Obesity: Analyzing Health Policy and Health Education - Research Paper Example

Obesity: Analysing Health Policy and Health Education INTRODUCTION The white paper Healthy Lives, Healthy People: Our Strategy for Public Health in England released in 2010 summarizes the proposal for a new public health system in the UK. It reflects the core values of freedom, fairness and responsibility and attempts to pass accountability for public health to local governments, community leaders, NGOs, businesses and employees in the hope of creating a sustainable public health agenda. By engaging all sectors in the society, the government is able to free up its resources so that it can focus on the improvement of health care services and deal with health emergencies more effectively. Considered as the first of its kind, the new public health agenda is crucial to the success of the bottom-up approach in policymaking. Using the policy analysis triangle by Walt and Gilson, the author argues that the policy cannot be implemented effectively without first addressing the systemic problems in UK society. This paper provides information about obesity (definition, statistics and effects) particularly among school aged children. It then goes on to summarize the policy agenda, and analyze the proposal for a new public health system. Lastly, the article summarizes some measures to improve the health policy as provisioned by the Health and Social Care Bill of 2011. OBESITY: DEFINITION, STATISTICS AND EFFECTS World Health Organization defines obesity as the “abnormal or excessive fat accumulation” (2011). An obese individual has a body mass index1 (BMI) of 30 or more, while someone with BMI equal or greater than 25 is overweight. Obesity statistics: World and UK As of 2008, 1.5 billion adults are overweight with atleast 10% of the adult population diagnosed as obese. In 2010, About 43 million children under five are overweight. In a 2002 survey of WHO, it was found that almost 39% of respondents in the UK aged 15-84 are overweight, with more men (43.9%) having a BMI of 25-29.99 compared to women (33.6). Meanwhile, a 2009 survey by the NHS Information Centre, almost 25% of adults are obese. One in 10 pupils (or 9.8%) aged 4-5 years and 18.7% of year 6 students were reported to be obese. Estimates show that if the trends will continue, almost half of British men would be clinically obese in 20 years (Hope, 2011; Walker, 2011; Wiley, 2011). The effects of obesity on health and government expenditure Obesity is a major health issue today because it is considered as a major risk factor for several diseases including heart disease and stroke, diabetes, osteoarthritis and certain type of cancers. An obese individual also has a high chance of developing sleep apnea, incontinence, fatty liver, high blood pressure and fertility problems. A study published by The Lancet confirms this claim (Wang, McPherson, Marsh, Gortmaker, & Brown, 2011). WHO statistics show that obesity leads to atleast 2.8 million deaths each year, and is now the fifth leading risk for global deaths (World Health Organization, 2011b). The issue of obesity is so widespread in that almost every newspaper in the UK is now talking about it. In a BBC article written by Prof. Tony Leeds, an obesity management specialist at the Central Middlesex Hospital, he said: “While many countries watch their financial debts mount, there is another ticking timebomb walking the street” (2010). Meanwhile, other UK newspapers have dubbed the phenomenon as the “global obesity pandemic” because of the uncontrolled increase in the number of people suffering from such condition countries like the UK, US and Australia (Walker, 2011). UK newspapers report that there would be 11 million people more who will become obese by 2030, about half of which will be British men (Hope, 2011; Walker, 2011; Wiley, 2011). In a study published by The Lancet (Wang et al., 2011), it was found out that the increase in obesity in the US and UK can lead to an additional 6 to 8.5 million cases of diabetes, 5.7 to 7.3 million cases of heart disease and stroke, and between 492,000 and 669,000 additional cases of cancer. In addition, there is a high tendency for increase prevalence of debilitating orders such as osteoporosis which could affect a person’s quality of life and lifespan. Note, however that the problem with obesity is not only related to its health consequences, but also to the added burden it places on the economy. According to estimates, obesity accounts for 0.7 to 2.8% of country’s total health care costs; medical costs for obese people are 30% higher than those with normal weight (Wang et al., 2011). In the UK, the continuing rise in obesity could lead to more than £5.5 billion increase in medical spending by the National Health Service (NHS) by 2050 (NHS Choices, 2011). Aside from the increase in the cost in the use of health services and medical treatments due to obesity-related diseases, the economy is disadvantaged by the reduction in productivity. Moreover, “society incurs substantial costs from obesity as a result of increased risks of disability and disability pensions, higher work absenteeism and reduced productivity, and increased risk of people retiring early or dying before they reach retirement age” (NHS Choices, 2011). GOVERNMENT ACTION CONCERNING OBESITY Policies aimed at improving public education about obesity As early as 2006, there have been moves designed to address obesity. For example, the Department of Health released a package of materials distributed to health professionals which can be used to educate their patients about obesity and their health care options The package included a booklet on how to manage obesity among adults and children. Moreover, the National Institute for Health and Clinical Excellence (NICE) produced distinct guidelines on the prevention, identification, assessment and management of overweight and obese children and adults (The NHS Information Center, 2011). Following this move is the publication of the white paper Healthy Lives, Healthy People: Our Strategy for Public Health in England (Department of Health, 2010) which provides a new approach for public health in the country and presented national level activities that can serve to address obesity. Here are some of them (The NHS Information Center, 2011): [1] Continuing to run the National Child Measurement Programme, including sharing results with parents, so that local areas have information about levels of overweight and obesity in children to inform planning and commissioning of local services. [2]Helping consumers make healthier food choices through the Change4Life programme2. [3] Sharing learning from `Healthy Towns’ which have been leading the way in developing community- led action to support people to become more active and promote healthy eating [4]Working with business and other partners through the Public Health Responsibility Deal3. In 2011, the Health and Social Care Bill (Lansley & Howe, 2010) was introduced to the parliament in the hope of modernizing the NHS so that it can ensure the delivery of world-class health service in the UK. UK Public Health Agenda: A summary Through the Healthy Lives, Healthy People: Our Strategy for Public Health in England, the Department of Health introduces a new approach in dealing with current and future health threats. Through the Public Health Responsibility Deal, the Department hopes to empower communities to take responsibility for their own (and their community’s) health and wellbeing. It gives mandate to local governments, community leaders, businesses and NGOs to create their own tools that will address their particular needs. “We will end central control and give local government the freedom, responsibility and funding to innovate and develop their own ways of improving health in their area. There will be real financial incentives to reward their progress...and greater transparency so people can see the results” (Department of Health 2010: p. 2). The Department of Health calls this “a radical new approach” because it holds communities accountable in promoting health behaviours and adapting an environment that will allow citizens to make healthy choices easier. Through this move, the Department hopes to address the root cause of poor health and be able to assist to families and communities most in need of support.. A ring fenced fund from the NHS is also provided so that budget is guaranteed and it will not be affected by other pressures. In this approach, the NHS continues to have a crucial role because it will provide the support to people with long-term conditions as well as directives to community nurses, hospital-based consultants and other health professionals. The NHS will ensure that the whole population will have access to high quality health care. The central government will coordinate activities so as to protect the population from serious health threats and other emergencies. The government’s approach to health promotion is best described by the ladder of interventions (figure 1) introduced by the Nuffield Council on Bioethics. Through the Public Health Responsibility Deal, the government hopes to prompt citizens to make lifestyle changes out of their own will. The government aims to use the least intrusive approach as long as necessary, but if this approach does not work, then they will consider to move up the “ladder”. Figure 1: A Ladder of Interventions (Department of Health 2010, p.30) Analyzing UK’s Public Health Agenda: Its weaknesses and some suggestions The proposed public health system offers five advantages (Department of Health 2010, p.52): [1] It will free up the resources of the Department of Health thereby allowing it to focus on the improvement of health care provision, as well as immediately address the health problems of the poorest; [2] Top down targets are repealed and local governments are given new freedoms (along with a ring-fenced budget) to create a public health plan which will provide the most impact in the community; [3] Through a new agency called Public Health England, public health becomes a top priority. Efforts towards improvement of public health status do not only have a protected budget, it will also be more efficient and effective because processes will be reorganized; [4] NHS will have enough resources in preventing avoidable diseases and in dealing with health emergencies (in terms of organizational preparedness and response). [5] By driving accountability and ensuring empowerment of communities, efforts towards health promotion will become more sustainable. Many international organizations have stressed the need for citizen participation in policy creation (in health care, education, etc.) to ensure its success. It must be noted that this policy proposal is the first of its kind in the world, and once approved (through the Health and Social Care Bill of 2011), will become a basis for health reform in many countries. Its results will prove (or disprove) the effectiveness of decentralization of authority and the importance of grass root movements. Personally, I support this move by the government however there are some weaknesses to this proposal. I will discuss two of them below. First, the new public health proposal is more effective as a method of prevention. In the white paper, it mentioned: “Public Health England [as the main source of health budget for the entire country] will fund those services that contribute to health and wellbeing primarily by prevention rather than treatment aimed at cure” (Department of Health, 2010: p.59). Through the different proposed programs, more people will know the disadvantages of obesity and will discover new ways of preventing it. The Child Measurement Program ensures that children are brought up in a healthy environment so that they can make healthy lifestyle choices later in adulthood, hence sustaining improvement in health. Yet, it must be remembered that 62% of Britons are already overweight or obese (Leeds, 2010). How will the policy address their condition? The National Bariatric Surgery Registry (NBSR) proposes bariatric surgery as an alternative and cost-effective solution to prevent obesity-related health problems (Diabetes UK, 2011). However, like any other surgery, this procedure has its risks and can only be used when all other attempts to lose weight has failed. Bariatric surgery is an expensive procedure, and often, it is not covered by insurance policies. The government may choose to cover partial amount of the surgery, but, with more than 3 million Britons who are obese or overweight, such subsidy can use up the entire budget for the entire public health plan. Moreover, not all obese individuals are eligible for the surgery, they must first undergo psychological assessments and meet the maximum weight limit, which essentially means that there are only a few people who will benefit if the state decides to subsidize bariatric surgery expenses. Without solution for already obese individuals, economists estimate that the increase in obesity-related problems can lead to decreased productivity. This decrease will then result to lower incomes for citizens, which then increases the burden on the state since more citizens will rely on government budget for welfare and health spending. “Without prevention and control of the risk factors for obesity now, health systems will be overwhelmed to breaking point” (Wang et al., 2011), which means more individuals will seek health support from government agencies, which can not only overburden public health professionals, but can also stress government budget for health. Hence, I, along with several journalists and academics (Hope, 2011; Leeds, 2010; Walker, 2011; Wang et al., 2011; Wiley, 2011) believe that the while prevention is necessary, it is also important for the government to use direct intervention to create a better health environment (see table 1 for a summary of measures to reduce and prevent obesity). It is important for the government to identify the exact target for such policies. This step is essential, especially since there are studies in the US which show that health promotion policies relying on voluntary participation (the framework used by the UK health policy agenda) tends to benefit those that need them least (Blacksher, 2008). Obese people with lower social positions have less chance to belong to a gym or have access to fresh and healthy food. The government can pass on the problem of obesity to its citizens, but it has to ensure that disabling factors such as low income, less access to health services, low education, etc., have been eliminated. Obese individuals will often prioritize their basic necessities and pressing needs before they decide to do something about their figure. Table 1 below summarizes some of the direct intervention that the government can implement to help obese individuals to overcome their affliction. Table 1: Obesity Measures (Triggle, 2011) Category Saves Money Minor Cost Higher Cost FOOD Tax junk food Limit junk food ads Traffic light labelling Cost-benefit category LIFESTYLE Discourage kids from TV Exercise and healthy eating at school Work with obese children Help families with overweight obese children School walking trains TREATMENT Surgery for obese teenagers and adults Weight loss drugs Having stated that, we now come to the second problem of the new health policy: it does not consider the interconnectedness between obesity and a person’s social conditions. In the US, obesity is more commonly found in women who belong to socially disadvantaged groups (Adler & Stewart, 2009: p.51) and this same trend is found in the UK (The NHS Information Center, 2011). One reason for this is that low-income households often choose energy-dense foods instead of healthy foods because they are often cheaper. However, it must be noted that the connection between socioeconomic status (SES) and weight is cyclical. Low SES encourages weight gain, and at the same time, obese individuals experience discrimination from occupational, educational and social opportunities (Adler & Stewart, 2009: p. 51) which further lowers their SES. Proof of this is the results of one surve (Crosnoe, 2007), which shows that obese girls were less likely to attend college compared to their non-obese peers. Without college education, many of these girls are unable to find a decent job, hence, they are unable to provide for their families or help their partners in earning income for the household. This condition will again, exert pressure on the government budget because these families will rely on welfare spending. This the reason why there have been calls for providing government assistance to teenagers who wish to undergo bariatric surgery. Through this move, teenagers are afforded with better opportunities in adulthood (Leeds, 2010). Unfortunately, this is not a provision of the new health agenda, and with decentralization to local governments (which has lower budgets compared to the national government), this will probably become the last priority. While the proposal for a new public health system seeks to empower individuals in the low SES, empowerment must not only center on behavioural changes, it should also be complemented with policies that seek to address disparity in income and socioeconomic status. The government has to present a comprehensive approach to public health, considering the effect of education and household income to the overall success of the plan. Integrating approaches: A Conclusion The success of plans to reduce obesity relies on an individual’s free choice or “will power” to change his lifestyle, as well as the environmental forces that affect a person’s capability to engage in healthy behaviours. Yet obesity has become a pervasive problem that tends to overwhelm individual choices. It can no longer be addressed simply by educating people and promoting healthy lifestyle. Instead, health plans to control obesity must be complemented with “legislative and regulatory means to remove obstacles to healthy eating and activity habits and/or to create incentives to support them” (Adler & Stewart, 2009: p.57). Moreover, it is my belief that such interventions have to combine with methods that enable people to take advantage of increase economic and environmental resources. General prevention strategies must be combined with targeted intervention through service provision to high-risk groups. Governments must provide target social services to these groups so as to grant them improved capacity to make the change towards a healthier lifestyle. The claim may be summarized by this statement: “The obese are already a stigmatized group, and they may become even more stigmatized unless the public understands and accepts that people need adequate resources [such as] affordable healthy food, and the absence of advertising of unhealthy choices” (Adler & Stewart, 2009: p.69). Works Cited Adler, N. E., & Stewart, J. (2009). Reducing Obesity: Motivating Action while Not Blaming the Victim. The Milbank Quarterly, 87(1), 49-70. Blacksher, E. (2008). Carrots and Sticks to Promote Healthy Behaviors: A Policy Update. The Hastings Center Report, 38(3), 13-16. Crosnoe, R. (2007). Gender, Obesity, and Education. Sociology of Education, 80(3), 241-260. Department of Health. (2010). Healthy lives, healthy people: our strategy for public health in England. Retrieved from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127424.pdf Diabetes UK. (2011). Bariatric surgery could reduce NHS costs. News. Retrieved November 21, 2011, from http://www.diabetes.org.uk/About_us/News_Landing_Page/Bariatric-surgery-could-reduce-NHS-costs/ Hope, J. (2011, August 26). Nearly half of UK men “will be obese by 2030” and women won’t be far behind. Daily Mail Online. Retrieved from http://www.dailymail.co.uk/health/article-2030271/Nearly-half-UK-men-obese-2030-women-wont-far-behind.html Lansley, A., & Howe, E. (2010). Health and Social Care Bill 2010-11. House of Commons. Retrieved from http://services.parliament.uk/bills/2010-11/healthandsocialcare.html Leeds, P. T. (2010, April 28). Obesity: The walking financial time bomb. BBC Mobile News. Retrieved from http://news.bbc.co.uk/2/hi/health/8646677.stm NHS Choices. (2011). Half of UK obese by 2030. National Health Service. Retrieved October 28, 2011, from http://www.nhs.uk/news/2011/08August/Pages/half-of-uk-predicted-to-be-obese-by-2030.aspx The NHS Information Center. (2011). Statistics on obesity, physical activity and diet: England, 2011. Triggle, N. (2011, August 25). Global governments “must get tough on obesity.” BBC News Mobile. Retrieved from http://www.bbc.co.uk/news/health-14669203 Walker, P. (2011, August 26). Half of UK men could be obese by 2030. The Guardian. Retrieved from http://www.guardian.co.uk/society/2011/aug/26/half-uk-obese-by-2030 Wang, Y. C., McPherson, P. K., Marsh, T., Gortmaker, S. L., & Brown, M. (2011). Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet, 378(9793). Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60814-3/fulltext Wiley, J. (2011, August 26). Half of Britons will be Obese in Under 20 Years. Express. Retrieved from http://www.express.co.uk/posts/view/267226/Half-of-Britons-will-be-obese-in-under-20-years World Health Organization. (2011a). Obesity. WHO Health Topics. World Health Organization. (2011b). Obesity and overweight. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/index.html Read More