Obesity is a condition characterized by body mass index above 30. Diabetes on the other hand refers to elevated blood glucose levels above the normal range. The four common bioethical principals applicable to treatment of other health conditions also apply to obesity and diabetes.
The principle of beneficence requires care givers to consider benefits of a given treatment and risks involved in decision making. Non-maleficence on the other hand refers to avoidance of harm. The two principles are applied together in treatments. Care delivery to children with diabetes and obesity should observe the two principles. Autonomy is also a bioethical principle. In means respecting rights of patients to make decisions. During interventions on obesity and diabetes in children, beneficence and non-maleficence may violate autonomy. This is only recommended if the patient’s decision violates the policies of beneficence and non-maleficence. Children should be consulted on their treatment preferences only if none of the preferences can affect beneficence and non-maleficence.
Another principle that equally applies to children with obesity is justice. The principle requires that there should be equality and fairness in treatment of patients with different conditions. Policies addressing children with diabetes and obesity should ensure equity and fairness in all dimensions.
This paper focuses on children with obesity and diabetes living in Florida. Children in Florida make up a significant proportion of the state population. According to the 2010 census, population of persons under the age of eighteen years was 4,002,091. 2012 population estimates reveal that population of children living in Florida aged below five years was 5.5% of the total population of the state. On the other hand, population of persons under the age of eighteen years living in the same state was 20.7%. Nationally, the population of children aged below five years was found to be 6.4% according to the estimates. In 2011, there were 1.9 billion children globally. Florida is ranked at position nine based on percentage population growth of children from the year 2000 to 2010. Table 1 shows percentage population growth of children between 2000 to the year 2010.
Obesity is one of the most serious health concerns affecting children in Florida as well as the entire United States. One study found that Children are the fastest growing demographic among the overweight population in the United States (Janssen et al., 2004). According to Baskin, Ard, Franklin, and Allison (2005), data collected from 1999 to 2002 estimates that one in every six children living in the United States is overweight. According to another study by Ogden, MD Carroll, Kit, and Flegal (2012), between the years 2009 to 2010, 16.9% of children and adolescents aged between 2 to 19 years were obese. In Florida, it is estimated that 553,000 out of 1,702,000 children aged between10-17 years are obese as assessed through BMI-for-age standards (Edwards, 2009). This represents a percentage of 32.5%. Children with obesity tend to develop more chronic health complications that their healthy counterparts. A study by Hlaing, Messiah, Lipshultz, and Ludwig (2011) suggests that children who are obese stay longer in hospitals.
Diabetes type 2 is another health problem that affects many children in Florida. It is also a serious health concern in the entire US. According research by CDC (2010), diabetes affects nearly 25.8 million people in the US (CDC, 2010). This represents 8.3% of the entire US population. Of this population, type 2 diabetes accounts for 90-95%. It is the sixth leading cause of death in the US (CDC, 2010). Even though children are less affected than adults, children with obesity are at risk of developing the diabetes given that obesity is one of the risk factors to diabetes type 2. Furthermore, prevalence of diabetes in children has increased over the last few years. In Florida, diabetes hospitalization for children aged between 5-11 years increased consistently from 2009 to 2011.
Over the last sixty years, several policies on social welfare have been set up in the US. These policies have shown various impacts on children especially those with obesity and type 2 diabetes living in Florida as well as those living in other states. One such policy is Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), which was introduced in 1996. It made significant adjustments to the welfare system of the United States. This law was designed to serve three main purposes: to move adults permanently into the workforce, to give states more flexibility in drawing programs on public-assistance, and to support stability of families.
The introduction of PRWORA led to replacement of certain federal welfare programs that had been in place with new programs. For instance, Aid to Families with Dependent Children (AFDC) was eliminated and Temporary Assistance for Needy Families (TANF) created in its place. TANF seeks to empower states to be able to provide cash assistance to families. In this case, block grants are given to states to aid in this function. Rules of TANF seek to move more low-income adults into work force. Since its inception, PRWORA has shown various impacts on children welfare. Children with obesity and diabetes have also been affected in all states including Florida. Let us consider some of the impacts of this policy on children with obesity and diabetes.
Since its inception, PRWORA has led to a remarkable increase in the population of women with young children participating in labor force. For instance, the number of employed mothers aged below 18 years with young children increased from forty-seven percent to seventy-one percent between 1975 and 2008 (U.S. Department of Labor, Bureau of Labor Statistics, 2009). The rates of increase in childhood obesity over the last four decades coincide with increased rates of labor force participation of women with young children over the same period (Hoffman & Averett, 2005; U.S. Census Bureau, 2009). This shows that maternal labor force participation influences prevalence of obesity among children.
Mothers who spend adequate time with their children exercise maximum care to them. They prepare the children’s meals as well as those of the family, feed the children, and control their dietary behaviors. In other words, they allocate adequate time to domestic tasks. However, there has been significant decrease in time allocated to domestic tasks by women in the last recent decades. This has partly contributed to rise in prevalence of child obesity.
PRWORA has also led to many children taking most of their meals from schools. This implies that the children’s nutritional status would depend on the environment of the schools. Ceratin schools sell high calorie foods that predispose the children to obesity. Meals given at child care centers too may also predispose them to obesity.
Rise in child obesity rates has also caused increase in prevalence of diabetes type 2. Pathophysiology of type 2 diabetes links accumulation of triglycerides in the body with reduction of insulin sensitivity of muscle cells. This leads to insulin resistance which eventually causes uncontrolled fluctuations in blood glucose levels. Several children with obesity have developed diabetes type 2 since the inception of this policy.
Some studies report certain positive impacts of PRWORA on children. For instance, one study found out that children performing poorly improve in learning and show greater readiness to school when paced in childcare centers than their counterparts in home-based care (Fuller et al., 2002).
Nursing organizations have played vital roles in advocating for children with diabetes and obesity throughout the United States. Children in Florida have also benefited from efforts of these organizations. These organizations have made their contributions mainly through; educating, advocating, and partnering. In terms of educating, nurses have been given responsibility to educate parents, community members, families, and children about effects of obesity. School nurses also strife to induce culture of health through designing of requirement that teachers should be nutritional role models.
In a bid to advocate for children with obesity and type 2 diabetes, various nursing organizations have used approaches such as supporting such policy recommendations as; funding for wellness programs in schools, setting of federal standards on nutrition, and provision of recreational facilities in underserved areas. Partnering is also another approach that has been explored by various nursing organizations. For instance, American Nurses Association (ANA) has partnered with the White House in promoting an initiative branded “Let’s move”
Full implementation of Affordable Care Act (ACA) will benefit children with obesity and diabetes in Florida and other States. The proposals of the policy seek to address some of the most serious concerns pertaining to children’s welfare.
First, ACA seeks to expand coverage so that many uninsured patients can benefit. This will definitely help reduce the population of the uninsured by the end of the implementation period. In this sense, children with obesity and diabetes will benefit. Critics have argued that affordability of subsidized coverage in the new insurance exchanges may still make it difficult for many eligible children to benefit. However, if the policy funding is maintained throughout the implementation period, this concern may be addressed.
Secondly, under the policy, both federal and state governments are seeking to enroll many newly eligible individuals. Most of these targeted individuals are adults. This will improve healthcare systems available to parents and also improve their access to healthcare services. This will in turn impact positively on children since improved health of their parents’ bears psychological and emotional effects on them. Children with poor dietary behaviors may benefit as well since their parents act as nutritional role models. Parents will help improve conditions of children with obesity in this sense. In addition, parents will be able to seek more advice pertaining to management of diabetes under this policy.
Thirdly, flexibility of State in design and administration will help keep coverage of children strong. The policy accords States some level of flexibility that will allow them to tailor programs on the basis of their culture, finances, systems of healthcare delivery, and populations. This will ensure that coverage approaches are relevant and sustainable. Children who are genetically predisposed to diabetes for instance may be given more attention. For instance, states that are inhabited by many blacks, who are more predisposed to type 2 diabetes, may tailor implementation of the policy to cater for needs of this population.
Affordable Care Act also requires most insurers to deal with obesity. However, plans on how to do this is upon the insurers themselves. For instance, some insurers may decide to offer counseling services to their patients through telephone. Furthermore, the act requires that screening and counseling for obesity should be covered without patient cost-sharing. These provisions will definitely benefit children with obesity and diabetes.
Even though much effort has been made to address various healthcare concerns of children with obesity and diabetes type 2 through designing various policies, certain concerns still remain unaddressed. There are majorly three concerns: accessibility, quality, and cost. ACA mainly seeks to address the aspect of accessibility. However, quality still remains the main concern. Medicare patients in particular need to receive quality services just like the rest. However, this has not been addressed. Children in Florida and especially those with chronic illness such as diabetes are the main beneficiaries of ACA. Therefore, such challenges as low quality health being offered to them should be addressed.
Another serious concern is the need to move children from care centers into family homes where they can enjoy family intimacy. Emotional aspects can aggravate condition of children with obesity and diabetes. Many children in the daycare centers lack family love. Adoption can also aid in introducing these children into families so that they can also experience family life and get good parenting. Many policies encourage moving children away from families instead.
Ileana Ros-Lehtinen is currently serving as a US congress representative for Florida. She has served in the congress since 1989. During her tenure, Ros-Lehtinen has voted for and against many bills. For instance, she has supported gay rights despite being a republican. She also sponsored the Every Child Deserves a Family Act which sought to promote adoption of children in the foster care.
Congress representatives play big roles in supporting various policies and laws governing states as well the federal government. They can also sponsor various bills concerning welfare of residents of the states they represent. It therefore follows that .Ileana Ros-Lehtinen has high capability of advocating for children with obesity and diabetes in Florida. Her support to policy recommendations that concern this population is very crucial hence she is an important personality for children with diabetes and obesity.
Source: William P. O'Hare (2011)’s analysis of data from the U.S. Census Bureau
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