What Are the Implications of Using Public Health Initiatives to Help Individuals to Change Their Lifestyle in Order to Improve Their Health and Well-Being?
Is public health becoming a nanny state?
This essay will look at what public health initiatives can do to help individuals to change and improve their health and well-being. It will also look at what the pros and cons are of such initiatives impacting the individual’s lifestyle and identity. It will take into account the theories of sociologists Peter Berger and Thomas Luckman on identity and those of Erving Goffman, who looks at stigma, labelling and how public health initiatives can encourage society to label others based on appearance (Leach, 2010 pp7-10). The essay will also look at individuals who have acknowledged that there are dietary problems in or society and had lead campaigns to prevent obesity especially in children and prevent other diet related diseases.
"Public health" means preventing illness and disease and reducing mortality rates and helping people maintain their health. However, the other side of the argument is that public health is turning the country into a "nanny state" and telling people what they can do, eat, and drink, it is up to the individual to choose what they eat and how they live their life (MacKian, 2010. p84). In the United Kingdom, we have seen public health focusing on banning smoking in public places, fast food advertising stopped advertising to children, how many units of alcohol a male or female should drink in a week, and the possibility of a sugar tax focusing on fizzy drinks. However, it is also a way of reducing mortality rates based on ill health caused by negative lifestyle choices, it is the government's responsibility to "guide" and safeguard the public into choosing the healthier options to reduce ill health and also to reduce the ever-increasing burden on the NHS.
“The role of public health is to help people live a healthy life without threats from disease or illness; it is also about reducing mortality rate and to include the individual to make healthy choices to maintain their health and environment” (MacKian, 2010. P.78). The Public Health Act was formed in 1848 when Sir Edwin Chadwick observed that people were living in crowded living and working conditions and improved the sanitary conditions in towns and cities to prevent the spread of infectious diseases (MacKian, 2010 p.79). He removed the filth of animal and human waste from the street, which he believed was the cause of cholera in the city of London. In 1854, John Snow investigated how cholera was spreading throughout the city and found that bacteria were being transported through water pumps, which he then had disconnected with the result that the cases of cholera dropped. This was the first indication that people who died from disease were not lazy and inadequate but that both social and economic situations played a part in public health and well-being. Health and well-being was defined by the World Health Organisation in 1948 as being in complete “physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO 1948).
However, as previously mentioned, there are several factors that can influence a person’s health, such as background (identity), lifestyle, social, and economic conditions. In Berger and Luckman’s social construction of reality theory, identity is described as "socially constructed," meaning that a person first learns about human behaviour as a child through primary socialisation from parents and other close family members. As the child grows, they are then introduced to secondary socialisation in the form of attending school, perhaps university, and then work. Each place has its own set of rules and regulations that the individual must follow and learn about different sub-behaviour, such as wearing a uniform to school or to a place of work. The difference between primary and secondary socialisation is that it is in the former where the individual learns and holds their beliefs; for example, they may listen to rock music, wear clothes to reflect this, and have body modifications such as piercings and tattoos. But they also may be a professional at work and their attire will reflect this, such as being a nurse and wearing a uniform and behaving in a professional manner.
One public health initiative is to promote healthy eating. Obesity and other diet-related illnesses, such as type 2 diabetes and heart attacks, are currently the UK’s biggest public health problem. Although it may not just be over-eating that causes a person to be overweight, society labels people who are overweight as lazy and responsible for their own ill health (Puhl and Heuer, 2010). This type of stigma was defined by Goffman as a "spoiled identity." He noted how the "normals" of society, as he referred to them, would use certain classifications to label someone as a burden to society. Society assumes that a person who is overweight does not work, that they over-eat and do not take exercise and have made bad lifestyle choices by choosing to eat unhealthy foods. Society does not look at other possible factors that could cause a person to be overweight. It could be for medical reasons, or another reason why a person may have dietary problems is because they have a learning disability. A report written by the Disability Rights Commission (DRC), "Tackling health Inequalities," noted that people with mental health or learning difficulties find it difficult to get access to health services (disability-studies.leeds.ac.uk, n.d.). This is for a variety of reasons. Staff at health services do not see past the disability to see what is causing the person’s ill health. It has been documented that health professionals have been focusing on physical disabilities rather than mental health issues and therefore not responding to a person with learning difficulties who is asking for help. They also do not help a person who has difficulties reading and writing to make appointments; again, this is another problem that ostracises people asking for help. The DRC points out that health programmes and initiatives need to look at involving people in high-risk groups as there is evidence that people with mental health and learning difficulties are more likely to suffer from heart disease, stroke and obesity. A healthy person will take more responsibility for their health and contribute to society and to the economy as they will be well enough to find employment. The cost to the NHS and other services will reduce. Currently, obesity is costing NHS Wales £86 million a year (walesonline, 2016).
However, the DRC recognises that to achieve this, the health services need to look at their approach on how to help people in these high-risk groups; this can be by helping them to make appointments either by telephone, text or email if the person finds this an easier alternative.
Another high-risk group that has been included in an initiative on healthy eating is children. Based on Berger and Luckman’s theory, if a child is brought up in an environment where the parents eat a diet of takeaways and other fast food, they will see this as normal eating, as this is learned behaviour. Solutions to this problem are to educate people in how to look after their health and what is causing the problem in the first place. For example, the charismatic chef, Jamie Oliver, has led the Ministry of Food to encourage people to cook healthy meals. This was a public health answer to resolve issues with illnesses that were diet related, such as diabetes and heart disease, as well as the ever-growing concern about childhood obesity. Jamie Oliver started his Jamie’s School Dinners, Ministry of Food and "Pass-it-on" contacted schools as he was extremely worried about what children were eating for dinner (MacKian,2010 p.90). He experienced resistance, not from the children but from the parents and some schools. He also wanted to educate the parents on how to cook healthy and nutritious food as more and more people are finding that they do not have the time. Jamie has a clear vision of his campaign and has shown results. As a passionate and charismatic leader, he encourages and empowers others to participate and see results for themselves. However, not everyone followed Jamie’s lead and he was also criticised for presenting the people in the north of England as typical working class people. Schools also declared that his meals were unaffordable to produce due to tight budgets (Cassetty, 2016). The health sectary, Andrew Lansley, also criticised Jamie Oliver by saying that lecturing people will have the opposite effect as they will feel undermined (BBC News, 2010). It was reported that children stopped having the healthy lunches provided by schools as the parents would either turn up at the school with bags of chips or give the money to purchase food outside of school. This was due to them not liking the fact that a choice had been taken away from their children and felt that they were being dictated to. However, the positive result was that, in 2014, schools reintroduced cooking as a compulsory lesson to teach children as young as eight to cook simple healthy meals (Ensor, 2016). This was one answer to combat the increase of childhood obesity and other diet-related illnesses by teaching them good, healthy habits in a secondary socialisation situation and giving the children skills to cook for themselves. This is a positive result for Jamie Oliver. In the same year, Lidl was one of the first supermarkets to remove sweets from the checkouts after listening to parents who were concerned about their children’s diet (Ft.com).
Jamie has also faced criticism from journalists who accuse him of being out of touch with society and that there are areas where people are deprived and simply cannot afford to cook the meals that he is demonstrating. There is evidence to show that there is inequality in society throughout the UK and that the worse a person’s socio-economic and social position, the worse their health will be (MacKian, 2010 p.76). In Blaenau Gwent, life expectancy is increasing but there are gaps between the most and least deprived areas. The average life expectancy for men in Wales is 78.2 (2010-12) but in Blaenau Gwent it is just 75.7 years (wales.nhs.uk, 2016). Cardiovascular disease and cancer are the major causes of premature mortality. This can be caused by poor diet, little exercise, smoking and too much alcohol intake. Figures found by the National Assembly for Wales Research Service found that obesity is higher in deprived areas such as Blaenau Gwent and was recorded at 26%, whereas the Welsh average is 22% (Assemblyinbrief, 2016). In the research conducted by the National Assembly, it was found that this "endemic" has been blamed on a mixture of sedentary lifestyles and genetics, as well as the deprived areas which included unemployment and inequalities. Local public health solutions have been put into action to encourage people to take up exercise by giving them incentives, such as attending their local leisure centre through the GP Exercise Referral scheme (blaenau-gwent.gov.uk, 2015). However, there is an argument that people who do not look after their health by eating healthily and taking regular exercise are being rewarded for bad behaviour. People who act and look after their health have to pay to attend the gym while others will get access to the same facilities for free through their GP.
In conclusion, public initiatives are vital to the nation as a reminder for us to take some responsibility for our health. However, it is also important that those who live in deprived areas receive the help they need, and that all individuals are included, especially with the focus being on children to promote good healthy eating behaviours in the child’s early development years. Public health initiatives need to be clear and provide evidence, such as Jamie Oliver producing results with his healthy school dinners. The initiatives need to be long term and not gimmicky. Rather than stigmatise people who are obese, initiatives need to focus on how to maintain a healthy weight. It is also important that any public health initiative is affordable for everyone to participate in so as not to discriminate between wealthy and poorer areas. It is clear that, in the case of obesity, it is the poorer areas and people with disabilities that suffer with this health issue the most. It is also important to give the person choice and public initiatives have to be driven with the individual’s needs in mind rather than feeling that they are being coerced into something they do not want to do as this will not produce positive results.
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