Escalating Rates of Childhood Obesity Public Health Policies in Need of a Paradigm Shift - Essay Example

Escalating Rates of Childhood Obesity – Public Health Policies in Need of a Paradigm Shift Schools Number and of Course Instructors Name Date of Submission (e.g., November 22, 2011) Table of Contents Introduction 3 Existing Public Health Policies for Tackling Obesity in Children 4 Why these Policies have not been Successful in Achieving the Desired Outcome? 5 Importance of a Multi-disciplinary Approach to Policy development 7 Proposed Model for Policy Improvement 8 Policy Framework for Policy Improvement 8 Discussion 10 Conclusion 11 Figure 3 Adapted from Hall et al., 2008, p. 19 13 Figure 4 Adapted from Walt and Gilson, 1994, p. 354 13 Figure 5 Adapted from WHO, 2010, p. 9 14 Figure 6 Modified framework 14 References 16 Public Health Policies in Need of a Paradigm Shift Introduction It is a comic irony that while some countries fight malnourishment and underweight in children, most others battle obesity and overweight. That obesity is now much more prevalent in children is a grim reality, and the fact that obesity in childhood is an important predictor of obesity in adulthood, makes the situation even worse. It has been well documented that both obesity and overweight are pressing health concerns as they lead to a wide range of health disorders such as type 2 diabetes, cardiovascular diseases, hypertension, gastrointestinal disturbances, cancers, osteoarthritis and stroke (Parliament.uk, 2003). Because of the impending consequences of childhood obesity, governments worldwide have taken up the task of preventing it so much so that “obesity has become a policy obsession” (Caraher, Crawley & Lloyd, 2009, p. 52). Significant amounts of funding has been allotted for childhood obesity prevention programs, and in the four administrative areas of UK, namely, England, Scotland, Wales and Northern Ireland, obesity is currently a “priority” funding stream (Caraher, Crawley & Lloyd, p. 52). In spite of the existence of numerous public health policies and health initiatives for prevention of childhood obesity, it still remains a prominent area in need of health policy improvement. The aim of this paper is to analyze public health policies in the context of childhood obesity in order to propose suitable improvements in health policies. It seeks to explore why health policies have failed to achieve the desired outcomes. Although current policy frameworks take into account the role of key stakeholders such as school administrators, school boards, vendors, parents, teachers, local city officials, food and beverage industries etc, little or no importance has been given to the possible existence of other stakeholders such as the children themselves. Moreover, while the consumption of unhealthy foods and lack of sufficient physical activity have been implicated in the incidence of obesity, other possible causes such as stress and depression have not been explored while formulating health policies. Therefore, the aim of this policy essay is to highlight the past and current health policies, followed by a critical review of their effectiveness in achieving the desired outcomes. The need for a paradigm shift in the existing health policies is highlighted in this paper which also proposes how policy models and frameworks can be altered to improve the existing policies in light of a more robust and all-encompassing policy module. Existing Public Health Policies for Tackling Obesity in Children Current health policies for the management of childhood obesity focus on improvement of diet and physical activity in the early years of life, working at school, family and community levels. In all the four administrative areas of UK, policies for tackling obesity only focus on increase in physical activity and improvement of children’s diets at school and home (Caraher, Crawley & Lloyd, 2009). The Healthy Start initiative was launched in 2004 to provide healthy fruits, vegetables, and other foods such as cereal based foods. The Sure Start initiative focuses on economically disadvantaged children up. In line with the 2001 NAO report, better co-ordination for policy implementation has been top priority for policy makers. Apart from appointing school sports coordinators at the local level, the Cabinet Committee on Children and Young People’s Services was appointed at the national level for policy coordination (Parliament.uk, 2003). The food and beverage industry has been working with the FSA and DoH to reduce fat and sugar content of foods and snacks, apart from reducing portion sizes (Parliament.uk). Moreover, from April 2007 onwards, all advertisements for unhealthy HFSS (high fat, sugar and salt) foods were prohibited from being telecast in TV programs for children between 4-9 years of age (Caraher, Crawley & Lloyd, 2009). In England, the current target set out in Public Service Agreements (PSA) is to bring down the proportion of overweight and obese children to levels that were prevalent in the year 2000 (Caraher, Crawley & Lloyd, 2009). England has also launched the Change4Life health initiative to engage parents in tackling childhood obesity. Similar campaigns have been launched in Scotland, Wales and Northern Ireland (Caraher, Crawley & Lloyd). Why these Policies have not been Successful in Achieving the Desired Outcome? The lack of a decline in the number of overweight children over the years, and the seemingly insignificant decline in childhood obesity rates suggest that, as of now, public health policies have not yet achieved the desired outcomes. The problem may either be with the policy framework at the concept stage, or with the policy coordination at the implementation stage. A large drawback of the current policies is their narrow field of vision, wherein, the policies target only two things – increased physical activity and improved diet. However, other determinants of obesity are ignored in these policies. For instance, studies by Kuo et al. (2008) have shown that high fat, high sugar diets alone do not cause obesity and that these combined with chronic stress are the actual causes. Other studies have shown that impulsive children are more likely to have eating binges, are not able to control eating behavior, are the least likely to lose weight and are more prone to relapse after weight loss regimens (Nederkoorn et al., 2006; Nederkoorn, 2007). As is evident, obesity is related to psychological factors and current health policies do not address these factors. Present health policies also fail to monitor and confirm whether schools are following the prescribed directives and whether children are actually getting healthy eating options. Most schools ignore such directives as they contradict with the commercial interests of their school vendors (Dodson et al., 2009). According to Caraher, Crawley & Lloyd (2009), very few measurements on health improvement have been performed and there is a “lack of clear nutrition guidance on which to base action” (p. 7). The healthcare policies for tackling obesity have not been resourced, designed, or timetabled to include an exhaustive evaluation of the outcomes of the policies (Pearce et al., 2008; Reilly, 2010). Therefore, the health policies are not evidence-based and there is no clear indication of whether they are actually working. Another limitation of healthcare policies in England and other countries is that UK, being a member of the European Union, has to implement European Directives. This limits policy implementation. For instance, even though there is regulation on food advertising in England, viewers will still be able to access shows from other European states where there are no such HFSS food advertising regulations (Caraher, Crawley & Lloyd). The lack of a focused approach in health policies of the UK is illustrated in Figure 2. One of the major concerns for effective policy implementation is the strong presence of the food industry. While health policies may incorporate food companies “as part of the solution”, there is always a danger of commercialization and personal interest, which may harm the actual objectives of the policies (Caraher, Crawley & Lloyd, 2009, p. 17). For instance, a news article by Bowater (2011) reports that members of an advisory group set up under Labour sarcastically suggest that the Government prefers to consult food and drink companies rather than scientific experts for overcoming the obesity crisis in Britain. The report comes in the wake of the Government’s decision to dissolve the advisory panel. Panel members blame the Government for being more in favor of the food and drink companies’ interests rather than public interests. Modern day children are much smarter and can make informed decision. Studies by Rees et al. (2011) have shown that children are well aware of the “social impact of body size” and are concerned about their own body sizes and shapes. The present policies do not consider these aspects and are more indirect in their approach. These policies mainly direct parents, teachers and school administrations. However, policymakers fail to realise that children themselves are potential stakeholders in the drive against childhood obesity. Policies should focus on how they can directly influence children and motivate them in getting involved in the policies, both at inception and implementation stages. As the current policies do not address many of the issues discussed in the preceding section, there is an urgent need for a paradigm shift in the current policies. Importance of a Multi-disciplinary Approach to Policy development Effective policies for childhood obesity can be tackled through a multidisciplinary approach as obesity depends on an innumerable variety of factors (Figure 3). According to data from the Millennium Cohort Study, children from poor households are more prone to obesity and overweight (Caraher, Crawley & Lloyd, 2009, p. 17). Obesity is not just limited to eating habits but is also based on cultural determinants. Obesity prevention needs a human-rights approach (Waters et al., 2011). Therefore, obesity prevention would require a combined knowledge of Sociology, apart from Psychology, as it depends on psychological factors that need to be addressed in policies, Biology, as obesity is a biological causation, Agriculture, as the agricultural sector will be involved in the production of healthy foods, Manufacture & Retail, as this sector also plays an important role in the provision of easy access to healthy food, Economics, for the generation and allocation of funds, and Education, as teachers and activists play an important role in educating children and parents on health issues. Proposed Model for Policy Improvement Children should be involved as key stakeholders in policy reforms. Food and drink companies and other commercial interests should not be involved at the policy formulation stage but can be involved at the implementation stage. Food and drink companies influence key policy decisions in their favor, disabling effective and good legislations that go against their commercial interests. By directly involving children in policy issues, it would be easier to identify what is to be done and how it can be done for preventing childhood obesity. The Health policy triangle (Figure 4) proposed by Walt and Gilson (1994) as a model for health policy analysis shows how most health policies only focus on the “content of reform” rather than on the “actors involved in policy reform”, the processes, and the context of policy reforms (p. 354). Similarly, as in the case of childhood obesity, health policies neglect the role of children as actors in the policy reform. Thus, a new model for health policy is envisaged. According to this model, children will monitor their own progress, weight, BMI and other health concerns. They will also regulate their own diets at home and school, and will modulate a fixed quota of physical exercise. They will be encouraged to take up full responsibility of their weight issues. Policy Framework for Policy Improvement Present health policies should be improved so as to include the psychological and other determinants of obesity, to provide better health reforms at school and individual level, to involve children at policy inception and implementation stages, to directly motivate and engage children in obesity prevention initiatives, to influence broadcast, print and social media so as to affect children’s perception of health, to restrict advertisements of commercial interest that contradict with healthy values, to regulate food and beverage companies and school based vendors, and to make sure that policies are actually being implemented not just at the community and school level, but also at the individual level. The psychological, socio-economic and cultural determinants of obesity have to be addressed. School based vendors will continue to sell unhealthy foods in spite of regulations. Teachers cannot monitor whether each child has had enough physical activity based on his/her requirement. Food and drink companies will continue to influence policies and so, children will continue to be exposed to unhealthy eating choices. These are some of the loopholes of the existing public health policies. Children are much smarter today and can make well informed decisions related to diet and health if motivated to do so. A modified form of the implementation framework of the WHO for the Global Strategy on Diet, Physical Activity and Health (2010, p. 9) (Figure 5) for the formulation of better policies is proposed as follows: Apart from a national strategic leadership on diet and physical activity, an international strategy is proposed. The international strategy will focus on integrating healthy ideas and lifestyle changes through international films, social media, social networking sites and celebrity endorsements. Just as “being cool” has been ingrained in children’s thinking through media, “being healthy” will have to be embedded too. The supportive environment, policies and programs will not only focus on healthy diet and physical exercise, but will also focus on behavioral change and psychological amendments. Sociologists and psychologists will have to be mobilized to provide psychological and behavioral change therapies. Moreover, the supportive programs will also have to encompass children volunteers who can instill healthy values in their peers. This approach will be more effective than parents and educators teaching healthy practices. As part of the national and international strategies, children should be involved internationally in policy making for obesity prevention. Online media can help children in voicing their thoughts and needs. Just as children have taken up global warming as an international campaign, childhood obesity too can be taken up on similar lines. The monitoring and surveillance mechanisms will have to ensure that each child is taking up enough exercise specifically according to his/her own body requirements. A health grading system should be formulated, implemented and mandated in schools to help children in keeping track of their own weights and BMIs. The modified policy framework according to the above proposed guidelines is shown in Figure 6. Discussion According to statistics from the Health Survey for England (HSE), about 3 in every 10 boys and girls, aged between 2-15 years, are either overweight or obese (The NHS Information Centre, 2010). According to the Health Survey for England, 2009 data, 16.1% of boys and 15.3% of girls in the 2-15 age groups are obese (Harker, 2011). The prevalence of obesity among boys increased from 11.1% in 1995 to 19.4% in 2004, subsequently falling to 16.1% in 2009 (Harker). Similarly, the prevalence of obesity among girls increased from 12.2% in 1995 to 18.8% in 2005, and then decreased to 15.3% by 2009 (Refer Figure 1) (Harker). Although the data suggests a slight decline in the prevalence of obesity since 2005, it must be noted that the prevalence of overweight children has remain unchanged from 1995 to 2009, and is currently 12.9% for girls and 15.4% for boys (Harker). About one-third of obese pre-school and half of obese school-age children remain obese even in their adulthood (Chu, 2010). Obesity in adulthood places a great strain on healthcare costs due to an increased incidence of chronic life-threatening diseases. As Harker describes, economic costs of obesity not only arise from healthcare services but also because of “lost productivity” due to high unemployment and absenteeism rates among obese individuals (p. 6). According to a report by the Foresight Programme, costs to the NHS due to obesity were £2.3 billion in 2007, and if the trend continues to grow, it would cost the NHS £4.2 billion a year, doubling by 2050 (Harker). Therefore, obesity prevention is now an indispensable target for health policies for ensuring a stronger nation, both in terms of health and finance. Thus, public health policies need innovative reforms that are in line with present needs. Conclusion This essay contributes to the areas of public health policy involved in the prevention of childhood obesity. It is expected that the proposed policy improvements will result in an active participation of children in the drive against obesity, a more robust surveillance and monitoring of schools for policy implementation and more hopefully, a steady decline in the prevalence of childhood obesity. This essay highlighted the major shortcomings of the current health policies for the prevention of childhood obesity and discussed how these can be improved. The essay takes a stance on how present health policy models and frameworks can be re-worked to include major stakeholders and health determinants of obesity. The essay concludes that children should be involved directly as stakeholders in health policy and that other determinants of childhood obesity such as psychological and cultural factors should be taken into account during policy formulation. A more individualized approach is warranted so as to monitor policy implementation at a more individual-specific level. By ensuring that each child receives personalized guidance, healthy diet, physical education and exercise based on his/her specific needs, it will be possible to tackle the obesity epidemic in a more dynamic, result-oriented manner. 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