- The SEA Change Portland community have worked tirelessly to make the healthy choice the easy choice for local children and are a role model to other communities looking to address childhood obesity.
- The project has demonstrated that empowering the community and mobilising existing knowledge, capacity, skills and resources can make meaningful changes in the community for the next generation of children.
- SEA Change Portland uses systems thinking methods to help communities identify barriers to healthy lifestyles and create actions for change
- SEA Change Portland won the Victorian Public Healthcare Award for Supporting Healthy Populations in 2018 (note combined application with GenR8 Change)
- SEA Change Portland has resulted in more than 300 community actions being taken to address childhood obesity locally.
Developed by the community, for the community
A joint project between Deakin researchers and community members from the regional Victorian town of Portland is tackling the complex problem of childhood obesity.
Using a systems-based approach, visual mapping software, and working with community stakeholders like schools and sports clubs, the program has seen an improvement in the dietary behaviours of local children and an increase in the consumption of healthy foods.
Obesity is a risk factor for chronic and life-shortening diseases such as type 2 diabetes, heart disease and cancer, so tackling rising rates of obesity is a global health priority. When more than one quarter of Australian children are overweight or obese, the case for prevention in our own backyards is compelling.
In a joint project between researchers from Deakin University’s Global Obesity Centre and the community of Portland, the causes of obesity in children are being addressed through systems thinking. Specialists in systems thinking, health economics and implementation are empowering community leaders and members with the necessary skills to develop strategies and interventions to improve childhood health in their region.
The project, Sustainable Eating and Activity Change Portland (SEA Change Portland) is a long-term community-led initiative that seeks to identify and address the causes of unhealthy weight, develop sustainable local solutions and ‘make the healthy choice the easy choice’ in the regional Victorian town of Portland.
Overcoming the complex problem of obesity in communities requires a new approach to that of short-term programs that rely on funding with an end date. SEA Change Portland is a systems-based approach that mobilises local community resources and connects stakeholders, with the aim of delivering sustained change in the weight status of children aged 7–12 years through the implementation of community generated - and led – changes to their environments.
Using Systems Thinking in Knowledge Exchange (STICKE) – a visual mapping software developed by intelligent systems researchers at Deakin – the community was able to define the problem, identify the drivers of the problem in their community, and then co-design actions to make the local environment healthier for everyone, especially children.
‘This unique intervention empowers the community to make lasting changes to health and wellbeing, taking into account the wider economic, commercial and social influences and barriers to healthy eating and active living specific to each community,’ says Mayor Cr Anita Rank, Glenelg Shire Council.
‘It’s already resulted in hundreds of community‐led actions focused on changing norms and environments, and the insights gleaned may be useful to support other communities in translating systems theory into systems practice.’
A complex problem
‘In Australia, obesity costs the health system more than $21 billion annually. Childhood obesity is a great public health concern, with 27% Australian children classified as overweight/obese and at increased risk of developing cardiovascular disease, type 2 diabetes, musculoskeletal disorders and some cancers. The high adult burden and developmental profile of adult obesity reinforces the need for prevention during childhood, and particularly in early childhood,’ says Cr Rank.
Monitoring data from the region, which included Portland, revealed higher than expected rates of overweight or obese children compared to the national average. As key modifiable determinants of childhood obesity include diet and physical activity, related data showing only 13% of children were meeting guidelines for eating vegetables and that 31.6% didn’t meet guidelines for physical activity were concerning.
However, reducing rates of obesity is a complex problem. Research from Deakin’s public health experts has shown that residents of remote and regional towns in Victoria face difficulties in accessing affordable, fresh, healthy food. Widespread access to junk food, barriers to physical activity and efforts to promote health predominantly through programmatic approaches have all been identified as potential root causes of obesity in regional areas.
SEA Change Portland has seen almost 300 community led actions from promotion of drinking water to school canteen menu changes, resulting in a decrease in local children’s BMI.
The systems-thinking methods used in SEA Change Portland have improved the ability of the community and researchers to measure the drivers of systems that impact childhood obesity in the local community, to map and understand these systems, and to use systems data and models in real time to implement change and make ongoing improvements to the environments children live, learn and play in.
Community members with the ability to change environments to improve health led the project, and included representatives from local health services, the primary care partnership, education sector, government and business owners. This approach built new relationships and strengthened existing relationships. Willingness to take risks, change existing practice, and redesign health promotion work to have a community development focus, were levers for change.
More than 300 individual community-led actions have been taken so far, including:
- changes to school canteen menus and the introduction of school health policies
- changes to the availability of sugar-sweetened beverages (SSBs) in health services, sporting hubs, clubs and community events
- increased access to, and promotion of, drinking water
- increased active transport
As a result, this intervention has seen significant benefits for health-related quality of life, with a reduction in takeaway and packaged snack consumption in boy participants and increased water consumption in girls.
Grants and funding
SEA Change was established through a 2014 Western Alliance Grants in Aid award and recurrent funding from the Department of Health and Human Services to Portland District Health and the Southern Grampians Glenelg Primary Care Partnership, with in-kind contributions from Glenelg Shire Council, Dhauwurd-Wurrung Elderly and Community Health Service and Deakin University.
This initial funding led to the award of a larger NHMRC Partnership Project titled ‘Whole of Systems Trial of Prevention Strategies for childhood obesity: WHO STOPS childhood obesity’ (APP1114118). Partners to this grant include the Western Alliance, Portland District Health, Southern Grampians Glenelg Primary Care Partnership, Colac Area Health, Southwest Primary Care Partnership, Portland Hamilton Principal Network of Schools, Colac Corangamite Network of Schools, Glenelg Shire Council, Southern Grampians Shire Council, Warrnambool and District Network of Schools, Western District Health Service, and the Department of Health and Human Services.
Deakin researchers Professor Steve Allender, Nic Crooks, Dr Kristy Bolton, Penny Fraser, Andrew Brown, Ha Le, Alfred Deakin Professor Marjorie Moodie, Professor Colin Bell, Dr Claudia Strugnell and Professor Boyd Swinburn (now University of Auckland), participated in a NHMRC Centre for Research Excellence in Obesity Policy and Food Systems project (GNT1041020) throughout this grant period.
Professors Allender and Swinburn are also researchers on a US National Institutes of Health grant titled ‘Systems Science to Guide Whole-of-Community Childhood Obesity Interventions’ (1R01HL115485-01A1).
Dr Kristy Bolton and Penny Fraser, in a partnership with Wannon Water, have been involved in supporting evaluation of a reverse osmosis filtration system fitted into the local health service (Portland District Health), which formed part of the Great Tasting Water project led by Wannon Water.
SEA Change Portland, and more broadly WHOSTOPS (Whole of Systems Trial of Prevention Strategies) led to the application of the community-led approach at-scale across 12 local government areas in North-East Victoria through Reflexive Evidence and Systems interventions to Prevent Obesity and Non-Communicable Disease (RESPOND), an Institute for Health Transformation project*.
Allender S, Orellana L, Crooks N, Bolton KA, Fraser P, Brown A, Le H, Lowe J, de la Hay K, Millar L, Moodie M, Swinburn B, bell C, Strugnell C. Four-year outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHOSTOPS), Obesity 2021 in press accepted January 2021 Article DOI: 10.1002/oby.23130.
Sweeney R, Moodie M, Nguyen P, Fraser P, Bolton K, Brown A, Marks J, Crooks N, Strugnell C, Bell C, Millar L, Orellana L, Allender S, “Protocol for an economic evaluation of the WHO STOPS childhood obesity stepped wedge cluster randomised controlled trial”, BMJ Open, 2018 May 14;8(5): e020551.doi: 10.1136/bmjopen-2017-020551.
Jenkins E, Lowe J, Allender S, Bolton KA. Process evaluation of a whole-of-community systems approach to address childhood obesity in western Victoria, Australia. BMC Public Health 2020. Apr 6; 20(1):450.
Allender S, Millar L, Hovmand P, et al. Whole of Systems Trial of Prevention Strategies for Childhood Obesity: WHO STOPS Childhood Obesity. Int J Env Res Pub He 2016;13(11) doi: UNSP 114310.3390/ijerph13111143
Alston L, Crooks N, Strugnell C, et al. Associations between School Food Environments, Body Mass Index and Dietary Intakes among Regional School Students in Victoria, Australia: A Cross-Sectional Study. Int J Env Res Pub He 2019;16(16):2916.
Allender, S., Orellana, L., Crooks, N., Bolton, K., Fraser, P., Brown, A., Le, H., Lowe, J., de la Haye, K., Millar, L., Moodie, M., Swinburn, B., Bell, C., Strugnell, C. Four-year behavioural, health related quality of life and BMI outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHOSTOPS Childhood Obesity).
*Allender, S., Strugnell, C., Swinburn, B., Nichols, M., Peeters, A., Bell, C., Moodie, M., Orellana, L. RESPOND: Reflexive Evidence and Systems Interventions to Prevent Obesity and Non-Communicable Disease APP1151572: 2017 Partnership Projects PRC2 funding_\ commencing 2018. 2018-2023. $4,101,240 ($2.6m partner contribution; $1.5m NHMRC).