Health is political as the right to living for adequate health and wellbeing is an aspect of human right and citizenship. Health is politics may be a confusing phrase as why one needs to appeal to economic theory or political ideology arguing for social support or greater welfare improving health of society. It is overwhelming that health status is a way society is organized and not individual factors or healthcare system quality. Public policy is an important determinant of health that requires routine acknowledgement, however, the concepts of politics, ideology and power that are underpinning policy making influencing public health is still a mainstream debate. The demonstration of explicit acknowledgement of health’s political nature can help to provide more effective health promotion and policy making towards an evidence-based health promotion and practice. Health is political as the social determinants being amendable to the political interventions and dependent on the actions of politics. This aim of improvement of the nation or society is the creation of common good, equity and fairer society and community safety. Nurses advocate for the safety of patients promoting health and protection. For this, the governmental policies work in collaboration with nurses and other healthcare professionals in reducing the inequalities in healthcare. For this, National Health Service (NHS) is working towards improvement of healthcare services in the community (Department of Health 2010). Therefore, the aim of the essay is to evaluate Department of Health (2010) Healthy Lives Health People White Paper: Healthy Lives, Healthy People: our strategy for public health in England: London related to obesity and discussion of political ideology in framing the document and impact on the chosen obesity group people.
The policy definition is a regulation, law or any sort of administrative action where decisions are involved in allocation of resources. Health is also influenced by policy making influencing healthcare delivery and in achieving healthcare goals. Policy is defined as course of regulatory measures, actions and laws that concerns a topic promulgated by governmental representatives or entity. Policy is not only related to what a government does, but also guides the government actions towards a perceived problem. These policies are committed to the social and economic forces (redistributive) such as social parties that are successful in the improvement of health in the populations. Policy in context to the health is the development of health policy that work together for achieving the specific goals of healthcare within the society. According to World Health Organization (WHO), health policy is defined as vision that helps in the establishment of points of references and targets for short and long term goals (Kelley and Hewitson, 2017). There is outlining of policies that provide expected roles for building consensus and informing people.
However, the understanding of political context is important for the development of health policy as the contextual factors influence health policy making process and health. According to Shanahan et al. (2015) health policy is a form of agreement that outlines the health issues and plans accompanied by main guidelines and objectives for achieving health priorities. It is concerned with the medical management or provision of health care for the people experiencing poor health. WHO demonstrates that health policy positions public health to politics agenda at every level that direct them to be aware of the community health consequences and understanding their responsibilities in mitigating health issues (Dahlgren and Whitehead 2017). Health policy constitutes governance structures for the creation of policies that take public health into consideration and address their issues.
In context to health, NHS has developed a strategy for the public health in England, United Kingdom (UK) for tackling the health challenges. This White Paper is a radical shift for combating the lifestyle-driven health problems that are faced by people reaching alarming levels. There is raising problem of obesity in the large population estimating to tackle and reduce the burden of disease. Obesity has become one of the biggest concerns in Britain as the rates are increasing being called as ‘the fat man of Europe’ ahead of countries like Germany, France, Sweden and Spain as per the report by NHS 2013 (Penn and Kerr 2014). UK is the most obese country across Western Europe declaring it an epidemic that requires immediate attention. The healthcare services in UK are estimated to improve only one-third of the health inequalities and in changing their lifestyles and removal of biggest future threats like obesity in relation to public health (Edelman, Mandle and Kudzma 2013). People suffering from obesity are prone to cardiovascular diseases that lead to early demise and increase the burden on UK healthcare system. This is the reason this White paper has been introduced that is a health policy as well as political document. This document is defined as concrete strategy that addresses the specific issue by the government in context to public health.
The White paper sets out plans that put the government at the heart of health. The local government is given the freedom and power to fund and take the responsibility to develop and innovate their own ways of dealing with the public health issue of obesity in their community (Davies et al. 2014). This paper commits to protect the population from the threats of overweight and obesity helping people to lead a healthy life by promoting healthy lifestyle choices. The goal of the White paper is to achieve desired results, liberation of professional leadership and unleashing innovation. As per The Department of Health, the White paper is an important link between obesity, socioeconomic status and public health (Kelley and Hewitson 2017). The government need to understand and take initiative to make obesity a nation concern that tackles social and economic inequalities to make Britain a healthy population and longer lives.
The policy document is developed in response to Fair Society of Sir Michael Marmot’s reporting that adopting life courses tackling social determinants of health (Marmot et al. 2010). This approach helps to build the self-esteem of the people, resilience and confidence to support in healthy living. This approach provides more specialized and preventative services focusing on the delivering of best healthcare services to citizens and builds a good society. Marmot studied that life expectancy gap is experienced between the richest and poorest with high levels of deprivation, and low income. The white paper is the major response to Marmot’s view addressing the wider social determinants of health. When stringent policies are implemented, this can help to avoid the health inequalities that seem to be unfair and social injustice (Marmot et al. 2010).
The political ideology behind the white paper is the definition of health and approaches to behaviour change that can help to lead a healthy life with achievement of better health outcomes. The ideology explains that through reduction of health inequalities and promotion of social inclusion is evidence-based providing healthy living behaviour in people. Specific competencies and strengths of people can work in behaviour change impacting health and positive outcomes like health literacy and healthy living. The publication, Our Health and Wellbeing is a coalition where the government need to work towards health inequalities and healthy living (Marmot et la. 2010).
However, the policy highlights that one should be responsible for their health and it is not the responsibility of others. This is the main ideology that although, policy can establish the healthy lifestyle behaviour making good choices for better living, people have to take the responsibility of their own health. The concept of Fair Society is acknowledged by the white paper, Healthy Lives, Healthy People as it is conventionally operated in the Western capitalism having interrelated aspects; health being considered as commodity and absence of disease. However, these definitions focus on individual factors like lifestyle choices and genetic heritage and as commodity where individuals can avail healthcare services and enjoy healthy life (Natale et al. 2014). Another ideology behind the health policy making is the identification of the health’s political nature. The health determinants, unequal distribution, citizenship and organization depicting that health are political and there is exercising of power. The population health is not entirely under the individual control, rather under the relations of societal political relations as the changing society is possible through political struggle and politics. The economic, social and cultural circumstances are the power determinants in the modern population; however, differences are present between social groups and gender, ethnic and socio-economic status. The inequalities in healthcare are highly ideological and political in the society being addressed by the White paper (Smith 2016).
Conservatism ideology is different from others as it is against radical change whereas other ideologies focus on even resources allocation and warn against disassembling established institutions. According to conservatism, society is collection of individuals underlying Margaret Thatcher’s claim that is infamous stating that nothing such exist in the society. Conservatives feel that there is minimal and limited welfare provision preferences and on the other hand privileged people enjoy basic welfare as compared to poor people (Luck-Sikorski, Riedel-Heller and Phelan 2017). This scenario creates a culture that is dependent and permanent underclass where Thatcher called them ‘moral cripples’. The exception of this ideology is that there is minimal intervention of government in the society tending to be surrounded by law and order that is viewed as an essential component in the smooth running of the society. Despite of tradition and conservatism, there are some strands that advocate radical change. There is presence of social hierarchy that is inevitable and rich people are the creators of prosperity where society can benefit from leadership of these people (Berg et al. 2014). Concisely, the conservatism explains the extent to which the political ideologies govern policies perceptions of inequalities of health.
On a contrary, neo-liberalism is an economic approach like doctrines that is far above the social and political repercussions. This concept emphasize on the importance of human rights over societal hierarchy. According to liberalists, there should be social justice as poor individuals are lazy due to weakness and being powerless. Liberalism explains that state interventions are required for the reduction and mitigation of these negative effects that is undesirable in the society (Carter 2015). With this view, the white paper is working towards closing the gap between the health inequalities explaining neo-liberalism where economy is deregulated and favouring traditional and conservatism with moral responsibility. Concisely, liberalists and conservatives’ objects labour and recognize that government should not be coerced in performing their individual interests, rather involved in protecting people from illness and harm promoting well-being. This can be achieved through making improvements in accessibility and affordability of services to the people. In this way, the white paper is asserting radical change adopting that although, government is involved in promoting healthy lives, people should take responsibility of their own health making healthy lifestyle choices (Cairns and Johnston 2015).
The coalition is developed with a view to reduce obesity by adopting lifestyle modifications and food habits as sedentary lifestyle is the main factor that contributes to obesity. This concept is looking into the wider social determinants of ill-health demonstrating social inequality. According to Peacock, Bissell and Owen (2014) NHS is aimed at preventing people from premature death and mitigating health inequalities. This is greatly helpful in tackling the health inequalities from the lifespan point of view mapping out areas and epicentre of health inequalities with social justice and health policy addressing the inequalities for better health outcomes. For the obese clients, this policy emphasizes on the behaviour change in them through modifications in diet and physical exercise. Evidence suggests that in UK children are obese followed through adulthood giving rise to ill health conditions like risk for diabetes or cardiovascular diseases in the future. This white paper is working towards the health improvement in children, adults and older people by tackling obesity and related health consequences. According to Brown et al. (2013) for tackling heath inequalities, access to affordable and quality food is of paramount importance. This policy also influences the behaviour of the parents who are at the frontline in inculcating healthy behaviour among them. Evidence showed that during pre-school years, if children are taught to eat healthy food and perform physical exercise, this can be effective in promoting healthy eating habits (Glasgow and Schrecker 2016). Parents work better in taking care of their children and improve their health. Similarly, through this policy, the modifications made in one’s eating and lifestyle behaviour can reduce premature illness and decreases the burden of disease posed on the society.
The impact of the policy is that the public health services functioning at the local level are collaborating with the white paper leading from NHS to local governmental bodies. The impact is quite worthy as the problem is shifted from wider policies towards a localism and democratic involvement crucially affecting the lives of people putting great impact on personal responsibility at every level of the society. The local government is having responsibility to cover activities that impact food, health and safety of the population promoting wellbeing in the local community (Lee, Shapiro and Niederdeppe 2014). Previously, the marginalized people were struggling to avail the healthcare services being in a deprived area and when the economic constraints are improved, they can enjoy the basic necessities of life. This is evident from Marmot’s review that social gradient plays an important role in health as individuals with scare resources experience worsened health and unequal access to healthcare services. This shift in power and resource allocation enables local authorities to influence the lifestyle of the people including children to curb obesity. According to Ulijaszek and McLennan (2016) the local authorities arrange for activities like walking, cycling, open green spaces and sports for reducing the consumption of high carbohydrates food in schools and at even at workplaces. This would help to emphasize on the wider determinants of health and create an environment where the inequalities are dealt broadly.
Health promotion and integrating people in activities with responsibility can help to tackle obesity with a combination of healthy eating goals outlined in the white paper can impact people suffering from overweight. Teenagers are also affected as it is their crucial time that decides their later life health and wellbeing, so adoption of healthy lifestyle during this stage by lifestyle modification can help to achieve overall health and wellbeing (Rudolf 2017). Apart from health promotion, conservatism explains that a healthy society is possible when every person is responsible for their health that contributes together in resolving national health issues.
This white paper is a new approach to the public health policy encouraging partners and people to take action on the issue of obesity published under the coalition of Conservative and Liberal Democrat government. The impact of this policy is also on the individuals and families because it is impacting their lives, NHS and economy. This policy is working at the individual level with the coalition from local government impacting their personal lives by making lifestyle modifications making them lead a healthy life (Natale et al. 2014). Schools provide the benefit of investment as risk for obesity is less and inculcating healthy lifestyle in them can help to fight the future obese population as they transit to adulthood. There is growing burden on the public sector impacting healthcare services, however, with this policy, local government is aiding in curbing obesity along with social services working at the local level. Local authorities are working towards the consequences of obesity and illness and there providing necessary education by health promoter in the schools, canteens, workplaces and gyms.
In addition to obese people, this white paper has serious implications on the partners in coalition viewed differently. Foresight’s analysis states that for achieving and promoting calorific balance in the individual lives about diet and physical activity, one has to make hard lifestyle choices that can assure tackling with obesity. The national, local and key stakeholders have to change the environment where high-calorie foods are available and in this way, they can support changing people’s behaviour. Local authorities have to empower individuals focusing on consumption of healthy foods and physical activity in their daily life through white paper giving them freedom to work best in curbing the greatest problem of obesity (Gallouj et al. 2015). Concisely, this policy put children as top priority as it helpful in reducing the health equalities and help them start a new life with achievement of optimal development.
Although, this policy is new and requires critical evaluation, however, it has certain implications on the nursing practice while working with obese clients. Nurses advocate for the health and wellbeing of the children, this policy acts as a framework for them to push for their active and healthy wellbeing. This white paper will provide nurses a stand to empower the children at their starting life along with parents and family members in adopting health lifestyles and avoid obese conditions. Through the stringent vigilance and working towards stringent implementation of this policy, the nurses can support the healthy lifestyle activities that serve best for the children, adults and older people. Through health promotion, nurses can also work towards reduction and prevention of childhood obesity reducing the inequalities in healthcare prevailing among the population. Through the creation of awareness among the population regarding the risk factors for obesity from environmental factors, it can better support children and their families in preventing obesity. Nurses working in collaboration with other healthcare professionals and local authorities can support obesity prevention and white paper guidelines by making people informed through relevant information and providing effective guidance helping to battle the serious problem of obesity (Letvak 2014).
From the above discussion, it can be concluded that this policy is encouraging as it provide solution to thorny issue of obesity that is tangling UK increasing the burden of disease. It addresses the inequalities in health that is prevailing in UK and the wider social determinants of health. However, this white paper failed to provide detailed information on allocation of resources and coordination between the stakeholders. There is also insufficient information regarding the functions and ensured goals of the public health department. There is also lack of emphasis on the public accountability and community engagement playing a role in the political industry. The important issue is reforms and cuts in the NHS and public sector is presenting serious risks to the public healthcare system rushing into making modifications. This is the reason the white paper is failing to deliver its goals and work on the expected promises. As a result, it is unable to close the gap between the inequalities in health and curb the obesity issue. The disadvantaged population is still experiencing poorer health outcomes and widened health disparities. Therefore, this white paper policy requires further critical evaluation and judgment to deal with the wide social determinants and serious health problems faced by the UK population.
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