Discuss about the Bicycle Model For Public Health Intervention.
Obesity poses a great challenge on most of the developed countries and New Zealand is no exception to the blight of obesity. There has been an enormous rise in the number of obese people in New Zealand. Children and adults are equally under threat of risk posed due to obesity. Given, the issue of weight gain becoming a dominant problem, it is important to consider the different dynamics related to obesity with the objective of seeking the most appropriate solution. Fat has been defined as excessive flesh in the body whereas obesity is understood be the condition of being abnormally fat (Ministry of Health. 2018). Obesity and overweight can be related to the multiple factors that includes genetics and bad behavior. The prevalence of bad behavior contributing to obesity includes medication use, physical activity, dietary patterns and the exposure to a sedentary lifestyle. Apart from these, there several factors that contributes to obesity. This includes physical activity, skills, consumption of particular kind of food and food marketing. Another concern related to obesity is that it leads to negative mental health. In the previous assignment the impact of obesity was studied among the population of the Manukau District. The geographical area of the Counties Manukau Health is part of the territorial authority of the Auckland Council. The second largest assesses resident population is with the Counties Manukau Health out of the 20 District Health Board in New Zealand (World Health Organization, 2018).The ethnicity mix of the Counties Manukau population has found to be differed by age. The younger population of the District is composed of Asian, Pacific and Maori peoples whereas the older population who are above the age of 65 years constitutes of two-third of the population who belong to the European and native NZ ethnicity. In the year 204, twenty-four per cent of the estimated resident population of the Counties Manukau is aged at 14 (Swinburn & Vandevijvere, 2016). It has been found that the Maori and the Pacific population comprises of the highest population. Studies have demonstrated that the adult population of the Counties Manukau experienced population is obese according to the NZ Health Survey 2011-13. The rate of obesity among the children are found to be 18.6 per cent among the people from the Pacific region, 24. 5 per cent among the people from the Maori region and 10. 2 per cent among the Asian children (Yofee, 2009). The attributable effects and the costs of obesity and overweight ensues that the health and the well-being of an individual is affected due to the adversity of obesity. Some of these problems include depression, pulmonary disorders, chronic musculoskeletal problems, problems in the relationship and infertility. Some of these life-threatening effects of obesity can be categorized into four categories-these are cardiovascular diseases, gall bladder disease, certain types of cancer that are triggered by obesity, and insulin resistance linked to the conditions like Type 2 diabetes (Utter, Denny, Teevale, Peiris-John & Dyson, 2015). Apart from the damaging and long-term consequences of obesity, overweight and obesity severe social and economic pressure on the person. This also poses severe economic and social pressure on the healthcare in NZ. Direct and indirect medical costs are related to obesity. The measurement of the productivity is done based on absenteeism and presenteeism. Absenteeism refers to the cost incurred due to the absence of employees at the workplace whereas presenteeism refers to the reduced productivity of the employees despite the fact that they are present at work in addition to prematurity and disability. If obesity is not controlled, it will trigger high blood pressure, stroke, fatty liver disease, osteoarthritis, pregnancy related difficulties and heart disease amongst others. Increase in BMI may lead to the risk in non-communicable diseases.
Capacity Analysis and Development Plan
The successful healthcare promotional plan needs to be targeted at the community along with the specific location and the identification of the specific outcomes that may be used for the location and the communities. Manukau district has been chosen for the implantation of the healthcare plan on addressing obesity and overweight. The community that will be targeted for the proposed intervention will be the Maori community. Therefore, the stakeholders for the proposed healthcare intervention plan would be the Maori community, the healthcare workers operational in the Manukau distrust, people who would be involved in the in the promotional campaign, the policy makers, employees working in the healthcare facilities, local government, ministry of healthcare, labour and the different profitable and non-profitable organizations. At the stage of the leadership, the proposed intervention would be assessment of the leadership potential of the Maori community representatives (Williams, Mesidor, Winters, Dubbert & Wyatt, 2015)It has been found that although the Maori community members were visible in the Healthcare Ministry and the medical association.
Considering the power of the community in influencing the community members to pay attention of their health needs, building the capacity of the Maori members is quite important. This would be done through tapping the potentiality of the Maori leadership. This is because studies have shown that the New Zealanders are part of an environment. As it has been recognized earlier, the policymakers and the healthcare professionals possess the requisite capacity and competence to generate awareness among the Maori community members about the importance of curtailing unhealthy eating practices and prevent sedentary lifestyles that contribute to the prevalence of obesity. The knowledge by the healthcare professionals would be transferred to the fieldsite volunteers who would be engaged in door-to-door campaigning in the Manukau district, visiting the schools where children and the parents will be sensitized about the causes of obesity and the role of alternative lunch that can go a long way in arresting obesity. Given, the power and reach of the local government, it has the maximum capacity in the prevention of obesity through both short-term and long-term prevention plans. Out of all the stakeholders in this obesity intervention plan, the Maori members initially may feel reluctant to engage with the project assuming that it is an outside intrusion and is a state-sponsored strategy to target and label them as unhealthy. Therefore, there may be initial resistance and lack of cooperation from the community members. This may also be due to the attitude of previous intervention plans that have not kept a track of the outcome of the interventions. In the last 10 to 15 years, there have been a series of interventions in the Maori communities to prevent obesity and the high-risk diseases that are caused due to obesity. Although some of the elements were successful, there was no permanent support of these initiatives of the Government or the DHB funding level. It is difficult for the Maori community to sustain the benefits of these intervention plans without continuous and concerted support in the form of financial assistance. Some of the members in the Maori community are of the view that only a limited section of the elite is able to sustain the requisite lifestyle that is compatible to obesity. Therefore, the government possesses the greatest capacity by making the obesity friendly food at lower cost and food with higher calories at high lost to make it accessible for the marginalized Maori community at a subsidized rate.
At the level of the workforce those workers will be selected based on their knowledge of health literacy and expertise on obesity and the concomitant risks. Leaders from the Te Puni K?kiri community will be involved. This would be done with the aim of tapping their potentiality to lead the workforce in the five different locations of the Manukau District. In addition, 100 people would be recruited for the healthcare program in the Maori community and would be directed in five locations in the district (Counties Manukau Health, 2015). The local government and the municipal would be exhorted to be a part of the healthcare programme for the entire community. NGOs and the governmental organizations would be targeted for the welfare of the Maori community. The rationale behind the inclusion of the municipal and the local schools that would be important for arranging the accommodation for the healthcare campaigns. Inclusion of the municipal would ensure that there is an additional amenities that would be utilized in the population gatherings namely the safety and security instruments. This project would feature working along with the synchronization of the leaders and the elderly members of the community. The thrust would be to educate them about the effects of obesity in the community by motivating them to veer towards healthy lifestyle. The Maori community would accomplish the key role in decision-making regarding the utilization of the resources and the strategies to be implemented for their healthcare needs. In this case, the intervention that would be used will be based on evidence existent in the society with the aim of the processes and the decisions to implement in the process. The local government and the municipal officers would be involved through community prospect, facilitation of the contribution for all the service providers, including the training personnel in the promotional event and intensifying the healthcare infrastructure of the local healthcare facilities.
Project Governance
All the above mentioned stakeholders will be part of the advisory team who will lead the project and will look into the initiation, governance and the successful implementation of the intervention plan. In addition to the above mentioned stakeholders there will be sponsors namelycompanies that are known for their obesity friendly food products. Spinsorship will be important considering the scale of the project and the finance that will be required in the implementation of the various activities associated with the project. Their involvement would be crucial for the long-term success of the project.
Initial Goal
The aim of this public intervention plan on obesity is to reduce the incidence and prevalence of obesity in the Counties Manukau district in New Zealand. For the purpose of the study, the Maori community would be selected as the target population owing to the fact that there has been a rise in obesity among adults and the children in the community. The rationale behind the selection of the Maori community is that it is the third largest community in the region after the Asian and the Pacific community (Ministry of Health, 2018). Previous studies have shown that the important determinant on the social health was the key reason for the rise in obesity among the members of the community considering they did not have access to good food, quality healthcare and a healthy compatible environment to control this rise in obesity. Therefore, the goal of the intervention would be to reduce obesity among the Maori community through the involvement of the various stakeholders and keeping the Maori leadership at the forefront to bring in transformation.
- Specific
As stated earlier, the objective would be reduce and the prevent obesity among the members of the Maori community. This would be done through collaborating with the different stakeholders namely the Maori community, the healthcare workers operational in the Manukau distrust, people who would be involved in the in the promotional campaign, the policy makers, employees working in the healthcare facilities, local government, ministry of healthcare, labour and the different profitable and non-profitable organizations (CDC, 2018). I seek to implement the plan from June as the need assessment and identification of the problem has already been completed. This s is a goal considering the veracity of obesity identified through the attributable effects and the costs of overweight and obesity and the price of not doing anything. One objective would be to reduce the intake of sugar and sweetened beverages among the Maori community members by 50 % within one year. The second objective would be to increase the proportion of days during which the at least 30 minutes of exercise would be taken by the community members by 20 per cent by 2020. Another goal for preventing obesity would be imposing higher tax on the food products that contribute to obesity thereby curtailing the consumption of such products by the year 2020.
- Measurable
Goals and Objectives- Smart Objectives
To ensure that the goals have been a number of methods will be adopted. A longitudinal research design would be the most appropriate choice. Firstly a survey would be conducted among the Maori community to assess the difference in their health outcome post the obesity intervention plan. The data collected from the survey would be processed and the findings of the survey would be helpful in indicating whether there has a been a decrease in the incidence of obesity. Based on the survey if it s found that obesity continues to remain a problem then there would a restructuring of the intervention plan. Secondly, there would be a routine weight check of the Maori members who have been earlier diagnosed as obese.
- Achievable
The public health intervention plan can be translated into reality only through the capacity building of the different stakeholders involved with the project. As discussed earlier each of the stakeholders will have specific responsibilities in this intervention plan. Firstly leadership skills need to be developed among the Maori community members. Secondly, there needs to be a health awareness education for all the stakeholders of the project to ensure that everyone is on the same level and to eliminate any discrepancy. The health education programme would provide an opportunity to all the stakeholders to understand their responsibility in the intervention plan and also to clarify regarding any issue.
- Relevant
The goal is relevant considering that obesity leads to a number of severe health conditions and if it s not addressed at the earliest it will lead to health epidemic. Secondly, the Maori community due to lack of education and awareness are not sensitized about the veracity of obesity. The gola is aligned with the overall objective of the healthcare intervention.
- Time-bound
The deadline for the public health intervention plan would be six months (June-November). The time span seems realistic considering that any community model involves the stages of community assessment, prioritization of the health problems in the community, program planning and the evaluation of the program. All these process are time consuming and hence, the six-month time period. It may be extended depending on the progress of the intervention plan.
Strategy Mix/Intervention Research/Logic Modelling
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PROBLEM STATEMENT High prevalence and incidence of obesity among the Maori community |
DETERMINANTS |
STRATEGY TYPE |
DESCRIPTION |
RATIONALE OF THE STRATEGIES |
|
High cholesterol and high sugar Food bought from home (lunchbox) |
Developing personal skills |
Healthy lunchbox packing education sessions for children and parents. Designed to be 15 minute “super sessions” to coincide with children being collected after school. Sessions complemented with “how to” fridge magnet cards that are marketed to children as “parents homework”. |
Earlier consultation with parents indicated a need for skills development relative to selecting and preparing lunchbox contents that were consistent with dietary guidelines. Parents expressed knowledge of best limited time, food options as lunch food and were amenable to short education sessions coinciding with pick-up. |
|
|
Lack of adequate physical activity due to urbanization and availability of new transportation facilities. This may be attributed to the societal and environmental changes |
Developing personal skills |
The municipal and the local government can promote cycling among the community members. Young children can be gifted with cycles so that they develop the habit of cycling and thereby reduce weight. |
A survey conducted among the members of the Maori community revealed that they lack the adequate finance to afford bicycle. Therefore, a little push from the government will be a great initiative. |
|
|
Another determinant about obesity can also be attributed to the lack of awareness about obesity |
Developing personal skills |
The Maori community members need to sensitized about obesity and made aware about the risks of overweight or obesity. This can be achieved through workshops, focused group discussions and door-to-door campaigns |
The Maori community members could predict the health epidemic that maybe caused due to obesity |
|
|
Consumption of fatty food without knowing that the food would contribute to obesity |
Government intervention |
There should be a new standard for labeling of food by distinguishing the so-called functional food that makes loft claims about health issues from the actual healthy food. A new draft from the government would restrict the claim of nutrition content from the food products with infant formula. |
It has been found that the food labeling laws can play a great role in facilitating informed food choices among the consumers both the stage of consumption of food at the same time during the purchase of food. Therefore, there should be the implementation of Food Standards Code. Food labeling laws would further expand their utility in supporting the healthier and more informed choices. |
Before the outset of the intervention plan, an intervention research will be conducted on the Maori community for example a pilot study to understand the veracity of the problem that would be helpful in formulating the strategies and designing the intervention plan. The logic behind altering the contents of the lunchbox was felt after a discussion with the parents that the kind of lunch the children bringing to school were not healthy and was recognized as the widespread prevalence of obesity. There is a lack of physical activity among the Maori adolescents and owing to their poor economic status, they were unable to afford cycles. Therefore the strategy of involving the government to buy cycles for the Maori adolescents have been included as one of the key strategies. Considering that the easy availability of pro-obesity food contributes to an obesogenic environment it is has been thought out to be important that such food products be labeled by the Food law so that during the consumption of such products, the consumers are aware about what they are purchasing and in what ways it can affect the health.
Strategy options for level of intervention
|
Strategy options |
|
|
Community level |
The population based- community level intervention practice are involved in changing the community norms, community attitudes, community awareness, community behaviors and the community practices. This is targeted at the entire population (all age-groups) within the Maori community (Hutchison, Matto, Harrigan, Charlesworth & Viggiani, 2007). The highlight of the community-focused practices is that it is measured in terms of to what extend the population requires changes. At the community level, the strategy would be to organize healthcare programs in collaboration with the Maori community. In this, the members of the Maori community would have the say in decision making utilization of the resources and in the implementation of strategies based on the healthcare needs of the community members. These interventions would be based on the evidence collected about obesity with the aim of the implementation of the decisions and the procedures. |
|
Systems level |
The population based systems focused practice deals with the interventions at the stage of policies, laws, and the power structures. In this stage, the focus would be the community or the individual. The rationale behind this intervention is that bringing a change at the systematic level is believed to be more effective and long lasting. Systematic intervention to mitigate obesity would be leadership by being visible in the media. Secondly, through role modeling of healthy behaviors at the individual level for the prevention of obesity. Thirdly, through creating mechanisms for the whole-of-government response of obesity and the fourth step can leadership constitute lifting the priority for health (versus) commercial outcomes. In case of advocacy, the government can advocate for the multi-sector response of all the societal sectors like the governments, private sectors, the public and the civil society. The government can advocate the private sector for the corporate responsibility around the marketing of children through the creation of high-level taskforce to oversee and supervise the multi-sector actions. In the domain of funding, the government secure the increasing and continuing funding to create, sustain and perpetuate non-obesogenic environments and promote healthy lifestyle choices. This can be achieved through a health promotion foundation to fund programs and strengthen further research. In the domain of policy, the government can develop, implement and monitor a set of policies, regulations, taxes and subsidies that would make the environment less obesogenic. This may be achieved through banning the unhealthy food to children, subsidizing public transport and active transport as compared to cars. There should be the provision of traffic lights front of pack on the labeling of food. Nutritional surveillance can be conducted on schools. There should be restriction of the sale of food that claim to be healthy (Hebestreit, Börnhorst, Pala, Barba, Eiben, Veidebaum,& Pigeot, 2014). |
|
Individual level |
The individual-focused interventions bring a change to the knowledge, attitudes, beliefs, behaviors and the practices of the individuals. This type of practice level intervention is directed against the individuals who receive services as they are identified as being part of the population who is at risk. In this type of intervention, there would be door-to-door campaigning and the BMI of each child in the community will be measured. There will be caregiver support groups and health classes for preadolescents and the adolescents. |
|
Intervention and setting |
Target population |
Measurement of change (method of evaluation) |
|
Active after school communities program. It would be run for 8 weeks after the school terms. |
Primary school children |
Survey questionnaire after 2 weeks to understand the change and thereby seek adequate measure. |
|
Multi-faceted program that would include health education with the aim of improving the nutrition of children and increasing their physical activity and the component of education. |
Children in primary school |
Survey questionnaire after 2 weeks to understand the change and thereby seek adequate measure Focus group interviews with the parents of the children who have been diagnosed as obese to track the changes through the strategies and assess their success. |
|
Multi-faceted program that would include health education with the aim of improving the nutrition of children and increasing their physical activity |
Children in primary school grade |
Survey questionnaire after 2 weeks to understand the change and thereby seek adequate measure Focus group interviews with the children in the primary school grade to understand about the barriers |
|
Multi-faceted program targeting obese and overweight children |
Overweight or obese children aged 7-10 years |
Survey questionnaire after 2 weeks to understand the change and thereby seek adequate measure. Qualitative interviewing and focus group interviews with the children |
|
Education program to curtail sedentary lifestyle |
Students who are in higher education |
Survey questionnaire after 2 weeks to understand the change and thereby seek adequate measure. Qualitative interview and focus group discussions with the children to understand whether the education program was successful |
5 This section itemises and justifies the resources required for intervention implementation.
This section outlines identification and mitigation of identified or anticipated risks, such as to funding or staffing, or actual health and safety hazards.
|
Resources |
Purpose |
Risk Identification |
Mitigation |
|
Whiteboard and stationeries |
Sessions and workshops |
Funding |
Raising fund crowdsourcing |
|
Educative materials for door-door-door campaigning and health education program |
Health awareness programs |
Funding and loss of items |
Raising fund through crowdsourcing and seeking help from the NGO and private sponsors |
|
Workforce (volunteers) |
Campaigning and awareness programs |
Occupational hazard and illness |
Safety kit box, dietary surveillance of the workers and the presence of doctor at the site. |
References
Burns, D., Costello, J., Haggart, M., Kerr, J., Longshaw, K., & Thornton, E. (2009). The public health challenge of obesity: is it the new smoking?. Journal of Community Nursing, 23(11), 4-9.
CDC. (2018). The Health Effects of Overweight and Obesity. Retrieved March 13, 2018 from https://www.cdc.gov/healthyweight/effects/index.html
Counties Manukau Health. (2014). Counties Manukau District Health Board. Retrieved March 13, 2018 from https://www.countiesmanukau.health.nz/assets/Blog/teamcounties/obesity-way-forward-a-paper-presented-to-elt-august-2014.pdf
Counties Manukau Health. (2015). Demographic Profile: 2013 Census Population of Counties Manukau. Retrieved March 13, 2018 from https://www.countiesmanukau.health.nz/assets/About-CMH/Demographics-and-populations/Census-2013-profile-for-residents-of-Counties-Manukau.pdf
Hebestreit, A., Börnhorst, C., Pala, V., Barba, G., Eiben, G., Veidebaum, T., … & Pigeot, I. (2014). Dietary energy density in young children across Europe. International Journal of Obesity, 38(S2), S124.
Hutchison, E. D., Matto, H. C., Harrigan, M. P., Charlesworth, L. W. & Viggiani, P. A.(2007). Challenges of Living: A Multidimensional Working Model for Social Workers. SAGE Publications.
Ministry of Health. (2018). Childhood obesity plan. Retrieved March 13, 2018 from https://www.health.govt.nz/our-work/diseases-and-conditions/obesity/childhood-obesity-plan
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Health Risks of Being Overweight. Retrieved March 13, 2018 from https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight
Rossen, L. & Rossen, E. (2011). Obesity 101. Springer Publishing Company.
Swinburn, B., & Vandevijvere, S. (2016). WHO report on ending childhood obesity echoes earlier recommendations. Public health nutrition, 19(1), 1.
The Hub by Superu. (2018). Actions to Encourage Healthy Weight and Healthy Lifestyles. Retrieved March 13, 2018 from https://thehub.superu.govt.nz/project/actions-encourage-healthy-weight-and-healthy-lifestyles
Utter, J., Denny, S., Teevale, T., Peiris-John, R., & Dyson, B. (2015). Prevalence and recent trends in overweight, obesity, and severe obesity among New Zealand adolescents. Childhood Obesity, 11(5), 585-589.
Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015). Overweight and obesity: prevalence, consequences, and causes of a growing public health problem and management. Current obesity reports, 4(3), 363-370.
Wolin, K. Y. & Petrelli, J. M. (2009). Obesity. ABC-CLIO.
World Health Organization. (2018). Obesity and overweight. Retrieved March 13, 2018 from https://www.who.int/mediacentre/factsheets/fs311/en/
Yofee, L. (2009). How to Avoid the Obesity Epidemic. Retrieved March 13, 2018 from https://www.everydayhealth.com/healthy-living/obesity-prevention.aspx
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