Ethics Health Promotion Child hood Obesity Case Study

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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
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Community engagement
and information sharing
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Introduction
Childhood obesity is an adverse problem in the united states with 31.7 percent
of children being obese.

Obesity causes several health issues in children including both physical and
mental challenges like joint problems, heart diseases, high cholesterol, high
blood pressure and asthma among others
There has been an increase in the creation of awareness in the past few years
but many parents still have the challenge of determining obese children

Legal considerations in the health education
campaign
The following laws can be put into consideration:

•Americans with Disabilities Act (ADA)
•Breastfeeding Promotion program
•Deficit reduction Act
•Federal Trade Commission Act
•National School Lunch Programs (NSLP)

Stakeholders in the obesity health campaign
They include:






The nation...


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