Identify a health initiative, critically and analytically discuss its potential for bringing about sustainable change
Introduction
Obesity has become a worldwide health concern. Obesity is one of the biggest health problems in the United Kingdom. It affects the whole society and has negative implications on the health and well-being of the people. This essay aims to explore the meaning of health and how the concept of health is being applied to health promotion. The study will focus on health promotion in adults with obesity in the United Kingdom. This essay seeks to identify the merits of individually focused health promotion, particularly behavioural change in solving the problem of obesity among adults in the United Kingdom. This essay will also outline the different tools and strategies that service providers are employing in order to facilitate behavioral change and promote health among people that are affected by obesity.
Health
Definitions of Health
Let us begin our discussion with the definition of health. Health, as most of us see it is merely the absence of disease. Let us view health from three different perspectives first is the Medical Model of health. The medical model of health is based upon the perspective of illness, disease and proper functioning (Larson 1991). Initially, the medical model defined health as simply the absence of disease. In the absence of disease, health exists (Chen and Bush 1979). Disease according to Blaxter (1990) is defined as deviations of measurable biological variables from the norm, or the presence of defined and categorized forms of pathology. This definition can be considered as the foundation of health and illness. However, this definition may be found lacking. Health is not merely the absence of illness. The Wellness Model is concerned with ‘better than normal’ states, as well as subjective feelings of health. Health is conceptualized as a state of feeling, the layman’s intuitive notion of health as physical wellbeing – comfort, energy and ability to perform (Greer 1986). It is optimal personal fitness for full, fruitful creative living (Goldsmith 1972). The third model is the Holistic Model. The holistic model encompasses the whole person, including physical mental and social health. The holistic model defines health as the health of a whole person including physical but also extending to mental and social aspects of health (Larson 1991). Health, as defined by the World Health Organization (1946) is a state of complete physical, social and mental well-being and not merely the absence of disease and infirmity. Lalonde (1974) presented a new and comprehensive perspective on health that is consisting of human behaviour, environment, and lifestyle and healthcare organizations. Lalonde believes that health an individual’s health is greatly affected by his or her lifestyle. The World Health Organization (1986) defined health as the extent to which an individual or group is able, on the other hand to realize aspirations and safety needs; and on the other hand, to change or cope with the environment. WHO added that health must be seen as a resource for everyday life and not merely the objective of living (cited in Macdonald 1998, p. 25).
Health Promotion Initiative in Adults with Obesity
What is Health Promotion?
Health promotion is considered as a vital part of public health. Health promotion is a unifying concept that brought together different fields of study. Today, health promotion is a part of the health services of most industrially developed countries. Health promotion addresses health care issues of today by contributing to newer approaches to health improvement, whole population programmes, health impact assessment, investment for health projects, capacity building, community planning and involvement, and evidence-based practice.
Health promotion, broadly defined, is a strategy for promoting the health of whole populations. Health promotion strategies are greatly affected by individual and structural elements. The individual approaches to health promotion aims to identify and reduce behavioural risk factors associated with morbidity and premature death. The structural approaches focus of macro-social and political processes of health promotion (Tones 1983; WHO 1984: Tannahill 1985; Kickbusch 1997; Bracht 1999; Griffiths and Hunter 1999 cited in Macdonald and Bunton 2002, p. 10).
How Does the Health Promotion Initiative view Health?
The definitions above present a picture of health that is holistic. These definitions view health in its social context. The definitions emphasize social and personal resources as well as physical capacities (Macdonald 1998). The health promotion initiative in adults with obesity in the United Kingdom views health as greatly affected by an individual’s lifestyle. Obesity is largely seen as a product of unhealthy lifestyle choices.
Obesity in Adults
Obesity is now a leading cause of illness and death. According to Leonard (2002), the cause of obesity is the imbalance between the energy we consume and the energy we expend. Obesity is also linked to poverty and social deprivation (Marsh 2004). The Office for National Statistics (2004) in the United Kingdom has reported that obesity is linked to social class. Obesity as studies show is more common among those in the routine or semi-routine occupational groups. The increase in number of fast food restaurants are seen as one of the cause of obesity in the United Kingdom. Schlosser (2002) wrote, the obesity epidemic, which is so evident in the United States, has spread to Britain, and fast food restaurants are often blamed for it. The obesity rates among adults have doubled from 1884 to 1993 (cited in Debris 2005).
Individually Focused Health Promotion
Beattie (1991) characterizes this kind of health promotion as being focused on the individual, either controlled in an authoritarian manner by people who claim expert status, or negotiated using techniques such as education and counseling. Individually focused health promotion emphasizes that the responsibility for ensuring good health rests with the individual.
Unhealthy lifestyle is often blamed for the emergence of obesity in the United Kingdom. Lifestyle and health are inextricably linked, and that in order to bring about improved prospects for health it is necessary to restructure the damaging effects of unhealthy lifestyles (Parish 1995). The Ottawa Charter of 1986 defined health promotion as the process of enabling people to increase control over, and to improve, their health (WHO 1986). Individually focused health promotion aims to produce behaviour change in a particular direction in order to impose a state of perfect health, but to help people to be as healthy as they wish to be. The key principle of individually focused health promotion is empowerment (Tones and Tilford 1994).
Individually Focused Health Prevention: Behavioural Change
The key elements of successful behavioural change are frequent contact and support. Weight loss plans move through various stages:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
Patients need help to make plans with achievable goals. Commonly used techniques, such as self-monitoring, identifying internal triggers for eating, and the creation of coping strategies, can help with behaviors change. These techniques have been incorporated into the Counterweight Programme, which is one of the most successful weight management and primary care initiative in the United Kingdom. There are evidences that these techniques aid in weight loss and maintenance. In order to build better habits, prompts and reminders are used. When there is a lapse, the health professional together with the client plans in order to successfully deal with the experience in the future. The giving of rewards should be well planned and evidences of the benefits such as reduction on cardiovascular risk factor that the client will gain through the health initiative can be helpful. A diary of food intake and physical activity can prompt discussion about situations that led to particular behaviour, so that strategies can be planned.
Behavior Therapy Strategies
Individually focused health promotion aims to change the patient or the client’s attitude and behavior. Obesity is widely seen as a lifestyle disease. With the help of the health professional, the client undergoes a program that will help him to acquire knowledge and information about the health problem. There are different strategies that help change the patient’s behavior.
1. Self-Monitoring
Self-monitoring is the most important of all behavioral interventions. It involves self-observation, self-recording, and feedback of relevant behaviors by the patient. The purpose of self-monitoring is to raise the patient’s awareness of eating and physical activity behaviors and the factors contributing to them. It includes the use of a food diary in which the patient writes down all foods eaten and the conditions or situations in which the eating occurred. The diary can be a simple, inexpensive notebook. The recording ideally should be done as soon as possible after the food is eaten. The feedback can include looking up and recording the number of calories or fat grams that each food contained. The patient should do the recording and the feedback, followed by reinforcement from the physician or behavioral counselor. In addition to recording food consumed, other behavioral patterns to write down might include time of day the food was eaten, where the food was eaten, mood state, and who else was present. The physician or behavioral counselor can then look at the diary and help identify patterns that might need to be changed. Physical activity can be recorded in the same diary. Minutes of activity, along with time of day, are usually best to record. The physician can help reward consistency, trying to build a habit of daily brisk walking.
2. Stimulus Control
Stimulus control involves identifying and modifying the environmental cues or barriers that are associated with the patient’s overeating and under activity. By changing the cues, the patient may be more likely to be successful in managing eating and physical activity. Controlling these cues (stimulus control) may help the patient long term because their exposure is frequently related to relapse.
3. Goal Setting
Realistic goal setting, involving separating short-term goals from long-term goals, is important in preventing discouragement in the patients. In goal setting, it could be more advantageous to focus on short-term goals and reinforcing small positive behavioural changes.
4. Problem Solving
Losing weight involves having to learn to manage emotional issues and social events. Problem solving involves identifying and managing these situations (Lombard et al 1995).
5. Cognitive Restructuring
Cognitive restructuring involves helping patients change their inaccurate beliefs about weight loss. Cognitive restructuring encourages patients to examine their thoughts and feelings about themselves with respect to their obesity. It challenges them to change the ones that are inaccurate. Their lives may not change significantly when they lose weight. It is important to help patients understand why it is important to lose weight, such as for better health, than for unrealistic reasons (Foreyt and Paschali 2001).
Which Determinants of Health does the Initiative attempt to address?
There are different factors that affect the health of a person. The circumsatances and the environment in which a person finds himself affect his health. Factors that have significant impact on health include the state of his environment, the place where he lives, his family background, his income and education level and his relationship with his family, friends and the people around him. The determinants of health are the following:
1. The social and economic environment
2. The physical environment
3. The person’s individual characteristics and behaviors (WHO 2008)
Individually focused health promotion initiatives attempt to address individual characteristics and behaviors. Through individually focused initiatives such as behavioural change, health education and empowerment, health is promoted among individuals.
Does the Initiative address Inequalities in Health?
The individually focused health promotion is primarily concerned with changing behaviour and promoting healthy lifestyle choices. However, the policy is also initiative is also geared at finding ways to make healthful choices easier for consumers and producers. The initiative is tied with different government and community initiatives. Personal behaviour patterns are not simply free choices about lifestyle, isolated from their social and economic context. Lifestyles, rather, are patterns of choices made from the alternatives that are available to people and influenced by the ease with which they are able to choose (Milio 1985). Individually focused initiatives are aware that inequalities exist. It has been found obesity is more common among lower social groups.
Despite the effort to bridge the inequalities is health, the “lifestyle choices” model of individually focused health promotion tend to look at the health problem as a lifestyle choice of an independent consumer. However, it must be taken into consideration that marginalized individuals and those low-income workers are often the sufferers of health problems.
Which Need does the Initiative Addresses?
The health initiative is applicable to Normative Needs. Normative needs are determined on the basis of research, professional opinion and value judgments. Different studies and researchers in the United Kingdom and in many parts of the world, reveal that Obesity has become a health epidemic that has tremendous effects on the individual, the community and the society.
What is the level of Prevention?
The level of prevention is at the primary and secondary. The approach of changing behaviour is more effective in the primary and secondary levels. Food preferences and behaviour are learnt from childhood onwards and become an integral part of how individuals identify themselves as socio-cultural beings (Lupton 1996). The choice of food that individuals eat is shaped by factors such as ethnic heritage (Helman 1984), financial status (Driver 1984) religious beliefs (Mares et al 1985) as well as personal preferences (Lyman 1989). Empowering individuals to make healthy dietary choices is an important aspect of health promotion as the self-care level. It is frequently felt by individuals that they have little control over many of the factors that determine their health, including the availability, accessibility and affordability of healthy foods (Kemm and Close 1995). However, the efforts people make to deal with their health concerns by working together, could involve people supporting each other emotionally, sharing ideas, information and experiences (Epp 1986). This mutual help may emerge within a family, a neighborhood, from a voluntary organisation or within a self-help group.
Individually focused health promotions on Obesity aim at prevention and management of lifestyle choices. Although these initiatives are considered effective. There are some members of the community who fail or resist to be treated. This is sometimes because of their social status. There are studies that reveal that low income groups tend to make the least use of preventive medicine and health education despite being in the poorest health conditions.
Are the Aims and Objectives clear?
The aims and the objectives of the initiative are clearly stated. The initiative aims to change behaviour and to promote healthy lifestyle among adults with obesity. The objective of the initiative is to encourage and convince individuals to take action regarding their health. The objective of the initiative is to educate, empower, support, monitor and manage individuals who seek help.
Which Quadrant of Beattie Model is used?
The personal counseling quadrant was used to assess the health promotion initiative. Beattie’s (1991) framework identifies health promotion activities around the dimensions of authoritative/negotiated and individual/collective. The initiative is primarily individual/collective.
Critical Analysis using Beattie Model
According to Beattie Model of health promotion, health promotion is essentially individually focused. This can be done either in an authoritarian manner by people who claim expert status of the health problem or through negotiation and techniques such as education and counseling. Individually focused health promotion initiatives on Obesity in the United Kingdom are negotiated with the responsibility of good health resting on the individual.
Perhaps one of the weaknesses of individually focused health promotion, according to its critics is its failure to take into account the structural constraints on people’s lives. There are evidences that health promotion campaigns become unsuccessful because it fails to take into account the environmental and social factors that are sometimes out of the individual’s control. For example, there are studies that obesity is linked to social status. Most poor families are at risk of obesity. Individually focused health promotion proposes that health problems such as obesity are the result of wrong lifestyle choices. Its critics argue that poor families have no or little choice and there are factors that hinder them from making the right choices. Programs that aim to achieve individual behavioral change simply through persuasion is also seen as flawed and unsuccessful. This is because such campaigns construct health problems such as obesity as a lifestyle choice, rather than understanding it within a material and cultural framework incorporating an analysis of class, gender and other inequalities. Critics of the individual approach have highlighted the limitations of the “lifestyle choice” model in which people are seen as consumers exercising market choice between healthy and unhealthy products (Naidoo 1986). Some people, particularly those who are marginalized and belong to low income families are rather hard to be categorized as independent consumers. Members of low income groups tend to make the least use of preventive medicine and health education experiencing the poorest health (Townsend et al 1988).
The increased use of market analogies in health and welfare in recent years has reinforce the “lifestyle-choice” model, which offers most to those with the economic and political resources with which to exercise meaningful choices. At the same time, inequalities in society have widened, as a result of increased unemployment and flexible working patterns including casual, part-time and low-paid employment (Brown and Scase 1991). This has led top the marginalization of some groups for whom deprivation is increasingly recognized as a critical influence on health-related behavior (Marsh and McKay 1994; Phillimore et al 1994).
Perhaps one of the most criticized areas of individually focused health promotion is its tendency to blame the victim or the patient of the health problem. Because individually focused health promotion essentially believes that health is the responsibility of the individual and health problems arise because of the unhealthy choices that the individual makes, it sometimes fail to deal with the real issues. Marginalized citizens according to Kenner (1985) often find themselves unable to make healthy choices, because the choices most readily available represent unhealthy options.
If the victim-blaming approach of individually focused health promotion is criticized some areas of the approach are considered effective and essential. These areas include counseling whether individually or in groups, health education, empowerment and consultation. Counseling and other techniques may be useful interventions. These techniques are likely to appeal to health professionals who wish to work in supportive non-authoritarian ways. Whether authoritative or negotiated, individually focused health promotion needs to consider the broader issues in promoting health. Telling the patient to select healthy food items may be problematic if the pressures that lead to unhealthy food choices are not determined and analyzed.
Conclusion
The discussion above points out that health promotion among adults with obesity is among the top priorities of the British government. Obesity is one of the biggest problems in the United Kingdom. It has negative effects on individuals, the community and the society. In order to solve the problem, the government and its agencies, health and private organizations, local governments, communities, schools and other concerned bodies are cooperating in the promotion of health. One of the most notable health promotion initiatives is individually focused health promotion that seeks to change behaviour, educate and empower. Individually focused initiates aim to encourage individuals to take responsibility for their own health, with the assistance and support from the government, the community and the health service providers.
References
Avenell, A, Sattae, N and Lean Mike (2007) ABC of Obesity, Management: Part 1 – Behaviour Change, Diet and Activity, BMJ, viewed 15 March, 2008 <http://auraserv.abdn.ac.uk:9080/aura/bitstream/2164/134/1/bmj7571.pdf>.
Blaxter, M (1990) Health and Lifestyles, Routledge, London.
Brown, P. and Scase, R. (eds) (1991) Poor Work: Disadvantage and the Division of Labour, Milton Keynes: Open University Press.
Chen, M and Bush J (1979) ‘Health Status Measures, Policy, and Biomedical Research’, in S Mushkin and D Dunlop (eds.), Health: Is It Worth It? Measures of Health Benefits, Pergamon Press, New York.
Debres, K (2005) ‘Burgers for Britain: A Cultural Geography of McDonald’s UK’, Journal of Cultural Geography, vol. 22, no. 2, pp. 115+.
Foreyt J P, Poston W S C (1999) ‘The Challenge of Diet, Exercise and Lifestyle Modification in the Management of the Obese Diabetic Patient’, International Journal of Obese Related Metabolic Disorder, vol. 23.
Foreyt, J and Paschali (2001) ‘Behavior Therapy’, in P G Kopelman (ed.), The Management of Obesity and Related Disorders, Martin Dunitz, London.
Goldsmith, S (1972) ‘The Status of Health Indicators’, Health Service Reports, vol. 87, no. 3, p. 213.
Green, L W and Kreuter, M W (1991) Health Promotion Planning: An Educational and Environmental Approach, Mayfield, Toronto.
Greer, A (1986) ‘The Measurement of Health in Urban Communities’, Journal of Urban Affairs, vol. 8, p. 11.
Health Impact Assessment: Evidence Base of Health Determinants 2008, World Health Organization (WHO), viewed 15 March, 2008 <http://www.who.int/hia/evidence/doh/en/index1.html>.
Kenner, C. (1985) No Time for Women, London: Pandora Press.
Lalonde, M (1974) A New Perspective on the Health of Canadians, Ottawa, Canada.
Larson, J S (1991) The Measurement of Health: Concepts and Indicators, Greenwood Press, New York.
Leonard, W R (2002) ‘Food for Thought’, Scientific American, vol. 287, no. 6, pp. 106-111.
Lombard D, Lombard T, Winett R (1995) ‘Walking to Meet Health Guidelines: The Effects of Prompting Frequency and Prompting Structure’, Health Psychology, vol. 14, pp. 164-70.
Macdonald, T H (1998) Rethinking Health Promotion: A Global Approach, Routledge, London.
Macdonald, G and Bunton, R (2002) ‘Health Promotion: Disciplinary Developments’, in R Bunton and G Macdonald (eds.), Health Promotion: Disciplines, Diversity, and Development, Routledge, London.
Marsh, S. and McKay, S. (1994) Poor Smokers, London: Policy Studies Institute.
Marsh, P (2004) Poverty and Obesity, viewed 15 March, 2008
<http://www.sirc.org/ articles/poverty_and_obesity.shtml>.
Naidoo, J. (1986) ‘Limits to Individualism’ in S. Rodmell and A. Watt (eds) The Politics of Health Education, London: Routledge and Kegan Paul.
Parish (1995) ‘Health Promotion Rhetoric and Reality’, in R Bunton, S Nettleton and R Burrows (eds.), The Sociology of Health Promotion: Critical Analyses of Consumption, Lifestyle, and Risk, Routledge, New York.
Phillimore, P., Beattie, A. and Townsend, P. (1994) ‘Widening Inequality of Health in Northern England, 1981-91′ British Medical Journal, 308, 1125-8.
Rodmell, S and Watt, A (eds.) 1986, The Politics of Health Education, Routledge, London.
Schlosser, E (2002) Fast Food: The Dark Side of the All-American Meal, Perennial, New York.
Tones, K and Tilford, S (1994) Health Education, Effectiveness, Efficiency and Equity, Chapman and Hall, London.
Townsend, P., Phillimore, P. and Beattie, A. (1988) Health and Deprivation: Inequality and the North, London: Routledge.
WHO (1986) Ottawa Charter For Health Promotion, WHO, Geneva.
WHO (1986) ‘Lifestyles and Health, Regional Office for Europe, Health Education Unit’, Social Science and Medicine, vol. 22, no. 2, pp. 117-124.
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