Health and Social Care Committee

Inquiry into Stroke Risk Reduction

SRR 6 - All Wales Dietetic Managers Committee

Promoting Cardio-Vascular Health:

The Stroke Risk Reduction Action Plan

Diet and Nutrition play an important role in the health of the population. Dietitians support a reduction in health inequalities through enabling and supporting people to access a healthy balanced diet. Rates of obesity are increasing and there are still inequities in accessibility to an affordable, nutritious diet. Compounding this is a lack of supporting knowledge and skills. There is a wealth of evidence demonstrating the positive relationship between the uptake of a healthy balanced diet and good health throughout life. A healthy balanced diet contributes to a reduction in cardiovascular risk, including stroke. Research suggests that improved diet could reduce CVD and cancer deaths by a third, thus improving life expectancy and general health and well being.

What is the current provision of stroke risk reduction services and how effective are the Welsh Government policies in addressing any weaknesses in these services?

Stroke reduction is encompassed in the general public health strategies, in particular ‘our healthy futures’ as part of the universal health improvement plan. Reducing unhealthy eating is a priority within this plan and also within the obesity pathway. Dietitians are key to taking this work forward, in particular through providing training in community settings to improve knowledge and skills around good nutrition. The dietetic WAG capacity grant has been key to providing increased dietetic capacity to undertake this work and take forward the recommendations in the WG policies. The Dietetic capacity grant previously targeted 0-25 year olds and has this year broadened its focus to include older people. It has developed a standardised approach for accredited nutrition training across Wales, promoting consistent nutrition messages and contributing to preventing nutrition related disease. The work that dietitians have undertaken as part of this grant scheme has been proven to be effective (through external evaluation by Glyndwr university) and now needs to be incorporated into mainstream dietetic service provision through provision of an ongoing funding stream. Consideration also needs to be given to extending the scheme to incorporate the working age population, in particular  working age men, who are a priority group for stroke risk reduction.

The dietetic capacity grant deals with prevention of ill health, it is important to note that there are no dietetic services targeting lifestyle management in the secondary prevention of stroke and the obesity pathway mapping exercise undertaken by health boards has highlighted a lack of multidisciplinary services at level 3 to support lifestyle management in people with complex obesity.

Implementation of the Welsh Government Stroke Risk Reduction action plan whether action to raise public awareness of the risk factors for stroke has succeeded?

There has been a variety of campaigns to raise public awareness of stroke, through Welsh Government as well as third sector organisations. Whilst we feel these have been successful it is important to ensure that messages do not get confusing for the population. Having a healthier lifestyle through smoking cessation, reducing unhealthy eating and increasing physical activity will benefit the population through reduction of multiple conditions including cardiovascular disease, obesity, diabetes, cancers. We need to keep the primary prevention message generic to improve health rather than target messages at individual specific conditions. These generic messages are promoted through Health Challenge Wales and the Change for Life campaign and continued use of the Change for Life campaign should be endorsed.

What are the particular problems in the implementation and delivery of the stroke risk reduction actions?

Action area 1. it is important that all community groups working to address health inequalities have a basic level of nutrition knowledge so they can support people in achieving a healthier diet. Training being developed in this area needs to link with the dietetic capacity grant training to ensure that communities first staff have the relevant skills and knowledge around nutrition.

Action area 9. The expansion of the capacity grant to older people will support awareness raising of nutrition and the prevention of problems associated with under nutrition in the older population. This work will not directly support the stroke prevention agenda and consideration needs to be given around investment in training capacity to support the working age population.

Action area 10. Publication of the All Wales Obesity Pathway has provided information against which health boards can map their services. A group of Welsh Dietitians are now working with the Health Improvement Team to develop a weight management programme that can be delivered by leisure services and third sector organisations. This will give the general population (estimated 52% of whom are overweight or obese) the opportunity to access evidence based programmes to help them make lifestyle changes to manage their weight and so reduce their risk of cardiovascular disease. Continued support from Welsh Government will be required to enable the full potential of this accredited programme to be achieved and to improve access to weight management services across Wales.

Action area 16. The healthy schools part of the action plan should now be extended to include the new preschool healthy schools scheme so there is a co-ordinated approach through the care settings. Also consideration should be given to incorporating nutrition education programmes into the flying start schemes around Wales so that nutrition is addressed with families at the earliest stage.

Consideration also needs to be given to expanding guidance to leisure services on the food provided in their catering outlets to ensure it promotes the correct health messages and enables people accessing leisure facilities to have a healthy diet.

References

NICE Public health guidance 25 Prevention of Cardiovascular disease

Food and Well Being: Reducing inequalities through a nutrition strategy for Wales. WAG / Food Standards Agency 2003

Our Healthy Future: WAG 2009

Helen Nicholls on behalf of :All Wales Dietetic Managers Committee

Sept 2011.                                                                  

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