The cliché Health is wealth rings true for anyone and in any situation. As individuals address their own health concerns, governments endeavor to come up with policies related to health that would benefit all. However, even if such policies are intended to be for the common good, inequalities in the implementation of policies and still occur consistently.
Policies are created as guidelines for people to follow. With regards to public health a more general and thorough policy paper is presented to everyone so that not only are they ably guided about the rules and provisions of government but they also know what to expect. For this paper, the policy document to be analyzed with regards to a social problem is Healthy Lives, Healthy People: Our strategy for public health in England (2010).
May & Jochim (2013) explain that public policies provide benefits, regulate harms and deliver services (p. 426). In relation to politics, policies trigger the selection of people who are deserving and undeserving of its benefits. It also sets up a method to collect feedback from all sectors which could affect the political operations of the policy as well as its future changes and demands. Public policies are considered key in governance. Lowi (1972) simplifies it as policies beget politics (cited in May & Jochim, 2013, p. 427). Hence, policies may change with each term of incumbent politicians.
Healthy Lives, Healthy People (2010) is one example of policy document that claims to adopt changes from its previous platform. It presents the governments strategies for their programs in public health in England. It promotes a radical new approach that empowers local communities to implement the government initiatives to improve the health of their constituents and reduce the inequalities that exist. This means that the government will allocate funding for health programs and services to local government agencies as well as increase their accountability. Thus, integration and partnership working across care, the NHS and public health shall likewise increase (HM Government, 2010).
Grogan (2012) explains that in terms of ideologies, liberalism favors such radical transfer of power from the government to local communities. Liberals support individualism and the market mechanism that promotes competition. They prefer that the government play a minimal role in the implementation of health initiatives and instead provide equal opportunities to all local communities and non-government agencies in terms of the provision of education, health care, housing and nutrition programs. On the other hand, conservative-controlled governments have been known to spend less on social welfare and would rather keep the funds centralized in government stewardship.
Because it is in the interest of everybody, the government has taken the responsibility to ensure that everyone is healthy. The World Health Organization (WHO) (Sorte et al, 2011) defines health as a state of total physical, mental and social well-being, not just the absence of disease (WHO p. 286). If health issues arise such as health inequalities or some disease becomes prevalent in society, then it becomes a political issue. This is echoed by the government in the following statement:
a healthy population is fundamental to prosperity, security and stability a cornerstone of economic growth and social development. In contrast, poor health does more than damage to the economic and political viability of any one country it is a threat to the economic and political interests of all countries(Government HM 2008,, p.7).
Not only does ill-health weaken members of the population but it also depletes government funding, hence affecting its economic status.
One health problem that needs to be addressed is childhood obesity. The Department of Health (2013) reports that nearly 30% of children aged 2-15 are considered either overweight or obese, which is following the trend for overweight or obese adults (60%) in England. Obese children are at risk for high blood pressure, high cholesterol levels, orthopaedic problems, sleep apnea, diabetes, cancer, cardiovascular disease, among others (Snorof et al, 2004). It can also affect their activity levels and self esteem (DH, 2013). Such children can also be prone to social discrimination and are likely targets for taunts from peers and negative reactions from others. This may cause much psychological pain, lowered self-esteem and even depression at their very young age (Holmes, 1998). These negative effects pose to be detrimental to obese children, so the problem of obesity needs to be addressed early on to reverse the trend (Barnes, 2011). If not, the health problems may escalate and the risks can heighten as they grow up to be obese adults. Ignoring the problem leads to a great societal impact which concerns NHS because the burden and costs of health care provision for obese patients with various health complications fall on them (NHS, 2011). More importantly, it deprives obese children of their right to a quality of life that promotes their well-being. The Office of the United Nations High Commissioner for Human Rights (1989) declared that:
the child should be fully prepared to live an individual life in society, and brought up in the spirit of the ideals proclaimed in the Charter of the United Nations, and in particular in the spirit of peace, dignity, tolerance, freedom, equality and solidarity (para. 7).
That is why the government takes much effort and planning of policies aimed to optimize the health of everyone, most especially the vulnerable children.
Healthy Lives, Healthy People White Paper and The Marmot Review
This policy documents the governments strategic plans to ensure the health and well-being of people. It gives emphasis to providing better care for childrens health and development because these are key in improving their educational attainment and the reduction of mental health risks, unhealthy lifestyles, hospitalization and deaths (HM Government, 2010). It addresses the issue of health inequalities as reported by Professor Sir Michael Marmot in Fair Society, Healthy Lives (2010). This report acknowledges a social gradient in health, meaning that the poorer an individual is, the worse is his or health. Social inequality should not hinder the delivery of health care services to all. Action on health inequalities must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. Reducing health inequalities is vital to the countrys economy, and as one delays in addressing this issue, the costs to the economy continue to increase (The Marmot Review, 2010).
The Marmot Review (2010) presented six policy recommendations to target the reduction of health inequalities as follows:
Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure a healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill-health prevention
Healthy Lives, Healthy People (HLHP) responds to the Marmot Reviews recommendations and seeks to reduce health inequalities by cascading authority to implement programs to local communities because it is believed that local officials have a greater knowledge about the specific conditions of their constituents. With Marmots highest priority in their policy recommendation of providing children with the best start in life, HLHP shall invest to increase the accommodation of health visitors in public health centres partnering with the Family Nurse Partnership programme and the Sure Start Childrens Centres.
Over the years, government efforts to improve health initiatives for the poor have increased. It targeted a great reduction in health inequalities and improvement in health outcomes. Sure Start is a multi-agency working initiative established in 1999 to ensure the well-being and welfare of children. This organization implements the governments initiative to ensure the best start in the life of every child. Start brings together early education, childcare, health and family support services for families with children aged five and under. In line with the governments drive to fight child poverty and social exclusion, Sure Start works with parents and future parents, carers and other professionals working with children to promote the physical, intellectual and social development of babies and young children so they are readied for the challenges of school (Sure Start, 2009). Sure Start also networks with other service providers from the health, social services and early education sector as well as voluntary, private and community organisations to provide the necessary services for young children and their families (HM Government, 2006). Sure Start is one organization that shares the aim of breaking cycles of deprivation, closing achievement gaps in education between the privileged and the disadvantaged, endorsing better parenting strategies, enhancing child development, confronting poverty issues, promoting safeguarding and community cohesion and supporting healthier lifestyles and seeking opportunities for learning for all individuals (House of Commons, 2009).
Childhood Obesity Embedded in Health Inequality
The Black Report (1980) identifies the issue of health inequalities starting that ill health and mortality is related to social class but also more generally to the health differences between people in more or less favourable situations with respect to income, prestige (standing in the community) and education (p. 1). The House of Commons (2009) identify some causes of health inequalities as lifestyle factors that people adopt that make them and the people around them unhealthy. Some of these are smoking, poor nutrition, lack of exercise and sleep. Other determinants of poor health are poverty, poor or lack of housing, employment and education and limited access to healthcare. Children are vulnerable to parental influences on health habits and attitudes because they are dependent on their parents. Section 4 of the Childcare Act of 2006 mandates local authorities to improve outcomes for all children in reducing inequalities. It was suggested that provision of early years services should be a priority and these should be delivered in integrated ways that maximize the access and benefits to young children and their families (Armstrong, 2007).
Childhood obesity also follows the social gradient. Economic deprivation is a strange bedfellow of childhood obesity. One wonders how children of the poor can afford to eat so much to the point of obesity. This may be mainly due to the existence of obesogenic environments which encourage the consumption of unhealthy foods and the adoption of lifestyle choices over healthier ones (Jones et al., 2007). With the cost of high quality healthier foods, people from low social economic status resort to buying cheap foods often lacking in the right nutrients. The feeling of deprivation may drive obese children to eat more than they should. Like the law of supply and demand, individuals who have an abundance of good food do not see much demand in it, and therefore, just eats enough as compared to individuals who seek more food because they simply do not have enough.
Criticisms of the Governments Health Reforms
The Department of Health (2011a) of the English government claims to have updated its strategy on obesity in 2011 in continuation of the Healthy Weight, Healthy Lives (DH, 2008) policy commissioned under the previous administration. With the implementation of health policies, HLHP claims that progress is being made with regards to child obesity.
the rise among 210-year olds from 1 in 10 children in 1995 to almost 1 in 7 in 2008 appears to be levelling off. However, more than 1 in 5 children are still overweight or obese by age 3. Rates are higher among some black and minority ethnic (BME) communities and in lower socioeconomic groups. (HM Government, 2010, p. 19)
Although such report may be true, critics of this policy may doubt if such progress is directly due to the policy implementation. Since the main feature of HLHP is devolution of authority to local communities and multi-agency cooperation, sources of the cause of progress have increased. Parental awareness can be one of them, and because parents have become alerted to the risks of obesity, it is most likely that they have taken charge. It is also possible, though, that such awareness may have been borne from campaigns instituted by the government as part of HLHP.
The shifting of power to local authorities have shown marked changes in some programs. For example, the programme called Change4Life recruits families to participate in regular physical activity (Change4Life, 2011). Increasing physical activity and engaging in exercise helps to maintain a healthy weight. This marketing campaign has been criticized for not directly promoting awareness on obesity and being sponsored by food and drink companies which were considered unhealthy. Still, this initiative was endorsed by the government because it was believed to create balance between autonomous choices of adults while protecting children from an obesogenic environment. With the implementation of HLHPs shift in authority to more localized agencies, central government decreased its funding, changing it from a proactive central government marketing campaign for physical fitness to a light-touch brand available for sponsorship from commercial and independent partners (DH, 2011a).
The effects of HLHPs reforms in the provision of health services such as cuts in funding and less participation of central government in implementation are slowly being noticed by concerned groups (Penn & Kerr, 2014). Health professionals have been lobbying for taxation of products which are high in sugar and fat and for food and drink companies to significantly reduce calories on their products as well as well as recommended the banning of junk food advertisements (UKFPH, 2011). However, with due respect to the voluntary Public Health Responsibility Deal (DH, 2011b) which the government endorsed, food and drink companies were then asked to just lower the calorie content of their products. Penn & Kerr (2014) argue that while the governments actions shows respect for the autonomy and choice of people, it also frees it from responsibilities and leaves the bulk of the accountability to companies, local authorities and individuals. The UK Faculty of Public Health (UK FPH) agrees with this contention. This group of academic commentators criticized the government for being complacent with regards to tackling the problem of rising rates of obesity. They expect more upstream government initiatives to investigate the underlying causes of obesity such as obesogenic environments, exposure of children to unhealthy food advertisements, control and quality of school meals and food prices. They also expect less of downstream programmes that HLHP advocates, which encourage people to be more responsible for their own health and weight (UK FPH, 2011). Children who are at risk for childhood obesity are not yet reliable in assuming responsibility for their own food choices and frequency of physical activity to maintain a healthy weight. Hence apart from the influence of their families, schools and other social, environmental and economic influences, the government should take a more active stand in its advocacy to battle childhood obesity and intervene in alleviating health inequalities, as the Marmot Review has strongly recommended (Penn & Kerr, 2014).
Implications on Children
Being the most vulnerable members of the population, children need to be protected from threats to their health and well-being. The people around them, their parents, teachers, peers, and health advocates and government leaders should be dutiful in modelling healthy behaviours and attitudes to steer them in the right direction that prevents them from developing obesity. Parents should avoid creating obesogenic environments for their children, meaning they themselves should avoid unhealthy food and lifestyle choices as these are easily imbibed and copied by children. It is one of their main responsibilities to nourish their children with healthy and nutritious food and beverages that will help the children to grow and develop as healthy individuals. Such healthy practices should be consistently observed in all environments children are exposed to. Schools should have health promotion programmes in place which aim to inculcate in the students the value of adopting healthy practices such as eating right, exercising regularly, being well-groomed, having enough rest and visiting their doctors and dentists regularly.
The Healthy Lives, Healthy People policy claims to put children as their top priority in the provision of programmes that reduce health inequalities. The document presents all their good intentions in helping children have the best start in their lives and achieve a their optimal development. It takes on the challenge recommended by the Marmot Review in battling health inequalities. The government enjoins all parts of society to actively take part in pursuing their own health and well-being and foster collaborative partnerships with local communities and other agencies such as Sure Start, which actively addresses childrens rights to quality health services, care and education.
Because the policy is relatively new, its ambitious strategies for public health may often be criticized and regularly evaluated if they are being effectively carried out. Health advocates similarly have the best intentions in ensuring good health in everyone else so they keep a close watch on government efforts. Even without the mandate that individuals should be responsible enough to make wise lifestyle choices for themselves and their children, common sense dictates that all individuals in their right minds are expected to do this. However, it would greatly help if the presented strategies of the HLHP are truly put in place and appropriately delivered to the people especially those who are disadvantaged by health inequalities. HLHP should keep endorsing effective health programmes especially those for children which have been adopted by schools. Since it is in schools where children usually learn conformity to societal expectations, food choices in the cafeteria should be well-planned, leaving out junk food which contributes to childhood obesity. The curriculum should also emphasize the pursuit of healthy living and the encouragement of physical exercise.
People from the medical field, especially doctors and nurses who mainly advocate for childrens health should also take a more active stand in pushing for effective health policies. They are in a position to empower children and their families to adopt healthy lifestyles. Penn & Kerr (2014). Being vigilant in watching policy implementation unfold, nurses should support strategies that best serve childrens interests and speak out when they deem that they are not working well. With regards to the prevention of childhood obesity and the reduction of health inequalities in its management, an awareness of all factors contributing to obesity, coming from the environment, economics and society in general can help nurses support children and families better by providing informed, relevant and effective guidance to battle the illness