Within the context of health implications, global or planetary health alludes to phenomena such as environmental degradation and climate change, amid a host of other synthetic health challenges. As such, the need for novel ideas and germane actions attuned to the assurance of meaningful health progress across the planet is evident. Fundamentally, how individuals think and view issues to do with global health depends on their critical belief system. Matters such as perspectives in the world we live in, the kind of future aspirations we envision for ourselves, and the pursuit of research and development for such goals are at the core of proper global health trends. Commensurately, whichever goal agreed upon, or the established balance thereof, the resultant influence, or action, will bring about either a positive or a negative repercussion on global health trends. In most cases, symbols, often subliminal in nature, influence and mobilize both feelings and motivations to certain health trends that are either advantageous or can cause harm to the physical mental or spiritual states of persons. This paper is a reflection on one of the numerous policy, politics, and global health trends. Further, it presents thorough analysis, the promotion, and advocacy of this pertinent policy initiative, which ultimately improves the nursing profession on both the local and the international level. The paper focuses on the ban of sugar-laced beverages as a local policy within the area of Rochester, Minnesota.
Over the past ten years, a growing recognition of weak health systems has ensued. Such recognition is bringing into reality the fact that there is a threat to international health progress, further exacerbated by an ignorant tendency when it comes to global health trends. Present global health leaders from institutions such as the World Health Organization and the GAVI Alliance endorse the objective of strengthening health systems; although, little to no consensus has been reached concerning required standards. In most scenarios, the strengthening of health systems often has an interpretation of being technical, focused on business aspects, and mirroring the perspective of giant health actors while assuming social relations and politics, thereby, affecting and reshaping health systems globally. Consequently, the emergence of the novel health sub-discipline of health policies and systems research (HPSR) has brought about augmented interest on social perspectives that continually challenge both technocratic and biomedical understandings of health practices; thus, the essence of this paper.
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Health Care Issue That Requires Policy Change
Wojcicki (2013) postulates in her research that hospitals need to be exemplary models of apposite health care reforms not only within their communities but also internationally. As such, the removal of sugar-sweetened beverages (SSBs) is an absolute and necessary step towards realizing this goal. Commensurately, hospitals should enact this policy to correspond to a ban on vending machines, cafeteria beverages, and sugary items sold within hospital vicinities. Primarily, serving such beverages within local hospitals impacts select groups of individuals and begs an immediate policy alteration. Specifically, considering a local hospital, which serves a community of patients suffering from complications such as diabetes, heart failure, obesity, and other co-morbid conditions, the implementation of this policy will be highly advantageous to the community.
In the western world, the highest source of sugar is primarily the consumption of sugar-sweetened beverages. It is an apparent fact that childhood obesity is an international problem, however, in the United States; the problem is highly severe in its extent and influence. This challenge has resulted in quite a number of initiatives, which limit the sale and distribution of sweetened drinks. Sugar plays a central role in its effect on brain dopamine transmission, thereby; the lack thereof results in a feeling of not being satisfied, leading to more consumption. In addition, medical research over the years has indicated that increased and consistent sugar consumption leads to an augmentation of blood pressure, obesity, and cancer. Sugar-sweetened beverages are rampant throughout city hospitals, within cafeterias and vending machines. This fact is an established one.
Such over-indulgence in sugar results in flagrant abuse, and subsequently brings about various problems to the body, which eventually translates to the community. Here, the community refers to the patients who frequent hospitals in search of services, the staff members of a hospital, and even ordinary individuals visiting hospitals or making deliveries. All these categories of individuals are at dire risk of suffering from increased problems related to excess sugar. This health issue is a perennial problem that leads to various diseases, which ultimately increase healthcare costs. Such problems are why the focus of this paper is on the policy of sugar eradication through the elimination of sugar-sweetened beverages within hospital vending machines and cafeterias. The paper focuses on the headquarters of the hospital Mayo Clinic in Rochester, Minnesota (Scott, 2015).
Policy Relevance to the Health Profession
Medical research indicates that sugar is harmful to one’s health. Further, Lustig, Schmidt, & Brindis (2012), postulate that an increase in the consumption of sugar correlates to the augmentation of communicable and co-morbid diseases. This hypothesis originated from the authors’ deductions of a United Nations study, having the declaration: ailments, which include cancer, heart disease, and diabetes, are non-communicable, yet pose an increasingly exponential threat while compared to communicable ones. Further, the study by Lustig, Schmidt, & Brindis (2012), suggests that within developing countries, the embrace of westernized diets is resulting in the susceptibility to these non-communicable yet fatal diseases. It is inherently clear that this study reflects daily occurrences within the community and its population at large.
Mekonnen et al. (2013), states that there are numerous benefits to the reduction of sugar consumption. Contrariwise, increased, uncontrolled, and consistent consumption of sugar eventually leads to an augmentation of calories and a commensurate weight gain. Most manufacturers of sweetened beverages add high fructose contents such as corn syrups to increase the sweetness of their drinks further. Corn syrup is typically the most common type of sweetener due to its availability and cheapness. On the other hand, medically, corn syrup that is high in its fructose content is highly poisonous to the body, in particular, the liver. As a result, persons with a high sugar intake often suffer from liver damage, metabolic syndromes, hepatic insulin resistance and numerous other conditions brought about as the consequences of having high fructose corn syrup within their systems. Therefore, from the aforementioned research and more, community study reveals a dire and compelling issue pertinent to the public at large.
Financial Impact of the Policy
As stated above, a link perpetuates between sugar-sweetened beverages and the increase of weight in children, which leads to obesity. While a hospital like Mayo Clinic is typically built with the aim of giving back to the community in terms of quality medical services, the initial investment has to attain profitability hence the business aspect of running a hospital. Most health facilities use amenities and other social utilities such as cafeterias, and vending machines to add financial advantages to their operations. From the findings of literature, as deduced in the article “Reducing Sugar-Sweetened Beverage Consumption in a Hospital Cafeteria,” by Bethany Cook, data analysis indicate that little to no financial loss transpires in the long-term eradication of sugar-sweetened beverages (SSBs) (Cook, n.d.). However, on the other hand, the initial implementation of this kind of policy results in a dramatic reduction of revenues, with an average of 75 percent sales recoupling within the initial year of enactment.
While it may be a non-profitable initial year of operations, the enactment of pertinent programs, which encourage a choice of healthier drinks, provides room for recovery and a break-even point for the local hospital. An exemplary example here is the Steward Health Care hospitals located in New England. This health facility came up with an effective educational marketing campaign titled “Stop, Rethink Your Drink, Go on Green,” which resulted in a number of fiscal advantages: a 43 percent reduction in SSB purchases; a commensurate increase of 36 percent in healthier beverages; and no decrease in the average beverage sold even after implementing the changes. From the above example, it is evident that hospitals are capable of stepping out of financial woes once the implementation of this policy takes root. As such, while its effect on the profitability of hospitals is negatively profound, in the long-term, reaching a fiscal balance is possible while at the same time maintaining advantageous health benefits.
My Values Impacting the Proposed Policy
My values are relatively apposite to the proposed policy. Essentially, the prime foundation of nursing as a science that entails the caring of humans accords immense mutual respect between patients and nurses. Therefore, in light of the demands of nursing and the foundational knowledge of human nutrition, my stand is that sweetened beverages are a health hazard to patients first, in that they significantly augment their morbid conditions, and second to healthy individuals, in that they result in the development of co-morbid conditions. Moreover, SSBs worsen the overall health of community members and is one of the prime goals that this paper seeks to alleviate. As a prime goal in this paper, my comprehension is that this proposed policy will bring about an overall benefit to the community.
One of the numerous ethical beliefs I hold dear is the belief in non-maleficence. Rosa (2014) describes non-maleficence as the attribute that pertains to ethical principles that have the focus of not necessarily preventing harm but doing no harm in the first place. As such, it remains imperative that the benefits of this ethical stand should outweigh the risks involved. In the implementation of this ethical principle to the proposed policy of banning sugar-sweetened beverages, the establishment of a basis that portends positive results ensues. Ultimately, the benefits of banning sugar outweigh those of promoting in within local hospitals, predominantly, in a non-maleficence sense.
Another ethical principle I believe in is the potentiality of sound justice. Rosa (2014), states that justice is an inherently complicated principle, with a variety of meanings, which usually range from equitable resource allocation to the free and fair treatment of persons. As such, in the proposition of this policy, I am applying the principle of justice to allude to the fair dispensation and implementation of common knowledge for the good of the community and individuals. Essentially, it would not be fair to the community if local hospitals keep on promoting and selling sugar-sweetened beverages due to the resulting health imbalances. On the other hand, in terms of revenue, it would be fair to hospitals since they can implement a healthier alternative that people would appreciate. Therefore, the principle of justice becomes known here, and further convicts the thinking of an individual and attunes it to the support of the ban on sugar-sweetened beverages. Therefore, the adoption of this policy indicates the promotion of justice by the adoptees. Moreover, an emergence of the nursing evolution role within the community continues to be pertinent. As such, core values remain pertinent in the application of ethical principles, which translates to a suitable proposed policy. Core values such as justice and non-maleficence are highly suitable to this proposed policy.
Policy brief
To counteract the growing crisis in global healthcare favorably, solid data, a firm knowledge base, and reliable research are the cornerstone of progress. Proper research aids policymakers in their decision-making processes, and in their quest to find answers that are crucial to policy issues, particularly, those relating to challenges stemming from sugar-sweetened beverages. There are various disparities in the quality of total health care and health statuses within a population group based on multiple variables such as ethnicity, race, immigration status, sexual orientation, age, and socioeconomic status. While such variables bring about various complications to the formulation of a policy that is unanimously acceptable, the issue of this policy affects all individuals, with a minute divergence attributed to the aforementioned variables. Precisely, this brief addresses John H. Noseworthy, the Chief Executive Officer of the Mayo Clinic as the final decision maker.
Novel Research Demanding the Attention of the Decision Maker
Research by Wojcicki (2013), postulates that the number one cause of childhood obesity in the United States is due to the emergence and prolonged use of sugar-sweetened beverages. As stated above, childhood obesity is a recurrent challenge that is sweeping America under the rug in terms of its health status. In this study, the problem has reached levels in which a call for initiatives is inevitable to minimize morbid conditions among children. As such, the research indicates that major hospitals within America are calling for initiatives that ultimately result in the progress of nutritional values particularly within hospital cafeterias. A case in point is the New York’s Department of Health and Mental Hygiene, which announced an initiative geared towards Healthy Hospital Foods on September 25. This initiative involved over 30 hospitals within the New York metropolitan area and was part of the initiative aimed at reducing beverage vending machines in hospitals and their content in terms of availability and portion size. Correspondingly, on October 6, 2012, the Partnership for a Healthier America (PHA) announced the increase of water, tea, coffee, unflavored milk, and 100 percent fruit and vegetable juices in over 150 hospitals including Catholic Health Initiatives, Kaiser Permanente, and the Cleveland Clinic. This increase in preference, as regards to healthy beverages, resulted in a significant decrease in soft drinks and other high-calorie drinks popularly sold in hospital cafeterias (Wojcicki, 2013).
In Australia, the Princess Margaret Hospital in Perth proscribed the sale of deep-fried foods and sodas from its cafeteria and vending machine. This ban, which took place in 2006, shows the need to suspend sugar-sweetened beverages also, as they cause more demerits than merits. Another case study shows that in 2008, the United Kingdom’s National Health System instituted a policy that banned all forms of sodas from vending machines within hospitals located in wales. While this was the case, however, McDonald's and other franchises remained within the vicinity of these hospitals. Overall, the banning of such vending machines in hospitals is a bold but ultimately beneficial move for not only the community’s health status but also that of the individual.
Statistical data from pertinent research paints an ugly picture of the presence of sodas and low-quality food items in North America. This grotesque image is in part due to the perennial existential problem of the obesity epidemic. A study of food and beverages served in the U. S. and Canadian Children’s Hospitals indicates that regular soft drinks took a hefty toll on all the amount of drinks sold with 99 percent (McDonald, Karamlou, Wengle, Gibson & McCrindle, 2006). While this is the case, recent surveys of 16 U.S. hospitals, listed as being ‘honor roll’ hospitals show that within these institutions, the prevalence of fast food franchises is a normal occurrence. This phenomenon goes to show that the removal of sweetened beverages in hospitals should be a prime agenda within hospital nutritional improvement programs. This begs a policy that is defined as such that beverages lead to increased cases of obesity among children and the adult population alike.
Numerous researches are showing the potentially morbid and mortal side effects of taking SSBs. The Australian Healthcare and Hospitals Association (AHHA) (2016) elucidates that SSBs are a major source of added sugar to the diet of most individuals. Further, the report details that a continual consumption of SSBs results in various morbid conditions, which range from not only obesity but also to type 2 diabetes, problems in bone density, cardiovascular diseases, tooth erosion, and eventually tooth decay (Narain et al., 2016; Singh et al., 2015). Presently, it has been medically established that SSBs are by nature discretionary, in that, they do not offer significant contributions to indispensable nutritional requirements; thus, resulting in more harm than good to the health of an individual and the community. Presently, Australians are the world leaders in the consumption of SSBs. This consistent consumption trend has fostered a flagrant increase of obesity cases that have overtaken traditional killers such as smoking as the leading cause of preventable illnesses and deaths (Institute for Health Metrics and Evaluation, 2015). Therefore, to the implementation decision maker of this policy, consider the numerous factual research data that shows the downside of SSBs as health hazards to the individual first, then the community. Since the more people who suffer from heart conditions and obesity increase so does the budget in health care costs owing to the increase in drug and service prices.
Challenges for the Proposed Policy
There are numerous challenges regarding the aforementioned public policy issue. Primarily, the most intense opposition originates from individuals highly bent on personal freedom of both choice and expression within the area of Rochester, Minnesota. According to research, such types of bans, which limit an individual’s ability to choose as they see fit are by nature discriminatory. The paternalistic natures of certain policies fundamentally infringe personal responsibilities and freedoms; especially, owing to the fact that such decrees come from a higher social hierarchy to the subordinate strata. Therefore, certain individuals within health care may refute this policy owing to paternalistic reasons.
In addition, the debate on the regulation of SSBs has continually faced immense criticism from various stakeholders. Chiefly, most eccentrics to such regulations and policies often cite economic reasons. This is an immense challenge, and as such, people often reason that the ban of SSBs, even within hospital premises, might jeopardize those dependent on the manufacturing and distribution chain. This argument is becoming remarkably effective as seen in Denmark where they recently decided against the implementation of effective taxes on SSBs, citing losses in revenue and jobs leading to the damage of its competitive nature in terms of external trade agreements with other nations ("Health Be Damned: Denmark Hopes Cheaper Soda Will Boost Economy", 2013). Consequently, economic reasons and job security remains the biggest challenge in the implementation of this policy.
Tangible Actions for the Decision Maker
In light of the aforementioned challenges within the implementation strategy of this policy, John H. Noseworthy can use Medical Center Wide (MCW) policies, which accords germane frameworks guiding the proper management of resources – both technical and human – and their operational requirements within the organization. Essentially, the formulation and implementation of policies aim at the promotion of consistent practices in compliance with regulatory requirements and applicable legal entry requirements. Moreover, policies minimize risks and enact strong internal controls within a target organization. As mentioned above, the decision maker remains to be the medical director of the hospital. Therefore, as the individual with the final say, the director can decide to take the following tangible actions towards the implementation of the proposed policy.
The CEO can choose to properly read the proposal and reach a final decision of leaving the current policies unaltered. While this is a tangible scenario, it remains a poor intervention as numerous evidence shows that SSBs correlate directly to the development of various health issues in individuals and subsequently to the community.
A second scenario might ensue whereby the director implements a divergent policy as instigated in other healthcare facilities. While this policy may take root within the hospital, it might not be as effective as a policy designed to work for the hospital in question. Many times, leaders often copy the decisions of others thinking that they will work in their scenarios; this is often not the case as each scenario has varied attributes, which ultimately result in either success or failure
The third and best tangible action for the decision maker is the implementation of this policy relating to the ban of sugar-sweetened beverages in the Metropolis Hospital. The reason for this is two-pronged. First, it is evident from various research sources that the over-consumption or continual and consistent consumption of SSBs lead to various complications in the bodies of individuals. Secondly, people are raising their awareness that increased sugar intake causes immense bodily harm and can significantly increase the cost of healthcare in terms of resources needed to cater for morbid populaces. Therefore, as a course of action, the implementation of a ban would be wise.
Course of Action
In the implementation of policies, much like life, challenges are inevitable. The list below provides possible intervention methodologies.
To curb the challenge that arises from the ideology of freedom, the implementation of sensitization strategies and proper education of benefits and drinks alternatives is necessary
Lastly, the decision maker can use unions within the hospital to influence favorable conditions in the event of internal strife and fights for control
Success of the Policy’s Top-Down Approach Evaluation
The success of this policy partially relies on a top-down approach in that the management should adhere to decisions stemming from the executive down to the subordinates. This will aid in the development of pertinent objectives and procedures, including their subsequent implementation within Mayo Clinic. The approach starts with the Director or Manager and is implemented across respective departments, down to subordinates such as clinical overseers. Its evaluation will depend on numerous aspects including but not limited to timely implementation of project modules and the overall success of the project.
Identified Organization to Aid in the Implementation of the Proposed Policy
One organization that may ultimately support this policy is the Service Employees International Union (SEIU). This organization would practically support the ban on SSBs. Moreover, Mayo Clinic has workers represented within the SEIU. Consequently, the implementation of this ban has to attain a conversant level of success.
Policy Implementation Plan
Community-Based Participatory Research that Addresses the Issue
Within the community, CBPR is a significant aspect that represents collaboration. This policy aims at implementing the following CBPR principles within the community at Rochester area. Burke et al. (2013) illustrate three that are pertinent but not limited to this research; they are:
The involvement of community partners in the initial stages of policy development
A focus on benefits to the community through the hiring and training of community members throughout the development of this project
The empowerment of community members to conduct their research on other pertinent health-related projects
Goal Alignment with the Public Issue
The hospital in question (Mayo Clinic) aims at working with the community. Within a community, disease prevention is highly imperative as it promotes community wellness. Moreover, this public policy issue aims at reducing hospital expenditures, thereby, aligning its goals to the needs of the community
Action Steps for Goal Achievement
To achieve this goal by the policy, the following actions steps are recommended but not limited to the project:
Bimonthly meetings to discuss the current state and future trends
Community outreach
Periodic meetings held with the objective of maximizing budgeting strategies
Capacity Building and Problem Solving Roles
To implement this policy, working with selected groups of individuals with reasonable experiences in capacity building and problem-solving is imperative. They must be willing to take up the following roles:
Working within a bi-monthly Metropolitan Hospital Community outreach program, which has representatives in various regions
Working as community facilitators through an RN license to act as technical advisors to the community programs
Attending bi-monthly meetings geared towards the discussion of varied information concerning the topic
CBPR Key Elements, Principles, and a Collaborative Plan
At the beginning of the project, there will be the definition and evaluation of pertinent research objectives. In doing this, project stakeholders, such as community partners are apprised of the project for them to adequately provide pertinent input to critical objectives
Within the project, community members will be hired and trained to sensitize and apprise them of best practices and methodologies
Lastly, community members will be empowered to initiate their projects in research. This principle will be implemented efficiently through empowerment from the onset of the project to its conclusion.
Analysis
Strengths and Challenges of the Top-Down and Bottom-Up Approach
To ensure proper management, the Top-Down approach has the following strengths as illustrated by Rhodes, Fusilero & Williams (2010)
Consistent quality control
Recognition and respect of straightforward roles among subordinates
The leveling of the playfield
The Bottom-Up approach has the following strengths
The promotion of agility and flexibility
The promotion of collaborations among community members
The initiation of a process unified through teams
When it comes to barriers, the Top-Down approach has the following according to Rhodes, Fusilero & Williams (2010)
Negative impact on morale
Loss of potential talents due to misunderstandings from an authoritarian leadership style
Barriers to the Bottom-Up approach include:
Higher implementation costs due to resources constraints needed to decide among a pool of suggestions
Project fragmentation in terms of objectives obscurity
Frequent customization of the project
Most Effective Approach
Chiefly, the community represents an ever-dynamic part of healthcare. As such, approaches to various beneficial projects are typically adjusted or modified based on the needs of policies and even the projects themselves. While one approach may seem advantageous at a point within the project, it may prove fatal in other phases. Therefore, the most effective strategy is an amalgamation of both, particularly when aiming at national and international audiences.
References
Australian Healthcare and Hospitals Association. (2016). Sugar-Sweetened Beverage Consumption . Retrieved from https://ahha.asn.au/sites/default/files/docs/policy-issue/ahha_position_statement_-_sugar_sweetened_beverage_consumption_0.pdf
Burke, J., Hess, S., Hoffmann, K., Guizzetti, L., Loy, E., & Gielen, A. et al. (2013). Translating Community-Based Participatory Research Principles Into Practice. Progress In Community Health Partnerships: Research, Education, And Action , 7 (2), 109-109. http://dx.doi.org/10.1353/cpr.2013.0020
Cook, B. REDUCING SUGAR-SWEETENED BEVERAGE CONSUMPTION IN A HOSPITAL CAFETERIA KRISTA ULATOWSKI, MPH-NUTRITION, NUTRITIONAL SCIENCES PROGRAM . Presentation, University of Washington Medical Center.
Health Be Damned: Denmark Hopes Cheaper Soda Will Boost Economy . (2013). SPIEGEL ONLINE . Retrieved 19 April 2018, from http://www.spiegel.de/international/europe/denmark-to-repeal-tax-on-soda-and-beer-to-limit-cross-border-shopping-a-895857.html
Institute for Health Metrics and Evaluation. (2015). Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 . The Lancet.
Lustig, R., Schmidt, L., & Brindis, C. (2012). Public health: The toxic truth about sugar. Nature , 482 (7383), 27-29. http://dx.doi.org/10.1038/482027a
McDonald, C., Karamlou, T., Wengle, J., Gibson, J., & McCrindle, B. (2006). Nutrition and Exercise Environment Available to Outpatients, Visitors, and Staff in Children's Hospitals in Canada and the United States. Archives Of Pediatrics & Adolescent Medicine , 160 (9). http://dx.doi.org/10.1001/archpedi.160.9.900
Mekonnen, T., Odden, M., Coxson, P., Guzman, D., Lightwood, J., Wang, Y., & Bibbins-Domingo, K. (2013). Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Model. Plos ONE , 8 (12), e81723. http://dx.doi.org/10.1371/journal.pone.0081723
Narain, A., Kwok, C., & Mamas, M. (2016). Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis. International Journal Of Clinical Practice , 70 (10), 791-805. http://dx.doi.org/10.1111/ijcp.12841
Rhodes, A., Fusilero, J., & Williams, C. (2010). Development of the role of director of advanced practice nursing. Nursing Economics , 28 (1), 58-62.
Rosa, W. (2014). Reflections on Self in Relation to Other: Core Community Values of a Moral/Ethical Foundation. Creative Nursing , 20 (4), 242-247. http://dx.doi.org/10.1891/1078-4535.20.4.242
Scott, P. (2015). Should Mayo Clinic get rid of sugar sodas? . PostBulletin.com . Retrieved 19 April 2018, from http://www.postbulletin.com/life/health/should-mayo-clinic-get-rid-of-sugar-sodas/article_4f76c477-890d-5212-8dce-dce5076b7d19.html
Singh, G., Micha, R., Khatibzadeh, S., Shi, P., Lim, S., & Andrews, K. et al. (2015). Global, Regional, and National Consumption of Sugar-Sweetened Beverages, Fruit Juices, and Milk: A Systematic Assessment of Beverage Intake in 187 Countries. PLOS ONE , 10 (8), e0124845. http://dx.doi.org/10.1371/journal.pone.0124845
Wojcicki, J. (2013). Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity. Acta Paediatrica , 102 (6), 560-561. http://dx.doi.org/10.1111/apa.12216
