Why the Public Health Systems Policies are failing

Obesity is one of the most prevalent chronic health conditions; and one of the most complex public health problems affecting over two-thirds of adult Americans. More than $35 billion is spent on weight-loss products and services annually but strategies for encouraging personal responsibility and effectively encouraging people to make healthy choices are failing. The public health system structures have failed to apply social cognitive behavior and Transtheoretical behavior models to their strategies which may help explain why many initiatives have failed.

The current public health mission which is a combination of public and private organization’s efforts joined to prevent disease, and promote healthy living. The current structure is typically divided into epidemiology (factors affecting population), biostatistics (raw data) and health services. Public health deals with preventive rather than cures and it is population based rather than individual based. The current public health method of addressing obesity through mass media health campaigns and support of health care and public health professionals does not appear successful.

The goal of these methods has been to motivate people to adopt specific behaviors. This approach falls short as it does not approach the root cause of the behavior thus not promoting a behavioral change. According to Tuffano and Karras (2005), two examples of the failure of public health communication interventions aimed at obesity are: o The largest-scale public health intervention attempted in Europe during the latter part of the 1990s was the Active for Life campaign, a three-year intervention that aimed to promote moderate-intensity physical activity as a part of everyday life.

The multi-faceted intervention ran from 1996 to 1999 and included a variety of mass media communication components, as well as a program of support to health care and public health professionals who worked to develop and promote localized community-based physical activity programs. Evaluation showed that, after three years, there was no evidence that the campaign improved physical activity, either overall or in any subgroup o The California Five-A-Day for Better Health Campaign and the former Health Education Authority (HEA) of England’s Active for Life campaign.

The California Five-A-Day Campaign was an intensive five-year statewide intervention aimed at promoting dietary behavior change by increasing the consumption of fresh fruits and vegetables. Program evaluation showed that knowledge and understanding of the importance of eating more fruits and vegetables increased substantially among Californians as a result, but this did not result in any measurable behavior change. There was no increase in fruit and vegetable consumption in any population group, and among Hispanic adults, consumption actually dropped by 18%.

The specific examples above are excellent examples of failure to account for human behavior and rationale. The first example may have been more effective had there been targeted tailored attempts utilizing the theory of social cognitive behavior employed. This theory suggests that people’s behaviors and decisions are often based on a variety of developmental or learned rationalizations often influenced by their environment (family, friends, workplace, neighborhood, and economics) as well as their genetics and mentality.

Even though there were community based activity programs, there is no mentioned of tailored programs which accounted for the environmental nuisances of that community. This has proven difficult from a public health standpoint to develop strategies that can be measured or will work on a national scale. The second example illustrates a failure to possibly utilize the decisional balance component of the Transtheoretical model which implies we adhere best that with which we are most familiar. The major task of public health intervention is to shift people’s decision tree or choice from unhealthy to healthy alternatives.

To prevent and treat obesity, the simplistic solution is that people must make concurrent choices of choosing to eat healthy and be more active. The Transtheoretical decisional balance implies that the prevalence of a particular behavior is reduced either by decreasing the reward value it produces or by increasing the value of competing activities (i. e. physical activity). Current public health structures have not on a large scale incorporated either of these theories in their strategies to combat obesity.

Also, exacerbating the issue is that 57.2% of American clinicians fail to advise their obese patients to lose weight during routine medical checkups. The State governments are supporting various approaches including the mass media campaigns and supporting healthy living initiatives. As a move in the right direction many states have also started to develop partnerships with private and public entities and health services organizations to prevent obesity. An example of this is a Healthy States Grant Program which provides funding for community and worksite wellness efforts.

It focuses on prevention through policy and environmental changes. Local governments are also starting to initiate obesity-related health promotion efforts such as mandating restaurants to provide increased nutritional information and improving the quality of food sold in schools and encouraging increased physical activities. Partnerships are also increasing in an effort to combat obesity as illustrated by the Alliance for a Healthier Generation, a partnership between the American Heart Association and the William J.

Clinton Foundation to fight childhood obesity. The organization’s goal is to empower kids nationwide to make healthy lifestyle choices, by targeting their environment: homes, schools, and community. The public health system structures have failed to apply behavior models to their strategies and initiatives are failing. However if public health structures expand the development of public education campaigns by targeting individual behavior and take actions now the impact of obesity can be lessened. References Levi, Jeffrey, Segal, Laura M, Gadola, Emily. (2007).

F as in Fat: How Obesity Policies are Failing in America. Retrieved from http://www. healthystates. csg. org/NR/rdonlyres/16BAD6F2-6F6B-4FC9-AA3B-2F81A63D374C/0/fasinfat2007. pdf Public Health (n. d. ) In Wikipedia. Retrieved from http://en. wikipedia. org/wiki/Public_Health Tuffano, James, Karras, Bryant. (2005). Mobile EHealth Interventions for Obesity: A Timely Opportunity to Leverage Convergence Trends. Journal of Medical Internet Research, volume 7, number 5. Retrieved from http://www. jmir. org/2005/5/e58