Obesogenic Environment and Race, Ethnicity and Health

Question 1

What is the consensus with obesity and general harm in the form of diseases (co-morbidities)?

Answer 1

Obesity harms health as multiple morbidities associated with obesity of which may be very wide-ranging

Question 2

What is the epidemiological trend of obesity e.g. USA? Is this ubiquitous?

Answer 2

Obesity increasing ≈ greater proportion of patients obese ≈ multi-morbidities

Question 3

Is obesity a growing problem and why?

Answer 3

Worldwide prevalence ≈ ubiquity of fast-food revolution, reduced agricultural quality (growing global population) + portion sizes increasing as well as availability and normality of calorie-dense foods 

- Growing prevalence 

- Fast-food revolution

- Reduced agricultural quality

- Portion sizes

- Availability + normality of calorie-dense foods

Question 4

What is the obesogenic environment?

Answer 4

sum of complex interactions of surroundings, opportunities, condition of life ≈ physical environment; food environments; society; media; infrastructure; psychological; developmental ≈ increase obesity in individuals

Question 5

List the main components of the obesogenic environment.

Answer 5

• Built environment 

• Food environments
  
- Society
  
- Media

• Infrastructure

• Psychological
  
- Developmental

Question 6

What is the relationship with media and obesity?

Answer 6

Media: Education, media consumption, media availability, peer pressure, importance of body-size image

Question 7

What are some influencers of physical activity?

Answer 7

Activity: domestic activity, occupational activity, recreational activity, functional fitness, social depreciation of labour and Infrastructure: safety of unmotorised transport, dominance of motorised transport, walkability of living environment, ambient temperature

Question 8

What are some environmental factors?

Answer 8

• Walkability = access to shops and services; high residential density; pavements; public transport associated with residents meeting physical activity



- Density of fast food outlets associated with overweight and obesity in children and young people 



• Interplay with other factors - one Australian study showed high stress levels found in socially disadvantaged neighbourhoods were associate with poor weight management, less physical activity in leisure time and frequent fast food consumption in women

Question 9

What is public health?

Answer 9

‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private communities and individuals’ - CEA Winslow

Question 10

What is the public health approach?

Answer 10

Identifying the problem and endeavouring to reach the response through: surveillance, risk factor ID, intervention, evaluation and implementation



Problem: Defined and identified issue 



Risk factor: increasing likelihood of disease 



Intervention: aetiology ≈ intervention (vice versa)



Measurability: measures to bring about ∆

Question 11

What is the distribution of obesity in adults in Scotland amongst the most and least deprived?

Answer 11

Data shows a disparity and inequity in wealth/deprivation and obesity incidences (percentage of population obese). The gap between level of obesity in the 20% most ad least deprived areas in Scotland is bigger for women than men but the size of the gap has not changed much since 1995 thus inequality still plays a part in obesity

Question 12

What is the distribution of obesity in adults in Scotland for children in the most and least deprived 20%?

Answer 12

Obesity risk has increased for children aged 2-15 and in the most deprive areas sine 1998

Question 13

Is life expectancy strongly associated with deprivation?

Answer 13

Yes, life expectancy is strongly associated with deprivation as shown by SIMD1 (most deprived) having a life expectancy of 76.7 and 71.3 (females and males) to SIMD5 (least deprived) 84.5 and 81.9 (females and males)

Question 14

How can you promote healthy behaviour in public health at a macroscopic level?

Answer 14

• Commission services providing support for struggling families to access fresh food 

• Qualitative research into what motivates people in specific communities to take up exercise 

• Support for national and local campaigns 
- Targeting resources for maximum health benefit - proportionate universalism 
- Lobbying government for changes to laws and policy e.g. sugar tax

Question 15



How can you monitor the health status of the population?

Answer 15

• Survey data on obesity rates in population, including variation by e.g. sex, age, deprivation, ethnicity and learning disability 

• Data on risk factors for obesity e.g. physical activity levels, alcohol intake 
- Direct measurement
• National Child Measurement Programme in England and Wales 

• Data on illnesses for which obesity is a risk factor e.g. diabetes, coronary heart diseases, some cancer

Question 16

What is 4-P medicine in Public Health?

Answer 16

1. Personalised: right for individual and tailored to their disease and circumstances 

2. Predictive: what will happen to this person, not the general %s 

3. Preventive: best way to avoid the fallout from many diseases but all too easily forgotten as we chase technological solutions 

4. Participatory: patients and healthy public involved in their own preventive and management strategies

Question 17

What is race?

Answer 17

Division of species into groups based on frequency of hereditary traits ≈ phenotype

Question 18

What is ethnicity?

Answer 18

Social division of people into groups based on their identification with shared origin


Question 19

List 3 following ways by which people may be divided socially (ethnically).

Answer 19

- Language 

- Food 

- Religion 

- Clothing 

- Myths 

- Traditions

- Music 

- Art

Question 20

What is the relationship between race and ethnicity?

Answer 20

Race is a biological and genetics approach whereas ethnicity is socially produced 



1) Biological: Biological division of species into groups based on frequency of hereditary traits 


2) Social: Social division of people into groups based on their identification with shared origin

Question 21

What is naive biology?

Answer 21

A historical assumption that physical differences between people of different ancestry are a stable grouping.

Question 22

What is a cline?

Answer 22

Measurable gradient in a single character or biological trait of a species which are gradual gradients across space. Spaces of rapid change are geographic boundaries but even these are clines rather than distinct groups

Question 23

What is naive biology?

A. Measurable gradient in a single character or biological trait of a species which are gradual gradients across space.

B. Historical assumption that physical differences between people of different ancestry are a stable grouping

C. Re-racialisation of medicine

D. Biological division of species into groups based on frequency of hereditary traits 


Answer 23

B. Historical assumption that physical differences between people of different ancestry are a stable grouping

Question 24

What is an example of race in medicine?

What flaws may exist in this?

Answer 24

Re-racialisation of medicine in discovery of BiDil which showed no significant improvement in treatment of white patients but benefited Black patients for heart failure

Flaws:

- Black (race)?

- Poverty

- Stress

- Genetic differences in the ACE gene due to selection

- Where do you draw the line of ‘black’ e.g. Ethiopians or South Indians?

Question 25

What are the main patterns of racial/ethnic inequality in health and illness and debates about their causes?

Answer 25

• Worse health: ethnic minorities < white
  
- Socioeconomic inequality: ethnic minority < white 

• Racism increased: poorer ≈ increased likelihood of racial harassment
  
- Gender variation: Men (white Irish, mixed white-black Caribbean, gypsy/Irish traveller) vs Women (Bangladeshi, Pakistani and Gypsy/Irish traveller)
  
- Age: differing patterns of health inequalities for different racial groups
  
- Generation: Socio-economic improvement however if controlled for socio-economic status, worse health of second generation cf first
  
- Specific health condition: e.g. Thalassaemia for people of more common among Cypriots, South Asians and Chinese but also occurs among African-Carribean people 


Question 26

What problems do these complex ‘risk’ groups of race and ethnicity create with screening policies?

Answer 26

Complexity may not be represented in current efforts at thalassaemia screening which are ad-hoc and rely on crude and stereotyped measures of racial/ethnic profiling


- Screening people: Crude Race


- Rigid and unidimensional view about who is eligible for screening: de novo mutation/complex inheritance pattern

Question 27

What form of racism surrounds consanguinity and what is the result of this?

Answer 27

Cultural racialism is strongly associated with consanguinity debates.

Question 28

What critiques can be made of cultural competency training?

Answer 28

• Lack of discussions with racism 

• Cook book approach - narrow-focused and doesn’t account for sub-ethnicities and regional differences 

• Cultural safaris can advocate supremacy or ‘White saviour’ approach

Question 29

Which of the following is not a critique made of cultural competency training?

A. Lack of discussions with racism 


B. Cook book approach - narrow-focused and doesn’t account for sub-ethnicities and regional differences 


C. Forcing views of equality into the workforce, impeding free speech and thought

D. Cultural safaris can advocate supremacy or ‘White saviour’ approach

Answer 29

C. Forcing views of equality into the workforce, impeding free speech and thought

Question 30

Outline the key differences between Cultural competency and Cultural humility.

Answer 30

1) Cultural competency:

- Mastery of finite body of knowledge and information

- Endpoints defined by exams 
- Commitment to competency

2) Cultural humility:

- Assess new cultural dimension of each patient 

- Engage in self-reflection

- Check power imbalances in clinical relationship 

- No end-point 

- Commitment to social justice