Review the articles linked in the Additional Supplemental Materials and Box 11-1 in Chapter 11 of your textbook. According to the information provided, Huntington, WV scored poorly on cardiovascular disease, obesity, diabetes and oral health measures. This week you will describe a road to recovery for Huntington, WV by applying an ecological framework tooneof these health issues. Choose an ecological model from chapter 11 and describe how it could be used to effectively change your chosen health issue.
Four categories of structural factors - (1) availability of protective or harmful consumer products, (2) physical structures (or physical characteristics of products), (3) social structures and policies, and (4) media and cultural messages. The first three can directly influence individuals through facilitating or constraining behavior. The fourth, media, operates by changing individual-level attitudes, beliefs, and cognitions, as well as group norms.
CONCLUSION:
Interventions that target the four identified structural factors are a means to provide conditions that not only reduce high-risk behavior but also prevent the adoption of high-risk behaviors. Structural interventions are important and underutilized approaches for improving our nation's health.
Using the Structural Model of Health Behavior to Address Obesity in Huntington, WV
The city of Huntington is facing a situation that appears to already be “out of hand.” Each individual could attempt to make a change like those in the choir of Christ Temple Church, but they are not all likely to be successful as the city itself isn’t set up to help the behavior change. According to DiClemente, Salazar, and Crosby, the Structural Model of Health Behavior emphasizes environmental influences of behavior. The four categories of environmental factors are viewed as critical in shaping health behaviors: availability/accessibility, physical structures, social structures and policy, and media and cultural influences (2013). In order for the people of Huntington to change the “healthiness” of their city, environmental influences will need to be changed.
According to the articles, Huntington had more pizza places than the whole state had gyms or fitness centers. That’s a huge obstacle when one is trying to fight obesity. The availability of pizza places makes it easy for one to choose to eat pizza. And, if there are 200 pizza places in Huntington, I am going to assume that prices are very competitive which likely means pizza is affordable for most families. While I don’t think one can legally limit the number of pizza places or put an extra tax on pizza purchases, I do think availability and accessibility can be addressed by providing healthier choices/options for the pizza. For example, if most people order a thick (i.e. pan) or stuffed crust, making a thin crust option cheaper may persuade more people to order a thin crust. Or, making pizza options that have less cheese and more veggies on them cheaper may encourage people to order up more veggies.
Some other options for availability/accessibility may be:
· Provide tax incentives to business that target better health such as gyms/fitness centers, “whole foods” type grocers, or restaurants that offer at least 50% of their menu as “healthy.”
· Creating a city-wide plan to build more “walkable/bikeable” areas and parks with equipment that encourages activity such as Frisbee golf or soccer and baseball/softball fields would allow people access to physical activity that is both affordable and safe.
· Offer city-wide cooking classes that teach people how to shop for healthier options and prepare healthier foods that are still irresistible.
· Find land within the city that can be utilized for community gardens so families can grow their own produce.
· Citywide reinforcement of support for farmers markets and food co-ops to encourage people to both grow their own fresh foods as well as purchase fresh foods.
· Upon completion of walkable/bikeable trails, start family night’s out to encourage use of the trails.
· Plan to make sidewalks safe for use to schools so kids can be safe walking or biking to school rather than depending on someone giving them a ride.
Some of the above-mentioned possibilities could also fall into the environmental factor of physical structures. For example, building more trails and widening roads/shoulders to provide for bicycle access as well as running/walking access throughout the city and improving quality of sidewalks so kids have safe and accessible walking or riding routes to school would be physical improvements in the city that could directly impact the obesity epidemic. Providing land for community gardens and more park space would also fall under impacting physical structures.
Some of the social structures that need to be addressed in Huntington are the smoking regulations as well as trans-fat regulations. Although the mayor believes that Huntington would not “allow” for non-smoking areas or regulation of fats or sugars in foods, but that doesn’t mean it shouldn’t be addressed at the city, if not state, level. By designating public areas and restaurants/bars as non-smoking, those who smoke may end up smoking less or even quitting. Furthermore, those people who frequent those places and don’t smoke will have cleaner air to breathe which can also enable them to have better lung capacity for performing activities such as walking, running, biking, swimming, etc. By regulating the amount of trans-fats that can be in the foods served in restaurants or the amount of sugar (and/or sodium) in a serving of a food or drink, the city is essentially making “health” a little more accessible to its citizens.
Lastly, with today’s use of media, especially social media, the city of Huntington could be inundated with advertisements and public service announcements addressing their health, specifically obesity. With many people not realizing how unhealthy they are because of their weight, media could start with informing the public of what healthy choices look like compared to many current unhealthy choices. For many people, a juicy cheeseburger hamburger loaded with pickles, onions, tomato, mayo, ketchup and mustard served with French fries and a large soda is a “healthy” option because they have addressed most of the food groups (meat, dairy, grains, and vegetable). Most people have no idea what a “real” serving size is and how many calories are actually needed to sustain oneself for a given day. People become overweight because they are consuming more calories (energy) than they actually use.
With today’s access to media, Huntington could start by having a designated cable station and/or website promoting healthy activities happening in their city. Furthermore, they could utilize the university (Marshall) in promoting healthy activities while building/revamping the sidewalks, streets, and trails throughout their city. For example, Marshall could open up access and/or organize softball/baseball or soccer leagues targeting elementary students through adults. This could be advertised from multiple outlets (i.e. TV, webpage, flyers, letters sent home from school).
For those people without access to a vehicle or who are not able to get out due to their weight, videos showing the cooking lessons, fitness lessons, lessons on healthy foods versus unhealthy foods, why policy that addresses trans-fats, sugar, and sodium consumption is necessary and helpful, consequences of being overweight ( – personal, community, and nationwide effects), and videos showing people (individuals, families, friends, neighbors) being active and happy could be shown on a designated cable station or uploaded to a website. Furthermore, people could sign up for updates on activities or food specials (grocery, farmers markets, co-ops, trail activities, gym membership specials, etc.) via a Facebook or Twitter page designated for happenings in Huntington. With this, motivational quotes could also be sent out that may provide encouragement or enhance self-efficacy at the individual level.
With the Structural Model of Health Behavior, I believe there are many options for communities to adopt healthier habits. However, in order for it to work, positive leadership as well as determined leadership is necessary. Many people don’t like to be “forced” into change, but many people simply don’t realize that by changing, there is potential for a happier and healthier life. When people don’t know better, they need to be allowed to learn about their current choices/behavior and “why” it isn’t healthy. They also need to be informed on why societal change (i.e. smoking laws or trans-fat regulations) is good for people as a whole.
Public health needs to be ensured in order to protect society as a whole even if some individuals feel a right or entitlement is taken away. Overweight and obesity are problems in many places; Huntington is not alone Beating obesity will have a direct effect on other issues such as cardiovascular disease, high blood pressure, high cholesterol and stroke. Going forward, like protecting public health in general, combatting the obesity epidemic requires leaders to: brainstorm with businesses and communities, innovate, be more effective, and to accomplish more with less.
Associated Press. (2008). CDC: Huntington, W. Va. nation's unhealthiest city. Retrieved from http://www.foxnews.com/story/2008/11/16/cdc-huntington-w-va-nation-unhealthiest-city/
DiClemente, R.J., Salazar, L.F., & Crosby, R.A. (2013). Health behavior theory for public health. Burlington, MA: Jones and Bartlett
Robert Wood Johnson Foundation. (2013). New public health. Retrieved from http://www.rwjf.org/en/blogs/new-public-health.html?bst=new-public-health%3awelcome