Complete Statement of Problem and Needs Assessment
The Scope and Nature of the Problem
Obesity is a serious, costly, and joint health issue that is present in the United States. Obesity has health impacts that may result in short/long-term illnesses commonly associated with heart disease, stroke, diabetes, premature death, and more (Centers for Disease Control and Prevention, 2021). Unlike other conditions, obesity can be treated and prevented by a healthy diet and regular physical activity. Starting a healthy diet and regular physical exercise at a young age will help prevent obesity from progressing into adulthood.
Obesity impacts different populations in different ways. Across the United States, the most impacted people are Hispanic adults, non-Hispanic white adults, and non-Hispanic Asian adults. The state of Maryland is ranked 9th on the list of obesity rates in the United States, with the obesity rate being 32.3 percent. According to the 2010 census, Maryland has an estimated total population of 5,773,552; adults 18 years and older made-up 76.6 percent of the total population, while under 18 years made up 23.4 percent. Thus, 65.4 percent were overweight, with a Body Mass Index of 25 or greater, and 27.1 percent adult are obese, with a Body Mass Index of 30 or greater, which sum up the current adult obesity rate in the state of Maryland to 32.3 percent (State of Maryland Nutrition, Physical Activity, and Obesity, 2016). One of the main ways to combat obesity is through physical activity. Somerset County has the highest obese county in Maryland with 36%; data has shown that most adults do not get enough physical activity to meet the federal recommendations of physical activity for adults (Maryland Department of Health and Mental Hygiene, 2021 March 22). Much like the entire nation, there is a similar correlation between education, poverty, and obesity rates. According to the CDC, adults who have achieved high education levels (ex. bachelor’s degree, master’s degree, etc.) and live above the poverty level are more likely to meet the federal physical activity recommendations (Centers for Disease Control and Prevention, 2021).
Social Determinants, Patterns, and Trends
The social determinants of health primarily apply to the trends and patterns commonly seen with obesity rates. On average, social determinants include social, educational, and economic stability, community context, health care, neighborhood, and built environment (United States Census Bureau, 2020 September 6). The significant connections for obesity rates are education level and the poverty level of an individual. In Somerset County, 20.8 percent of adults do not have a high school education above Maryland. Also, it has the lowest rate of high school and a college degree with 14 percent of the population. The same is also applicable to Baltimore, Garrett, and more (Statistical Atlas, 2018 September 4). For comparison, the percentage of Maryland students receiving a high school diploma remains consistently high at 86.8% in 2020, according to the data, and this is four points better than the 82.8% rate registered a decade ago in 2011 (National Center for Education Statistics, n.d.). The level of education an individual has will also impact the type of job they can get. The areas with the highest rates of poverty are Baltimore City and Somerset and Allegany counties. According to the report, Baltimore’s poverty level is 131.5% above the state’s poverty line, while Somerset County is at 117% and Allegany County at 75%. (U.S. Census Bureau, 2020 September 6).
The Overall Program Goals
The overall goal should be the best way to mitigate the complex issues of combat obesity rates across Maryland, such as race, cultural, environmental issues, and more. Can do it through several different methods like physical exercises, healthy dieting, and partnerships with health programs that help communities rebuild their recreation centers/parks. The development of this program has several different goals, both long-term and short-term, that will help decrease obesity rates in the counties across Maryland.
The central focus that the goal will address by the program is to decreasing obesity rates and increasing physical exercise. Simultaneously, across Maryland, the rate of physical inactiveness is at 23.4 percent (America’s Health Rankings, 2021). While the local rate is improving over time, it is lower than the state percentage of 29.1 percent (Centers for Disease Control and Prevention, n.d.). Meanwhile, the first issue to address in the program’s goal is to develop an education program that features modules a nutrition system, physical exercises, and healthy dieting. The plan would provide information about programs that focus on assisting parents who qualify for Women, Children, and Infants and Supplemental Nutrition Assistance Programs (SNAP). Thus, with nutritional modules and assistance projects, the goal would provide an understanding of income inequality. Furthermore, it is also essential to focus on improving the facilities that can be used for physical activity and increase the number of facilities that are accessible to everyone in Baltimore City/Baltimore County. The goal will focus on improving the environment throughout Baltimore to ensure that all members of the communities feel safe to participate in physical activity.
Meanwhile, the main problems with obesity stem from the diagnosis. Currently, there is not an efficient and affordable option for health facilities to diagnosis obesity. One of the leading and most affordable methods that are used is through calculation. Clinicians will take the weight in kilograms of the client or patient divided by their height in meters squared. The disadvantage of this method is that it does not account for the individual’s muscle mass which could skew the calculation to make the client or patient obese when they are not. With this in mind, one of the long-term goals that we have established is to continue research that focused on developing a new method that is both inexpensive and accurate.
Maryland ranked in the top ten of the highest obesity rates in the United States for both children and adults (Maryland Department of Health and Mental Hygiene, 2020). As mentioned before, obesity can cause several different health issues, such as hypertension and diabetes. In Maryland, there are also has a high rate of non-communicable disease such as diabetes and hypertension among adults. Diabetes rates are ranked 20th in the nation, with 11.0 percent of adults having diabetes (The State of Childhood Obesity, n.d.). The State of Louisiana is also ranked 9th in the nation, with 32.3 percent of adults having hypertension (The State of Childhood Obesity, n.d.). Due to obesity causing various other health conditions and the high rates in Somerset County, it is essential to identify the critical issues related to obesity rates.
Among diabetes and hypertension, other problems contribute to obesity in Baltimore City/Baltimore County. Access to physical activity centers that address the crime rates by engaging community leaders and access to healthy foods by encouraging gardens behind homes to help healthy eating and improve obesity rates. In most communities, physical activity facilities and crime rates coincide with one another. If the facility is not in a safe location, community members will not feel safe participating in physical activity. It is a similar relationship for access to healthy foods. For example, if a grocery store is not in a safe neighborhood or is not close to low-income neighborhoods, community members will not have sufficient access to healthy foods.
In Somerset, Baltimore City, and some other counties, two prominent programs are available to community members to decrease obesity rates. Thus, one standard program throughout the United States is Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC Maryland is a Supplemental Nutrition and Healthcare program that provides services for pregnant women, breastfeeding infants, and children under five (Baltimore City Health Department, 2019). WIC Maryland also provides breastfeeding support and education, monthly vouchers for healthy foods, formula, infant foods, referrals to other health programs like Medicaid, and group education classes that teach healthy choices regarding health care and nutrition. WIC also provides personalized counseling for families about nutrition choices.
The Baltimore City Health Department sponsors another resource specific to the Baltimore City dwellers and is called Fit NOLA. Fit NOLA is a health and fitness program that increases awareness by providing resources to the community, empowers youth to be advocates for healthy policies, building capacity by improving access to affordable, nutritious food as well as safe environments for exercise and physical activity, and programs and policies that encourage healthy lifestyles (Baltimore City Health Department, 2019). These programs are great resources for Baltimore City/Baltimore County to combat obesity rates in the community.
The Scope of Need
Thus, to combat the high rates of obesity in Maryland, it should address in the community. The first barrier that should address is the issue of increased crime and violence rates. Recently updated data reveal members of the Baltimore City/Baltimore County community reported crime and violence as barriers to healthy living, such as early morning and evening walking exercises (Baltimore City Health Department, 2019). If an individual feels unsafe while engaging in physical activity, the individual will likely decide not to participate in physical activity. Environmental factors are another area of barrier that should address within these communities. Community members reported neighborhoods as unsanitary and filled with trash (Baltimore City Health Department, 2019). Much like the crime and violence barrier, if members of the community don’t feel like their environment is clean, there is a chance that they may not engage in physical activity.
Also, to address these barriers, a public health program that focuses on neighborhood clean-up would be ideal. This program would have weekly or bi-weekly clean-up days for community members to participate in to help keep neighborhoods clean and in a condition where community members feel safe exercising. Another program that could help with the barrier of crime and violence could be partnerships between Baltimore City/Baltimore County law enforcement and the health department to encourage law enforcement to patrol areas of concern within the community to feel like law enforcement is a presence.
The Benefits of Collaboration
Collaborating with community leaders/members is essential to determine the health needs in a community. Community leaders/members offer a unique perspective to health care officials that allow officials to focus on the community’s actual needs. Located in the Baltimore City/Baltimore County Community Health Assessment, members of the Baltimore City/Baltimore County community asked to identify their greatest assets, barriers, and current health issues present in the Baltimore City. Based on the data, the top three assets identified by members of the Baltimore City/Baltimore County community: healthy food, parks and greenspace, and safety (Baltimore City Health Department, 2019). The exact date identified the following barriers to healthy living; crime, violence, infrastructure, and environment (Baltimore City Health Department, 2019). Finally, community members were asked to identify the top health concerns in Baltimore City. Community members identified mental health, cancer, and obesity as top health concerns (Baltimore City Health Department, 2019). Without these surveys, health professionals would not know what the 8 top concerns are for their community. Surveys like this allow healthcare professionals to identify problem areas in neighborhoods and establish a plan for improving those areas of concern.
Several different items contribute to obesity in the state of Maryland and the counties. Figure 1.1 compares the overweight and obesity rates between the State of Maryland and the United States. Overweight rates are similar between the United States and Maryland, but obesity rates in the National are 10 percent higher than in Maryland. As discussed before, education and poverty level are directly related to obesity rates. In the table below, it is clear that obesity rates have been rising over the years. Also, to educate, income impacts obesity rates. Figure 2.1 displays the percentage of individuals who are living in poverty in the State of Maryland. Poverty levels among a population like Somerset County and Baltimore City can assist health professionals with targeting any problem areas contributing to high rates of obesity.
Figure 1.1 The State of Maryland is the top and National data below
Figure 2.1: The Poverty rate in the State of Maryland
Persons in poverty, percent – (Percent) County Value
Allegany 16.7 | Anne Arundel 7.0 | Baltimore 9.9 | Baltimore city 21.8 | Calvert 5.4 Caroline 13.2 | Carroll 6.0 | Cecil 8.3 | Charles 6.6 | Dorchester 15.4 | Frederick 6.2 | Garrett 12.2 | Harford 7.0 | Howard 5.2 | Kent 12.9 | Montgomery 6.9 | Prince George’s 8.3 | Queen Anne’s 6.5 | Somerset 23.4 | St. Mary’s 8.0 | Talbot 9.2 | Washington 11.1 | Wicomico 14.6 | Worcester 10.4
Findings, Priorities, and Actions
Throughout the research, several key findings related to obesity rates in Maryland and the Counties. One of the significant findings was that high obesity rates across the state and the Cities are often correlated with communities having high diabetes rates and high hypertension rates. Also, to increased diabetes and high hypertension rates, many community members felt that crime rates and poor environmental conditions had impacted their ability to participate in physical activity safely. It also found that an individual’s education level affects their income and impacts whether or not they are obese. With these findings in mind, we should focus three priorities on combating the high obesity rates:
· Create a community safety program that will enable community members that felt they could not participate in physical activity due to the crime.
· Reenforce the nutrition, physical activity, and more to begin with education.
· One difficulty that is associated with obesity is the diagnosis.
There currently is no definitive way that is accurate and affordable, making it difficult to diagnose an individual who may be obese properly. Also, there are several different ways to begin to decrease obesity rates in Maryland and the Counties. Also, to improve the crime rates and the unsanitary areas within the parish, there could be partnerships with law enforcement and the public works department to increase patrol presence and clean up neighborhoods to ensure that community members feel safe to participate in physical activities activity. Furthermore, to improve areas, implementing education for all populations as recommended. Education programs could range from game time to participating in physical activity that is imperative to combating obesity. Finally, partnerships are also vital in improving the community’s health. Partnerships with law enforcement, state and local health departments, and other programs that work to decrease obesity provide a group effort in response and reduce obesity and other health issues in Maryland.
America’s Health Rankings (2020). Annual Report. https://www.americashealthrankings.org/learn/reports/2020-annual-report Baltimore City Health Department (2019). Community health assessment. health.baltimorecity.govCenters for Disease Control and Prevention. (2021, February 11). Adult Obesity Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html.Measuring Obesity. Obesity Prevention Source. (2016, April 12). https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-tomeasure-body-fatness/.Obesity Definition. Obesity Prevention Source. (2016, April 14). https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/. United States Census Bureau Economic Indicators (2020 September 6). https://www.census.gov/