Public Health

Obesity is becoming a leading killer disease in the world. The changing nature of life has led to change in lifestyle which has led to increased cases of lifestyle diseases.  It is estimated that more than half of the population of United States is obese or overweight.

However epidemiological studies show ethnic and racial dimension with regard to prevalence of obesity in the population. African Americans especially African American women have a higher prevalence of obesity compared to other races.

There are many genetic and environmental factors which have been predisposing African Americans to increased cases of obesity. Obesity does not only affect health and social life of the individual but it is also a gateway to development of many other chronic illnesses.  If not well managed, obesity leads to other terminal illnesses like diabetes, cardiovascular diseases and others.

Change in diet and tendency towards a sedentary lifestyle have been identified as the leading causes of obesity all over the world.  The increasing prevalence of obesity in the population has been correlated with myriad of environmental, behavioral, physiological, and genetic factors.  Attenuated metabolic response to the exposures in the environmental combined with a number of predisposing factors and low level of energy expenditure leads to  positive energy balance which increases body weight.

Several researches have underpinned the importance of diet modification and exercise in reducing body weight. However the emphasis has been mainly on diet modification with less attention on the role of exercises. Regular exercises can help to burn the excess body fats leading to reduction of obesity.

In this study we are going to review a number of studies which have looked into the role of exercise in the management of obesity. The study  review a total of 10 studies from American Journal of Nutrition, JAMA, British Journal of Sports Medicine, and many  other renown medical sites. The key search words used include obesity, African Americans, Body Mass Index, and physical activities

Obesity

Obesity is one of the growing health problems in the world. Since the mid 20th century, the number of obese individuals in the population has been growing at an alarming rate due to the changing nature of our life.  The high prevalence of overweight and obesity is a great concern for adults, children, and adolescents not only in the United States but also in the rest of the world.

 Obesity can be defined as increase in body weight due to accumulation of fat tissues. Individual weight status is usually determined by the Body Mass Index, which is a ratio of individual’s weight to height.  Body mass index has been shown as one of the most effective tools to assess the level of risk from individual weight. Obesity can be described as accumulation of fast on the body due to a positive energy balance.

The food we eat is used up for body metabolism processes and the rest is stored as fats in the body adipose tissues.  If we eat too much and engage in fewer exercises, there is that energy balance in the body that is converted to fat.  Therefore the more we eat or the higher calorie foods that we eat, the more we gain weight and we end up being obese.

According to the body mass index measure, a health individual should have a BMI of 18.5 – 24.9 kg/m2. The following table shows the classification of BMI and the body weight status.

After working through the project “Disaster in Franklin County,” I will admit that I have a new appreciation for the role of the public health nurse in the event of an emergency. The simulation helped me to understand the important role that the public health team. The plays in assisting the community during a disaster. Role of the Major Public Health Personnel Each of the major public health personnel, including the public health nurse, play a key role in keeping a disaster organized flowing smoothly.

The key roles are the medical health director, agency incident commander, public information officer, liaison officer, operations chief, planning chief, logistics chief, finance and administration chief, and public health nurse. With the exception of the public health nurse, the positions are often filled by people who may not be specifically trained for the roles, however, have a general overview of what the specific role requires.

Agency Incident Commander – The agency incident commander is responsible for making the assignments of each of the other roles. She/he will have a familiarity with the specific skill sets of each person who is eligible for a role and be able to use these skill sets appropriately with in each role to obtain the highest amount of effectiveness. The incident commander will have a broad overview of what the different areas are working on, and know how each role will work to benefit other roles within the big picture.

The AIC oversees the development of the incident mission and key goals, and from this comes the development of an Incident Action Plan (IAP). The AIC is responsible for ensuring that the public health agency incident mission and goals are synchronous with those of the other responding agencies and jurisdictions. The person in this position will have natural leadership qualities such as reliable critical thinking and problem solving skills, ability to make a quick decision, flexibility, adaptability, and a broad understanding of the area affected.

Public Information Officer – The public information officer is the communication coordinator or spokesperson. This individual is responsible for assuring that appropriate information is provided to the public, governmental officials and collaborating agencies. The Public Information Officer also assures that the required information is provided to the public health agency staff, so that the message of the agency is consistent, and in synchrony with other agencies.

This person needs to be proficient in gathering the correct data for the situation, organizing facts, preparing appropriate releases for the press and the public, should have good communication skills, the ability to think quickly before responding, and have a good working knowledge of correct policy and procedure, standards, and laws in the public health realm. Liaison Officer – The liaison officer interfaces with and coordinates all activities with external agencies.

The Liaison Officer assures that external agencies that are working with the department of health are provided with the resources that are required, as well as assure that agency policies, procedures and sovereignty are respected. She will be a point of contact for other agency representatives, and will coordinate assistance from other agencies such as hospitals, counties, EMS and federal emergency management.

She will be responsible for creating and maintaining a list of cooperating agencies, their representatives, and point of contacts, and keeping other agencies aware of the public health status within the given situation. The liaison officer will have a functional working relationship with other agencies and have good communication and organizational skills. Operations Chief – The Operations Chief carries out the specific tasks and objectives that the public health agency needs to do in order to accomplish the goals of the incident.

In this section, the Incident Action Plan is actually executed. This person will have a working knowledge of what needs to be done, how to get it done, and who to send to complete the task. He will also identify additional issues and resources needed and make those requests to the appropriate people. Examples of Operations activities include distribution of vaccines, water or soil sampling, delivery of risk communication messages to the public and case investigation, to name a few.

The skill set appropriate for this person is someone with leadership qualities such as critical thinking, direct communication, and the ability to multitask. Planning Chief – The planning chief position is used to organize data, make projections and forecasts about the event and report the information to the AIC. Where required, this person may engage in intelligence activities – which for public health may be gathering, analyzing and sharing incident information (some of which may be sensitive) with other agencies.

Examples of intelligence activities may include analysis and projections regarding epidemiological data about a bioterrorist event, risk assessments based on information reported by law enforcement or determination of toxic contamination levels in an environmental incident is responsible for knowing the status of all resources available during a disaster both personnel and equipment. They will know how to obtain these resources, be able to determine current situation and status of the event, making a plan to provide the community with the things that are needed during a disaster, and have contingency plans in case the initial plans are unable to be carried out.

This person will have strong contacts throughout the community, a working knowledge of resources available and strong planning skills. Logistics Chief – The Logistics Chief provides the support to all other sections that have been activated in the public health agency so that the work can be accomplished. Logistics acquires and sets up the things that are needed for Operations to get the job done. A logistics chief will have excellent organizational skills and good ties with the community.

Finance and Administration Chief – The finance and administration chief has an essential role including assuring that a contractual and financial process is in place for emergency procurement of supplies, equipment, space and personnel; interpretation of human resource policies; tracking of fiscal resources that are expended during the response (so that costs can be recovered by the agency during the recovery phase of the event) and in some cases, assurance of availability of resources to address the physiological and psychological needs of the paid and volunteer agency personnel who are engaged in the response.

Diligent work done by the Finance / Administration Chief during an emergency can serve to prevent a financial or human resource disaster after the event. This person will have a skill set and background in finance or bookkeeping. Public Health Nurse – The public health nurse’s role in a disaster is to assess medical health and safety needs of the community and implement interventions as soon as safely possible after the event.

This may include assessing individual needs of community members for things such as appropriate shelter, medications, basic provisions, such as food and water, and assessing for overall coping and stress management skills within a household. As these needs are assessed the public health nurse may refer to other agencies for resources in assisting these community members. The public health nurse will also be involved in vaccine delivery as appropriate and treating basic emergencies as needed.

Chain of Command for the Community Health Nurse

In the simulation “Disaster in Franklin County,” the chain of command for the community health nurse began with reporting to the agency incident commander who reported to the public health director, who reported to the medical health director, who then reported to the operations chief for the county incident command system, who reported to the emergency operation center commander. This clear-cut chain of command makes it easy to get information up the chain to the appropriate people without the public health nurse having to relay information to multiple people.

Available Resources

Resources available to the community health nurse to deal with situations outside her scope of practice included environmental health specialists to assist with inspections of restaurants available to reopen and inspections of housing before people returned home and help educate the public regarding the use of generators; law enforcement to assist with volatile situations, security and safety needs; hazmat and fire crews to assure safety of homes and businesses, and assist with cleanup efforts; public works to assure water safety, electrical safety, and assess for gas leaks are just a few of the resources available to the public health nurse to assure that the community is safe throughout the event and healthy upon returning to their homes.

Actions Taken During the Door-to-Door Interviews During the door-to-door interviews in the simulation, the community health nurse encountered Mr. Fugate, who did not have his blood pressure medications. This had the potential to be an emergency, had Mr. Fugate’s blood pressure been high, or had he been symptomatic. The simulation stated that Mr. Fugate could have stayed at home or gone to the shelter, according to the community health nurse.

In this situation, even though his blood pressure came back at a reasonable reading at the moment, I believe Mr. Fugate would be best served at the shelter where his blood pressure and his general safety could be monitored until events after the storm could be better stabilized. Should Mr. Fugate, choose to stay at home, there is a risk that his blood pressure would spike to a much higher level at a time when he is alone, and unable to receive appropriate medical treatment in a timely fashion. This also increases his risk for issues such as stroke and falls. While we must respect the wishes of the patient, as nurses, we also can make strong recommendations to our patients using basic health facts and logic that will sometimes change their decisions.

In the case of Mrs. Alvarez, who spoke Spanish only, the enclosed generator had the potential to be lethal to Mrs. Alvarez and her son. The immediate education regarding the ventilation of the generator was necessary to prevent a buildup of deadly gases. Had there not been anyone at the Alvarez his residence who spoke English, not having access to a translator could have been detrimental to their health as they would not have been a way to discuss the risks with Mrs. Alvarez. Having a plan in place for access to a translator in a time of the disaster is very important as education, such as this, may be necessary on the spot, as opposed to at a later time.

In the case of Susan Fuhr, my main concern would have been a lack of coping skills and an immediate danger to herself and her child. In a disaster, many things can happen to cause an increase in stress levels. In a person who is already stressed, any one of the stressors may cause an already overloaded person to be pushed beyond their breaking point. This puts at risk everyone in their path for physical and verbal abuse. Susan Fuhr had the stressors of a young child, as well as caring for her mother-in-law to deal with before the storm. While a recommendation to go to the shelter would have provided her with food, shelter and water, sometimes the stress of being away from your home, especially when caring for others is more difficult to deal with.

Assuring that the family had the essentials that they needed and that follow-up was arranged was imperative in this situation. In a disaster, many people are afraid that they will be a burden to others if they ask for help. In the case of Mr. Westlund, the chemical spill and cleanup without being educated about the proper ways to do this could be detrimental to Mr. Westlund’s health. Putting him in touch with the appropriate resources, such as the hazmat team, was imperative to assuring that the chemical spill was cleaned up properly, both for Mr. Westlund and the community. Assisting the Community in Coping The community health nurse provided education to each of these families appropriate to their situations.

She acted as a coordinator and advocate to put them in touch with the appropriate resources as well as a collaborator, by listening and respecting their needs and wishes. Using these techniques helps to calm the fears of the residents of the community by helping them feel more prepared through education, know that there needs and wishes are important and will be respected by those providing help to them, and by acting as an advocate, they are reassured that someone cares about their situation and wants to help them in this time of need. Disaster Nursing-How Can I Help As a nurse in the community, whether working in the public health realm or another sector, it is our instinct to go where they need is.

One of the first things that you can do to help in the situation of the disaster is to be preregistered with an organization that is known to provide first responder assistance such as the Red Cross, Salvation Army, or local disaster teams. Even though the areas we are needed are rarely the areas of our expertise, extra bodies and extra hands are always welcome in a disaster. For those that work in areas such as hospitals, emergency rooms, and urgent care centers, checking in with your employer to see where help is needed is always appropriate. As a nurse, I worked through Hurricane Ike in September 2008 as it hit the Texas coastline and wreaked havoc on the city of Houston and surrounding communities. Even though I was in management at the time, I worked 58 hours straight through the hurricane coordinating nursing staff, caring for patients, and doing whatever needed done.

This meant that, along with normal nursing duties, I made sandwiches, I cleaned beds, I removed red bags with patient waste inside, I assisted in putting out small fires, and I coordinated a move of the nursery when water started leaking through the ceiling. None of these was my regular duty, however, they were things that needed done at that moment. I believe the biggest service in any disaster for nursing personnel is to first be prepared for the disasters that can happen in your area; have a plan for your own family that can include being separated from them; know how you will get to the area you could be working in should a disaster occur in; and once you’re

there, be willing to do what needs to be done, even if it’s outside your comfort zone. Being a nurse during a disaster can be stressful and exciting all at the same time. It will make you think outside the box to solve situations in new and different ways. Critical thinking and problem solving are taken to a whole new level during a disaster. Nursing of this type will boost confidence and test endurance as the nurse often works with little sleep, little food, and stress surrounding her. I will also say that nursing during a disaster is some of the most rewarding nursing I have ever done, and as crazy as it will sound to the rest of the world, nurses will always run in as everyone else runs out. It’s just who we are.

Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S.

However, cholera outbreaks are still a serious problem in other parts of the world, where cholera affects an estimated 3 to 5 million people and causes more than 100,000 deaths each year. The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

• Municipal water supplies
• Ice made from municipal water
• Foods and drinks sold by street vendors
• Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea. It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection. Signs and symptoms of dehydration include:

Rapid Heart Rate

Loss of skin elasticity (the ability to return to original position quickly if pinched) Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids

• Low blood pressure
• Thirst
• Muscle cramps

If not treated, dehydration can lead to shock and death in a matter of hours.

Yellow fever is caused by a virus. The yellow fever virus is a single-stranded RNA virus that belongs to the Flavivirus genus. After transmission of the virus occurs, it replicates in regional lymph nodes and subsequently spreads via the bloodstream. This widespread dissemination can affect the bone marrow, spleen, lymph nodes, kidneys, and liver, in addition to other organs. Tissue damage to the liver, for example, can lead to jaundice and disrupt the body’s blood-clotting mechanism, leading to the hemorrhagic complications sometimes seen with yellow fever. Yellow fever is transmitted to humans by the bite of infected mosquitoes.

Various species of Aedes and Haemagogus mosquitoes serve as vectors and are responsible for the transmission to human and nonhuman primates, which serve as reservoirs for the disease. Three transmission cycles for yellow fever have been identified. Sylvatic (jungle) cycle: In tropical rain forests, infected monkeys pass the virus to mosquitoes that feed on them. These infected mosquitoes then bite humans who enter the rain forest for occupational (for example, loggers) or recreational activities. Intermediate (savannah) cycle: In humid or semi-humid regions of Africa, mosquitoes that breed around households and in the wild (semi-domestic mosquitoes) infect both humans and monkeys.

The virus can be transmitted from monkeys to humans, or from human to human by the mosquitoes. This is the most common type of outbreak in Africa. Urban cycle: When infected humans introduce the virus into urban areas with large numbers of unvaccinated individuals, infected mosquitoes (Aedes aegypti) transmit the disease from human to human. This form of transmission can lead to large epidemics.

According to Gerstman (2007), a binomial event is that which has only two outcomes, and therefore if the probability for one of the outcomes is known, then the probability that the other outcome will occur is simply the difference of the known probability from 1. Treating repeated trials as independent events, the compilation of results of a binomial experiment altering the number of desired successes while keeping the number of trials fixed forms a binomial distribution.

The binomial probability distribution thus gives an idea of how likely it is that successive successes can occur over a given number of trials. For say a simple experiment of throwing a fair coin 4 times, the probability of getting a heads in any toss is 0. 5. Thus, the probability of getting no heads at all in the four tosses is 0. 5^4 while the probability of getting exactly 1 heads is 0. 5^2, and the probability of getting 2 heads is 0.

5 and then the probability of getting more than 2 heads decreases in the same manner that the probabilities increased in the progression described. If the probabilities are altered in such a way that success is much more likely in a single event than failure, then given five trials it would be expected that having successive successes would be more probable than successive failures. The binomial distribution also allows probabilities for multiple events to simply be added in order to give an idea of the total probability for that event.

For example when determining what the probability of getting at most 2 heads in four tosses of a coin, the probabilities of getting exactly 0 heads, 1 heads, and 2 heads can simply be added to give the correct probability for getting no more than 2 heads. Give this nature of the binomial probability distribution, its applications to public health becomes apparent. Villeneuve (2002) states that the binomial distribution can be used “to describe the number of times an event [such as a disease] will occur in a group of [people]” if the probability concerning the occurrence of that event is known.

For example, if the probability of getting infected by rabies if you were bitten by a particular animal is known, then given a certain number of people who were all bitten by that particular animal in an area it would be possible to reasonably determine how many of those people are likely to be inflicted with rabies. Public health practitioners need to be well briefed with what binomial probabilities and distributions are so that they will be able to make sound decisions based on data that they have on hand.

Oftentimes, public health practitioners that have responsibilities at the macro-level are placed with decisions involving prioritization wherein the one responsible needs to make a decision that would concern the division of a limited amount of resources. With information that can be modeled using a binomial distribution, the public health practitioner would be able to have a more reliable idea on how to allocate such resources.

Going back to the example of rabies, if several outbreaks occurred at the same time in different areas with a different animal causing each outbreak, then based on the probability of getting rabies from each particular animal and the number of patients bitten in each area, a public health practitioner can use binomial distributions as a good basis for allocating a limited number of personnel, equipment, and medicine for each of the areas. Many diseases such as cancer or AIDS can be described as a binomial experiment. That is, one either has cancer or does not and one either has AIDS or does not.

In such cases, knowledge of the binomial distribution can be very useful to public health officers in enabling them to predict the likelihoods associated with the condition occurring on a certain population. References Gerstman, B. (2007). Basic Biostatistics: Statistics for Public Health Practice. Jones & Bartlett Villeneuve, P. (2002). “Binomial Distribution. ” Encyclopedia of Public Health. Ed. Lester Breslow. Gale Cengage. Retrieved December 26, 2008 from eNotes. com: http://www. enotes. com/public-health-encyclopedia/binomial-distribution

Abstract

A proposal for a PhD study looking at the evaluation of public health and nutrition programmes within the UK. The number of such programmes has increased since the late 1990’s, and with them have developed strategies for evaluating their success. However, some suggest that evaluation so far has been flawed. This study aims to review evaluation practice through primary and secondary research, and thus contribute to best practice for future evaluation of health programmes.

1. Introduction

Since the 1980’s there has been growing awareness of the impact of diet and other lifestyle factors on public health, however it is only since the 1990’s that the UK government has started to take an active role in promoting health and nutrition programmes (Caraher et al 2009). Since inception, there have been attempts to monitor and evaluate the success or failure of these programmes, however some have suggested (Hills 2004; Caraher et al 2009) that such evaluation has a number of flaws, particularly gaps in coverage and a lack of cohesiveness.

In the light of this, the following study aims to investigate the positive and negative features of the evaluation programmes which have looked at public health and nutrition programmes in the UK.It will combine a literature review investigating previous evaluations of UK-wide and local programmes with a primary phase gathering information from academics involved in evaluation research regarding their views of the advantages and disadvantages of the programmes. The overall aim of this research is to uncover gaps in evaluation procedure and suggest ways in which these might be addressed, in order to improve future practice.

2. Literature Review

2.1 Why public health and nutrition programmesGovernment Initiatives

Public health programmes have been in existence in the UK only since the 1980’s, and were slow to impact on a population more concerned with cheap, long lasting food products. However, as links between diet and health became more apparent, so did the need for the government to take a more active role (Caraher et al 2009)

This more active role started in the early 90’s, with the publication of ‘The Health of the Nation’ (DoH 1992). This report was followed by others including ‘Eat Well’ (Department of Health 1994) and ‘Our Healthier Nation’ (Department of Health 1998). Early attempts were less than successful, however (Caraher et al 2009).

The 1997 Labour Government, started to make public health programmes a central part of policy. Initially there was a focus upon the role played by the individual in making healthy choices, but this was followed by a recognition of the wider picture, the social, economic and environmental factors involved (Crawley 2008), for example the notion of ‘food poverty’ or ‘food inequality’ (Bunton and Macdonald 2002), the idea that financial poverty, poor diet and increased risk of diet-related illnesses are linked (Faculty of Public Health 2004)

Consequently, the later years of the Labour Government saw the publication of a range of public health and nutrition programmes, for example (in England) ‘Food Matters’ (2008) and in Scotland ‘Recipe for Success – Scotland’s National Food and Drink Policy.

2.2. Evaluation of Public Health Programmes – Strategy and Evidence

There are a number of research initiatives concerned with the evaluation of Public Health and Nutrition programmes in the UK. The National Institute for Health and Clinical Excellence (NICE) issue guidelines on assessment of health programmes, and five UK Clinical Research Collaboration Public Health Centres of Excellence work with a range of stakeholders and partners to examine public health issues. In addition the Social and Public Health Sciences Unit based at Glasgow University uncovers evidence in order to support best decisions about public health (NOO [online] 2011). The NHS also support a Public Health Research Programme with a multi-disciplinary and broad approach (NHS 2011).

The new government have also made changes to public health evaluation programmes, with a commitment to “the best evidence and evaluation” (DOH 2011, p. 8) through establishing a new National Institute for Health Research (NIHR), a School for Public Health Research, and a Policy Research Unit on Behaviour and Health (Department of Health 2010). They claim that previous attempts at evaluation have been insufficient, marked by lack of cohesion and lack of ‘localism’ (Department of Health 2010)

2.3 Evaluation of Public Health Programmes Successes and Failures

To what extent are the suggestions by the new government about current evaluation of health programmes supported by research evidenceSome writers do seem to suggest that policies have been poorly evaluated: A study of policies across Northern Ireland, Wales, Scotland and England found a lack of cohesion in policy and poor analysis of provision with gaps in existing evaluation (measurement of attitudinal and behavioural change, but far fewer assessments of changes to health).At the same time, evaluation is insufficiently tied in with guidance on future action, particularly on the way the food industry might be involved (Caraher et al 2009). A review by Hills (2004) suggested that while advances have been made in evaluation, there is still a need to improve on methods.

2.4 Research question

Within the UK, therefore, there has been a vast increase in the number of public health and nutrition programmes, from the large-scale and national to the small-scale and local. There also exist a number of projects concerned to evaluate these programs. However, opinions differ regarding the success of this evaluation, with many suggesting improvements could be made. This study therefore seeks to answer the following research question:

How successful have previous evaluation of public health and nutrition programmes been, and how could these evaluations be improved?

3. Methodology

3.1 Research Philosophy / Research Approach

The study takes a positivist approach, assuming that reality is objective and knowable, and that a deductive, scientific methodology is most appropriate (Babbie 2010).The study rejects an interpretivist viewpoint, or the idea that reality is primarily subjective (Knapp and Powers 2005).

3.2 Research Strategy / Data Collection and Analysis

The study will include both primary and secondary data. Secondary data, or information derived from already published sources (Wrenn et al 2006), will be accessed from government information, academic journals and other publications both online and through libraries. Where online databases are used, clear inclusion and exclusion criteria will be drawn up and appropriate keyword searches will be defined. In addition, the study will include a primary phase, to gather information from a number of respondents involved with the process of assessing public health programmes in the UK over the last 10 years. The primary phase will be shaped by information collected in the secondary phase. Questions will be designed to see if respondents agree with earlier findings, and to investigate areas neglected previously. The primary data will include quantitative, numerical data gathered by a questionnaire consisting of rating scales and single or multiple choice questions regarding experience of assessing public health programmes, tools used and other areas. It will also include a semi-structured element in order to assess in more detail respondents thoughts about the successes and failures of the programmes of which they were a part. Data will be analysed to produce descriptive statistics and analysis of significance. Textual data collected through the semi-structured questions will be subject to content analysis (Babbie 2010) by transferring the data and examining it for emerging themes.

3.3 Access / Significance / Ethical Issues

Access will be made by telephone contact with university departments and government organisations. There may be some ethical issues regarding confidentiality, as respondents may fear that any negative views they might hold about evaluation of public health programmes might filter back to their employer and lead to unwanted consequences. It will therefore be necessary to draw up a comprehensive confidentiality agreement in order to persuade participants and institutions to take part.

3.4 Research Limitations

The research is limited to one point in time, shortly after a new government has introduced new guidelines on the evaluation of public health programmes. A fuller evaluation might only be possible at a later point in time, once the new initiatives have been introduced.

4. Conclusion

The above sets out a framework for a research project concerned with the evaluation of public health and nutrition programmes within the UK. The rationale for the research has been discussed, and a literature review section indicates areas of concern. A methodology sets out the means to be employed in the study.

5. Time Chart

Activity Time Scale

1. Research Design
2. Planning
3. Literature Review
4. Refine Research Objectives
5. Design Questionnaires
6. Contact Organisations
7. Carry out Survey
8. Data Analysis
9. Dissertation Draft
10. Dissertation Final

6. References

1. Babbie, E R (2010), The Practice of Social Research (12th edn.), Cengage Learning, Belmont, CA.
2. Bunton, R and Macdonald, G (2002) Health promotion: disciplines, diversity, and developments (2nd edn.) Routledge, UK
3. Cahill, M and Fitzpatrick, T (2002) Environmental issues and social welfare
   Broadening perspectives on social policy (6th edn.), Wiley-Blackwell, Oxon
4. Caraher, M, Crawley, H and Lloyd, S (2009) ‘Nutrition Policies across the UK 2009’,
5. Caroline Walker Trust, Herts
6. Crawley, H (2008) ‘Public Health Nutrition: challenges for the 21st Century’,The Caroline Walker Trust, Herts.
7. Department of Health (1992) ‘Health of the Nation: A Strategy for Health in England’, HMSO, London
8. Department of Health (1994) ‘Eat Well! An Action Plan from the Nutrition Task Force to Achieve the Health of the Nation Targets on Diet and Nutrition’, HMSO, London
9. Department of Health (1998) ‘Our Healthier Nation: A Contract for Health. A Consultation Paper’, HMSO, London
10. Department of Health (2008) ‘Food Matters’, HMSO, London
11. Department of Health (2010) ‘Healthy lives, healthy people: our strategy for public health in England’, HMSO, London
12. The Faculty of Public Health of the Royal College of Physicians of the United Kingdom (2004) ‘Food Poverty and Health’, FPH, UK
13. Hills, D (2004) ‘Evaluation of community-level interventions for health improvement:
14. a review of experience in the UK’, Tavistock Institute / NHS Health Development Agency, UK.
15. Knapp, T R and Powers, B A (2005) Dictionary of Nursing Theory and Research, Springer, NY
16. National Obesity Observatory (2011) ‘Evaluation Websites’ [online] (cited 11th July 2011), available from
17. http://www.noo.org.uk/core/eval_websites National Obesity Observatory 2011 online
18. NHS (2011) ‘Research to improve the health of the public and reduce inequalities in health’, [online] (cited 10th July 2011), available from http://www.phr.ac.uk/
19. Wrenn, B, Stevens, R E and Loudon, L (2006) Marketing research: text and cases (2nd Edn), Routledge, UK