Non-communicable diseases

  1. State the two desired outcome(s) with baseline and target for your community obesity
    prevention project.

2. Describe SMART process, impact and outcome evaluation objectives you would use
to evaluate the outcomes of implementation of this policy.

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 7th 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, and 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.

Healthy People 2020. (2012).  Access to health care.G, Thompson D, et al (2010). An Evaluation Framework for Obesity Prevention Policy Interventions. Prev Chronic Dis 2012;9:110322. DOI:

 Frieden, T., Dietz, W., and  Collins, J. (2010). Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity. Health Aff March 2010 vol. 29 no. 3 357-363 doi: 10.1377/hlthaff.2010.0039 Nebraska Summary report (2014). Health care

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