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May May Leung, PhD, RD is an assistant professor at the CUNY School of Public Health at Hunter College.  Her research expertise includes the development and evaluation of innovative health communication and community-based interventions to prevent childhood obesity. 

http://blandineguzman.files.wordpress.com/2011/11/kfc.jpg

http://blandineguzman.files.wordpress.com/2011/11/kfc.jpg

So, I’ve been working on a paper exploring the differences in childhood obesity in both China and the US and thought I’d share with you some interesting findings.  At first glance one may assume, because of the influx of western culture, that the factors associated with this epidemic are fairly similar in both countries…well, not quite.

Many of us are all too familiar with the childhood obesity epidemic that the US is facing; however, China is also dealing with her own public health crisis.  In China, childhood obesity rates have grown exponentially (cities like Shanghai and Beijing have observed up to a 7-fold increase over the last 20 years).  And, the prevalence in some groups is actually now comparable to rates observed here in the States; nearly 35% of male children in major urban regions in China are actually considered overweight or obese.

To better understand the epidemic in China and its potential causes, one needs to consider what has gone on in her recent history.

The One-Child Policy, which was implemented in the late 1970’s for population control purposes, has actually had an unintended consequence on childhood obesity.  This policy has produced what are coined China’s Little Emperors and Empresses.  Because of this policy, it has produced a 4:2:1 ratio in many families, where the attention and resources of four grandparents and two parents are all directed towards a single youth and these ‘pampered’ children often get to dictate what foods they would like to eat.

To make matters worse, many of today’s grandparents very much fear an underweight grandchild as they remember their personal experiences of the Great Chinese Famine, which happened about 60 years and resulted in a loss of up to 42 million lives.

Certainly the influx of western culture has played its own role in the development of childhood obesity, particularly the importation of fast food outlets.  McDonald’s© first appeared in China in the early 1990’s and now has over 1,400 establishments across the country.  In fact, China is the company’s third largest market-US and France happen to be the top two.  In addition, Yum! Brands, which owns Pizza Hut©, Taco Bell© and KFC© have over 4,500 establishments dotted around China.

Childhood obesity has quickly become a major epidemic in China and some of the statistics parallel what’s happening in the US.  However, it’s important to recognize that while there are certainly some similarities between countries, cultural and historical events play their own role in shaping childhood obesity and making it unique to each country.

May May Leung, PhD, RD

May May Leung, PhD, RD is an

Keiran Healy, Duke University. Source: Wonkblog, http://tinyurl.com/bt29w79

Keiran Healy, Duke University. Source: Wonkblog, http://tinyurl.com/bt29w79

As are so many others, I am deeply saddened by the violent deaths at the Sandy Hook school. Repeated episodes of mass killings may lead us to think that this is simply our world today. It doesn’t have to be. A public health approach to reducing the risk of perpetuating such violence leads to at least the following possibilities:

1. Reinstate the ban on assault weapons. They have no place in hunting and cannot be justified. The Federal Assult Weapon Ban signed into law in 1994 by President Bill Clinton included a sunset provision that allowed it to lapse after ten years. Attempts to restore it have been unsuccessful. A Harvbard School of Public Health review of the evidence on gun control found that fewer guns means fewer murders. For those who dispute the evidence, why would you not want to err on the side of reducing the risk of mass murders by making these guns less available?

2. Physician Denise Dowd, director of the Injury Free Coalitioin for Kids of Kansas City, is calling for all health care providers need to include routine questions for families about whether there are any weapons in the house. A number of years ago, the Oregon Nurses Association was part of a state-wide campaign to encourage primary care providers to ask their patients, particularly those with children living at home, if there were weapons in their homes. Since this is a state that supports gun rights, the campaign focused on encouraging safe storage of guns (including keeping guns stored unloaded and putting the ammunition in a separate locked space), and actually worked with stores to provide discounts on locked gun storage cabinets. In October, the American Academy of Pediatrics reissued a policy statement supporting this position on guns in the home. But the final analysis of the Sandy Hook situation may indicate that this will not be sufficient to stop mass murderers. Health care providers should advise parents to remove guns from their homes, particularly if there is any indication of mental illness in the family.

3. We have a mental health system that is broken, particularly in relation to our nation’s youth. We can and must use the opportunity that the Affordable Care Act is providing to transform how we think of mental health assessment and treatment.

4. Finally, we need to mandate the teaching of non-violent conflict management in all of our schools. The Quakers have long recognized the importance of teaching non-violent responses to conflict and have incorporated it into the Friends Schools’ curriculum. Why aren’t all schools following this model?

The profound sadness that we feel about Friday’s events can be tempered by a commitment to reduce the risk of this ever happening again.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

[caption id="attachment_5590" align="alignnone" width="1024"] Keiran Healy, Duke

This post is by CHMP senior fellows Jim Stubenrauch and Joy Jacobson, co-founders of the program in Narrative Writing for Health Care Professionals. Follow them on Twitter: @jimstuben and @joyjaco. Woman Reading

When talking about the work we do here at the CHMP, bringing workshops and classes in writing reflective narratives to nurses and nursing students, we occasionally get puzzled looks. Why teach writing to nurses?

A recent essay in the Narrative Matters section of the journal Health Affairs exemplifies the power of nurses’ narratives and the way personal stories can illuminate larger policy issues.

In “A Nurse Learns Firsthand That You May Fend for Yourself After a Hospital Stay,” Beth Ann Swan tells of a dire medical ordeal: while in Chicago on a business trip, her husband was hospitalized after a brain stem stroke. “In an instant,” Swan writes,

we were thrown into the unreal world of medical “care coordination” and “transition management.” There would be no easy way for us to get Eric from a hospital there to a hospital here and then to home. And along the way there would be gaps in the care Eric received—gaps so large they were more like chasms. We just didn’t know it yet.

It fell to Swan, dean and professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, to coordinate all aspects of her husband’s recovery, including his transfer from Chicago to a rehab facility in Philadelphia. Even with all of her nursing knowledge and medical contacts, Swan found the following year of coordinating Eric’s outpatient care nearly all-consuming.

In addition to telling this compelling personal story, Swan goes on to advocate one of the strategies for health care reform supported by the Affordable Care Act. Often overlooked in political debates and mainstream media coverage, the ACA’s transitional care initiatives offer real hope of improving health care by bridging the many gaps in our fragmented health care system.

Nurses play a crucial role in transitional care. Swan writes that her husband’s hospital nurses answered questions at any time but that after Eric’s discharge—when they needed as much help as they did during his hospitalization—the nurses were nowhere to be found:

As a patient’s wife, I would have welcomed having an RN as a point of contact. As a nursing school dean, I know the evidence demonstrating that registered nurses are critical to the operational and financial success of health care delivery systems. . . . I also know that nurses have the expertise to bridge care transitions and are critical to coordinating care across all settings.

Swan shows how a well-told story can bring home, with urgent poignancy, a complex topic like transitional care and explain why it should be part of the ACA. (For more on the ACA’s support of new transitional care models, see CHMP co-director Diana Mason’s recent HealthCetera blog post.)

Fitzhugh Mullan, a physician who founded the Narrative Matters column in Health Affairs, said in an interview published in the Permanente Journal that he defined the policy narrative as “an essay form that falls between the editorial and the short story or memoir.” He goes on to say,

This post is by CHMP senior fellows Jim Stubenrauch and Joy Jacobson, co-founders of the program in Narrative Writing for Health Care Professionals. Follow them on Twitter: @jimstuben and @joyjaco. Woman Reading

When talking about the work we do here at the CHMP, bringing workshops and classes in writing reflective narratives to nurses and nursing students, we occasionally get puzzled looks. Why teach writing to nurses?

A recent essay in the Narrative Matters section of the journal Health Affairs exemplifies the power of nurses’ narratives and the way personal stories can illuminate larger policy issues.

In “A Nurse Learns Firsthand That You May Fend for Yourself After a Hospital Stay,” Beth Ann Swan tells of a dire medical ordeal: while in Chicago on a business trip, her husband was hospitalized after a brain stem stroke. “In an instant,” Swan writes,

we were thrown into the unreal world of medical “care coordination” and “transition management.” There would be no easy way for us to get Eric from a hospital there to a hospital here and then to home. And along the way there would be gaps in the care Eric received—gaps so large they were more like chasms. We just didn’t know it yet.

It fell to Swan, dean and professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, to coordinate all aspects of her husband’s recovery, including his transfer from Chicago to a rehab facility in Philadelphia. Even with all of her nursing knowledge and medical contacts, Swan found the following year of coordinating Eric’s outpatient care nearly all-consuming.

In addition to telling this compelling personal story, Swan goes on to advocate one of the strategies for health care reform supported by the Affordable Care Act. Often overlooked in political debates and mainstream media coverage, the ACA’s transitional care initiatives offer real hope of improving health care by bridging the many gaps in our fragmented health care system.

Nurses play a crucial role in transitional care. Swan writes that her husband’s hospital nurses answered questions at any time but that after Eric’s discharge—when they needed as much help as they did during his hospitalization—the nurses were nowhere to be found:

As a patient’s wife, I would have welcomed having an RN as a point of contact. As a nursing school dean, I know the evidence demonstrating that registered nurses are critical to the operational and financial success of health care delivery systems. . . . I also know that nurses have the expertise to bridge care transitions and are critical to coordinating care across all settings.

Swan shows how a well-told story can bring home, with urgent poignancy, a complex topic like transitional care and explain why it should be part of the ACA. (For more on the ACA’s support of new transitional care models, see CHMP co-director Diana Mason’s recent HealthCetera blog post.)

Fitzhugh Mullan, a physician who founded the Narrative Matters column in Health Affairs, said in an interview published in the Permanente Journal that he defined the policy narrative as “an essay form that falls between the editorial and the short story or memoir.” He goes on to say,