BMI) assessment was performed for the year 2016-2017 demonstrated that ten per cent of the under the age of 6 and 18% of the children above six years were obese which is significantly higher than average England population (Public Health England, 2022). Statistics indicated that female had life expectancy of 82.8 years in Derbyshire while males had slightly lower i.e., 79.4 years (PHE Fingertips, 2022).
Furthermore, it is reported that Derbyshire Sustainability and Transformation Plan regions have higher rates of hospital admissions due to coronary issues than average population of the country (Derby City and Derbyshire County, 2019). Additionally, Derbyshire has higher mortality rate because of heart-related conditions as compared to England average, with most hospital deaths than at homes (Derby City and Derbyshire County, 2019). This demonstrates that quality of care is poor at the hospital settings and has significant effects on the health and wellbeing of the service users.
Mental health conditions are another determinant for decreased health and wellbeing in Derbyshire and it is identified that prevalence of dementia (0.9%) and depressive disorders (1.7%) is slightly higher than country’s average, whereas rates of chronic or serious mental health conditions are lower (Derbyshire County Council, 2022). Similarly, self-harm incidences are higher in females (287 cases) than males (170 cases) which is higher as compared to other areas of the country. Moreover, Derbyshire has a rate of 10 individuals per 100,000 with higher rates in men (17%) than women (4.5%) and this data is similar to average England population i.e., 16% and 5% respectively (Derbyshire County Council, 2022).
Key Stakeholders- Target Population
The key stakeholders or target population identified in this report is the Derbyshire’s adult population (19-64 years). Derby City and Derbyshire County (2022) report highlighted the prevalence of chronic illnesses in the borough. It is estimated that cases of hypertension will increase up to 80% by 2023, indicating the prevalence of cardiovascular disorders in the area. The rates of hypercholesterolemia (2 in every 3 adults) and diabetes are also higher among adults and increase the burden on NHS. One of the risk factors of cardiovascular symptoms and diabetes is obesity. NHS Digital (2018) provides that 90% of adults in Derbyshire with type II diabetes are overweight or obese, which is higher than the average England rate of 84%. Moreover, Derbyshire Observatory (2022) report highlighted that more than 96000 individuals between 16 to 75 years have a single or multiple mental health condition. The figures are even higher in disadvantaged areas including Erewash and Hardwick as compared to developed areas in southern borough side (Derbyshire County Council, 2015).
- Adult Health Needs Assessment of Derbyshire
Health need assessment refers to a systematic procedure used by NHS and local bodies in England for assessing the health problems within a given population (NICE, 2022). It also includes exploring the factors leading to illnesses and disparities in care in specific area concerning the health provisions. It allows the local bodies for prioritising the care needs and planning the strategies and measure for fulfilling the community needs. The health needs of a population are categorised into four types including the normative needs (common for all), felt needs (required by a person), expressed (voiced out needs within a community), and comparative needs (leading to inequalities) as presented by Bradshaw (1972). The identified health needs of the Derbyshire include the normative, comparative, and expressed and required national and local health initiatives to meet them. All needs associated with the health conditions will be categorized using Bradshaw’s Taxonomy of needs in the following section:
Diabetes
Diabetes mellitus refers to a metabolic disorder that decrease the body’s ability to generate enough insulin to regulate the blood glucose (Sapra and Bhandari, 2021). Derby City and Derbyshire County (2019) report shows that UK has around 4.6 million patients with diabetes and 8.8% of them are adults of 16 years and above residing in Derbyshire. Since 2013, the borough has seen an upsurge in cases of both type I and type II diabetes, which increased from 6.6% to 7.1%. In terms of age prevalence rates, Derbyshire (45%) and England (44.8%) have similar averages where the diabetes rates are higher among adults under 40 years. For people above 40 years to 65 years, the diabetes is less common in both local average of 41.7% in Derbyshire and national average 40.4% in England. Moreover, Derby City and Derbyshire County (2019) report show surprising figures where the diabetes rates are least in most vulnerable age group (people above 65 years) where national average is 2.1% and local figures are 1.6%. It highlights the high diabetes rates among the adult population in borough. However, type II diabetes rates in the town are higher among the elderly population with national average of 13.8% and local average of 14.7% compared to adults under 40 years with national average at 3.9% and local average at 3.6% (Derby City and Derbyshire County, 2019).
Normative Needs: The key risk factors of escalating diabetes among the adult population include increased sedentary behavior, smoking, obesity, and social inequalities (Kennerley and Kirk, 2018: NHS, 2016). The need to address these concerns falls under Normative needs as per Bradshaw’s taxonomy of needs. Thus, for mitigating the increased diabetes rates among the adult population of Derbyshire, policies and interventions need to address these issues.
Mental Health
The most prevailing mental health condition in the town include depression with overall rates of 7.3%, which makes around 61500 adults above 18 years with a diagnosed condition. Another common disorder among the adults in the area is psychosis where around 3400 adults have condition in Derbyshire. The personality disorders are also common such as around 1712 adults in town have antisocial personality disorder and 2283 individuals suffer from borderline personality disorder in brough as reported by Derbyshire County Council (2015). The prevalence of eating disorders among the adults is also high where around 6.4% adults have any type of eating disorder, making it more than 38000 adults. Moreover, PTSD is at 3% and more than 17500 adults in the borough have PTSD and on in every 15 adults between 10 to 24 years have self-harm condition and 1 in every 12 individuals above 24 years are involved in self-harming behavior.
Expressed Need: Additionally, the Derbyshire County Council (2015) report presented that key risk factor of decreased mental health in the borough is social deprivation where people living in disadvantaged areas suffer more from such disorders. Hence, the interventions for improving the mental health in the Derbyshire need to decrease the inequality and poverty by improving people’s social outcomes.
Obesity
While the previous two health concerns also require significant attention, Obesity is the most serious problem faced by Derbyshire. The latest reports show that around 66% adults in Derbyshire borough have obesity (Derbyshire County Council, 2022). Among other common disorders in the town, it is most prevalent and will be core focus in the present report for improving the health condition of the population. The obesity has an association with type ii diabetes as having high Body mass index has high risk of developing type II diabetes (NHS Digital, 2022). So, combining the individuals with comorbid type II diabetes with obesity in the town, around 84% adults in Derbyshire have obesity. Obesity is not just consequence of type II diabetes but also leads to increased vulnerability to hypertension in around 26% males and 45% females. The disorder is more common among the male population where six males in every 10 and five females in every 10 have obesity (Derbyshire County Council, 2022).
Additionally, the Derbyshire Sustainability, and Transformation Plan presented by NHS (2016) identified that rates of obesity in borough are higher than England average. It also stated that obesity among adult is most common chronic illness with 27.4% compared to other condition such as childhood obesity at 22.7%, alcohol consumption at 19.5%, smoking at 12.4%, and inborn obesity at 10.7%. The higher cases of obesity cost around £27 million on indirect expenses and around £5.1 billion on direct cost of treatment on NHS. It also has additional expenses of £13.3 million on pharmaceutical measures of obesity, £16 million on obesity-related absentees, and £352 million on social cost. Moreover, NHS spends around £116 million in treating the comorbidities of obesity such as type II diabetes and hypertension (NHS, 2016). It highlights that obesity has adverse consequences for patients and healthcare system.
Derbyshire County Council (2022) identified obesity as an epidemic with its adversities surpassing smoking. It not only deteriorates the individual’s health but posit negative influences on the wellbeing of individual hindering their personal, social, and occupational outcomes. If not prevented, it might lead to further complications such as diabetes, cardiovascular complications, and mental health problems like depression and anxiety. Obese people also face psychosocial complications which forces them to avoid human contact and continue living their sedentary lifestyles (NHS Digital, 2022).
Expressed and Comparative need: The report also highlighted that obesity is more common in the disadvantaged areas as researchers have associated obesity with poverty (Zukiewicz-Sobczak et al., 2014). Poverty decreases the likelihood of an individual’s involvement in sports and physical activities due to inadequate equipment leading to increase in sedentary behaviour. It also decreases the life expectancy rates as poor people have around 4 to 8 years lesser than advantaged individual (World Health Organisation, 2017). Additionally, it also increases the inequalities and discrimination at workplace where the employers are reluctant to offer obese females but give chances to obese males (Flint et al., 2016). Hence, it is important to tackle these issues in Derbyshire using evidence-based measures.
Justification of the Prioritized Need
The need of a homogenized parity-based resource allocation and community-based physical engagement initiatives is extremely important to tackle physical health related aspects as well as to improve the psychosocial well-being of the community. It is important that the community-based initiatives involve the disadvantaged regions of the county as well. This will also inculcate a sense of confidence and trust among the people for the local authorities and government.
- Community-based Intervention
The key risk factors of obesity include the health behaviour and social consequences of an individual such as food rich in sugar, non-availability of physical space for exercise, and unhealthy eating patterns. Hence, researchers usually suggest using behaviour change interventions for the individuals with obesity that can promote positive change among people with obesity (Martin et al., 2013). Several socio-economic, cultural, environmental, social, and personal factors influence the health habits of an individual. Therefore, using individual-focused interventions cannot offer the required outcomes and need community-based interventions that modify overall population behaviour (NICE, 2015) and help in prevention along with treatment. Bagnell et al., (2019) recommend using whole system or community level interventions that involve understanding of complex system that informs the latent conditions and highlight ways that can enhance these conditions. Public Health England (2019) recommends using local whole system intervention that inform adaptive and dynamic process for working by involving stakeholders for providing for providing sustainable and long-term consequences. Though regional and community-centred approach for reducing obesity is not same but share some common features such as long-term engagement of patients, community involvement, emphasis on social networks, and studying the cause-and-effect factors (South, 2015). Hence, tackling the increasing obesity issues among adults in Derbyshire, the local leadership has recommended various community-focused health promotion measures and strategies.
NHS (2016) stated that Derbyshire is introducing community-focused and whole system approaches for upgrading the support system for individuals with obesity or overweight issue. It will include planning for improving the physical activity of people and their access to open and green spaces. These interventions are significant for reducing the disorder in the borough and enhancing the adult population health. Active Derbyshire (2022) is an effective approach that include Be Portion Size Wise. The strategy aims to reduce the obesity by stating that it is not linked to individual efforts but also need environmental changes. It also stated that health habits of an individual shaped by social and environmental factors influence obesity (Active Derbyshire, 2022). Tiwari and Balasundaram (2021) associated the healthy consumption and low calories det with better glycaemic control and support for reducing weight. The small portion ensures that people are consuming less fat and sugar that help to lose and maintain weight. The strategy includes health education measures for educating the community to contribute with their little efforts to the strategies that can make large differences in life and health of people. The educational intervention motivates the individuals to be mindful of their eating portions and manage their diet to maintain healthy weight. The poor motivation, reluctance to change, lack of access to health services, and personal health habits reduce their will to modify their behaviour (Coyle et al., 2022). Hence, the families and close relatives and friends of patients are included in the change process. Families and friends play a significant role in helping the people modify their health behaviours by promoting their healthy eating habits and physical activity. Therefore, the key stakeholders in the health education and behavioural modification interventions are families and friends along with patients, local authorities, and healthcare professionals.
Another evidence-based intervention used by Derbyshire County Council (2022) is ‘Active Lifestyle’ approach that aims to reduce obesity by involving local bodies to support an individual to lose weight. ‘Live Life Better Derbyshire’ is community-based health service that inspire the sustainable and persistent improvements in behaviour of an individual by providing individualised weight management interventions for adults above 18 years. The intervention involves different county wide measures such as physical activities and sports for promoting the healthy life. Derbyshire Council (2022) offers another program that seeks to influence weight management and smoking cessation interventions and strategies using Referral Derbyshire Scheme that improves the long-term physical activity and prevent sedentary behaviour. ‘Walk Derbyshire’ is among the core weight management and health promotion initiatives by local services at county where they promote county-wide health campaigns inspiring individuals to walk every day. NHS (2016) suggest using self-management and community resilience services for reducing obesity, which involve creating Derbyshire-wide wellbeing plus service improvement. It also supports social training measures in schools, colleges and workplace to prevent obesity and associated conditions.
Stakeholder Analysis
Stakeholder analysis helps to identify the key population subsets that play a contributing role in inducing or solving the problem at hand. This analysis will identify the three levels of stakeholders involved and then identify the key stakeholder.
Stakeholder Identification
Primary -Target Population
The present health need assessment report will focus on the adult population (19-64 years) and identify and prioritise their health needs in Derbyshire. City Population (2022) survey report that the adult population is the second-highest population in the borough (21.9%) but significantly lower than the elderly population (58.8%). It indicates that around 475,457 adults reside in Derbyshire, and most of them are between 40 to 49 years (100,232), followed by adults between 30 to 39 years (94,920), and adults between 20 to 29 (87,654). The male adult population in Derbyshire is 25,262 individuals, and the female adult population is 26,064, indicating a slightly higher rate of female adults in the town. Official Labour Market Statistics (Nomis Web, 2022) reports that 81% of adults in Derbyshire are employed compared to the national average of 78.5%, and only 4.2% are unemployed compared to the 4.8% national average. Moreover, males are more economically active (89.1%) than females (74.2%), despite the town’s higher number of female adults. The earning rates among adults indicate that the gross weekly pay of full-time working males is more elevated at £676.3 compared to females at £548.1.
The rates of smoking in Derbyshire are higher (17.9%) than the England average (16.9%) among adults above 18 years (Derbyshire Observatory, 2022). The sexual health of adults in town is better than in England, with low cases of HIV, STIs, teenage conceptions, and long-acting reversible contraception. However, Health Need Assessment Data (2017) showed high levels of sexual health among homosexual males, vulnerable adults living in poverty and deprivation, and young adults have higher rates of sexual health disorders.
Secondary- Local Authorities
The early intervention for adults includes the behaviour modification that can decrease the vulnerability of disorders to increase wellness (NHS, 2022). The effective early interventions can improve adults’ outcomes, life quality, autonomy, and enable successful ageing. It also offers a financial return to the Local Authority in the form of cost decrease and a drop in the use of more costly, acute resources. The life course approach theory informs the early intervention that presents that all events over the life impact the future outcomes of an individual and specific experiences during the core life stages such as childhood have compounding influence on adult life (Jacob et al., 2017). The UK Government (2022) stated that the theory supports the health and wellbeing of individuals and identify various factors that increase or decrease the health. The identification of these factors allows to mitigate the risk and generate positive outcomes.
The local authorities and health bodies in the borough have knowledge of these issues and intervention and are designing policies for enhancing the adult care via Adult Social Care (Derbyshire Council, 2020). The policies related to adult care include a system manager for adult health and perform their duties following the major health legislations of UK. These legislations include Mental Capacity Act (2005), The Care Act 2012 Regulation (2014), and Mental Health Act (2017). The Derbyshire Council (2020) health department offers direct support and care provisions for facilitating the home cares, residential care homes, and day care centres for promoting the adult’ autonomy and wellbeing. It also bears the responsibility for protecting adult with an aim to follow the personal safeguarding and protection principles for offering the individualised and practical care. The core objective of Adult Social Care is ensuring that the care provisions and services that patients receive are person-centred and collaborated for enhancing the adults’ autonomy and contentment with their lives within the community.
Tertiary- Government
The UK government holds the position of a tertiary stakeholder. Initiatives requiring fund allocation for medical, transport and accommodation can be achieved by reaching out to the government. While not a key stakeholder in the present scenario, the government agencies and organizations can help to improve medical facilitations and rehabilitations centers by restructuring, restocking and expedited hiring procedures. Moreover, regular accounting and transparent fund allocation can help to create more jobs and curb the rapidly increasing poverty. People close to hitting the poverty line also face the same dire living circumstances as the people below it. Therefore, government initiatives can be a potent alternative solution to improve living conditions.
Possible Challenge to the Intervention and a Contingency Plan
A possible challenge to a large scale, community level implementation of the “Active Lifestyle” and “Live Life Better Derbyshire” approach is to involve all people of the community. Some people maybe reticent to share the predicament facing them, others might be socially recluse and prefer to stay isolated. Some people may also have different physical exertion tolerance than others requiring specifically tailored exercise regimes. This challenge can be rectified by recruiting young volunteers with incentives such as internship certificates and letters of recommendations. These young volunteers can help create awareness in the community and organize bimonthly physical activities for different population groups. Derbyshire has an enthusiastic sense of community and people will be encouraged and encourage others to participate. As this will not target people with a specific ailment, therefore, people will not feel highlighted or stereotyped against. It will also require less funds than required when hiring an organization team.
Adopting the right leadership style for ensuring successful implementation and execution of this community-based intervention, is essential. For initiatives like these, creativity and lead0by-example approaches are effective instead of a hierarchical leadership style. A combination of collaborative and transformational leadership styles has also proved to be effective by allowing the participants to reevaluate their perspectives and form an active part of the society as well as the initiative (Okpala, 2017).
Conclusion
The health need assessment report identified the geographic profile of Derbyshire local council. The geographical profile highlighted the main characteristics of town such as health status of population and various indicators of good health and illness in the borough. Moreover, it chose adult population as target for early intervention and used life course approach and its main characteristics and health conditions were highlighted. In later section, three prevailing health needs of population were identified including poor mental health, diabetes mellitus, and obesity and obesity was prioritised as core health need in the community. Various community-wide interventions were suggested for improving the outcomes, which include educational interventions for promoting healthy eating and physical activity. The need assessment report provided the effective information related to Derbyshire community for improving the adult population conditions and reducing the health-related issues for promoting the overall health.
References
Active Derbyshire, 2022. Be Portion Size Wise. [online] Available at https://www.activederbyshire.org.uk/be-portion-size-wise
Bagnall, A. Radley, D. Jones, R. Gately, P. Nobles, J. Van Dijk, M. 2015. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health. https://doi.org/10.1186/s12889-018-6274-z.
Bradshaw, J. 1972. The concept of social need. In: Gilbert N, Specht H, editors. Planning for social welfare: Issues, Models and Tasks. Englewood Cliffs, NJ: Prentice-Hall.
City Population, 2022. Derbyshire. [online] Available at https://www.citypopulation.de/en/uk/admin/E10000007__derbyshire/
Coyle, E. F. Burton, H. M. Satiroglu, R. 2022. Inactivity Causes Resistance to Improvements in Metabolism After Exercise. Exerc Sport Sci Rev. DOI: 10.1249/JES.0000000000000280.
Derbyshire County Council, 2022. Index of Multiple Deprivation. [online] Available at https://observatory.derbyshire.gov.uk/poverty-and-deprivation-imd/
Derbyshire County Council, 2022. About Derbyshire. [online] Available at https://www.derbyshire.gov.uk/council/news-events/about-derbyshire/about-derbyshire.aspx
Derbyshire County Council, 2022. Mortality and morbidity. [online] Available at https://observatory.derbyshire.gov.uk/wp-content/uploads/reports/documents/health/life_expectancy_and_mortality/Mortality&MorbidityMentalv1.2.pdf
Derbyshire County Council, 2022. The State of Mental Health in Derbyshire. [online] Available at https://observatory.derbyshire.gov.uk/wp-content/uploads/reports//documents/health/disease_and_long_term_conditions/mental_health/SO_Mental_Health_Derbyshire_2015.pdf
Derbyshire County Council, 2022. Obesity facts and figures. [online] Available at https://www.derbyshire.gov.uk/community/heart-of-derbyshire/portion-control/obesity-facts-and-figures/obesity-facts-and-figures.aspx
Derbyshire County Council, 2022. Index of multiple deprivation. [online] Available at https://observatory.derbyshire.gov.uk/poverty-and-deprivation-imd/
Derbyshire County Council, 2022. Active lifestyle. [online] Available at https://www.derbyshire.gov.uk/social-health/health-and-wellbeing/your-health/healthy-and-active-lifestyles/active-lifestyles.aspx
Derbyshire County Council, 2022. Weight management. [online] Available at https://www.derbyshire.gov.uk/social-health/health-and-wellbeing/your-health/weight-management/weight-management.aspx
Derby City and Derbyshire County, 2019. Cardiovascular diseases. [online] Available at https://observatory.derbyshire.gov.uk/wp-content/uploads/reports/documents/health/specialist_reports_and_assessments/2019/CVD_HNA_FINAL20191120.pdf
Derbyshire Observatory, 2022. Understanding Derbyshire’s Geographies. [online] Available at https://observatory.derbyshire.gov.uk/wp-content/uploads/reports/infographics/people_and_place/i_pp_Derbyshire_Geographies.pdf
Derbyshire Observatory, 2022. Smoking in Derbyshire. [online] Available at https://observatory.derbyshire.gov.uk/wp-content/uploads/reports/documents/health/adult_lifestyles/smoking/Impact_of_smoking_infographicV3-1.pdf
Derbyshire Observatory, 2022. Unemployment. [online] Available at https://observatory.derbyshire.gov.uk/unemployment-claimant-count/
Derbyshire Observatory, 2022. Mental health. [online] Available at https://observatory.derbyshire.gov.uk/disease-and-poor-health/mental-health/
Derbyshire Observatory, 2022. Cancer. [online] Available at https://observatory.derbyshire.gov.uk/disease-and-poor-health/cancer/
Flint, S. W. Čadek, M. Codreanu, S. C. Ivić, V. Zomer, C. Gomoiu, A. 2016. Obesity Discrimination in the Recruitment Process: “You’re Not Hired!”. Front Psychol, 7: pp. 647.
Kennerley and Kirk, 2018. Physical Activity and Sedentary Behaviour of adults with Type 2
Diabetes; a systematic review. Practical diabetes, 35(3): pp. 86–89.
Jacob, C. Baird, J. Baker, M. Cooper, C. 2017. The importance of a life-course approach to health: Chronic disease risk from preconception through adolescence and adulthood: White paper. ResearchGate. [online] Available at https://www.researchgate.net/publication/338096490_The_importance_of_a_life-course_approach_to_health_Chronic_disease_risk_from_preconception_through_adolescence_and_adulthood_White_paper
Martin, J. Chater, A. Lorencatto, F. 2013. Effective behaviour change techniques in the prevention and management of childhood obesity. Int J Obes, 37(10): pp. 1287–94.
Ministry of Housing, Communities, and Local Government, 2019. The English Indices of Deprivation 2019. [online] Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/853811/IoD2019_FAQ_v4.pdf
NHS, 2016. Derbyshire Sustainability and Transformation Plan (STP). [online] Available at https://joinedupcarederbyshire.co.uk/application/files/6615/3121/5623/Derbyshire-STP-21Oct16-full-document-V2-website-copy.pdf
NHS, 2020. National Diabetes Audit Report 1 Care Processes and Treatment Targets 2017-18. [online] Available at https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/report-1-care-processes-and-treatment-targets-2017-18-short-report
NICE, 2022. Glossary.[online] Available at https://www.nice.org.uk/glossary?letter=h
NICE, 2015. Local government briefing on behaviour change (LGB 7). [online] Available at https://www.nice.org.uk/advice/lgb7
Nomis Web, 2022. Labour Market Profile – South Derbyshire. [online] Available at https://www.nomisweb.co.uk/reports/lmp/la/1946157140/printable.aspx
Okpala, P. 2017. Increasing access to quality healthcare through collaborative leadership. International journal of healthcare management.
Office of National Statistics, 2022. Exploring local income deprivation. [online] Available at https://www.ons.gov.uk/visualisations/dvc1371/#/E07000223
Public Health England, 2022. Obesity Profile. [online] Available at https://fingertips.phe.org.uk/profile/national-child-measurement-programme/data#page/1/gid/1938133219/pat/159/par/K02000001/ati/15/are/E92000001/yrr/1/cid/4/tbm/1
Public Health England, 2019. Whole systems approach to obesity. A guide to support local approaches to promoting a healthy weight. [online] Available at https://www.gov.uk/government/publications/whole-systems-approach-to-obesity.
Sapra, A. Bhandari, P. 2021. Diabetes Mellitus. StatPearls Publishing, [online] Available at https://www.ncbi.nlm.nih.gov/books/NBK551501/
South, J. 2015. A guide to community-centred approaches for health and wellbeing. [online] Available at https://www.gov.uk/government/publications/health-and-wellbeing-a-guide-to-community-centred-approaches.
Tiwari, A. Balasundaram, P., 2021. Public Health Considerations Regarding Obesity. StatPearls Publishing, [online] Available at https://www.ncbi.nlm.nih.gov/books/NBK572122/
UK Government, 2022. Health matters: Prevention – a life course approach. [online] Available at https://www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-matters-prevention-a-life-course-approach
WHO, 2017. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet, 390(10100): pp. 1151-1210.
Zukiewicz-Sobczak, W. Wróblewska, P. Zwoliński, J. Chmielewska-Badora, J. Adamczuk, P. Krasowska, E Zagórski, J. Oniszczuk, A. Piątek, J. Silny, W., 2014. Obesity and poverty paradox in developed countries. Ann Agric Environ Med, 21(3): pp. 590-4. DOI: 10.5604/12321966.1120608.
