Southwark's Obesity and Public Health

Introduction

Having a healthy weight means that someone’s body weight is not prone to health risks such as type 2 diabetes, heart disease or cancer. Clinically, body weight in adults and children is measured using Body Mass Index (BMI), which is the ratio of a person’s body mass to their height in square meters (Weng et al, 2012). Children’s BMI is plotted onto a gender-specific chart and those with over 85th percentile and on or below 96th centile are considered to be overweight. On the other hand, children over 95th percentile are considered to be ‘obese’. In adults, a BMI of over 30 is considered to be obese while a BMI of 25-30 is considered to be overweight (Lundahi et al 2011). Above all, anyone with a BMI above 25 is considered to be having excess weight. This essay seeks to address the issue of obesity in Southwark city of London. Southwark is a southern city in London and is connected to London by bridges that pass over River Thames. Southwark is of particular interest to this essay because the borough has some of the highest prevalence of obesity and overweight in the country i.e. 43% of children and 56% of adults are classified as obese or overweight (Southwark Health and Well-being Board 2016). Furthermore, obesity is of particular interest to this study due to the fact that it is a major health issue that predisposes victims to other chronic diseases such as type 2 diabetes, cancer, and heart diseases. The essay will be organized in sections. The first section will address obesity as a public health issue within the Southwark context. Secondly, the essay will conduct a critical review of literature on the concept of inter-professional working in the modern health and social care while in the third section, the essay will give concluding remarks summarising all the issues addressed within the essay.

Obesity as a Health Issue in the London

Key Variables That Determine Obesity

Obesity and overweight are determined by variables that can be considered as complex and simple. From the ‘simple’ context, Government Office for Science (2007) writes that overweight occurs when an individual eats or drinks more energy than their body can use up through a normal metabolic process or physical activity. Yet, humans energy balance is determined by their genetic composition (or biology) and behavioural characteristics (i.e. physical activity and eating habits) (NICE, 2006). From the ‘complex’ context, a person’s body energy balance is maintained by various cultural, societal and environmental influences (McPherson et al, 2014). In regards to the genetic variables, research pieces of evidence are increasingly showing that a person’s mother and father’s nutrition at conception and during pregnancy has an influence on their obese status; as a result of genetic transformations (Weng et al, 2012). Moreover, evidence by Government Office for Science (2007) indicates that there is a growing body of evidence associating the interaction between the environment and genetics as key determinants of obesity. From the perspective of social influences, behaviour and environmental factors, Borys et al (2016) argue that an individual’s environment influences their behaviour and this contributes to their weight and energy balance status. Furthermore, according to Khan & Wansink (2004), research has increasingly linked obesity and overweight to people’s obesogenic environment that affects both their physical activity and eating habits. In this regard, Lundahi et al (2011) contend that this situation has been so normalized so that adults may not notice that they or their children are obese or overweight.

The Impact of Health Inequality on Obesity

Ideally, obesity and overweight have more prevalence among people in the low socioeconomic status and this consequently contributes to the widening of health inequalities and other forms of inequalities (Borys et al 2016). Even so, the impact of health inequalities on obesity has largely been analysed through an ecological approach, whereby obesogenic environments are considered to be the primary cause of increasing obesity and further health inequalities. For instance, as part of the obesogenic environment, Kinra et al (2000) argue that in countries with high-socioeconomic inequalities, obesity are stronger in girls than in boys and among women than men. Besides, Saxena et al (2004) argue that in high-income countries, the prevalence of obesity varies among various ethnic groups, i.e. adults and children from minority ethnic groups being more predisposed to obesity than white children and adults. In the UK, men generally have a lower rate of obesity than in the general population, except for the Irish and Black Caribbean men; where the rates of obesity are high among black African and Pakistani women (Law et al 2007).

Main Challenges Facing the Issue of Obesity in the UK and Southwark

Firstly, it is important to acknowledge that the UK has risen to the European obesity league (Public Health England, 2014). Whereas eating and physical activity behaviour among the UK population predominantly blamed for this high rise, there are several challenges that still contribute to the increasing prevalence of obesity that still needs to be solved. On this note, Lindahi et al (2014) note that the rise in obesity cannot only be blamed on the increased availability of food because since time immemorial, most people in the UK have also had adequate access to food. Besides, the author claims that financial deprivation cannot be solely blamed for the rise in obesity especially among children. But, according to Baird et al (2005), a major challenge for the fight against obesity in the UK and in Southwark is that of an increasingly sedentary population whose lifestyles and jobs do not involve any burn of calories, especially because they either spend more time on the PC or watching television. This challenge is further combined by the availability of highly processed foods, that are both cheaply and conveniently accessible thereby providing an opportunity for high consumption of fat and sugar. These factors contribute to a high prevalence of obesity both in the UK and in Southwark because they apply much across the UK society.

Addressing the Challenges Facing the Issue of Obesity in Southwark London

There are several initiatives that have been implemented by both the government and London authorities to address obesity and the challenges associated with it. However, the Department of Health (2008) claims that going by the statistics, there seems to be no major progress made so far in addressing these challenges. But, much credit has been given to the UK government for exploring various avenues in an attempt to address the issue of obesity. For instance, the UK government has taken similar steps it took in tackling smoking through taxation by taxing sugary drinks (Department of Health, 2011). Whereas this move may be expected to be a normal one, commentators (e.g. Public Health England, 2014) have applauded the innovative nature of this strategy whereby the key players in the beverage industry were given an earlier warning of the proposed tax reforms, and given time to reformulate their products to avoid taxation. Consequently, most beverage manufacturers heeded to the calls and implemented the necessary changes in their products (Public Health England, 2014). Besides, In Southwark, parks, and leisure centres are required to provide healthy foods whenever possible, while local restrictions have been made on takeaway food outlets in close proximity to schools and high-end streets (Public Health England, 2014).

Problems with the Implementation of This Program and the Impact of Lifestyle on Public Health

Whereas England’s Department of Public Health has also worked with London’s food production industry to ensure that various food products are reformulated, there is a laxity that has been noted on the side of the government for having not been able to control advertising and not giving the Southwark local councils powers to do the same (Southwark Childhood Obesity, 2012). Besides, Southwark health authorities are still facing the challenge of lack of knowledge among health practitioners and social workers on how to provide convenient, current, consistent and evidence-based lifestyle support and advice, as well as how to signpost to local residents and children to appropriate local and national obesity services (Southwark Council, 2015). According to Southwark Joint Strategic Needs Assessment (2015) a major challenge that has also been experienced by Southwark in the fight against obesity is being able to incorporate healthy activities and behaviour in schools including the provision of healthy foods to students, and the implementation of a ‘whole school’ program that seeks to implement a healthy lifestyle including physical activity among students.

Key Facets of Health Promotion In Relation To Obesity

Health promotion is one of the key strategies implemented to promote health awareness among any population. In regards to obesity and overweight, there are several key considerations that health authorities can make to promote health awareness about obesity and overweight. For instance, marketing and promotions can be targeted at persuading the Southwark public to consume healthy foods and avoid poor food choices (Rimmer et al, 2010). Evidence by Southwark Health and Wellbeing Board (2016) indicates that the UK has the largest volume of food promotion compared to any other European country. Hence, a key consideration that can be made to promote healthy food behaviour and address obesity is to take the opportunity of food promotion to create awareness about healthy food behaviours (e.g. healthy calorie intake). This can be done by embedding health messages on the logos and food advertising images – just as it is done in alcohol and tobacco health promotions.

Critical Review

The Concept of Interprofessional Working In Contemporary Health and Social Care

Contemporary healthcare is increasingly being anchored on inter-professional collaboration (IPC). World Health Organization (2010) defines IPC as a situation whereby workers from different professional backgrounds work together with patients, carers, families, and communities to deliver high-quality healthcare. Furthermore, Kohn et al (2000) indicate that IPC is based on the idea that when healthcare providers consider each other’s perspectives, they are capable of delivering better quality healthcare. IPC exists under three major objectives namely: to improve the population’s health, to reduce the cost of healthcare to the lowest attainable level that cannot be achieved without IPC, and to improve patient satisfaction and experience (Greiner & Knebel, 2003). Currently, IPC tends to be the exception and not the rule. It is increasingly being apparent that each profession within the healthcare fraternity should shift their focus towards partnerships, sharing, and collaboration rather than operating themselves. According to Brandt & Lutfiyya (2015), the safety and quality of care and the need to maintain the low cost of care requires all professions in the healthcare industry to work together with mutual respect. Institute of Medicine (2015) justifies the concept of IPC by asserting that with the increasing shortage of healthcare professionals including nurses and physicians, it is monumental for the available professionals to work collaboratively towards more efficient service delivery. This concept is therefore borrowed from other professions such as sports where, where teamwork is mandatory. A key aspect of IPC is communication. In this regard, Andel et al (2012) contend that performance cannot be achieved without effective collaboration and communication. In fact, in the context of health care, poor communication has been cited as a key cause of medical errors (Leape et al, 1999). Moreover, the relationship between communication and quality of care has been highlighted in various pieces of research especially in regards to patient handoff and the way poor communication during that process can contribute to increased risk of medical errors. Nonetheless, the role of IPC in enhancing the quality of care cannot be overemphasized. For instance, a systematic literature review involving 36 randomised control trials on coordinated care found that coordination among various professionals in healthcare reduced the risk of hospital readmission by 19% (Tricco et al 2019). The study also found that coordinated care among older adults contributed to a 30% reduction in the likelihood that they would visit the emergency department.

Advantages and Disadvantages of IPC

Regardless of the fundamental truth that IPC contributes to positive patient outcome, existing research evidence indicates that IPC provides various benefits to both the patients and the healthcare professionals. However, it is also important to acknowledge that IPC has been associated with several disadvantages both at the individual and organizational levels of practice. This section entails a review of existing literature on the advantages and disadvantages of IPC. Until the application of IPC rose in the healthcare fraternity, doctors were considered as the ‘quarterback’ of healthcare (World Health Organization, 2010), and this still happens in some medical environments. Medics relied on doctors to make some of the major decisions regarding patient care. However, Andel et al (2012) observed that with an increased uptake of IPC, other members of the health professionals such as nurses, radiologists, social workers and psychologists from other disciplines within medical care have been empowered to take part in making major decisions in patient care. It is, therefore, possible to conclude that IPC has the advantage of empowering various professionals in regards to their roles of providing medical care. But one disadvantage that is related to this is that whereas the team may feel empowered, they may experience some conflict regarding their individual relationship with the patient. Research evidence by Chomienne et al (2011) reveals that coordinated care facilitated by IPC teams contributed to patient satisfaction. Additionally, in this study, it was found that adding psychologists to primary care in clinics contributed to an improved rating of the quality of life and mental illness symptoms among the patients. A dramatic improvement in patient confidence was also observed.

Existing literature also indicate that IPC has the advantage of closing the communication gap between the medical team. When the professionals work together, they develop a more communicative environment; as opposed to before the adoption of IPC where medics would simply rely on patient records to review patient history (Brandt & Lutfiyya, 2015). According to the World Health Organization (2010), working independently was could contribute to miscommunication and missed symptoms. Furthermore, Andel et al (2012) contend that IPC contributes to increased coordination thereby providing an opportunity for healthcare professionals to interact both at a personal and organizational level about patient treatment – working in harmony to enhance continuity of patient care. Nonetheless, according to Brandt & Lutfiyya, (2015), it is highly likely that the hierarchal educational and administrative structures within the care setting may discourage or regulate the free-flow of information among the professional. This is a major disadvantage of IPC. Existing research pieces of evidence also support that IPC facilitates the delivery of comprehensive care to patients. for instance, Tricco et al (2019) argue that a joint working of team members from different professions forms a comprehensive view of the patient, enabling each professional to hold a piece of the patient puzzle. This enables the professionals to bring the pieces together to enhance a better understanding of the patient’s needs. However, it may not be easy to for the medical teams to work together amidst the difference in professional cultures and traditions especially in reference to the procedures of how each professional delivers their responsibilities. IPC has largely been associated with a team mentality. According to literature by Andel et al (2012), it is not only the patients who receive the benefits of IPC but also the professionals involved in treating the patients. This is especially so, considering that when the professionals work together, they support each other by breaking down the task into simpler ones according to the disciplines involved. Ultimately, the team’s morale is raised by the team mentality, which encourages the team to work harder in enhancing the life and well-being of the patient (Brandt & Lutfiyya, 2015). Nonetheless, Tricco et al (2019) argue that whereas IPC promotes team mentality, such teams still meet the challenges and barriers if teamwork including such as confusion about other team members’ roles and the use of different approaches that results to untrusting others.

Policies for IPC in the UK

The important nature of IPC in delivering quality patient care has earned it a place in various national healthcare policies and guidelines in the UK. For instance, the UK’s National Institute for Health and Care Excellence (NICE, 2012) has developed several policies and guidelines on how communities can work together through IPC to enhance the fight against obesity in the UK. The public health guideline published in 2012 advocates for an integrated commissioning of various stakeholders and professionals taking part in the fight against obesity, with specific recommendations that public health teams should develop an integrated and coordinated approach towards supporting long-term health and well-being strategy aimed at enhancing the fight against obesity, while creating an environment that allows team coordination and collaboration that enhance a community-wide approach towards obesity. This guideline is especially important to Southwark health authorities in regards to developing a multi-disciplinary approach towards the fight against obesity. However, several factors would apply when adopting this policy guideline. First, Southwark would need to avail the necessary financial resources and communication infrastructure required in the development of any multi-disciplinary system of coordination, a phenomenon that might be of the high cost to the authorities (Brandt & Lutfiyya, 2015). Secondly, according to Andel et al (2012), there may be a need to training of the leadership on team coordination to equip them with skills of addressing the challenges that accompany teamwork and IPC.

Conclusion

In conclusion, this essay has highlighted various aspects of obesity and the fight against it in London, Southwark city. It has shown that here are various health inequality factors that contribute to the prevalence of obesity in Southwark, a major one being socioeconomic inequalities. Besides, the essay has shown that the key challenges facing the fight against obesity in the UK and in Southwark is an increasingly sedentary population who have adopted less physical activity and poor eating habits. The essay has also highlighted the concept of IPC, its advantages and disadvantages. In summary, it has been found that IPC enhances teamwork and professional empowerment among healthcare workers while enhancing the safety and quality of healthcare. On the flipside, it has been found that IPC is prone to several disadvantages of teamwork including conflicting interest. Future research should focus on various strategies of addressing team conflict as a key research issue.

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