Community Health and Population

Obesity in Spartanburg

Community Health and Population-Focused Nursing Practicum

Instructions:

I want the essay about obesity in Spartanburg South Carolina. And B4 is the longest part discussing what you did in the 65 hours which you can see the websites below to help. part D1 I want to focus on childhood obesity and the poverty population for obesity prevention and access for healthy foods for the poor people. complete the time log. I am sending more detailed instructions.https://youtu.be/DM5y6mLHmiQ

Solution.

Community Health and Population-Focused Nursing Practicum

Assessment

Spartanburg County is a county in South Carolina State. It was previously called Hub City due to its rapid growth and flourishing economy. However, as a result of deindustrialization, it has deteriorated in economy and consequently health. Currently, there are many poor neighborhoods in the region. Because of the poverty, many families do not have access to healthy foods. Many of the children do not get at least 60 seconds of exercise. This has led to poor living conditions that result in overweight and finally obesity (Moreno, Pigeot, & Ahrens, 2011). There are many fast food restaurants in the region, where people can obtain cheap fast foods. As such, the eating habits of the people, especially the youth is poor and unhealthy. Serious intervention is necessary if the condition is to be managed. One of the best intervention measures is helping children in schools to access healthy foods freely. Healthy classroom activities should also be promoted as much as possible (Frugier, 2004).

Health Concern

Previous research has shown that about 40% of the youths in Spartanburg County are obese. Another large percentage of the young people are overweight. Their condition puts them in a high risk of other serious diseases. This issue has sparked a lot of concern from different organizations. The health concern is intensified by the high rate of poverty among the Spartanburg community neighborhoods. Poor children do not have access to healthy foods. Despite interventions that are already in place, the poor kids still need to be helped to get healthy foods. This can be done through the provision of free lunch in all schools for all identified poor children. A lot of funding is needed for this initiative, but it is worth it, if obesity is to be completely eradicated (Berg, 2004).

Target Population

Spartanburg County, South Carolina is a community composed African Americans and Whites. It has a total population of 39,673 people. African Americans make up 50% of the population while whites make up 47%. 23% of the residents have incomes that are below the poverty line as determined by the federal government. 25% of the population is aged below 19 (CDC, 2015).

Deindustrialization and the job losses that resulted from it had caused significant changes in the financial health of Spartanburg County. The county was once a fast growing textile center and hub for transportation in the entire northwest South Carolina. As a result of the economic downturn, the physical health of the residents of the county also began to deteriorate. About 70% of the residents were either obese or overweight. The unhealthy weight caused many of the people to suffer multiple problems (Payne, Hahn, & Mauer, 2013).

A report by the Spartanburg Childhood Obesity Taskforce revealed that 33.4% of the first graders, 38.0% of the third graders and 38.1% of the fifth graders in Spartanburg County were either obese or overweight in 2013 (USC, 2014). Through some interventions, there have been improvements. However, the improvements have not been significant, one of the major reasons being poverty. The report also showed that there is a difference between the distribution of obesity among the blacks, whites and the Hispanics.

However, there were groups and organizations that came in to help improve the wellbeing of Spartanburg. There were non-profit groups that worked hard on promoting more nutritious eating and active living for each resident. The City of Spartanburg and the County of Spartanburg worked in unison to pass the Complete Streets resolutions. The County Council had also approved a hospitality tax for supporting parks and recreation. The interventions led to more biking and walking trails. As a result, there were improved sidewalks and bicycle racks. They also paved way for future policy changes and environmental interventions (Spartanburg Regional Healthcare System, 2016).

Community Resources and Partners

Childhood obesity has been on the rise in the Spartanburg County which has sparked local and international interest (Dawes, 2014). My fieldwork involved identifying some of the intervention measures that can be put in place to reduce childhood obesity within the Spartanburg community. In my research, I contacted 15 community organizations and institutions. Some of the institutions were non-governmental while others were government institutions and organizations. Some were hospitals and healthcare institutions while others were action groups and volunteer organizations. The information from interviews with contacts from some of them are discussed in the following paragraphs.

Partners for Active Living (PAL), Childhood Obesity Task Force and the Hub City Farmers’ Market (HCFM) started to implement programs and policies for the improvement of the health of the current as well as the future generations. In 2008, Healthy Kids, Healthy Communities (HKHC) was formed and its funds were used in building on the work. The program also advocated for connectivity to healthy food outlets and parks in at-risk communities. They included the northwest neighborhoods of the city, predominantly African American. Near all students in these neighborhoods qualified to receive the programs of free or reduced-price school lunch. Access to healthy food outlets and parks was also promoted in the majority-White rural communities of Pacolet, Boiling Springs and Woodruff (HKHC, 2016).

HKHC is a national program under the Robert Wood Johnson Foundation. The organization is located in Spartanburg County. It is responsible for ensuring that kids are healthy, with the aim of improving the health of the community. The program accomplishes its objectives by bringing together different organizations and groups into partnerships to ensure that childhood obesity is minimized as much as possible in the community (HKHC, 2016).

The Partners for Active Living is an organization based in Spartanburg, which works in partnerships to reduce the rates of and prevent the growth of childhood obesity in the county. To prevent childhood obesity, the organization promotes physical activity and healthy eating. They ensure that healthy lifestyles are promoted in the places where children are, including churches, pre-schools, schools, and after school activities (Partners for Active Living, 2015).

PAL carries out researches to investigate the rates of childhood obesity. It partners with all seven school districts in the county and the South Carolina Department of Health and Environmental Control (SC DHEC) Upstate Region in measuring the obesity rates of more than 87% of all the children in the county (SCDHEC, 2016).

Mary Black Foundation provides funding for various research activities geared towards reducing childhood obesity. The foundation is run by Mary Black Hospital in Spartanburg and it partners with the Partners for Active Living and other like-minded organizations and groups to help prevent childhood obesity. For instance, in 2013, the foundation provided funding for all scales at each school as the PAL was measuring the obesity rates. The Foundation also constructed a two mile long trail for biking and walking exercises. The project is called Mary Black Rail Trail. It was Constructed to promote healthy exercises which are geared at reducing the risk of obesity (USNews, 2016).

The Childhood Obesity Taskforce is an organization that works in partnership with other organizations in Spartanburg to reduce, and prevent, childhood obesity in the county. Through partnerships, the organization measures the body mass index (BMI) of the pupils in each school. Through their research, many other players in the sector are able to identify the areas that need action in order to improve the health of the community.

The Spartanburg Childhood Obesity Taskforce recently launched a branding campaign, Good for You, which was created to capture the grassroots supports that are broad-based, the institutional, governmental and nonprofit support. Its aim is to promote the development of a healthy status in Spartanburg County. Partnership opportunities to this effort are open to schools, businesses, neighborhood associations, nonprofits and all other interested parties (USC, 2014).

The taskforce works with members from USC Upstate, Spartanburg Regional, DHEC, Mary Black Foundation, Hub City Farmers’ Market, Partners for Active Living and the Spartanburg County Parks Department. Its Good For You Spartanburg campaign has a mission to improve health behaviors and prevent chronic illnesses including obesity, cancer and diabetes. It was designed to act as an online guide for healthy eating and moving more in the county. It focuses on equipping worksites, schools, places of worship and other places with resources that will make them healthier. It functions through a partnership program (Spartanburg County Public Libraries, 2016).

The Good for You Spartanburg project received funding from the Action Communities for Health Innovation and EnVironmental change (ACHIEVE) grant. The campaign is managed by the Partners for Active Living. It is also supported by the AmeriCorps*VISTA grant, which is provided by the United Way of the Piedmont. The program, which has more than 20 partners, has 13 sectors. The sectors include healthy eating committee, active living committee, schools committee, after school/ youth programs committee, preschools committee. All the partners are based in Spartanburg. Their purposes are to improve the livelihoods of the people of the county, reduce the rate of childhood obesity and promote exercises that enhance health. They also educate the children and the locals on proper diets and dietary exercises.

Eat Smart, Move More Coalition of South Carolina (ESMM-SC) is a public-private partnership. It has a mission to improve the unanimous promotion of the healthy choice as the easy choice. This is with regard to healthy nutrition and active living. ESMM-SC is responsible for building capacity and providing information, guidance and resources for supporting the implementation of the obesity plans goals of the state. It accomplishes this through training, advocacy, communication and implementation (ESMM, 2016).

The partnership has increased the affordability and availability of produce that is grown locally. This has also increased the economy of the local people. It has accomplished the mission through the Farmers’ Market Toolkit. It has a web-based tool for guidance of the implementation of the programs for the prevention of obesity in particular settings like schools and churches. It partners with the Safe Routes to School program of the SC Department of Transportation in implementing the program in all neighborhoods in the state. It also promotes programs for physical activity, nutrition and obesity.

Mary Black Memorial Hospital is a general medical and surgical hospital. It is located in Spartanburg. The hospital has 181 beds. It provides funding for obesity and BMI research and partners with other organizations and groups within the state to promote healthy living. It engages in philanthropy and raises a lot of money for helping poor families (USNews, 2015).

The Alliance for a Healthier Generation, funded by the Robert Wood Johnson Foundation, works with communities within Spartanburg in making it easier for kids to lead healthier lives. They accomplish their mission by helping children in developing healthy habits. Schools within South Carolina state are offered membership in the Healthy Schools Program. Currently, the Alliance has 630 schools as members, serving over 390,000 students. The program creates healthy environments in schools in which children can thrive. There are National Healthy Schools Awards given to schools that have outstanding efforts. The alliance also supports out of school time programs that help youths to eat right and move more. They accomplish this objective through their Healthy Out-of-School Time Initiative (Alliance for a Healthier Generation, 2014).

SNAP and Farmers’ Markets, South Carolina, helps in improving and promoting access to healthy foods like fresh fruits and vegetables. All participants in the SNAP program have higher priority access to such healthy foods. The access is, however, not free. Some still find the foods very expensive and unaffordable (SNAP and Farmers Markets, 2016).

The Nutrition Coalition (TNC) is an organization that is nonprofit and advocates for strengthening the national nutrition policy. Its aim is to ensure that the nutrition policy is based on conclusive science rather than speculation. In the absence of science, the organization promotes additional research. The Coalition educates policymakers, the public and other stakeholders on the need for conclusive science. It is their belief that conclusive science can be an effect tool in combating obesity and diabetes. They also provide education on the solutions for reform. TNC advocates for nutrition policies that reflect evidence-based and up-to date research, and, in the absence of conclusive evidence, they advocate for clinical trial research funding (Nutrition Coalition, 2016).

Other organizations I contacted include the Action Now Initiative (ANI), which is an advocacy organization. It has a strategy that covers many interventions that have high rewards. They have supported many obesity movements including inducing tax on soda to reduce its consumption. It has also provided funding for many intervention measures for childhood obesity in Spartanburg (Ballotpedia, 2016). ACHIEVE was also contacted to form a network for potential partnership and establish a source of funding. Just like ANI, ACHIEVE has provided funding for many intervention measures for obesity in the county and advocates for obesity education (CDC, 2012).

CDC. Division of Nutrition, Physical Activity, and Obesity (DNPAO) was also contacted in order to establish the current research and state of childhood obesity in Spartanburg County. The contact was also counted as a potential source of funding in the implementation of the proposed nursing interventions (CDC, 2015).

Even though there have been numerous intervention measures, the nurse was able to notice that some poor children still have no access to healthy foods. This is because they cannot afford the healthy foods. As a result, they still engage in unhealthy eating and behaviors. Urgent intervention measures need to be taken to take care of these unlucky children.

Aspects Not Being Addressed

However, due to the high level of poverty within the region, there is still need to increase access to nutritious foods. This can be done in partnership with the City Hub Farmers’ Markets and the provision of free lunch to school children from poor homes. Recent research by the Spartanburg County Childhood Obesity Taskforce revealed that more of the third graders and fifth graders are obese or overweight than the first graders. This implies that the 3^rd and 5^th graders need more attention. I believe that, through integrated efforts and partnerships, the provision of free lunch to all pupils from poor families can help in reducing the reported rates of obesity (Peele, 2010).

Children get obese by eating foods that are less nutritious. These foods deceive their systems into feeling hungry all the time. They end up resorting to cheap fast foods, which only increase their fat levels. Because they are always not satisfied, they tend to feel very tired and cannot exercise their bodies. As a result, they progressively gain weight until their body mass index goes too high. Provision of nutritious foods for free to these children can help in improving their health. Together with the healthy exercises already being promoted by the community groups, these children can be helped.

Outcomes Identification

The overall goal of all interventions that have been, are being and will be put in place is to reduce the rate of childhood obesity, which is a major problem in Spartanburg County. After the implementation of the proposed intervention measures, it will be possible to monitor the outcomes by conducting a new body mass index measurement in the sampled schools (United States, 2010). It is expected that, two years after the implementation of the actions proposed by the nurse, the percentage of obese and overweight children in 1^st, 3^rd and 5^th grades will have reduced significantly. This will be the measure of the effectiveness of the provision of nutritious lunch to poor children for free.

Planning

Objectives

The objectives of the proposed intervention program is to:

1. Promote access to nutritious foods by poor children
2. Encourage healthy eating among all members of the community
3. Introduce classroom activities that are essential in promoting healthy lifestyles
4. Improve the livelihoods and economy of the community members
5. Call for political intervention in the matter
6. Support other intervention measures already in place

Nursing Interventions

The nurse will collaborate with team members to carry out the activities outlined below, with an attempt to promoting healthy living among poor children in the community.

Community organizing: we will bring the members of the community together so that they can act together in their own interest. It is the desire of every parent to ensure that their children are healthy. Therefore, we do not expect to receive any objection if we suggest to them that we want them to unite in pulling resources to ensure that nutritious foods reach their children in schools freely. Parents from poor neighborhoods will be asked to come together and hold fundraisings to generate some of the money for supporting the program.

Community-based participatory research: The key areas that need our nursing interventions will be identified by carrying out a research as an equal partnership between us, who are traditionally trained, and the members of the community. This partnership will help us to pin-point how wide the identified gaps really are, from the point of view of the community members.

Community building: we have noticed that the lands in the region are only partially cultivated due to lack of financial support. The team will encourage parents with farms and educate them on how they can make the best out of their farms. As a source of labor force, the parents will be encouraged to work together to help each other prepare their lands for planting and in doing the weeding and watering of the crops. This will help in improving the income and livelihoods of the local people.

Community and Economic Development: we will inspire the community to carry out major financial activities like agri-business to improve their income. They will be asked to form small self-help groups and micro-finance groups where they can support each other in growing their small businesses. Many families in the region keep hens and goats. It is a good idea to encourage them to increase the scale at which they do this, to help them gain more income.

Charitable volunteerism: We will also approach churches within the region and ask them to support the program by appealing to members to lend a hand. We hope to obtain some of the people who will be responsible for the food distribution in all the schools in the region. Some donations may also come from the churches and other social services agencies.

Philanthropy: To increase the livelihoods of the people of Spartanburg, it is important to encourage and seek charitable aid and donations. These will be obtained through partnerships and networking with some of the key stakeholders within the community and in other locations and states.

Through informal collaborations, the members of the community will be encouraged to work together to improve their livelihoods without expecting any pay. When the citizens are motivated and inspired, they can help each other to achieve higher living standards.

In calling for political intervention, the team will mobilize the community members to hold peaceful demonstrations requesting the elected leaders to intervene in the current issue of childhood obesity. If political support is obtained, it is expected that more stakeholders and donors will be inspired into making contributions towards improving the livelihoods of the people and reducing rates of childhood obesity.

Social entrepreneurship: there is a 4 hectares piece of land in the community, which is not being used for agricultural production currently. The team, in collaboration with the nurse, will acquire permission to use it for growing an identified cash crop. The community members will then be encouraged to participate in the farming exercise. The proceeds from the produce will be divided equally among all families. This project will help in improving the economy of the people.

Socially responsible daily behavior: The nurse and team members will also encourage all community members to behave in manners that are, not easy, but responsible. In doing this, the community members will learn to be responsible for each other and to mind the health status of their neighbors. It will also encourage the members to be vigilant about what they eat and how it will affect their lives. As they do that, the young ones will also learn from them and behave responsibly.

Timeline

Within the first six months, a community based participatory research shall have been completed and the gaps in the poor people in Spartanburg community reached. At the same time, 50 schools with poor populations will be identified. After identifying the deserving schools and the children from poor families, at least half of the free lunch project will be implemented in those schools. Within the first one year, 50% of the members of the community shall have been reached through community organizing. This will be done with the aim of promoting healthy eating. Once every fortnight, community gatherings will be organized and the community members taught on responsible behavior, philanthropy and charitable volunteerism. At the end of the first year, at least 30% of the community members shall have been sensitized.

Community building will carried out in the next six month phase of the program implementation. After one year, at least 100 hectares of community land shall have been identified and cultivated. Families will also be requested to donate portions of their lands for the free lunch program, and in return, their own lands will be cultivated and managed for them. Within the two years of program evaluation, it is expected that food production in the county shall have increased to at least 50%. In conjunction with SNAP and Farmers’ Markets, healthy foods will be identified and cultivated in the farms. Labor will be provided by the willing community members who have been sensitized and educated on the importance of improving access to healthy foods for their children. Through the farming program, it is expected that by the end of the two years, the livelihoods and the economy of the community members shall have increased by 40%. The high percentage is due to the implementation of other intervention measures like social entrepreneurship

Classroom activities that are essential in promoting healthy lifestyles will be introduced through peaceful demonstrations for political intervention in modifying the syllabus to accommodate healthy classroom activities. This will help in promoting healthy living among the school-going children within the county. It is expected that after the first one year, grade one to grade five children shall already have a syllabus that allows them to perform certain healthy exercises within their classes.

Evaluation

The nurse and the team members will work together to implement the proposed action plan and then they will monitor the implemented program for two years. It is expected that, if the proposed action plans are successfully implemented, the livelihoods of the children will improve and their body mass index will reduce. The evaluation will be carried out by surveying the 1^st, 3^rd and 5^th grade students in the 50 schools in which the project will be implemented in its first phase. After it is confirmed that the project has led to a significant reduction in the body mass index of the students, the nurse will collaborate with team members and identified stakeholders to expand the project to all the other schools. This way, all the students in the county will receive healthy food freely, at least for one meal each day. The nurse believes that this is an effective way of combating childhood obesity.

References

Alliance for a Healthier Generation. (2014). Alliance for a Healthier Generation: South Carolina. Retrieved October 28, 2016, from https://www.healthiergeneration.org/about_childhood_obesity/in_your_state/south_carolina/

Ballotpedia. (2016). Action Now Initiative – Ballotpedia. Retrieved October 28, 2016, from https://ballotpedia.org/Action_Now_Initiative

Berg, F. M. (2004). Underage & overweight: America’s childhood obesity crisis– what every family needs to know. New York: Hatherleigh Press.

CDC. (2012). ACHIEVE Communities. Retrieved October 28, 2016, from http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/communities/achieve/index.htm

CDC. (2015). State of South Carolina. Nutrition, Physical Activity, and … Retrieved October 28, 2016, from http://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/South-Carolina-State-Profile.pdf

Dawes, L. (2014). Childhood obesity in America: Biography of an epidemic.

ESMM. (2016). Eat Smart, Move More South Carolina. Retrieved October 28, 2016, from http://eatsmartmovemoresc.org/

Frugier, M. K. (2004). Childhood obesity in the United States. New York: Novinka Books.

HKHC. (2016). Healthy Kids Healthy Communities. Retrieved October 28, 2016, from http://healthykidshealthycommunities.org/

Moreno, A. L., Pigeot, I., & Ahrens, W. (2011). Epidemiology of obesity in children and adolescents: Prevalence and etiology. New York: Springer.

Nutrition Coalition. (2016). About Us. Retrieved October 28, 2016, from http://www.nutrition-coalition.org/about-us/

Partners for Active Living. (2015). Partners for Active Living | Spartanburg, SC. Retrieved October 28, 2016, from http://www.active-living.org/

Payne, W. A., Hahn, D. B., & Mauer, E. (2013). Understanding your health. New York, NY: McGraw-Hill.

Peele, T. (2010). Quick Wins for Healthy Eating: Easy Changes You and Your Family Can Make Now!. Cork: BookBaby.

SCDHEC. (2016). South Carolina Department of Health and Environmental Control: Public Health Clinics. Retrieved October 28, 2016, from http://www.scdhec.gov/Health/PublicHealthClinics/

SNAP and Farmers Markets. (2016). SNAP and Farmers Markets. Retrieved October 28, 2016, from http://www.fns.usda.gov/ebt/snap-and-farmers-markets

Spartanburg County Public Libraries. (2016). Spartanburg Regional Healthcare System collection. Spartanburg, South Carolina: Spartanburg County Public Libraries.

Spartanburg Regional Healthcare System. (2016). Nutritional Navigation: A Grocery Store Tour. Retrieved October 28, 2016, from https://www.spartanburgregional.com/community/events/

United States. (2010). Solving the problem of childhood obesity within a generation: White House Task Force on Childhood Obesity report to the President. Washington, D.C.: Executive Office of the President of the United States.

USC. (2014). Local Childhood Obesity Taskforce releases Spartanburg BMI Report. Retrieved October 28, 2016, from http://news.uscupstate.edu/wp-content/uploads/2012/04/Good-For-You-Spartanburg-Obesity-Press-Release.pdf

USNews. (2015). Mary Black Memorial Hospital in Spartanburg, SC. US News … Retrieved October 28, 2016, from http://health.usnews.com/best-hospitals/area/sc/mary-black-memorial-hospital-6370600/contact

Appendix

Figure 1: Spartanburg, SC community map obtained from Healthy Kids, Healthy Communities website (www.healthykidshealthycommunities.org)