Total Place approach on St Helena
The NSMC has been very fortunate over recent years to island hop and work on various different islands around the world, including the British Virgin Islands, Jamaica, and now St Helena. With the drive for place-based approaches to health, local authorities and Clinical Commissioning Groups could learn a lot from the approach taken by these islands, particularly St Helena and their natural total place approaches.
St Helena, is an Overseas British Territory most famous for being Napoleon’s prison and final resting place and has also held a number of other prisoners including a Zulu King and thousands of South African soldiers during the Boer War. However, it not only imports prisoners, it also imports the majority of its food, which suppliers require to have a decent shelf life.
The island, like the British Virgin Island is a microcosm of western society and how changing lifestyles are affecting our health. Twenty years ago most people grew their own food, eating fresh food and exercising while working the land. However, with the advent of imported food, screen time, car ownership, and increased incomes, islanders’ (or Saints) diets and levels of exercise have changed, which along with increased smoking, has contributed to the subsequent health issues. For example, 1 in 5 Saints has diabetes, a number that is expected to increase steadily over the next five years.
The St Helena government asked if we could help and create a healthy community campaign aimed at changing people’s eating and exercise habits and smoking. Fortunately, a sense of community is very strong on St Helena and our insight research showed that Saints were very worried about the island’s future and the impact on their children if they were to get diabetes.
The insight led us to develop, with Saints, the brand Saints Together which was launched last week, as well as collaborating with the government’s Health Promotion and Social Marketing Lead, Dr Angie Jackson-Morris on some of the policy and service interventions being included in the Health Promotion Strategic Framework. This strategy focuses on enabling the behaviours that the campaign will encourage - to make eating healthier and taking more exercise, fun, easy and popular, and to nudge smokers towards thinking about quitting and promoting support to quit. Some of these interventions include:
- Extending government employees lunch break from 30 minutes to 60 minutes once weekly to participate in organised workforce walks / activities.
- Working with food importers to import products with less sugar.
- Working with the hospitality sector and government institutions to offer healthier meal options.
- Recruit and train community physical activity trainers to support communities to take more exercise and engage with some of the national exercise challenges.
- Launch the first behaviour change campaign focusing on reducing consumption of fizzy drinks.
- A range of policies to nudge smokers towards quitting and establishing support to quit – a cessation service and offering free nicotine replacement therapy across the community for a test period
The deep understanding about the community culture and behavioural influences, the structural changes the campaign is driving and the involvement of local food providers is vital in the provision of any successful place-based approach and is a model that local authorities and CCGs could learn from. (It also provides an excellent excuse for a study trip, particularly now that the airport has opened!)
We will keep you posted.