Assessing Population Health

Introduction:

This essay is about assessing a community profile of Lewisham population. The health issue to be discussed is childhood obesity in Lewisham Borough.
The essay will define population health, and give a brief overview of childhood obesity. It will give the rationale why the writer decided to write on this issue. The essay will describe the population, and explain briefly why it is important.
It will explore the factors that influence this particular population including geographical location, neighbourhood, educational attainment, family members, peer groups, social economic factors and culture as well as ethnicity.
It will critically discuss the health profile of the population group and exploring the factors that lie beneath the profile. More importantly, the essay will analyse the main factors that influence the contemporary health of the given population in relation the determinants of health of the population health as well as the indicators of the population's risk and morbidity rates.
It will look at the health needs of the population and examine the external and internal factors that could influence their behaviours and choice. It will make conclusion and recommendations on how to improve this health issue and enable the writer to understand the subject in great depth.

The primary reason why the writer has chosen to focus on childhood obesity is because she wants to meet the learning outcomes of the module in order to pass the course. Other rationale is to improve her knowledge and understanding of childhood obesity, as it is one of the greatest public health concern facing children in the United Kingdom. According to WHO (2011) Childhood obesity is increasing amongst children in the United Kingdom between the ages of 2 to15 years. The study has shown nationally 3 in 10 children are either overweight or obese, and 1 in 6 are obese. Childhood obesity increased among boys and girls by 4.9 percent to 7.8 percent, over half among girls and rise among boys from 2.9 percent to 5.7 percent. The report indicated that between 33 percent of girls and 20 percent of boys would be obese by the year 2020. The above findings predict that children who are overweight are more possible to be obese as adult in the future (WHO 2011).

Discussion:

I am looking at the profile relating to physical inactivity relatively to childhood obesity of Lewisham borough.

Lewisham borough has a high prevalence of childhood obesity, 13.6% of reception children were obese as were 24.4% of children in year 6 in 2009/10. Over 40% of 10-11 year olds and over a quarter of 4-5 year olds were overweigh or obese in 2009/10. In 2011/12, 23% of Year 6 (10 to 11 year old) children were obese compared to 19% in England on average. This gap has remained unchanged since 2005/06, when levels of obesity were lower in both London (21%) and England (17%) (NCMP). Lewisham borough has a high proportion of young people, with nearly a fifth of the population under 15, estimated at 49,002 for 2009, of these 19,762 are children under 5 years (7.5% of the population). The borough is the 15th most ethnically diverse local authority in England with over 170 different languages spoken, overall 40% of all Lewisham residents are of Black and minority ethnic origin. It is projected that by 2020 the percentage of residents from Black and minority ethnic groups will have increased to 44%. Lewisham has a high proportion of children and young people from black and ethnic minority groups (59% of under 15), with the highest ethnic groups being Black African (17.6%), Black Caribbean (13.8%) and Black Other (13.2%) with under 15% from all other ethnic groups. Lewisham has the highest proportion of lone parent families in London, with 17.8% of all households’ lone parent families, this compares to 11.6% for Inner London and 7.2% for England. It is the 39th most deprived local authority in the country, 8 out of Lewisham’s 166 Super Output areas are in the 10% most deprived and 64 are in the 20% most deprived in the country.

There is a strong relationship between deprivation and childhood obesity. Analysis of data from the National Child Measurement Programme (NCMP) shows that obesity prevalence among children in both Reception and Year 6 increases with increased socioeconomic deprivation (measured, for example, by the 2010 Index of Multiple Deprivation (IMD) score). Obesity prevalence of the most deprived 10% of the population is approximately twice that of the least deprived 10%.

For children the link between childhood obesity and deprivation is well established. In year 6 children the prevalence of obesity was almost two thirds higher in the deprived group. Obesity prevalence in children increases with increasing levels of children eligible for Free School Meals.

Obesity prevalence varies between ethnic groups, in children national date show a higher prevalence of overweight in Black African and Caribbean children and obesity almost four times more common in Asian children than in white children.
A local result shows that there is no statistically significant difference in the prevalence of obesity between ethnic groups in Lewisham.

The health issues which arise as a result of childhood obesity in another word the health profile of the children who are obese in Lewisham. This group of children have medical conditions secondary to obesity or who have co-morbidities such as a physical or learning disability or another underlying chronic disease or psychological problem. There may also be a small minority of children who may have a medical condition causing their obesity such as Prader Willi syndrome, Cushings and monogenic causes.

The predisposing factors to obesity for this age group come from low socio-economic background because they are more likely prone to eating processed food which contain high in saturated fat and high in sugar. Poor diet is one of the main factors that is contributing to an increase in childhood obesity. The increase of children eating fast food is alarming in United Kingdom. There are unhealthy eating habits that are usual among children such as avoiding of breakfast and consuming oversized portion of excess calorie drinks and after school buying fast food in the restaurant for lunch that contain excess levels of saturated fat which will then build up in the body, resulted in weight gain and lead to obesity. Poor dietary intake is linked with overweight children, and that these families should be a target for prevention and awareness campaign. (Solley and Lyttle, 2012).

Children who are obese are more likely not to engage in physical activity. Sedentary lifestyle and lack of exercise are other factors that are contributing to an increase in obesity among children. Technology advancement has caused child obesity to be on a rise. Children engage themselves more with games on the computer and watching TV in the house, whilst consuming high energy foods which causes an increase in saturated fat that are deposited as fat in the body (Lazarou and Kouta, 2010). Poskitt and Edmunds (2008) argue that due to advancement in technology there is a tendency for parent/s to use cars to transport their children not encouraging their children to walk or cycle a shorter distances which result in less physical activity causing an excess weight gain since the body burns fewer amounts of calories ( Solley and Lyttle 2012 ).

Determinantes of population’s health

The determinants of health are the conditions of daily living that determine someone as chances of maintaining good health. These conditions are divided into 4 categories, which are lifestyle, genetics, environment and healthcare. Lifestyle is a way of life or style of living that reflects the attitude and values of a person or group. An example of this would be going on a diet or exercising. This can also include choosing behavior of your lifestyle that could affect you, like smoking or people eating habit. Genetics is the branch of biology that deals with heredity, especially the mechanisms of hereditary transmission and the variation of inherited characteristics among similar or related organisms. Environment is the totality of circumstances surrounding an organism or group of organisms. Especially the combination of eternal physical conditions that affect and influence the growth, development and survival of organisms. This also includes the complex of social and cultural conditions affecting the nature of an individual or community. Healthcare is an organized plan of health services by which health care is made available to the population and financed by government or private enterprise, or both.

According to WHO ( ) Social determinants of health reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning, and quality-of-life outcomes.

There is a relation of inequalities relate to the determinant of health in relation to obesity in this population. There are differences in the prevalence of obesity in children are seen with deprivation, ethnicity and parental obesity. The prevalence of children at risk of obesity is higher in more deprived areas, analysis of the London school measurement data revealed that the prevalence for year 6 children was almost two-thirds higher in the deprived group, they also reported a higher prevalence of obesity in children from Black ethnic minority groups. National data show 22% of girls from the low income groups were obese compared to 9% in the highest income group and children from Black ethnic minority groups and Pakistani boys were at higher risk of obesity than the general population. Children from households where one or both natural parents were classed as obese had much higher rates of obesity than children from households where parents were classed as normal or underweight.

Maslow (1943) stated that people are motivated to achieve certain needs. When one need is fulfilled a person seeks to fulfil the next one, and so on.
The earliest and most widespread version of Maslow's (1943, 1954) hierarchy of needs includes five motivational needs, often depicted as hierarchical levels within a pyramid. This five stage model can be divided into basic (or deficiency) needs (e.g. physiological, safety, love, and esteem) and growth needs (self-actualization).
The deficiency, or basic needs are said to motivate people when they are unmet. Also, the need to fulfil such needs will become stronger the longer the duration they are denied. For example, the longer a person goes without food the hungrier they will become. One must satisfy lower level basic needs before progressing on to meet higher level growth needs. Once these needs have been reasonably satisfied, one may be able to reach the highest-level called self-actualization.
Every person is capable and has the desire to move up the hierarchy toward a level of self-actualization. Unfortunately, progress is often disrupted by failure to meet lower level needs. Life experiences including divorce and loss of job may cause an individual to fluctuate between levels of the hierarchy. Maslow noted only one in a hundred people become fully self-actualized because our society rewards motivation primarily based on esteem, love and other social needs.
Social cognitive theory also considers the importance of an individual’s knowledge and attitudes in influencing behaviour and behaviour change.2 In addition, it also recognises the impact of external factors such as social and environmental influences on individual behaviour.3 For example, the likelihood of a child eating five portions of fruit and vegetables a day will be influenced by social factors (e.g. their parents’ views on healthy eating), and environmental factors (e.g. the availability of fruit and vegetables at home).
The population trend of childhood obesity seems to be a slowing in the rate of increase of child obesity prevalence since 2004, particularly among older children.
Figure 1. 9.9% of boys and 9.0% of girls in Reception (aged 4-5 years) and 20.8% of boys and 17.3% of girls in Year 6 (aged 10-11 years) are also classified as obese according to the British 1990 population monitoring definition of obesity (≥95th centile) (NCMP 2013/14). Figure 2. shows the trend in child obesity prevalence using data from the Health Survey for England. A trend of increasing child obesity can be seen between 1995 and 2004.

Lifestyle and behaviour choices are important factors in influencing weight status. Unhealthy diets and physical inactivity are major risk factors for overweight and obesity as well as a number of chronic health conditions including cardiovascular disease, diabetes, some cancers and high blood pressu

It is much more common for young people who come from a racial or ethnic minority, or for those who have a lower socioeconomic status, to be overweight and to engage in less healthy behaviors and sedentary activities.

The British Social Attitudes Survey 2008 (BSAS 2008) reports on adult perceptions of the quality of information about food and healthy eating for children. Almost 70% of respondents felt that schools should ensure that children eat healthily and exercise. Over 50% of respondents thought that the government should provide advice for parents, but only 35% stated that advice currently provided by the government for parents was useful.

Nutrition plays an important part of your child's physical and mental development, according to the American Academy of Pediatrics on the website, HealthyChildren.org. Calcium is needed to develop healthy bones and teeth, and protein and fats are necessary to give your child energy and help him grow. The AAP warns that once children start attending school and have more choices in what they eat for lunch in the cafeteria, they may stock up on sugary sodas, candy bars and chips rather than a well-balanced meal with the nutrients their growing bodies need.

Media
A 2003 study by the Kaiser Family Foundation found that children spend an average of two hours a day in front of the screen. According to child development experts at the Kids Health website, television in moderation for children age 2 and up can be educational, but too much television can have negative affects. Children who regularly watch more than four hours of television each day have an increased risk of being overweight, and children who view violent television shows have a tendency toward aggressive behavior.

NICE ( ) identify children who are at risk of obesity and recommends that overweight and obesity are measured using Body Mass Index (BMI) for children by calculating the Body Mass Index (BMI) above the 98th centile and overweight as above the 91st centile of the UK reference charts for age and gender (Ewles, 2005).Using the formula : BMI = weight in kilograms/height in square meters.

Conclusion:

The essay has shown that obesity is increasing amongst children and it has been a public health issue in the United Kingdom.
People who are clinical obese tend to have a lot of health issues and can have higher risk of morbidity and mortality rate in adulthood. Overweight and obese children are more likely to become obese adults in future if is not tackled.
As child obesity
Summary

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