Social Determinants/Health Promotion of Inglewood

 

Living or working in Inglewood California has its perks and its negatives just like anywhere, but one thing I noticed which seemed very evident right off the bat was the types of restaurants and markets available to the local residents, as well as the amount of them, prompting me to select the social determinant category of Neighborhood and Built Environment – Access to Foods that Support Healthy Eating Patterns. In many cities across the United States, particularly some of the bigger ones, attempts are being made to increase the amount of farmers markets, health food stores, and other healthy options for food so that the residents can lead healthier life styles. I actually decided to take a long walk around to assess the neighborhood and as well as the environment and was quite disappointed to see that the majority of the food establishments consisted of unhealthy varieties, including a large amount of fast food places. There have been many studies conducted over the years on the impact of food accessibility for local residents, regular and healthy, and it should be no surprise that the areas with less access to healthy food have increased rates of health issues such as obesity, diabetes, cardiovascular problems and so on. These potential health issues may further degrade the person’s health which increases their need for modifications to their diet by way of healthier options, yet when those options are not readily available or convenient, people simply continue with their unhealthy eating habits which only exacerbates their health issue creating a vicious cycle.

There was a study conducted on forty thousand California residents to determine the correlation and impact having access to healthy food options has on diabetes and obesity rates. Not surprisingly, it showed that the neighborhoods and communities which have less access to fresh and healthy food options have increased obesity and diabetes rates (HealthyPeople, 2020). Additionally, the areas where schools are in relation to the nearby restaurants impact the likelihood of those students becoming over weight or developing health issues. Based off of the information provided by the Los Angeles County Department of Public health, in Inglewood the percentage of adults who are obese is 32% compared to 24% in Los Angeles County as a whole, while the best performing community had an obesity rate of only 6% (Los Angeles County Department of Public Health, 2018). This was surprising even though I anticipated a higher incidence of obesity in Inglewood, as it is 8% higher than that of Los Angeles County. Even the prevalence of Diabetes is higher in Inglewood with a 12% average compared to 10% in Los Angeles County, and only 4% in the best performing community (Los Angeles County Department of Public Health, 2018). The picture this is beginning to paint is one where it definitely seems to be more challenging to maintain a healthy diet and lifestyle while living in areas that are saturated with fast food restaurants and are limited in the amount of establishments selling healthy and fresh foods. Furthermore, Inglewood has a large number of small neighborhood markets and convenience stores which are often very limited in their healthy options and instead carry a variety of lower nutritional value items, and when they do carry healthy foods or fresh produce, it is often more expensive as small mom and pop typically stores have higher markup prices. When you add all of these factors together, it appears that for the people living in the communities which have lower income means placing them in a lower socioeconomic bracket, they often times have fewer options to afford health insurance or go to the doctor regularly to maintain their health, placing them at a disadvantage from the get-go. 

The average median household income of residents living in Inglewood was approximately $46,386 in 2017 with the average amount in the whole United States being $62k, but had a 4.53% grown in 2018 (DataUSA, 2020). This decrease in income coupled with the fact that almost 17% of the residents do not have health insurance places them at an already increased risk for developing health issues as screenings and checkups which may alert them to a potential issue prior to it fully developing are less common. African Americans are already at an increased risk for developing diabetes and hypertension, so when they are living in a community which lacks opportunities for them to mitigate these inherent risks via the availability of healthy foods, adequate recreational areas where they can exercise, or good access to healthcare services, it further places them in an unfortunate circumstance which can perpetuate their disadvantaged statistics (Holmes, 2020). 

Some ways which would help to rectify and mitigate some of these unfortunate issues can include having town hall meetings where residents can voice their concerns, and with enough people it may sway the city to entertain the idea of creating more recreational areas or parks, open up new farmers markets where fresh fruits and vegetables can be purchased at affordable prices, and potentially even open up some clinics or wellness centers for those who can afford to pay for healthcare. By intervening and enabling individuals to lead healthier lifestyles as well as them being able to receive more frequent and consistent healthcare including screenings for potential issues prior to their actual development, it would greatly benefit the local residents and would actually benefit the city as well as it is far cheaper to maintain someone’s health than it is to fix an issue once it already develops, and if someone cannot afford insurance and they have to call 911 with a life threatening emergency, the hospital must foot the bill which may mean collecting from other patients in some form or another in order to compensate for the financial cost. 

Since the country observed the increasing prevalence of health issues related to poor dietary consumptions and lifestyles, various programs have been implemented to control the problem. Most of the interventions are aimed at encouraging behavioral shifts among communities to lower the susceptibility of becoming ill. Nutritional Education is an example of such policies taken to achieve the intended objectives. It entails enabling people to understand what constitutes a healthy diet as well as ways to improve their eating habits and lifestyles. The program was established based on the assumption that a lack of knowledge concerning the right food items is what influences people to choose unhealthy foods, thus increasing their susceptibility of developing nutritional-related disorders, such as obesity or type 2 diabetes (Shepherd et al., 2006). For example, the ‘Know Your Body’ program is a policy intervention aimed at educating people on ways to limit the risk of cardiovascular disorders through healthy eating and living. It delivered nutritional knowledge to school children in classrooms through teachers, educated parents, and community members, with emphasis placed on vulnerable populations. Hence, the provision of nutritional knowledge has been a major approach employed to promote healthy eating and behaviors in an effort to curb illnesses and potential health issues caused by poor feeding habits in vulnerable populations like Inglewood, California.

The other program is Nutritional Labeling, which purposed to influence healthy food choices similar to that of the previous intervention. The idea aimed to enable consumers to better understand the dietary characteristics of the food supplied to them. Similar to the previous intervention, the approach was designed based on the assumption that the lack of knowledge concerning the nutrients contained in the foods is to blame for inappropriate food selections. The initiative also relied on the view that mandatory disclosure of the nutritional value would also encourage the supply of the right quantities of nutrients among food vendors, including restaurants (Moore, Donnelly, Jones, & Cade, 2018). The implementation of the view intensified after the passage of the U.S. Nutritional Labeling and Education Act in 1994. The tactics employed to implement the program have been varying significantly with technology and the provision of nutritional information available electronically through the internet being a key step. Therefore, Nutritional Labeling is an approach employed to ensure consumers understand the nutrients contained in the food they buy to encourage healthier eating habits.

Next, increasing the availability of healthy food is another strategy adopted to curb the spread of nutrition-related illnesses in communities. The objective is to make healthy foods as easy or more easily available compared to the non-healthy ones, which may encourage more appropriate eating patterns. The intervention was formulated based on the belief that the unavailability of appropriate dietary options is responsible for the wrong choices among people leading to the widespread consumption of unhealthy meals. Schools, companies, and restaurants were encouraged to reduce the supply of harmful foods such as those highly rich in sugar and fat. Moore, Donnelly, Jones, and Cade (2018) pointed out that in the United States, school education and media programs encouraged people to opt for fruits, vegetables, and organic foods as opposed to fast-foods to reduce the disproportionate gain in body mass. The ‘Slice of Life’ is a slogan employed to educate school children and adults regarding the consumption of the right amount of food, the benefits of healthy eating and physical exercises, and methods of interpreting food labels and menus. Hence, making healthy food readily available has been a key policy intervention to curb the problem of poor nutrition and lifestyles in highly susceptible populations like Inglewood.

Lastly, the provision of food subsidies to the poor is an intervention employed to promote healthy eating and lifestyles in order to address the problem of unhealthy eating. The strategy was designed based on the assumption that poor dietary consumption is a result of financial constraints that influence people to opt for fast-food which is cheaper compared to the recommended meals. The Special Supplemental Nutrition Program for Women, Infants, and Children is an example of such initiatives (McFadden et al., 2014). The purpose was to enable vulnerable communities to access quality diets irrespective of their poor financial position. Therefore, overcoming financial barriers to healthy eating has been a major policy used to curb the rising nutrition-related illnesses among highly susceptible populations. 

Notably, scholars and policy experts have compiled reports to reveal the relevance, efficiency, and effectiveness of the programs aimed to promote healthy eating and lifestyles. The various works explain why vulnerable communities like Inglewood have recorded successes and failures in achieving the intended outcomes. Studies indicate that food subsidies aimed at enabling the lower socioeconomic classes to have better access to healthy foods are effective for addressing nutritional issues than other methods. A study noted that a price subsidy of 10% on vegetables and fruits would trigger an increase in the rate of consumption by up to 7% (Brambila-Macias et al,. 2011). The value is higher compared to the use of the same quantity of money to cater to appropriate food stamping, which would only increase the consumption of healthy food to around 0.4%. Nevertheless, price subsidies are costly to implement, which prompts reluctance in utilizing its use to address the problem. This partially accounts for the high vulnerability of the less financially stable such as in Inglewood, and therefore approaches that target lowering the financial barriers to the access of healthy diets are more effective but rarely utilized because of the relatively high funding compared to other approaches.

Another similar study also revealed the significance of subsidies in promoting healthy eating and lifestyles among communities, noting that high prices are a serious barrier to the consumption of appropriate diets among people of low socioeconomic status. The study found that the cost of fruits and vegetables can be as high as four times compared to the non-healthy food items. The research is effective in revealing the reason for the high disparity in the vulnerability of suffering from diseases related to poor nutrition among the poor, where fast-foods are cheaper than healthy foods. Critically, interventions to curb the high prevalence of illnesses related to poor diet have to focus on lowering the cost of healthy meals.    

Relatedly, empirical evidence pointed out that Nutritional Knowledge as a method of promoting healthy eating is non-reliable. The choice of the right diet is an inter-play of many factors including gender, taste preference, allergies, and so on which may or may not limit the relevance of education in encouraging appropriate food choices. A study found that an increase in nutritional knowledge did not always result in desirable changes in eating habits, lifestyle, or even the mitigate the risk of suffering from illnesses linked to poor feeding like obesity, cardiovascular issues, or diabetes (Shepherd et al,. 2006). A nutritional education program has been observed to improve consumption patterns among women but presents insignificant impacts on other groups such as school children. Hence, the exclusive use of knowledge-based interventions accounts for the sustained vulnerability to nutrition-related illnesses among poorer communities.

Moreover, increasing the availability of healthy foods is a highly recommended program for addressing poor nutrition and lifestyles to free communities from chronic diseases linked to improper diets. There was a randomized block experiment to evaluate the effect of increased accessibility of fruits and vegetables on the degree of consumption among employees earning low wages in various worksites in the United States (Backman et al,. 2011). The results indicated that workers significantly increased the intake of vegetables and fruits and developed a higher tendency of buying the same foods for their families. The findings also showed that the respondents experienced higher job satisfaction and self-efficacy leading to a reasonable improvement in their wellbeing and the desire to exhibit healthy behaviors. The study outcomes conform to the findings made by study conducted by Brambila-Macias et al. in 2011, stressing the significance of overcoming financial constraints to gain better access to healthy diets and lower the risk of developing the symptoms or illnesses related to poor nutrition and lack of physical activity. Therefore, California should to commit to interventions that will enhance the supply of healthy options in restaurants to improve the health of the residents.  

Undeniably, the choice of an appropriate model to help guide through the journey towards freeing the Inglewood population from difficulties caused by poor nutrition and lifestyles is important. The idea will lay down the foundation for addressing all of the key factors contributing to the problem from lack of nutritional knowledge to financial constraints. The Health Belief Model (HBM) is precise as it advocates for preventive measures through behavioral change. The theory is based on five main factors namely, perceived susceptibility, severity, barriers, cues to action, and self-efficacy (Rural Health Information Hub, 2020). Indeed, step-by-step implementation of programs to match the items will address the problem. 

Perceived Susceptibility refers to the idea that behavioral shifts can only occur if people feel they are at risk. In this regard, healthy eating habits and lifestyles in Inglewood will result if people understand that poor diet, lack of physical activity, and foregoing routine medical examinations often due to not having access to healthcare or health insurance, makes them vulnerable to contracting chronic diseases such as obesity and other related illnesses. The view conforms to the findings that nutritional knowledge might help to promote healthy food choices (Moore, Donnelly, Jones, & Cade, 2018). Hence, disclosing the dangers of unhealthy foods and inactivity is a critical policy for addressing the problem. 

Perceived Severity is the idea that behavioral changes result when people incept that the consequences are significant. Appropriate feeding habits and lifestyles in Inglewood will come when people understand the high costs caused by nutrition-related disorders. The disclosure of the high number of deaths caused and poor health in the population will thus trigger rapid shifts in behavior (Brambila-Macias et al., 2011). Therefore, disseminating regular information regarding the adverse effects of wrong diets has to be an initiative to promote proper food consumption. 

The factor signifies the removal of obstacles that inhibit behavioral changes or discourages people from adopting new styles. Communities in Inglewood will shift to healthy food and exercise frequently if the environment allows them to do so. The removal of financial constraints and better fields for exercising is thus critical to address obesity and nutrition-related illnesses (McFadden et al., 2014). To this end, the financial cost and the physical hindrances to a good diet and physical activity are paramount in the efforts to restore good health. 

Cues to Action are any external or additional items that assist people to adopt healthy behavior. For the case of Inglewood, nutritional labeling acts as a reminder to enable people to choose healthy foods every time they visit restaurants or stores (Moore, Donnelly, Jones, & Cade, 2018). The idea reinforces the main message and builds a new culture to make the change permanent. Therefore, events that alert people to eat healthily and exercise frequently have to be part of the intervention to free Inglewood from diseases related to poor diet and lack of physical activity.  

Self-Efficacy suggests that a change is possible, especially if the people have confidence of success. The view suggests empowering the people of Inglewood to incept that they have the energy and power to eat healthy foods and exercise frequently to lower the risk of developing the symptoms of diseases linked to poor diet (Backman et al., 2011). In summary, the HBM has resolved the controversies pointed out by scholars in addressing the problem. The theory has unraveled the significance of using multiple interventions that address the economic, social, and psychological aspects to encourage people to consume healthy diets and exercise. Imparting nutritional knowledge has to be accompanied by subsidies and availability of appropriate diets and building confidence in the ability to address the problem. 

 

References:

An, R. (2013). Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public health nutrition16(7), 1215-1228.

Backman, D., Gonzaga, G., Sugerman, S., Francis, D., & Cook, S. (2011). Effect of fresh fruit availability at worksites on the fruit and vegetable consumption of low-wage employees. Journal of nutrition education and behavior43(4), 113-121.

Brambila-Macias, J., Shankar, B., Capacci, S., Mazzocchi, M., Perez-Cueto, F. J., Verbeke, W., & Traill, W. B. (2011). Policy interventions to promote healthy eating: a review of what works, what does not, and what is promising. Food and nutrition bulletin32(4), 365-375.

DataUSA. (2020). Inglewood, CA. Data USA. Retrieved July 19, 2020 from https://datausa.io/profile/geo/inglewood-ca/.

HealthyPeople. (2020). Access to Foods that Support Healthy Eating Patterns. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-foods-that.

Holmes, T. E. (2020, February 3). Steps to Address the Health Needs of African Americans. AARP. https://www.aarp.org/health/healthy-living/info-2020/health-risks-african-americans.html.

Los Angeles County Department of Public Health. (2018, June). City and Community Health Profiles Inglewood. http://publichealth.lacounty.gov/ohae/docs/cchp/pdf/2018/Inglewood.pdf.

McFadden, A., Green, J. M., Williams, V., McLeish, J., McCormick, F., Fox-Rushby, J., & Renfrew, M. J. (2014). Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start program in England. BMC public health14(1), 1-13.

Moore, S. G., Donnelly, J. K., Jones, S., & Cade, J. E. (2018). Effect of educational interventions on understanding and use of nutrition labels: A systematic review. Nutrients10(10), 1432-1445.

Rural Health Information Hub. (2020). The Health Belief Model. Retrieved from: https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/health-belief

Shepherd, J., Harden, A., Rees, R., Brunton, G., Garcia, J., Oliver, S., & Oakley, A. (2006). Young people and healthy eating: a systematic review of research on barriers and facilitators. Health education research21(2), 239-257.

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