Ethical considerations in the prevention of childhood obesity

Kooverjee, Yoshna Ishwarlal (2018-12)

Thesis (MA)--Stellenbosch University, 2018.

Thesis

ENGLISH ABSTRACT: Childhood obesity is a global pandemic, the prevention of which is a public health priority. The aim of this thesis is to explore the ethical issues that arise when designing, implementing and assessing public health interventions to prevent childhood obesity. As childhood obesity is a social justice issue, ethical analysis of such interventions must utilise frameworks with a social justice orientation. Public health ethics differs from ethics at the individual level therefore moral theories used in individual medicine are unsuitable for application in public health. The well-being theory of social justice recognises that there are multiple causes of systematic disadvantage, not just in health, but in social, economic and political aspects of life and requires that we address these social and economic determinants which compound insufficiencies in wellbeing. This is particularly relevant in interventions targeting childhood obesity, as evidence has shown the impact of socio-economic and environmental factors as a major contributor to the problem. Where moral theory may not be able to provide enough concrete guidance, the use of ethical frameworks is of practical assistance. Ethical frameworks compatible with different moral theories and incorporating an analytic tool would be particularly useful in the South African public health context. Three such ethical frameworks are those of Nancy Kass, Nuffield Council on Bioethics, and Andrew Tannahill. These are compared for ease of use, applicability to different stages of interventions and specific relevance to childhood obesity. An ethical problem in childhood obesity interventions is the issue of who is responsible for childhood obesity. The personal responsibility paradigm is problematic, as it ignores social determinants of health leading to childhood obesity and results in victim-blaming. The role of the parents and the extent to which the state should intervene when childhood obesity is regarded as medical neglect are considered. Obesity prevention as a societal responsibility has ethical implications for government, schools, industry and society in addressing the obesogenic environment. The ethics of food advertising and marketing to children in South Africa in particular exploits the vulnerability of children and is aggravated by ineffective regulation and insufficient legislation. Stigma associated with childhood obesity has become a well-documented phenomenon and is another major ethical concern. A good understanding of stigma is provided by Link and Phelan’s conceptualisation, all the components of which occur in childhood obesity. Stigmatisation of obese youth is pervasive, occurring across multiple domains and from various sources, and results in adverse psycho-social, academic and physical consequences. Two aspects of stigma from a public health perspective are considered. The first is the perpetuation of stigma through the preference of certain health identities. The second is its adverse effects on public health efforts, resulting in increased morbidity and mortality. Evidence shows that stigma is harmful on the individual and the public health level and is neither useful nor ethical as a motivator for weight loss. Stigma reduction is recommended in the planning and assessment of childhood obesity interventions. I conclude that the prevention of childhood obesity in South Africa is a matter of social justice and that interventions be assessed by the Nuffield Council on Bioethics’ Stewardship framework.

AFRIKAANSE OPSOMMING: Kinderobesiteit is ’n wêreldwye pandemie en die voorkoming daarvan is ’n openbaregesondheidsprioriteit. Die oogmerk met hierdie tesis is om die etiese kwessies te ondersoek wat ontstaan wanneer openbaregesondheidsintervensies vir die voorkoming van kinderobesiteit ontwerp, geïmplementeer en beoordeel word. Aangesien kinderobesiteit ‘n sosiale geregtigheids kwessie is, moet etiese analise van sulke intervensies raamwerke gebruik met ’n sosiale geregtigheidsoriëntering. Openbaregesondheidsetiek verskil van etiek op die individuele vlak en daarom is morele teorieë wat in individuele geneeskunde gebruik word nie geskik vir toepassing in openbare gesondheid nie. Die teorie van maatskaplike geregtigheid erken dat daar meervoudige oorsake vir sistematiese benadeling is, nie net in gesondheid nie, maar ook in die maatskaplike, ekonomiese en politieke aspekte van die lewe, en dit vereis dat ons hierdie maatskaplike en ekonomiese determinante aanspreek wat ontoereikendhede in welsyn vergroot. Dit is veral ter sake by intervensies wat op kinderobesiteit gemik is, aangesien daar bewys is dat die impak van sosio-ekonomiese en omgewingsfaktore aansienlik tot die probleem bydra. Waar die morele teorie dalk nie genoeg konkrete leiding verskaf nie, is die gebruik van etiese raamwerke van praktiese hulp. Etiese raamwerke wat met verskillende morele teorieë versoenbaar is en waarby ’n ontledingsinstrument geïnkorporeer kan word, sal veral in die Suid-Afrikaanse openbaregesondheidskonteks nuttig wees. Drie van hierdie etiese raamwerke is dié van Nancy Kass, die Nuffield Raad op Bio-etiek, en Andrew Tannahill. Die raamwerke word vergelyk op grond van gebruiksgerief, geskiktheid vir verskillende intervensiestadiums en spesifieke relevansie vir kinderobesiteit. ’n Etiese probleem by kinderobesiteitintervensies is die kwessie van wie vir kinderobesiteit verantwoordelik is. Die paradigma van persoonlike verantwoordelikheid is problematies aangesien dit die maatskaplike determinante van gesondheid wat kinderobesiteit veroorsaak, ignoreer en tot slagofferblamering lei. Die rol van die ouers, en die mate waartoe die staat behoort in te gryp wanneer kinderobesiteit as mediese verwaarlosing beskou word, word oorweeg. Die voorkoming van obesiteit as ’n samelewingsverantwoordelikheid het etiese implikasies vir die regering, skole, industrie en die samelewing wat betref die aanpak van die obesogeniese omgewing (die skadelik vetsugtige omgewing). Die etiek van voedseladvertering en -bemarking aan kinders veral in Suid-Afrika buit die kwetsbaarheid van kinders uit en word deur oneffektiewe regulering en onvoldoende wetgewing vererger. Die stigma wat met kinderobesiteit geassosieer word, het ’n goed gedokumenteerde fenomeen geword en is ’n belangrike bykomende etiese kwessie. ’n Goeie insig in stigma word voorsien via Link en Phelan se konseptualisering, waarvan al die komponente by kinderobesiteit voorkom. Die stigmatisering van vetsugtige kinders is diepgaande, dit ontstaan oor verskeie domeine en uit verskeie bronne, en dit het nadelige psigomaatskaplike, akademiese en fisieke gevolge. Twee aspekte van stigma word vanuit ’n openbaregesondheidsperspektief oorweeg. Die eerste is die voortbestaan van stigma deur voorkeur aan bepaalde gesondheidsidentiteite. Die tweede is die nadelige gevolge vir openbaregesondheidspogings, wat tot verhoogde morbiditeit en mortaliteit lei. Daar is aanduidings dat stigma skadelik op die vlak van individuele en openbare gesondheid is, en as motiveerder vir gewigsverlies is dit nóg nuttig nóg eties. Stigmavermindering word aanbeveel wanneer kinderobesiteitintervensies beplan en beoordeel word. Ek kom tot die gevolgtrekking dat die voorkoming van kinderobesiteit in Suid-Afrika ’n kwessie van maatskaplike geregtigheid is en dat intervensies volgens die Nuffield Raad op Bio-etiek se Rentmeestersraamwerk beoordeel moet word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105026
This item appears in the following collections: