Childhood Obesity and the Affordable Care Act ACA

Topic 1: In reviewing the Affordable Care Act, what are the potential effects of the options for insurance coverage in both the private and public sectors? How will this impact the discussion about population-based nursing?

The Affordable Care Act (ACA)’s individual mandate, which demanded that all Americans purchase some form of health insurance if they were not covered by their employer, had a sizeable impact upon dramatically increasing enrollment in healthcare plans. It also had a dramatic effect upon the structure of healthcare plans, since the law placed restrictions on the type of coverage available to Americans that did not exist previously. The expansion of the population covered by insurance, including sicker people who were not able to purchase healthcare before, likewise had a significant impact upon the need for population-based nursing. As more people enroll in healthcare insurance, it is vitally important to draw connections between the needs of different populations.
Population-based nursing focuses on similar health concerns or characteristics; for example, the dramatic rise in obesity overall in America and specific populations that are at higher risk for obesity and obesity-related conditions (“Population-Based Public Health Nursing Practice,” 2007). Instead of merely assessing individuals, population-based nursing focuses upon community needs and promoting overall wellness. It is more important than ever before that individuals who are well counterbalance the costs of maintaining the health of sick people who are now newly enrolled in healthcare plans. It is also important now that more people are covered within the system to minimize costs by promoting health. Primary versus secondary and tertiary prevention is always preferable. Furthermore, health insurance plans in the future may need to emphasize lower-cost wellness initiatives and also consider empowering other types of qualified and trained providers, such as APRNs, to provide care to patients.
Topic 2: Identify a population-based problem of interest, such as obesity among children. After reviewing topical information in Healthy People 2020 and The Community Guide to Preventive Services, identify relevant outcomes related to this problem that will help guide your plans for intervention.
Although obesity is a significant concern for any population, obesity in children is particularly worrisome given the costs it may incur for the healthcare system as a whole as well as the profound personal costs it poses for the individual. Firstly, children have historically had less of a risk of being obese than adults, due to higher levels of activity, physical growth rates, and faster metabolisms. Losing weight becomes more rather than less easy with age, particularly after negative lifestyle patterns become ingrained for the individual. Secondly, the longer someone is obese, the greater the risks of suffering obesity-related illnesses such as type 2 diabetes, heart disease, and osteoarthritis. When children are obese, they are more likely to become obese adults.
But viewing the problem of childhood obesity solely as an individual problem of willpower is likely to be ineffective. Certain population-specific pressures clearly have an impact on individual’s likelihood of becoming obese. Cultural preferences for certain foods or body types can exert pressure on young children in a positive or negative way. Socio-economic status can have a very significant impact on the ability of a family to afford tasty, healthy food or for children to have access to leisure time to exercise. According to the Food Research and Action Center (FRAC) (2018): “…children who experienced poverty by two years of age were 1.66 times more likely to be obese by 15.5 years of age than children who did not experience early poverty” (par.2).
For these reasons, targeting initiatives may be particularly important to improve the health of socioeconomically disadvantaged children. For example, improving the nutritional content of school lunches, while important for all children, is particularly important for children who depend upon reduced price lunches as a significant portion of their daily calories. While physical education is good for all children in schools, children who lack the ability to participate in expensive and time-consuming outside sports are particularly dependent upon physical education classes. Targeting the needs of the highest risk populations of children regarding obesity is thus a vitally important step in making a meaningful reduction in the obesity rate.


References
Population-based public health nursing practice. (2007). AC DPH - Public Health Nursing.
Retrieved from: http://publichealth.lacounty.gov/phn/docs/Level%20of%20Care.pdf
Relationship between poverty and obesity. (2018). FRAC. Retrieved from:
http://frac.org/obesity-health/relationship-poverty-obesity