Public Health - The Obesogenic Environment

Question 1

Which 5 ‘why’ questions would be asked in root cause analysis of obesity with respect to behavioural aspects?

Answer 1

1. Why did the patient put on weight?
2. Why was there an imbalance of energy intake vs. expenditure?
3. Why did she take the bus instead of walking?
4. Why could she not be bothered?
5. Why did she feel undervalued?

Question 2

Give examples of environmental factors which can affect obesity.

Answer 2

• ‘Walkability’ - especially access to shops and services; high residential density; pavements; public transport associated with residents meeting physical activity guidelines.
• Desnity of fast food outlets associated with overweight and obesity in children and young people.
• Interplay with other factors - one Australian study highlighted that high stress levels found in socially disadvantaged neighbourhoods were associated with poor weight management, less physical activity in leisure time, and frequent fast food consumption in women.

Question 3

What is the public health approach to a problem?

Answer 3

1. Surveillance - What is the problem?
2. Risk factor identification - What is the cause?
3. Intervention evaluation - What works?
4. Implementation - How do you do it?

Question 4

List the 10 core activities of public health.

Answer 4

• Preventing epidemics.
• Protecting the environment, workplaces, water and food.
• Promoting healthy behaviour.
• Monitoring the health status of the population.
• Mobilising community action.
• Responding to disasters.
• Assuring the quality, accessibility and accountability of medical care.
• Reaching out to link high risk and hard to reach people to needed services.
• Researching to develop new insights and innovative solutions.
• Leading the development of sound health policy and planning.

Question 5

Describe the inequality of obesity.

Answer 5

Obesity is more common among:

• People from more deprived areas.
• Older age groups.
• Some black and minority ethnic groups.
• People with disabilities.

Question 6

What is the role of public health in promoting healthy behaviour?

Answer 6

• Commission services that provide 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 policies, e.g. ‘sugar tax’.

Question 7

What is the role of public health in monitoring the health status of the population?

Answer 7

• Survey data on obesity rates in the population, including variation by, for example, sex, age, deprivation, ethnicity, learning disability.
• Data on risk factors for obesity, for example, 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, for example, diabetes, coronary heart disease, some cancers.

Question 8

What is the role of public health in assuring the quality, accessibility and accountability of medical and social care?

Answer 8

• Research into cost-effectiveness of health interventions.
• Evaluation of novel initiatives to promote healthy weight.
• Equality impact assessments of new policies or services.
• Engagement with third sector providers of care.
• Scrutiny advice and leadership in Health and Social Care Partnerships.

Question 9

What is the role of public health in reaching out to link high risk and hard to reach people to needed services?

Answer 9

• Identiying communities who struggle to access services.
• Making the extra effort to contact and engage with those communities.
• Consider an assets-based approach.
• Listen to their priorities.
• Then start to introduce discussion about ways to promote physical activity, healthy eating.