Implementing a Change in Population Health - Essay Example

Running Head: Health Campaign – Part III Healthy People and Issues on Obesity: A Public Health Concern – Part III Implementing A Change in Population Health Abstract This paper is written with the objective of developing a health campaign on obesity as one of the national issues identified in Healthy People 2010, specifically focusing on the following: (1) to recommend the implementation of a campaign for obesity to improve population health addressing social, economic, and cultural factors; (2) to recommend approaches, such as programs, policies, laws, and environmental aspects, to assess the health and wellness of the target population; (3) to determine the challenges related to improving the population health for the target population by examining global implications, environmental factors, and disease prevention; and (4) to provide a summary of useful epidemiology or other data models managers may use to make decisions on the ground and to anticipate future trends on obesity. Introduction The issues that surround obesity threatening the health condition of the American population cannot be overemphasized. Healthy People 2010 proffered a comprehensive discourse on specific objectives, agencies involved in monitoring and directly addressing obesity related issues, the models and systems used for monitoring this chronic illness and epidemiologic surveillance systems and tools which guide community based health practitioners and ultimately, national agencies in recommending solutions to this dilemma. The scope of the health campaign to fight and prevent obesity on a wide scale level encompassed an evaluation of the target population, as well as the community based response to the issue. Starting from the grass root level of identifying the root causes and enumerating the specific strategies that communities plan to implement as a means of addressing and preventing obesity within their localities, the road to prevention is made more viable and feasible through coordinated efforts of both local and national agencies. The critical roles of leaders in communities and institutions, as well as funding and social marketing which contribute to the promotion of a healthy lifestyle and in enforcing strategies to ultimately prevent obesity were previously identified. In this regard, this paper is written with the objective of developing a health campaign on obesity as one of the national issues identified in Healthy People 2010, specifically focusing on the following: (1) to recommend the implementation of a campaign for obesity to improve population health addressing social, economic, and cultural factors; (2) to recommend approaches, such as programs, policies, laws, and environmental aspects, to assess the health and wellness of the target population; (3) to determine the challenges related to improving the population health for the target population by examining global implications, environmental factors, and disease prevention; and (4) to provide a summary of useful epidemiology or other data models managers may use to make decisions on the ground and to anticipate future trends on obesity. Recommendations for the Implementation of a Campaign A workable implementation of recommendations to minimize the incidence and prevalence of obesity through strategies and programs must be designed with a well defined time table. The starting point is always the identification of goals. The nationally identified objectives specific to the issue of obesity are quoted, to wit: “the program goal is to prevent and control obesity and other chronic diseases through healthful eating and physical activity. The goal will be achieved through strategic public health efforts aimed at the following program objectives: (1) decrease prevalence of obesity; (2) increase physical activity; and (3) improve dietary behaviors related to population burden of obesity and chronic diseases.” (CDC, 2009, 1) The short term goals would be: (1) the determination of updated incidence and prevalence of obesity through epidemiologic surveillance tools and systems identified by local and state agencies; (2) a comparison of the deviation from previous findings to determine the trend (increasing or decreasing) given the strategies implemented from the community based response programs and state funded programs; and (3) a determination of the factors which have a significant effect on the deviation from previous results. This short term goals must be measured on its accomplishment within a span of three to six months’ time. The long term goals would be: (1) to implement well identified strategies enumerated in the study by Khan, et.al. (2009) focusing on strategies which have contributed to positive improvement in addressing obesity issues; (2) to evaluate and analyze the progress of the strategies implemented through close coordination with the Division of Nutrition, Physical Activity, and Obesity (DNPAO) that “monitors the prevalence of overweight, obesity, nutrition quality, physical activity levels, and the program impact to change overweight and obesity related behaviors, particularly nutrition and physical activity” (CDCP, Funded States, 2009, par. 5); and (3) to focus on factors which continue to contribute to the identified population’s incidence of obesity and to design improved strategies to address these. It should be noted that the success of the local agencies’ plans towards the accomplishment of goals to address obesity are measured against the plans of the state, the implementation plan outlined per annum, the work plan for the yearly cooperative agreement, and plans forged on a per state basis. Long term goals should be measured in terms of its accomplishment within a one year period and monitored, updated, evaluated yearly. More importantly, any recommendation to address obesity should take into account the advise of the U.S. Preventive Services Task Force (USPSTF) (2003, 1) that “initial interventions paired with maintenance interventions help ensure that weight loss will be sustained over time. It is advisable to refer obese patients to programs that offer intensive counseling and behavioral interventions for optimal weight loss.” In addition, “the USPSTF defined intensity of counseling by the frequency of the intervention. A high-intensity intervention is more than 1 person-to-person (individual or group) session per month for at least the first 3 months of the intervention. A medium-intensity intervention is a monthly intervention, and anything less frequent is a low-intensity intervention. There are limited data on the best place for these interventions to occur and on the composition of the multidisciplinary team that should deliver high-intensity interventions.” Approaches for the Assessment of the Health and Wellness of the Target Population The US Department of Health and Human Services has identified approaches for the assessment of health and wellness of the identified population on obesity issues. Through its agency, the Agency for Healthcare Research and Quality (AHRQ) with a task force formed specifically for screening for obesity, the target population is assessed, monitored, evaluated as to which approach is most effective in addressing obesity. Accordingly, the AHRQ recommends that “clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. The most effective interventions combine nutrition education and diet and exercise counseling with behavioral strategies to help patients acquire the skills and supports needed to change eating patterns and to become physically active. The 5-A framework (Assess, Advise, Agree, Assist, and Arrange) has been used in behavioral counseling interventions such as smoking cessation and may be a useful tool to help clinicians guide interventions for weight loss.” (U.S. Preventive Services Task Force, 2003, 1) Challenges to Improve the Population Health for the Target Population According to Matheson and Gillespie (2006, 45), there are two major challenges facing the target population in the future, not only on issues of obesity but also in health protection, in general, to wit: “(1) pandemic preparedness emphasizing the need for rapid reaction, command and control, regulatory powers, and intersectoral activity; and (2) Healthy Eating Healthy Action which has provided a platform for debating the role of regulation in broader public health programs and the need for developing healthy public policy.” In addition, “geographic and demographic challenges create issues with respect to coverage and specialization.” (Matheson and Gillespie (2006, 45) The evolving social and lifestyle factors, migrants and cultural diversity contribute to shifting risks from the physical environment. In this regard, any significant resurgence of biological factors increasing the incidence of obesity could immediately create pandemic issues necessitating immediate action and an application of regulatory policy. As averred by the USPSTF, “obesity is associated with decreased quality of life, including diminished mobility and social stigmatization. The association between obesity and health outcomes may vary by ethnic group, but the USPSTF found the evidence insufficient to draw conclusions. Recent analyses estimate that direct costs of obesity account for 5.7 percent of total U.S. health expenditures.” (USPSTF: Scientific Evidence, 2003, 2) Summary of Useful Epidemiology to Anticipate Future Trends In terms of obesity, these challenges pose awareness and a call for immediate action to health care practitioners from the community level, to the state agencies to intensify efforts to address obesity. As such, the USPSTF have enumerated other agencies that seek to improve the health of the target population by outlining specific recommendations to prevent obesity, as quoted below: “The American Academy of Family Physicians and the American College of Obstetricians and Gynecologists recommend periodic measurements of height and weight. NIH has a 2-step guideline of assessment and treatment management of overweight and obese individuals. The American College of Preventive Medicine recommends periodic BMI measurement of all adults and diet and exercise counseling of all adults (irrespective of BMI) and endorses NIH management guidelines. The American Diabetes Association has published a position statement that recommends the use of intensive lifestyle modification programs along with standard weight loss strategies for long-term weight loss and maintenance.” (USPSTF, Recommendations of Others, 2003, 1) The coordinated efforts of local and national agencies, the target population would be assured that challenges are to be faced with preparedness and vigilance; in conjunction with policies identified in the Healthy People 2010 national agenda. The Behavioral Risk Factor Surveillance System (BRFSS) which had been used in the United States since the 1980s to monitor the prevalence of health risk behaviors would continue to be helpful in anticipating future trends. The behavioral targets which specifically identified include decreasing the frequency of viewing television; identifying high energy dense food and decreasing consumption for these; minimizing the consumption of sugar laden drinks; increasing intake for high fiber foods such as vegetables and fruits; and encouraging physical fitness and activities should provide relevant data to project future trends. Local and state agencies use these behavioral risk factors to monitor any drastic changes in current obesity level per state to be compared to past levels. Reassessment must be made after the short term time interval initially indicated (for short term goals) and annually for long term goals. Any significant deviation would be evaluated and assessed as to the factors which caused it and determine the appropriate action to immediately solve it. Conclusion The success of a health campaign should be measured in terms of its effectiveness in the accomplishment of specifically defined goals. The problem of obesity is continually increasing as it pervades other sectors of the American population. Although it is commendable that local and national agencies join hands in coordinated efforts to monitor, evaluate and assess underlying factors contributing to this illness, the challenges of the future need to be incorporated in obesity programs and plans to create a comprehensive health campaign to ultimately find a solution to this dilemma. Aside from focusing on the primary causes of obesity, the factors contributing to an individual’s vulnerability to this illness must continuously be monitored. The treatment for obesity would involve a long time commitment to change one’s lifestyle in food preference and exercise. In the end, it is still the individual’s determination to lead a happy, healthy life that is first and most important step in the treatment for obesity. References Centers for Disease Control and Prevention (CDCP). (2009). Funded States. Retrieved 24 Dec. 2009. < http://www.cdc.gov/obesity/stateprograms/fundedstates.html> ----------------------------. (2009). Overweight and Obesity. Retrieved 24 Dec. 2009. < http://www.cdc.gov/obesity/stateprograms/index.html> Khan, L.K., Sobush, K., Keener, D., Goodman, K., Lowry, A., Kakietec, J. & Zaro, S. (2009). “Recommended Community Strategies and Measurements to Prevent Obesity in the United States.” CDC. MMWR Recommendations and Reports. July 24, 2009 / 58(RR07); 1-26. Print. U.S. Preventive Services Task Force. Screening for Obesity in Adults: Recommendations and Rationale. November 2003. Agency for Healthcare Research and Quality, Rockville, MD.Retrieved 24 Dec. 2009. Read More