February 7, 2014—all day! Tweet the fight on childhood obesity in 140 characters using the hashtag #onechobesity.
Critical to improving the health of the US population is expanding the role of primary care in the prevention and treatment of childhood obesity. Providers can improve prevention and treatment through efforts in clinical and community setting, healthy lifestyle promotion, community health education, policy advocacy, weight status assessment and monitoring, clinic infrastructure development, and multi sector community initiatives. Coordinated and collective efforts in multiple sectors and settings are needed to address high prevalence of childhood obesity. There is a recognized need to expand the role of primary care to include advocacy in addition to traditional measurement of patients’ heights and weights to assess growth. It is important to identify successful models that integrate primary care, public health, and community-based efforts to accelerate progress in childhood obesity prevention. Vine, Hargreaves, Briefel & Orfield (2013) stated that based on 96 peer-reviewed articles published between 2005 to 2012, primary care providers (PCPs) are increasingly being included in childhood obesity interventions which is consistent with current recommendations from scientific and professional organizations. Being the critical stages of growth and healthy lifestyle development, prenatal and childhood periods need new strategies that encompass more than individual-level behavior change and post-assessment treatment. Well-child visits is the best timing to counsel parents about healthy lifestyle, mold healthy behaviors and refer families to community resources. It is necessary to stress the importance of PCPs to take on the role as educators, promoters of healthy lifestyle practices, and advocates in the broader community on treatment and intervention initiatives. Incorporating curative health services into broader population health is in essence within the scope of universal health coverage (UHC). Built on the 1978 Declaration of Alma Ata, Rodin (2013) stated that UHC movement reaffirmed that health is a human right and identified primary healthcare as the means for attaining “health for all” (p. 710). Transitioning towards UHC, it is necessary for government leaders and policy makers to take into consideration the unique health needs of women. It is important for policy makers to understand the biological and gender-based differences to successfully incorporate women’s needs into UHC schemes. The social protection schemes that cover women’s preventive services and curative services should seek to eliminate or at least reduce out-of-pocket spending on health and to remove the formidable financial barriers that prevent more women than men from accessing needed services (Rodin, 2013). The success or the efficient performance of UHC systems will be dependent upon the stakeholders’ focus on persistent differences between men and women’s health risks, health status, and access to service. Systematically including women’s health needs during the planning process of UHC will not only improve women’s empowerment, but also economic development.
Linguistic facility is a cultural health capital element that could be improved in order to understand, recognized and increase access to care for cultural and linguistic minorities utilizing ethnicity-specific subsystems of care. To create an organizational development model for ethnicity-specific health care organizations and infrastructures, it is useful to consider the historical experiences of the Chinese community in San Francisco. This model includes the development and recruitment of bicultural and bilingual healthcare workforce which will induce satisfying engagements between the target population and health professionals. The other stages in the development of this model are structuring health care resources for maximum accessibility, expanding health care organizations, and integrating ethnicity-specific health care resources into the mainstream health care system (Yang & Kagawa-Singer, 2007). This study further stated: “moving forward from the documentation of racial and ethnic disparities in health care toward long-term solutions that ameliorate disparities, ethnicity-specific health care organizations have untapped potential as a source for a strategy that addresses the structure of health systems that inhibit full access to quality health care for cultural and linguistic minorities” (p. 546). Ethnicity-specific health care systems can contribute to greater equity, comprehensive, and accessible quality care by greater expansion and integration of this health system into the mainstream. Delivering quality health care in culturally appropriate way, and opening the access which was impeded by cultural and linguistic characteristics could be efficiently implemented by matching of patients and providers. Integration of this system to the mainstream will need monitoring of discriminatory practices, and appropriate action to ensure fair competition among provider groups.
Baum, F. E., Legge, D. G., Freeman, T., Lawless, A., Labonté, R., & Jolley, G. M. (2013). The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints. BMC public health, 13(1), 460.
Rodin, J. (2013). Accelerating action towards universal health coverage by applying a gender lens. Bulletin of the World Health Organization, 91(9), 710-711.
Shim, J. K. (2010). Cultural Health Capital A Theoretical Approach to Understanding Health Care Interactions and the Dynamics of Unequal Treatment. Journal of Health and Social Behavior, 51(1), 1-15.
Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic-and Community-Based Recommendations and Interventions. Journal of obesity, 2013.
Yang, J. S., & Kagawa-Singer, M. (2007). Increasing access to care for cultural and linguistic minorities: ethnicity-specific health care organizations and infrastructure. Journal of Health Care for the Poor and Underserved, 18(3), 532-549.
Health within the looking glass of a population health perspective is defined in broad terms which address questions such as what are the most important factors affecting the target population’s health; why some people are sicker than others; and what initiatives can be implemented to improve the health of all people and communities. The less talk, more action approach of Canadian health professionals and policy makers recognized the emerging field of research that is critical in advancing initiatives to reduce health inequities. Canadian Institutes of Health Research-Institute of Population and Public Health, (2011) stated that population health intervention research built on several decades of research in important areas such as health promotion, health education and community interventions. The Institute of Population and Public Health (IPPH) in partnership with the Canadian Population Health Initiative (CPHI) shared the vision to develop the program that will promote, advance and support population and public health research, infrastructure development, capacity building and knowledge exchange to improve the health of individuals, communities and global populations. The partnership developed a strong pan-Canadian population health research network to implement proactive and ongoing external relations with research organizations, population and public researchers, and research funders across disciplines and sectors. The synthesis on lessons learned from research to address population health issues of vulnerable populations is applied to the real-world situation as continuance of research that involves complex interventions in non-health sectors or multi-level interventions that cut across the socioecological systems. This strategy will give way to the proper application of intervention programs, use evidence to make decisions on how to use scarce resources in ways that will equitably improve the target population’s health status.
The Population Health Intervention Research Initiative for Canada (PHIRIC) aims to increase the quantity, quality and use of population health intervention research through a strategic and deliberate alignment of initiatives by key organizations responsible for public health research, policy and practice. Public Health Agency of Canada has invested in six National Collaborating Centers for Public Health which have a knowledge synthesis, translation and exchange mandate that can promote population health intervention research. In addition, Di Ruggiero, Rose & Gaudreau (2009) noted CIHI, CIHR, the Heart and Stroke Foundation of Canada, and the Public Health Agency of Canada are examples of national organizations that have made strategic funding investments in population health intervention research. Population health intervention research supported through a variety of implementation processes such as intersectoral collaboration, knowledge synthesis and the development of decision-making tools could empower communities to support school nutrition. School nutrition programs in remote First Nations communities of the western James Bay region implement school-based nutrition interventions and improve access to quality healthy diets. In collaboration between academics and First Nations communities, this project highlights the factors that support sustainable change in remote settings which include comprehensive program design and provision, supportive infrastructure such as modified school curricula and policies, greenhouse gardens, funding, and local champions and volunteers. Stakeholders such students, teachers and parents valued this program regardless of the challenges and barriers. It continue to address the significance of school-based nutrition programs for the continuum of equal access to healthy foods, systematic action to address inequities. I believe that such a program should be replicated to United States school system to help reverse US obesity epidemic. Canadian initiatives to improve children’s access to healthy foods could act as the basis for US frameworks to make societal changes to enhance the target population’s well-being, and address socially-determined health conditions while preventing new incidence from emerging.
Canadian Institutes of Health Research – Institute of Population and Public Health, (2011). Canadian Institute for Health Information – Canadian Population Health Initiative. Population Health Intervention Research Casebook, 2011.
Di Ruggiero, E., Rose, A., & Gaudreau, K. (2009). Canadian Institutes of Health Research Support for Population Health Intervention Research in Canada. CJPH 100 (Suppl. 1) I15-I19.
Hawe, P., & Potvin, L. (2009). What is population health intervention research? CJPH 100 (Suppl. 1) I8-I14.
Manuel, D. G., & Rosella, L. C. (2010). Commentary: Assessing population (baseline) risk is a cornerstone of population health planning—looking forward to address new challenges. International journal of epidemiology, 39(2), 380-382.
Ndumbe-Eyoh, S., & Moffatt, H. (2013). Intersectoral action for health equity: a rapid systematic review. BMC public health, 13(1), 1056.
Ostry, A., & Morrision, K. (2013). A Method for Estimating the Extent of Regional Food Self-Sufficiency and Dietary Ill Health in the Province of British Columbia, Canada. Sustainability, 5(11), 4949-4960.
Raine, K. D. (2010). Addressing poor nutrition to promote heart health: moving upstream. Canadian Journal of Cardiology, 26, 21C-24C.
Rhona Hanning, R. D., Skinner, K., & Tsuji, L. (2011). Empowering Communities to Support School Nutrition. Population Health Intervention Research Casebook, 45.