The Beattie Model of Health - Essay Example

?Analysing Public Health Introduction Public health has become the primary focus of the health care system especially in recent years when its practice has had a significant impact on the management of diseases. Public health has a wide coverage and potentially assists in the management of diseases which often affect the general public. Health promotion takes on an important aspect of public health and various approaches to its application forms a significant part of its effective management. This essay shall provide an analysis of public health, paying particular attention to the following points: two contrasting health promotion approaches; health topic or health concern; two approaches in the management of the health concern; analysis of two approaches; strengths and weaknesses of each approach; impact of health promotion model; and a personal reflection on the topic. Beattie model of health The Beattie model of health includes four mutually exclusive health promotion elements. This model supports the fact that health promotion is founded on various social and cultural practices (Wills and Earle, 2007). It includes four quadrants laid out on two axes. The four quadrants indicate the different ways by which health can be ensured by professionals as well as government authorities via health persuasion processes, laws, counselling, and community development (Wills and Earle, 2007). The two axes include the authoritative (top-down) or the negotiated (bottom-up) mode of intervention and the focus intervention (individual or collective) (Wills and Earle, 2007). Health promotion and health counselling are supported by an individual focus of intervention as they focus on the different elements of personal behaviour and lifestyle (Piper, 2009). On the other hand, community health development is the scenario where groups with like-minded people who are sharing problems, unite in order to express their concerns and to support a common agenda and secure social and structural change (Piper, 2009). These approaches have a different conceptualization of health promotion, with one side being focused on personal behaviour and the other side highlighting the importance of community participation. In order to understand the application of these approaches, the obesity health issue shall provide a context for this discussion. Health concern: Obesity Obesity has doubled since 1980 (WHO, 2012). In 2008, about 1.4 billion adults, aged 20 years and over have been classified as overweight and 500 million of these individuals have been considered obese. About 65% of the global population reside in areas where obesity has killed more people than the underweight population and in 2010 more than 40 million children below the age of 5 have been classified as overweight (WHO, 2012). Overweight and obesity generally refer to the condition wherein there is an abnormal and excessive fat accumulation in the body. The body mass index (BMI) is considered the general standard in evaluating overweight and obesity among adults (WHO, 2012). It is measured using the formula: weight in kilograms divided by the square of the person’s height in meters. A computed BMI of greater than or equal to 25 (less than 30) is considered overweight and a BMI of greater than or equal to 30 is considered obese (WHO, 2012). However, other measures are also being considered by health authorities in order to guarantee discerning health assessment standards. Waist measurement is also being forwarded as a standard in health assessment because it can measure cardio-metabolic risk (Pearson, 2012). Waist measurement assesses actual internal fat, while BMI measures overall fat, and a waist measurement of higher than 35 among non-pregnant women and a waist circumference of 40 among men presents a more accurate assessment of an individual’s health risks (Pearson, 2012). Overweight and obesity represent the fifth leading cause for deaths in the world. About 2.8 million adults perish each year as a result of conditions caused by obesity and overweight. Moreover, obesity also carries the burden for diabetes, ischemic heart disease, and cancer (WHO, 2012). In 2010, about 40 million children under the age of five were considered overweight. The high rates of obesity and overweight is also no longer concentrated on high income countries, it is also considered an issue for the lower and middle income economies, especially in the urban communities (WHO, 2012). In effect, this health concern has truly become a global issue. Obesity and overweight is caused by various factors, mostly the imbalanced intake of calories consumed which significantly contrasts with calories used (WHO, 2012). Increased intake of food which is high in fat and sugar and low in vitamins and minerals are also significant issues in the manifestation of obesity. Moreover, decreased physical activity also contributes to the increased rates in obesity and overweight (WHO, 2012). At present, changes in dietary and physical activity patterns have been founded on environmental and social changes caused by development and limited support for policies on health, agriculture, transport, environment, and food processing (WHO, 2012). Common health impacts for obesity and overweight include various health issues including cardiovascular diseases, diabetes, musculoskeletal disorders, and some forms of cancer (WHO, 2012). For those with higher BMI, the risk for developing these diseases is higher. As individuals are experts in their own care, and as such, they are also able to identify health issues from their experiences. In relation to the management of diabetes and obesity, the members of the community must be allowed to evaluate their own lives and health issues (Centre for Health Improvement, 2009). In the process, the social, environmental, and economic factors which impact on positive, holistic health must be addressed. In developing the community response, the social elements relating to the creation of healthy communities are very much significant (Centre for Health Improvement, 2009). Previous efforts to change individual behaviours have not been successful in managing obesity; as a result, most of the newest efforts refer to the idea of establishing healthy communities. This approach calls for the significant commitment of diverse organizations, including concerns of education, healthcare, housing, city planning, parks and recreation, public health and the engagement of communities in matters of community transformation (Centre for Health Improvement, 2009). Even as not previously included in discussions on healthy foods and physical activity, experts within the transportation and city planning are now being included in these discussions. For urban environments, design efforts would likely indicate that residents are able to access public transport, green space, neighbourhood stores, and streets which are safe for all, including pedestrians, bicyclists, and cars (Mousouli, 2008). Actions in the rural areas would likely include designs which seek to improve walkability in neighbourhoods as well as around schools via safe walking routes, allowing residents to buy locally grown foods. Other benefits for these designs will impact on individuals who will likely be more physically engaged if they walk towards bus stops or ride bicycles to work or school, to businesses where local produce can be bought, and to the general environment by reducing the negative impact of climate change (decreasing greenhouse gases via fewer vehicle miles traversed) (Centre for Health Improvement, 2009). Actions to address the obesity issue must also focus on underserved communities, especially those who belong to the low income group, engaging community residents from all ages, including organizations from various disciplines in clear efforts to implement changes in policies which impact on the creation of healthier communities (Poskitt and Edmunts, 2008). Examples of these changes include locally grown foods available in the locality, via farmers’ markets and farm-to-school activities, establishing the use of agreements for schools in order to make sure that playgrounds are secured to allow physical activity during non-school hours, as well as implementing complete streets which are secured for all users (Committee on Prevention of Obesity in Children and Youth, 2005). Community development in relation to obesity and diabetes also refers to the acceptance of diversity in the community, and then using such template in order to organize and plan activities. Each individual has a specific quality and need; these qualities refer to ethnic, religious, cultural, and gender-based characteristics which impact on health behaviour (Institute of Medicine, 2009). Community development planning must consider all of these qualities in order to manage weight loss within such a diverse population. The planning and implementation therefore is a collective process, one which increases community involvement and the development of knowledge and skills (Institute of Medicine, 2009). Within this setup, the economic disparities within the population may be apparent. Therefore, issues of inequality must be addressed in order to allow disadvantaged groups to take control of their lives. For the overweight and underprivileged individuals in the community, a plan towards healthy living must adjust and encompass their needs (Committee on Prevention of Obesity in Children and Youth, 2005). Community recreation centres may help resolve the unavailability issue, thereby allowing access to healthy activities and resources would help provide opportunities to the underprivileged communities to stay and be healthy. Frequent consultations with the people by the policy-makers also secure the concept of community involvement in decisions, especially in terms of participation, not representation (Institute of Medicine, 2009). Community meetings can be carried out by community leaders, soliciting suggestions and recommendations from the people about their needs and health concerns. The people can then express their concerns, and the leaders can consider these concerns while making policies. Within this context, the input of various individuals, primarily the people, and secondarily, the health professionals can then help establish a holistic and multidisciplinary means of providing solutions and opportunities (Mousouli, 2008). In the end, these plans and policies can provide sustainable resources for the community, in order to manage weight loss and healthy activities of daily living. Sustainable plans would include changes in the infrastructure of the community, including the building of bike paths, wider sidewalks, well-maintained parks, and recreation centres fully equipped with the necessary exercise equipment (Mousouli, 2008). Securing agreements with farmers for the marketing of fresh produce to be marketed locally can also promote healthy living within the community. Reducing access to fast food chains would also discourage residents to patronize and frequent these chains. Health persuasion includes the management of individual behaviour which is often founded on culture and social structure, habits, values, beliefs, attitudes, as well as ideas (Lloyd, et.al., 2007). Persuasion is less coercive and is based on less stern health promotion activities. Persuasion utilizes lifestyle and prevention behaviours in order to help manage obesity (Wills and Earle, 2007). This would include changes in habits, promoting exercise, supporting healthy food consumption, and preventing (stopping) smoking (Lloyd, et.al., 2007). Behaviour change is the primary goal of health persuasion which includes strategies like: clear definition of product, product relationship, and tools which can promote product acceptance (World Bank, 2011). This approach is aimed at individuals, including their families. It can be carried out by general practitioners attending to families with obese family members (World Bank, 2011). This approach has a smaller target group focus as it seeks to promote healthy habits among individuals. This public health approach and similar approaches have gained significant importance in recent years (Aranceta, et.al., 2009). The establishment and implementation of obesity prevention techniques must cover the elements which impact on obesity, they must also cover lifestyle changes within the fabric of personal, environmental, as well as socioeconomic levels; they must also cover various levels of stakeholders and other related parties. Sacks (2009) indicates that policies which help in the development of effective health strategies for obesity prevention must also cover the food environment, as well as the physical activity environment; it must directly impact on behaviour, on highlighting the improvements in eating and physical activity behaviour; and it must cover health services and clinical remedies. Issues on the efficacy of anti-obesity programs through the above policy approaches are apparent in the actual implementation. These approaches mostly involve lifestyle changes which seek to utilize behavioural changes for each individual. Policy is not sufficient to secure such changes as they only help facilitate the process (Shields and Temblay, 2008). Nevertheless, other factors also serve as barriers to change. The general application of behavioural change in all settings, at work or at home can be difficult to actually implement especially as individuals may not get the same level of commitment in all aspects of their life (Shields and Temblay, 2008). Human behaviour includes the use of information technology, social networking, computer-based work stations, and school work based on internet or computers. Social networking is a strong motivation for computer use in their homes, and work demands often calls for continued use of the internet (McDonald, et.al., 2009). For most people, it would be difficult to balance the reduction of physical activity in the current system of technology and information technology. Habits of snack consumption during computer use also predispose individuals to obesity (McDonald, et.al., 2009). In general, the goal in managing the obesity and the diabetic problem is based on the individuals themselves, as they are the individuals who would act on the health promotion processes and efforts. In a study by Ludwig and Nestle (2008) lifestyle modification programs assessed based on the perspective of clients manifested the significance of client-focused care in guaranteeing lifestyle modifications. More studies may be needed to assess individual perspectives, mostly on whether obesity is given as much concern as the diseases like cancer or heart disease (Ludwig and Nestle, 2008). Studies in relation to the elements which improve the level of their physical activity and behaviour change must also be undertaken. These studies would help provide more specific details on appropriate interventions and public health modifications for diabetes. Two approaches in relation to different factors: • Assumptions about the nature of health in each approach The aim of the health persuasion approach is to promote positive health. It seeks to ensure that individuals are able to apply and accumulate habits which can help them gain better health (Ewles, 2005). Health persuasion targets values and habits which eventually seek to ensure that individuals would be more conscious about their diet and their need for physical activity. The aim of community development is to prevent disease (Bunton and MacDonald, 2002). However, with society becoming more competitive, factors like stress can impact on overeating with many people seeking their comfort in food (McDonald, et.al., 2009). It has been suggested that the increased cortisol release often caused by stress may disturb the food intake and can cause long-term increased energy intake (De Vriendt, et.al., 2009). Unhealthy choices related to poverty are also difficult to address through policies, unless the issue of poverty reduction is addressed (Drewnowski, 2009). The goals of food industry are directed towards profit and this goal does not necessarily match the public health efforts in managing obesity. The food industry techniques to secure profits include increasing portions, increasing snacking, and inclusion of sweets, soft drinks, and fast foods as daily food items (Ludwig and Nestle, 2008). • Assumptions about people Health data is expected to be objective because these can be drawn from government figures and reports (Whitehead, 2001). These data would also be based on objective data which are supported by research trends. The decisions would also be made by both the health professionals as well as the general public (Whitehead, 2001). Health professionals are tasked with the development of policy which helps support interventions on the management of obesity. The main implementers of these policies are the health professionals as they are involved in the daily step-by-step routine of health promotion and community health development (Beattie, 1991). However, the public also plays a significant role in health promotion. For one, their participation is necessary in order to ensure the success of these health promotion activities. Moreover, their participation would also support the more specific details of health promotion activities (Beattie, 1991). The health professionals cannot carry out the health promotion process on their own, they need the public to create significant results. In the case of obesity, health data would be objective because it would come from compiled figures of government agencies, schools, as well as workplaces (NICE, 2006). Health professionals are needed in order to implement health promotion because they are tasked with the creation of policies against obesity and the implementation of these to the general public; in turn, the general public participates in and supports policies, with the end goal of preventing obesity and overweight. Barriers in the effective management of obesity and diabetes have been identified. Among practicing clinicians, limited time to address obesity during routine office visits is a major issue. Some physicians also do not have enough training in managing obese patients. Among patients, there is also a stigma against obesity, limited financial incentives, and issues in securing weight management services (Lajunen, et.al., 2007). There are also various aspects of policy where involvement in managing overweight and obesity can be increased. These aspects include the greater number of dieticians and nutritionists in hospitals as well as the subsidization of weight loss medications (Sacks, et.al., 2009). In a systematic review on the efficacy of interventions to improve health management of obesity, no clear conclusion could be indicated on how obesity management obesity can be improved; nevertheless, the majority of the studies indicated that reminder systems, shared care, and dietician-led interventions helped secure improved results for some obese patients (Sacks, et.al., 2009). • Ethical and cultural considerations Moral issues which arise from each approach relate to the matter of least infringement, which includes issues of paternalism, privacy and autonomy. Since health promotion supports the improvement of conditions where people live, including their personal health practices, it is apparent that civil liberties would likely be curtailed (Breslow, 1990). Proportionality is also another issue. Health issues have different effects on the weaker members of society, including the poor and the homeless (Breslow, 1990). Under these conditions, various factors which relate to the health issues cannot be resolved through health promotion only. In actuality, health promotion can potentially increase inequality if it is unintentionally skewed towards those enjoying better health (WHO, 2000). In effect, while health promotion reflects the bigger social concerns, the causes of the issues are not given proper consideration. The public justification relating to health promotion is very much important. Reilly (1993) discusses that it is possible to justify the violation of autonomy if the goal of health promotion is to prevent and manage harm caused to society, and the means in securing such conditions are ethically proper. Ethical considerations are based on autonomy in relation to health promotion policies as imposed by the government which may violate the right of an individual to manage his life and to determine his activities (Morrison, 2009). Policies imposed on the communities, schools, cafeterias, and workplaces on food portions and nutritional allocations are part of the community health development remedies for health promotion (Morrison, 2009). However these policies may be considered unethical because they dictate behaviour and interfere with an individual’s right to eat what he wants, where he wants, and how much he wants. • What support does each approach have from government or other polices? Support from government or other policies has generally been strong. Health promotion policies have been encouraged by the government, with individuals also encouraged to participate in healthy living (Hunter, et.al., 2010). The greater support is seen through government policies and community development programs. The WHO has established its Global Strategy on Diet, Physical Activity and Health as well as its 2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases in order to initiate programs on the management of obesity and overweight (WHO, 2012). In the UK, the NICE has also established various policies addressing the obesity issue mostly through the different NHS partners and through the Change4Life programme (NICE, 2011). Other policies have also been set forth involving schools, mostly preventing fastfoods joints from being built near schools. Health education has also been adopted by government, with the assistance of schools in order to help prevent and reduce obesity and overweight (NICE, 2011). There is a need however to secure measures for policy approaches in order to secure public health policy surveillance processes. Policy-relevant research and evidence is also lacking from settings which indicate public health practice and policy. Actual practice and policy applications must be measured within frameworks which eventually help manage improved health outcomes for at risk patients (Brownson, et.al., 2010). Kenner and colleagues (2011) writing for the Centres for Disease Control discuss suggestions on the management of the obesity and ultimately the diabetes issue through the establishment of community development programs. Various elements of the physical environment which impact on health are created and maintained by local governments (Kennery, et.al., 2011). For instance, local policies often impact on the presence and absence of parks, sidewalks, bike lanes, healthy food retailers, as well as farmer’s markets. Moreover, public schools also have a crucial role in guaranteeing that children have the opportunity to access healthy foods in school as they go about their school day. In essence, local governments and public schools have a major impact on establishing healthy food and activity environments which benefit most individuals in their communities (Kenner, et.al., 2011). Aside from health benefits, there are also economic perks for local governments in establishing walkable, safe, and healthy food supportive scenarios. For instance, home values are often set to increase at faster rates in healthy communities which are pedestrian-friendly by securing mixed-use developments, sidewalks, and traffic-calming environs (Local Commission Centre for Livable Communities, n.d). Local governments can focus on strategic investments which support healthy eating and active living within their communities. This can be accomplished by using data about the present situations within the community which can be improved to secure improved health of their residents (Kenner, et.al., 2011). Moreover, communities can also use tools to evaluate their progress and to assess themselves in relation to other similar communities based on environmental and health measures relating to obesity and diabetes management. In general, various strategies and methods are also meant to secure these needs (Kenner, et.al., 2011). Strategies can focus also on baseline assessments which are meant to assess policies in the community, identifying priorities for action, and measuring change over time. Strengths and weaknesses The main strength of health persuasion is that ultimately it is a voluntary process on the part of the individual (Harman, 2001). He is not being forced to change. When he is persuaded to change and accepts change, the change can have a longer and deeper impact on him. On the other hand, for community health development, the process of change covers a bigger ground and may not impact significantly on individuals (Piper, 2009). Nevertheless, the community health development approach has a bigger and a far-reaching impact on the people. It can effectuate change based on the programs and policies being implemented. Weaknesses for health persuasion are grounded on the fact that it covers a smaller percentage of the population (Piper, 2009). Moreover, persuasion may not eventually achieve improved health outcomes because people may or may not choose to be persuaded to change. For community health development, its broad impact implies that the development programs may not provide sufficient details in order to secure effective and individualised change (Beattie, 1991). The health belief model discusses that before individuals can adopt the recommended physical activities, their possible threat of disease must be evaluated versus possible barriers to action (Edlin and Golanty, 2009). In other words, individuals usually consider changes in their life when they perceive that making these changes in their life would be more beneficial to them. They also consider these changes in the light of possible barriers to action. Among the obese and the diabetics, the time to consider changes often sets in when the actual threat to health manifests (Edlin and Golanty, 2009). Lifestyle changes are often considered only when there is a perceived threat to one’s health; if there is no threat perceived then any possible changes in life are often not implemented. More often than not, such belief can be a double-edged sword because the changes in one’s life in relation to health considerations can be most effective when carried out at the earliest possible stage-even before perceived threats are seen (Edlin and Golanty, 2009). Gibbs Reflection The writing of this paper has included the process of research and analysis, searching through the library resources, including internet materials in order to establish clear answers to the issues raised in this paper. In writing this paper, I feel that I was able to understand health promotion as well as obesity more. I felt that health promotion models and approaches are not given sufficient attention by the government and health practitioners. These approaches can sometimes also be out of touch with the reality of the health practice. I also felt much concern about the issue of obesity and overweight, including the trends surrounding it and the urgency of its management. I also feel that there are major gaps in the community development projects in the management of obesity and mostly these gaps can be attributed to the fact that institutions cannot be forced to comply with the policies and programs passed by the government authorities on the prevention and management of obesity. In evaluating this writing process, I believe that this paper has provided me with the necessary tools I can use in order to improve my practice. It provides both theoretical and practical applications which can be used in order to support and adjust to change. I also feel that this essay did not adequately provide me with the tools in order to understand public health. However, it has provided sufficient ideas for me to draw from, mostly in relation to how obesity can be managed, as well as what policies are needed in order to reduce the impact of obesity and overweight. During the writing process, I was able to enrich the information I had on health promotion and public health, as well as obesity and overweight. The research process involved in writing this essay made such accumulation of information possible. Research is one of the supporting tools which learners can use in order to improve their knowledge and to eventually implement change (Jasper, 2003). Research helps detect gaps in the practice, and also helps to fill in these gaps. In the course of this research I was able to learn more about Beattie’s model of health promotion. Beattie’s model provided a diverse and contrasting basis for change in the health habits and practices. Models of health promotion indicate trends and guidelines of change which can serve as templates for health professionals in their implementation of behavioural change (Seedhouse, 1997). These models are based on different foundations of care, including diverse resources which help support change. For the general public, these models are important tools of change and health promotion (Katz, et.al., 2001). They may seem unrealistic at times, however, with strong and collaborative processes, their goals can reach fruition. Obesity is a preventable disease. With the implementation of health promotion practices and policies, it is possible to reduce obesity rates, and/or eliminate it totally (National Heart Forum, 2006). Preventing and managing obesity is however founded on both individual and policy-based impositions. Individuals must want or must seek to change, and the appropriate policies must be in place in order to guide the individuals as well as the health practitioners in the implementation of policy. In order to successfully address the obesity issue, it is important to recognize that the problem is a significant and a widespread issue. It is also important for policy-makers to understand that it is an urgent issue (Cancer Research UK, 2006). Such recognition would then help emphasize the need to implement policies which would also promote health and help manage the obesity issue. Implementing policies to cover individuals and communities is also an important consideration in order to manage obesity. References Aranceta, J., Moreno, B., Moya, M., and Anadon, A., 2009. Prevention of overweight and obesity from a public health perspective. Nutr Rev., 67(1):S83-8. Beattie, A., 1991. Knowledge and control in health promotion: a test case for social policy and theory. In: Gabe J, Calnan M, Bury M (eds) The Sociology of the Health Service. London: Routledge/Taylor and Francis. Breslow, L., 1990. A health promotion primer for the 1990s. Health Affairs, 9(2), pp. 7-21 Brownson, R., Seiler, R., Eyler, A., 2010. Measuring the impact of public health policies. Prev Chronic Dis., 7(4), A77. Bunton, R. and Macdonald, G., 2002. Health promotion – disciplines, diversity & developments. London: Taylor Francis. Cancer Research UK, 2006. The causes of obesity – genes, behaviour and the environment [online]. Available at: http://info.cancerresearchuk.org/healthyliving/obesityandweight/whatcausesobesity [Accessed 11 December 2012] Centre for Health Improvement, 2009. Tackling obesity by building healthy communities: Changing policies through innovative collaborations [online]. Available at: http://www.chipolicy.org/pdf/Issue_Briefs/CHIObesityBriefFinal.pdf [Accessed 02 April 2013]. Committee on Prevention of Obesity in Children and Youth, 2005. Preventing childhood obesity: Health in the balance. New York: National Academies Press. De Vriendt, T., Moreno, L., and De Henauw, S., 2009. Chronic stress and obesity in adolescents: scientific evidence and methodological issues for epidemiological research. Nutr. Metab. Cardiovasc. Dis.,19, pp. 511-519. Drewnowski, A., 2009. Obesity, diets, and social inequalities. Nutr. Rev., 67, S36-39. Edlin, G. and Golanty, E., 2009. Health and wellness. London: Routledge Ewles, L., 2005. Key topics in public health. London: Elsevier. Harman, R., 2001. Handbook of pharmacy health education. London: Pharmaceutical Press. Hunter, D., Marks, L., and Smith, K., 2010. The public health system in England. New York: Policy Press Institute of Medicine, 2009. Community perspectives on obesity prevention in children: Workshop summaries. New York: National Academies Press. Jasper, M., 2003. Beginning reflective practice – Foundations in nursing and health care. London: Nelson Thornes. Katz, J., Peberdy, A., and Douglas, J., 2001. Promoting health knowledge and practice. London: Palgrave Macmillan Keener, D., Goodman, K., Lowry, A., Zaro, S., & Kettel Khan, L., 2009. Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Lajunen, H., Keski-Rahkonen, A., Pulkkinen, L., Rose, R. et.al., 2007. Are computer and cell phone use associated with body mass index and overweight? A population study among twin adolescents. BMC Public Health, 7, p. 24. Lloyd, C., Handsley, S., Douglas, J., Earle, S., et.al., 2007. Policy and practice in promoting public health. London: Sage. Local Government Commission Center for Livable Communities. (n.d.). The economic benefits of walkable communities. Sacramento, CA: Author. Ludwig, D. and Nestle, M., 2008. Can the food industry play a constructive role in the obesity epidemic? JAMA, 300, pp. 1808-1811. McDonald, C., Baylin, A., Arsenault, J., Mora-Plazas, M., et.al., 2009. Overweight is more prevalent than stunting and is associated with socioeconomic status, maternal obesity, and a snacking dietary pattern in school children from Bogota, Colombia. J. Nutr., 139, pp. 370-376. Mousouli, V., 2008. Obesity in childhood and adolescence: understanding development and prevention. London: Greenwood Publishing Group. Morrison, E., 2009. Health care ethics: critical issues for the 21st century: Critical issues for the 21st century. London: Jones & Bartlett Learning. National Heart Forum, 2006. Overweight and Obesity. National Heart Forum [online]. Available at: www.heartforum.org.uk/AboutCHD _Riskfac_Oweightobesity.aspx [Accessed 08 December 2012]. National Institute for Health and Clinical Excellence, 2006. Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children [online]. Available at: www.nice.org.uk/nicemedia/pdf/CG43NI CEGuideline.pdf [Accessed 11 December 2012]. NICE, 2011. Government plans to tackle obesity unveiled [online]. Available at: http://www.nice.org.uk/newsroom/news/GovernmentPlansToTackleObesityUnveiled.jsp [Accessed 12 December 2012]. Pearson, C., 2012. Weight measurements may be more accurate using waist circumference than BMI, study says. Huffington Post [online]. Available at: http://www.huffingtonpost.com/2012/05/11/weight-measurements-bmi-waist-circumference_n_1510215.html [Accessed 02 March 2013]. Piper, S., 2009. Health promotion for nurses: Theory and practice. London: Taylor & Francis. Poskitt, E. and Edmunds, L., 2008. Management of childhood obesity. London: Cambridge University Press. Reilly, R., 1993. Combating the tuberculosis epidemic: The legality of coercive treatment measures. Columbia Journal of Law and Social Problems, 27, pp. 101-149 Sacks, G., Swinburn, B., and Lawrence, M., 2009. Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity. Obes. Rev.,10, pp. 76-86. Seedhouse, D., 1997. Health promotion: Philosophy, prejudice and practice. Chichester: Wiley Thomas, S. and Stewart, J., 2005. Optimising health promotion activities. Journal of Community Nursing 19(1), pp. 9-12. Shields, M. and Tremblay, M., 2008. Sedentary behaviour and obesity. Health Reports, 19, pp. 19-30. Whitehead, D., 2001. Health education, behavioural change and social psychology: nursing’s contribution to health promotion? Journal of Advanced Nursing, 34(6), pp. 822-832. Whitehead, D., 2003. Evaluating health promotion: A model for nursing practice. Journal of Advanced Nursing, 41(5), pp. 490-498. World Health Organisation, 2000. The world health report 2000 – Health systems: improving performance. Geneva: WHO WHO, 2012. Obesity and overweight [online]. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ [Accessed 12 December 2012]. World Bank, 2011. Persuasion [online]. Available at: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTHSD/0,,contentMDK:22510815~menuPK:6485077~pagePK:148956~piPK:216618~theSitePK:376793~isCURL:Y,00.html [Accessed 12 December 2012]. Wills, J. and Earle, S., 2007. Theoretical perspectives on promoting public health. in Theory and research in promoting public health. Earle, S., Lloyd, C. E., Sidell, M. and Spurr, S., London: Sage, London. Read More