A Social Determinant of Health Impacting Public Wellbeing in Preston, UK

People’s sense of security, health, social engagement and overall wellbeing are generally affected by where they live (Linda, 2015). A-2018 report, titled: “Obesity: Preventing and Managing the Global Epidemic”, by World Health Organisation (WHO), stated that most of these factors can be collectively grouped under appropriate social determinants of health. Social determinants of health are defined as the conditions in the environment that people are born, live, play, work, learn, worship and age, which largely affect their functioning, health and quality-of-life outcomes. In this context, physical, social and economic conditions that take place in various settings like school, workplace, church and neighbourhood are referred to as ‘places’. This paper focuses on lifestyle factors and specifically discusses obesity as one of the leading contemporary social determinants in relation to public health and overall wellbeing of the people by trying to unveil the health-related global implications of obesity. It further narrows the statistical evidence down to the national level in an attempt to ascertain the level of negative impacts that obesity has on public health. In furtherance and in respect to the subject matter, the paper sheds light on Preston, the possible economic constraints and widely adopted lifestyles, which are believed to have largely contributed to the rate of obesity in the area. The paper also seeks to analyse all the intervention approaches (both at national and local levels) that have so far been employed towards mitigating the instigators of this social determinant. The beneficent and non-maleficence of these approaches are also closely reviewed in a manner that either gives credence to such measures or discredit them in sincerity of relevance and usefulness.

Background

Obesity is defined as excessive or abnormal accumulation of fat in the body to such volume that has the tendency of impairing health (Ranjiani, Mehreen, Pradeepa, Anjana, Garg, Anand and Mohan 2016). World Health Organisation (WHO 2018) points to any Body Mass Index (BMI) greater than 29 for adults as being obese. According to the same report, global obesity rate has nearly tripled since 1975. In the year 2016, about 1.9 billion people that were 18 years and above were overweight out of which more than 650 million were completely obese (WHO 2018). Rightly put, 39% of people within the said age brackets were overweight in 2016 and 13% were particularly obese. The same report also hints on the prevalence of obesity amongst children and adolescents, which rose from 4% in 1975 to about 18% in 2016. More than 41 million children that were 5 years or below were overweight (WHO 2016) and by slight extension of the age group, over 340 million children and adolescents between the ages of 5 and 19 years were overweight or completely obese in 2016.

Preston is the 50th city of England – a non-metropolitan district in Lancashire, with a population of well over 142,000 people (Abbas, 2017). The city of Preston is well represented in educational sector in the whole of England and can be considered proportional to the national statistics but in health, Preston takes a negative turn in comparison with the national statistics. According to Collins, Jones, Patel, and Scott (2015), supported by Public Health England (2016), in 2011, the census on Preston general health statistics revealed that the percentage of residents who rated as being very good in health was less than the national average. While the national average stood at 62.7%, Preston was at 54.6%. Conversely, the percentage of those that rated as being very bad in health was 13.1% for Preston, while the national average was 9.4% (Farha, 2017). This development suggests that Preston could largely have underperformed in the areas of health awareness campaign and adoption of necessary intervention measures. Obesity is known to be a major contributor to the health issues in Preston (Farha, 2017). In response to this, the World Health Organisation, governmental and non-governmental agencies have developed a number of intervention measures to curb obesity and other social determinants in Preston. These intervention approaches were mainly aimed at reducing socioeconomic inequalities and reducing weight gain among low-literacy, low-income adults through various awareness campaigns, diet and physical activity (WHO, 2014).

Epidemiology

According to the World Obesity Federation (WOF 2019), obesity is a chronic disease. In 2019 Journal publication, titled: “Obesity – a chronic relapsing progressive disease process”, the World Obesity Federation confirms obesity as a chronic, relapsing disease because it fits the epidemiological model of disease processes except that the pathological agent in its case is diet-related instead of microbe (WOF 2019). Bray, Kim and Wilding (2017) had earlier made suggestions that supported this claim. It was stated that obesity is best regarded as a disease because doing so will help remove the feeling that obese individuals are solely responsible for their excess body weight and this will greatly impact on the efforts to effectively arrest the causes. In line with a 2018 report by the World Health Organisation, titled “Key Learning on Health in All Policies Implementation from Around the World” about 2 billion adults are overweight, out of which an estimation of 650 million persons are considered to be affected by obesity, having BMI > 30kg/m2. This figure of overweight population equates to about 39% of adults aged 18 and above while 13% is obese. If there are no interventions to change the present trend, it is estimated that the number of overweight adults will rise to an average of 2.7 while the obesity figure may rise to as much as 1 billion by the year 2025 (Bray et al., 2017).

In the United Kingdom, Obesity is a huge contemporary health concern, which many authorities believe to be among the leading preventable causes of death (Andrew, 2016). It was for this reason that the former Health Secretary Jeremy Hunt referred to the alarming obesity rate especially amongst the teenagers as a national emergency (Andrew, 2016). About 84% of the adult population in England was considered overweight as at 2014 (Sarah, 2016). According to Wang, Mcpherson, Marsh & Gortmaker (2011), up to 11 more million adults in the UK may be classed as obese before 2023, which might translate to as much as 668,000 additional cases of diabetes mellitus, 130,000 cases of cancer, 461,000 cases of heart disease and stroke and this may lead to additional medical cost that might be amounting to 2 billion Pounds annually. Similarly, the Health and Safety Executive (HSE) conducted a research in 2014 to ascertain the true rate of obesity prevalence among children in England. According to Linda (2015), about 17% of children aged 2 to 15 were completely obese. The report pointed towards Preston as one the cities with the highest prevalence of obesity.

Making the use of Public Health England (PHE) health profile tools together with the Quality and Outcomes Framework (QoF) disease registers, Abbas Farha (2017) reached an understanding of the major health issues affecting the people of Preston among which obesity came out prominently. Obesity is one of the major driving factors for heart disease, stroke and diabetes in Preston (Farha, 2017). There is a record of high level of deprivation in Preston with well over 91,759 individuals living within neighbourhoods (LSOAs), which is largely considered to be one of the most deprived in the whole of England. The district equally has about 20% of its teenagers living in low income families (Farha, 2017).

Social Determinant of Health

All over the world, the growing rate of obesity is influencing a lot of health challenges (Swinburn, Sacks, Hall, McPherson, Finegood, Moodie & Gortmaker, 2011). Obesity is closely associated with a number of diseases, which include Type 2 diabetes, high blood pressure, heart disease and strokes, cancer, sleep apnea, osteoarthritis, fatty liver disease, kidney problem and pregnancy problem like high blood sugar during pregnancy (Swinburn et al., 2011).

Lack of physical activity coupled with excess consumption of high energy foods are major lead factors that make people develop obesity (WHO 2017). It is fundamentally caused by an imbalance between consumed calories and expended calories (WHO 2018). Studies also show that lack of sleep, sedentary behaviour and high stress level are big contributing factors too (Patel & Hu 2008). These things can happen conjointly in a dynamic way and at different levels of intensity in the period of a day, year of lifetime. These behaviours, in turn, are influenced by a range of factors, which include genetic, biological and psychological factors (Patel & Hu 2008).

Decades earlier, people did manual work such as farming, building, transporting etc, but in the contemporary world, technology has significantly removed those manual labour from our daily lives through the aid of machines and this has automatically resulted in excess weight for individuals who have a bit of difficulty restricting themselves from consuming more energy foods than they can expend (Swinburn et al., 2011). In studying the main upstream determinants of obesogenic behaviours, neighbourhood and community were at the centre consideration (Diez-Roux and Folgueras, 1997). Social factors like social networks and segregation are also considered to have impacts on neighbourhood social interaction through their ability to influence where and with whom they live, shaping how people perceive their circumstances and shaping available resources (Swinburn et al., 2011). Content and quality of houses, facilities and infrastructure in neighbourhoods have great impact on the behaviour and health outcomes of the people (Swinburn et al., 2011). Good understanding of the relationship between lifestyle and obesity goes a long way to adding potency to whatever intervention measures any organisation intends to introduce. In Preston, as stated by Hill (2018), one in 5 out-of primary school children are obese. There has been the question as to the exact factors that set Preston apart in the high obesity rate.

National and Local Strategies

In 2017, the World Health Organisation, in collaboration with several other world bodies had a conference in South Australia for International health policy formulation (WHO 2017). The commission discussed extensively on increasing impacts of social determinant factors and how they could hamper the Shanghai Declaration on promoting health in the 2030 agenda for Sustainable Development (SDGs). Central in the agenda was how to curb the health-related impacts of obesity. Rose (1994) argued that instead of focusing on high risk individuals such as those whose conditions were being fueled by genetic factors, it was much more plausible to concentrate on the majority of others whose conditions were fueled by socio-economic factors. If lack of money was the major cause of certain medical conditions, it then means that availability of money can correct most of them. Building on the outcome of arguments like this, the British government is taking different levels of intervention measures to curtail the menace of obesity in the whole of England, targeting more of areas with greater socio-economic challenges (WHO 2014), which correctly defines the category that Preston falls into as at today’s ratings.

All these are the intervention measures as projected at the international level. On the national level, the British government has at various points, reached respective sections of the country in an attempt to integrate plans that if implemented would significantly mitigate the increasing rate of obesity. For instance, the British Prime Minister, Theresa May, during a 2017 nationwide broadcast, as published by the Department of Health and Social Care (2018), stated that obesity was increasingly causing many sicknesses among school children, which include Type 2 diabetes and liver problem. She further said that the government had started its intervention through sensitisation campaign. According to the Department of Health and Social Care (2018), this was aimed to educate people especially parents on the possible ways they could avert child obesity amongst their children through giving them the right diet and helping them to be physically active and the implementation was done nationwide.

It is estimated that obesity-related cases cost as much as 6.1 billion pounds directly from the NHS and 27 billion pounds from the overall society annually (DHSC 2018). Following other numerous intervention measures, the government, in 2016, took its campaign against obesity down to the grassroots in the whole of United Kingdom (DHSC 2018).

The beneficence and non-maleficence of the different approaches employed by the different bodies, fighting obesity have been reviewed in an attempt to measure their levels of effectiveness. Studies have shown that different individuals have different abilities to adapt and accept medical procedures (Perryman and Sidoti 2015). Nevertheless, the benefits of the adopted preventive approaches, which include grassroots obesity control campaigns, outweigh the visible downside (Perryman and Sidoti 2015).

For instance, this will reduce the cost of treating complications that emanate from obesity. This development will reflect on the living standard of individuals as well as help governmental agencies save some money that would otherwise go into treatment of diseases. Attention seems to be more on arresting childhood obesity than that of the adults. This is because the prevalence of obesity in children and adolescents appear to be stabilizing now than ever before (Perryman and Sidoti 2015). In this course, the different intervention programs do not favour only those that have money and can pay but capture every individual that is in need (Abbas 2017). Among many known approaches to mitigating the impacts of obesity, mostly in obese children population of Preston is decentralized pharmacotherapy. This process involves the use of pharmaceutical drugs to control the accumulation of fat in the body (Abbas 2017). This approach is only applied in rare cases, particularly when diet and exercise do not give desired results. It is used to save affected persons from developing complications and it has helped reducing the number of obese individuals in the whole of United Kingdom (Abbas 2017).

Others are family-based behavioural treatment (FBBT) and in rare cases, surgery (De Godoy-Matos et al., 2009). The collaborative efforts from different contributing bodies have significantly facilitated the process of selecting right treatment options for patients and implementing them. Although, the use of pharmacotherapy in the treatment of childhood obesity, according to (Diaz and Folgueras 2014), sometimes, has serious downsides, it is however, the most appropriate response to certain difficult cases of obesity like when the patient has difficulty in following the recommended diet.

Conclusion

Obesity has been widely recognized as a major social determinant of health. Some known causes are diets and lack of physical activity. Other prominent influencers include environmental factors like the people one associates with, the residential facilities - housing and utilities; as well as infrastructure. A significant portion of the world’s population turns obese at some points in their lives. Obesity is known for its tendencies of leading affected individuals to a number of medical complications and diseases amongst which are stroke, heart disease, type 2 diabetes etc. As a result of such negative outcomes, several governmental and non-governmental international organisations have mapped out measures towards fighting obesity down to its causes. Prominent among these international bodies is the World Health Organisation (WHO). Most of these international bodies and agencies have, at various capacities, worked with governments and institutions of different nations in attempt to reduce the impact of obesity in those nations. In the United Kingdom, the negative impacts of obesity are as severe as it is in other European countries, for which there has been the introduction of different categories of both government-sponsored and non-governmental intervention mechanisms. These mechanisms largely focus on areas with greater environmental challenges. One of such areas is the Preston City. Studies have revealed that Preston has one of the greatest numbers of children living with low income parents in the UK. Also, it ranks high in other environmental challenges. For effective outcome, some Lancashire-based organs have taken huge stride to educate the populace about the downside of eating more calories than what the body really needs. The beneficence and non-maleficence spans across security of lives and wellbeing of individuals; more importantly, it ripples down to the economic benefits for the state and the affected individuals.

References

1. Abbas, F. (2017). Public Health Intelligence Team Business Intelligence. Lancashire County Coucil. Retrieved from: https://www.lancashire.gov.uk/media/898285/greater-preston-ccg-mini-summary-profile-2017-18.pdf
2. Boseley, S. (2016). The chicken shop mile and how Britain got fat. The Guardian. Retrieved from: https://www.theguardian.com/society/2016/jan/28/chicken-shop-mile-britain-fat-cheap-food-obesity
3. Bray, G., Kim, K. and Wilding, J. (2017). Obesity: A Chronic Relapsing Progressive Disease Process. A Position Statement of the World Obesity Federation
4. Collins, S. Jones, D. Patel, A. and Scott, D. (2015). Health Behaviours Joint Strategic Needs Assessment Secondary Data Analysis. Retrieved from: https://www.lancashire.gov.uk/media/901334/health-behaviours-jsna-secondary-data-analysis-february-2015-updated.pdf
5. De Godoy-Matos, AF., Guedes, EP. De Souza, LL. Martins, MF. (2009). Management of obesity in adolescents: state of art. Arq Bras Endocrinol Metabol.
6. Department of Health and Social Care (2018). Childhood Obesity: A Plan for Action. Chapter 2.
7. Retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/718903/childhood-obesity-a-plan-for-action-chapter-2.pdf
8. Diaz, EG. Folgueras, TM. (2014). Systematic review of the clinical efficacy of sibutramine and orlistat in weight loss, quality of life and its adverse effects in obese adolescents. Nutr Hosp
9. Diez-Roux, AV. Nieto, FJ. Muntaner, C. Tyroler, HA. Comstock, GW. Shahar, E. Cooper, LS. Watson, RL. Szklo, M & Am J Epidemiol. (1997). Neighborhood environments and coronary heart disease: a multilevel analysis, 146(1), 48-63. doi:10.1093/oxfordjournals.aje.a009191
10. Hill, M. (2018), One in Five Primary Schoolchildren in Preston are Obese. Lancashire Post
11. Linda, N. (2015). Health Survey for England, 2014. Health and Social Care Information Centre
12. Patel, SR & Hu, FB. (2008). Short sleep duration and weight gain: a systematic review. Obesity Silver Spring, 16(3), 643-53. doi:10.1038/oby.2007.118
13. Perryman, M. and Sidoti, K. (2015). Ethical Considerations in the Treatment of Childhood Obesity. Retrieved from: https://www.dovepress.com/ethical-considerations-in-the-treatment-of-childhood-obesity-peer-reviewed-fulltext-article-MB. DovePress
14. Public Health England (2016). Commissioning for Value Long Term Conditions Pack. NHS Greater Preston CCG. Retrieved from: https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2016/08/cfv-greater-preston-ltc.pdf
15. Ranjiani, H. Mehreen, TS. Pradeepa, R. Anjana, RM. Garg, R. Anand, K. and Mohan, V. (2016). Epidemiology of Childhood Overweight and Obesity in India: A Systematic Review, 143(2), 160–174. doi:10.4103/0971-5916.180203
16. Rose, G. (1994). The Strategy of Preventive Medicine. Oxford University Press
17. Sarah, B. (2016). The Experience of Stigma in Overweight Adults. University of Louisiana
18. Sparrow, A. (2016). Childhood obesity is a national emergency, says Jeremy Hunt. The Guardian. Retrieved from: https://www.theguardian.com/society/2016/feb/07/childhood-obesity-national-emergency-jeremy-hunt-health-sugar-tax-jamie-oliver
19. Swinburn. BA. Sacks, G. Hall, KD. McPherson, K. Finegood, DT. Moodie, ML & Gortmaker, S. (2011) The global obesity pandemic: shaped by global drivers and local environments
20. Wang, C., Mcpherson, K., Marsh, T., & Gortmaker, S. (2011). Health and Economic Burden of the Projected Obesity Trends in the USA and the UK. THE LANCET
21. World Health Organisation (WHO 2018). Key Learning on Health in All Policies Implementation from Around the World, Information Brochure. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/272711/WHO-CED-PHE-SDH-18.1-eng.pdf?ua=1
22. World Health Organisation (WHO 2017). Health in All Policies: Progressing the sustainable Development Goal, PHE. Retrieved from: https://www.who.int/phe/events/HiAP-conference-March2017/en/
23. World Health Organisation (WHO 2018). Obesity and Overweight, Retrieved from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
24. World Obesity Federation (WOF 2019). About Obesity. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12551
25. World Health Organisation (2017). Obesity and overweight. Fact sheet. Updated June 2016. Retrieved from: www.who.int/mediacentre/factsheets/fs311/en/
26. World Health Organisation (2014). The Challenge of Obesity in the WHO European Region and the Strategies for Response. Edited by Francesco Branca, Haik Nikogosian and Tim Lobstein. Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0010/74746/E90711.pdf