An Analysis of Public Health Theory Underpinning Breastfeeding What is Public Health - Essay Example

An Analysis of Public Health Theory Underpinning Breastfeeding What is Public Health Sir Donald Acheson, of the Faculty of Public Health of the RoyalColleges of Physicians of the United Kingdom, defined public health as "the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society"(FPH, 2005). This seems like a rather complex definition because the concept of public health itself is a complex issue. It is unmistakable, however, that this definition implies that it is not only a systematic detail but also that its interpretation is used to improve the population's health. The focus of this paper is to provide an analysis of public health theory underpinning the practice of breastfeeding. Public health refers to the creation of preventive measures and programs through organized, inter-agency and reform efforts that address the physical, mental and environmental health concerns of communities and populations that may otherwise be at risk for disease and injury. The purpose of public health theory is the onset of health promotion and disease prevention strategies and interventions that are designed to improve and enhance the quality of life. The issue of breastfeeding is one that raised concern, and as a result will be focused on within this paper as it relates to the various components of public health. Breastfeeding is a public health concern because of its relevance to the health of the Scottish population. There is a very high incidence of heart disease, stroke and diabetes in Scotland, and obesity and high blood pressure are recognized risk factors for these conditions. What do we mean by Health Promotion The Ottawa Charter for Health Promotion (1986), defines health promotion as "the process of enabling people to increase control over, and to improve their health". It goes on to state that "to reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment". Public health promotion is a concept that uses particular strategies as a means of addressing health issues such as communicable diseases that may threaten health and human development. The idea behind health promotion is to empower and enable people to take action and control of their health and life decisions. A good health promotion program is one that focuses on making individuals capable of taking action and acting as a group gain control over the components of health and positive change within their community. Health promotion consists of a variety of strategies, some of which were set forth in the Ottawa Charter (1986), including building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and the recognition of health services. Thus health promotion must have means of tackling health challenges that are not inside of the immediate control of individuals. They must consider those that derive from social and political conditions as well. Health promotion action focuses on confronting these challenges through advocacy for health. Health personnel as well as other professional and social groups have a responsibility to mediate between the various interests that the different groups in society may bring to the table. The challenge remains in the UK for policy-makers, healthcare professionals and managers to develop and deliver effective breastfeeding promotion programs that also address the socio-economic bias in the initiation of breastfeeding. Health promotion and disease prevention strategies include a broad collection of functions and expertise such as the assessment and monitoring of at-risk communities and groups to identify health problems and priorities, working with government and community leaders to establish public policies designed to solve known widespread health problems, and assuring that all populations have access to effective and affordable health care. The widespread problems are issues that are often considered to plague an entire country, such as in the case of Britain's infant and child mortality rates due to respiratory infections and other childhood illnesses. According to the World Health Organization (2005), the breastfeeding rate of Britain is among the lowest in Europe. Only seven out of ten babies born in the Britain are breastfed at birth. One out of five babies receives breast milk up to six months in age. Based on research, a child's chances of developing many of these illnesses are significantly lower if the mother chooses to breastfeed. Research has shown that there is no exact substitute for human milk. In the UK, the policy statement of the British Pediatric Association (2005) supports the promotion of breastfeeding. It identifies the promotion of breastfeeding as a means o f assisting improvements in health as well as the reduction of health inequalities among mothers and children in the UK. The Department of Health set a target for breastfeeding to "deliver an increase of two percentage points per year in breastfeeding initiation rates, focusing especially on women from disadvantaged groups" (Department of Health, 2005). Human milk and breastfeeding of infants provide advantages for the infant's general health, as well as growth and development, while significantly decreasing the infant's risk for a great number of acute and chronic illnesses and diseases. Research in Europe, as well as the United States and Canada, provides strong evidence that feeding infants with human breast milk decreases the incidence illnesses such as urinary tract infections, lower respiratory infections, diarrhea, bacterial meningitis (Wolf, 2003). Some of these studies also show that breastfeeding has a protective effect against sudden infant death syndrome, childhood diabetes, Crohn's disease, and some allergies Breastfeeding has also been associated with more advanced cognitive development in young children. Human milk is recommended for all healthy term infants. All parents should be fully informed about the research, benefits, and techniques for breastfeeding. There are also a number of studies that also show that there are some health benefits for new mothers. Ideologies of Public Health The ideology of public health is the basic need for an overall healthy nation of people that will create a striving economy for a sound future. All of these organizations have a common goal and are able to come together and have a strong impact on society for the greater good. Collectivism / Socialism. A large number of organizations, agencies, legislatures, and the like, have come together to change the statistics that are reported today on the low averages of breastfeeding mothers. This represents the collectivism within public health theory. Some examples of these are the legislative bills and proposal that have been presented in recent years. Organizations such as the United Kingdom and Ireland Public Health Evidence Group, the British Association of Perinatal Medicine, and the Public Health Evidence Steering Group have all played a major role in the challenge of promoting breastfeeding for the health of the country. To date, these campaigns have been rather successful. Although breastfeeding percentages have increased slightly in recent years,the percentage of women currently breastfeeding their babies is still lower than those seen decades ago. The initiation of breastfeeding has now increased to 63% in Scotland, a further 8% increase during the last five years. However, the UK Infant Feeding 2000 survey shows rates of initiation are still relatively low, with initial breastfeeding rates at 71% in England and Wales, 63% in Scotland and 54% in Northern Ireland. Research shows that few mothers actually breastfeed their babies exclusively for the first six months of their infants' lives, despite the advice of health officials. Such an uninformed decision can put a child's health at an unfortunate disadvantage, according to the Department of Health. Individualism / Libertarianism Although public health theory is a collective effort to inform and protect society, it must be promoted and not forced upon the population. A society must buy into an issue just as much as the government leaders. Participation is of free will. For example, it is still up the mother whether or not she chooses to breastfeed despite the suggestions given. However, there are promotional programs that help to encourage the decision. For practicing physicians, consideration should be given to providing supplementary breastfeeding support as part of routine health service provision. There is clear evidence for the effectiveness of additional professional support in prolonging any breastfeeding but the strength of its effect on exclusive feeding is less certain (Donald, 2004). Training courses appear to be an effective model for professional training. Lay support is effective in promoting exclusive breastfeeding although the strength of its effect on the duration of any breastfeeding is uncertain. Evidence supports the promotion of exclusive breastfeeding as central to the management of many illnesses in breast-fed infants. Pediatricians, as well as other health care professionals, are given specific guidelines for helping mothers begin and maintain successful breastfeeding. This is important information for all labor assistants and childbirth educators to know. Many of the recommendations are for practices that are central to the welfare of mothers and their newborns. Environmental / Green Ideology A large of public health theory is environmental (or green ideology). This is another reason that breastfeeding has been taken on as a public health project. Breast milk is said to be one of the most ecologically sound foods available to humans. There is no pollution involved in its production or delivery and it is a natural resource. Its use has only positive effects on the environment. In addition to breastfeeding being the best feeding method for infants. Bottle production and feeding pollutes the air, water and land, wastes resources, creates disposal problems and increases population levels. Breast milk produces no waste because only the amount the baby needs is produced. It does not need to be packaged as does formulas and other feeding substitutions, it does not need to be heated or cooled because is ready to use at the right temperature. This cuts down on energy use. In a more indirect way, breastfeeding helps the environment because most women do not menstruate when breastfeeding. This cuts the need for more environmentally damaging items such as some feminine hygiene and sanitation products. Public Health and Barriers to Breastfeeding There are a number of barriers to breastfeeding that make it a good representation of a public health issue. For example, the extensive promotion of distributing free infant formula expectantly creates a barrier for the successful initiation of breastfeeding for new mothers. This is particularly true of programs that offer this service to those families of low socioeconomic status. Many of the communities that are identified as at-risk for public health issues are those that of low socioeconomic status. It is in these communities and populations that studies and interventions are conducted with a focus on keeping the issues from becoming epidemic. Another set of barriers to breastfeeding are the inequalities in the percentages of breastfeeding mothers across socio-economic status and non-supportive work programs. Babies of mothers classified in higher occupations are much more likely to be breastfed at birth than babies of mothers in lower occupations. The UK Infant Feeding 2000 survey (Department of Heath, 2005) shows that mothers most likely to initiate breastfeeding are those who reach higher educational levels, are aged over 30 years, and are feeding their first as opposed to subsequent babies. Rates also varied by socioeconomic status, family participation in day care programs, and geographic residence. (Ruowei et al., 2005). A new breastfeeding mother who returns to a workplace that does not actively support breastfeeding creates a barrier to long-term breastfeeding. The apparent lack of acceptance and support that new mothers see by the community and society is also a barrier to breastfeeding. Many breastfeeding mothers are apprehensive about breastfeeding, particularly in the presence of others because of socialize feelings of embarrassment and disgust. The World Health Organization suggested that "hostility to mothers and babies in our culture based on archaic and outdated moral taboos" could cause a new mother to decide against breastfeeding (Crenshaw, 2005). Hopefully, that enacting this legislation would help put an end to the embarrassment and ignorance regarding breastfeeding so that mothers would choose to breastfeed their babies without feeling discriminated against. Medical and Social Methods of Health Significant advances in science and clinical medicine have occurred in recent years in support of breastfeeding. These adjustments cite substantial new research on the importance of breastfeeding and sets principles to guide pediatricians and other health care professionals in assisting women and children in the initiation and duration of breastfeeding. The ways pediatricians can protect, promote, and support breastfeeding in their individual practices, hospitals, medical schools, and communities are clearly defined. The central role of the pediatrician in coordinating breastfeeding promotion programs is emphasized. These recommendations are consistent with the goals and objectives of a number of public health organizations and movements across the country. Several recent studies on the initiation of breastfeeding by new mothers provide evidence of the impact that a neonatal intensive care unit can have on a mother's choice or ability to breastfeed or express breast milk to their infant. In 1983, a team of researchers in Dundee, Scotland studied the relationship of childhood health to the type of diet the children received during infancy. The team randomly selected 750 pregnant women to participate in the study. After the birth of their babies, the research team visited them regularly at home and recorded observations such as the type of infant feeding and frequency of illness as well as other relevant social and family data. The information that they collected was carefully analyzed. The results showed that breast fed children had noticeably less diarrhea, vomiting and respiratory illness during the first year of life compared to children who were bottle fed (Department of Health, 2005). According to Latto (2004) 90 percent of the 44 mothers they interviewed in their study had previously decided in early pregnancy how they wanted to feed their baby. Of that 90%, only 10 percent chose to formula or bottle-feed. A quarter of that group changed their mind following an early delivery. The reasons the mothers gave for this change of mind focused on the vulnerability of their baby's health at birth. Fifty-nine percent reported that the hospital had suggested breastfeeding as the best method at that stage of baby's life. There is also evidence that programs combining breastfeeding education with behaviorally oriented counseling are associated with increased rates of breastfeeding initiation and its duration for up to three months, although effects beyond three months are uncertain. Effective programs generally involve at least one extended session, followed structured protocols, and included practical behavioral skills training and problem solving in addition to didactic instruction. There is also fair evidence that providing ongoing support for patients through ongoing contact with providers or counselors increased the percentage of women who continue breastfeeding for up to six months (Collen et al., 2005). However, such support had a much smaller effect than educational programs on the initiation of breastfeeding and its duration. Too few studies have been conducted to determine whether the combination of education and support is more effective than education alone. There is insufficient evidence, however, that the effectiveness of counseling by primary care providers during routine visits and the effectiveness of peer counseling initiated from the clinical setting were significant when used alone to promote breastfeeding without the aid of breastfeeding education. The evidence for the effectiveness of written materials suggests no significant benefit when written materials are used alone (McKinley et al., 2004). Some reported reasons for the low percentages of breastfeeding mothers include a lack of interest in breastfeeding from physicians, misinformation, inadequate education about breastfeeding, and the immediate return to work by new mothers (Tyson, 1998). Public Health and the Relationship to Policy Pubic Health theory can often change or create policy. Initially, legislation concerned itself with issues of breastfeeding in public, stating that mothers have a right to breastfeed their babies wherever they go. Since then, other issues have occurred, such as allowing breastfeeding mothers to be exempt from jury duty, or safeguarding the jobs of breastfeeding mothers when they return to work (Dykes, 2005). Legislation is being enacted to make it easier for new mothers to breastfeed in a number of ways. Despite the growing awareness of the advantages, there are still some obstacles that affect a mother's decision to breastfeed or to continuing to breastfeed once leaving the hospital. Much of the new legislation amends some laws and statutes in order to ensure that breastfeeding mothers are protected from being charged with indecent exposure or lewd conduct while breastfeeding (Galtry and Callister, 2005). This is a problem because many of these statutes are vague and could apply to the occurrence of breastfeeding in public. It is a surprising act that many people in society view breastfeeding in public as obscene or indecent (Battersby et al., 2005). The Health Belief Model The model suggests that "whether or not people change their behavior will be influenced by an evaluation of its feasibility and its benefits weighed against its costs". Individuals own views come into play regarding the likelihood of contracting an illness or injury themselves, perceived the severity of this illness or injury, and the effectiveness of the action being taken and whether it will keep the illness or injury from occurring. As stated previously, public health cannot be forced upon a group or an individual, or suggested or promoted. The individual must make the decision on his or her own to take action. According the model, if a behavior change is going to take place, individuals must first have an incentive to change. Given the suggestions and research on the health benefits of breastfeeding, it is being made evident to new mothers that breastfeeding would provide the most health benefits to baby. The incentive should come from the want to provide those benefits for a healthier child. The individual must also feel threatened by their current behavior and feel that changing this behavior would be beneficial and have few adverse effects. The incidents of childhood illnesses that are declined by the initiation of breastfeeding as well as the economic benefits for the families of breastfed babies provides a sound foundation for an individual to choose to breastfeed. The illness spoke of range in severity. It is normal for new mother to feel threatened by the idea of their babies being diagnosed. This threat itself is in promotion of breastfeeding. Finally, the individual must feel competent in carrying out the changes made. If society were to become more accepting and supportive of breastfeeding mothers, more individuals would be likely to reach this stage and choose breastfeeding as the feeding method of choice for their babies. Social, Economic, and Political Influence on Health A major focus of public health theory is the influence that these issues have on the social, economic, and political aspects of society. Breastfeeding is a good example because it can manipulate all of these things. Since breastfeeding has proved to be connected to fewer childhood illnesses, it creates reduced health care costs and less employee absenteeism for mothers of young children (Schoen, 2004). A lower occurrence of sickness in breastfed infants allows the parents to give more attention to other family matters and cuts down on the loss of household income. It is also evident that the amount of money that families spend in the care, particularly the feeding, of non-breastfed infants is much greater than for those that are breastfed. It has been estimated that approximately $855 per year is spent in the purchasing of infant formula for the first year of life for the average family. An approximate saving of more than $400 per child for food purchases can be expected during the first year for breastfed children (Zaghloul et al., 2004). Not only does breastfeeding reduce an infant's chances of developing many developmental deficits and illnesses, but it has also been found that women who practice prolonged breastfeeding have considerably reduced rates of breast cancer (Wolf, 2003). Today there remain to be epidemics of asthma and obesity among children, which is causing health care costs to increase. Increasing breastfeeding rates could very well be the most logical way to improve the health of the nation's children as well as to diminished health care costs. With this in mind, several organizations have initiated breastfeeding promotions (Labarere et al., 2005). According to research, if women breastfed their infants until two years after birth, the incidence of breast cancer in women could decrease by twenty-five percent (Swanson, 2005). Considering the health care costs for cancer patients, as well as the loss of household income and the emotional trauma for families, promoting breastfeeding is in society's best interest. 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