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Childhood Obesity: How is Public Health doing?
On the eve of the International Conference on Physical Activity and Obesity in Children, and with the recent release of Healthy Weights for Healthy Kids, the Report of the federal Standing Committee on Health (March 2007) [PDF], very few issues are receiving more attention than the obesity epidemic in the world of public health. For good reason.
Childhood obesity has major implications for the health of children and communities, and the rates are rising. According to the government’s report,
In 1978, 12% of children and adolescents aged 2 to 17 years were overweight and 3% were obese — for a combined overweight/obesity prevalence of 15%. By 2004, 18% were overweight in this age group and 8% were obese — a combined prevalence of 26%. (p. 2)
The well-documented health effects of poor nutrition, physical inactivity and obesity in childhood include Type 2 diabetes, cardiovascular disease, anemia, and myriad psychological and social impacts,. Beyond these health effects, obesity also has implications for our health care system and for our economy:
One estimate suggests that obesity in the overall population currently costs Canada about 1.6 billion annually in direct health care costs, or 2.4% of total health care spending. In addition, there is another $2.7 billion in indirect costs associated with obesity, including lost productivity, disability insurance, reduced quality of life and mental health problems due to stigmatization and poor self-esteem. (p.3)
Public health has a key role to play in stemming this epidemic. Public health practitioners provide valuable programs and services throughout the province, particularly in schools. These individual programs, while extremely helpful in building momentum and mobilizing change, unfortunately vary from health unit to health unit, region to region, school board to school board, and even school to school. This piecemeal approach to program delivery means that the impact of public health is not as great as it should and could be.
There are signs that more attention is being given to this issue. One year ago, the Ministry of Health Promotion (MHP) launched the Healthy Eating and Active Living (HEAL) strategy. NGOs are rallying around the issue with new strategies and more local initiatives. However, if we are really going to see change to reverse the the alarming rise in the prevalence of obesity among our children and youth, we must do more — now. Here are a couple of comprehensive actions that could move us along faster.
The Ontario Society of Nutrition Professionals in Public Health (OSNPPH), an OPHA Constituent Society, released a Call to Action in 2004. "Creating a Healthy School Nutrition Environment" [PDF] outlines nine "Essential Elements of a Healthy School Nutrition Environment" and provides a very detailed analysis of the barriers to implementing these in the current school environment.
There are also a number of initiatives taken on by schools and their communities as through the healthy school movement, and these must be continued and expanded.
As a society, we need to go further upstream with our thinking on this issue. For example, we must also think about fundraising in school. People for Education's Annual Report [PDF] stated that a total of $576,040,304 was raised by school boards through methods such as parent fundraising, fees for materials and athletics, vending machines and donations. A number of aspects of this finding are troubling.
Parental fundraising results in a two-tier system as students in high-income communities will have better playground equipment, more school trips and improved physical education programs.
As well, much fundraising revolves around food. Hot dog days, pizza lunches, chicken finger Fridays – these are just a few examples from the schools attended by the children of our own OPHA staff. A Google search for “school fundraising” turned up hundreds of websites with fundraising ideas. One website lists eight fundraising products on its home page – of these, half are food, and none of these are healthy. Another lists seven, with four being of minimal nutritional value. Scroll through the websites and the results are similar. Fundraising is big business, and candy, cookie dough and cheesecake are a huge part of this business.
Election time is drawing near in Ontario. Although there are many other strategies that we could recommend, reaching children and adolescents through schools and school communities is an obvious place to begin. Ask potential political candidates about their support for adequate funding to support healthy schools, for provincial school food/nutrition policy and increased PA in schools and beyond.
Working together with health units, the province, NGOs, school boards, and local communities is the key to success. Resources, ideas and programs currently exist. Using a best practice alignment approach we can halt the rise in obesity.
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