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Social Determinants Of Health: WHO

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Question:

Write about the Social Determinants of Health for WHO.

 

Answer:

Obesity is the public health issue as per World Health Organisation or WHO. It is one of the leading causes of death in both developing and developed countries (World Health Organization, 2014). Worldwide, the prevalence of obesity has increased two fold over the past two decades among children, teenagers, and adults. Therefore, the rising burden of obesity has created a moral panic. Obesity is a multifactorial disease. It is known to be caused by genetics, over-eating and inappropriate diet, over-weight, hormones, environmental factors and lack of physical activity (Mitchell et al., 2014). The health impact of obesity includes diabetes, eating disorder, cancer, comorbidities such as renal failure, heart failure and death (Buchmueller & Johar, 2015). Consequently, the disease has increased the health care cost. The exact cause of obesity must be known to prevent the global pandemic of obesity. The essay aims to identify if obesity is caused by broader social determinants of health or individual lifestyle choices. The essay highlights the determinants of obesity and discuss its  relationship with individual lifestyle choices. The risk factors of obesity and its implications are also explored in essay.

Obesity is characterised by excess fat accumulation in body which is found to reduce life expectancy. It is also measured in terms of body mass index or BMI. A BMI over 30kg/m2 represents obesity and is calculated as a ratio of individual’s weight in Kg and square of height. It an important tool to asses obesity in all age groups at population level (Tanamas et al., 2014). Different BMI scores can determine the health risks due to obesity. For instance, if an individual’s BMI is between 25-29 the condition can be referred as overweight. There are three classes of obesity and the first class is identified by BMI range of 30 and 34.9. Obesity of class 2 is recognised by BMI between 35 and 39. If the BMI is 40 or more then it is an alarm for high risk obesity and adverse consequences (Swinburn & Wood, 2013).

Worldwide, the prevalence of obesity has increased two fold over the past two decades among children, teenagers, and adults. According to WHO, in 2014, there were 1.9 billion obese adults and of these more than 600 million adults were marked obese. As per these reports 13% of the world’s adult population  in 2014 were obese. It includes 15% of women and 11%  of men.  These reports highlighted that 39% of the population (18 years and above) were overweight in 2014 (World Health Organization, 2014).  The rate of obesity is climbing faster in Australia than any other place in world. Australia is considered as one of the fattest developed nation due to rising trend of obesity (Kendall et al., 2015). According to the reports of Swinburn & Wood, (2013) the obesity is estimated to rise to 38% by 2025 from current per cent of 28. In Australia, higher numbers of young adults are representive of obesity than the adults, which indicates individual lifestyle factors as underlying cause of the disease.

The cause of obesity is debateable as there are multiple factors responsible for rising trend of obesity in children, adolescents, and adults.  Diet is primary factor responsible for obesity. The weight of an individual is determined by the energy expenditure and the intake of calorie. The imbalance between the two parameters leads to overweight or underweight. Obesity is identified to be primarily associated with intake of high calories food and lack of physical activity (Teixeira et al., 2015). Overweight can result from genetic predisposition, defect in metabolism, individual behaviour, environmental and cultural factors. For instance, fat regulation is impaired by leptin deficiency and this problem is hereditary in nature.  Similarly, intake of diet rich in carbohydrates, and saturated fatty acids leads to overweight individuals. Weight gain results from spike in insulin level which occurs due to consumption of large meals. The insulin level remains stable when small meals are taken frequently. Sedentary life style, results in weight gain due to low amount of calories burnt and is one of the major contributing factor of obesity. Hypothyroidism is the endocrine disorder which also contributes to obesity (Suglia et al., 2013). According to WHO, the risk factors of obesity are unhealthy lifestyle choices such as having fat and calorie rich diet, lack of physical activity, stress, and lack of sleep. Socioeconomic factors are also a risk for obesity development. Low social connectedness or unhealthy social environment, low socioeconomic statuses are found to be factors contributing to obesity (Roberto et al., 2015).

Social determinants of health on a broad aspect are recognised to cause obesity. In order to develop effective interventions, it is necessary to know the relationship between social determinants and obesity. Educational status, Gender, age, employment status ethnicity, behavioural factors like smoking, alcohol abuse, lack of exercises and socioeconomic factors are the determinants of obesity. Among all the determinants, the socioeconomic factor is highest concern for obesity (Flores et al., 2015). People belonging to low socioeconomic class are prone to eating unhealthy diet and malnutrition due to low cost of living. They depend on fast foods and other food that do not met the body’s requirements of fats, protein and carbohydrates. Thus, people with obesity are highly represented from low socioeconomic status (Bhurosy & Jeewon, 2014). On the other hand, people belonging to upper class society or having high socioeconomic status adopt healthy lifestyle. They have good housing facilities, healthy diet, and people participate in health promoting activities (Kennedy, 2015). However, it was also found that people with high socioeconomic status highly engage in sedentary lifestyle.

 

The working population of high socioeconomic group due to busy schedule depend on ready to eat food of fast food centres, do not participate in physical activities, and are vulnerable to obesity. Children of working parents engage in watching television, eating junk food at schools and other sedentary behaviours that are not monitored on time and contribute to high BMI and obesity (Popkin & Slining, 2013). The high socioeconomic group of people have been found to regularly visit fast food chain restaurants such as McDonald’s. These groups of people mostly purchase large sizes of burger and consume beverages that increase calorie and fat level in body. However, due to lack of physical activities these fats and calories are accumulated leading to weight gain and obesity. Residents in close proximity of fast food centres are highest consumers of fat and calories then residents staying far apart. This behaviour indicates influence of individual lifestyle choices on obesity. Obesity is recognised to be an extension of advancing economy and technology (Bhurosy & Jeewon, 2014). With the availability of smart phones and increasing popularity and use of e-commerce, accessing fast food has become easy for people living in distant part of cities or remote areas. These labour saving devices have increased consumption of fast food due to home delivery of food in maximum 30 minutes of time. It saves cooking time and people are more attracted to fast food. In addition, smoking and alcohol consumption add to the sedentary choices. Consequently, this group of people are found with low energy expenditure (Witten, 2016).

Another most important factor determining obesity is gender. For instance, in America, more women than men are obese as women have higher body fat percentage.  However, the scenario is not same in different countries (Flores et al., 2015). Cultural factors also play great role in obesity. In some countries, cultural factors favour larger body size (fat acceptance). It is regarded as sign of healthfulness, fertility, and prosperity (Robinson & Christiansen, 2014). Age is another risk factor of obesity. In Australia, the number of overweight and obese males over 18 years was more than females. Obesity has been identified to increase with age. In Australia, rate of obesity is found to increase between 45 and 74 years for males and between 55 and 74 years of age for females. After 75 years of age the rate of obesity declines by 69% in males (Rahman & Harding, 2013).

Environmental factors influence eating behaviour. For instance, remote regions and rural areas lack accessibility to variety of food items therefore, people choose from limited options that may not meet adequate nutritional requirements of body (Flores et al., 2015). Psychological factors such as depression and anxiety also determine eating behaviours. Problematic eating such as snacking high calorie food items mindlessly or night eating leads to binge eating disorder in adolescents and children (Suglia et al., 2013). Education and health literacy is related to rising trend of obesity. People with high educational attainment tend to easily understand health and illness. The awareness of healthy and unhealthy lifestyle activities assist in making effective health decisions. People with poor educational attainment lack awareness about consequences of overeating and obesity.    Health literacy help people participate actively in health promoting activities such as exercises, maintaing normal vital signs, making lifestyle modifications and seeking counselling services for psychological issues. On the people with low health literacy, remain unaware of risk factors of chronic illnesses and initiatives that can prevent the adverse consequences (Witten, 2016).

The cumulative effect of cultural, social, environmental and individual lifestyle factors causing obesity has several implications (Flores et al., 2015).  The health implications of obesity include insulin resistance diabetes mellitus, hypertension, high cholesterol, and cardiovascular diseases. More men that are obese are dying due to colorectal cancer and women that are obese are dying due to endometrial cancer. Severe obesity leads to sleep apnoea, hypercapnia, and degenerative joint disease. These health risks are due to distribution of body fat. Obesity has significant impact on economy due to rising health care costs related to mortality and morbidity (Specchia et al., 2015). Since, it is evident that obesity is a complex mesh of multifactorial interactions, there is a need to address the dominant determinants of obesity such as individual choices and social factors causing obesogenic behaviour (Buchmueller & Johar, 2015). Understanding the risk factors and raising awareness may decrease the vulnerability to the illness. More interventions are needed at societal and individual level then at medical level. Healthy lifestyle modification is vital which may be possible through stringent government policies on fast food restaurants, and initiate compulsory health education in every country (through campaigns and mass awareness) (Malik et al., 2013). More interventions are needed at psychological level to change compulsive eating behaviour, promote uptake of physical activities, and omit “fat acceptance”.

In conclusion, obesity is the outcome of complex interactions of individual lifestyle choices and social determinants of health. Social factors and individual lifestyle choices are primary contributing factors of obesity out of various cultural, psychological and environmental factors. It implies the need of health education to address obesity and its adverse health activities. People need to be educated about healthy lifestyle choices. There is a need of more research in the area of gender disparities in overweight and obesity and cultural influences to understand the pandemic and develop preventive strategies.

 

References

Bhurosy, T., & Jeewon, R. (2014). Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic status?. The Scientific World Journal, 2014.

https://www.hindawi.com/journals/tswj/2014/964236/abs/

Buchmueller, T. C., & Johar, M. (2015). Obesity and health expenditures: evidence from Australia. Economics & Human Biology, 17, 42-58.

https://www.sciencedirect.com/science/article/pii/S1570677X1500012X

Flores, M. R., Velazquez, V. V., Mejia, G. T., Fuentes, V. S., Peniche, L. P., Maciel, R., ... & Garcia, E. G. (2015). Association of Socioeconomic Factors with Success in the Treatment of Obesity. Canadian Journal of Diabetes, 39, S72.

https://www.canadianjournalofdiabetes.com/article/S1499-2671(15)00303-2/abstract

Kendall, B. J., Wilson, L. F., Olsen, C. M., Webb, P. M., Neale, R. E., Bain, C. J., & Whiteman, D. C. (2015). Cancers in Australia in 2010 attributable to overweight and obesity. Australian and New Zealand journal of public health, 39(5), 452-457.

https://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12458/full

Kennedy, K. (2015). Increased Patient Health Literacy and Healthcare Provider Structural Competence: Public and Private Strategies for Improving Patient Health Outcomes.

https://digitalcommons.tacoma.uw.edu/tactalks/2015/spring/6/

Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology, 9(1), 13-27.

https://www.nature.com/nrendo/journal/v9/n1/abs/nrendo.2012.199.html

Mitchell, R. J., Lord, S. R., Harvey, L. A., & Close, J. C. (2014). Associations between obesity and overweight and fall risk, health status and quality of life in older people. Australian and New Zealand journal of public health, 38(1), 13-18.

https://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12152/full

Popkin, B. M., & Slining, M. M. (2013). New dynamics in global obesity facing low?and middle?income countries. Obesity Reviews, 14(S2), 11-20.

https://onlinelibrary.wiley.com/doi/10.1111/obr.12102/full

Rahman, A., & Harding, A. (2013). Prevalence of overweight and obesity epidemic in Australia: some causes and consequences. JP Journal of Biostatistics, 10(1), 31.

https://search.proquest.com/openview/83c4e06e520973d6bd8ac2a3fff46085/1?pq-origsite=gscholar&cbl=1816344

Roberto, C. A., Swinburn, B., Hawkes, C., Huang, T. T., Costa, S. A., Ashe, M., ... & Brownell, K. D. (2015). Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. The Lancet, 385(9985), 2400-2409.

https://www.sciencedirect.com/science/article/pii/S014067361461744X

Robinson, E., & Christiansen, P. (2014). The changing face of obesity: exposure to and acceptance of obesity. Obesity, 22(5), 1380-1386.

https://onlinelibrary.wiley.com/doi/10.1002/oby.20699/full

Specchia, M. L., Veneziano, M. A., Cadeddu, C., Ferriero, A. M., Mancuso, A., Ianuale, C., ... & Ricciardi, W. (2015). Economic impact of adult obesity on health systems: a systematic review. The European Journal of Public Health, 25(2), 255-262.

https://academic.oup.com/eurpub/article/25/2/255/2837324/Economic-impact-of-adult-obesity-on-health-systems

Suglia, S. F., Duarte, C. S., Chambers, E. C., & Boynton-Jarrett, R. (2013). Social and behavioral risk factors for obesity in early childhood. Journal of developmental and behavioral pediatrics: JDBP, 34(8), 549.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960979/

Swinburn, B., & Wood, A. (2013). Progress on obesity prevention over 20 years in Australia and New Zealand. Obesity Reviews, 14(S2), 60-68

. https://onlinelibrary.wiley.com/doi/10.1111/obr.12103/full

Tanamas, S. K., Shaw, J. E., Backholer, K., Magliano, D. J., & Peeters, A. (2014). Twelve?year weight change, waist circumference change and incident obesity: The Australian diabetes, obesity and lifestyle study. Obesity, 22(6), 1538-1545.

https://onlinelibrary.wiley.com/doi/10.1002/oby.20704/full

Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I., ... & Brug, J. (2015). Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC medicine, 13(1), 84.

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0323-6 

Witten, K. (2016). Geographies of obesity: environmental understandings of the obesity epidemic. Routledge.

https://books.google.co.in/books?hl=en&lr=&id=0O4GDAAAQBAJ&oi=fnd&pg=PP1&dq=Geographies+of+obesity:+environmental+understandings+of+the+obesity+epidemic&ots=D74S9aG_On&sig=ZKaQyxj2799KcvqRR5KmfAc5ut8#v=onepage&q=Geographies%20of%20obesity%3A%20environmental%20understandings%20of%20the%20obesity%20epidemic&f=false

World Health Organization. (2014). Global status report on noncommunicable diseases 2014. World Health Organization.

https://www.cabdirect.org/cabdirect/abstract/20153093363

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