Childhood obesity declines in several states,cities

Written by Charmaine Ruddock

‘Childhood obesity declines in several states, cities” was the title of an article in today’s  USA TODAY. http://www.usatoday.com/story/news/nation/2012/10/24/childhood-obesity-declines/1652955/

In the article are listed several states and cities in which the data points to gains made in the current battle to reduce, what many have deemed, the epidemic rates of children who are overweight or obese. Listed among such states and cities as Mississippi, California, Philadelphia, Anchorage and El Paso was New York City where the decline in obesity rate was for K-8^th grades from 21.9 percent to  20.7 percent.   In fact, according to the CDC New York has even more to be encouraged by because for the kindergarten group the decline was even steeper, as much as 10%. By any standard this is good news and is in part due to such City efforts as serving healthier foods in the cafeterias, switching to low fat milk, http://www.bronxhealthreach.org/wp-content/uploads/2011/06/Got_Low_Fat_Milk.pdf.pdf , and eliminating unhealthy items from vending machines in the schools.  But, along with these encouraging signs there are disturbing ones.  Even as the overall childhood obesity rates fall, it is not across the board for all racial and ethnic groups.  In a December 2011 article in DNAinfo.com New York, it was reported that the substantial declines in obesity were primarily in white children from more affluent neighborhoods.  For poor black children the decline was only 1.9 percent and for Hispanic children it was 3.4 percent.  Interestingly, while Mayor Bloomberg attributed the disparity primarily to economics he was also vetoing  New York City Council’s living wage bill  City Council Overrides Bloomberg’s Living Wage Veto. 

In the south Bronx, where Bronx Health REACH focuses much of its work, the overweight and obesity rates for elementary school students is about 40 percent. Recognizing that even for city wide policies place matters when it comes to their implementation and effect, Bronx Health REACH has sought to buttress some of the city’s anti-obesity policies by working with several public schools and even charter schools.  These joint efforts include putting in place class room based nutrition education and physical education activities.  With support from the Johnson and Johnson Community Healthcare Program and the Centers for Disease Control and Prevention REACH US initiative we have piloted nutrition education in third grade classrooms in four schools with early results showing promising effect in nutrition behavior and even reduction in body mass index (BMI).  In addition, we have been working with a number of schools in Districts 7 and 9 to increase physical activity.  In the 2011 – 2012 school year, with support from New York State Department of Health’s School Wellness Initiative and the Centers for Disease Control and Prevention REACH US program, training sessions were conducted with 179 teachers in 13 schools to implement Tai Chi http://www.taichiforkids.com/ and Activity Works www.activityworks.coms.

In a recent conversation with the principal and staff from one of the schools in which we have both programs it was brought home to me how enormous is the task they face to be on the front line of addressing childhood obesity while at the same time battling to improve the academic standards and opportunities for their students.  It is no coincidence that the same children battling for academic improvement are the same children waging the battle against overweight and obesity.   The underlying reasons for both battles share a common root, socio-economic inequalities.  Nevertheless, schools such as PS 218 featured here give us cause for hope http://www.uft.org/feature-stories/healthy-and-green.

Written by Charmaine Ruddock ‘Childhood obesity declines in

And all this while giving medications too?

Ann Campbell, RN-BC, MPH is a hospice nurse at an inpatient palliative and hospice care program in New York, and is currently an NP student at Hunter Bellevue School of Nursing. She is a research associate for the CHMP.

In nursing, we often joke about needing a feeding tube or urinary catheter ourselves. In the 14-hour workday we are often so focused on patient needs that sometimes it’s a luxury to take a break for food or even use the bathroom.

Every nurse I know wants to help people; patients and their loved ones know this from firsthand experience. However, nurses function within the confines of a system driven by economic, political, and legal forces. The challenge to turn caring into policy can seem insurmountable.

As a public health policy masters student at Columbia University, the topic of nurses in leadership positions triggered a memorable discussion. One classmate, when asked if she thought a nurse could become a CEO of a hospital or other health care organization, responded with a resounding “no.”  Nurses lack the necessary clinical and leadership training, she argued. My classmate raised a provocative question; are nurses prepared to become leaders in the redesign of healthcare?

I believe that nurses are uniquely equipped to lead. In fact, a nurse now leads the Center for Medicare and Medicaid Services (CMS).  And many others are CEOs of health care organizations.

Nurses must have the necessary tools and knowledge to influence this complex system. Obviously, the nursing role has evolved dramatically since the days of Florence Nightingale. Modern nursing education deeply involves sciences, and benefits from accomplished theorists and instructors. There are several masters’ level degrees that prepare nurses for clinical, administrative, and educational leadership. Moreover, two doctoral level advanced degrees are available: the research-focused PhD and the clinical leadership DNP.

The clinical leadership Doctor of Nursing Practice (DNP) coursework has been refined by evidence from the Institute of Medicine (IOM) reports: To Err is Human: Building a Safer Health System (1999), Crossing the Quality Chasm (2001), and Health Professions Education: A Bridge to Quality (2003). DNP clinicians are trained in health policy, scientific underpinnings of practice, organizational/systemic leadership, analytics, health information technology, and interdisciplinary collaboration. These tools can be utilized to produce quality healthcare delivery models.

Development of the DNP curriculum has been so effective that the American Association of Colleges of Nursing (AACN) took a position in 2004 recommending that all APNs be doctorally-prepared. While this is what AACN wanted, the plan will not go into effect by 2015.

Despite this progress, nurses must prepare for the challenges ahead. This includes caring for the 32 million newly insured patients with implementation of the Affordable Care Act over the next 10 years as well as a rapidly aging population. An estimated 1.2 million new nurses are needed by 2020. It also includes developing a strategy for changing the mindset of those who do not understand the leadership capacity of nurses.

The IOM report on the Future of Nursing sets forth clear goals for nurses to lead in this dynamic environment:

1. Practice to the fullest extent of the scope of their education and training
2. Achieve higher levels of education and training through an improved education system that provides seamless progression
3. Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts
4. Improve data collection for more effective workforce planning, information infrastructure, and policymaking

The implications for practice, research, and advocacy are extensive.  With the right education, nurses will lead innovative transformations in healthcare into the future.

Ann Campbell, RN-BC, MPH is a hospice