MSC Public Health and Health Promotion - Research Paper Example

MSC Public Health and Health Promotion Health Promotion Practice SHGM 54 Jane Thomas of the placement No: 628587 Word Count: 4409Submission Date: 21-4-2011 Introduction I decided to do my placement within an organisation called MEND –Mind, Exercise, Nutrition and Do it. MEND is a project that works with obese children aged 7-13 and their families within Swansea. This project works by promoting healthy eating and physical activities to the obese children and their families. MEND was set up as a part of a National Initiative funded by the Welsh Assembly Government until March 2011. I have chosen this project because of my interest in nutrition, and it was very much in line with my Bachelor’s Degree in Nutrition and Food Science. Furthermore, I felt that the issue that MEND is tackling – that of obesity – is a serious and growing issue within children not just in the UK but also in all other countries of the world. In fact, among the world’s school aged children, approximately 10% are carrying excess body fat, leading to an amplified risk for developing chronic disease (Lobstein et al., 2004). From this percentage, a quarter of the children are classified as obese. Obesity among children is an unfortunate situation because it opens them to multiple risk factors, including type 2 diabetes, heart diseases, and a variety of other co-morbidities before or during early adulthood (Lobstein et al., 2004). The above statistics portrayed an urgent need for a health programme to be implemented among children, and I felt that in choosing a placement in the MEND programme, I would be given a practical means of contributing to the prevention and the management of childhood obesity. The main objectives of this placement include the following: (1) To be involved in efforts to control childhood obesity; (2) To establish practical applications for health practitioners in promoting healthy habits for children and their families; (3) To evaluate current methods in the MEND program in terms of their efficacy in battling childhood obesity. Obesity has a higher incidence rate at economically developed areas, however, overall, overweight issues are rising highly in most parts of the world (Lobstein et al., 2004). My placement therefore gave me a means to be part of a programme which would impact on not just my community, but on the world as well. I was able to assess the population of children within the MEND programme and I was able to detect that the children within the programme did not just belong to the more economically progressive families, but some of them also came from the poorer families and communities. In my interaction with them, I was able to establish the importance of access to healthy foods, and that some of them did not financially have access to healthier food choices. This is an ironic consideration when applied to the richer families who were able to financially access healthier foods, and yet, a great percentage of them were still obese. The strain on the health services due to childhood obesity cannot be recorded (Lobstein et al., 2004). This is due to the fact that childhood obesity causes a large amount of health problems, including hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression. As the next generation of adults appear, after the present childhood obesity epidemic goes into adulthood, the health problem they face will be greater. These health problems which will be found in the young adult populations will include higher rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesity-related conditions. Treatment for these conditions could potentially last for the remainder of their lives. Claims have been made that as a result of the recession, Wales has seen an increase in childhood obesity. An increase by 3% in children under 16 who were classified as obese has been shown by The Welsh Health Survey of 2009 (Brindley, 2010). Wales actually holds a high position in the childhood obesity league, with nearly one in five children being classed as obese. As a possible result of the recession, more families have been prompted to look or to switch to cheaper foods, but these cheaper foods tend to be processed and to contain high levels of salt, fat and sugar (Brindley, 2010). As indicated by 2009 Annual Survey (as cited by Brindley, 2010), the number of adults classed as overweight or obese – 57% – have been increasing gradually over the last ten years. Furthermore, health experts in Wales have been are raising concerns over children’s long term health should obesity continue to rise unchecked. For all of these reasons, the UK government set up the MEND programme to decrease the numbers of these problems and to protect children’s health, allowing them the chance to live a healthy life. Furthermore, it has been established that it is within the government’s financial interest to fund these programmes. In the long term, preventative work with childhood obesity is a far cheaper programme to implement as compared to programmes which would manage obesity-related conditions. Activities which are set up in order to assist in preventing diseases, improving health and increase wellbeing come under the umbrella term of ‘health promotion’ (Nnakwe, 2009). When looking at health promotion, it can be defined in a variety of manners. However one of the more helpful models is the model by Tannahill (1985). This model defines the content of health promotion, as opposed to looking at the practice by marking out the boundaries of health promotion. It also looks at the good and bad aspects of health. In addition, it also takes on a political dimension (Tannahill, 1985). Three overlapping spheres of activity, which are health education, health protection, and ill-health prevention make up health promotion (Tannahill, 1985). These spheres of activity are meant to ensure that the individual would be able to prevent diseases and protect his health with the assistance of laws and policies implemented on the wider community scale. Tannahill Model of Health Promotion (Tannahill, 1985). Health Education: This is done via communication activities which concentrate on improving well being and aiming to stop ill health by changing the knowledge, beliefs, attitudes and behaviour of the community (Tannahill, 1985). Health Protection: This is referring to policies and codes of practice which are geared at stopping ill-health or improving well-being, for instance, no smoking in public places (Tannahill, 1985). Prevention: This looks at the first occurrence of disease, and also to the progress of the disease and its final outcome (Tannahill, 1985). When I initially went to my placement within MEND, I felt apprehensive as it was a new environment I was not familiar with. However after meeting with the staff and having a short induction, I felt more at ease and I then came to understand more clearly what the aims and objectives of the organisation were. I was also given an overview of the organisation and how the sessions were run; the workers explained the structure of the sessions so I was well prepared and knew what to expect when the service users arrived. Description of the placement MEND (Mind, Exercise, Nutrition...Do it!) was first set up in 2004, as a social enterprise. The Great Ormond Street Hospital for Children and the University College London Institute of Child Health worked in partnership to formulate the MEND programme. The programme was set up in order to offer healthy lifestyle programmes for children and their families, to establish obesity management training for front-line staff, and to facilitate self-help programmes for adults. The running times for Swansea MEND were every school term, twice-weekly, for 3 months at the Bishop Gore Comprehensive School (City and County of Swansea, 2011). The MEND Programme sessions included: - A workshop for children and parents, which was one hour long. - Exercise for the children whilst the parents have an adult discussion (one hour) - Before and after the programme, measurements were taken of the overweight child, there was follow-up contact through newsletters, reunion events and telephone support. Due to its secured funding from the Welsh Assembly Government, the MEND programme was also made available to families. This has always been a huge advantage for the programme as it meant that everyone had the opportunity to access the service (Welsh Assembly Government, 2010). Registration of a child In order to register into the programme, GPs, school nurses, and other health professionals were allowed to refer any children into the programme. The referrals had to be with the consent of the families, specifically, the parents. The programme is not however suitable for children with any serious medical, developmental, or psychological conditions (City and County of Swansea, 2010). The MEND project Team Through local, regional, and national partners, MEND delivered about 400 MEND programmes in different parts of the world; in a school term, MEND implements about 350 programmes in the UK and these programmes have supported and improved the lives of 15,000 families (MEND, 2010). Each programme is managed by a programme manager who possesses appropriate and adequate leadership skills to carry out the goals of the programme (MEND, 2010). There are leaders within the MEND programme and these leaders implement the aims of the MEND through sessions with the children and their families. Within the session, there are also theory leaders, exercise leaders, and programme assistants (MEND, 2010). Working with each other, these leaders help carry out the specific goals of the MEND programme. In the Swansea MEND team where I carried out my placement, the programme included two managers and three leaders who run the sessions. The Swansea MEND programme has successfully engaged with 30 families since the project has started. During the placement, I was able to work with the leaders in the implementation of the MEND programme among obese children and their families. The programme was devised as fun, providing engaging activities for the children; and this process enabled more participation from the children and their families. During the placement, the children were able to participate in activities which enabled them to interact with each other, to raise their activity level, and to be less sedentary in their daily routine. The activities included swimming, dancing, cycling, and ball games. Being children, most were eager to participate in the activities, which were fashioned in such a way as to attract and sustain their enthusiasm. This is an important element of the MEND programme, from crossing the boundary between what is in the mind – and to doing what is actually in the mind. The different activities with the children were at once mentally stimulating, and then physically engaging, and this helped steer the transition from the mind, into the “doing it” stage. In evaluating the activities carried out with the children and in assessing their progress through the MEND programme, I was able to note how the children were able to progress from being sedentary to being active, like most children should be. At first, some of the severely obese children were reluctant to join the activities, saying that they would just watch. But as they saw how fun and engaging the activities were, they were slowly enticed to join in. The activities were designed on the basis of their tolerance and their interest, with some of the children being allowed to participate in more rugged and hyperactive activities, and the other children gradually progressing in their activities from the mild activities, to the more highly engaging and high energy games. As a result of the programme, overweight children were able to increase their activity levels and in the process, to also improve their metabolism. By being more active, they were also able to interact more with other children, to make friends, and to interact more with their families. The sessions were also an eye-opener for the children and their families. It re-educated them about nutrition and about health improvement. Teaching the children about their bodies, about their physiological make-up and other pertinent details about their bodies helped the children understand why they needed to take care of themselves and what would happen if they would not take care of themselves. It also taught them how to take care of themselves – what to eat, what not to eat, why they must stay active, and what they could do to stay healthy. Re-educating the children’s families also taught them the importance of healthy living. It taught them how important it was for them to make available the proper foods for their children, to keep their children active, and to maintain these healthy habits with their families. The placement in the MEND programme gave the nutrition and health processes a more concrete foundation for the children. Being healthy became more than a concept to these children, instead, it also became a solid goal, one which they had to reach in order to avoid obesity-related diseases. The MEND programme also integrated the children and their families into the health promotion programme. This was an important aspect of the MEND programme because it allowed support for the children from the carers and parents. Emotional support is an important aspect of losing weight because the children would not feel alone in their efforts to lose weight (Rathus, 2010). Team support is also apparent with the participation of the family in the MEND programme. This team support can help gradually introduce changes into the family habits, teaching the members to change their mentality towards food and exercise, and eventually allowing long-term change to be implemented in the family (Armstrong and Van Mechelen, 2000). During the placement, I witnessed how the members of the family were more effective in working with each other as a team. They leaned on each other, they encouraged each other, and they were more likely to make commitments as a team and as a family, and not so much as individuals. Once again, this is part of the team dynamics in the family setting which helps achieve goals in a more efficient and in a faster way. The MEND programme set-up folders for children, separate from the folders of their parents. Each folder contained different information about healthy living and about healthy food choices, as well as physical activities that children can follow in order to achieve better health. Such varying information allowed for individual plans for the children and their parents. Food choices for either group are, after all, different in terms of preferences and nutritional needs. The recommended caloric intake for adults is lower as compared to children, due to the higher metabolism of children and the lower metabolism for older adults. In my placement, I saw a crucial need to explain to the older adults the importance of decreased caloric intake (Harford University, n.d). The older adults found it difficult to understand that they no longer had the faster metabolism they had when they were younger, and that failing to stay within their recommended caloric requirements caused them to gain weight. By educating them about their bodies and health processes, we were able to make the healthy processes clearer to them. They were actually more cooperative in making adjustments in their diet and activity as soon as they understood the health processes better. The folders for the parents and the children were linked with each other, in order to establish eating and food preparation habits which may be impacting on their weight gain. The programme also recommended an easy to read and follow website which contained various useful health and nutrition tips for parents and children. This website was 100% accessible to the parents and the children. In the current age of digital and electronic technology, it is important for any health programme to be implemented based on available tools. The MEND programme is very much updated with the latest technology in terms of the using the internet to provide an easier and more accessible means for children and their parents to stay and to become healthy. The leaders of the programme used small targets in order to motivate children to become more active; this included asking children to do an hour of exercise a day and asking them to eat two pieces of fruit daily. During the weekly sessions, the leader evaluated these targets and established how much these children have achieved. If the leader saw positive results, a sticker was given to the child. This is part of the reinforcement process which is crucial in working with children. Receiving positive feedback from adults and leaders boosts children’s self-esteem (Andersen, 2003). They would feed off of such good feelings and are encouraged to once again reach the next goal, and the next, and so on and so forth, until the ideal weight levels are reached. The leaders also allocated time with parents, gathering as much data as possible from them, mostly on their food purchasing and their food preparation choices and habits. This time helped the leaders assess each family in relation to each child on what exactly is causing the obesity, and what food habits need to be changed. Families have various food purchasing habits. Some families may have the habit of purchasing junk food, or red meats, processed foods, high sodium, high cholesterol, or high sugar content foods, and hardly purchase any fruits and vegetables for their children (Webb, et.al., 2008). During my placement, each family exhibited their own ‘fattening’ habit. The programme identified the habit for each family and therefore considered a plan for each family in order to undo such habit. The programme was then able to conceptualize public health concerns for possible recommendations to public health officials on proper legislation and subsequent policy implementation. Possible health concerns which need to be highlighted include the fast food portions, healthier school cafeteria food, high fat and sodium content of fast foods, and exercise/activity regimens for school children. In assessing my placement with the MEND programme, I was able to lend support to the fact that project management is the skill of successfully balancing time, quality, and resources in order to produce a particular change or product (Pencheon, 2001). From spending time within MEND, I believe that the organization was able to follow the preceding recommendations, and I felt that they were also able to manage their time, the quality of their services, and their resources well. It is important for any health programme to be efficient because the current economic crisis is also affecting health allocations, making them vulnerable to budget cuts. The MEND programme was able to achieve its goals by applying smart and efficient tools. Support for the programme was apparent in a report by Atul Singhal (Business Wire, 2010), pediatrician and head of clinical trials in the Childhood Nutrition Research Centre at University College London Institute of Child Health (ICH) when he stated that “these results suggest that the MEND programme helps overweight and obese children lose weight. They also show that child weight management programmes have a positive effect on a child’s health and so could help to address the rising obesity problem in children” (Business Wire, 2010). This is a strong endorsement for the programme in fighting and managing obesity among children. With this endorsement, it is hoped that more children and families would be enticed to consider the programme. Health Promotion Approaches Health promotion plays a vital role within the new public health movement (Bunton, Macdonald, & NetLibrary, 2002). The MEND programme has been established in order to enhance the health and well-being of communities and to support them in their unmet health needs; it has also been established in order to meet national and local targets on a variety of issues, e.g. childhood obesity and health inequalities (MEND, 2010). MEND works by looking at ways in which to promote sport and health within the community. MEND also supports local authorities and sport/leisure providers to increase the number of people using leisure facilities (MEND, 2010). During my placement, I saw how the children and their families were provided recreational facilities for sports activities. A variety of sports activities were allowed in the programme, giving each child and their families the chance to choose which sports activities they wanted to participate in and to participate in these activities at their own leisure time. The programme highlights the importance of adopting a social approach of health education. Tones and Tilford describe this as being concerned with trying to alter attitudes, knowledge and behaviour via education. This includes looking at these and relating them to social issues (Draper et al., 1980). During my placement, I was able to note how weight issues are very much related to the society and social issues; in fact, on their own, weight issues are already social issues as they affect people socially, especially in terms of their behaviour and habits. In effect, applying also a social approach to the issue is an effective way of resolving the issue as it stands. In line with the MEND programme, it is important to help keep people empowered because it is necessary for the person to feel passionate about wanting to change their circumstances. Moreover, it is important for that person to feel well equipped to change it by having the information, support and skills to do this (Naidoo & Wills, 2005). I was able to witness how people, armed and empowered with the right information, were able to take a more active stand and active participation in their lives and in their health. This made the health education and health promotion very much effective in achieving weight loss goals for children and their families. Evaluation The success of the MEND programme has been evidenced by independent studies. These studies show that after attending the MEND programme children lost weight (specifically body fat), they increased their physical activity levels, they improved their self-esteem, and they reduced their sedentary behaviours e.g. screen time. During my placement, I was made aware of various children and families benefiting through the programme with the above improvements. In an independent study conducted by a team at University College London Institute of Child Health (ICH), the MEND programme was able to exhibit positive results in weight management for obese children and their families (Sacher, et.al., 2010). This study involved 116 children aged between 8 and 12 years; these children took part in a nine week MEND programme, then followed by 12 weeks of free family swimming between January 2005 and January 2007. All the children in this study reported loss of weight, lowered BMI (Body Mass Index) and waist circumference, and improved self esteem and physical activity levels. The children’s general health, including cardiovascular fitness, also improved (Sacher, et.al., 2010). The authors also indicated that young people and children participating in the MEND programme, showed long term health improvements, after just 12 months with the Programme. In this study random participants were assigned to either start the programme immediately (intervention group), or to receive the intervention six months later (control group). Waist circumference, BMI, body composition, physical activity level, sedentary activities, cardiovascular fitness, and self esteem were recorded initially and then again at 6 and 12 months. From these assessments it was found that all measures improved at 6 months and were maintained at 12 months. The authors also revealed the suitability of the programme for children and their families (Sacher, et.al., 2010). After spending my placement with MEND, I was able to establish strong support for the programme. Moreover, I was also able to establish important links between theory in weight loss, as well as practical applications to the process. I thoroughly enjoyed my time there, and I found it hugely beneficial to see theory being applied in practice. I also learned how to detect issues in the health of families, not just among children, but their parents’ habits as well. I was able to understand why obesity can sometimes run in families because of the habits of the parents passed on to their children. I learned about the importance of establishing clearer and simpler diet plans for the parents and the children, plans which they can easily follow and implement into their daily habits. All in all, I completed three sessions with MEND, and after spending time within the organisation, with the staff and service users, I feel that the programme is offering an invaluable service to society. I feel that in my own small way, I can also contribute in establishing healthy habits for myself and my family. Conclusion In relation to the aims and objectives of this placement, I feel that I have achieved all my objectives for this placement. First and foremost, through this placement, I was able to involve myself in effort to control childhood obesity; secondly, I was also able to learn and establish practical ways by which I could promote healthy habits for children and their families; and thirdly, I was able to review and assess the current methods being implemented under the MEND programme and evaluate their efficacy in the battle against childhood obesity. This placement with the MEND programme was also able to establish for me a strong link between theory and practice. My placement informed me about the statistics in relation to obese children. It informed me well about the risks which these children would likely be exposed to as older adults. My placement informed me of how important nutrition, eating healthy, and physical activity is in the process of losing weight. The MEND programme contained these aspects of weight loss and how they have applied to the children. It informed me of the difficulties which the programme often encountered, as well as the gains which it was able to make. The importance of establishing recreational facilities for obese children and their families was highlighted within the programme, and by acknowledging the importance of physical activities in children’s lives, better gains in weight loss were achieved for many children and their families. I also established from the placement how important healthy food habits are, and how these habits within families can impact on the weight of the children. This programme has a significant potential for application in my own county. With the strong cooperation of my community and most especially the parents, it is possible to achieve the goals of the MEND and of health programs against childhood obesity. All in all, this placement helped me understand the importance of implementing healthy habits for children and their families. It helped me understand that in the end, a strong family unit can provide obese children the long-term and sustainable means of losing weight. References Andersen, R. (2003). Obesity: etiology, assessment, treatment, and prevention. Leeds, UK: Human Kinetics. Armstrong, N. & Van Mechelen, W. (2000). Paediatric exercise science and medicine. Oxford: Oxford University Press Brindley, M. (2010). Recession fuels new rise in child obesity across Wales. Wales: Wales News. Bunton, R., Macdonald, G., & NetLibrary, I. (2002). Health promotion: Disciplines, diversity, and developments (2nd ed.). London: Routledge. Business Wire ( 2010) New Study Shows Effectiveness of the MEND Program (Mind, Exercise, Nutrition, Do it!) in Prevention and Treatment of Pediatric Obesity. Available at: http://www.businesswire.com/news/home/20100201005595/en/Study-Shows-Effectiveness-MEND-Program-Mind-Exercise (Accessed: 8 March 2011). City and County (2010) How can I register / refer a child?. 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