Ethics in Health Promotion Case Study
Power point 10 slides only
Must have a references page
Community Engagement and Information Sharing
Introduction to the Topic
The obligation to engage with the community arises out of public health’s population focus and is
the public health version of the informed consent procedure. Engaging with the community
involves information sharing but also gathering input from the community. Providing input and
having the sense that it is being given a fair hearing is crucial for the community to develop a
sense of shared responsibility and to support programs. Input should not end with the
implementation of a program, but should be ongoing. In the case of emergency preparation and
response, it is essential to engage the community in advance and establish strong relationships.
Democratic process depends on an informed community, while any relevant data obtained by
public health should be made available to the public. When programs contain potential risks and
benefits, the public should be informed and in some way give its consent to their implementation.
Transparency and clear communication expedite this democratic process, help build and maintain
trust, and facilitate accountability.
Case 1: Childhood Obesity Educational Campaign
Disclaimer: This case study is solely an educational exercise and does not necessarily reflect the
position of Centers for Disease Control and Prevention on this issue.
Background
Childhood obesity is a serious problem in the United States. Nearly one-third (31.7%) of children
in this country are overweight or obese. Childhood obesity rates across the nation have more than
tripled since 1980, increasing from 5% to 17%.1
Obesity poses numerous challenges for childhood health. Excess weight impacts children’s
mental and physical wellbeing and is associated with numerous conditions: breathing conditions
such as asthma and sleep apnea, joint problems and musculoskeletal discomfort, risk factors for
heart disease including high cholesterol and high blood pressure, and type 2 diabetes.2 In
addition, obese children are more likely than normal weight children to become obese adults,
leading to continued risk factors and disease.
Awareness of the magnitude and severity of childhood obesity has been increasing in recent
years. By 2010, 80% of Americans recognized that childhood obesity is a significant and
growing challenge.3 However, many parents still have difficulty determining whether or not their
child is at a healthy weight. While nearly one-third of children and teens are overweight or
obese, over 80% of parents think that their child is at a healthy weight.3 This problem is
particularly pronounced for overweight parents. They are both more likely to have an at-risk or
overweight child, and less likely to accurately assess their child’s weight--which limits their
ability to take action to promote their child’s health.4 Cultural influences also may affect parents’
perceptions of children’s weight, reflecting differences in values or beliefs about body size among
various ethnic groups.4
Health officials are particularly concerned that parents may lack the knowledge and skills
necessary to help their children maintain a healthy weight. This may indicate a broader issue of
health literacy in the population, described by the Institute of Medicine as “the degree to which
individuals have the capacity to obtain, process, and understand basic health information and
services needed to make appropriate health decisions.”5-6 Limited health literacy has broad
implications for health. It increases barriers to managing chronic illnesses, accessing care, and
receiving preventative services.7 Furthermore, while limited health literacy affects Americans of
all backgrounds, it disproportionately affects vulnerable populations, most notably, ethnic
minorities, some of those disproportionately affected by childhood obesity, and those with lower
socioeconomic status. To advance health literacy, the Institute of Medicine recommends
collaboration with the population of interest through the four Es: Engage, Educate, Empower, and
Enable. Collaborations to build the skills of health literacy can support population health across a
wide range of conditions.
Case Description
State health officials in State X have become particularly concerned about the impact of
childhood obesity on their communities. The state’s adult obesity rates are average with respect
to the rest of the country. However, the level of childhood obesity in the state far exceeds the
national average, suggesting not only problems for the health of today’s children and teens, but
also the future health of the broader population. One in five children in the state are obese,
ranking it in the top five states for childhood obesity. Furthermore, obesity disproportionately
affects minority populations in the state. While whites have an obesity rate of just over 25%,
rates for Latinos and African-Americans are substantially higher, at 31% and 40%, respectively.
The state health department has been asked to provide input on a health education campaign
being developed by an alliance of health advocates. The campaign has two goals: first, to use
social marketing to change social norms about healthy weight, the social desirability of physical
activity, and making healthy food choices; and second, to improve health literacy, particularly in
minority and lower socioeconomic populations.
The alliance is concerned that in today’s crowded media market, other media sources will
overshadow health promotion messages. The alliance wants to ensure that the childhood obesity
campaign not only captures the attention of the public, but also motivates individuals to change
behavior. To do this, the alliance is considering launching a public awareness campaign focused
around attention-grabbing advertisements that put a face to the health hazards associated with
childhood obesity.
Advertisements will depict overweight and obese children from the community engaging in
activities linked to obesity, such as consumption of less healthy foods (such as soda or other sugar
sweetened beverages) and sedentary activities such as playing videogames and watching TV. A
billboard, for example, might feature an overweight, sedentary child playing videogames,
surrounded by “junk foods”, with the tagline: “Childhood obesity—a game no one wins.” An
internet or TV video clip might offer testimonials from children about the ways obesity keeps
them from enjoying life, such as being picked on by their peers or playing in games at recess or
on sports teams.
The head of the alliance has contacted you, the local health director of the state’s largest city, for
your thoughts about whether to conduct the health education campaign.
Discussion Questions Must answer the question
1. Are there any legal considerations (e.g., laws or regulations mandating or prohibiting the
activity) that must be taken into account?
2. Who are the stakeholders that should be considered in deciding whether this health education
campaign should be put into place?
2.a What are the values and perspectives of each of these stakeholders in this decision?
3. As a local health director, what are some of the advantages and disadvantages of the proposed
social marketing strategy that you would consider in advising the alliance?
4. Should “shock messaging” be used to draw attention to health issues?
4.a What might be some of the unintended consequences of these messages?
5. What level of evidence of potential impact is necessary to justify the campaign?
6. What would be your recommendation to the alliance?
Scenario Shift
7. How might the following policy provisions change your view?
• Parallel advertisements will also be run which depict healthy-weight children engaging in
health-promoting behaviors, such as being physically active and eating fruits and vegetables.
• The health department will launch a new program to promote healthy eating and physical
activity within the community (increased funding/access to safe places for play, cooking
demonstrations and discounted or free fruits and vegetables, etc.).
Case References
1. Centers for Disease Control and Prevention. National Center for Health Statistics (NCHS).
National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department
of Health and Human Services,2007.
2. Centers for Disease Control and Prevention. Basics about childhood obesity. Available at:
http://www.cdc.gov/obesity/childhood/basics.html
3. Robert Wood Johnson Foundation’s Trust for America’s Health. F as in fat: How obesity
threatens America’s future, 2010. Available at:
http://healthyamericans.org/reports/obesity2010/
4. Doolen J, Alpert PT, Miller SK. Parental disconnect between perceived and actual weight
status of children: A metasynthesis of the current research. Journal of the American Academy
of Nurse Practitioners 2009;21(3):160-6.
5. Institute of Medicine. Health literacy: A prescription to end confusion. Washington, DC : The
National Academy Press , 2004. Available at: http://www.iom.edu/Reports/2004/HealthLiteracy-A-Prescription-to-End-Confusion.aspx
6. National Center for Education Statistics. The health literacy of America's adults: Results from
the 2003 National Assessment of Adult Literacy. Washington DC: US Department of
Education, 2006. Available at: http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483
7. Schillinger D, Keller D. The other side of the coin: Attributes of a health literate healthcare
organization. Commissioned Paper for the Institute of Medicine Roundtable on Health
Literacy. 2011. Available at:
http://www.iom.edu/Activities/PublicHealth/HealthLiteracy.aspx
Additional Resources for Module 5:
•
Blendon RJ, Koonin LM, Benson JM, et al. Public response to community mitigation
measures for pandemic influenza. Emerging Infectious Diseases, 2008;14(5)778-86.
•
Bruni RA, Laupacis A, Martin DK. Medicine and society: Public engagement in setting
priorities in health care. Canadian Medical Association Journal 2008;179:15-8.
•
Dickert N, Sugarman J. Ethical goals of community consultation in research. American
Journal of Public Health 2005;95:1123-27.
•
French PE. Enhancing the legitimacy of local government pandemic influenza planning
through transparency and public engagement. Public Administration Review
2011;71(2):253-64.
•
Gazmararian JA, Curran JW, Parker RM, Bernhardt, Debuono BA. Public health literacy
in America: An ethical imperative. American Journal of Preventive Medicine
2005;28:317–22.
•
Hanks CA. Community empowerment: A partnership approach to public health program
implementation. Policy, Politics, & Nursing Practice 2006;7(4):297-306.
•
Laverack G. Improving health outcomes through community empowerment: A review of
the literature. Journal of Health, Population and Nutrition 2006;24(1):113-20.
•
Roberts N. Public deliberation in an age of direct citizen participation. The American
Review of Public Administration 2004;34;315.
Tindana PO, Singh JA, Tracy CS, Upshur REG, Daar AS, et al. Grand Challenges
in global health: Community engagement in research in developing countries. P
Ethics and Health Promotion
Program Learning Outcomes
PLO 3: Demonstrate professional and ethical leadership inclusive of strategic
planning and decision-making skills.
Course Learning Outcomes
CLO 3. Implement ethical leadership practices and identify potential ethical
concerns in research and health promotion activities.
Module Learning Outcomes
3a. Identify and describe the implications and penalties associated with engaging
in unethical practices in an organization and/or research setting.
LoS Medicine 2007;4(9):e273
Purchase answer to see full
attachment