Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 27
level and macro - changes at the political and policy
level.
A c ritic ’ s p erspective
Having arrived at a definition for community capacity
building within the context of health promotion, it
should be noted that the discourses have not been
without their criticisms. Community capacity building
has been criticised as being a smokescreen
for more subtle forms of social control because proponents
claim that it is an alternative to economic
regeneration but does little to challenge structural
10 – 12
forms of inequality. For instance, concerns
reflected in UK urban regeneration policy that community
capacity building is about “ expecting groups
of people who are poorly resourced to pull themselves
up by their collective bootstraps ”, 13 are mirrored by
those who feel that similar approaches in primary
health care policy in Australia depoliticize “ Indigenous
health, whilst legitimising and mystifying relations of
white dominance ”. 14 Such critiques, however, give
little space for collective human agency, condemning
“ the poor ” and disenfranchised to what Bourdieu
called “ the weight of the world ” without acknowledging
that, where formal politics have failed, such
approaches may provide a mechanism through which
people can be authors and co - authors of transformations
of their local, social, economic and cultural
15
worlds.
Why b uild c ommunity c apacity?
The Jakarta Declaration 7 answers this question in its
justification for health promotion by stating that “ it
improves both the ability of individuals to take action,
and the capacity of groups, organisations or communities
to influence the determinants of health ” . What
can be inferred here is that health promotion principles
are about increasing the ability and building the
capacity to affect health determinants. Put simply,
community capacity building has the power to influence
individual and population health outcomes
through empowering people and making changes sustainable.
Although this is largely agreed upon, the
rationale of empowerment and sustainability is not
always made explicit.
The a pplication of c ommunity
c apacity b uilding to c hildhood
o besity p revention
In assessing community capacity building approaches
to preventing childhood obesity we find ourselves
at the heart of a charged political and theoretically
contested arena. Discourses on the “ childhood obesity
epidemic ” are themselves framed, on the one hand,
as problems of individual behavior and on the other,
as a consequence of structural inequalities. Also,
while there are a growing number of successful interventions,
18 we do not yet know what works to
16 –
prevent overweight and obesity in children at a population
level. However, we do know that multiple
strategies are required in multiple settings, 19 and
that this cannot be achieved in a sustainable way
unless communities take on the problem themselves.
Indeed, given the pervasiveness of the epidemic, it is
likely that communities will not only need to take on
the problem but also link with other communities and
harness the support of governments so that they can
overcome the sectoral (e.g. transportation) and global
(e.g. fast - food franchising) contributors to the epidemic.
In other words, communities need to move
from the current state of disengaged awareness of
childhood obesity, through recognizing and owning
the problem, to accessing expertise and external
resources, to intervening so that it becomes easy for
children to be active and eat well. Community capacity
building is the process through which this can
occur.
Raising c ommunity a wareness
of h ealth r isks
For action to be taken on health risks, the scale of the
problem needs to be meaningful for communities and
they need to have an understanding of who is most
at risk. In Australia, as in other Western countries,
about a quarter of children are either overweight or
obese and this continues to increase steadily. 20
Generally, there are minimal differences in prevalence
by gender. However it is usually higher among children
from lower socio - economic status backgrounds. 21
Behavioral determinants, in line with findings from
other countries, include sweetened drinks, energy -
dense food consumption, sedentary behavior and
234