- State the two desired outcome(s) with baseline and target for your community obesity
prevention project. (5 points) - Choose and describe a strategy from IOM (2012) Accelerating progress in obesity
prevention: Solving the weight of the nation or CDC (2009) Recommended community
strategies and measurements to prevent obesity in the United States with a policy
component that you would support in your community to reach your desired outcomes
for a community obesity prevention project. (10 points) - Provide evidence to support the need for the policy in your community. This will
come from your community assessment data and your PRECEDE information. (15
points) - Provide evidence that this implementation of this policy would be effective as one of
the strategies to meet your desired outcome in a community obesity prevention project.
This evidence may come from some of your reading sources and from references within
these reading sources. (15 points) - Describe three community institutions/organizations/agencies/businesses you would
bring together to strengthen support for the policy. Provide your rationale. (15 points) - Describe how implementation of this policy may specifically reach a vulnerable
population in your community. (15 points) - Describe SMART process, impact and outcome evaluation objectives you would use
to evaluate the outcomes of implementation of this policy. (15 points) - Describe who would be responsible for voting on/passing the policy and who would be
responsible for enforcing it. This might be a government agency or a specific
institution/organization/agency/ business. This information should be based on your
knowledge of the policy making process. (15 points) - References (5 points) relevant, current
- Scholarly writing (10 points) APA, grammar, spelling, logical flow
Introduction
The non-communicable diseases consequences on the nation’s health and economy are
significant. Obesity is the major challenge of public health as it is associated as risk factor of
myriad chronic diseases such as diabetes, cancers and the cardiovascular diseases (Coggon,
2012). In the USA, the estimated costs associated with diabetes are approximately 147
billion dollars.
Most of the communities in the USA are characterised by unhealthy lifestyles such as poor
dietary and increased physical inactiveness. The issue of obesity in Scottsbluff’s town has
continued to escalate. According to the quality Health 2009 article about the fattest cities in
America, Scottsbluff was ranked as the 7 th city with the most obese population.
Approximately, 31% of the residents in this region are obese. Despite the increase resources
that promote physical activeness, residents are reluctance to exercise- i.e. suffers from
outdoor deprivation disorder. This calls for effective approaches that will help the resident’s
access and embrace healthy options (Datar & Chung, 2015).
IOM strategy of obesity prevention
Obesity effects on people’s health, health costs and community productivity is extremely
catastrophic if left unchecked. Nationwide, the toll of chronic diseases as well as disabilities
associated with disability costs about $190.2 million. This calls for an urgent need to
strengthen the prevention of obesity in the USA. In this reason, the strategy chosen is the
IOM accelerating progress in prevention of obesity (Healthy People 2020, 2012). This is
chosen because it evaluates thoroughly the goals as well as the recommendations that will
help accelerate the identification of risk factors as well as the recommendations that aids in
prevention of childhood obesity. This strategy is indicated by the evidence based research as
effective in addressing the complex healthcare issues. This is because the strategy provides a
systematic approach to the problem, allowing easy identification of the factors,
recommendations and in understanding the way these factors are important of implemented
collectively. This will strengthen the efforts of preventing obesity (Frieden, Dietz, and
Collins, 2010).
Some of the IOM recommendations include establishing policies in the community that will
ensure that physical activeness is routine part of every child and adult in the Scottsbluff
community. The strategy also supports the creation of environments that will help ensure
that healthy food are easily accessible and that are the routine choice for each resident of
Scottsbluff community. Other recommendations includes the activation of the organizations
as well as the health care providers to establish community based programs that will aid
emphasize support for healthy living choice; this includes the school based programs.
Research highlights that each of the recommendations identified would aid in reduction of
obesity if implemented individually, but if reinforced together, they speed up the progress
(Benator & Brock, 2011).
Community measurements and strategies for obesity prevention
As evidenced, obesity and its associated healthcare complications cause strain in the Nation’s
healthcare systems. We cannot afford to put on any more pounds and this challenge must be
turned around. According to literature, local policies have great influence on people’s daily
lifestyle choices. For instance, unsafe neighbourhoods could restrict physical activeness as
the children would remain indoors for insecurity reasons. Issues such as poor pedestrian
pavements impede the community efforts of cycling or walking to their places of work.
Similarly, inadequate grocery stores make it hard for the community to access fresh fruits as
well as vegetables (Rand, 2014). Therefore, policies that address these challenges will
facilitate the promotion of healthy lifestyles; thus reversing the obesity epidemic as indicated
below:
Local government plays a major role in prevention of obesity because most of the community
aspects that influence the community health is maintained and managed by the local
communities. Therefore, the local policies on maintain healthy environments and incentives
that benefit the Scottsbluff community. To target strategic investments; the local government
require to analyse the measures of environment that will dictate the most effective policy
level change. This includes the current conditions in the Scottsbluff community that need to
be improved for better health. In this context, out of the 24 strategies as well as measures
outlined by the CDC implementation as well as the measurement guide, three broad
approaches can be applied to strategically identify measures that can be used by Local
government (Leeman et al., 2010).
In this context, to identify the baseline assessment, the policies proposed were evaluated to
check whether they promote active and healthy lifestyles. More evaluations were made to
compare how similar policies have been effective in similar environments of similar
population structure and size. To identify the action priorities, the aspects of Scottsbluff
community that are in greatest demand to improve the health of the citizens were evaluated.
This aided in establishing the strategies that are believed are more needed by the Scottsbluff
community to reduce obesity and establish a healthier community (Dawson, 2011). Lastly, to
evaluate the effectiveness of the suggested policies; a yearly evaluation process since the
implementation process should be done, and the findings compared to the initial baseline
assessment for the community. This will aid in identifying if the policy change is
retrogressing or progressing obesity endemic in Scottsbluff community (CDC report, 2013).
The strategies described in this paper are product of intensive analysis of literature and
collaboration with local government experts. This helped in identification of broad range of
policy change strategies for prevention of obesity in this region. The results obtained were
reviewed, which enabled prioritization of the strategies based on transferability, effectiveness
as well as the sustainability. This also facilitated the process of nominating measures for
each strategy based on its utility, feasibility and validity. From this assessment; two policy
change were proposed including;
a) Establishment of food policies to reduce and prevent obesity in Scottsbluff community
b) Environmental policies that facilitate physical activeness in the community.
Evidence that support the policy change in the community
According to Centre for Disease Control and prevention (CDC), Scottsbluff community
health eating habits are poor. Approximately, only 22.9% of the people eat more than five
servings of vegetables and fruits. This is attributed to few grocery facilities in within the
vicinity. This causes healthy foods to be relatively higher as compared to unhealthy foods.
From my observations, the rates of fast foods are higher as probably than it should be.
Consequently, the obesity rates are high. This is also true about physical activeness; as
indicated by CDC. Some of the causes of physical inactiveness is outdoor deprivation
disorder where the residents opt to spend hours indoors watching TVs or on Social media as
their leisure activities. This is linked to high incidences of obesity in this region. The other
reasons I believe are attributable is technology conveniences that makes people to work
within the comforts of their home (Nebraska Summary report, 2014).
The environment in also seems not to support healthy lifestyles. The work schedules seem to
be very tight, such that the employees have limited time to work out or to make homemade
foods. This makes most family rely on outside foods. The other issue is that of oversized
food portions. The residents in this community are exposed to huge food portions; which are
all over the region. The fast foods are in every corner of the area including in the movie
theatres, supermarkets, gas stations and in home deliveries. This easy accessibility of fast
foods is associated with weight gain, especially if it not balanced with physical activeness.
Accessing healthy foods in the region is somewhat expensive, and not accessible in low
house hold incomes. Food advertising in the area is also a potential factor that has led people
to consume high calorie food. These ads target children- which seem to have been very
effective in swaying children into consuming them (CDC report, 2013).
Approximately, every 2 adults in 3 adults and every one in three children are overweight. The
CDC average rates of obesity and obese in Scottsbluff community is 34.8% and 32.1%
respectively. However, there are some disparities across the ethnic communities. I believe
this topic should be investigated in order to identify the cultural factors that could be
promoting obesity. Obesity is correlated with a myriad of non-communicable diseases. For
instance, cardiovascular disease is 29.6%; with 29.4 % of the population have high blood
cholesterol. According to the statistics, 10.7% of the adults in this community suffer from
diabetes, with at least 95.9% of the residents having multiple risk factors. Therefore, there is
need to implement the proposed policies (Nebraska Summary report, 2014).
Implementation of the policy
As indicated, obesity is one complex and stubborn issue that demands a bold and
comprehensive approach. To effectively manage it, actions must be done across all
individuals in the community and the society. In this context, various stakeholders should be
engaged across all levels and sectors of the society. This is important as obesity matters affect
people across all levels; and the stakeholders have contributions that are feasible and great;
which will help develop meaningful changes thereby accelerate the implementation of the
policy.
In this case; the following organizations would play a major role in policy change including
UNL Department of Nutrition and Health Sciences, Alliance for Healthier Generation and
Department of Administrative Services and Health fitness. Other organizations that are
involved in this process include Department of Health and Human Services, and Lincoln-
Lancaster County Health Department. The local representatives from these organizations
would be approached to strengthen and support the policy change. This is because these
individuals are involved in community health, and have the underlying statistics of the
menace, and understand the cost implications associated with obesity in the region (CDC
report, 2013).
Scottsbluff County will help reduce obesity as it will improve healthy food environment.
Notably, supersized food portions and much sweetened beverages are prime contributors to
obesity. Regulations of these foods can be done through three strategy includes a)
alteration of relative food prices, b) improvement of exposure of healthy food, c) shifting the
exposure to food. In this context, in the past decades, healthy food has increasingly become
expensive; making the junk food become cheaper. In this case, the policy changed proposed
is to increase the taxes of unhealthy food to make it more costly as compared to healthy
foods. The healthy food production should be minimized via subsidies. Reduced cost of
production could lead to lower costs of healthy foods making it affordable even to the
vulnerable people in the community. Research indicates that an increase by one cent on each
of ounce of sugar sweetened beverages, it will increase the cost of twelve once beverage by
10%; which is estimated to reduce 8,000 calories per capita; which prevents an average of
2.3% of weight gain (Leeman et al., 2012).
Food policies also ensure that there is increased availability of healthier foods especially in
public venues places such as child care centres, schools, theatres and at home. This will
improve healthier consumption of foods- preventing obesity. For instance in St. Paul
Minnesota begun a ‘Five a Day Power Plus Program’ facilitated increase of fruits and
vegetables in schools; where a fruit was served for each baked desserts. This strategy
promoted the perception of healthy foods among the children. The New York move in 2008
to set nutritional standards for the foods served in public services such as homeless shelters,
correctional facilities, schools, public healthcare facilities and parks caused significant
reduction of obesity in the region (Gostin, 2010). The nutritional standards demanded two
servings of vegetables and fruit. The standard demanded reduced salt content, taking healthier
beverages and increased intake of fibre. Setting nutritional standards policy that is aligned to
the dietary guidelines for American in Scottsbluff community will help manage the issue
amicably (CDC report, 2013).
The most ease approach to access healthy foods is in supermarkets. Supermarkets have
lower prices as compared to grocery stores. However, this is a limiting factor because the
vulnerable people in the community; whose household income is low have fewer
supermarkets as compared to the more affluent regions. The local government should
strategize on ways to manage this dilemma by either constructing new supermarkets in the
regions to establish systems that improve public transport to regions where food prices are
low. Similar strategies have been successful in Hartford and Philadelphia (Leeman et al.,
2012).
Zoning restrictions policies will help in elimination of high density of fast-food restaurants is
also effective in managing the issue of obesity. This includes the establishment of buffer
zones between the recreation areas and schools will help reduce easy access of the foods with
high calorie intake. Lastly, the proposed policy component is that of improving the image of
healthy foods. This can be done by regulating the advertisement of the unhealthy foods as
most of these adverts are inherently deceptive. This can be achieved through counter
advertisement. This entails advertising the true impact of unhealthy food. This has been
achieved in controlling other harmful lifestyles such as substance abuse and tobacco use. The
New York anti-soda campaigns have yielded substantial improvements in supporting intake
of healthy beverages (CDC report, 2013).
The issue of food policies have been emphasised in this paper because it is stated that healthy
body is as a result of 80% of what one consumes and 20% of physical activeness. Therefore,
food play integral role in obesity matters. However, physical inactiveness cannot be
overlooked as it significantly contributes to obesity. The local government must establish
policies that promote easier and safer physical activity. Interestingly, the Scottsbluff
community street design supports healthy environments. The sidewalks are well maintained
and the parks are well maintained. The main issue that should be addressed is strategies to
reduce sedentary behaviours; which could be adequately addressed using physical activity
programs at the work place and school based. The local government should state the
recommended physical activity programs that must be integrated in these facilities (Carroll &
Buchholtz, 2014).
Impact and outcome evaluation of the policy implementation
Impact and outcome evaluation is important because it guides the local government on the
effectiveness of the intervention by analysing the long term impacts. This is done by
analysing the residents behaviour change, improved health outcomes and the prevalence rates
for obesity. In this context, the local government involved will develop a customized
template to monitor and to summarize the identifiable outcomes (Bennett, 2010). In this
context, the community health assessment will be done using the health care facilities and
the local government’s Health Impact Assessments (HIAs). The specific data will be
analysed using GIS. The entire process will evaluated based L.E.A.D. (Locate evidence,
Evaluate it, Assemble it and Inform Decisions) framework. It will mainly be driven by the
information needs of the Scottsbluff community. I restrain to use a uniform method because
the local interventions of this community are diverse, but basically the evaluation will
comprise of information shown in table 1.
Outcome/effectiveness
Results or changes for community including family, organizations and other systems
Short term
Environment
Economic
Social
Physical
communication
Intermediate
Social norms
Unintended
consequences
Behavioural changes
Breastfeeding
Dietary intake
Physical activity
Long term impact
Public health impact
Health income at the
population level
Equitable distribution of
resources
Improvement cost
effectiveness.
Passing of the policy and its enforcement
Conclusion
References
Benator, S. & Brock, G. (2011).Global Health and Global Health Ethics, Cambridge
University Press, London.
Bennett, P. (2010). Risk Communication and Public Health, Oxford University Press,
London.
Carroll, A. & Buchholtz, A. (2014). Business and Society: Ethics, Sustainability, and
Stakeholder Management, Cengage Learning, New Jersey.
CDC report (2013). Strategies to Prevent Obesity.
Coggon, J. (2012). What Makes Health Public? A Critical Evaluation of Moral Legal, an
Political Claims in Public Health, Cambridge University Press, London.
Dawson, A. (2011). Global Heath and Global Health Ethics: Key Concepts and Issues in
Policy and Practice, Cambridge University Press, London.
Gostin, L. (2010). Public Health Law and Ethics: a reader, University of California Press,
California
Datar, A., & Chung, P. (2015). Changes in Socioeconomic, Racial/Ethnic, and Sex Disparities
in Childhood Obesity at School Entry in the United States. JAMA Pediatrics.
doi:10.1001/jamapediatrics.2015