PBH 602 - Social Justice Assignment

When I would walk out of my childhood apartment, the closest supermarket in my neighborhood was six blocks away. This supermarket was the only supermarket that my father could afford. I’ve recently re-visited this supermarket; the produce section hasn’t changed much. There is no such thing as “organic” in this establishment. Everything is “on sale”, and the meat packaging only tells you what kind of meat it is, nothing about where it comes from or how it was grown. Markets that carry the organic or more nutritious products are non-existent in neighborhoods like these. The social gradients that we see in health, along with the social inequalities in populations are clearly unjust. Children eat what is available in their neighborhoods, and what their families can afford. The healthier markets that exist still continue to be unrealistic, or unfeasible for many families. The social inequalities that families face can lead to children becoming obese from an early age. The harms that come to children from obesity is something that amounts to a problem of social justice.

Social inequalities in health have risen over the past several decades. Inequalities in chronic disease risk factors such as obesity and poor diet have contributed greatly to the persistence and widening of the health gradients (Singh et al., 2010). Dramatic increases in the overall prevalence over time, and the existence of substantial social group disparities have brought childhood obesity to the forefront of the national health policy and research agenda (Singh et al., 2010). While substantial racial/ethnic and socioeconomic disparities in the U.S. childhood obesity are well documented, the extent to which social disparities in obesity and overweight prevalence have changed over time is less well examined (Singh et al., 2010). Previous studies analyzing trends in social disparities have mostly focused on age and gender, and on only one other dimension of social status, which is namely a family’s poverty status (poor vs. non-poor). Analyses of a wider range of social determinants of childhood obesity, such as parental education, household employment, family structure, place of residence, household language use, and neighborhood safety are either rare or have not yet been attempted (Singh et al., 2010).

A study that covered a wider range of social determinants such as race, household, income, parent employment status, parent’s education level, neighborhood, television and computer hours, and physical activity was done. The purpose of the study was to examine changes between 2003 and 2007 in obesity and overweight prevalence among U.S. children and adolescents 10 to 17 years old from detailed racial/ethnic and socioeconomic groups. The study documented rising inequalities in U.S. childhood and adolescent obesity by a broad range of social and economic factors (Singh et al., 2010). About 16.4% of U.S. children aged 10–17 years were obese in 2007, an increase of 10% in prevalence since 2003. An overweight prevalence of 31.6% in 2007 meant that there were over 10 million children 10 to 17 years of age who were obese or overweight, an additional 512,000 overweight children since 2003 (Singh et al., 2010).

The recent trends presented in this study underlie the significance of increased monitoring of social group disparities, of an urgent need for effective social and public health policies to tackle the problem of increasing prevalence, as well as rising social inequalities in childhood obesity (Singh et al., 2010). Obesity prevention efforts, therefore, need to target ethnic minority and socioeconomically disadvantaged children who have high obesity rates in order to not only reduce overall disparities but to also halt or reverse the increasing trend in childhood obesity (Singh et al., 2010). Child mortality rates are the highest among the poorest households, but there is also a social gradient: the higher the socioeconomic level of the household the lower the mortality rate (Marmot, 2005). You can’t just tell a deprived population that they should take better care of themselves. There needs to be an examination of the causes of the causes, such as the social conditions that give rise to high risk of non-communicable disease, and whether families are acting through unhealthy behaviors or through the effects of impossibly stressful lives (Marmot, 2005).

According to Marmot (2005) Recognizing the health effects of poverty is one thing, but taking action to relieve its effects entails a richer understanding of the health effects of social and economic policies. The areas that get health resources are socially determined, and there needs to be wider social policies that are crucial to reduction of inequalities in health. We know that health is important, however, it is more challenging to convince policy makers and others that the health of the population is important precisely because it is a measure of whether, in the end, a population is benefiting as a result of a set of social arrangements (Marmot, 2005). Reducing these social inequalities in health, and thus meeting human needs, is an issue of social justice (Marmot, 2005).

In the United States, childhood obesity afflicts as many as one in three socially disadvantaged children, with especially high rates among African American girls, Hispanic, and Native American children of both genders. For almost every childhood health indicator, minority and poor children do worse than their white and more affluent peers (Blacksher, 2008). A social commitment to investing in children's health and futures requires a social commitment to investing in their families (Blacksher, 2008). Obese children are subject to early systematic discrimination (Blacksher, 2008). Between 40-77% of obese children remain obese as adults, leading to further health risks, and premature mortality (Blacksher, 2008). Obesity also influences adult health status indirectly by adversely affecting adult socioeconomic status (Blacksher, 2008).

Children’s health inequalities are a breach of justice because early life deficits jeopardize children’s opportunities to “do” and “be” things that society values (Blacksher, 2008). Socially disadvantaged children often have truncated opportunities to develop competencies and capacities that contribute directly to their well-being or that may yield social goods (Blacksher, 2008). Children’s dependence on others for their health is also relevant to considerations justice (Blacksher, 2008). Children are neither responsible for the adversity and deprivation that harm them, nor are they capable or changing their circumstances until late adolescence or early adulthood (Blacksher, 2008). The increased incidence of poor health outcomes among socially disadvantaged children implicates social arrangements (Blacksher, 2008). The rapid increase in obesity prevalence over the last three decades reflects structural shifts in human living, working, playing and consumption (Blacksher, 2008).

Researchers found that food advertising, neighborhoods, schools, and parental practices are all social determinants that play a role in childhood obesity (Blacksher, 2008). Families that live in low income neighborhoods often have access to less parks and recreation centers for children to go play at. These neighborhoods also tend to be too dangerous for children so parents opt to keep their children at home (Blacksher, 2008). These children then stay indoors playing video games or watching television, which expose these children to a higher consumption of media advertising, which leads to higher consumption of junk food (Blacksher, 2008). These neighborhoods also have an abundance of fast food restaurants and a shortage of places selling affordable, nutritious food (Blacksher, 2008). Schools have unregulated food items in vending machines on school grounds, which resource-poor schools may rely on more than better-funded schools (Blacksher, 2008). Mandatory physical education in schools is increasingly rare, with fewer than 30 percent of youth participating in some physical activity on a daily basis at school (Blacksher, 2008). Moreover, a school’s location may prevent many children from walking or riding bicycles to school (Blacksher, 2008). Children from low-income families tend to have fewer structured, costly, parent-organized activities, leading to more television viewing, and the parents with limited money and time tend to purchase cheaper, high-caloric prepared foods (Blacksher, 2008).

These findings illustrate the nature of injustice that there is to children and it suggests that minority and poor children often lack access to the resources that they need to be healthy (Blacksher, 2008). Justice requires that there be a basic minimum of core capabilities that is secured for all persons (Blacksher, 2008). If the disproportionate incidence of obesity among socially disadvantaged children constitutes an injustice, then there is a social obligation to improve the harms and correct the conditions that produced them (Blacksher, 2008). A big part of society includes health educators, who have a moral responsibility to address the related themes of health inequalities, social justice, and social and public policy to the population they serve (Balog, 2016). Obesity is an impediment to the health of children as it is to justice for children. Health Educators in school site settings are professionally and morally obligated to attend to their social responsibilities when implementing childhood obesity intervention programs (Balog, 2016).

The loss of health has a significant impact on a child’s ability to pursue what we value in life, including health, happiness, utility, and liberty (Balog, 2016). To provide children a fair opportunity to health and to help children secure their own future liberty, and utility, children need to be able to achieve just levels of health that would ordinarily exist if remediable injustices that threaten health were reasonably addressed and eliminated; doing so is an applied idea of justice for children (Balog, 2016). Advantages and disadvantages bestowed upon an individual by chance, birth, or inheritance are not deserved, and such factors should not determine one’s life chances or opportunities for health (Balog, 2016). Justice is fairness and it must be recognized that health is an essential ingredient for justice (Balog, 2016).

Social inequalities that many families face are a big contributor to childhood obesity. The harms of childhood obesity can limit opportunities and drastically impact how these children are viewed by society. This creates an unjust life experience for children who suffer from the cyclic patterns society has deemed appropriate for them. All members of society should play a part in reducing health inequalities that low-income families face in an attempt to protect our future generations from this cycle society has placed on them. All families should have access to supermarkets that are not only affordable, but allow them the choices of purchasing nutritional, and wholesome produce, honestly raised meat and dairy products. Those same families should be provided equal opportunities in their school systems for outdoor activities, as well as assistance to parents who are working and cannot provide appropriate after-school care for their children. If these things could be addressed, the harm that is currently befalling our children in society would not be as harsh, and could offer a better lifestyle and outcome to those same children.

References

Balog, J. E. (2016). Public Health, Historical and Moral Lessons for the Preparation of School Health Educators: The Case of Childhood Obesity and the Need for Social Responsibility. American Journal of Health Education, 47(6), 334-342. doi:10.1080/19325037.2016.1219683

Blacksher, E. (2008). Children's Health Inequalities: Ethical and Political Challenges to Seeking Social Justice. Hastings Center Report, 38(4), 28-35. doi:10.1353/hcr.0.0035

Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104. doi:10.1016/s0140-6736(05)74234-3

Singh, G. K., Siahpush, M., & Kogan, M. D. (2010). Rising Social Inequalities in US Childhood Obesity, 2003–2007. Annals of Epidemiology, 20(1), 40-52. doi:10.1016/j.annepidem.2009.09.008