Public Health Report

1. Discuss the concepts and principles of modern public health that underpin the initiative you have chosen.

The rise in global obesity in the present day world is a signifier for several things. Obesity is a significant threat to the general health and well being of an individual as it impacts several organs and deters their proper functioning.Around 250 million individuals are overweight worldwide, with the World Health Organization projecting that 300 million will be obese by 2025 (WHO). Attitudes about obesity vary by population and, as a result of economic developments, may alter over time within populations. Obesity is more frequent among people with poor socioeconomic position in developed countries. In non-industrialized nations, on the other hand, obesity is more common among high-income persons and may be regarded a status symbol. This might alter if non-industrialized nations grow more prosperous, and obesity becomes more prevalent among people with low socioeconomic level (Visscher, 2001).

Obesity and overweight pose a high health risk and will have a major influence on health-care costs. Obesity has a strong link to the incidence of chronic medical problems, a reduction in health-related quality of life, and an increase in health-care and medication spending, and the associated health-care costs for obesity-related difficulties are significant for both individuals and health-care systems (Zhang et al., 2009; Langille et al., 2009). Obesity can take place because of two main factors; eating unhealthy kinds of food or eating too much food, and not enough physical activity. Many people work jobs that require them to sit at a desk for the majority of the day. They also drive rather than walk or ride their bikes. Many individuals watch TV, surf the internet, or play computer games to unwind, and they rarely engage in regular exercise. If one is not physically active enough, they will not utilise the energy given by the food you eat, and the excess energy will be stored as fat by their body. Adults should engage in at least 150 minutes of moderate-intensity aerobic activity each week, such as cycling or rapid walking, according to the Department of Health and Social Care. This does not have to be completed in one sitting, but may be done in smaller increments. One might, for example, exercise for 30 minutes five days a week (nhs.uk).

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Obesity, in particular, affects nearly every area of health, from sexual and pulmonary function to cognition and mood. Obesity raises the risk of a variety of severe and fatal illnesses, including diabetes, cardiovascular disease, and some malignancies. It accomplishes this through a number of mechanisms, some as simple as the mechanical burden of carrying more pounds, and others involving complicated hormonal and metabolic changes. Obesity reduces the quality and duration of life while also raising healthcare expenditures at the individual, national, and international scales (hsph.harvard.edu).

Research has clearly shown the consumption of junk food has a clear impact on obesity. Fast food, according to scientists, increases obesity by fostering the feeling of purposeful consuming. Fast-foods are foodstuffs with 150 percent more high-density energy than any other regular meal, according to a close interpretation of the claim made by scientists. High-density meals encourage people to consume more calories than their bodies require. The low cost of fast food is one of the primary reasons why people cannot stop eating it. A meal comprising 2000 calories of fast food costs significantly less than a diet including 2000 calories of nutritious food, according to a study done by the University of Washington (Axelerad et al., 2017). Children and teenagers are typically more affected by fast meals than adults. This is due to the fact that the majority of fast meals are marketed to youngsters, and there is a consistent pattern of consuming fast foods and dining out. Obesity develops over time in children with a prolonged excess energy imbalance intake of about 2%. A 2% imbalance might result in a daily surplus of merely 30 kilocalories. This is the equivalent to two-thirds of a chocolate cookie, two French fries, or a quarter of a can of soda. Another important cause to childhood obesity is eating out. According to studies, the calorie content of out-of-home meals consumed by youngsters was 55 percent greater than that of home meals (Vad, 2003).

Apart from the physical problems caused by obesity, obesity causes many mental problems. A link between depression, suicidal tendencies, and fat has been discovered in several research. Obese women, for example, are considerably more prone than their normal-weight counterparts to have suicidal thoughts and attempt suicide. Extremely obese people have been found to be more prone than the average population to attempt suicide. Weight loss is linked to a reduction in depressed symptoms in general. Several studies, however, have discovered a higher-than-expected risk of suicide among those who have had bariatric surgery (Heneghan et al., 2012). These findings are surprising and alarming, given the generally favourable connection between weight loss and mental performance. Sadly, little has been known about the psychological reasons and/or personal life that may have had a role in these suicides. These findings highlight the significance of ensuring that patients with psychiatric illnesses receive adequate mental health treatment before and after bariatric surgery in the absence of this knowledge (Carpenter et al., 2000; Dong et al, 2006).

Weight loss is linked to a reduction in depressed symptoms in general. Several studies, however, have discovered a higher-than-expected risk of suicide among those who have had bariatric surgery. These findings are surprising and alarming, given the generally favourable connection between weight loss and mental performance. Sadly, little has been known about the psychological reasons and/or personal life that may have had a role in these suicides. These findings highlight the significance of ensuring that patients with psychiatric illnesses receive adequate mental health treatment before and after bariatric surgery in the absence of this knowledge (Tindle et al., 2010).

Obesity is a problem which needs to be addressed from the perspective of changing the lifestyle of people, and not just using surgical interventions (Sarwar, 2012). This is because surgical intervention through the form of bariatric surgery can result in a variety of other things or which the individual has to face. Weight reduction is frequently linked to a better sense of self. 32 Unfortunately, some patients who lose a significant amount of weight experience lingering body image dissatisfaction linked with loose, saggy skin of the breasts, belly, thighs, and arms, most commonly following bariatric surgery. The majority of people who have had bariatric surgery perceive the development of extra skin to be a bad side effect of the procedure. This unhappiness is likely what drives people to seek out a cosmetic surgeon for body contouring operations, which more than 50,000 people did in 2014 (Sogg, 2007).

Obesity can be regarded a strong indicator of commercial success since customers are buying more food, automobiles, and energy-saving devices as a result of the commercial drivers of the obesity pandemic. Consumer aspirations to eat less and walk more, as well as corporate aspirations to be more socially responsible, are unlikely to sway these enormous economic forces significantly. When the free market produces significant population losses and health disparities, government interventions are required to shift the playing field in favour of populations gains (Narukawa, 2003). Governments must take coordinated action in four areas: provide leadership to set the agenda and lead the way; advocate for a multi-sector response and establish mechanisms for all sectors to engage and improve action; design and evaluate policies (including laws and regulations) to promote healthier eating and physical activity environments; and secure increased and ongoing funding to reduce obesity.Policies, rules, and regulations are frequently required to drive the social and environmental changes that will, in turn, have a long-term influence on obesity reduction. An 'obesity effect evaluation' of laws governing public liability, city design, transportation, food safety, farming, and commerce might reveal 'rules' that contribute to obesogenic settings (Swinburn et al., 1999). There may be chances for legislation to actively promote obesity prevention in other areas, such as advertising to children, school meals, and taxes/levies. Obesity prevention may be aided by legislation in other areas, such as legislation to combat climate change ('stealth interventions'). Successful obesity prevention will almost certainly start with a political willingness to utilise policy instruments to promote change (Swinburn, 2008; iota.org).

2. Identify and explain the key elements of this public health intervention and how they would be evaluated

As was discussed in the earlier section, one of the aspects of combating obesity which was discussed was the earlier sections was controlling the advertisement one sees on television.

Advertisement affects a large percentage of consumers to make purchases. Advertising expenditures account for 34% of a product's overall cost. This is significant since advertisers strive for high top-of-mind recall through ads (Singh, 2012). As a result, ads are an important element of any marketing plan, particularly in business-to-consumer situations.

A number of evaluations have reviewed the evidence on food advertising to children and have come to the conclusion that food advertising leads to increased preferences for and purchases of the goods promoted in the advertisements (Hastings et al., 2003; Story & French, 2004). Furthermore, according to findings from correlational and quasi-experimental research, children who consume more media are more likely to have poor diets and to be overweight (see IOM, 2006). A small number of studies have also looked at the impacts of food advertising on real eating behaviours, which are often measured by food choices made after being exposed to marketing (Hastings et al., 2003;). The results of one research with strong ecological validity exposed youngsters at an afterschool program to a daily cartoon that included candy or fruit marketing, public service announcements, or no advertisements. Youngsters who were exposed to the candy advertisements snacked on fruit and orange juice less frequently than the other children during a two-week period.In the light of this, in May 2021, the UK government announced that it will be putting a ban on advertisements of junk food before 9pm (Harris et al., 2009).

A new rule would also prohibit TV advertisements for unhealthy meals — those heavy in sugar, salt, and fat – before 9 p.m., when children may be watching. Advertising of discount offers for junk foods will be prohibited, and individuals who lose weight and exercise will be compensated with shopping vouchers as part of an incentive programme to encourage better living. From April 2022, the Act will also limit retailer marketing on high-fat, high-salt, and high-sugar foods and beverages. The rule, which aims to combat childhood obesity in the UK, has been welcomed by health activists but slammed by a trade group representing the country's food and beverage sector. The government has been considering a ban for some time and has redoubled its efforts in light of the Covid-19 epidemic (just-food.com).

According to this legislative initiative, the objective is to make sure that the children do not watch these advertisements which show food that is high in sugar and high in sodium. This particular decision was taken after the Statistics on Obesity, Physical Activity and Diet, England, 2020 was published by the National Health Service. According to this report, every year, obesity-related hospitalizations accounted for 11,117 hospitalizations. The report also elucidated that the vast majority of people were overweight or obese, with 67 percent of men and 60 percent of women falling into this classification. In this group were 26 percent of males and 29 percent of women who were overweight or obese (NHS).

The administration is hoping that this will save lives. The prevalence of morbid obesity among critically critically ill patients with covid-19 in intensive care units is around 8%. According to the British government, around 3% of the population is morbidly obese, with a further third being clinically obese, which increases their chance of having more serious consequences from the virus. Firms have expressed concern that the new rules will have little impact beyond harming businesses who are already struggling to recover from the financial impacts of the shutdown. In an interview with the BBC, Sue Eustace, head of public relations at the Advertising Association, stated that the United Kingdom currently has some of the "strictest" advertising regulations in the world. Graham MacGregor, professor of cardiovascular medicine at Queen Mary University of London, pointed out that the steps outlined on Monday were primarily aimed at increasing commercial awareness of the disease (Adam and Booth, 2020).

For some goods, pricing promotions such as "buy one get one free" or "three for the price of two" will be prohibited, and free refills of soft drinks will also be prohibited. This is to make sure that the people who are more inclined to avail these offers, like children or youngsters. HFSS or High in Fat Salt and Sugar foods are not permitted to be placed in checkout lanes, at the end of store aisles, or at the entrances to the store itself. A similar prohibition applies to the advertising of HFSS meals on the homepage of an online shopping site or any pages where shoppers view their online shopping basket before checking out. Small companies with fewer than 50 workers would be free from price promotion requirements, and commercial advertising exemptions will be granted to firms with fewer than 50 employees, establishments smaller than 2,000 square feet, and speciality retailers such as bakeries and patisseries (nycfoodpolicy.org).

3. Review the evidence that supports this intervention and determine if the intervention could be replicated in the neighbouring country to the one it was carried out.

As was discussed earlier, the main objective of this policy is to ban advertisements which show junk food on television in order to influence the opinion of children. Which is why, the policy seeks to ban all television advertisement before 9pm (just-food.com).

This is a policy which is concentrating on preventing children from being influenced by food marketing, of food which is unhealthy for them.T aking advantage of children's and teenagers' developmental weaknesses is common in the food marketing industry. When watching television, for example, kids aged than about 5 years are still unable to distinguish between a programme and an advertising (American Psychological Association). Even older kids who are aware of advertisements lack the cognitive abilities and life experience necessary to evaluate marketing messages objectively. Adolescent brains are more prone to responding to incentives than adults' brains, and they are more inclined to respond to environmental signals such as marketing. Young teenagers are strongly influenced by the opinions of their classmates when assessing the riskiness of ordinary events, indicating that they place a high value on conformity (Casey, 2015).

In addition to targeting children as customers in their own right, unhealthy food marketing also targets them as intermediates who may influence other consumers, notably their parents, which is referred to as ‘pester power’ and classmates. Children's brand recognition and preferences, as well as subsequent purchases and consumption, are influenced by exposure to harmful food marketing, according to the findings of the research (Cairns et al., 2013). Several studies have found that children's food consumption rises as a result of exposure to harmful food ads. For example, a research conducted in Australia found that children aged 7 to 12 years upped their food consumption after being exposed to harmful food marketing, and that they did not adjust for this by decreasing their food intake at a later meal (Kelly et al., 2015).

Commercial screen time is independently related with obesity in children, and researchers conclude that this association is most likely due to the promotion of unhealthy items on commercial television (Zimmerman, 2010). When harmful items are promoted, it not only encourages company shifting within a product category, but it also boosts consumption of certain types of meals, such as fast food and soft drinks. It draws new customers and helps to build cultural standards around what foods are acceptable and desired (Powell, 2017). Children aged 6 to 13 years in England were subjected to food advertisements, and the results revealed that they had a stronger preference for high-fat and high-carbohydrate foods, both branded and unbranded after being presented to food advertisements than when the same children were exposed to control advertisements on a separate occasion. Children who viewed a lot of television on a regular basis had the most noticeable influence on the study (Boyland, 2011).

Hence, based on the research which has been done, advertisements and images have a strong effect on individuals to buy junk food, especially very young children. Hence, this policy will be expected to control and/or regulate the advertisements which is consisting of junk food and food which is low in nutritional content.

A similar policy can be implemented in France, the neighboring country of UK, which also has a significant problem of obesity within its populations. Previously, France was considered a country where the population where the people were slimmer than the rest of the world and do not have an obesity problem. However, recent reports have suggested that the French citizens who are below the national average income are more likely to be obese. This is usually because fast food is cheaper and it is usually more expensive to eat healthy than to eat unhealthy food which is more filling (Gee, 2016).

UFC-Que Choisir is seeking to get advertisements for food products classified as "D" or "E" on the Nutri-Score chart banned. This means that the food has minimal nutritional value and would be seen as "junk" or highly-processed by the majority of the population. In its report, the association stated that it had examined "448 hours of televised programmes" and "7,150 advertisements," and discovered that 90 percent of advertisements intended for children were for foods that were high in fat, sugar, or salt, and classified as D or E - such as sweets, ice cream, fast food, sugary cereal, and cakes, among other things.The petition arrives 13 years after the group issued its initial demand for restrictions on such public relations activities. It is now pushing for a complete ban on television and the internet. The French government has studied tightening restrictions on food advertising to minors and lowering advertising pressure on young people since 2007, according to a report published in 2007 (Thompson, 2020).

4. Describe ways to evaluate a public health intervention. Which method would you use to evaluate this intervention and justify why.

The method of evaluating a public health intervention is a methodical process where the real-life implications of the policy which is being undertaken. When it comes to implementation science, it is concerned with the extent to which beneficial health interventions can be successfully integrated into real-world public health and clinical care systems. Multiple evidence-based interventions are compared, strategies to encourage the provision and use of effective health services are identified, evidence is integrated into policy and programme decisions with the goal of adapting interventions to a variety of populations and settings are identified, and approaches to scaling up effective interventions to improve health care delivery are identified (Zepeda et al., 2018).

Impact evaluation, on the other hand, is concerned with determining how an intervention affects both intended and unintended outcomes. It entails the use of a counterfactual to evaluate what occurred when the intervention was enforced with what would have happened if the intervention had not been implemented. The latter is referred to as the counterfactual. In order to remove or at least reduce the biases that can emerge as a result of not being able to turn back the clock and perform the alternative treatment with the same group at the same time, a variety of approaches have been created or are in the process of development (Spiegelman, 2018).

A multidisciplinary approach known as health technology assessment (HTA) utilises systematic processes when assessing health technologies in order to assist and guide health decision making. Health technology assessment (HTA) is a thorough evaluation of health technologies that considers both their direct and indirect impacts. Tradition dictates that the great majority of HTAs have concentrated on the clinical sector, as well as medicines and/or medical instruments as the primary subject of their investigations. According to Lavis et al., an inventory of health technology assessments across nine distinct health technology assessment organisations, undertaken from 2003 to 2006, revealed that just 5% of healthcare technology were PH treatments (Drummond et al., 2016).

Even if a detailed study of efficacy may be performed readily in the field of therapeutic treatments, the intricacy of pulmonary hypertension therapies in the real-world environment continues to provide methodological obstacles. A recent systematic evaluation of HTAs of PH treatments discovered that there are only a small number of rules in this sector. They also noticed many, and sometimes unwarranted, changes to recommendations, including modifications to the quality evaluation and applicability assessments, as well as the incorporation of qualitative and quantitative data in the recommendations. These methodological adjustments were primarily motivated by the fact that complicated PH treatments employ a variety of techniques that frequently do not take place in a controlled experimental setting, such as those used in randomised controlled trials, and so require further consideration. However, this is not being used to justify the small number of PH solutions that have been evaluated by HTA committees to yet (Stojanovic et al., 2020).

In order to evaluate the effectiveness of the policy which has been implemented in order to evaluate whether or not the policy is working, is to evaluate the results from the ads in order to track whether or not the policy is working. A similar form of evaluation was undertaken by Sebayang et al. (2019) to see the effect of tobacco ad ban on the population of Indonesia. They found that, despite the fact that huge tobacco billboard advertising were no longer shown in Banyuwangi are , breaches of the laws continued to occur in all areas with the exception of Jl Simpang Gajah Mada area of Indonesia. Many of those who responded to the survey were ignorant of the regulation, and just a tiny fraction of those who did disagree with it. The lack of knowledge among community members and law enforcement officers, the lack of a real-time monitoring and reporting system, and the absence of clear performance metrics all contributed to the difficulty in enforcing regulations.

Tobacco advertisements were nevertheless visible near schools in Banyuwangi area, with levels comparable to those observed in cities where tobacco promotion is not restricted by law, albeit the style of the advertisements changed, with posters rather than billboards being the most common vehicle utilised. Hence, what was gauged from this study was that even though a health policy was implemented, it did not result in complete ban of tobacco related ads (Ibid).

The primary objective of policy analysis is to determine the impact of a policy intervention on patients, health-care providers, and hospitals, among other things. Despite the fact that a randomised controlled design is regarded the gold standard for identifying a causal impact, such a design is rarely feasible in the context of public health policy assessment. As a result, academics frequently depend on observational data when evaluating the implications of a policy. Recent evaluations of the connection between the Patient Protection and Affordable Treatment Act (ACA) and outcomes for surgical patients have revealed significant increases in health insurance, timely access to care, and greater access to rehabilitation facilities following discharge (Basu et al., 2017; Scott et al., 2016).

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