The
social determinants of health are shaped by the communities we grow up in and
the environmental conditions that surround us as we grow, work and age. These circumstances are decided based on the
distribution of money, power, family’s socioeconomic status and resources. As
noted by the World Health Organization in 2014,
These in turn shape the way society, both at
national and local level, organizes its affairs, giving rise to forms of social position and hierarchy, whereby
populations are organized according to income, education, occupation, gender,
race/ethnicity and other factors. Where
people are in the social hierarchy affects the conditions in which they grow,
learn, live, work and age, their vulnerability to ill health and the
consequences of ill health (p. 1)
Examining
social determinants related to childhood obesity at macro, meso, and
micro-levels will allow community members to identify the root causes of this
issue in order to prevent it from occurring.
At a macro-level, cultural norms and
political agendas play a role in childhood obesity. It is widely known that the
American diet consists of a lot of processed carbs, meats, and sugars. Slow
cooked, fresh food isn’t as common as it was half a century ago where stay-at-home
moms or multi-generational units cooked family meals daily. Now, there is a widening
gap between the rich and poor, and both parents typically work a job, don’t
share a home with their extended family, and/or may not have time to pack
lunches or cook dinner. Parents often depend on institutions to provide their
children’s meals. While the middle class has been disappearing, the amount of
community investment has also dwindled. Meal plans at day cares and schools
highly depend on the funding they receive as a result. The class status of
children’s parents will determine where and what their children are fed. Those
whose parents are upper class have more access to organic, fresh meals at their
homes or schools. According to Kolata (2014), “most efforts to reduce childhood
obesity concentrate on school-age children and apply the steps indiscriminately
to all children, fat and thin — improving meals in schools, teaching nutrition
and the importance of physical activity, getting rid of soda machines” (p. 1). To
make a difference, we can support more funding for schools and lobby for the
use of organic, fresh ingredients for children to consume, especially since
parents are busier than ever and families may not have immediate access to
grocery stores or expensive organic goods.
In an article written by Irwin & Solar (2010),
the authors highlight the difference between
levels of causation, distinguishing between the mechanisms by which social
hierarchies are created, and the conditions of daily life, which then result
from these social inequalities (p. 4). At a meso-level, our
family’s socioeconomic status, the neighborhood where their home is located,
the city, the state, the country in which they reside, these all shape our
social determinants of health, and yet, it is not a choice that we get to
make. The inefficient system in place is
largely to blame for the obesity crisis we are experience here in the states;
citizens of lower socioeconomic status don’t have as much power as their
affluent white counterparts to control zoning laws in neighborhoods to not
allow fast food restaurants to be built near their homes and neighborhoods. Also,
they don’t have the money to petition against the city to change zoning laws.
The obesity epidemic is not just a crisis due to the lack of available and
affordable healthy foods, but also the lack of safe environments surrounding the
supermarkets that are located in the lower income communities. This makes it
even more difficult for individuals to change their behavior.
Furthering our scope to a micro-level, people of
lower socioeconomic and ethnic minority status, typically have higher rates of
obesity within a community. Obesity prevalence varies by age, gender, race,
ethnicity and socioeconomic status, but is also associated independently with
higher levels of physical inactivity and an increase in television viewing. As
stated by Ebbeling (2002),
Television viewing is thought to promote weight
gain not only by displacing physical activity…US and British children are
exposed to about ten food commercials per hour of television time (amounting to
thousands per year), most for fast food, soft drinks, sweets, and
sugar-sweetened breakfast cereal. Exposure to 30-second commercials increases
the likelihood that 3–5-year-olds would later select an advertised food when
presented with options (p. 475).
Children
of lower socioeconomic status have increased risk of obesity due to the lack of
affordable activity/sport programs that can replace sedentary entertainment
like television. They also have the inability to control if their families can
afford to buy healthy alternatives to cheap meal options, such as organic
fruits and vegetables, and raw goods and poultry to cook a well-balanced meal. Coupled
with the fact that there are increased amounts of fast food available to these
areas, those who belong to a minority and are of lower socioeconomic status are
at risk for becoming obese at a young age.
Childhood obesity is not a new
concept - obesity in children has existed throughout all decades. However, that
is not the current problem in the realm of childhood obesity; the problem is
the rate at which the population of overweight children is growing. The facts
make for a solid argument to study ways to intervene and prevent childhood
obesity from occurring. According to national research and data, the amount of
overweight youth (6-17 year olds) has more than tripled in the past 50 years.
Approximately 4% of youth in the 1960’s were overweight, compared to 15% in
2000 (Ritchie et al., 2001). The most recent data from the 2008 National Health
and Nutrition Examination Surveys shows that 17% of youth is obese, and an
additional 15% is overweight (“Childhood Obesity Prevention”). More children are becoming overweight each
year, which poses a threat to their overall health and well-being, sometimes following
them into adulthood. Tackling the ongoing problem of overweight children is
essential, because it is estimated that one-half of overweight youth remain
overweight as adults, and one-third of overweight preschoolers remain
overweight throughout adulthood as well (Ritchie et al., 2001). Obesity in
adults has been linked to and associated with an increased risk of multiple
health problems such as high cholesterol, high blood pressure and type 2
diabetes (Ritchie et al., 2001). There are a great deal of reasons why
interventions and community based programs that teach children healthy eating
and physical activity habits should be prevalent and widespread throughout the
nation.
One of the
biggest lessons learned from overweight intervention studies is that healthy
habits and lifestyles start in the home and are long-term. Parents and families
play a major role in assessing the eating habits of children. Children learn
from their parents, and tend to model the behaviors carried out by their
parents such as food preparation, purchasing, and consumption (Ritchie et al.,
2001). If a child grows up in a home where only fast-food is consumed, then
chances are that child will grow up to have the same poor eating habits.
Because children often carry out the same habits and behaviors all throughout
life, parents should teach their children about healthy eating habits, cook
healthy and nutritious meals, and limit access to oily and sugar-filled foods
and beverages. Parents should also encourage their children to spend more time
outdoors and participating in physical activities, and spend less time being
sedentary by watching TV, playing on the computer or playing video games.
While the goal for many adults during interventions is
focused around weight loss, the goal among children is weight maintenance
(Ritchie et al., 2001). By teaching children to remain a healthy weight,
children are able to learn healthy habits that lead to a healthier lifestyle
rather than focusing on weight and body image. Weight status does not always
directly correspond to health status, which is why improved health through
multiple indicators and goals is used to measure and evaluate success in
overweight interventions. Components of physical activity, a healthier diet and
psychosocial adjustment are all used as indicators and measurements of a
healthy lifestyle during interventions (Ritchie et al., 2001). These three
strategies must be extended to our daycares and schools, too. Healthy habits
start at home, but should also be continued in the places where children spend
the majority of their time. This requires action at the individual level at
home and at the community level through our voting practices, food quality
expectations, and societal investment in our youth. Through each of these
levels, we can prevent at-risk populations from developing obesity as a child.
References
Childhood Obesity Facts. (2014,
August 13). Retrieved November 19, 2014, from
Ebbeling, C. B., Pawlak, D. B.,
& Ludwig, D. S. (2002). Childhood obesity: public-health crisis, common
sense cure. The lancet, 360(9331), 473-482. Retrieved from
