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Health is of top concern in society. Health determines the quality of life of a person and their lifespan. According to Monteiro et al. (2004), there is a link between the individual’s health and a country’s levels of poverty. Although there are many factors that determine the development of a country, such as the lack of proper infrastructure, inappropriate technology, and the lack of industrial inputs just to mention a few, the availability of a capable workforce is of great importance to the country. Human labor comprises one of the key factors of production. Therefore, it is crucial for the country to achieve high health standards not only for the sake of protecting people’s lives but also to secure a workforce that can contribute to the growth of the country. The United Nations ranked health as one of the issues that need to be addressed in an attempt to eradicate poverty in less developed countries (Vandemoortele, 2002).

Irwin and Scali (2005) argue that it is hardly possible to determine the health status of a country without considering the social determinants of health (SDH). SDH refers to other factors in terms of their well-being apart from the physical appearance of a person that influences the likelihood of the person to have health complications (ibid). These factors include the conditions in which people are born, a person’s genetic composition, the environment in which a person grows which in turn determines their vulnerability to diseases, and their age which also determines a person’s ability to fight diseases. Additionally, the social determinant of health (SDH) also includes other forces and systems such as the economic systems and policies, social norms, development agendas, political systems, and social policies (Exworthy, 2008). In this regard, this paper is purposed to explain how social determinants of health contribute to the health behaviors observed within the population.

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First, it is imperative to mention that the social determinants of health vary across nations and amongst different populations. As such, this paper will focus on the SDH that influence the health behaviors of Howard County, Maryland, USA. Howard County, which is in the state of Maryland, is one of the best counties in the U.S. in terms of the living standards of the people. According to the statistics as of 2013 (Bonica et al, 2013), Howard was the third-highest median household income earner across the country. Taking into account the fact that most of the residents in Howard are income earners, there are rare cases of extreme poverty in the area, and therefore, the health status of people is high. Consequently, with the availability of income, most households in Howard have high standards of living, which reduce their vulnerability to diseases, and most importantly, the majority of people in the county can afford health care. Frumkin (2003) asserts that Howard Country is the home to the healthiest residents in Maryland.

Although Howard is a renowned county in the US for its residents’ well-being, the county also has public health issues that contribute to the low mortality rate in the country. For example, in the span of three years, from 2008 to 2010, there were 4,105 cases of premature deaths in Howard which was relatively low compared to Baltimore City which recorded 13,272 cases of premature deaths over the same period. Moreover, a significant percentage of the population living in Howard, 8 percent, is in poor health with around 25 percent of the population living with obesity (Thom et al, 2006). The Howard County Health Assessment Survey indicates that although Howard is on top of the list among the healthiest counties in the U.S. (Koh et al., 2010), obesity is a public health issue. At least half of the population in Howard has signs of obesity: according to this survey, for every two persons in Howard, there is one person who is obese. The young population comprises the highest number of people living with obesity in Howard. Poor style of living, more so poor eating habits, is cited as the major cause of the many cases of obesity in the county.

Obesity is one of the major health issues that are of top concern in Howard and in the entire United States. The youths comprise the largest percentage of the population living with obesity in Howard County. There are a number of indicators of obesity as a public health issue in Howard. First, most parents in the county confirm that they have received warnings from doctors about their children suffering from obesity (Mullis, 2004). Also, Jeor (2001) affirms that a great number of people in Howard do not eat a healthy diet and are not physically active, and therefore, do not maintain proper health. The consumption of manufactured products, more so junk food, and the lack of exercise are the major causes of obesity (Wright & Aronne, 2012). Moreover, doctors recommend the consumption of a certain amount of vegetables, which most people in Howard do not adhere to. Poor feeding habits and the lack of exercise are the major indicators of obesity in Howard.

According to Marmot and Wilkinson (2005), the social determinants of health can either have a positive or negative effect on health. For example, the condition in which a person is born can make them either vulnerable to some diseases, especially those that are genetically inherited, or reduce their chances of getting diseases depending on their genetic composition. The rate of obesity in Howard is influenced by a number of factors such as the conditions in which people grow, age, and forces such as economic policies and development agendas.

The society has undergone major changes in terms of the lifestyle of people. Nowadays, there is an efficient and effective mode of transport due to the advanced levels of technology. With the now better means of transport, people do not have to walk long distances. Moreover, technology has simplified work by making human involvement less required as most of the work can be effectively executed by machines. The overall change in the lifestyle of people is one of the social determinants of health that has resulted in the rampant increase in the obesity cases in Howard. People, especially the youths, are not engaged in physical activities as required, and therefore, they do not observe their body weights properly.

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Economic policies and development agendas have equally contributed to the rise of obesity in Howard. Howard is one of the counties in the U.S. with the high rates of households’ income. The number of poor people in the county is significantly low compared to other counties, with only 10 percent of people living in poverty (Glennerster, 2002). Industrialization is one of the factors that has helped create employment opportunities and a source of income for the Howard population. Just like the rest of the states in the U.S., Maryland seeks to grow in terms of industrialization not only to create employment opportunities for its people but also with the aim of increasing its foreign income (Declercq, 2011). As such, the economic policies for industrialization have been emphasized in Howard. Although industrialization has helped as a source of income for most people in Howard, it has contributed to the rise of cases concerning obesity. Manufactured foods are readily available for consumption which has made people less concerned about the diet.

According to Latour, (2005), a theory is a set of generalized thinking which tries to relate things systematically as a part of the whole. In line with the Aronson and van Andel (2006) argument, the socio-ecological theory is a theory that does not only relate issues as a part of the whole but goes beyond a unit and relates it to the environment. For example, socio-ecological theories attempt to explain the behaviors of people, specifically the health issues of the population, by relating the personal factors to the environment.

The socio-ecological theory is founded on the belief that diseases and other public health issues can be effectively addressed if medics first focus on understanding the factors that cause diseases. Moreover, diseases can be treated if their causes are known and there are known prevention strategies that can stop the spread of those diseases.

The socio-ecological theory is very fundamental in addressing public health issues since it does not only focus on treating an individual but also examines the factors within the environment that cause the diseases. The model establishes a relation between individual, relationship, community, and societal factors.

The socio-ecological theory demonstrates how a health issue can be countered in stages. One must successfully understand each stage before proceeding to the next level. The first stage is the understanding of an individual. At the initial stage, one focuses on understanding biological factors and personal history that are unique to an individual, which makes them vulnerable to the health issue. Factors that are considered at the individual level include age and income among others. Secondly, at the relationship level, one examines the kind of relationships that an individual has with other people and how those relationships enhance the person’s vulnerability. Thirdly, one considers the environment in which a person relates to other people. The aim is to establish whether the setting has an effect on the person. Lastly, the theory suggests that one should end by examining societal factors that may have an impact on a person. Societal factors are those that play a part in encouraging or discouraging the occurrence of the health issue.

The socio-ecological theory can be applied to address the issue of obesity in Howard. The theory suggests that public health issues should be considered as an outcome of the interplay of many factors, which are unique to an individual and those that relate to the environment. Although obesity is a public issue in Howard, it can effectively be addressed by examining the patients at different levels. For example, at the individual level, factors such as a person’s age, their feeding habits, and their engagement in physical activities should be evaluated. At the levels of the relationship, factors such as the genetic composition of an individual should be of concern. At the third level, the contribution of the community, such as the availability of hospitals that can give medical care for the obese and the number of manufacturing industries that produce junk foods, should be considered. Lastly, factors related to the entire society, such as the kinds of meals that people consider being their stable food, should be examined. Evaluation of the issue of obesity in Howard in stages as outlined in the socio-ecological theory will help identify all the causes and consequently formulate prevention strategies.


The SEM can help solve the problem of obesity as a health issue in Howard. There is the need to ensure that there are intervention measures at each level as outlined by the SEM. According to Wright and Aronne (2012), poor eating habits and the lack of physical exercise are the major factors that have contributed to the increase in the cases of obesity in Howard. Therefore, I would recommend intervention measures that will ensure that the affected population observes the diet and also monitors their body weight. At the individual level, I would propose that the most vulnerable people, that is, children and teens, be educated on the need for physical exercise as a way of ensuring that they do not become overweight.

At the level of the relationship, I suggest that those people that are close to the affected persons and the vulnerable group be sensitized on the need for observing a healthy diet as well as participating in physical activities. This intervention can be achieved through the cooperation of guardians and teachers who should create an environment for children to be engaged in physical activities. For example, parents should take responsibility for ensuring that their children feed on healthy food.

At the community level, I recommend that intervention measures aimed at minimizing the exposure of children to poor eating habits be adopted. For example, hotels and restaurants should reduce the manufacturing of junk food and concentrate on producing healthy food. It is the social responsibility of food manufacturing industries to ensure that they promote the welfare of the community.

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Finally, at the societal level, I advise that the society be encouraged to abandon social norms and practices that have a negative effect on people’s health. For example, people should be motivated to eat home-made food as opposed to processed food. I also recommend that the government ensure that there is a balance between the economic growth resulting from industrialization and the health standards in Howard. For example, the government should give incentives to industries that process healthy food and impose penalties, such as high taxation, on industries which products contribute to the public health issue of obesity.

Visual Representation of SEM

SEM factors Proposed Interventions
Individual Encourage behaviors and attitudes toward a healthy lifestyle
Relationships Involving parents in monitoring children’s behaviors
Community Establishing facilities for body exercises such as playgrounds
Societal National implementation of policies for health lifestyle

Stakeholders Involved

The General public population

A public health issue influences every person in the affected region or country. Therefore, it is important to ensure that every person afflicted is involved in the intervention programs. In order to successfully execute the proposed intervention measures, I will ensure that I work with the entire targeted population. This is to be performed to make sure that everyone is informed of the health challenges facing the county and how each person can play part in preventing the increase in the cases of obesity. Considering the aforementioned, I would conduct seminars for all people to be educated on healthy living and how they can avoid obesity.

Parents and Guardians

According to Salvy (2009), children and young people comprise the largest percentage of the population living with obesity. Although it is important to enlighten children on how they can avoid obesity, it is more vital to ensure that parents and guardians are more involved in monitoring and guiding their children. Therefore, I would work with parents in an attempt to reduce the causes of obesity amongst children. Additionally, most cases of obesity are associated with the lifestyle of children which, on the other hand, depends on the exposure that they get from their parents. Parents have a great role to play in ensuring that children adopt a desirable lifestyle.

The Government

One of the functions of the government is to provide affordable healthcare to its people (Dalen, 2010). The provision of healthcare to the citizens is one of the functions administered at the expense of government, and therefore, the latter should be involved in matters concerning health. Therefore, I would work with the government to ensure that it is aware of the proposed intervention measures which it should take to reduce the causes of obesity in Howard and consequently decrease the expenses that are used in the treatment of obese people. Moreover, sick people are less productive for the nation, which makes it necessary for the government to be involved.

Application of the Principles of Community-Based Participatory Research

The community-based participatory research (CBPR) requires the involvement of all parties affected, such as community members, organizational representatives, and researchers, and the consideration of all players in the decision-making process (Minkler and Wallerstein, 2011). The core principles of CBPR are to increase knowledge and understanding of the phenomenon and use that knowledge to develop intervention measures and policies. I would apply the principle of CBPR in my interventions by ensuring that I include the views of the society as well as other health experts on how the prevalence of obesity in Howard can be reversed.

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The Likelihood of the Intervention Measures to Succeed

According to Sobush (2009), obesity can be prevented and reduced through a healthy lifestyle. Intervention measures aimed at solving the problem of obesity in society should focus on encouraging people to adopt a healthy lifestyle by following a healthy diet and being physically active. Some of the activities that can aid in enhancing a healthy living include making healthy food choices, reducing the consumption of junk food, being physically active, and ensuring that one keeps track of their body weight, body mass index, and waist circumference. The above-mentioned intervention measures are aimed at ensuring that children who are the most affected are encouraged to adopt a healthy lifestyle by making every stakeholder play their part effectively. For example, the intervention proposed recommends that parents be involved since they can easily influence their children’s kind of lifestyle, while the government can implement policies that discourage business persons from producing food that threatens the health of the nation. The fact that the proposed intervention measures are solely aimed at promoting a healthy lifestyle makes them appropriate in contributing to favorable health outcomes for the population in Howard.

How the Proposed Intervention Addresses Essential Public Health Services

The roles of public health care services include ensuring a competent workforce; providing care; evaluating and monitoring health; informing, educating and empowering the public; mobilizing community partnerships; and developing policies among others (Baum, 2003). The above-proposed intervention measures are aimed at ensuring that the government plays its role effectively in the provision of healthcare and the sensitization of the public about obesity. The proposed intervention requires that the government in Howard implement policies that discourage excessive processing of junk food by industries. The implementation of restrictive policies will encourage the government to execute its role in developing policies for health care successfully. Also, the proposed interventions require that other stakeholders, such as teachers and parents, be educated on the measures that need to be taken in order to overcome obesity. The proposal will ensure that people in society are informed and educated, which is also a public health service to some extent.

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