This essay will outline a key policy and how it influences current practise. It will analyse the economic, political and philosophical context of the policy. The student will appraise the ethical and moral implications for practice drawing on appropriate principles, theories and frameworks. Implications for future practice will also be highlighted.
Outline one recent key policy document and critically discuss how it influences your current practice.
The key policy identified is the Healthy Child Programme (2009): Pregnancy and the first five years of life. It is the successor to Health for All Children and Health promotion programme launched by the National Service Framework and published in 1989. It was developed to provide guidance to everyone who work with children in the health and children’s sectors. (DOH 2009). Payne (2009) states that it helps to evaluate how effective the services are in relation to their cost. It focuses on a universal preventative service, providing families with a programme of screening, immunisation, health and development reviews, supplemented by advice around health, wellbeing and parenting. It is the evidence based public health programme for children and young people, which provides a range of health interventions and support beginning in pregnancy and continuing through childhood (DOH 2009). Burau (2004) defines a health policy as the plan of action chosen by a government to deal with financing and provision of health services. It helps to create a vision for the future and also tackle health inequalities.
The main focus of this essay is childhood obesity in the borough of Hackney. According to Rudolf (2009), The Healthy child Programme seeks to ensure that all children receive a basic package of health promotion which can increase based on individual needs. This includes childhood obesity .Children are at greater risk of obesity through family lifestyle, genetics and poverty. According to Greater London Authority [GLA] (2011) evidence have shown that obesity is mostly caused by high intake of calories. In addition to that it is also linked to family and parental influences on the food and activity they provide to their children. Childhood obesity can contribute to psychological and physiological health problems. For example it can cause low self ‘confidence, low self-image and can lead to depression in some children.
According to the JSNA of City and Hackney (2014), between the period 2011 and 2012 children aged 5 were overweight or obese and 43% of children aged 11 were overweight or obese. Obesity in Hackney is strongly linked to deprivation even though the proportion of children living in poverty has dropped from 44% in 2008 to 40% in 2009, however this remains almost twice the national average for England of 21%. In Hackney 13.2% of children in preschool are obese and most of the boroughs in London are below or just above the national average of 10.8%. The JSNA of Hackney also indicates that 25.2% of year 6 school pupils are obese, higher than the national rate of 22.4%.
The HCP emphasises on the importance of supporting parents and children to change their behaviours in order to improve the health of themselves and their children (DOH 2009). In order to reduce childhood obesity health visitors provide health education to families in relation to changing eating habits, exercising, playgroups, toddler groups, cookery and refer them to healthy eating classes or outreach through children’s centres. In my area of practice leaflets are given and there are posters in clinics promoting health eating. One to one health education is given during home visits and in clinics using the WHO percentile charts in the children’s books and referrals are made to the dietician.
The health visitors focus on early identification and prevention of obesity by promoting breastfeeding, healthy weaning and eating and healthy activities with babies and young children. The HCP offers evidence-based intensive home visiting for first time mothers and those with children at risk. Through the HCP children are weighed and records are kept to monitor their weight gain and support is given to parents and carers
Critically analyse the economic political and philosophical context of the policy According to Burau (2004), a health Policy is regarded as a political matter which involves institutions, regulatory agencies and health commissions. According to Baggot (2011) the Blair government introduced a wide range of policies in order to reduce in equalities and poverty. The government’s aim was to develop policies that would redistribute services to the poor and disadvantaged children and improve support in early years. Mitchel et al cited in Baggot (2011) argued that policies of redistribution of wealth and income have a significant impact on health inequalities. After replacement of Blair by Brown in 2009, investing in early years became a priority hence the HCP was developed to provide health interventions and support to families beginning in pregnancy and continuing through childhood.
During the Labour government professor Marmot was assigned to review health in equalities in England and he produced the report in 2010. Marmot (2010) identified six objectives which include giving every child the best start in life and to enable them to maximise their own capabilities and control over their own lives. The NHS, communities and voluntary organisations had to work together in order to achieve his objectives. The conservative and liberal government took over and inherited the Marmot review. The government devised the health visitors’ implementation plan in 2011 aimed at recruiting more than 4200 health visitors to effectively implement the health child programme.
According to Public health England (2013), of overweight and obesity to the UK economy was estimated to be ??15.8 billion per year in 2007, and ??4.2 billion in costs to the NHS. The government since then has launched several healthy living campaigns aimed at reducing the rising rates of obesity in England. UNICEF (2013) states that the social spending cuts and austerity measures that have been undertaken by some countries like England to curb the effects of the financial crisis, have a devastating impact on the lives of children. Based on these findings it therefore urges the governments to place children at the centre of their decision making process and to explore the effects of every new policy on families and children. In City and Hackney many families are on low income. The European Public Health Alliance (EPHA) (2011) asserts that families on lower income tend to spend most of their money on food. They often choose food that is rich in energy but poor in nutrients. Energy products are usually cheaper than wholegrain and fruits. According to Taylor-Robinson (2014) the most deprived areas are being the hardest hit by the current austerity measures. The children’s services are facing significant cuts and about six hundred children’s centres have closed. The EPHA 2011) advocates for tax to unhealthy food and subsidising fruits, vegetables and wholegrain to reduce the rising rates of obesity.
The DOH (2011) developed a Healthy Lives, Healthy People approach which focused on taking action across the civil society in order to drive be-haviour change. The government also launched a Change4Life campaign. It was the first national marketing campaign to tackle obesity. Farley et al (2012) claimed that this programme outlined the long-term health consequences for unhealthy eating. Some food companies like Tesco, Kellogg’s were involved in promoting the change for life strategy in 2009 (Farley et al 2012).
Its main objectives were to ensure that children had five a day fruits and vegetables, cut back salt and sugar, and encourage exercising .The main aim of the Change4life campaign was to use marketing as a driving force to shift lifestyles in England resulting in changes to behaviours that leads to obesity. The DOH (2013) advocates for the labelling of food to be clear and to indicate what is in the food or drink and the high street businesses to include in-formation on their menus so that individuals will make health choices. Some television adverts were banned on children’s programmes and during programmes were there is a high turnout of viewers under 16 years of age. The Health exercise Nutrition for the really Young (HENRY) programme was funded by the department of health for school and families. HENRY train-ing courses are underway in children’s centres in order to reduce the rate of obesity among children.
Most of the parents and carers in England do not consider their children to be obese and therefore do not consider childhood obesity as important Klein and Dietz 2010). The HCP is based on the philosophical concept of paternalism. Paternalism according to Merry (2012) is the interference of a government or individual with another person which limits their autonomy or liberty for their own good. The main aim of paternalism on The HCP is to act on behalf of children because of their limited cognitive and emotional development (Holm 2006).The government had to intervene in reducing childhood obesity in order to protect the welfare of children. According to De Marneffe (2006), libertarians also believes that it is necessary for the government to interfere with the liberty of others if their actions have disastrous consequences. Childhood obesity is believed to be harmful and most of the parents and carers are responsible for this harm.
Although paternalism limits parents’ liberty for their own good, it seems that the parents and carers are undermined and treated as children. It ap-pears to be overprotecting children and interfering with individual choices. However this is justified on the basis of preventing children from harm (Swinburn 2008). Soft paternalism approach of health promotion programmes is applied through the Health child programme. Soft paternalism allows the expression of choice (Holm 2006). Health visitors act as government advocates. They offer health promotion to parents and sign post them to other health professionals depending on their individual needs. For ex-ample parents with children who are overweight are given health education and if there is no change they are then referred to dieticians. Parents are sign posted to children’s centres where children engage in a lot of activities to keep them active and therefore reducing the risk of obesity. Swinburn (2008) argues that interventions such as health education may increase health inequalities if they are picked up more by people from upper class than those from lower class. In the borough of hackney it is breastfeeding friendly. Parents are encouraged to breastfeed their children exclusively in order to reduce the rate of obesity in later life as supported by WHO (2003). There are breastfeeding clubs and breastfeeding advisors to help parents with breastfeeding.
Critically appraise the ethical and moral implications for practice drawing on appropriate principles theories and frameworks
There are two theories of ethics namely consequentialism and deontology. The HCP is based on consequentialism sometimes called utilitarianism. Consequentialism is a moral theory that believes that an action is good or bad in relation to the outcome, consequence or end results. (Burkhardt 2008). He also claimed that all action is for the end results. The HCP’s aim is to ensure that children become healthier adults. However this theory does not respect individual rights. Have et al (2011) asserts that some campaigns about the health risks of obesity confront healthy people with health risks that they currently do not experience and which they may not even encounter in the future. Therefore it has a negative psychosocial impact on some people like fear and concerns about the health risks of overweight and obesity, stigmatization and blaming, and unjust discrimination.
Autonomy, beneficence, nonmaleficence and justice are four principles which form the framework for moral reasoning. According to the Food Ethics council (2013), the government argues that people should take responsibility for their own health. Some believe it is the consumers themselves responsible for the increase of global obesity. According to Donna et al (2011), one of the ethical concern raised by this policy interventions is the relationship between individual autonomy and government authority. Autonomy according to the Nuffield Council on Bioethics (2007), respect for clients or individuals and their ability to make decisions regarding their own health. A Government’s intervention is justified when individual actions affect others.
According to Donna et al (2011 ), the issue of individual autonomy is difficult to apply on obesity because individual behaviour are influenced by the environment which is also heavily influenced by national and local government. This principle of autonomy recognises that it is the government responsibility to protect children from harm (Donna et al (2011). Children are not autonomous because they do not have the experience and knowledge needed to make decisions regarding their food therefore the HCP advocates for health professionals to provide health promotion on healthy eating for children’s benefit. According to Jonas (2010) the need to respect autonomy ends where harm to others begins. Health visitors are therefore involved in signposting clients to dieticians for weight management.
Nonmaleficence according to Crawford et al (2011) is a principle based on the assumption that interventions should not cause any harm. For example providing nutritional advice does not cause harm. However by providing easy access to foods of poor nutritional quality is considered to cause harm. The government through the heath child programme has supported the five a day programme of fruits and vegetables by issuing vouchers that are means tested to lower income families with children to ensure that everyone has access to healthy foods. The government has imposed regulations on food and drink industries. For example Ofcom (2007) banned food and drink advertisements in children’s programmes and in programmes that at-tract a large number of viewers below the age of sixteen Beauchamp and Childress (2001) asserts that the principle of beneficence as acting with the best interest of the other in mind. Through the health child programme the parents and carers are educated on healthy eating and other ways like exercising in order to reduce obesity. Cookery clubs and the Henry project were introduced in children’s centres to help parents and carers to provide foods that meet the recommended balanced diet for children.
Justice refers to the fair distribution of resources. According to the Nuffield council on bioethics (2007), justice is being fair to the community in terms of consequences of actions. It is a concept that emphasises equality and fairness among individuals. The health child programme seek to ensure that children’s interests are prioritised and also to ensure that all children are not dis criminated against on the basis of ethnicity, race, gender, disability and economic status. The HCP advocates for universal services for all children and universal plus and partnership services depending on individual needs. Children from families on low income sometimes experience more psychosocial stresses but having more access to healthy foods can help to reduce these stresses. Children are vulnerable and causing harm to them can never be justified (Nuffield Council on Bioethics 2007). The HCP is aimed at changing people’s personal lifestyles since it focuses exclusively on the nutritional value of food however, people may feel offended in their cultural identity when valued practices are violated and disappear.
Critically reflect on the implications of this policy for future practice.
For the Health child programme to be successfully implemented some of the services need to be re-organised in order to support the health visitors’ flexibility and autonomy during practice (Kings College London 2013). According to Rudolf (2009) some health care professionals lack confidence and skills in addressing the issue of obesity therefore training them on obesity and overweight and how to educate families is essential. The Royal College of paediatrics (2006) reported that health visitors often felt uncomfortable to raise the issue of obesity when mothers are obese themselves and that they lacked skills and training to work with parents. The health visitors should be trained to identify overweight and obese children accurately and counselling their parents in an appropriate environment that is child friendly.
Continuing professional development should be encouraged for newly qualified health visitors so that they will be able to deliver high quality services that will change the life course of children and in turn lead to savings in health and social care costs ( Rudolf 2009). However due to lack of funding from the government and local authorities it is very difficult to fund the continuing professional development courses. ( ) recommends that the Local authorities has to develop an understanding of what is required by the HCP to enable them to set aside resources for educating and training health visitors. The health visitors and some health professionals do not have enough time to spend with families due to high caseloads. Rudolf (2009) states that other ways of achieving behaviour change should be explored if time is an in evitable barrier. For example the health visitors might conduct group work with parents to promote health. Have et al (2011) reports that some health visitors believes that prevention and treatment of obesity is not part of their role.
Practitioners’ own health weight can also influence their ability to work with parents and carers. Those who are overweight or obese often find it uncomfortable to counsel parents with children who are obese or overweight (Rudolf 2009). The health professionals who work directly with children are therefore encouraged to model health behaviours so that children and parents can copy them.
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