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Michael Chang – “Every Little Action from Everyone Counts”
Michael Chang in conversation at Salzburg Global Seminar
Michael Chang – “Every Little Action from Everyone Counts”
Oscar Tollast 
In October 2018, health and urban planning professionals from more than 15 countries convened in Salzburg to explore how urban environments can affect health and the public good. The group came together for Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment. Among the participants was Michael Chang, a project and policy manager at the Town and Country Planning Association. Chang, a chartered town planner, and an honorary member of the UK Faculty of Public Health, leads the Reuniting Health with Planning initiative of stakeholder engagement and policy research across the UK. We spoke with Michael after the program to discuss what he had learned and his decision to create the Health and Wellbeing in Planning Network. Read our interview below. SG: Building Healthy, Equitable Communities was your first experience of taking part in a Salzburg Global program. What were your expectations heading into the event? MC: I had high expectations and was highly excited heading into the event, after doing a bit of research into the organization, about its work and the impacts it has had over the years. I knew there would be a presence from colleagues across the globe so there would be an exciting melting pot of ideas, experiences, and cultures. I was looking forward to harnessing that energy and the opportunity the experience would bring to enhance my own work back in the UK. SG: How would you describe your experience in Salzburg? MC: I am not usually an expressive type of person, but I would describe the experience in Salzburg as phenomenal, a once in a lifetime opportunity and such a privilege. The setting gave me a safe thinking space which I don't usually have. The connections allowed me to share my thoughts openly with others. The [program] provided a structure for me to reflect on my own circumstances.    SG: What impact did the conversations and ideas generated at Schloss Leopoldskron have on your work? Was there an idea or perspective you heard which you hadn't considered before? MC: Everyone was open and honest with their conversations and professional views. I was grateful to everyone for this level of transparency. It did raise a couple of challenging conversations especially when it came to issues around racially-related inequalities in the American and South African contexts, and the nuance between ‘gentrification’ and “regeneration.” I learned that while as professionals, we may use these terms interchangeably to suit, it doesn't alter the level of impact our actions can have on local communities. Fortunately, as the experience of attending a planning conference in New Orleans earlier in 2018 was still fresh where such issues are very much at the fore, I was able to relate and have a broader mind-set during discussions. The ideas discussed and presented show that every little action from everyone counts, and sometimes the big idea may not be the answer. We don't tend to learn and acknowledge the lessons of the past and from others, so having that critical mass of thinkers and doers was really beneficial. SG: What's inspired you to move forward with the Health and Wellbeing in Planning Network? MC: I wanted to move forward with the idea of identifying [and] then bringing together that critical mass, at least initially in the UK context which doesn't currently exist in a structured way. The ability to exchange and share experiences, potential transferable solutions or even to have those challenging conversations at the Session demonstrated that perhaps if only initially replicated in a virtual forum, it would be worthwhile. The thinking space provided during smaller group discussions with colleagues such as Gemma McKinnon towards the end of the [program], and with external colleagues such as Rachel Flowers gave me the conviction to press the “go” button for the Health and Wellbeing in Planning Network. This meant activating a series of communication platforms via a LinkedIn group, a Twitter account, and a simple website. SG: What response have you had to the Network so far? MC: In the first weekend of the Network being set up on Twitter right after #SGSHealth, it had close to a couple of hundred followers already. By 2019 new year’s day the number of followers is at 350. On LinkedIn, the Network has 48 members, and on the website, there is a list of 17 members who sent in a short biography to be included. SG: In the long-term, what are your hopes for the Network? MC: It is still early days for the Network to be fully activated across its different communication platforms. I am hoping that the Network members will increase to build a critical mass of “public health planners,” its presence enhanced through its website and its value widely recognized, which means ultimately more virtual peer to peer exchanges taking place in 2019. The Network can function in a number of different ways that is focused on its members acting as ‘peers’ to help each other signpost requests for further support and technical expertise. I hope it can be self-sustaining and become the go-to one-stop-shop for information on all things about planning for health and wellbeing. SG: What do you think practitioners working to improve health and wellbeing need to know more about when it comes to planning? MC: The first step is to understand the parameters of what you mean by “planning.” Certainly, I learned that planning in the UK is very different from planning in the USA, South Africa or New Zealand. By understanding the parameters, you can begin to think about the possibilities including the limitations of what legislation and policy allow you to do. Most importantly this allows you to know who else you have to work with, engage and involve in the process, and appreciate that working together is always better than working alone. SG: The Network is in its early days, but what is one thing you have learned already? MC: It is important to articulate a need for an idea and whether such a need is sustained and regular or just a one-off. This can really be done by having lots of conversations with others so as well as understanding more about the target audience, you are also making links and thereby helping to create the need. Come back to me in a year or so to see whether I am on the right track or not! 
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Healthy Children, Healthy Weight - Making an Impact
Participants of Healthy Children, Healthy Weight outside Schloss Leopoldskron
Healthy Children, Healthy Weight - Making an Impact
Oscar Tollast 
Innovators from across the world have outlined new ways to help promote and safeguard children’s health and wellbeing. On the final day of the Healthy Children, Healthy Weight program, participants presented outputs from their workgroup discussions with the aim to help improve children’s lives. After four days of cross-border sharing and learning, more than 50 participants came together to outline the next steps forward and prepare recommendations for action. In total, seven groups put forward ideas. The first group to present sought to reframe the debate for healthy children and make change happen at a higher level. This group suggested creating a playbook of tactics which any broker or advocate of change could use to help push policies which better serve children. Brokers and advocates need to use their expertise, participants heard. These change-makers can move further forward by building alliances and aligning partnerships. Participants referred to this process as the “Salzburg schmooze” and indicated they had plans for a destination point where this information could be visible. Building on this proposal, the next group to present discussed the need for a values-driven learning journey for child and family programs. Participants in this group discussed developing a brief for practice leaders to better support meeting their program goals. As part of this process, the group developed five principles. They argued the goal of learning and evaluation is to accompany, scaffold, and strength both child and family programs and their leaders. They said organizations could and should use data iteratively as possible to improve programming. With data in mind, the group said many forms are valuable and have different weights to different stakeholders. This diversity of data should be taken into consideration. Various methods of learning and evaluation are appropriate for different phases and can contribute toward program learning. Finally, the group indicated the voices of families and staff could strengthen the design of research and evaluation. This point is the most important to consider, participants heard. Other parts of the group’s end-product included organizational readiness for evaluation, an overview of evaluation tools and instruments, ethical and equity considerations, and a glossary of terms. In short, the group’s end game is for leaders to have a more positive perspective when it comes to learning and evaluation. Having discussed the “Salzburg schmooze,” participants were introduced to the “Salzburg shift” in the third presentation of the day. This group’s members sought to revisit the model to optimize nutritional status and wellbeing that allows children to thrive across the world. Obesity and malnutrition can exist within the same country, and neither should be seen as separate challenges, participants heard. The group focused on areas including food systems, policy, regulation and finance, cultural practices, and emerging knowledge. Participants called for a greater understanding of the food system, reviewing the subsidies which fuel it and the shift needed to move toward a more localized approach. They also want to examine the relationship between industry and regulation, accessibility toward good food options, and the sugar tax dilemma. By learning more about cultural practices in different parts of the world, participants heard healthy eating could be promoted further through education, community leaders, and institutions. There is emerging knowledge concerning inflammation, infection, gut health, and the importance of sleep. Issues of intervention investing early are also gaining traction. The group has split these topics into three groups: program-ready, worthy of further investigation, and implementation research. Moving forward, members hope to shift the conversation be it in the form of a publication or collaboration. One message which emerged during the program is the variety of stakeholders involved in improving children’s health and wellbeing. One group decided to focus on how a healthy food economy could drive a successful city – rethinking health from a business perspective. Citing Amsterdam as an example, the presenter said the city had approximately 5,300 food outlets. Food marketing is everywhere and encourages people to spend money on “anytime food.” The approach, moving forward, should involve improving the quality of “anytime food.” The presenter for this group indicated that government authority should be utilized, while consumer demands should be optimized. This process would also involve supporting shop owners. An “anytime food” standard could be established by a council, for example. Shop owners could be supported through the creation of a ranking system for “anytime food” outlets, innovation challenges, and marketing and sales training. This paradigm shift toward healthy food could also involve community debates, workshops targeted at children, capacity building, a multi-level approach reaching all aspects of a child’s circle of influence. Another group worked on principles for governments to achieve health equity with a focus on indigenous and marginalized populations. Members of this group said all children, young people, and their families are valued, have a sense of belonging and control of their own destiny. These communities are inclusive, adapt to change, actively seek out those who feel invisible and engage them. The group aims to raise the visibility and voice of indigenous and marginalized people to achieve health equity. The group will do this through a paper that outlines principles for governments to shift power, mind-sets, policy and practice toward equity. Principles for success include voice and aspiration, accountability, transparency, identifying and addressing inequity in the system, and acknowledging and addressing the past. This work is targeted at all levels of government and will be influenced by indigenous leadership structures, including tribal authorities and other marginalized groups. There is a lot of literature on scaling, but not enough on what it means when systems scale. This view was shared by the next group to put forward their idea. This group focused on shifting power conditions to scale systems change, so all children, families, and communities thrive. Members of this group would like to work on an insight paper exploring the relationship between power, equity, and scale. This approach includes examining the underlying hypothesis of power and its relationship to shaping conditions. During the presentation, participants heard how much of the focus had been on how to scale rather than the requirements needed to scale. The group discussed five core elements including leaders, stakeholders, and audience; information and insights; agents and mindsets; funders and resources; and – linked to this all – equity factors. All elements must be addressed to create conditions for scale. There is a need to reconceptualize power, so it is more accessible to more people, participants heard. The final group to present discussed the shared values and learnings which had emerged during the program. This group, which featured two participants, created an early draft of a potential Salzburg Statement, outlining a call to action. This document will be shared with other participants for their critique and feedback and will be worked on outside of the program. Participants were reminded that the health of the world and the health of children were intrinsically linked, and this Statement could be a way to bring others on board with their ideas and recommendations. As the discussion came to a close, participants were reminded of a quote by Astrid Lindgren to serve as inspiration: “I have never tried that before, so I think I should definitely be able to do that.” Participants will continue to work on their ideas outside of Salzburg and move toward disseminating their reflections to a wider audience, including key stakeholders. The program Healthy Children, Healthy Weight is part of Salzburg Global's multi-year series Health and Health Care Innovation. This year’s program is being held in partnership with the Robert Wood Johnson Foundation.
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Hot Topic - Fellows Discuss Main Take-Aways from Salzburg
Salzburg Global Fellows share their views during Healthy Children, Healthy Weight
Hot Topic - Fellows Discuss Main Take-Aways from Salzburg
Anna Rawe 
A select number of Fellows at Healthy Children, Healthy Weight were asked: "What is your main take-away from this week's program?" We have published their answers below. "The power of the collective wisdom and thinking from diverse perspectives, and that it doesn’t matter where you are… in the world, the need to narrow things down, to focus, because we went wide… different nationalities or countries perspectives, that same thing happens. You kind of go off track to get back on track… and a commitment to stay in contact and keep moving.” Michelle Palmer, Australia Director of Partnerships at the New Zealand Department of Conservation "For me, it’s just how do we continue to break down silos between education and health? ... How do I continue to work with health practitioners and other individuals? ... How can we have the education practitioners come together to look at a holistic way of supporting children and families? How do we continue to weave in families into our school model that doesn’t keep them so isolated [and] on the outside… in a way that gives them more agency and voice?” Dominique Lee, USA Founder and Executive Director of Building Responsible Intelligent Creative Kids "I think it's really the collective sense of unity amongst policymakers [and] professionals [plus] commonalities we’ve all found in our own work, both in terms of problems but also in solutions [and] communities as well. I think that’s been really surprising... particular highlights, I think there’s been a sense of action and a sense of agency that we don’t necessarily need to call on other people or we shouldn’t be asking for agencies to do things. We should be taking it on within ourselves...” Matt Creamer, UK Senior Policy Officer at the Greater London Authority “I’ve been taken aback by the ways that power has shown up in the conversation… the ways in which it shapes people’s access to healthy food and to opportunities that would enable them to have an equitable start at life. I’ve just had a renewed appreciation for the role, and the purpose of power in shaping child outcomes and that’s… more on the public health side, but it’s less clinical than often our discourses around health tends to be.” Sebabatso Manoeli, South Africa Director of Innovation for the All Children on Track by Grade Four Portfolio at the DG Murray Trust “I think one of the main takeaways is that across different countries there are a lot of commonalities about the ways in which organizations and leaders are trying to improve the status of children and families. However, you know, context really matters and understanding the complexities of opportunities and challenges is really important... without that knowledge, you most likely will not thrive… [there were] so many diverse people coming from different perspectives but still looking at different strategies in a similar way. There is a lot of values-based leadership here focused on the fundamentals of understanding and valuing the voices of families in their work.” Marjorie Sims, USA Managing Director of Ascend at the Aspen Institute The program Healthy Children, Healthy Weight is part of Salzburg Global's multi-year series Health and Health Care Innovation. This year’s program is being held in partnership with the Robert Wood Johnson Foundation.
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Knowledge Cafe - Ideas Supporting Children's Health
Photo by Jaredd Craig on Unsplash
Knowledge Cafe - Ideas Supporting Children's Health
Anna Rawe 
During Healthy Children, Healthy Weight, participants took part in a knowledge cafe with several stations showcasing projects supporting children's health. Participants moved every 30 minutes among stations. Each table had a facilitator who gave a brief impulse talk on the topic and then led the discussion. We spoke with each facilitator to garner what their take-aways were. “The thing that particularly came out… was the relational nature of the work we do and the significance of - when you build a collaboration - how you need to be thinking long term about how you can establish relationships and how you can keep working on those relationships during the life course of whatever your collaboration is doing… disseminating knowledge was another theme that came out… I was trying to emphasize the need for the whole of community responses and the best way to do that is effectively design, run and then evaluate collaborations.” Penny Dakin, Australia Acting CEO of the Australian Research Alliance for Children & Youth (ARACY) “I heard different perspectives - how communication was strategic in the work of different kinds of organizations or governments… there is a path to really use communication especially in non-profits and government in a way that it can really help. For example, the programmatic area or the development of public policy…. Normally, what you see is the communication helping the programmatic area… but in the foundation I have been working in [both of] the two [areas] became programmatic - they work together, exchanging knowledge and information.” Eduardo de Queiroz, Brazil Former CEO of the Fundação Maria Cecilia Souto Vidigal “Designing policies around data was the main theme… there are other information [sources] like polling behavior of people, and usage of transport, if more people use public transport, so it’s basically behavioral data that can also get integrated into the epidemiological data, combining both how can we align our policies with the targets we keep for ourselves... [and] how do we learn on the ground then take it back to the government to negotiate for certain changes that we would like in policies or targets…” Shalini Rudra, India Consultant for TATA Trusts “I think [what I wanted to get across was] the importance of building trust with children and helping them do that for themselves was a really important message, that they can do so given an enabling environment… our work is about growing that capability because once they’ve got it, then can then share it with others, and Kitbag is there just to get you started.” Margaret Hannah, UK IFF Kitbag Lead and Director of Health Programmes “The things that we’re discussing in terms of the health and wellbeing of children, [I wanted to convey] that it really does filter down through very many aspects of the way we create and shape our cities, and that relates to programs and policies but also in terms of the actual physical environment that we create. Very rarely when we’re designing cities do we actually think about what effect the planning of the city will have on a child.” Natalia Krysiak, Australia Architect “We talked about the country strategies and how it’s a lot of top bottom approaches but a bottom to top approach of what the policy should actually be. I think that then there were a lot of questions the participants asked like, ‘How is it possible?’ Then we talked about happiness: how do you measure? Then we went onto the indicators… the Gross National Happiness Survey that is done every four years, and how the finding from there, the analysis from there, actually feeds into the country program which eventually becomes the five-year plan… there is continuity. It’s a long-term goal, the whole country of Bhutan actually has one goal, and that is achieving Gross National Happiness” Dorji Ohm, Bhutan Executive Director of the Bhutan Youth Development Fund The program Healthy Children, Healthy Weight is part of Salzburg Global's multi-year series Health and Health Care Innovation. This year’s program is being held in partnership with the Robert Wood Johnson Foundation.
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Utilizing Communications, Social Media, and Peer Group Initiatives
Photo by Jason Rosewell on Unsplash
Utilizing Communications, Social Media, and Peer Group Initiatives
Oscar Tollast 
Our voices matter. The use of communications, social media, and peer group initiatives can help amplify our messages and enact change. During Healthy Children, Healthy Weight, participants considered how these practices could best support child health and wellbeing and help establish a shared value for all children. Sometimes, language can be complex and difficult to understand. Organizations have to consider how to put across concepts - particularly those affecting children’s health and wellbeing - in a manner which can be appreciated by both children and adults. Sesame Workshop is the nonprofit organization behind Sesame Street, the hit American educational children’s television series. Since 1969, the show has educated millions of children across the planet through live action, comedy, animation, and the use of muppets. Grandparents, parents, and children, in some cases, have all shared the experience. However, there’s a lot more to the organization than what’s on television. In the United States, Sesame Street in Communities is focusing on Healthy Bodies, Healthy Minds; ABC’s and 123’s; and difficult times and tough talks. It’s working with partners in eight states, sharing free tools, and collaborating with local community efforts. Sesame Workshop is also working with military families and children with autism. The Workshop focuses on synthesizing, visualizing, and strategizing. This strategy involves creative co-modeling and scaffolding across all platforms. Any program it has must have three messages. When approaching obesity, the Workshop looked at the circle of care around children - those who influence a child’s behavior. Staff recognized framing the conversation around “obesity” was not positive. Instead, it used the much-loved Cookie Monster to demonstrate a concept called “sometime and anytime foods.” Participants were recommended to communicate in a synthesized way and consider how they could make their tagline visible across multiple platforms. From a different speaker, participants heard when devising cross-sector approaches that improve the wellbeing of young people, they had to consider who their audience was and the best way to put their message out there. The speaker discussed how he and his organization faired better once they began targeting groups instead of individuals. They implemented co-design projects that used youth culture as a segmentation tool to reach and engage young people who were ambivalent to mainstream health messages. One unsuccessful co-designed approach, however, involved creating an app to provide relevant information.  It became apparent that the app wasn’t being used by the target audience, as this audience didn’t have enough storage space on their phones for it. Instead, this audience prioritized other apps. In some cases, it might be better to use existing channels of communication than creating new ones, participants learned. As the conversation came to a close, participants reflected on a case study where children in kindergarten were encouraged to be more active. The developers of the program worked closely with kindergarten teachers and parents to put this message across. This approach was an example of community intervention. Previously, attempts had been made to tackle obesity through therapy, but this proved to be unsuccessful. This newly-devised program was able to reach the majority of five- to six-year-olds in the region with modules on topics such as eating behavior and physical activity. Topics would be introduced into the curriculum at kindergarten for six months. The program used a wide range of channels to put their messages across, including traditional routes such as written materials, emails, and newsletters. Other avenues, however, were also explored, such as a website which contained a forum for parents to access and exchange information. By establishing a presence on Facebook, people were also encouraged to interact and engage with the content through competitions. The program Healthy Children, Healthy Weight is part of Salzburg Global's multi-year series Health and Health Care Innovation. This year’s program is being held in partnership with the Robert Wood Johnson Foundation.
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Targeting Childhood Obesity from All Sides at Once
Photo by Jace & Afsoon on Unsplash
Targeting Childhood Obesity from All Sides at Once
Kwasi Gyamfi Asiedu 
“It is often easier to have an unhealthy snack or food moment than it is to have a healthy food moment,” says Karen den Hertog, program manager of the Amsterdam Healthy Weight Programme (AHWP). In 2012, 21% of young people aged zero to 19, in Amsterdam were overweight or obese. The problem was especially visible in children from low earning and immigrant households. “We [have seen] that number lower to 18 percent. So, that’s a reduction from 21 to 18 percent and the difference in the numbers is even bigger among the families with the low and the extreme low socioeconomic status,” den Hertog says. Den Hertog has run the program on three key messages: active behavior, food, and sleep. Success has not come without ruffling some feathers, however. Den Hertog says, “We stopped the food industry [from] sponsoring sports events or handing out funding materials... we said ‘We want to work together, but we want you to change something to the core of your entire enterprise... We can’t have you subsidize sporting events anymore because no amount of sporting can help children trade off the calories they have just eaten or drunk'.” She adds, “So, food reformulation or from the package labeling to smaller portion sizes charged with marketing, if you’re willing to do stuff like that we’re willing to work with you… I mean it’s not very strange [to] actually say ‘I want you to work in the core of your business.’” The program scored a significant win when one of the industry’s large retail chains in the country came on board. Den Hertog reveals she has also faced pushback from her colleagues at various other city departments. She says, “It’s not that they don’t want to help. But it is asking something different from them to include health in all their policies.” Citing the millions of tourists that visit Amsterdam annually, she says, “Inventing policies to balance out the crowded city center is difficult as it is, let alone if you need to include health in there as well.” So, how to do you gain the buy-in from colleagues? “You need to adapt more to the language of the other policy departments,” one of her colleagues, Thomas de Jager (who is also attending the program) told her - a point she agrees with. Den Hertog says, “It really takes time and shared language to actually understand each other really and to help each other.” Asked about what a straightforward initiative if adopted in other cities can help reduce childhood obesity, Den Hertog refers to an often ignored message of her program: sleep. “The evidence of how important sleep is is incredible. If a child - and the same applies to us as adults, but we don’t want to listen - doesn’t sleep enough, so many hormones get upset... It is unhealthy [and] you become overweight and obese far more quickly than if you would sleep enough. “It’s a very simple thing, and it’s of course very difficult because so many parents are struggling [with] multiple jobs, or they have poor living conditions with multiple children in one room, or they might live next to big roads or train tracks or [have] lots of light in the living room. “We should really take sleep as an essential thing as healthy food and [daily] physical activity.” AHWP's Outputs and Results 11 neighborhoods have a joint local Healthy Weight Pact More than 1,200 preschool parents are involved in Amsterdam Healthy Weight Programme activities Every year, an average of 60 information meetings of healthy eating and a healthy lifestyle are organized 1,200 severely obese children identified and being treated 300 health ambassadors highlight the importance of a healthy lifestyle in the focus neighborhoods 1,734 healthy eating consultations for overweight children and their parents 50 community initiatives a year 67 healthy school playgrounds More than 150,000 neighborhood residents reached 18 courses on healthy shopping and healthy cooking involving 150 participants 80 additional water fountains in the city 24,500 businesses reached through social media campaigns One Amsterdam Standard of Care, which is adopted throughout the city 160 curative interventions involving more than 1,000 participants The program Healthy Children, Healthy Weight is part of Salzburg Global's multi-year series Health and Health Care Innovation. This year’s program is being held in partnership with the Robert Wood Johnson Foundation.
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Healthy Children, Healthy Weight - Creating Healthier Environments
Photo by Luca Micheli on Unsplash
Healthy Children, Healthy Weight - Creating Healthier Environments
Oscar Tollast 
According to the United Nations Department of Economic and Social Affairs, at least two-thirds of the world's population is expected to live in urban areas by 2050. Cities will have to respond to the needs of more adults and children. How we design and build our environments to support health and wellbeing remains of paramount importance. Participants of Healthy Children, Healthy Weight heard of promising developments in both London, England, and Amsterdam, the Netherlands to tackle childhood obesity. In London, several organizations focused on creating a healthy food environment are catering to a population estimated to be as high as 8.7 million. Organizations have engaged residents in a Great Weight Debate. People have considered how they can lead healthier lives. The debate has engaged more than two million people. People have revealed their concerns about the number of fast food shops and the amount of advertising for sugary products. The Healthy London Partnership, who helped spark the Great Weight Debate, has recognized several of the solutions to these problems lie on London’s high streets. The Healthy High Streets challenge has sparked new ideas as to how high streets can become healthier for children and young people, tapping into the knowledge of communities and businesses. At the launch of the initiative, three high streets offered specially prepared, healthier meals for one week – available at a reduced cost for children and young people. The challenge has led to the creation of cooking clubs, classes, and new, healthy menus targeted at children. Toolkits have been designed to help businesses sell healthier food to children and families. In the past year, the Mayor of London, Sadiq Khan, has launched a dedicated London Child Obesity Taskforce and shown commitment toward tackling London’s childhood obesity epidemic. From February, meanwhile, junk food adverts will be banned on London Underground, train, tram, and bus services. Fast-food chains will still have the opportunity to advertise on the tube, but they will only be able to promote healthy products. One participant suggested the environment people grow up in can be a significant contributor to the obesity pandemic, and it is an area which requires greater focus if the numbers of those obese or overweight are to decrease in the long-term.  The program Healthy Children, Healthy Weight is part of Salzburg Global's multi-year series Health and Health Care Innovation. This year’s program is being held in partnership with the Robert Wood Johnson Foundation.
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