A Simple Solution to Child Health Inequalities?
How a community-led health project in London is transforming children’s health in one of the capital’s most diverse communities — and what lessons could be learned by Scotland.
By Samar Jamal | Photo by Rhiannon Davies
When you become a mum, you can face challenges that leave you feeling isolated and out of your depth; it can sometimes seem like you have to learn all the milestones of being a new mum by yourself. Diet can be a particularly challenging thing to learn about, especially nowadays when it can be expensive and time-consuming to make nutritious food. Down in London one programme, Nurture Early for Optimal Nutrition (NEON), is working with local communities to improve infant health, in a project co-created by the participants.
NEON ran out of the Flower and Dean Community Centre in Tower Hamlets, from 2015 until earlier this year and worked with parents from South Asian communities to support their children who are two and younger. The latest trial worked with mums from the Bangladeshi community — Tower Hamlets has the largest Bangladeshi community in Europe. Greater Govanhill editor, Rhiannon, and I went to London to understand how NEON works.
The project is unique for several reasons, It is culturally considerate and inclusive with the focus of the project being decided by both healthcare professionals and parents. Monica Lakhanpaul is a professor of integrated health and was one of the lead investigators for the project. Speaking about how the idea first formed, she said:
The origins of this project were totally from the community themselves. We knew that more and more children were becoming obese, they’ve got a risk of heart disease, they’ve got a risk of diabetes… and what better way than asking the communities what they needed – and what help they wanted from us?
They could really advise you from their own lived experience on what to do. Whereas, as professionals, we're just telling people what to do. We've not had those same lived experiences. So we can't really always put ourselves in somebody else's shoes.
Monica explains that by monitoring the first 1000 days of a child's life, parents have a better chance of preventing overfeeding and understanding how to safely handle malnutrition: “The first 1000 days are the most important time in the child's life if you get that right you have a much better chance of your child being healthier in the future.”
“I could see the struggles that my aunts and uncles were facing with diabetes and all the struggles with long-term health conditions. ”
To maintain a connection with the community, NEON was delivered and facilitated by trained community members who are multilingual and have a cultural understanding of the barriers the mothers faced.
“Another outcome was a weaning recipe book with South Asian recipes shared by the participants. Most books for infant feeding in this country include recipes of Western cuisine that were not already part of the parents’ culinary knowledge. ”
Lily Islam was one of the facilitators. She speaks Bangla, allowing her to translate the material for mums whose first language wasn’t English. NEON was a way for Lily to lift her community out of a feeling of resignation:
Having worked in health and working as an advocate I could see the struggles that my aunts and uncles were facing with diabetes and all the struggles with long-term health conditions. They had almost accepted it, ‘Because my mum has it I’m going to get it anyway’.
To break away from the traditional top-down healthcare process, and towards a more progressive approach to community health, parents spent eight weeks helping create resources that would be used by them and the facilitators in the workshops. Here they created picture cards depicting both solutions and barriers around dental hygiene, motor skills and brain development that they would engage in conversation in the workshops.
Another outcome was a weaning recipe book with South Asian recipes shared by the participants. Most books for infant feeding in this country include recipes of Western cuisine that were not already part of the parents’ culinary knowledge.
This was particularly useful for new mum Koli, who said: “I have one child and he is 15 months old. When I joined the NEON programme I learned a lot of things. In our countries [the Indian subcontinent] people say if you add sugary food [to a baby’s diet] your baby’s brain will be developed. And my mother-in-law and sister-in-law said if you don’t put salt in, this food will not be tasty.
Another thing, as Asian people, we say if you add sugary food your baby will talk sweet in the future. That’s why sometimes I put in sugar, but then when I joined this programme I learned that it’s not good for the baby's brain development and it’s not good for my baby’s health.
The situation in Scotland
Over the border, a 2018 report showed that Scotland had the highest overall obesity rates compared to the rest of the UK. To tackle this, former First Minister, Nicola Sturgeon committed to halving childhood obesity by 2030. Moreover, a freedom of information request made by The Herald also showed that NHS Greater Glasgow and Clyde received 3895 admissions for children aged under 18 with signs of malnutrition from 2018 to 2022. Working with communities to find solutions to child obesity and malnutrition like NEON could support Scotland in addressing these health challenges.
NEON’s culturally sensitive and participatory approach could benefit communities like Govanhill and its surrounding areas, where the majority of Glasgow’s South Asian community has settled. A Scottish Government report highlights the higher prevalence of cardiovascular conditions and diabetes for people from South Asian backgrounds.
Food insecurity in Scotland is also a huge problem, especially for the 1 in 4 children currently living in poverty. In Glasgow, The Health and Social Care Practise team’s Health Improvement Direction plan for 2023-2028 hopes to improve children’s health in a similar way by focusing on early intervention.
Whilst a project like NEON can help plug the gap in certain communities, there needs to be more systemic change. Currently, all school children from primary one to primary five are automatically eligible for free school meals in Scotland but after these ages, the scheme is means-tested.
The difference the project made
Back in Tower Hamlets, Lily told us how the workshops offered a space for mums to confide about their worries in a non-judgemental space and consequently, understand healthier ways to support their children:
One mum broke down and cried during our interview… Because she felt her child wasn't eating enough, she used to blend all the food and then put it in a bottle feed, cut the teat so it was a big hole, and then feed him while he was sleeping.
She didn't realise the hazards of choking and she actually was really, really upset and emotional to know that that was wrong what she did. But she said she didn't know any better. She was so overwhelmed thinking that her child wasn't eating enough. And yes, he was probably a fussy eater, but she didn't know how to manage that behaviour, so she just did what she thought was the right thing.
Another mum, Shakila, said she didn’t know the importance of tummy time and physical activity but now she is always encouraging her child to stay active or jump around on the bed.
These reflections also highlighted the cultural influence as well as the familial pressures that they face. Although NEON has been created to consider cultural preferences and obstacles, it was clear some challenges require conversations beyond the workshops.
Lily spoke more about this:
Physical activity outside the home can be difficult for our community. So when we talked about doing activities outside with your child, I think the question that came up was that it’s not going to be culturally appropriate for me to do, as an Asian Muslim woman. Even being seen running with your child or playing catch may be seen as inappropriate.
During the programme, the mothers who participated reported changes in their children’s development, both in their health and also in their ability to do things like feed and dress themselves. A report shared with Greater Govanhill shows children’s BMI improved after the Participatory Learning Sessions and was closer to the average BMI for children their age and sex.
The unexpected outcomes from the project
The programme was not only a space to develop their child’s health by sharing knowledge but the mums found that their own wellbeing was improving. NEON allowed them to meet new mums, realise their potential and develop their new English skills.
Lily told us how the workshops had helped improve Koli’s mental wellbeing:
When she came to our sessions, she was very anxious and very afraid of a lot of things…she didn't feel confident to go out. But after coming to our sessions, she felt empowered that she could do these things and there's nothing stopping her.
Monica pointed out that with many new projects like NEON one of the challenges is with resources but equally, it’s about convincing the public health teams, local authorities and other stakeholders about the importance of the project:
They have to see the importance of this work. And once you get the stakeholders on board, they can see why this could work. Then they will actually help you implement this program. So that's our challenge. Our challenge was winning them over by providing the evidence, providing the proof that this actually was an important project to do.
The project has also shown how inclined communities are to receive support and take action:
From my own experience of working with underserved communities, we say people are hard to reach. People are not hard to reach. If you find safe spaces for people to talk, build trust and relationships they will talk. People want to invest in their children's future but sometimes they're not given a voice to do that.
This indicates that, on average, NEON is a programme that values collaboration and community support, without this, it would not have been as successful as it was, Monica stresses:
There's no way I could have done this project without the community really putting themselves forward. We worked with the community facilitators and members of the community. They wanted to make a difference in their community… So really find your friends, build relationships, and work together with the community assets. I think that's the best way to make a difference.