PHE 690 Health Equity Analysis Evaluation
docx
keyboard_arrow_up
School
Southern New Hampshire University *
*We aren’t endorsed by this school
Course
690
Subject
Health Science
Date
Nov 24, 2024
Type
docx
Pages
15
Uploaded by Royina
1
Milestone Three: Health Equity Analysis and Evaluation
Erin Schlumpf
Southern New Hampshire University
PHE-690-X1196 Public Health Capstone 23TW1
Dr. Mike McNickle, Ph.D., MPH,
MPA, REHS
October 26, 2023
2
The Social Determinants
The social determinants of health build upon the pattern and trends of communicable and
noncommunicable disease that are found in communities at local, state, and federal levels. The
social determinants of health are considered where populations work, play, worship, and live in
their own unique environments. These factors are living enclaves that promote economic
security, level of education, behavioral and community trends, personal health, and healthcare
available, and the neighborhood of families, individuals, and groups. Thereby when a community
has a dipropionate number of people in populations facing a disadvantage within the social
determinants of health there is no health equity (
Frequently asked questions | Social
Determinants of Health | NCHHSTP | CDC
., n.d.). As a group of people living in a geographic
disparity can arise amongst the populations which has a negative impact on a person’s ability to
increase localized prejudices, inequality, access to health and education, racism, and poverty
(National Academies Press (US), 2021). A focus point of correlation as it relates to obesity and
data trends of the social determinants of health is obesity rates pertaining to educational levels
and income or poverty of an individual. For example, the most obese county in all of New
Hampshire is Coos County where the township of Whitefield is located (Byrnes, 2021). The data
suggests that individuals with lower income caused from lack of education do not have the same
access to healthy food, gyms, and affordable healthcare (Byrnes, 2021). Therefore, education has
a direct correlation to employment and one’s ability to earn a living and have an impact on one’s
ability to attain services. The current poverty level in Whitefield, New Hampshire is
approximately 10.1% of the population of 2,213 in 2018
(
Health Statistics & Informatics
, n.d.).
The Federal Poverty Level (FPL) in New Hampshire for an individual earning less than $14,580
per year (
Federal Poverty Level (FPL) - Glossary
., n.d.). As the information regarding the social
3
determinates of health indicates that state assistance food programs, such as WIC also have link
to education and poverty. The social determinants of health point to the development of food
insecurity, income through employment or underemployment, and reduce a person’s quality of
life and pregnancy related outcomes (
WIC is a Critical Economic Nutrition and Health Support
for Children and Families, n.d.). Because programs like WIC aid low-income mothers and
families with education and guidance on food nutrition and access to quality healthy foods it
levels the social justice and equity regarding food nutrition, food security and removes income
and educational barriers that individuals and families with middle to higher education and
income
(
WIC is a Critical Economic Nutrition and Health Support for Children and Families,
n.d.).
Behavioral Change
The role of social and behavioral health plays a part in how to correct the levels of
obesity in Northern New Hampshire in the townships of Warren and Whitefield. Because people
behave and interact in certain ways, it’s important to understand how it is important healthcare
professionals provide guidance in weight loss programs to improve health efficacy with
stakeholder participation in program design, implementation, and evaluation methods. By doing
so allows for public health professionals to address issues and use models, theories, and
frameworks that have been designed to reduce obesity and improve health, quality of life, and
wellbeing for the community. During the period from the 1970’s to the 1980’s in the United
States and in other western nations obesity became a behavior change which became a global
health issue and epidemic in the United States over the following twenty years (Temple, 2022).
Obesity is defined as having a Body Mass Index of 30 or higher. While being overweight is
having a BMI of 25-29 (Temple, 2022). In the state of New Hampshire obesity prevalence is
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
4
30.6% (
Explore Obesity in New Hampshire | AHR
. (n.d.). Obesity in the township of Warren is
25% and Whitefield obesity prevalence is 26.9% (
Explore Obesity in New Hampshire | AHR
.
(n.d.).
The increase in weight gain was caused an increase of eating and unhealthy food
consumption, an abundance of high fat foods, high calorie foods, the advancement of fast-food
chains, food became more accessible and cost less for consumers, direct marketing with glossy
television advertising (Temple, 2022).
Programs like WIC work to modify behaviors through social and physical conditions and
interact with community stakeholders to incentives healthy food to be placed in community
stores and markets. Eating healthy foods improves behavior, wellness, and provides essential
nutrients and vitamins to improve health for all members of society including children and
expecting mothers.
Usually there is a reason why a person decides to lose weight. A few of the indications
are self-awareness of one’s appearance and medical condition with the impact on self-
preservation. However, even though obesity is an epidemic in the United States at rate of 41.9%
of the population only 1% seeks medical treatment and interventions (
Obesity is a Common,
Serious, and Costly Disease
, 2022b). The goal and objectives to lose weight centers on an
increase in physical activity, improve diet intake with calorie restrictions, healthier more
nutritious foods that are low in fat, and education on a diet, health, and wellness that are time
specific where goals can be measured and attained with visible results
(Weight loss: 6 strategies
for success
, 2021). It’s not that simple because if it were easy everyone would be fit and healthy
with a Body Mass index below 25. There are natural and genetic components to obesity that must
be overcome too, as well as hormone imbalances, and lifestyles in our own environments where
are all obstacles to reducing weight from epigenetics (Wu, F., & Yin, R., 2022). By combining
5
proven methods of weight loss intervention reduction programs with community partnerships
and stakeholder participation the goal of weight loss can be achieved. These programs include
short, intermediate, and long-term objectives that focus on obesity prevalence in North New
Hampshire in Coos and Grafton Counties. The methodologies of behavior modification programs
are enacted in four parts, education, implementation, reducing obesity rates, and research. To
curb future obesity rates, programs must be introduced early through education and
implementation. Lastly, reviewing the findings in programs with successful outcomes. Other
roles of social and behavioral health science frameworks are because we want to deploy
successful programs and treatments. Research also plays a significant role because it can identify
and indicate what programs work and improve outcomes and effectiveness of those programs
that have been approved and applied. Obesity is an all-cause chronic disease that is progressively
becoming worse in New Hampshire, the United States, and effecting global health too (
Rising
obesity in the United States is a public health crisis, 2018). Therefore, the modifications of
programs to curb obesity are essential to preventative care and obesity management and program
implementations. Behavior modification concepts and treatments need to be researched and
practiced though qualitative and qualitative methods though participation, data, and surveys of
participants to improve behavior and psychological, sociological, and epidemiological concepts
to improve health impacts and outcomes.
Theoretical Framework
The program uses two models, the Health Belief Model (HBM) and the Ecological Model
(EM). The application of the EM model can best improve program goals and objectives because
it identifies behavior that applies to obesity and individual health through a community lens.
Whereas the HBM can be a compliment because of specific indicators that pinpoint and predict
6
modifications in healthy behaviors. Thereby creating the opportunities to reduce obesity in
prevalent communities such as Warren and Whitefield, New Hampshire and allow for the
creation and development of interventions that work in mitigating obesity rates.
I would like to support these models because when it comes to behavior modification it
takes some time to come to terms with adjusting personal behavior for the greater good of your
health and break lifelong cyclic unhealthy habits that can be subconsciously programmed into
your daily routine. The HBM uses a wheel of six stages,
perceived susceptibility, perceived
severity, benefits, barriers, action, and self-efficacy (
The health belief model
, n.d.). While the EM
uses contextual environmental, Intrapersonal social, and individual personal (
Ecological models
of behavior change
, n.d.). I think the application of these two behavioral modification models
combined gives a community and individual that enters a program or intervention to lose weight
the greatest opportunity for success and achieve the quality of health outcomes and equality.
Alternate Viewpoint
An alternate viewpoint a stakeholder might have from a historical perspective on
programs and policies that have worked to curb an increasing rate of obesity and preventing
obesity all together. Upon reflection of models and theories from a public health perspective we
know exactly how to reduce pounds off people when introducing an implementation on weight
loss and prevention, and yet the number of cases of obesity continue to increase or remain stable.
Early in the research the cause of obesity was concluded that obesity was the main contributing
factor of heart and cardiovascular disease was high fat intake (Teicholz, 2022). Because of this
research food production companies in the US decided to continue to manufacture their products
with sugar and shift the blame onto saturated, trans, poly and monosaturated fats (Domonoske,
2016). Research on engineering foods with sugar modification began being placed in the food
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
7
market with high fructose corn syrups and glyphosates which was included in drinks, processed
foods, and became widely and readily available without intervention due to special interest
research and lobbyist for food production companies which became the global norm for food
production and delivery for consumption which was the trigger event of the epidemic on obesity
because its, cheap, filling, and profitable (
Freudenberg, 2021).
Physical Activity is a behavior that most people need to lose weight resist (
Leitzmann,
2017). The design of most weightless programs heavily focused on exercise rather than on
nutrition or nutritional education
(
Leitzmann, 2017). While in the interim the programs have
poor planning because short-term success with participants shows improvements and weight
loss, intermediate and long-term goals prove the weight is put back on (Parker, et al., 2010).
Therefore, the program has been designed and implemented incorrectly on behaviors that will
fail to maintain their weight with long-term goals. It has been demonstrated that food intake of
healthy nutritious foods with limited exercise, and balanced caloric intake have proven to be
successful, and yet obesity prevalence continues to increase.
The alternative viewpoint would be to introduce incentive weight loss that is manageable
to develop a habit or routine to encourage financial reward for long-term incentives and benefits.
Secondly, remove companies that have a conflict of interests in diet programs by selling their
foods with misguided labels and nutritional information. Our nutritional guidelines are based on
a carbohydrate dietary intake of 2,000 per day, that 45%-65% 9
Carbohydrates: How carbs fit
into a healthy diet
, 2022). If we increased our protein intake (real food, i.e., meats and
vegetables), removed sugary drinks and diet drinks without artificial sweeteners, replaced with
water, and had limited exercise weight loss would be achievable.
8
Another alternative viewpoint from a stakeholder perspective would be the taxation on
sugar-sweetened beverages. For example, one 12oz can of Coca-Cola contains 140 calories
45gms of sodium, and 39g of sugar (
How much sugar is in Coca-Cola?
(n.d.). The sugar intake
increases as the ounces increase, which your body converts to fat. In any community, local
businesses focus on profit. Thereby a tax on beverages decreases profit. The consumer must pay
more for a product that they regularly consume. Stakeholders also consider the impact on
vulnerable populations which affect low-income communities that are affected
disproportionately by obesity (Clarke, et al., 2021).
Evaluation Method
The evaluation method selected for this program is an impact evaluation with a mixed
method designed to improve and achieve program goals and objectives. The reason I selected
this program is due to observed changes to participants to lose weight and improve health from
access to healthy foods through the WIC program and the impacts produced by the interventions
(
Impact evaluation
, n.d.). To lose weight observed results and key to the programs strengths and
using this method uses qualitative and quantitative data analysis and unique participation
approach (
Impact evaluation
, n.d.). The quantitative analysis uses mathematics to review
findings and participation samples. As we are analyzing the important factors of the program’s
participants and design as to where, when, who, and the program process success. For example,
the quantitative analysis looks at the total population, number of people overweight and obese,
what stakeholders are engaged, and community member participants, and reviews of data to best
improve the program and make corrections and adjustments when needed.
The qualitative analysis uses collected and gathered data from within the community
through methods such as surveys’ questionnaires, and observations. Health improvement plans to
9
lose weight determine the goals of the participants feelings about their success and
accomplishments and looks at their positive or potential negative feedback on the program
design and targets reached by the participants. Participants can also give detailed answers in
surveys and questionnaires as to their beliefs on food nutrition, physical exercise, and objective
toward meeting their goals.
Questions
Since the program will be using an impact evaluation assessment the questions on a
survey or questionnaire should be tailored to answer those questions.
1.
Did the program meet its goals? Short-term, intermediate, and long-term?
2.
Did the program work effectively?
3.
Who was most impacted by the program?
4.
Have attitudes and beliefs been attributed to the intervention?
5.
What part of the program contributed to health and wellbeing in the community?
Written Evaluation
To answer the first question, did the program meet its goals? The evidence suggest that
the Centers for Disease Control and Prevention programs called, HOP, REACH, WIC, and SPAN
work effectively and are cost driven and goal oriented federal and state funded health and
wellness programs targeting weight loss and curbing obesity (
CDC-funded state and local
programs
, 2023). These programs have demonstrated to reduce obesity, increase physical
activity, and breast feeding had a direct impact on increasing health and wellness in children and
infants through action-planned goals as well as adult participants and childhood obesity
(
CDC-
funded state and local programs
, 2023). A short-term goal was to make physical activity safe and
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
10
accessible for all and make breast feeding easier to start and continue (
CDC-funded state and
local programs
, 2023). An intermediate goal is for the targeted population to access healthier
more nutritious foods and decrease eating higher fatty and sugary food options, which increased
weight loss goals and breast-feeding habits become routine in targeted populations
(
CDC-funded
state and local programs
, 2023). The long-term goal is to reduce mortality rates and improve
health and well-being that were formerly caused by obesity. This also improves health for
children and infants by breast feeding
(
CDC-funded state and local programs
, 2023). The WIC
program in 2022 has 6.3 recipients, and 39% of program participants are children (
USDA ERS -
WIC program
, n.d.).
Did the program work effectively? The programs were designed and
implemented to impact their targeted audience, but more research needs to be done to have an
accurate assessment of the overall success of the program’s goals, objectives, and outcomes.
Who was most impacted by the program? The population most effective by the
implementation of programs are women and children, vulnerable low-income individuals, and
families with limited education. Obesity is a chronic disease that causes the development of
comorbidities if not treated in a timely fashion. Health equity in underserved populations
requires access and education due to systemic barriers and equal access to healthy foods
(
Equitable Long-Term Recovery and Resilience | Health.gov
, n.d.). The WIC program is
designed to help women and children overcome these health attributed obstacles, such as missed
medical appointments and receive prenatal care, (
USDA ERS - WIC program
, n.d.).
Have attitudes and beliefs been attributed to the intervention? When targeting obesity,
changes in the psycho-social behaviors include structural obesity programs have worked to
change attitudes and belief that weight loss is possible (
Backholer, K., Beauchamp, A., Ball, K.,
Turrell, G., Martin, J., Woods, J., & Peeters, A. (2014). However, participants with high
11
stigmatization are less likely to believe that weight loss is achievable
(
Backholer, K.,
Beauchamp, A., Ball, K., Turrell, G., Martin, J., Woods, J., & Peeters, A. (2014). According to
the CDC children with access to WIC have lower obesity rates, but children whose parents don’t
participate in the program have an increased risk to outside influence that affect their diet and
weight loss program because their fundamental beliefs and attitudes toward the overall success
of the program reduce with outside exposure (
CDC-funded state and local programs
, 2023).
What part of the program contributed to health and wellbeing in the community?
According to the CDC, children in ages between two years of age and four years old that were
receiving WIC benefits had a decline in obesity between the years of 2010 and 2020 (
Obesity in
Low-Income children
, 2022). The prevalence for overweight and obese children went down from
32.5% to 29.8% in 2020
(
Obesity in Low-Income children
, 2022). Due to this program children
losing weight contributed to an improved health and wellbeing for children enrolled in WIC.
Having multiple programs work in tandem with another state funded resource called, SNAP
provided for low-income families that qualified for assistance to have greater access to more
nutritious and healthier food combined with the WIC program gives families overall improved
health and wellness.
12
References
Backholer, K., Beauchamp, A., Ball, K., Turrell, G., Martin, J., Woods, J., & Peeters, A. (2014).
A framework for evaluating the impact of obesity prevention strategies on socioeconomic
inequalities in weight.
American Journal of Public Health
,
104
(10), e43–
e50.
https://doi.org/10.2105/ajph.2014.302066
Bar‐Tal, D., & Hameiri, B. (2020). Interventions to change well‐anchored attitudes in the context
of intergroup conflict.
Social and Personality Psychology
Compass
,
14
(7).
https://doi.org/10.1111/spc3.12534
Byrnes, H. (2021, June 1).
This is the most obese county in New Hampshire
. 24/7 Wall
St.
https://247wallst.com/state/this-is-the-most-obese-county-in-new-hampshire-2/
Carbohydrates: How carbs fit into a healthy diet
. (2022, March 22). Mayo
Clinic.
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-
depth/carbohydrates/art-20045705#:~:text=The%20Dietary%20Guidelines%20for
%20Americans,grams%20of%20carbs%20a%20day
.
Obesity in Low-Income children
. (2022, November 8). Centers for Disease Control and
Prevention.
https://www.cdc.gov/obesity/data/obesity-among-WIC-enrolled-young-children.html
CDC-funded state and local programs
. (2023, September 28). Centers for Disease Control and
Prevention.
https://www.cdc.gov/nccdphp/dnpao/state-local-programs/index.html
Clarke, B., Kwon, J., Swinburn, B., & Sacks, G. (2021). Understanding the dynamics of obesity
prevention policy decision-making using a systems perspective: A case study of Healthy
Together Victoria.
PLOS ONE
,
16
(1), e0245535.
https://doi.org/10.1371/journal.pone.0245535
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
13
Domonoske, C. (2016, September 13). 50 Years Ago, Sugar Industry Quietly Paid Scientists To
Point Blame At Fat.
NPR
.
https://www.npr.org/sections/thetwo-way/2016/09/13/493739074/50-
years-ago-sugar-industry-quietly-paid-scientists-to-point-blame-at-fat#:~:text=Ascui%2FGetty
%20Images-,A%20newly%20discovered%20cache%20of%20internal%20documents
%20reveals%20that%20the,of%20sugar%20in%20the%201960s.&text=In%20the%201960s
%2C%20the%20sugar,article%20in%20JAMA%20Internal%20Medicine
.
Ecological models of behavior change
. (n.d.). Change Theories
Collection.
https://ascnhighered.org/ASCN/change_theories/collection/ecological_models.html#:
~:text=Ecological%20models%20have%20been%20widely,we%20can%20change%20their
%20behavior
.
Equitable Long-Term Recovery and Resilience | Health.gov
. (n.d.).
https://health.gov/our-
work/national-health-initiatives/equitable-long-term-recovery-and-resilience
Explore Obesity in New Hampshire | AHR
. (n.d.). America’s Health
Rankings.
https://www.americashealthrankings.org/explore/measures/Obesity/NH
Federal Poverty Level (FPL) - Glossary
. (n.d.).
Freudenberg, Nicholas,
'Food: Ultra-processed Products Become the Global Diet'
,
At What Cost:
Modern Capitalism and the Future of Health
(
New York,
2021;
online Edu,
Oxford Academic
,
23 Sept. 2021
),
https://doi.org/10.1093/oso/9780190078621.003.0002
.
How much sugar is in Coca-Cola?
(n.d.).
https://www.coca-colacompany.com/about-
us/faq/how-much-sugar-is-in-coca-cola#:~:text=There%20are%2039%20grams
%20of,availability%20varies%20based%20on%20geography).&text=Do%20you%20have
%20any%20drinks%20with%20fewer%20calories%3F
14
Health Statistics & Informatics
. (n.d.). New Hampshire Department of Health and Human
Services.
https://www.dhhs.nh.gov/programs-services/population-health/health-statistics-
informatics
HealthCare.gov.
https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
Frequently asked questions | Social Determinants of Health | NCHHSTP | CDC
.
(n.d.).
https://www.cdc.gov/nchhstp/socialdeterminants/faq.html#:~:text=Addressing%20social
%20determinants%20of%20health%20is%20a%20primary%20approach%20to,other
%20socially%20determined%20circumstance'%E2%80%9D
.
Impact evaluation
. (n.d.). Better Evaluation.
https://www.betterevaluation.org/methods-
approaches/themes/impact-evaluation#:~:text=An%20impact%20evaluation%20provides
%20information,and%20unintended%2C%20direct%20and%20indirect
.
National Academies Press (US). (2021, May 11).
Social determinants of health and health
equity
. The Future of Nursing 2020-2030 - NCBI
Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK573923/
Leitzmann, M. (2017).
Physical activity, sedentary behaviour, and obesity
. Energy Balance and
Obesity - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK565813/
Obesity is a Common, Serious, and Costly Disease
. (2022b, July 20). Centers for Disease
Control and Prevention.
https://www.cdc.gov/obesity/data/adult.html
Parker, V. G., Coles, C., Logan, B. N., & Davis, L. (2010). The LIFE project.
Family &
Community Health
,
33
(2), 133–143.
https://doi.org/10.1097/fch.0b013e3181d594d5
15
Rising obesity in the United States is a public health crisis.
(2018).
www.commonwealthfund.org
.
https://doi.org/10.26099/fth3-sd41
The health belief model
. (n.d.).
https://sphweb.bumc.bu.edu/otlt/MPH-
Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories2.html
Temple, N. J. (2022). The origins of the obesity epidemic in the USA–Lessons for
today.
Nutrients
,
14
(20), 4253.
https://doi.org/10.3390/nu14204253
Teicholz, N. (2022). A short history of saturated fat: the making and unmaking of a scientific
consensus.
Current Opinion in Endocrinology, Diabetes and Obesity
,
30
(1), 65–
71.
https://doi.org/10.1097/med.0000000000000791
USDA ERS - WIC program
. (n.d.).
https://www.ers.usda.gov/topics/food-nutrition-
assistance/wic-program/#:~:text=WIC%20served%20about%206.3%20million,infants%20in
%20the%20United%20States
.
Weight loss: 6 strategies for success
. (2021, December 7). Mayo
Clinic.
https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-
20047752
WIC IS A CRITICAL ECONOMIC, NUTRITION, AND HEALTH SUPPORT FOR
CHILDREN AND FAMILIES. (n.d.).
Food Research & Action Center
.
https://frac.org/wp-
content/uploads/frac_brief_wic_critical_economic_nutrition_health_support.pdf
Wu, F., & Yin, R. (2022). Recent progress in epigenetics of obesity.
Diabetology & Metabolic
Syndrome
,
14
(1).
https://doi.org/10.1186/s13098-022-00947-1
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help