Public Health Policies and Childhood Obesity

At present, obesity is an epidemic plaguing the UK; where 1 in 5 children leaving school are considered obese (Public Health England, 2020). Several policies and initiatives have been implemented to police this. Nevertheless, obesity in children continues to rise in the United Kingdom (Middleton,2011). The government and other relevant stakeholders have worked to rectify this since the damning Black report in 1980, highlighting in great detail the inequality of ill health and the disproportionate reported deaths across Britain. (Gray,1982) The disparity in living standards between societies in the UK still exists with health inequalities remaining a targeted issue in 2020. (Marmout,2020). Obesity as an entity is entangled in this issue and this essay is a response to the needs identified. This essay will critically analyse the obesity-related public health policies, their application, and how health policies overlook a vulnerable group of our society. The author will also discuss the challenges of implementing the procedures, exploring health and health promotion models in the process. A model will then be selected to guide the development of a health promotion activity, which will be further evaluated. If you are seeking assistance with healthcare dissertation help, it is crucial to understand the complexities of addressing obesity and the underlying health inequalities in the UK.

This assignment aims to focus on the identified health need of obesity in children in the Rum worth area. As aforementioned it continues to be an uphill struggle in the UK with obesity considered to be the most common and significant health risk to school children. (P.H.E., 2020). Unsuprisingly there have been multiple national and local policies developed in order to tackle this issue. The harmful effects on health, social care, and the economy are well-known facts. Obesity increases the risk of heart disease, stroke, many cancers, type 2 diabetes, and overall reduces life expectancy (Black et al.;2018). The grave social implications of Obesity, aren isolation, discrimination, and bullying (Black et al.;2018). The impacts of the covid 19 pandemic on obesity as an issue have yet to reveal thems elves. However it has unequivocally struck people with obesity issues awfully hard. (Leon-Abarca,2020). Obesity costs the National Health Service enormously; in 2006-2007 it was approximately £5.1 billion which was 6% of the N.H.S. budget that year. It is estimated that future cost to the N.H.S. could be as high as £10 billion per year by 2050 (P.H.E.,2017) (Black et al.;2018).

Obesity intersects considerably with socioeconomic status (WHO,2020). Obesity is more significant in deprived areas, as evidenced in a study done in 2000 in England's Plymouth area. This solidified preconceived notions that Obesity was strongly associated with lower socioeconomic status and deprivation (Kinra,2000). The PHE 2020 document focuses on the issue in regards to four key domains including, obesity in reception children, excess weight in reception children, obesity in year six children and excess weight in year six children. On reviewing the statistics of these domains, comparing years 2008-10 to years 2017-18, there has been little change in the trends and overall significance of the problem. Please see appendix 1,2,3 and 4. (P.H.E 2020). It is evident that despite all policies, actions and good intentions from bodies such as the NHS, Public health and local government, the obesity indices have not improved in any of the four marked categories. The statistics for obese children in year six in Rumworth are very alarming. Children living in deprived areas develop food insecurities, which in turn can cause disruptive intake patterns, contributing to the overall issue. (Kaur et al.;2015).

World Health Organisation is reacting to the global Obesity issue on several fronts, including checking global trends and incidence and developing a comprehensive guidance range. Focusing on the prevention and treatment of Obesity and offering implementation support as recommended by the Commission's Report ‘ending childhood obesity’ (Hilton et al.;2012), the WHO have acted. Their excellent programme, ‘Childhood Obesity Surveillance Initiative’ (C.O.S.I) has been measuring trends of Obesity for the last ten years among overweight and primary school obese children (WHO,2018). This is an important database for researchers and relevant stakeholders to be able to monitor and track progress or exacerbations of the issue. WHO have established their position on exclusive breastfeeding for the first six months of a child's life, as perinatal mental and physical health are all linked with childhood obesity (WHO, 2014) Control of increased Obesity all over the world is feasible through the right mix of policies and actions (WHO,2014).

Other national policies have also been enacted in England to address the issue, such as the ‘The Plan for action’ (PHE 2017). This document describes (P.H.E.,2017) a few practical steps to directly minimise Obesity. One of the suggestions is to reinvest revenue from sugary drinks into healthy living and exercise programmes. Naturally the extent of this depends on the conscientiousness of individual companies, a drawback identified by the author. Moreover, a ‘structured sugar reduction programme’ has been described and shows evidence of implementation where products consumed by children have a reduction of overall sugar content by 20%. They are supporting businesses to make their products healthier and making healthy options available in the public sector. A ‘healthy start scheme’ is another part of this action plan which can support families with fruit and vegetables. Furthermore, Schools have been given instructions to provide more physical activity, providing breakfast and fruit as part of the Plan. Although this Plan came out in 2017, Obesity is still on a steep increase in England. A critique of this document by the author is that these are all outstanding initiatives, and have been rephrased from previous policies (Marmot,2020).

Challenges are present

Bolton has taken some excellent steps to reduce childhood obesity, with teams of professionals working hard to educate and support Bolton with the prevention of this epidemic (P.H.E., 2018/19). However, enaction of these services could potentially be more tailored to the people receiving them. Generic policies will always have this caveat as they lack the customisation for a particular subset of receipients; meeting targets but not meeting the needs (Marmout, 2020). There have been many initiatives taken in England to reduce Obesity such as, free breakfast and after school clubs. However, providing a service does not mean it will fulfil the purpose (Marmout,2020). Examining these policies, the author illicits an underlying theme that the state and governing bodies responsible, believe Obesity to purely be a health issue. It is merely a social issue that causes so many health issues (P.H.E., 2010).

A recent study done on children under five years of age who are left in childcare of informal carers mentioned that such children are more prone to be obese compared to children managed at the nurseries. This is because the informal carers are seen to meet frequent snaking needs of the children and support early weaning (Lidgate, Li and Lindenmeyer,2018). Other environmental factors responsible for increasing obesity among children are disturbed sleep pattern, increased sedentary activity by watching T.V. and other screen times, video gaming diet and low physical activity. Similarly, another study took place in the U.K. on environmental factors and Obesity on school-age children 9-11. Results show that sleep, diet and watching screen time has a strong link with Obesity (Wilkie et al.,2016).

The examination of the local services mentions that two N.H.S. teams are present one of which is delivering support to paediatric dieticians and another to Family Healthy Lifestyle Team in the Bolton Foundation trust. For example, early intervention activities are required to be right to control health issues at the earliest, so FAME team provides much work around breastfeeding, responsive bottle feeding, and when to start solid food, weaning process to avoid early obesity among children (P.H.E., 2018/19). The National Child Measurement programme (N.C.M.P) collects data each year for tracking the prevalence of obesity. It is a useful programme to determine how overweight children can modify their behaviour and habits to healthy habits. This is the most successful programme in all policies and procedures because it has some numbers available, which helps policymakers develop services for obesity to ensure lowering its prevalence (P.H.E.,2019). All these public health campaigns are funded by federal and local Government but there are still existing barriers to access support regarding obesity from thee programs. This is because there is stigma that people will be judged on their living style and behaviour while going through the programs for accessing help regarding obesity (Gordon,2020). There are considerable challenges to success of these policies as complex problems with many drivers, including behaviour environment genetics and culture, active engagement of school/communities/families and individuals are present in the approach (P.H.E., 2019).

Children live with shame and guilt caused by obesity; however, policymakers and physician do not understand roots causes of obesity and often mention the causes to be mixture of nutrition, genetic, lifestyle, psychological, economic, and environmental issues (Hilton et al.;2012). It is currently time to break this cycle of shame low confidence, low self-esteem for these children in Rumworth area who are overweight and provide them with positive and practical support. The Bolton foundation trust has been seen to introduce new guidelines for tackling obesity. This is evident as training has been delivered by the health professionals and healthy families teams’ members to others suffering from obesity. When the team receives the referral from a health professional, they will send a video link on the mobile number of parents of obese children to explain how a personal trainer would give them six sessions, the trainer showed the training video. The video was provided in English but Bolton has a multi-ethnic community where all individuals do nor understand or speak English leading to create language barriers in reaching certain families for promotion regarding obesity management (Joo and Liu,2019). Rumworth community needs tailored-made service for overweight children. As (Joo and Liu, 2019) said, communication issues, unclear culturally inappropriate care information and resources, and insufficient cultural training and education are concerns when caring for the multi-ethnic community.

Definition of Health is vital to understand to review all different health policies and understand health promotion, there have been several definitions of health, and models based on this. According to the Oxford dictionary, health is "the state of being free from illness or injury". However, the World Health Organisation defined in 1948 "Health is a state of complete physical, mental and social wellbeing" health is what the person perceived about their Health (Blaxter,2010). The baseline health definition cannot be given to define all as everyone has different capabilities (Levy,2007). The holistic model appears to be the correct way of evaluating health quality. This model is more inclusive than the medical model, which looks at just the human body (Mark and Lyons, 2010). Holistic health broadens the conventional medical emphasis on symptoms and disease to other health-related areas such as nourishment, emotional and spiritual wellbeing, social relations, and environmental influences (Mark and Lyons, 2010)

Health Promotion

Assessing health is a necessary action for health promoters and is central to the planning and evaluating health promotion programmes (Naidoo and Wills,2009 and WHO,2012). The author has searched local data to measure Bolton and Rumworth area residents' health in the first part through community profiling. As discussed in the introduction, needs regarding obesity among children in the chosen area that is Rumworth is a significant public health issue. It can be resolved by removing inequalities in health support with environmental issues by local and federal Government resolved poverty and given more economic strength and education (P.H.E.,2010, Naidoo and Wills, 2009).

Education is vital to resolve any public health issue as lifestyle choices can help reduce obesity massively. Obese children have obese parents and education for parents, developing resources and training health professionals can be the way forward to resolve this health epidemic (WHO,2020). Education is not effective if opportunities are not given to be healthy, and health policies are not considered seriously. It can cause an increase this type of health issue; for example, the Rumworth area has significant takeaways (P.H.E.,2018) it means competition. The unhealthy meal is cheap and available on your doorstep. "Health promotion incorporates all measures deliberately designed to promote health and handle disease”. A major feature of health promotion is undoubtedly the importance of 'healthy public policy' with its potential for achieving social change via legislation, fiscal, economic and other forms of environmental engineering" (Tones,1990 pp 2-6). The first International Meeting on Health Promotion was organised in Ottawa, Canada, in 1986. The members were agreed to achieve health for all and empower people to take control of their health and wellbeing (WHO,2012).

There are few approaches to health promotion, for example, the medical approach, which talks about reducing morbidity and premature mortality, usually targets the whole population or high-risk group (Naidoo and Wills, 2009). This approach focuses on medical knowledge and not considering people for their opinions or decisions (Kelly and Byrne,2006). The medical approach is divided into primary, secondary and tertiary (Naidoo and Wills,2009). Behaviour change is another type of approach, and this aims to encourage people to be healthy individuals, the behaviour change model acknowledges health as an individual responsibility. In this approach, the change model needs to be adopted to change people's behaviour, and sometimes people relapse due to the lengthy procedure (Kelly and Byrne,2006).

The educational approach aims to educate people to make choices based on knowledge and information (Ewles and sinnet,1999). The health workers prefer this approach and hope that giving information to patients might make them aware of risks associated with certain activities (Kelly and Byrne,2006). The social change approach is all about the importance of the socioeconomic environment and policies. Healthy choice can be a more comfortable choice if it is realistic as most people see the accessibility or availability (Naidoo and Willis,2009). This approach has to have the outcome of legislation which is a complex and long-term process and difficult to prove a link with any health promotion (Tilford,2018). The Empowerment approach is client-centred, and the client is encouraged to use the power to change things around them (Laverack,2005) Ref list page 73 from the book. Most health promotion approaches have been discussed. However, the synthesis of a proposed health promotion activity health model types must be reviewed (Naidoo and Wills,2009). Please see Figure 1 for all health promotion models.

Planning Health Promotion Activity

Health visitors are best positioned to contribute to the proposed changes to the system and improve the nation's health (Department of health,2010). Life expectancy gap between deprived and affluent areas is on the increase in England (Marmot and Bell,2012). Everyone deserves to live a healthy life despite the fact where they live and who they are (Middleton,2011) (P.H.E., 2019). Initiatives to change U.K. policy have been efficacious in reducing inequity and poverty-related adverse health (Warwick-Booth et al. 2018). Planning a health promotion activity needs knowledge of change cycle and leadership attributes (Thornbory,2009). The planning involves selecting the programme and identifying the key stakeholders. The author's new health promotion activity will be planned using Ottawa Charter's action areas, healthy public policy, strengthening community actions, creating supportive environments, and developing personal skills and rearranging health services (WHO Ottawa,2012).

A fundamental requirement of introducing the health promotion activity is that health professionals understand the community system in which they plan the health promotion activity (Jancey et al.,2019). The second important issue is capacity building, as this is vital before planning any health-promoting activity. By developing skills and capacity, individuals can understand issues that will ultimately affect their lives (Bennett and Gladman,2012). It is claimed that interventions devised to improve health-related behaviours should understand the existing culture and integrate culturally relevant matter into health messages (Larkey and Hecht,2010).

The author will increase awareness of the community in Rum worth area by sending letters about healthy eating and how Obesity affects our health. The poster will be placed in the five chosen schools. The author will arrange assembly talks around healthy eating and physical activity. Successful delivery of health promotion activity needs a good knowledge of the project, planning, implementation, and evaluation (Davies, McDowall and Bonnett,2006). All ethnic minority communities needs will be respected, and all information will be in multi-languages.

Health Promotion Activity

The key aim of the health promotion activity is to aware children and parents regarding the way they can improve their health behaviour to effectively manage and prevent obesity. The other purpose of the health promotion is also to lower health inequalities related to obesity and promote social inclusion of obese people in the society. The activity for meeting the aim and purpose in the health promotion is developed by following SMART framework (Guerra et al.,2014). In the health promotion activity, to maintain ethical consideration, no personal identity of the respondents involved would be shared and anonymity is to be maintained. Moreover, informed consent from the participants involved in the health promotion activity is to be gained by mentioning them regarding the way the health promotion is to be performed and way their involvement in the activity is to be used for the success of health promotion.

The Pender’s health promotion model is been used in framing the health promotion. This is because it helps to focus on key three areas required for successful health promotion which are behaviour-specific configuration, individual characteristics and behaviour outcomes (Khodaveisi et al., 2017). According to the model, individuals are involved in actively regulating their own behaviour (Bahabadi et al., 2020). Thus, the first objective of the health promotion is to plan 12 weekly session regrading obesity prevention that would be executed in the school to individually influence children regarding the way they can regulate their personal behaviour to overcome and prevent obesity. The Pender’s model informs that interaction of the individual with their biopsychosocial environment influences them to executed changed action with time (Naserpoor et al., 2018). Thus, the second objective developed is creating a social environment where cooking class for healthy eating is provided, physical activity clubs are arranged and posters for five days healthy and balanced diet is attached. This is because it would make the children have a socially interactive health environment from where they can learn about the actions to be taken to prevent and overcome obesity.

The Pender’s model mentions that involvement of health professionals such as nurses are required in health promotion as they are part of the interpersonal environment and influences people for changing behaviour in their life span (Goodarzi-Khoigani et al., 2018). Thus, the third objective of the health promotion is to involve school nurse and health visitor who runs a clinic to interact with the children and their parents regarding healthy eating behaviour and lifestyle o that they can aware them about the importance of healthy eating and way it can resolve obesity. The Pender’s model informs that self-initiated reconfiguration if their environment is important for changing the health behaviour of individuals (So and Jeong, 2017). Thus, the last objective is to develop a mobile application where children can inform their diet and physical activities each day to keep track of their performance and configure the actions they need to follow to avoid being obese.

Schools are ideal for delivering health promotion activities to parents and children (Vander Ploeg et al., 2014). The Chosen schools are in socioeconomically disadvantaged neighbourhoods of Rumworth and they are chosen based on National Children Measurement Programme (N.C.M.P.) data which informs in which area there is high number of overweight children in the locality. The chosen schools will be offered various enjoyable activities like go girl, dance, skipping and yoga clubs, walking initiatives and playground programme (Guerra et al.,2014). Headteachers of all five primary school were contacted through written information layout of the full Plan of health promotion activity and requested their co-operation. This health promotion activity's success requires support and commitment of diverse organisations and depends crucially on the degree of collaboration. This activity will use all health promotion approaches medical, educational and empowerment, and collaborative working to be crucial to success, and ethical issues will be considered carefully (Naidoo and Wills, 2009).

The evaluation of the success of the health promotion is to be done by accessing feedback through objective questionnaire from the participants which are children and their parents. This is because accessing feedback helps to analyse the impact of the actions on the mind and behaviour of the individuals for whom health promotion has been arranged (van der Krieke et al., 2017). The health promotion is to be further evaluated by interviewing the participants before and after the initiation and completion of the activity. This is because interview allows to gather verbal data about the thoughts and behaviour of the individual along with helps in analysing their feelings and emotions regarding certain activity (Hinrichsen et al., 2020). Thus, the interview is to be performed to determine the changed feelings, emotions, behaviour and thinking of the participants as a result of the health promotion regarding healthy eating and physical activity that prevents and resolves obesity.

Conclusion

The above discussion informs that the health promotion developed is aimed to raise awareness and education of obesity within the school, with help of local articles posters and presentations and school nursing professionals. It is determined that weekly clinic reviews by health visitors for high-risk children regarding obesity is to be made for health promotion regarding the disease. The relevant stakeholders to be involved in the health promotion are schools, G.P.S. surgeries to make use of this facility. The use of healthy eating and tracking health APP for high-risk children is to be implemented. The health visitors with the resources would ensure healthy weaning and breastfeeding behaviour is fostered throughout the community for parents to improve the overall index of nutrition for households in the community and avoid early obesity.

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Figure 1

Health Promotion Models