The Population health issue I have selected is Obesity. It is a serious health problem. Poor dietary habits and physical inactivity are among the factors that lead to obesity. About 70% of American adults are obese or overweight. In 2005, unhealthy diet was responsible for about 350,000 deaths in the United States (Knickman & Kovner, 2015). Our health status is mainly determined by how we live our daily lives. How we interact with the environment in which we live also support our abilities to live healthy and prosperous lives. Our engagement in physical activity helps to maintain healthy bones, muscles, joints, and weight. Our engagements with our physical environment associate with the promotion of feelings of well-being. It reduces feelings of anxiety and depression. Thus, the five population health determinants are; access to health care, individual behavior, social environment, physical environment and genetics (Knickman & Kovner, 2015). The concept of social determinants often denotes how income, education, access, housing and other factors contribute to our wellbeing. Knickman & Kovner (2015) defined social determinant as “The circumstances in which people are born, grow up, live, work and age, and the system in place to address an illness in turn shaped by larger forces, including economic, social policies and politics.” (Knickman & Kovner, p376, 2015). Public Policy influences these social determinants. For instance, the government health system contributes immensely to the health of the population. The individual choices that we make in our everyday lives have a lot to do with how we maintain our health. How we decide on what to eat, exercise and stay active are key health determinants (Knickman & Kovner, 2015). For the past twenty years, there has been scientific studies on stress responses and have correctly reported how stress affect multiple bodily streams in addition to the endocrine system, including the immunological, neural and cardiovascular system. Thus, scientists have recognized in both laboratory and community situations the mechanism by which social determinants act, depend on the context in which people encounter stressful situations/ events that culminate in diseases and sicknesses. In other words, stressful stimuli like social subordination, lack of job control, job loss and bankruptcy, and other situation resulted in anxiety. The end product is biological dysregulations, and consequently the onset and progression of diseases and poverty. One area emphasized is the interaction of social and physical determinants. It is, therefore, clear that our access to health care, individual behaviors, social environment, physical environment and genetics would lead to diseases like obesity (Knickman & Kovner, 2015). Treuhaft and Karpyn (2010) explained that “… for decades low- income communities of colors have suffered as grocery stores and affordable fresh food disappeared from their neighborhoods… without access to healthy foods, nutritious diets and good healthcare out of reach" (Treuhaft and Karpyn, 2010; Knickman & Kovner, 2015). Obesity occurs when people engage in poor dietary habits and physical inactivity. Dietary Guidelines (2010) for Americans recommended that people should reduce their caloric intake. The food guideline called for increases of fruits, vegetables and whole grains. Low-income families and minorities are less likely to be able to afford healthy foods, pay for an expensive gym membership to maintain their and to get daily exercises. It is also difficult for low-income groups and minorities to stay on top and comply with medical recommendations due to their financial situations. Significant gaps in dietary habits of low-income groups, minorities and unemployed contribute to numerous studies. In 2010, PolicyLink and the Food Trust published “The Grocery Gap: Who has access to Healthy Food, why It Matters”. PolicyLink reviewed twenty years of the status-quo; it correctly reported those who had access to food in the United States. These studies documented wide racial, ethnic and socioeconomic differences in access to health care, healthy food stores, and supermarkets (Powell, Han, & Chaloupka,2010). The evidence widely agreed that access to healthy food was very limited among low-income communities, communities of colors (blacks and Hispanics), as well as people in the rural areas. They were therefore at risk for obesity and other diseases. Unhealthy diets and lifestyles connect to obesity. It was, and it is now incumbent on the government and policy makers to have effective interventions to teach and reinforce health habits (Knickman and Kovner, 2015). Healthy People (2010) addressed issues of nutrition, physical activity and obesity in children and adults. Preventive measures to treat obesity include: to increase the number of schools that offer nutritious foods and beverages, to increase the hours that children engage in physical activities in schools (Healthy People, 2010). Increasing physical activities for children in schools can also prevent obesity. Schools are therefore encouraged to incorporate more day-to-day operations during recess, giving children more movements during the school day. According to Kindig, Asada, & Booske (2008), population health policy focused on improving individuals’ health. Government and States policies targeted the five domains of population health to eradicate obesity and other diseases. State policies include nutrition, physical education, school wellness programs, and insurance for obesity. Obesity is a major problem, getting the attention of policy makers, state and federal officials, families, schools and several institutions. I have located two scholarly articles each of which provides a description of an effective health advocacy campaign that addresses obesity. The two scholarly articles do demonstrate effective health advocacy campaigns. The articles are titled “Childhood obesity prevention: a review of school nurse perceptions and practices.” (Quelly, 2014). The second article I selected is “The Family Management Style Framework for Families of Children with Obesity” (Myoungock & Whittemore, 2016). I reviewed the two reports, analyzed their attributes and came up with a policy I would suggest in their place in a view to improving the health of the population. Knickman & Kovner (2015) have reported three intervention tools used to prevent obesity: population-based intervention models. These are different interventions that have been used to prevent obesity: downstream intervention, midstream intervention, and upstream intervention (Knickman & Kovner, 2015). The objective of any advocacy campaigns must be to focus on reducing obesity among adults, children and adolescents. Healthy People (2020), set a target rate of Adult and children at 31% and adolescents at 15%. In 2012, the IOM released five environmental areas in which reform was needed to prevent obesity, listed as physical activity; food and beverage, message, health care and work, and school environments (Knickman &Kovner, 2015; IOM, 2012). A review of the Book: Knickman & Kovner, (2015) Health Care Delivery in the United States, (11th.edition); they aptly described the use of physicians to help with behavior change in people with obesity. Physicians did help a large number of individuals to quit smoking and engage in diet change; they change people’s health knowledge, attitudes and belief and social norms. Unfortunately, this intervention, to prevent obesity, was insufficient; it failed to produce lasting behavior change (Knickman & Kovner, 2015). The primary care physician intervention or advocacy tool was limited because it lacked a long-term maintenance. It is a mistake to allow patients to return to the environment that has shaped and supported their unhealthy lifestyles and choices (Knickman & Kovner, 2015). Knickman and Kovner (2015), also reported the use of midstream intervention tool; that is population level intervention. This tool target defined a community to change and prevent behavior risk factors (Knickman & Kovner, 2015). In one of the scholarly research articles, the organization used the “Midstream intervention tool”, which involves mediation through a significant body. In this case, they used Nurses, who work in a school system as an advocacy tool to intervene and prevent obesity. The scholarly article “Childhood obesity prevention: a review of school nurse perceptions and practices.” uses the School Nurse perception to prevent childhood obesity (Quelly, 2014). In other words, the school used the Midstream intervention through the school-based nurse. Efforts were made to develop and implement interventions and policies through the role of the school nurse. This advocacy tool is to promote health environment and intervene with actual health problems: obesity. This tool seeks to increase the school nurse's engagement in Children Obesity Prevention (COP). It uses advocacy by school nurses for policies to mandate particular COP practice and improve student-to-school nurse ratio. It is also used to reduce perceived barriers (Quelly, 2014).
The second scholarly article “The Family Management Style Framework for Families of Children with Obesity” visited several family-focused preventive methods in childhood obesity. The intervention model is the following response, aimed at those who possess behavior risk, to modify childhood obesity (Myoungock & Whittemore 2015). This a family tool—how family members help to combat obesity; this designed to inform family members how to intervene and advocate for obesity patients (Myoungock & Whittemore, 2015). The articles in the two publications are very clear and easily understood. The roles of the School Nurse and Family members in treating and interacting with children, adolescents and adults with obesity are well spelled out. I think Healthier Generation, 2016, clearly and cleverly analyzes the attributes of campaigns. In other words, Healthier Generation aptly suggested effective policies and tools to combat and prevent obesity. It is given and proved that obesity is preventable. We, therefore, need to educate teachers, nurses, family members, people and community. As a nurse, I believe, prevention of obesity begins with education. It means we have to educate more parents than we have ever done. We have to involve more physicians, more Pediatrics and hospital-related people (healthy-care-skilled personnel) and more school staff participation with health habits and physical activities. Obesity programs should be implemented in all departments of lives beginning at the grassroots levels. I firmly believe the focus should be on healthy lifestyles and increased physical activities. Whatever policy I could propose would be in line with the relevant and valid suggestions in Healthier Generations, 2016, (Healthier Generations, 2016). I would suggest a modification of existing policy and regulations through legislative support. I will use health statistics gathered using epidemiologic methods to deal with obesity. Data from population health studies suggest that obesity is preventable and curable (IOM, 2012). Therefore, the Policy I put in place modifies perceptions so as to promote active engagement with obesity practices. The policy will be multi-pronged: a three- step- process using epidemiologic data (Milstead, 2013).

References

Berge, J.M., Wall, et al. (2015). The Protective role of family needs for youth obesity 10-year longitudinal associations. Journal of Pediatric, 166(2), 296-301 6p. doi: 1016/ jpegs. 2014.08.030
Institute of Medicine. (2010). Bridging the evidence gap in obesity preventions. A framework to inform decision- making. Washington, DC: National Academic Press.
Institute of Medicine. (2012). Accelerating progress in obesity prevention: Solving the weight of the nation. Washington, DC: National Academic Press.
Institute of Medicine. (2013). Creating equal opportunities for a healthy weigh: Workshop summary. Washington, DC: National Academic Press.
Healthier Generation (2016). About Child Obesity. Retrieved from https://www.healthiergeneration.org/about/tracking/about_childhood_obesity/in_your_state
HealthPeople.gov (2010) Foundation health measures. Retrieved from https//healthpeople.gov/2020/about/tracking.aspx
Journal for Specialists in Pediatric Nursing, July 2014 19(3)-198-209, 2p (Journal Article Research, Systematic Review tablets/charts/ ISSN: 153-0136 PMID 24612320
Myoungock, J., & Whittemore, R. (2015). The Family Management Style Framework for Families of Children with Obesity. Journal Of Theory Construction & Testing, 19(1), 5-14 10p
Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081-2083.
Knickman, J.R., & Kovner, A. R., (2015) Health Care Delivery in the United States. (11th.Eds). Springer Publishing Company. Treuhaft, S., & Karpyn, A. (2010). The grocery gaps: who has access to health food and why it matters? Oakland, CA: PolicyLink. Quelly, S. B. (2014). Childhood obesity prevention: a review of school nurse perceptions and practices. Journal For Specialists In Pediatric Nursing, 19(3), 198-209 12p. doi:10.1111/jspn.12071