The final application builds upon the applications (Parts One and Two) completed in weeks 4 and 7. To complete the final section of your paper: • Review provisions 7, 8, and 9 of the ANA Code of Ethics in relation to advocacy for population health. • Reflect on the ethical considerations you may need to take into account in your advocacy campaign (Developing an Advocacy Campaign That Addresses Obesity). • • Research the ethical considerations and lobbying laws relevant to the location where your advocacy campaign will occur. • Consider potential ethical dilemmas you might face in your campaign. To complete: • Explain any ethical dilemmas that could arise during your advocacy campaign, and how you would resolve them. • Describe the ethics and lobbying laws that are applicable to your advocacy campaign. • Evaluate the special ethical challenges that are unique to the population you are addressing. • Provide a cohesive summary for your paper. (Parts One and Two) completed in weeks 4 and 7 are as follows: Part 1 – Developing an Advocacy Campaign Developing an Advocacy Campaign That Addresses Obesity Obesity is a serious public health issue and is even considered an epidemic by many health care professionals that affects all populations—old, young, men, women and children, regardless of demographic or location (Mitchell, Catenacci, Wyatt & Hill, 2011). To address this issue, several public advocacy campaigns have been developed. Healthy People 2020, for instance, under the Office of Disease Prevention and Health Promotion, is currently advocating to raise awareness about obesity and how to reduce the rising rates of it in the U.S. This paper will examine two scholarly articles about advocacy campaigns centered on fighting obesity, what they say, and what takeaways can be identified to help develop an effective advocacy campaign in the future. The first article by Giang, Karpyn, Laurison, Hillier and Perry (2008) examines the effectiveness of the Pennsylvania Fresh Food Financing Initiative, which was designed to “bring awareness and policy change to the issue” of a lack of supermarket fresh foods in underserved areas (p. 272). In other words, it focused on addressing the grocery gap to help poorer communities obtain the kind of healthy, fresh food conducive to a diet that combats obesity. A key component of the advocacy campaign was “the creation of an evidence-based report that served as a strong, credible foundation for the campaign”—i.e., the situation/environment was researched, analyzed and tested to create a program that used evidence to support its directive. Evidence instead of ideology was the critical nexus of the campaign because it provided the advocacy leaders with an accurate picture of the real problems that needed to be addressed (specifically how to fight obesity in poor regions) and how to solve them (provide financing to help bring access to healthy foods to these regions). The evidence-based directive allowed the campaign to be a success, as it rightly identified the problem and the put into place an effective solution. The second article by Doroghazi (2015) examines advocacy campaigns focused on fighting obesity in general and provided a critical analysis of one detrimental factor common to those that fail—namely the fact that they focus too much on blame and pseudo-causes of obesity instead of on the actual science of obesity (such as metabolism rates, how they vary among individuals, how personal responsibility is a major factor in the spread of obesity, etc.). The study shows that in order for an advocacy campaign to be most effective, it has to refrain from shifting blame for the disease from both the body and the way people individually respond to the body to environmental factors that are extraneous to the issue if considered in the proper context (such as the fact that fast food establishments in and of themselves do not cause obesity but rather that individuals whose body metabolism is not high and who consume too much of the fast food products is what leads to obesity—i.e., there is a lack of understanding of one’s own body and its needs and a lack of control/responsibility in terms of being accountable for one’s own decisions). The study is helpful in showing that advocacy campaigns should target the issue in question in a way that does not make the beneficiary into a “victim” or a “passive” agent in the situation but rather into an active role player who must assume responsibility and raise his or her own awareness level about that true causes of the spread of the disease. With these two studies in mind, it is apparent that an effective advocacy campaign that focuses on combating obesity must be evidence-based and must engage participants by encouraging them to take an active role in understanding their own place in the fight. It must empower them instead of shift blame to external forces and focus solely on negating them; it must promote accountability among individuals and teach them how their bodies differ and how every person must be responsibility for his or her own eating decisions. It must base this approach on evidence so that it can effectively address the issue. A plan for a health advocacy campaign that seeks to combat obesity should focus on identifying critical factors in the spread of obesity—i.e., how personal dietary and exercise habits impact the onset of obesity and how every body requires unique understanding (since everyone’s body is different). The proposed policy solution is to promote a frank interaction between doctors and patients, as advocated by Doroghazi (2015) so that patients understand that their weight problem is their personal responsibility and that they are not passive victims of environmental factors beyond their control. The objectives of this policy is to empower doctors with evidence who can then empower patients through direct and frank communication of the facts—which are that obesity is deadly and that patients must take responsibility for their own dietary and exercise habits in order to fight against it. This policy is aimed at encouraging physicians to be more open and direct with patients instead of attempting to couch the discussion in ways that really do not benefit the patient—for example, by lamenting the popularity of soda and junk food. Instead, physicians must be bold, as Doroghazi (2015) states and face the evidence, as Giang et al. (2008) show, which is that “your obesity cannot be blamed on the fast food or carbonated beverage industry or on anyone or anything else. You weigh too much because you eat too much. Your health and your weight are your responsibility” (Doroghazi, 2015, p. 214). In conclusion, a health advocacy campaign should be evidence-based and focused on promoting accountability. The campaign should be evidence-based because the facts are what drive the policy. A campaign that is not guided by facts will be misdirected and inefficient. At the same time, a campaign should be aimed at empowering patients and encouraging them to take responsibility for their own lives to help combat the spread of disease. In the case of obesity, this is easily achieved by encouraging physicians to be honest with patients and to identify the issues that help spread obesity. For a campaign aimed at curbing the spread of obesity, doctors should focus on indicating to patients what factors help lead to obesity (diet and exercise) and how patients themselves can be more accountable. ? Part 2 – Developing an Advocacy Campaign The proposed policy is for dealing with the public health concern of obesity focuses on promoting interactions between doctors and patients through which patients take personal responsibility for their weight problem and become active participants in addressing environmental factors. This proposed policy is based on the premise that dealing with obesity requires patients to understand and responsibility for personal dietary and exercise habits (Doroghazi, 2015). As patients take personal responsibility through empowerment by physicians, they effectively address their weight problems, which in turn contribute to better health outcomes. However, the implementation of this policy requires modification of existing laws/regulations. The existing laws or regulations would affect health advocacy efforts as several obstacles could emerge in the legislative process. Modification of Existing Laws or Regulations As previously mentioned, the implementation of the proposed policy would require modification of existing laws or regulations on obesity. The existing laws or regulations on obesity target four intervention settings workplaces, schools, medical care, and communities as well as social issues that act as the foundation for public health initiatives/campaigns (Dietz, Benken & Hunter, 2009). Some of the target areas in existing laws and public health strategies include physical activity, consumption of health foods including vegetables and fruits, decreased consumption of sugar-sweetened or carbonated beverages, and initiation and duration of breast-feeding. On the other hand, the social issues addressed by these regulations include lessening health disparities among the obese population, enhanced access to medical care, and suitable medical equipment. Since these laws/regulations already address the issue of medical care and promoting healthy lifestyles, there would be no need to create new laws/regulations for the proposed policy. In this regard, the existing regulations should be modified to create a platform for enhanced interactions between physicians and patients with a view of enabling physicians to empower patients to take personal responsibility for their weight problems. The modification of existing laws/regulations will be centered on including provisions for establishment of communication channels through which doctors empower patients. Impact of Existing Laws/Regulations on Advocacy Efforts Since the implementation of the proposed policy would require modification of existing laws or regulations, the laws will have significant impact on advocacy efforts. Generally, health advocacy campaigns/efforts require collaboration between various stakeholders who play a crucial role in the society and healthcare. The existing laws or regulations will affect my advocacy campaigns by generating obstacles in the legislative process. The obstacles will emerge from the fact that these laws or regulations do not include critical forms of treatment or counseling despite recognizing the significance of diet and exercise in the fight against obesity. The overall focus of these laws or regulations is standard approaches towards the prevention and treatment of obesity. For instance, the Healthy Foods for Healthy Living Act focuses on providing grants to promote increased consumption of fruit and vegetables (Ferguson et al., 2009). On the other hand, the Improved Nutrition and Physical Activity Act (IMPACT) permit states to utilize preventive health and health services block grants to promote community education programs and activities for obesity and eating disorders prevention. These laws would generate obstacles in advocacy campaigns or efforts on the premise that they already address community empowerment towards healthy lifestyles. Actually, the proposed policy is likely to be objected by some stakeholders on claims that public education and awareness programs already exist to promote healthy lifestyles across various communities. The opposition is likely to occur despite the fact that the existing education programs do not address patient empowerment during medical care for obesity. Given the likelihood of opposition to the proposed policy, there would be additional demands in the advocacy efforts. The opposition is likely to create the need for enhanced lobbying for legislators and other policymakers to support the proposed policy, which will have significant cost implications. Methods of Influencing Legislators and Policymakers to Support the Policy One of the critical aspects towards the enforcement of the proposed healthcare policy to address obesity is obtaining critical support from legislators and other policymakers. This requires using the three legs of lobbying in the advocacy efforts since support from legislators and other policymakers is vital towards ensuring the implementation of proposed policies. The first step in lobbying in advocacy efforts for the proposed policy is professional lobbying, which entail enlisting physicians and other healthcare professionals to engage in lobbying efforts (Milstead, 2013). Professional lobbying is critical for this proposed policy since it directly impacts actions taken by physicians and other clinicians when dealing with patients. In this case, I will engage physicians and other clinicians in the advocacy process to call, email, or write to legislators and other policymakers on why they should support for the proposed policy. These professionals will also engage their relevant professional bodies/organizations to support the proposed policy. The second step in the lobbying process is grassroots lobbying, which refers to constituents who work together to affect public policy (Milstead, 2013; Siedlecki, 2016). Grassroots lobbying is geared towards convincing legislators and citizens to change their perspective regarding an issue or support a policy. In this regard, I will work with healthcare professionals to plan and conduct awareness campaigns in the community. The awareness community will focus on persuading the community and its legislators to support the proposed policy. Clinicians involved in these awareness campaigns will act as educators who will enable the public to make informed decisions regarding the proposed policy. The third step in lobbying for this proposed policy is money, which plays an important role in determining which policies are enacted (Siedlecki, 2016). Money will play a crucial role in the advocacy efforts given that the anticipated obstacles in the legislative process have significant cost implications. In this case, I will look financial support from healthcare professionals and professional organizations that support the proposed policy. The financial resources will then be channeled to the awareness campaigns and the other advocacy efforts. Anticipated Obstacles in the Legislative Process The proposed policy is likely to face some obstacles in the legislative process, especially because of the impact of the existing laws or regulation on the advocacy efforts. Some of these potential obstacles in the legislative process include ethical issues, opposition to the proposed policy, and lack of adequate knowledge on the role of physicians in empowering obese patients. These obstacles will be overcome through creating awareness of the issue through media, engaging clinicians and relevant professional organizations in lobbying efforts, and ensuring that provisions in the proposed policy are based on ethical principles and standards. In conclusion, advocacy efforts for a new healthcare policy require consideration of several factors that could affect its enactment. The proposed policy to address obesity requires modification of existing laws or regulations, which could affect advocacy efforts through generating obstacles in the legislative process. A critical step towards the enactment of this proposed policy is following the three stages in lobbying during advocacy.
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