Analysis of Health Issue - Childhood Obesity

Healthcare Economics Analysis of Health Issue – Childhood Obesity Analysis of Health Issue Economic Principles and Indicators: Childhood obesity was described by the World Health Organization as “one of the most serious public health challenges of the 21st century”. The WHO went further in saying “the problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. There is no consensus on a cut-off point for excess overweight or obesity in children and adolescents, according to article Childhood obesity: causes and consequences (2017).” In a study conducted in 1992, on 3,320 children in the age-group of 5–18 years were classified children as “fat” if their percentage of body fat was at least 25% for males and 30% for females, respectively. (Sontag, D., 2017). Childhood obesity was also prevalent among younger children ages 2-5, which was 13.9% among 2- to 5-year-olds. (Center for Disease Control). The prevalence of childhood obesity has increased at an alarming rate. Globally, in 2016 the prevalence of obese and overweight children under the age of five was estimated to be over 41 million (2011). In 2016, the rate in the US was estimated at 13.7 million children and adolescents (CDC). Economic Impacts: Childhood obesity does not only affect children, but can go on to affect them as adults, thus placing an economic burden on the country’s healthcare systems. Some of the impact on the economy are, high healthcare costs due to obesity-related illnesses, which, according to the National League of Cities, is a “staggering $190.2 billion or nearly 21% of annual medical spending in the United States”; changes in the economy, which can contribute to behavioral changes in people. Cawley (2010) asserts that changes in the economy give people incentives to consume more while burning fewer calories. Another is the increase/reduction in food prices. RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity Cawley pointed out that between 1990 and 2007, the “the real price of food (adjusted for inflation across all goods and services) had declined greatly and the real price of a two-liter bottle of CocaCola fell by 34.89 percent, as well as that of a McDonald’s quarter-pounder with cheese, which fell 5.44 percent” (Cawley, 2010). These food items are not known to be rich in nutrients. Indirect hidden costs of obesity also affect the economy by inhibiting businesses and organizations that stimulate jobs in the country. For example, in the same article by National Leagues of Cities, it was noted that “in the 10 cities with the highest obesity rates, the direct costs connected with obesity and obesity-related diseases are roughly $50 million per 100,000 residents” (NLOC). It was noted that if the obesity rates went down in these ten cities, the combined saving to the communities would be $500 million in health care costs each year” (NLOC, 2016). Food marketing to children and adolescents can be considered as another economic factor contributing to childhood obesity. A report in Annual Review of Public Health (Vol. 30, 2019) reported that “children and adolescents represent a vast market opportunity for food companies in the United States. These companies spend an estimated $200 billion per year advertising to children and adolescents, and invest heavily to increase sales and create brand loyalty among young consumers, many of whom are children”. Children are exposed to food ads on TV quite extensively in the United States. The Annual Review of Public Health, (Vol.30, 2019) reported that “the average child in the US for instance, views 15 television food advertisements every day, or nearly 5500 messages per year”. Socioeconomic Factors Socioeconomic factors such as unemployment, low educational status, low self-esteem, poverty, do contribute to childhood obesity. Hemmingson (2018) “having a low socioeconomic status is RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity arguably one of the strongest risk factors for developing obesity and many other adverse health conditions”. He noted that “…a growing body of literature suggests that the association between socioeconomic status and development of childhood obesity is increasing…between low and high SES groups”(2018). People living in poorer communities with less disposable income and low education status, are likely to choose foods with high calories because that is what is at their disposal on the shelves at the convenient store on the corner, rather than vegetables and produce. If they do, they are likely to cost more because they are perishable and does not have a long shelf life. Healthcare Organizations: The Department of Health and Human Services (DHHS) is mandated to enhance the health and well-being of Americans by providing effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services” (DHHS, 2015a). The Center for Disease Control (CDC) partners with healthcare providers to address the issue of childhood obesity, and reports that the consequences of obesity can last a life time because obese children are more likely to become obese adults (CDC). Some solutions which have been implemented by the CDC and healthcare partners help with screenings as a method of early detection. The US Preventive Services Task Force (USPSTF) in collaboration with the CDC “recommend that children and adolescents aged 6 years and older be screened for obesity, and those with obesity be offered, or referred to high-quality weight management programs” (CDC). They have also developed obesity models (Obesity Chronic Care Model) and framework (Integrator Framework) that provide approaches to combat childhood obesity by connecting healthcare systems. RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity Current Landscape Childhood obesity is a growing problem in the U.S, affecting over 17 percent of American youths, a number which has tripled over the past 30 years (National Conference of State Legislatures, 2013), and is a global epidemic that is steadily affecting many low- and middleincome countries. (WHO 2011). Data from the State of Childhood Obesity.com says that as at 2017, 4.1 million children were obese. There are also many economical and legislative factors that contribute to the childhood obesity (2010). Legislative factors such as licensing of child care facilities are important if the nutrition of our children is in the hands of childcare helpers. The American Heart Association mentioned that “with the exception of the federal Head Start program, state laws and regulations governing the licensing of child care facilities vary substantially depending on the state” (American Heart Association). These regulations, they say differ by state depending on the type of facility and provider and generally do not provide adequate nutrition and physical activity standards” (AHA). Some of the economic factors that contribute to childhood obesity are food prices, income, maternal employment, to name a few” (Health Affairs 2010). Take the price of food as an example. The price of food has changed over the past decade - bad food (example McDonald’s cheese burger) have gotten cheaper and good food (such as fruits and vegetables) have risen over 17 percent between 1997 and 2003 (Health Affairs 2010). Overall health care spending on obesity continues to significantly burden the nation...and research data estimated obesity-related health care costs at nearly $150 billion annually, with Medicare and Medicaid funding about half of these costs, at approximately $60 billion” (NCLS 2013). In an effort to stem the increase in childhood obesity rates, many policies were implemented by the Department of Health and Human Services in October 2008, one of which is RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity the Physical Activity Guidelines, which was issued as an operational strategy by the department. (NCSL, 2013). Operational Strategies The Physical Activity Guidelines was developed by experts in exercise science and public health, and recommends 60 minutes of age-appropriate, enjoyable and varied daily, moderate-tovigorous physical activity for children (NCSL 2013). The CDC in a report conducted of the same year, concluded that physical activity during the school day provides health benefits. It has been proven that physical activities contribute to health benefits that help to strengthen the heart, muscles and bones, as well as increases students’ academic achievement (NCSL 2013). Obesity in itself is an epidemic and hence a very complex issue to fix and tackle this monster will take the input of many stakeholders uniting around the cause. Parents, schools, community leaders, childcare and healthcare professionals, and even the children themselves must play their part (CDC 2019). Fostering healthy habits in children at the early childhood developmental stage, is absolutely important, and as such, the local state departments should play a more integral role in helping agencies and community groups to bolster nutrition and physical activity standards where the states fail (AHA). Implementing operational and intervention strategies can make a difference reducing the fight against childhood obesity. Programs, such as Coordinated Approach to Childhood Health (CATCH) are a comprehensive intervention for children in elementary school. (Healthy Affairs 201). Also, educating parents on how to prepare balanced meals on a budget in order to monitor the caloric, fat, sugar and salt intake of their children is another intervention strategy. State and local programs could help to disseminate information through public libraries, community groups, local schools, etc. There is a wealth of information available on the CDS’ website that individuals and schools can access. (CDC 2019). RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity Healthcare Organizations After the enactment of the legislation on Childhood Obesity policy options in 2013, at least five states enacted the legislation or adopted resolutions related to physical education or physical activity at school in 2013 (NCSL 2013). Only five states saw the immediate need to get on board. What happened to the other 45 states? Government should also do more by intervening in the food markets to protect consumers who are ignorant of food contents and mandate that nutrition facts be listed on every packaged food item. That would allow consumers to see facts about the nutrition content in the food they purchase (Health Affairs 2010). Other healthcare organizations such as Children's Health Insurance Program (CHIP), Medicaid and Children's Health Insurance Program Reauthorization Act (CHIPRA), can help contribute to the reduction of childhood obesity. Medicaid can partner with these entities to help in reducing the rate of obesity by improving access to health care services that support healthy weight (Medicaid.gov). For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services (Medicaid.gov). Improve Yielding the biggest improvements for the healthcare system would be for Government to make interventions cost-effective for stakeholders like insurance companies, hospitals, schools, etc., which decision-makers can use analyze and compare interventions in terms of their cost per quality-adjusted life-year (QALY) save (Healthy Affairs 2010). One such intervention which is considered to be the most cost-effective is the Coordinated Approach to Child Health (CATCH). This provides comprehensive intervention to promote healthy eating and physical activity in elementary schools and costs $900 per QALY saved (Healthy Affairs 2010). Improving children’s overall health by increasing physical activities will not only prevent obesity but also reduce spending in healthcare for treating related sicknesses. RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity Informed The Physical Activity or Physical Education in Schools and Schools Recess Legislation and the CATCH intervention program can collaborate in raising the awareness to families of socioeconomic factors that influence childhood obesity. Focus on the socioeconomic factors that have caused people to consume more calories and burn less, purchase high caloric foods over ones more nutrient-dense. These socioeconomic factors and more are the driving forces that influence child obesity. Addressing these factors will certainly contribute to a reduction in childhood obesity and the related diseases in children. Barriers and Supports to Policy Change Some potential socioeconomic barriers to change in policy, as identified by BMC Pediatrics (2009) parents’ resistance to adopting recommendations to increase physical activity, finances, time, neighborhood safety, and lack of affordable and accessible recreation facilities (2009). Parents are responsible for the many aspects of the nutrition and physical activity environment that contribute to a child's health-related behaviors. Parents should encourage the children’s participate in more physical activities by making TV and screen time less. Having no safe places to play in the neighborhood will also discourage children from going out to play (BMC 2009). On the other hand however, implementing changes to support policies can help to reduce obesity. As mentioned earlier, food manufacturers play a major factor in the high rate of childhood obesity by changing the food environment by imposing tariffs on sugary drinks, altering relative prices, and reducing the number of ads marketed to children. Other supports for policy change would be to impose taxes policies that decrease consumption of unhealthy foods, and used these taxes to promote or support physical activities in schools and communities (Health Affairs 2009). Call to Action RUNNING HEAD: HCM-320 Final Project: Analysis of Health Issue – Childhood Obesity Health Affairs asserted that “Obesity is a major public health problem facing the United States, with significant consequences for health care costs and productivity. Socioeconomic factors such as poverty, lack of proper education, transportation, and food sources, all have a major impact on the health of the population (2009). Incorporating economic perspective into obesity research, interventions and policies can help identify contributors to obesity, calculate the consequences of obesity, and allocate scarce resources to the interventions that offer the greatest benefit per dollar of cost” (2010). Empowering parents to see the need to change their mindsets, monitor children’s food intake, TV screening, and promoting physical activities will be important if we are to be successful. Public officials need to do more in implementing programs at the community level or providing grants and funding to communities so they can organize and run programs to help residents.