Policy and Evaluation in Public Health Discussion Paper

Over the years, childhood obesity has not only become a significant global public health concern, but also an enduring clinical and public health priority throughout the 21^st century (Noonan, 2018). Across developed countries such as the UK, childhood obesity has reached epidemic levels with the NHS reporting one of the highest annual rise in the obesity rates across reception-aged and year 6 schoolchildren of about 4.5% between 2019 and 2020 (NHS Digital, 2022). Statistics on obesity published by the House of Commons Library show that 9.9% of children aged 4 -5 years are obese with 13.1% being overweight while 21% of children aged between 10-11 being obese and 14% being overweight (Baker, 2019). With child obesity contributing to increased rates of obesity during adulthood, 70% of these obese children are likely to grow into obese adults. Childhood obesity has also been recognised as a risk factor for adult cardiovascular diseases and type-2 diabetes, in addition to being a strong predictor of mortality (Noonan, 2018). It is for this reason that different efforts and policies have been put in place by the UK government in a bid to help with the situation and maintain a healthy population with “Childhood obesity: A plan for action” being the most notable one. This essay provides a critical analysis and evaluation of this public health policy in terms of how and why it was developed, its impact in terms of meeting the public health of children and how it can be improved to better help them.

Background

Policy, according to the Centre for Disease Control and prevention can be defined as either a voluntary practice, incentive, administrative action, procedure, regulation or law by government and other institutions often reflected in the form of resource allocations (Centers for Disease Control and Prevention, 2015). In the UK, policies are developed by a government department such as the NHS in order to help it achieve its set objectives. Polices can also emerge from different points of a country’s political cycle in the form of party manifestos such as the commitment to a 25-year plan aimed at restoring the biodiversity of UK by the conservative party manifesto (British Ecological Society, 2017). However, according to Benson and Jordan, (2015) the policy process can be conceptualised in 6 simple steps, which include problem emergence, agenda-setting, consideration of policy options, decision making, implementation and evaluation. Policy and Evaluation in Public Health Discussion Paper During this process, the policy makers will rely on specialist advise to select the best course of action, make the policy and then hand it over to the administrators for implementation

Policies play an important role in maintaining health as public health can be influenced by policies effected across different sectors. For example, policies across the transportation sector can be used to develop pedestrian and bicycle friendly community design that will encourage physical activity (Centers for Disease Control and Prevention, 2015). The concept of policy development within public health involves promoting key improvements in health through the advancement and implementation of individual behaviour, organizational change, practices and regulations that influence systems development and public health law. These policies can be implemented within the health sector either through Medicare conditions of participation aimed at influencing the delivery of care or through tax codes. However, a study by Ricciardi and Boccia, (2017) shows that the achievement of public health goals can also done by working in tandem with other sectors such as employment, agriculture and education among others.

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The implementation of key policies will be important in helping curb the rates of childhood obesity across the UK. This is because, according to GOV.UK (2019), childhood obesity has become a national health problem with over a third of all children aged between 2 and 15 are either obese or overweight with younger generations becoming obese during their earlier stages of life and remaining obese for longer and even into their adulthood. The National Childhood Measurement Programme, which is tasked with measuring the prevalence of obesity among school-age pupils has provided a report showing an alarming increase the obesity levels across children in reception class to year 6 across the years 2019 and 2020 (Baker, 2019). When compared to single-year increases recorded over the years, the 2020 growth has been the most significant, increasing the number of obese children across England to one in every seven (Gregory, 2021). This number grows by the time they are aged about 10 or 11, where more than a quarter of children within this age group are obese.

Reducing obesity will be critical in heling save lives as obesity at a young age not only increases the risk of premature death but also maintaining obesity into adulthood puts the individual at a higher risk of developing cardiovascular diseases, in addition to type 2 diabetes, which might put them at risk of either having their limbs amputated or developing blindness (GOV.UK, 2019). Apart from the physical and mental health conditions associated with childhood diabetes, there are great economic costs associated with it too (Scarborough et al., 2011). The NHS budget on the treatment of obesity and diabetes has been reported as continuously growing each year with the government sending over £6.1 billion for this purpose alone within its 2014 – 2015 budget year (GOV.UK, 2019). Implementing policy towards reduction of childhood obesity rates will help reduce the burden of the condition, which mainly falls hard on children from low-income backgrounds. According to Goisis et al., (2015) young children from poorest income groups have twice the risk of developing obesity compared to those from well off neighbourhood with the risk increasing to trifold by they time they get to age 11.

Childhood obesity: A plan for action policy

For more than 20 years, tackling obesity has remained a policy priority in England with the government implementing two formal strategies on Obesity in 2008 and 2011, which worked to develop new initiatives and actions aimed at filling perceived gaps left by existing health policy (Jebb et al., 2013). Looking back over the years, there have been a range of policies put in place to help tackle obesity and these have focused on weight management services, active travel plans, schemes to boost participation in sport, restriction in the marketing of foods that are high in salt, sugar and fat to children and support for breastfeeding and healthy weaning practices. Obesity was initially recognised by the Conservative Government in England as a sufficient threat to the Nation’s health in 1991 and therefore warranted the need by specific action (Theis and White, 2021). It was therefore at this moment that a target to help achieve the target of reducing the prevalence of obesity among adults to the pre-1980 record of 7% by 2005 was set in place (Jebb et al., 2013). While this was a step towards the broader acknowledgement of the important role of interventions aimed at improving public health and lead to the formation of different task forces to help develop recommendations on promoting physical activity and healthy eating, these recommendations were not adopted as part of public policy. Despite a number of policies emerging in 2001, in response towards the National Audit Office (NAO) 2001 report, which showed trebled obesity rates across the country, the government responded by implementing a proactive approach towards obesity only that the focus was children (Northrop, 2015). This was followed by a national public service agreement to help halt the year-on-year increase in rates of obesity across children under 11 years by 2010 in a bid to help tackle obesity across the population as a while. In January 2008, the government implemented its Healthy Weight, Healthy Lives strategy influenced by the growing obesity rates across the country (Department of Health, 2010). This strategy would work to reduce obesity by focusing on children, the promotion of healthier food choices, physical activities, incentives for better health and personalised advice and support. However, despite these policies, data from annual surveys have shown that while the year-on-year increase in the levels of obesity has attenuated in recent years, it is yet to be reversed.

In August 2018, the Department of Health & Social Care, which is tasked with the responsibility of overseeing and setting obesity policy in England published a “plan for action” on childhood obesity (GOV, UK., 2019). This came after a call from the Health Select Committee for bold and brave action following its 2015 inquiry on childhood obesity which had revealed that one in every three children aged under 15 years were overweight, an issue that had been termed as a “national emergency” by the Secretary of State for Health and social care (Onis, 2015). The plan’s vision is to reduce the gap in childhood obesity between least and most deprived areas significantly. It mainly focuses on children since the failure to prevent obesity among children is likely to risk the persistence of the condition to adulthood, predisposing them towards the risk of developing heart diseases, high-blood pressure and diabetes, which are key comorbidities likely to affect a nation’s adult population (GOV UK, 2019). Prevention of obesity among younger generations will help safeguard their future and that of the country in terms of reduced costs of health. The plan for action aims to halve childhood obesity rates by 2030 through the introduction of a UK tax for importers and producers of soft drinks based on their sugar content and a voluntary scheme where players across the food and drink industry commit to remove 20% of sugar across different categories of their product (Knai et al., 2018). To help fill perceived gaps in its original plan, the government released the second chapter as an extension to its original childhood obesity plan with a focus to halve childhood obesity and reduce existing gaps in obesity between children by 2030 by committing to considering adding milk drinks to the tax on sugar content , consulting on the end of sale of energy drinks to children, provision of support to local areas and initiatives in school (GOV UK, 2019).

When viewed from a public health perspective the programmes and interventions included in the Childhood obesity: A plan for action policy are appropriate in a number of ways. Unhealthy behaviours such as unhealthy diets, drinking alcohol and smoking are key drivers of poor health outcomes for UK and likely to have significant consequences for not only the individual but also the society at large and the economy (Beech et al., 2020). Therefore, in such case, relying on individual responsibility will not be enough to effect behaviour changes and therefore the need for creation of environments that will support individuals towards making healthier choices. However, there are still gaps and missed opportunities within this plan and especially in terms of efforts aimed at addressing the risk factors for obesity during children’s early stages of life (three years) such as the need to avoid added sugar across baby foods used in weaning (Phulkerd et al., 2021). In failing to do so, the plan fails to recognise the significant formative role of childcare and a child’s early year setting on the child’s diet. Addressing this gap will be important in helping curb obesity across children since socioeconomic differences in obesity and weight in children from socio-economic derived areas become evident as early as when the children attain three years of age (Beech et al., 2020). Policy and Evaluation in Public Health Discussion Paper

There are a number of stakeholders that were involved in the development, implementation and operation of this policy. The main stakeholder, the department of health and social care had major influence over the policy as implementing a policy on obesity across England falls within its responsibility (Balogun et al., 2020). Having identified the policy area, the Department of Health and social care was to then work with a number of industry and non-industry stakeholders to ensure smooth implementation of the policy. Other main stakeholders include Public Health England and the Scentific Advisory Committee on Nutrition, which were commissioned to help start working on policies aimed at helping children and their families make better and healthier choices based on the latest research and evidence (GOV UK, 2019). Local bodies such as clinical commissioning groups and local governments also played a part in the policy process of this plan. These stakeholders, when provided with accessible data, tools, training and resources will be critical in helping reduce inequalities and supporting equity across all local government policies (Knai et al., 2018). The Health select committee and the NHS were tasked with making valuable contributions to the policy process by focusing on areas likely to have biggest impact towards tackling childhood obesity. Other key stakeholders playing a critical role in the policy process of this plan include representatives from the food and drink industry, and advertising standard authority (Owen, 2018). These will help develop and publish industry guidelines with mechanisms for achieving the reduction of sugar across their products, since this policy is likely to affect them and their operations the most.

One of the main aims of the “childhood obesity: A plan for action” policy is to address key inequalities in health by reducing the gap in childhood obesity between children from least and most deprived areas by two fold. Implementing this policy plan will be critical in helping address issues of health equity and inequalities. With the relationship between social advantage ad health being well documented across studies, a look into different environmental, economic and social factors point towards unhealthy behaviour especially in lower socio-economic groups, which is likely to fuel significant health inequalities (Perkins and DeSousa, 2018). Being that the exposure of individuals to these unhealthy behaviours is not evenly spread across society, their consequences are likely to be the cause of significant health inequalities. This means that health outcomes are likely to be different for each socio-economic group (Griffin et al., 2021). For example, when a social gradient is mapped on childhood obesity data, higher prevalence of obesity is seen across children from areas recording higher levels of socio-economic depravation. That means that children from some of UK’s most deprived parts are twice as likely to become obese compared to their counterparts in less deprived areas (Mackenzie et al., 2017). Given the magnitude associated with these inequalities, it is important that government efforts such as this policy are implemented to help improve health outcomes for these individuals. The policy achieves this by providing fiscal and regulatory levers that will facilitate the provision of health, information and other services that will create a supportive environment that can allow health services to address the mounting challenges of an obese population and give the government a chance to tackle widening health inequalities (Beech et al., 2020).

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There has been some level of success experienced with the implementation of this obesity policy across England. A report by Public Health England (2018) shows that there has only been a 2% reduction in total sugar and 2% reduction in calories from the food categories eaten most by children. Additionally, the soft drinks industry levy has recorded a stellar progress with soft drinks recording a 11%reduction in sugar content and 6% in calorie reduction (Public Health England, 2018). However, a review by Theis and White (2021), records that no change has been experienced across the out-of-home sector in terms of average sugar and calorie content. However, the consultations to end the sale of energy drinks to children is yet to yield any results. This is mainly because, while UK has strict laws that ban the advertisement of sugary, salt and fatty foods across children media, most children are more likely to spend more time viewing non-children media. A major point of criticism is that the measures included in the policy, especially those centred on sugar tax rely on voluntary action by the food and beverage industry, which has for months, lobbied hard against regulations (Boseley, 2016). While this strategy will make a difference in the health and fitness of children, it does not give extra consideration to the measures likely to have most impact on the childhood obesity epidemic such as banning price-cutting promotion of junk foods and restriction of unhealthy food advertisements during family TV programmes.

Conclusion

Policies play an important role in facilitating positive health outcomes among members of a population and the Childhood obesity plan for action will be important in achieving this by working to reduce the rates of childhood obesity across England. However, there are a number of trends expected to be adopted into the policy in future years such as increasing the responsibility of food manufacturers towards maintaining public health. Additionally, with the number of diabetics expected to grow exponentially in the coming years, it is expected that gaps and points of failures experienced during policy evaluation and analysis be filled through the implementation of a range of new health policies and plans. However, to better evaluate policy, it is important that policy makers rely on a mix of approaches such as public engagement, frameworks and metrics, futures and foresight, and use of independent decision-making bodies that will help improve long-term policy planning. This will help facilitate a cultural, leadership and political shift from short-termism and implement stronger mechanisms to hold policy decision-makers responsible for the long-term impacts for current policy decisions.

References

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