Preventing Childhood Obesity - Evidence Policy and Practice.pdf

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A human rights approach to childhood obesity prevention strengthened by a right to food approach is an area for further exploration throughout the international community. The r ight to h ealth The right to health, or in its fullest form, the right to the highest attainable standard of health, was first expressed in the constitution of the WHO in 1946. 31 It was restated in the 1978 Declaration of Alma Ata and again in the World Health Declaration adopted in 1998 by the World Health Assembly. 32 Within international human rights law, the right to the highest attainable standard of health is outlined within the UDHR 14 and subsequently reiterated in Article 12 of UESCR which states that: Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 15 This right to health is thus a claim to a set of social conditions, including norms, institutions, laws and an enabling environment that can best secure the realization of this right. 2 The nature of the right to health was further clarified in 2000 with the adoption of a General Comment on the right to health by the Committee on Economic, Social and Cultural rights which monitors the Covenant. 20 This General Comment recognized the close relationship between the right to health and other human rights including, but not limited to, the right to food, housing, work, education, participation, non - discrimination, equality and the prohibition of torture. In this way, the right to health was interpreted as including not only appropriate and timely health care, but also the underlying determinants of health. 2 The need for the right to health to be universally recognized and understood as a fundamental human right has recently been reiterated with the sixtieth anniversary of UDHR. 1,3 Doing so, it is argued, acknowledges the need for a strong social commitment to good health and thus should be included in national and international health policy. 3 The implications of the right to health, and its expanded focus to include underlying determinants of health, for childhood obesity prevention are yet to be fully explored as the wider public health community grapples with the translation of rights - based frameworks into practice. Approaches to i ncorporating h uman r ights into c hildhood o besity p revention What then does a rights - based approach mean, in practice, to childhood obesity prevention beyond, as others have said, 4 “ having a good heart behind efforts and actions ” ? It is claimed that one key contribution of human rights to public health is the provision of a persuasive argument for government responsibility to not only provide health services but also to address underlying determinants of health such as poverty, deprivation, marginalization and discrimination. 4 In the context of childhood obesity, this challenges the placing of responsibility for childhood obesity prevention within the family context 33 and clearly makes it an issue of governmental concern. In this way, a rights - based approach to childhood obesity can form the basis for action at a societal level, which is vital, given that childhood obesity is now widely recognized as a “ societal rather than a medical problem ” . 17 One argument against a human rights approach to health is the lack of binding legislation demanding that they be achieved. 3 While this issue of enforcement does create real challenges, this does not mean that rights - based approaches should be abandoned or dismissed as idealistic and unfeasible. Human rights provide an important overarching framework, or “parent ” to guide legislation 34 as well as many other ways of furthering the cause of particular rights. 3 Legislation is not the only requirement for the fulfillment of rights; rather public discussion, social monitoring, investigative reporting and social work all have critical roles to play. 35 Advocacy using a language of human rights, including those outlined within UNCROC, as well as the right to adequate food and the right to health, is a powerful way of drawing attention to issues related to childhood obesity prevention. This might include mobilizing public opinion and advocating for governmental and institutional changes to implement rights, even if they are not yet legally established. 4 Su ch a dvo - cacy can play an important role in moving such institutions towards a situation where human rights are 43
Chapter 5 legally enforceable. 4 Already, within childhood obesity prevention the ongoing work regarding marketing to children using a human rights framework provides an example of such advocacy in action. Similar advocacy is possible using a human rights approach to address other factors contributing to childhood obesity, such as safe spaces for physical activity and access to healthy food alternatives. Using the language of a rights - based approach for protecting children may help to avert the alternative risk - based approach where the health outcomes for children are somehow supposed to be balanced against the profitability of the industries developing and marketing unhealthy foods. Conclusions Consideration of human rights as they apply to childhood obesity prevention is an important area of work. Application of rights - based approaches to addressing childhood obesity are emerging internationally, and have so far largely focused on addressing issues of food marketing to children. Advocacy using the language of human rights as it applies to other determinants of childhood obesity prevention is suggested as having much to contribute towards addressing this issue, given that framing childhood obesity within a rights context firmly places responsibility at a governmental level rather than with families or individuals. Further exploration is needed to actualize such approaches in order to achieve positive outcomes for children. References 1 Editorial. The right to health: from rhetoric to reality . Lancet 2008 ; 372 : 2001 . 2 World Health Organization : Questions and Answers on Health and Human Rights . Geneva : WHO , 2002 . 3 Sen A. : Why and how is health a human right? Lancet 2008 ; 372 ( 9655 ): 2010 . 4 Gruskin S , Tarantola D : Health and human rights: overview . In: Heggenhougen K , Quah S eds. International Encyclopedia of Public Health . San Diego : Academic Press , 2008 : 137 – 146 . 5 Ingleby R , Prosser L , Waters E : UNCROC and the prevention of childhood obesity: the right not to have food advertisements on television . J Law Med 2008 ; 16 ( 1 ): 49 – 56 . 6 Hunt P , Bueno de Mesquita J. : Reducing Maternal Mortality . Colchester UK : University of Essex , 2008 . 7 World Health Organization : WHO Resource Book on Mental Health, Human Rights and Legislation , World Health Organization , 2005 . 8 Hunt P , Steward R , Bueno de Mesquita J , Oldring L. : Neglected Diseases: A Human Rights Analysis . Colchester Essex : University of Essex , 2007 . 9 Pillay N. : Right to health and the Universal Declaration of Human Rights . Lancet 2008 ; 372(9655) : 2005 – 2006 . 10 Hunt P , Backman G : Health Systems and the Right to the Highest Attainable Standard of Health . Colchester, UK : Human Rights Centre, University of Essex , 2008 . 11 Offi ce of the United Nations High Commissioner for Human Rights : Human Rights Council Resolution 6/29 Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health United Nations , 2007 . 12 Offi ce of the United Nations High Commissioner for Human Rights and the United Nations Staff College Project : Human Rights: A Basic Handbook for UN Staff . United Nations , 1999 . 13 Offi ce of the United Nations High Commissioner for Human Rights : What are human rights? United Nations. www2.ohchr.org (accessed 8 December 2008). 14 United Nations : Universal Declaration of Human Rights . United Nations. 1948 www.unhchr.ch (accessed 8 December 2008). 15 United Nations : International Covenant on Economic, Social and Cultural Rights . United Nations , 1966 . 16 United Nations : International Covenant on Civil and Political Rights. Adopted and Opened for Signature, Ratification and Accession by General Assembly Resolution 2200A (XXI) of 16 December 1966 Entry into Force 23 March 1976, in Accordance with Article 49 . New York : United Nations , 1966 . 17 Swinburn B. : Obesity prevention in children and adolescents . Child Adolesc Psychiatr Clin N Am 2009 ; 18 ( 1 ): 209 – 223 . 18 Swinburn B , Sacks G , Lobstein T et al: The “Sydney Principles ” for reducing the commercial promotion of foods and beverages to children . Public Health Nutr 2008 ; 11 ( 9 ): 881 – 886 . 19 United Nations : Full text of the Convention on the Rights of the Child . United Nations , 1989 . 20 United Nations : International Covenant on Economic, Social and Cultural Rights. General Comment 12 on the Right to the Highest Attainable Standards of health . United Nations , 2000 . 21 UNICEF . Convention on the Rights of the Child . 2008 (updated). www.unicef.org/crc/index_30160.html (accessed 18 December 2008). 22 Greenway J. : Childhood obesity: bringing children ’s rights discourse to public health policy . Community Pract 2008 ; 81 ( 5 ): 17 – 21 . 23 Lobstein T , Dibb S : Evidence of a possible link between obesogenic food advertising and child overweight . Obes Rev 2005 ; 6 ( 3 ): 203 – 208 . 24 Lavelle P. : Ban junk food ads from kids ’ TV? 2004 . www.abc. net.au/health/thepulse/stories/2004/11/25/1251181.htm (accessed 1 December 2008). 44
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Preventing Childhood Obesity Eviden
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Preventing Childhood Obesity Eviden
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Contents Foreword, vii Contributors
Page 10:
Foreword Obesity became a major hea
Page 13 and 14: Contributors Rob Carter PhD Head, H
Page 15 and 16: Contributors Shiriki Kumanyika PhD,
Page 18: Preface If we had all the evidence,
Page 22 and 23: CHAPTER 1 The c hildhood o besity e
Page 24 and 25: Childhood obesity epidemic Table 1.
Page 26 and 27: Childhood obesity epidemic explain
Page 28 and 29: Childhood obesity epidemic Table 1.
Page 30 and 31: Childhood obesity epidemic hepatiti
Page 32 and 33: Childhood obesity epidemic 15 Shiel
Page 34 and 35: CHAPTER 2 Lessons from the c ontrol
Page 36 and 37: Lessons from the control of other e
Page 42 and 43: Childhood obesity prevention overvi
Page 50 and 51: CHAPTER 4 No c ountry for f at c hi
Page 52 and 53: No country for fat children? Ethica
Page 60 and 61: A human rights approach to childhoo
Page 64: A human rights approach to childhoo
Page 67 and 68: Part 2 community and government age
Page 69 and 70: Chapter 6 Questions Evidence needed
Page 71 and 72: Chapter 6 ioral determinants rather
Page 73 and 74: Chapter 6 These issues are particul
Page 75 and 76: Chapter 6 15 Carrel AL , Bernhardt
Page 77 and 78: Chapter 7 at the state level to app
Page 79 and 80: Chapter 7 prevention efforts, parti
Page 81 and 82: Chapter 7 interventions. This appro
Page 83 and 84: CHAPTER 8 Evidence of the i nfl uen
Page 85 and 86: Chapter 8 choices in adolescence, 1
Page 87 and 88: Chapter 8 itself is unlikely to res
Page 89 and 90: Chapter 8 20 Cullen K , Baranowski
Page 91 and 92: Chapter 9 meal frequency, decreased
Page 93 and 94: Chapter 9 were behavioral (parent -
Page 95 and 96: Chapter 9 changes regarding partici
Page 97 and 98: Chapter 9 36 Campbell KJ , Hesketh
Page 99 and 100: Chapter 10 condition obesity in chi
Page 101 and 102: Chapter 10 the release of energy an
Page 103 and 104: Chapter 10 whereas Flynn et al 25 a
Page 105 and 106: Chapter 10 11 Baranowski T : Advanc
Page 107 and 108: CHAPTER 11 Obesity p revention in s
Page 109 and 110: Chapter 11 translation (see Chapter
Page 111 and 112: Chapter 11 overweight and obesity r
Page 113 and 114:
CHAPTER 12 The p revention of c hil
Page 115 and 116:
Chapter 12 Selective prevention pro
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Chapter 12 Table 12.1 Recommendatio
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Chapter 12 Table 12.1 Continued Gui
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Chapter 12 short - and long - term
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Chapter 12 33 Woo KS , Chook P , Yu
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Chapter 13 There is a relatively sm
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Chapter 13 Modifying the b uilt e n
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Chapter 13 capacity to support chil
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Chapter 13 45 Staunton C , Hubsmith
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Chapter 14 Changes in the food envi
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Chapter 14 Promising interventions
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Chapter 14 10 USDA - ERS : Food CPI
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CHAPTER 15 Food and b everage m ark
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Chapter 15 Box 15.1 The findings of
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Chapter 15 Food, however, is not to
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Chapter 15 competitive analysis eac
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Chapter 15 behaviour: exploring the
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Chapter 16 pawn or sell possessions
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Chapter 16 obesity and that this ma
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Chapter 16 impact of this deprivati
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Chapter 16 10 Marin - Leon L , Sega
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CHAPTER 17 Socio - c ultural i ssue
Page 159 and 160:
Chapter 17 The s ocio - c ultural e
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Chapter 17 with limited access and/
Page 163 and 164:
Chapter 17 What else can be done to
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Chapter 17 55 Grier S , Kumanyika S
Page 167 and 168:
Chapter 18 Ironically, these countr
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Chapter 18 key environmental factor
Page 171 and 172:
Chapter 18 countries precludes the
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Chapter 18 7 Jafar TH , Qadri Z , I
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CHAPTER 19 Evaluation of c ommunity
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Evaluation of community-based obesi
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Page 184 and 185:
Page 186 and 187:
CHAPTER 20 Economic e valuation of
Page 188 and 189:
Economic evaluation of obesity inte
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
CHAPTER 21 Monitoring of c hildhood
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Monitoring of childhood obesity Non
Page 198 and 199:
Monitoring of childhood obesity Noo
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Monitoring of childhood obesity Tab
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Monitoring of childhood obesity 11
Page 204 and 205:
Knowledge translation and exchange
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Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
The role of advocacy Why d o w e n
Page 214 and 215:
The role of advocacy mate long - te
Page 216 and 217:
The role of advocacy position put o
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The role of advocacy 6 Yach D , Haw
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Part 4 infrastructure, funding or r
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Chapter 24 by examining why policy
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Chapter 24 has privileged the manuf
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Chapter 24 case study is an analysi
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Chapter 24 by being highly visible
Page 231 and 232:
CHAPTER 25 Developing the political
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Chapter 25 Involuntary: all society
Page 235 and 236:
Chapter 25 Shiriki Kumanyika and co
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Chapter 25 The next steps Given the
Page 239 and 240:
CHAPTER 26 Community i nterventions
Page 241 and 242:
Chapter 26 Table 26.1 The health pr
Page 243 and 244:
Chapter 26 consider and build on th
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Chapter 26 programs and messages be
Page 247 and 248:
Chapter 26 Victoria, Australia. The
Page 249 and 250:
Chapter 26 participants for appropr
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CHAPTER 27 Community c apacity b ui
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Chapter 27 level and macro - change
Page 255 and 256:
Chapter 27 & Chomp ” where the co
Page 257 and 258:
Chapter 27 Box 27.4 Excerpt from Go
Page 259 and 260:
Chapter 27 Table 27.1 Capacity buil
Page 261 and 262:
Chapter 27 38 Borys Jean - Michel :
Page 263 and 264:
Chapter 28 Box 28.1 The EPODE progr
Page 265 and 266:
Chapter 28 Figure 28.1 For parents:
Page 267 and 268:
Chapter 28 Figure 28.2 Promoting ph
Page 269 and 270:
Chapter 28 marketing, there is ofte
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Chapter 28 social problems. The art
Page 273 and 274:
Chapter 29 length gain observed in
Page 275 and 276:
Chapter 29 tissue deposition relate
Page 277 and 278:
Chapter 29 A study in the USA found
Page 279 and 280:
Chapter 29 7 Cole TJ , Bellizzi MC
Page 281 and 282:
Chapter 29 environmental approaches
Page 283 and 284:
Chapter 30 it all on their own, sin
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Chapter 30 Forty - three countries
Page 287 and 288:
Chapter 30 Box 30.2 Elements of the
Page 289 and 290:
Chapter 31 childhood obesity rates
Page 291 and 292:
Chapter 31 became inactive or was t
Page 293 and 294:
Chapter 31 healthy diets and portio
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CHAPTER 32 Working with m inority g
Page 297 and 298:
Chapter 32 and reflect the circumst
Page 299 and 300:
Chapter 32 inclusion and exclusion
Page 301 and 302:
Chapter 32 3 Mercer SL , Vinney JD
Page 303 and 304:
Chapter 33 % of total DALYs lost 2
Page 305 and 306:
Chapter 33 Finally, within a given
Page 307 and 308:
Chapter 33 urbanized and have aband
Page 309 and 310:
Chapter 33 Box 33.1 Recommendations
Page 311 and 312:
CHAPTER 34 Preventing c hildhood o
Page 313 and 314:
Chapter 34 with a plateau in cigare
Page 315 and 316:
Chapter 34 segments of the populati
Page 317 and 318:
Index academic performance 11, 264
Page 319 and 320:
Index evidence-based and evidence-i
Page 321 and 322:
Index community-based 33, 58, 151,
Page 323 and 324:
Index parental support 67 PE 25, 81
Page 325:
Index Minnesota Heart Heath Project
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