Tag Archives: Let’s Move

Dallas’ Renaissance Plan: A Response to the Second Wave of Environmental Justice

Dallas is the seventh largest city in the United States with a population exceeding 1.1 million citizens in the year 2000. Dallas is the fourth largest park system in the United States. The second wave of the environmental justice movement is a concept concerned with urban design, public health, and availability of outdoor physical activities. The upgrade to the 21,526 acres of parkland will amplify the quality of and access to outdoor recreation. The Dallas Park and Recreation Department’s “Renaissance Plan” is a response to  the increased demand of the citizens for new and expanded park facilities, recreation programs, open space areas, and unique recreational amenities. Physical activity is one of the health indicators for Healthy People 2010, and responding to these demands is a step forward of meeting its goals.  Dallas’ wide spectrum of park facilities will provide physical activities that will have positive health outcome to Dallas residents including the low-income population of the Dallas County and contiguous counties. Recognition of environmental exposure affecting economically and politically disadvantaged members of the community gave birth to the first wave of environmental justice movement. In addition to health problems related to environmental exposures, environmental justice (EJ) also cover disparities in physical activity, dietary habits, and obesity among different populations. Disparities on the access of public facilities and resources for physical activity (PA) is an EJ issue that has a negative impact on health among low-income and racial/ethnic minorities (Labilles, 2013). The 2007 cross-sectional study of Taylor et al. suggest an association between disproportionate low access to parks and recreation services (PRS) and other activity-friendly environments in low-income and racial/ethnic minority communities.  The prevalence of lower levels of PA and higher rates of obesity was observed in the minority population, which is a direct outcome of the prevalence of lower levels of PA. These differences violate the fair treatment principle necessary for environmental justice.

The treatment of health conditions associated with physical inactivity such as obesity poses an economic cost of at least $117 billion each year. Physical inactivity contributes to many physical and mental health problems.  The reported 200,000-deaths per year in the US is attributed to physical inactivity, and data from surveillance system indicate that people from some racial/ethnic minority groups experience disproportionately higher rates of chronic diseases associated with physical inactivity. Taylor, Poston, Jones & Kraft (2006) findings, provided preliminary evidence for the hypothesis that socioeconomic status disparities in overweight and obesity are related to differences in environmental characteristics. However, most of the studies had encountered epidemiologic “black box” problem, making it impossible to determine which characteristics of the environment (e.g., density of food service outlets or physical activity resources) may be most important (Labilles, 2013). Ellaway et al. found that body-mass index (BMI), waist circumference, and prevalence of obesity, and greater obesity risk is associated with low area or neighborhood socio-economic status.

References

Behavioral Risk Factor Surveillance System (BRFSS). Atlanta: Centers for Disease Control and Prevention; 2000.Centers for Disease Control and Prevention; 2000.

Ellaway A, Anderson A, Macintyre S. Does area of residence affect body size and shape? Int J Obes Relat Metab Disord. 1997; 21:304-308.

Labilles, U. (2013). Environment Matters: The Disproportionate Burden of Environmental Challenges. PUBH 8115-1 Environmental Health Spring Qtr. Minneapolis: Walden University.

Taylor, W., Floyd, M., Whitt-Glover, M. & Brooks, J. (2007).  Environmental Justice: A Framework for Collaboration between the Public Health and Parks and Recreation Fields to Study Disparities in Physical Activity. Journal of Physical Activity & Health, 4, supp 1, s50-s63.

US Dept of Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

US Dept of Health and Human Services. Healthy People 2010: With understanding and improving health and objectives for improving health (2nd ed). Washington: US Govt Printing Office; 2000.

Wolf AM, Manson JE, Colditz GA. The economic impact of overweight, obesity, and weight loss. In: Eckel R, ed. Obesity Mechanisms and Clinical Management. Philadelphia: Lippincott, Williams, & Wilkins; 2002.

 

 

Parental Obesity and New Mentality: Raising the Risk of Child Obesity

Our nation’s most urgent health problem is the disparities in health care. There are stark disparities in health by gender and socioeconomic status. According to Davis et al. (2005), “the social and community environments affect health directly as well as indirectly by influencing behavior”(p. 2168). Which group do we put parents who have a distorted perception of their child’s body size? This phenomenon is most prevalent among low-income women and Hispanic mothers. But regardless of race or socioeconomic background, the obesity epidemic is eroding the general impression of what healthy looks like. What if obese is the new normal? If obese is the new normal, then it will be our failure as Public Health professionals to emphasize the importance of the role of parents and family to combat child obesity. Parents should play a crucial role in influencing children’s food habits and physical activity. Parental obesity may increase the risk of a child becoming obese. Wrotniak et al. (2004) is the first study to examine the incremental effects of parental weight change on child weight change while controlling for variables that influence child weight loss. The study stated that youth benefit the most from parents who lose the most weight in family-based behavioral treatments (Wrotniak et al., 2004, p. 342).

The prevalence of obesity is increasing in all pediatric age groups according to the Health and Nutrition Examination Survey (NHANES). Genetics, environment, metabolism, lifestyle, and eating habits are among the factors believed to play a role in the development of obesity. More than 90% of cases are idiopathic; less than 10% are associated with hormonal or genetic causes. Hirschler et al. (2008) found an association between mothers’ distorted perception of their children’s shape and eating habits and mothers’ obesity and their children’s overweight. The study provides clues for obesity prevention programs. There is a multitude of health problems that are associated with obesity. Without dealing with the new trend of maternally distorted perception of their child’s body size, health problems faced by family care physicians will continue to rise. There will be continued prevalence of obesity associated diseases such as type 2 diabetes and heart disease to hyperlipidemia, asthma, and obstructive sleep apnea. According to Friedman & Schwartz (2008), “A key concept in developing obesity-related policies is creating ‘optimal defaults’17. When there is an optimal default, the health promoting behaviors are those that come most easily, require the least effort or thought, and offer a more healthful option” (p.718).

References

JAMA Network | JAMA Pediatrics | Parent Weight Change as a … (n.d.). Retrieved from http://archpedi.jamanetwork.com/article.aspx?articleid=485676

Hirschler, V., Calcagno M., Clemente A., Aranda C., Gonzalez, C. (2008, July 21). Association between school children’s overweight and maternal obesity and perception of      their children’s weight status. Journal Pediatric Endocrinololgy & Metabolism. 7:641-9.

Cohen, L., Chavez, V., Chehimi, S. (2010). Achieving Health Equity and Social Justice. L. Liburd & W. Giles, Prevention is Primary (pp. 33-53). San Francisco: Jossey-            Bass.

Friedman, R., & Schwartz, M. (2008). Public Policy to Prevent Childhood Obesity, and the Role of Pediatric Endocrinologists.Journal of Pediatric Endocrinology &                    Metabolism, 21, 717-725.

Tweet the Fight on “Childhood Obesity” Hashtag #onechobesity

Reversing the childhood obesity epidemic will not be achieved until there is a change in societal norms which may require a new approach to improve child health. The progress toward the goal of effective, sustainable child obesity prevention strategies are dependent upon strengthening current approaches to add a component that addresses pregnancy onward. It is essential to alter early-life systems that promote intergenerational transmission of obesity that will intercept or stop the continuing cycle of the obesity epidemic. It was widely understood that the epidemic was caused by changes in children’s environments, Whitaker (2011) found that the expression of obesity genes can be altered by the environment. The study also found that obesity is caused by both overeating and inactivity. Other causes of obesity which are complimentary are the amount and type of food people eat, individual and group behavior, household and community factors, free choice and constraints on those choices, and poverty and affluence. Multiple causes of social origin are increasingly recognized to be related in childhood obesity which needs to be addressed with collective actions. Innovative multifactorial approach such as the “Let’s Move” campaign unveiled almost four years ago by First Lady Michelle Obama has the potential for altering the course of childhood obesity. Early intervention programs have higher overall impact on reversing the childhood obesity epidemic than health services focusing on health conditions associated with the disease. “Let’s Move” and “One Nation’s Echo (O.N.E.)” are examples of innovative strategies that will promote behavioral and social change.
References
Nader, P. R., Huang, T. T. K., Gahagan, S., Kumanyika, S., Hammond, R. A., & Christoffel, K. K. (2012). Next steps in obesity prevention: altering early life systems to support healthy parents, infants, and toddlers. Childhood Obesity (Formerly Obesity and Weight Management), 8(3), 195-204.
Whitaker, R. C. (2011). The childhood obesity epidemic: lessons for preventing socially determined health conditions. Archives of pediatrics & adolescent medicine, 165(11), 973.

Preventive and Curative Health Care Services: Integrating Cultural Health Capital

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.

References

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 health13(1), 460.

Rodin, J. (2013). Accelerating action towards universal health coverage by applying a gender lens. Bulletin of the World Health Organization91(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 Behavior51(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 obesity2013.

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 Underserved18(3), 532-549.

Canadian Strategies to Help Reverse U.S. obesity Epidemic

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.

References

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 epidemiology39(2), 380-382.

Ndumbe-Eyoh, S., & Moffatt, H. (2013). Intersectoral action for health equity: a rapid systematic review. BMC public health13(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. Sustainability5(11), 4949-4960.

Raine, K. D. (2010). Addressing poor nutrition to promote heart health: moving upstream. Canadian Journal of Cardiology26, 21C-24C.

Rhona Hanning, R. D., Skinner, K., & Tsuji, L. (2011). Empowering Communities to Support School Nutrition. Population Health Intervention Research Casebook, 45.