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The module assessment is a 3,000 written analysis of the three practice themes of the module: health protection, individual change, and community development, drawn together in relation to a public health challenge of your choice. There is a document on the module Moodle site with some ideas for your focus.
Your task is to compare and contrast public health practice according to the practice themes, to make sense of how public health practitioners could, or should, address your chosen public health challenge. You will consider the current and proposed public health activities, policies and practices used to address your chosen challenge, and critique them according to their effectiveness, appropriateness and impact.
• Identify the public health challenge you will focus on. Provide a brief background on why it is a public health concern and briefly introduce how it relates to the practice themes.
• Choose and briefly outline an analytical framework through which you will explore public health practice in relation to your public health challenge (i.e. Beattie, Ottawa Charter, Tannahill).
For each practice domain (health protection, individual change, community development) you will provide an analysis including:
i. A general outline of the practice domain and the principles/characteristics of it.
ii. A description of how the practice domain can be used to address your public health challenge according to its theoretical underpinnings (models, theories).
iii. A reflection on the ethical considerations which must be taken when using this domain in practice. You may wish to use a model to do this (i.e., Nuffield Ladder).
iv. A critical description of an intervention which has used that practice domain to address your public health challenge in the real world. This will include a brief contextual description of the intervention, and emphasise critical appraisal by considering the effectiveness, impact and ethical implications of the intervention whilst meeting the module learning outcomes for each approach .
v. A conclusion determining whether the practice domain is the appropriate approach for addressing your public health challenge.
You will consider the three practice domains in relation to your chosen public health challenge to draw a conclusion about which domain(s) are the most useful, impactful, and ethical for addressing your public health challenge. You may wish to conclude your essay by considering:
i. Imbalances seen in current practice: is one approach used more than the others?
ii. The holistic nature of public health: should more than one approach be used?
a. You must support your work by referencing scholarly sources. Follow the university Referencing Guidelines (linked from the Moodle site), ensuring that you use the Harvard format.
b. To pass the assignment you will need to demonstrate that you take a consistently ‘critical’ approach to evidence and arguments: do not just describe or repeat information.
In the United Kingdom (UK), eating disorders have become a serious public health concern. Anorexia, bulimia, and binge eating disorder have drawn attention because of the risks they bring to physical and mental health. An estimated 1.25–3.4 million persons in the United Kingdom suffer from an eating disorder (Robertson, et al. 2021).
About one-quarter of people with eating disorders are men. Due to cultural and media pressures to meet unattainable beauty standards, eating disorders like anorexia are on the rise and enduring (Brown, et al. 2021).
Based on the findings of the Adult Psychiatric Morbidity Survey conducted by the NHS Information Centre in 2007, it was observed that a proportion of adults, specifically up to 6.4%, had symptoms suggestive of an eating disorder.
Based on the findings of the National Institute for Health and Care Excellence (NICE), it has been determined that a considerable population of 1,309,000 individuals in the United Kingdom is afflicted by a range of officially acknowledged feeding and eating disorders (Hinojo-Lucena, et al. 2019).
The aforementioned figures encompass a total of 266,300 individuals aged 16 and above diagnosed with anorexia nervosa, 443,800 individuals diagnosed with bulimia nervosa, and 1,398,000 individuals diagnosed with binge eating disorder (Austin, et al. 2021).
The prevalence rates for eating disorders in the population are as follows: anorexia nervosa affects around 0.6% of individuals, bulimia nervosa affects approximately 1% of individuals, binge eating disorder affects approximately 3.2% of individuals, and some other kind of feeding and eating problem affects approximately 3% of individuals.
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The Ottawa Charter is built on the five pillars of public policy, the environment, community involvement, personal growth, and health care. The conceptual framework is used to the topic of eating disorders in this study in an effort to provide a holistic solution to the issues brought on by eating disorders in the United Kingdom. The inclusion of identifying legislative gaps, environmental triggers, neighbourhood-based programs, and personal empowerment tactics.
A complex interplay of biological, psychological, social, and cultural elements leads to eating disorders. These illnesses are wreaking havoc in the United Kingdom (UK), afflicting people of all ages and both sexes.
The National Institute for Health and Care Excellence (NICE) reports that young women are disproportionately affected by eating disorders. Eating disorders are linked to greater psychological suffering, a worse quality of life, and a higher risk of death in addition to the apparent detrimental impacts on physical health (Clark Bryan, et al. 2020).
Figure 1: Eating disorder
(Source: Statista, 2018)
| Health Protection | Setting standards to encourage equitable body depiction in media and advertising is crucial(Austin, et al. 2021). These rules may help with the root issues that lead to body dissatisfaction and promote a more realistic representation of individuals of all sizes in the media. |
| Individual Change | It is essential to create conditions that support body positivity and self-esteem in order to counterbalance the harmful impacts of social pressure. Schools, companies, and communities may all benefit from implementing initiatives that promote uniqueness and appreciate diversity. |
| Community Development | If communities are to act as a whole, services must be established for those with eating disorders and their families (Demmler, et al. 2020). Community-based efforts may make it easier for people to access resources like information, peer support, and counselling services. |
| Developing Personal Skills: | Public awareness of the signs, risks, and potential therapies is crucial. Public education initiatives that provide people the information they need to make healthy decisions may enhance health and wellbeing. |
| Reorienting Health Services: | Routine integration of psychosocial assistance and assessment for eating disorders and mental health problems should occur in primary care settings (Branley-Bell, and Talbot, 2020). The Ottawa Charter's tenets are adhered to in this shift from reactive to proactive actions. |
A diverse approach to therapeutic work in many disciplines will be required if the ideals of the Ottawa Charter for Health Promotion are to be applied to the issue of eating disorders in the United Kingdom. A key strategy for enacting appropriate public policy is to push for laws that restrict the ubiquitous impact of digitally changed pictures in media and advertising (Herle, et al. 2020).
Figure 2: Ottawa Charter emblem (1986)
(Source: futurelearn.com, 2023)
The Ottawa Charter is based on a philosophy that values neighbourhood involvement. Local support groups let those who are affected by eating disorders and their loved ones talk about their experiences with others who can relate (Touyz, et al. 2020).
Collaboration with local organizations that provide seminars on subjects like nutrition, mental well-being, and coping mechanisms may improve the community's toolkit for addressing this problem as a whole. Making wise selections requires autonomous problem-solving abilities and critical thinking (Dovey, et al. 2019).
Numerous measures can be taken to safeguard the public's health and reduce the risk of harm to the population. The basis of health protection is the prevention of damage to individuals and groups. To ensure that healthcare is provided in an ethical manner, safeguard patients, and prevent the spread of disease, it is necessary to draft laws and regulations.
As per Dovey et al. (2019), the utilization of the Social Ecological Model and the socio-ecological paradigm is crucial to the public's health. It recognizes the multiple ways in which social norms, cultural influences, and environmental factors influence an individual's health. In the Ottawa Charter for Health Promotion, health protection is established within the context of fostering health-promoting environments and supporting community efforts.
The Ottawa Charter's goals of promoting restorative communities and granting individuals control over their own health are compatible with health protection (Hinojo-Lucena, et al. 2019). It emphasizes the need for government actions and laws to maintain the well-being of the populace, which is consistent with the Charter's mandate to promote healthful environments.
Addressing health disparities, harmonizing individual rights with public health objectives, and resolving conflicts between economic interests and health outcomes are all ethical challenges in health protection. To ensure that health protection programs are equitable, efficient, and respectful of individual autonomy, professionals in public health must surmount these obstacles.
In order to safeguard the health of marginalized populations, practitioners must be aware of the ways in which their practice may be biased. Policies and legislation must be carefully devised so as not to exacerbate existing health disparities (Nagata, et al. 2020). It may be difficult to find a morally acceptable compromise between people's liberties and the preservation of their health.
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The Condition In 2007, mental health professionals, activists, and other concerned parties made a concerted effort to address mounting concerns about eating disorders (Nagata, et al. 2020).
These measures were taken to combat the rising incidence of eating disorders by encouraging healthier attitudes toward food and the body. This work emphasized the significance of health protection programs in enhancing the well-being of communities.
Evidence connecting eating disorders to significant medical and psychological consequences prompted the rules to adopt a multifaceted strategy. Included were school-based programs promoting positive body image and self-esteem(Robertson, et al. 2021).
In addition, we collaborated with the media to disseminate accurate dietary advice and promote body-positive depictions of people of all sizes.
Interventions, such as the implementation of measures to combat eating disorders, significantly contribute to the preservation of public health(Clark Bryan, et al. 2020). These actions safeguard the mental and physical health of individuals by getting to the root of the problems and raising awareness.
Efforts to protect people's health, such as those depicted in this case study, could make areas safer and reduce residents' health hazards.
Obtaining an education, acquiring new skills, exercising independence, and nurturing a positive self-perception are fundamentals of personal development (Samuels, et al. 2019). Two examples of health promotion theories applicable to the process of individual change are the Health Belief Model and the Theory of Planned Behavior.
These ideas highlight the significance of an individual's internal motivations, values, and goals in determining their behavior. In public health, interventions for individual change are pursued to cover knowledge gaps and give individuals more control over their health.
The Ottawa Charter is consistent with the notion of self-improvement because it encourages individuals to assume responsibility for their own health and well-being (Dovey et al. 2019). The significance of education, communication, and self-assurance in promoting healthy lifestyle choices and preventing adverse health outcomes is emphasized.
Attributing health problems to individuals, failing to account for structural elements that influence behavior, and ignoring cultural factors are all examples of potential ethical challenges in individual change therapy.
In addition to fostering personal accountability, public health professionals should recognize the significance of contextual factors (Weissman, et al. 2020). Providers of medical care should be compassionate and refrain from making generalizations about their patients' health. Therapy must be accessible to individuals of all socioeconomic and religious backgrounds.
In the year 2020, a British organization created a health education curriculum for the entire school. The program's major purpose was to teach young people about the importance of eating disorders and to encourage them to live better lives (Hinojo-Lucenaet al. 2019). A variety of student organizations and the university's health services collaborated to organize the event.
The program was so comprehensive that it included groups and presentations about the dangers of eating disorders and the importance of having a positive self-image. The program's principal objective (Wells et al., 2000) was to convince pupils to stop believing falsehoods and to modify their unfavourable attitudes. The participants were ecstatic, indicating that this endeavour was effective.
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Health education programs and other individual-level measures can greatly aid in the battle against eating disorders. These advertisements make people feel good about their bodies, educate people about the importance of eating disorders, and urge those with eating disorders to get assistance.
These types of interventions assist people make better decisions about their medical treatment by increasing their health awareness. According to Samuels et al. (2019), health promotion principles and the Ottawa Charter are utilized to assist people in changing their behavior for the better. However, experts have a moral obligation to ensure that they do not unduly favor one group or person over another.
It is essential to invest in community development in order to effectively address health issues. The initiative's ultimate objective is to mobilize community members to enhance their health through collaboration. Participation, openness, capacity-building, and the growth of social networks are the guiding principles of community development (Weissman, et al. 2020).
Community development is consistent with the Social Ecological Model, which emphasizes the influence of interdependent individuals, families, communities, and societies on health outcomes. Promoting social connection, civic engagement, and personal development in accordance with the Ottawa Charter for Health Promotion's principles.
Figure 3: Rise of the eating disorder
(Source: childrenscommissioner.gov.uk, 2023)
The Ottawa Charter's emphasis on empowering individuals and communities to assume responsibility for their health is consistent with sustainable community development principles.
Consistent with the Charter's call for supportive environments and active community participation, it encourages local partnerships to address health issues from multiple vantage points.
Issues of authority, representation, cultural sensitivity, and unintended consequences are examples of ethical dilemmas that community development employees may face.
These obstacles must be overcome if public health professionals are to ensure that community programs are truly participatory, egalitarian, and tolerant of diverse viewpoints (Nagata, et al. 2020). It is the responsibility of public health professionals to respect cultural norms, obtain the informed consent of community members, and avoid tokenism.
In response to the growing concern for individuals with eating disorders, a significant community organization in the United Kingdom was established. In response, they initiated a community-based initiative by establishing support groups for individuals with eating disorders (van Hoeken, & Hoek, 2020). The intervention was a complete approach to treating eating disorders since it drew on the expertise of both mental health experts and community members.
This case study demonstrates how community development may be utilized to address serious health concerns such as overeating. The intervention was effective in creating a secure space where individuals with eating disorders could express themselves without fear of repercussions and learn new coping strategies(Linardon et al., 2022).
Participation in neighbourhood development initiatives could be highly beneficial for individuals with eating disorders. Due to the stigma and social isolation that frequently accompanied eating disorders, community-based therapies are crucial for those battling with these conditions. Members of a support group are provided with a safe and accommodating environment in which they can communicate openly and honestly about their experiences, strengths, and recovery struggles.
The Nuffield Ladder, a paradigm for ethical analysis, can be used to critically consider health protection. When advocating for legislation governing the use of digitally altered photographs, ethical concerns arise, beginning with "Avoid Causing Harm." The intent of the policy is to promote healthy body image and diversity, but it may end up stifling expression and even infringing on the right to free speech.
It is crucial to strike a balance between protecting individuals from damage and allowing them to exercise their rights (Taquet, et al. 2022). In discussions of self-improvement, the "Enabling Choice" rung of the Nuffield Ladder is relevant. This field of study and practice is primarily concerned with empowering individuals to enhance their health and well-being through their own decisions.
Community development is related to the "Covert Persuasion" tier of the Nuffield Ladder. Support group meetings and educational seminars held in community centers may have a positive impact on the lives of those who attend if they are organized with transparency and consideration for the participants (Tyler, et al. 2019).
It is hazardous to have people participate in initiatives that could reveal their own difficulties without their knowledge and consent. It is essential to encourage individuals to participate openly and voluntarily, while also preserving their privacy. Lastly, the Nuffield Ladder can be utilized to assess the ethical issues that each practice area of the Ottawa Charter for Health Promotion presents (Tyler, et al. 2019).
Some nations, such as France and Israel, have outlawed the use of digitally altered photographs for commercial purposes in response to growing concerns about the link between negative media portrayals of the body and the development of eating disorders (van Hoeken, and Hoek, 2020). While Israel prohibits the use of underweight models in advertising, France has a "Photoshop Law" that mandates digitally altered images be labeled as such (Tyler, et al. 2019).
These guidelines combat perfectly proportioned bodies, peer pressure, and unattainable beauty standards. Although these developments are encouraging, it is still challenging to foresee their ultimate impact. It is controversial to label digitally altered photographs because some believe that viewers will neglect or scan over the information. In addition, it may be difficult to implement and monitor compliance with these limits, which could diminish their overall effectiveness (Hinojo-Lucena, et al. 2019).
The guidelines align with the learning outcome, which stresses the importance of analyzing the moral dimensions of public health activities. Protection and autonomy are contradictory values, which accentuates the difficulty of such interventions. Lastly, regulations prohibiting the use of digital image modification in advertisements targeting eating disorders are an excellent illustration of the practice area of health protection (Wells, et al. 2020).
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In-depth examination of the three practice domains of the Ottawa Charter for Health Promotion — health protection, individual transformation, and community development — reveals a multifaceted approach to addressing the grievous public health burden of eating disorders among the UK population (Vuillier, et al. 2021).
The policies and laws developed for the purpose of health protection provide a solid foundation for addressing the societal and cultural factors that may contribute to eating disorders. Advocates for restrictions on digitally altered images and the promotion of diversity in media portrayal recognize the pervasive impact of unattainable beauty standards (Linardon, et al. 2022).
The full impact of these prohibitions may be mitigated, however, by difficulties in enforcement and concerns regarding free speech. Individuals are enabled to assume responsibility for their health by providing them with the necessary information and resources in the Personal Change domain, which is grounded in behavioral theories.
The Health Belief Model provides a solid foundation for educational campaigns and skill-building activities designed to increase health awareness, resiliency, and healthy behavior among individuals (van Hoeken, and Hoek, 2020).
At now, prioritizing the augmentation of individuals' well-being and personal development has more significance than the advancement of the collective community. This discrepancy arises due to the inherent challenges associated with fostering effective collaboration among individuals from diverse backgrounds.
Nonetheless, for an eating disorder treatment to be comprehensive and effective, it is necessary to use the most advantageous elements from each of the aforementioned domains of practice. Due to the inherent complexity of public health, it necessitates the implementation of a diverse array of techniques. The treatment of eating disorders necessitates a comprehensive approach that addresses their multifaceted etiology and associated ramifications.
A more complete and adaptable approach to treating individuals with eating disorders may be achieved by integrating therapies from three distinct areas. This methodology explores the interrelationships of individuals' actions, societal conventions, and collective interactions. While it is true that every profession contributes useful insights, it is imperative that the public health approach to eating disorders include health education, behavior modification, and social support.
Austin, A., Flynn, M., Richards, K., Hodsoll, J., Duarte, T. A., Robinson, P.,and Schmidt, U. (2021). Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature. European Eating Disorders Review, 29(3), pp.329-345.Available at:https://discovery.ucl.ac.uk/id/eprint/10122397/3/Robinson_Manuscript_accepted.pdf[Accessed 24 August 2023]
Branley-Bell, D., and Talbot, C. V. (2020). Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders. Journal of eating disorders, 8(1), pp.1-12.Available at:https://doi.org/10.1186/s40337-020-00319-y
Brown, S., Opitz, M. C., Peebles, A. I., Sharpe, H., Duffy, F., and Newman, E. (2021). A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK. Appetite, 156, p.104977.Available at:https://doi.org/10.1016%2Fj.appet.2020.104977
Clark Bryan, D., Macdonald, P., Ambwani, S., Cardi, V., Rowlands, K., Willmott, D., and Treasure, J. (2020). Exploring the ways in which COVID‐19 and lockdown has affected the lives of adult patients with anorexia nervosa and their carers. European Eating Disorders Review, 28(6), pp.826-835.Available at:DOI:10.1002/erv.2762
Demmler, J. C., Brophy, S. T., Marchant, A., John, A., and Tan, J. O. (2020). Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: national data linkage study. The British Journal of Psychiatry, 216(2), pp.105-112.Available at:doi:10.1192/bjp.2019.153
Dovey, T. M., Kumari, V., andBlissett, J. (2019). Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different?. European Psychiatry, 61, pp.56-62.Available at:https://bura.brunel.ac.uk/bitstream/2438/18590/2/FullText.pdf[Accessed 24 August 2023]
Herle, M., De Stavola, B., Hübel, C., Abdulkadir, M., Ferreira, D. S., Loos, R. J.,andMicali, N. (2020). A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses. The British Journal of Psychiatry, 216(2), 1 pp.13-119.Available at:doi:10.1192/bjp.2019.174
Hinojo-Lucena, F. J., Aznar-Díaz, I., Cáceres-Reche, M. P., Trujillo-Torres, J. M., and Romero-Rodríguez, J. M. (2019). Problematic internet use as a predictor of eating disorders in students: a systematic review and meta-analysis study. Nutrients, 11(9), p.2151.Available at: https://www.mdpi.com/2072-6643/11/9/2151/pdf[Accessed 24 August 2023]
Linardon, J., Messer, M., Rodgers, R. F., and Fuller‐Tyszkiewicz, M. (2022). A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field. International journal of eating disorders, 55(1), 3-38.Available at:https://doi.org/10.1002%2Feat.23640
Nagata, J. M., Ganson, K. T., and Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities. Current Opinion in Psychiatry, 33(6), p.562.Available at:https://doi.org/10.1097%2FYCO.0000000000000645
Robertson, M., Duffy, F., Newman, E., Bravo, C. P., Ates, H. H., and Sharpe, H. (2021). Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey. Appetite, 159, p.105062.Available at:https://doi.org/10.1016%2Fj.appet.2020.105062
Samuels, K. L., Maine, M. M., andTantillo, M. (2019). Disordered eating, eating disorders, and body image in midlife and older women. Current psychiatry reports, 21, 1-9.Available at:https://doi.org/10.1007/s11920-019-1057-5
Taquet, M., Geddes, J. R., Luciano, S., and Harrison, P. J. (2022). Incidence and outcomes of eating disorders during the COVID-19 pandemic. The British Journal of Psychiatry, 220(5), pp.262-264.Available at:doi:10.1192/bjp.2021.105
Touyz, S., Lacey, H., and Hay, P. (2020). Eating disorders in the time of COVID-19. Journal of eating disorders, 8, pp.1-3.Available at:https://doi.org/10.1186/s40337-020-00295-3
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vanHoeken, D., and Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry, 33(6), p.521.Available at:https://doi.org/10.1097%2FYCO.0000000000000641
Vuillier, L., May, L., Greville-Harris, M., Surman, R., and Moseley, R. L. (2021). The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences. Journal of eating disorders, 9, pp.1-18.Available at:https://doi.org/10.1186/s40337-020-00362-9
Weissman, R. S., Bauer, S., and Thomas, J. J. (2020). Access to evidence‐based care for eating disorders during the COVID‐19 crisis. International Journal of Eating Disorders, 53(5), pp.639-646.Available at:https://doi.org/10.1002%2Feat.23279
Wells, K. R., Jeacocke, N. A., Appaneal, R., Smith, H. D., Vlahovich, N., Burke, L. M., and Hughes, D. (2020). The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. British journal of sports medicine, 54(21), pp.1247-1258.Available at:http://dx.doi.org/10.1136/bjsports-2019-101813
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