Childhood obesity: bringing children's rights discourse to public health policy.Abstract
Childhood obesity is widely understood as a public health issue, but is not commonly understood from a legal perspective. Children's rights The opportunity for children to participate in political and legal decisions that affect them; in a broad sense, the rights of children to live free from hunger, abuse, neglect, and other inhumane conditions. discourse can add significant empowerment to public health-based policy, which alone lacks effectiveness in the face of commercial and other counteracting influences. The United Nations Convention on the Rights of the Child The United Nations Convention on the Rights of the Child, often referred to as CRC or UNCRC, is an international convention setting out the civil, political, economic, social and cultural rights of children. has the potential to be used by advocates for children's health Children's Health Definition
Children's health encompasses the physical, mental, emotional, and social well-being of children from infancy through adolescence. to facilitate child health policies pertaining per·tain
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.
2. to the issue of childhood obesity. This is because children's rights, as defined in the articles of the convention, establish the essential conditions required by children to achieve optimal health and wellbeing. A rights-based approach may improve children's welfare by encouraging a less fragmented approach to the issue of childhood obesity. The articles of the convention can be used as a template for interdisciplinary collaboration, with a more coherent outcome possible. By articulating childhood obesity as a children's rights issue--not just a public health issue--a more effective strategy for addressing the problem can be developed and implemented.
Childhood obesity, children's rights, public health, interdisciplinary collaboration
Childhood obesity is becoming a significant public health concern with serious long-term implications for society. The government recognises that it is an issue that urgently needs to be addressed, and a raft of public health policies and new initiatives are being developed to tackle the problem (see Table 1). However, the issue is a complex one requiring a preventive strategy to be implemented at a number of levels, together with a number of groups, including the family, schools, government, the food industry, town planners, transport agencies and the media. With so many groups involved, there is a danger of a fragmented approach to the problem, with each group developing their own policies and initiatives in isolation of each other.
It was decided to explore the way in which a rights-based approach could be used to articulate the issue of childhood obesity and provide a focus for the groups involved, directing each to meet the overall needs of children with policies that support their health and wellbeing.
A literature-based study was undertaken with the current public health approach outlined using primary sources of information obtained from recent government policy documents. Legislation and international instruments were examined when considering how a legal approach to childhood obesity could be articulated.
Prevalence in the UK
Overweight and obesity are conditions in which weight gain has reached the point of endangering health. (1) The most appropriate measurement for identifying overweight and obesity is the body mass index (BMI BMI body mass index.
body mass index
Body mass index (BMI)
A measurement that has replaced weight as the preferred determinant of obesity. ), which is determined both by weight and height. A BMI above the 95th percentile is regarded as obese, while a BMI above the 85th percentile is regarded as overweight. (2) Between 1995 and 2006, the percentage of boys aged two to 10 years who were overweight or obese in England increased from 22% to 29%, while for girls the figures rose from 23% to 26%. (3)
This rising prevalence is of particular concern as there is now mounting evidence that obesity in childhood may have implications for physical health even at a young age. Studies have found that overweight and obesity in young people can be linked to the early development of risk factors for increased incidence of coronary heart disease coronary heart disease: see coronary artery disease.
coronary heart disease
or ischemic heart disease
Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). , the rise in the diagnosis of type 2 diabetes type 2 diabetes
See diabetes mellitus. (4) and an increased risk of iron deficiency anaemia Noun 1. iron deficiency anaemia - a form of anemia due to lack of iron in the diet or to iron loss as a result of chronic bleeding
iron deficiency anemia . (5) Evidence on whether obesity impacts on psychological wellbeing is less conclusive, with some studies showing that many children experience low self-esteem, (6) are more likely to be victims of bullying (7) and score lower on measures of health-related quality of life compared to normal weight children, (8) while others find that despite moderate levels of body dissatisfaction, few obese children are depressed or have low self-esteem. (9)
There is considerable debate regarding the reasons for the increasing prevalence of childhood obesity, but one contributory con·trib·u·to·ry
1. Of, relating to, or involving contribution.
2. Helping to bring about a result.
3. Subject to an impost or levy.
n. pl. factor would seem to be the increase in children's energy intake and the decrease in children's energy expenditure.
The energy intake of children
The consumption of diets high in fat and sugar is a major contributory factor in the rising trend in obese children, with the average proportion of children's food energy derived from these foods significantly exceeding government recommendations. (10) The consumption of fizzy fizz
intr.v. fizzed, fizz·ing, fizz·es
To make a hissing or bubbling sound; effervesce.
1. A hissing or bubbling sound.
3. An effervescent beverage. drinks has almost doubled in the past 15 years (10) and a positive association has been identified between the consumption of sugar-sweetened drinks and childhood obesity. (11)
Lifestyle trends tend to support the consumption of pre-prepared convenience foods and fast foods, with around two billion meals eaten at 'quick service' catering outlets in the UK in 2001. (12) Meals and snacks eaten outside the home have been found to contain higher levels of fat. (10) There is concern that the number of occasions that a family eats together has declined (13) and this trend may have led to a growing snacking culture among children, which favours the consumption of foods high in fat and sugar.
Advertising on children's television presents an imbalanced nutritional message, with the majority of products containing high levels of fat and/or sugar, creating a conflict between the types of food promoted to children and national dietary recommendations. (14,15) A review of the literature on the effects of advertising on children has identified a modest direct effect of advertising on food preference, consumption and behaviour (16) and a national report has highlighted the need for action to address the major imbalance in children's food advertising. (17)
The energy expenditure of children
Changes in patterns of physical activity and the adoption of more sedentary sedentary /sed·en·tary/ (sed´en-tar?e)
1. sitting habitually; of inactive habits.
2. pertaining to a sitting posture.
of inactive habits; pertaining to a fat, castrated or confined animal. lifestyles are also likely to be important factors in causing childhood obesity. Young people in this country are becoming increasingly inactive, with 30% of boys and 41% of girls aged two to 15 not meeting the recommended levels of physical activity. (3)
All of these factors combine to make childhood obesity a complex issue, with its prevention and management requiring a range of co-ordinated policies to improve diet and physical activity levels. The government recognises that it is an issue that urgently needs to be addressed and has set a target to reduce the proportion of overweight and obese children to 2000 levels by 2020 in the context of tackling obesity across the population. (18)
Public health approach
The current approach favoured by government in tackling childhood obesity is the public health approach (see Table 1), but this has a number of weaknesses.
Finance may prove to be a barrier to the provision of healthier food in schools. Vending machines bring in much needed income, and marketing in schools is particularly sought by manufacturers of crisps, soft drinks and sweets. Schools may also lack control over food provision if contracted catering companies decide what food to provide. These companies may be resistant to moves toward healthier provision that may be less popular with pupils and affect the profits or financial viability of their operation.
Ineffectiveness of voluntary controls
Consumer groups are not confident that the food industry will adhere to adhere to
verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful
2. voluntary controls, and argue that only statutory controls will sufficiently protect children from exploitation by advertisers. The healthy eating messages coming from the government are counterbalanced by the heavy advertising of unhealthy food unhealthy food Any food that is not regarded as being conducive to maintaining health; UFs include fats, in particular of animal origin, 'fast' foods–low in fiber and vitamins; 'junk food'–eg, potato and corn chips, pretzels, crackers–high in salt coming from the food manufacturers.
Public health programmes and policies, as outlined above, seek to provide individuals with information and education about risks associated with diet or lack of exercise. They are designed to address health-related behaviours, over which it is generally assumed individuals have, or want to have, complete control. However, surveys of consumer awareness (28) show that most respondents already know what constitutes a healthy diet. However, they often lack awareness of what such general information means in practice, or lack the ability through causes beyond their control to put their knowledge into practice. With regards to levels of physical activity, evidence shows that play space is frequently restricted for school-aged children and green space that is accessible to children continues to be sold off. (29)
Lack of opportunity to exercise and play outside, advertisements that emphasise unhealthy food and drinks, and a food industry that controls the content of foods can all be seen to contribute to an environment that encourages obesity. Many of these causes lie beyond the control of the individual. An alternative approach to address the issue of childhood obesity is therefore required that focuses on changing the wider environmental determinants within which obesity flourishes. Children's rights discourse can provide an alternative way of addressing this by constructing the issue of obesity as a legal problem, (30) with responsibility for addressing these wider determinants lying with the state, rather than the current focus on individual lifestyle choices with responsibility resting on the individual.
Children's rights discourse
Over recent years, there has been an increasing interest in children's rights due to two main factors. First, there is a greater rights consciousness generally, as a result of the Human Rights Act 1998. Second, there is an increasing appreciation of the UK's obligations under the United Nations (UN) Convention on the Rights of the Child 1989.
The Human Rights Act 1998
In October 2000, the Human Rights Act was implemented and the European Convention on Human Rights (ECHR ECHR European Court of Human Rights
ECHR European Convention on Human Rights
ECHR Exact Cell Hit Ratio ) was incorporated into domestic law. Since then, we have become increasingly aware of the importance of human rights in the provision of healthcare services. This has been particularly the case in the context of medical treatment and the relationship between individual patient and healthcare provider. Less attention, however, has been given to the role of human rights in public health. Children are also entitled to claim the rights guaranteed by the ECHR, as it guarantees the fundamental human rights of all people living within the boundaries of the states that ratified rat·i·fy
tr.v. rat·i·fied, rat·i·fy·ing, rat·i·fies
To approve and give formal sanction to; confirm. See Synonyms at approve. it, irrespective of irrespective of
Without consideration of; regardless of.
preposition despite age. The Human Rights Act also requires government departments to review carefully any new draft legislation that affects children, to ensure its compatibility with their convention rights.
The UN Convention on the Rights of the Child
The UN Convention on the Rights of the Child was passed by the UN General Assembly on 20 November 1989, and the UK ratified it on 16 December 1991.
The particular task of the convention is to emphasise that children too are holders of human rights, and the list of 54 convention articles constitutes an attempt to define children's needs and aspirations and commit ratifying states to their accomplishment. The convention emphasises that states must not only protect children and safeguard their fundamental freedoms, but also devote resources to ensuring that they realise their potential for maturing into healthy and happy adulthood.
Like many other countries, the UK has not incorporated the convention into domestic law, so it is of persuasive influence only. However, governments are directed to undertake 'all appropriate legislative, administrative and other measures' to implement the rights contained in the convention (Article 4). In addition, Article 42 obliges ratifying governments 'to make the principles and provisions of the convention widely known, by appropriate and active means, to adults and children alike.'
Article 44 also requires that state parties produce regular reports to the Committee on the Rights of the Child The Committee on the Rights of the Child (CRC) is the body of independent experts that monitors implementation of the United Nations Convention on the Rights of the Child by governments that ratify the Convention. on their progress toward implementation of the convention, and so, although not part of English law The system of law that has developed in England from approximately 1066 to the present.
The body of English law includes legislation, Common Law, and a host of other legal norms established by Parliament, the Crown, and the judiciary. , it exerts an increasingly powerful influence on the developing law. The children's commissioner Children's Commissioner could refer to:
When considering the issue of childhood obesity, the articles of the convention listed in Table 2 are particularly relevant.
Many healthcare professionals are fully committed (Law) committed to prison for trial, in distinction from being detained for examination.
See also: Fully to the idea that children have rights, but are uncertain as to how to promote such a notion in a way that improves children's lives at a practical level.
The UN convention can be utilised as a powerful tool by healthcare professionals (31) to address contemporary determinants impacting upon child health outcomes when considering the issue of childhood obesity. The articles of the convention can be used to give added influence to current public health policies and establish a framework for dealing with issues that impact on childhood obesity. Articles 24 and 27 could be used, for example, to give added influence to securing the resources needed to promote and support breastfeeding and to ensure that children receive a healthy diet in order for them to grow up to reach their full potential. Article 31 can be utilised in campaigns to secure the provision of safe play and recreational facilities for children. Article 36 could be used to support any campaign or policy that protects children from the effects of advertising unhealthy foods.
A focus on children's rights as a strategy to establish improvements in child health outcomes is a paradigm shift A dramatic change in methodology or practice. It often refers to a major change in thinking and planning, which ultimately changes the way projects are implemented. For example, accessing applications and data from the Web instead of from local servers is a paradigm shift. See paradigm. from current child health practice. Simpson and Simpson (30) argue that such a strategy is not about public health practitioners lobbying for changes to the law, but is instead about how, within current legal discourse, there is the potential to argue for changes that are consistent with both public health objectives and the law, and that articulating the problem of childhood obesity as one that involves issues of children's rights might shift thinking to such an extent that behaviour will change. They state that 'the public health practitioners who can articulate health issues in human rights terms may cause social change ... because the connection of health issues with human rights affects attitudes and the consequent behaviour of those with the power to bring about fundamental shifts in how things are done' (30) (p55).
It is the articulation articulation
In phonetics, the shaping of the vocal tract (larynx, pharynx, and oral and nasal cavities) by positioning mobile organs (such as the tongue) relative to other parts that may be rigid (such as the hard palate) and thus modifying the airstream to produce speech of children's rights, as contained within these articles, that changes the issue of childhood obesity from being one that focuses solely on the responsibility of the individual into one that incorporates the legal responsibility of the state, by requiring that consideration be given to the provision of safe play facilities, safer transport options that would facilitate children being able to walk or cycle to and from school, and adequate resources to ensure optimal nutrition and avoidance of exploitation from food advertisements.
One of the most valuable ways in which such a rights-based approach can improve children's welfare is to encourage a less fragmented approach to the issue of childhood obesity. A rights-based approach would address the problem of children being the focus of a number of disparate groups, rather than their overall needs being addressed. By placing the differing aspects of childhood in a framework of rights rather than, for example, in a health or educational-based context, the boundaries between the various disciplines start to become irrelevant, with a far more coherent outcome being possible. (32) The adoption of a rights-based framework is inclusive, as it would give all children the same basic entitlements, but would not rule out targeting resources at the neediest within the group.
If healthcare professionals and policy makers choose to adopt a rights-based framework for their work, then they will need to be clear about what children really need in order to improve their wellbeing. This can only be determined by the inclusion of consultation with children themselves, and such an approach accords with Article 12 of the convention--the right of children to express their views in all matters that affect them.
Conclusion and implications
The articles of the UN convention can be used to construct the public health issue of childhood obesity as a legal problem. This gives the opportunity to strengthen the challenge against commercial influences, which are constrained con·strain
tr.v. con·strained, con·strain·ing, con·strains
1. To compel by physical, moral, or circumstantial force; oblige: felt constrained to object. See Synonyms at force.
2. only by limited self-regulation, as well as to strengthen the case for the provision of resources to improve children's nutritional status nutritional status,
n the assessment of the state of nourishment of a patient or subject. and opportunities to increase levels of physical activity. Public health practitioners, such as health visitors and school nurses, are uniquely positioned to lead the utilisation of children's rights discourse to effect change in how the issue of childhood obesity is addressed. The resulting change of attitudes and perspectives could facilitate a change in the approaches encapsulated in public health policies. These new public health policies could provide a more effective positive impact on the issue of childhood obesity through a broad range of integrated strategies pertaining to child nutrition, food advertising, transport options and safe play facilities. In order for this to happen, it is essential that public health practitioners understand the principles of children's rights, so that they can use the convention as a tool to facilitate advocacy for children.
Further research should seek to discover how rights discourse could be applied to deliver preventive interventions to address the issue of childhood obesity at all levels from individual, family, school, local community and national levels. Environmental as well as individual interventions could result from policies and strategies developed by embracing children's rights. The adoption of a children's rights discourse should therefore be utilised by public health practitioners in order to help achieve significantly improved results in the prevention of childhood obesity.
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v. red·lined, red·lin·ing, red·lines
1. To refuse home mortgages or home insurance to areas or neighborhoods deemed poor financial risks.
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in full British Broadcasting Corp.
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Julie Greenway MA, BSc, RGN RGN (in Britain, New Zealand, and Australia) Registered General Nurse
RGN (Brit) n abbr (= Registered General Nurse) → staatlich geprüfte Krankenschwester f, , RHV RHV Regionale Huisartsen Vereniging (Dutch)
Doctoral student, University of Bristol
Table 1. Government strategies relating to children's welfare Policy document Summary of aims relevant to the issue of obesity 1 Every child matters: * To encourage integrated change for children (19) planning, commissioning and delivery of services * To improve multidisciplinary working and increase accoun- tability to improve outcomes for children 2 National Service * To enable children and young Framework for children, people to make informed choices young people and about healthy lifestyles, thus maternity services (20) empowering them to improve their own health 3 Choosing health: making States halting the growth in healthy choices childhood obesity as a prime easier (21) objective. Actions to improve Choosing a better diet: nutrition in the early years a food and health of a child's life include: action plan (22) * Healthy Start Scheme * Healthy Schools Programme * Food in Schools Programme (24) * National School Fruit and Vegetable Scheme (25) Choosing activity: a Actions to improve levels of physical activity action physical activity include: plan (23) * Safe active travel to school * Physical education and sport: investment in school sports facilities and promotion of physically-active lifestyles 4 Food Standards Agency * Schools should provide healthy action plan on food meal options and vending promotions and machines should promote children's diets (26) healthier options * Government and Ofcom should only endorse promotional campaigns that encourage children to eat healthier options * Advertising Standards Authority should review arrangements for the regulation of food advertising to children * Food manufacturers, retailers and the food service sector should agree targets for uptake of best practice advice on reducing the amounts of fat, sugar and salt in product ranges aimed at children 5 Healthy weight, healthy Identifies five areas for action: lives: a cross-government * Children, healthy growth and strategy for England (27) healthy weight * Promoting healthier food choices * Building physical activity into our lives * Creating incentives for better health * Personalised advice, diet support, activity and health issues Table 2. Convention articles relevant to the issue of childhood obesity Article 24 State parties recognise the right of the child to the enjoyment of the highest attainable standard of health. (Article 24 (1)) State parties shall pursue full implementation of this right and, in particular, shall take appropriate measures (Article 24 (2)): * 'To combat disease and malnutrition ... through the provision of adequate nutritious foods and clean drinking-water' (Article 24 (2c)) * 'To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding ...' (Article 24 (2e)) Article 27 State parties recognise the right of every child to a standard of living adequate for the child's physical, mental, spiritual, moral and social development (Article 27 (1)) and: * '... shall in case of need provide material assistance and support programmes, particularly with regard to nutrition, clothing and housing' (Article 27 (3)) Article 31 State parties recognise the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child Article 36 State parties shall protect the child against all other forms of exploitation prejudicial to any aspects of the child's welfare