Lewin on stakeholder perspectives concerning prevention of childhood obesity

Alexandra C. Lewin (2009, January). Whose responsibility? The role of the federal government in preventing childhood obesity: Perspectives of organizations, congressional staffers, and parents. Doctoral dissertation, Cornell University.

Abstract: This dissertation examined three stakeholder groups and their perspectives about the role of the federal government in preventing childhood obesity. The three stakeholder groups included organizations involved in childhood obesity, U.S. Congressional staffers working on health and agriculture policy, and low-income African-American parents of elementary school children in Washington, DC. Frequently at the core of the debate over the role of the federal government is the notion of personal responsibility � whether preventing childhood obesity is limited to individual decisions, whether there might be larger systemic issues that shape individual behavior, and when it may be the government�s responsibility to protect our children�s public health. The research completed to date has focused more on either the media�s use of the personal responsibility frame and public opinion studies that have gathered only a general understanding of individual support for/against pre-selected obesity frames and policies. The underlying perspectives shaping opinions, and the values and subjectivity embedded within these debates and policy options, have been sparsely documented. Rather than view nutrition as objective, where policy outcomes are the result of pure scientific debate, this research considers the policy process itself and within it the nuanced opinions, strategies employed, and values invoked by these three sectors. A discourse analysis to define and examine interpretive packages was completed to examine organizations� press release language in response to one or more of the four obesity-related Institute of Medicine reports. A Q study, using statements largely from the aforementioned press releases, and follow-up interviews, were completed with individual Congressional staffers. A Q study was also completed with each parent, and follow-up focus groups were completed with groups of parents. Two interpretive packages, with two sub-emphases, emerged from the organization study. The Multiple Responsibility package contained both Political Responsibility and Everyone�s Responsibility sub-emphases. The Self-Reliance package contained both Self-Regulation and Consumer Sovereignty sub-emphases. The Congressional staffer Q study revealed three perspectives: Government Action Advocates, Select Government Action Advocates, and Personal Responsibility Advocates. The Parent Q study also revealed three perspectives: Parents + Specific Government, Parents + General Government, and Government + Other.

Alexandra Lewin received her undergraduate degree from Cornell University in 2004 and a Masters in Public Administration from the Cornell Institute for Public Affairs in 2005. Her thesis focused on the impact of different sugar trade policies on least-developed countries. As part of her MPA, she attended Cornell-in-Washington and worked as an Agriculture Fellow in the U.S. Senate. She is currently a Nutrition Policy Fellow at the Center for Science in the Public Interest.

Q Workshop in Thailand

A training workshop on Q methodology was held March 10-12 in the Miracle Grand Convention Hotel in Bangkok, Thailand, and was attended by more than 30 Thai participants (plus 2 from Australia) with specializations primarily in public health, medicine, nursing, pharmacy, veterinary medicine, and agriculture, most of them involved in programs related to avian influenza (AI). Other represented specializations were in management, communication, economics, and sociology. Organized by Suttini Wattanakul, Lecturer in the Sirindhorn Public Health College (under the Ministry of Public Health), Ubonratchathani, the workshop was sponsored by the International Development Research Center (IDRC) of Canada and organized by Sirindhorn Public Health College and the University of Ubonratchathani. The workshop was underwritten by a grant from IDRC to the Asian Partnership on Avian Influenza Research in five Asian countries (Cambodia, China, Indonesia,Thailand, and Vietnam). The workshop director was Steven Brown.

The workshop involved lectures and an exercise using a Q sample focused on AI. The resulting Q sorts produced three factors, two of which were bipolar. FACTOR A placed emphasis on vaccine development (There is an immediate need to promote international research programs to develop new and better diagnostics and vaccines for AI control and Countries should be encouraged to license and use only high-quality AI vaccines that meet good manufacturing and quality control criteria), increased compensation for farmers as an inducement to early reporting (Governments should increase the amount of compensation for poultry farmers to encourage them to report and cull sick birds), and expressed concern about the evolution of a virus that would pose a threat to humans (Recent AI epidemics have created significant human health issues, including the risk of generating a new pandemic virus for humans via the avian-human link). FACTOR B emphasized the shoring up of certain institutions (For compartmentalization to be effective, it requires the country to have a robust and credible veterinary service, as well as a strong collaboration between the private and public sectors) due to weaknesses in others (Bird flu has been able to spread partly due to ignorance among the millions of farmers in poor nations), and also the proactive protection of vulnerable groups (The pre-vaccinating of high-risk groups could almost immediately be implemented and spread out over months and even years so that production capacity would be less a constraint in pandemic preparedness). The other end of the factor (FACTOR B-NEGATIVE) was critical of some harsh policies of the past (e.g., Stamping out policies have led to very high costs and economic losses for the affected nations, stakeholders, and, ultimately, consumers) and favored the development of incentive systems (There is need for an incentive mechanism for industry to substantially invest upfront in the research and development of various pandemic flu vaccines knowing that these products may eventually not be used or acquired) and directed attention to migratory rather than domesticated birds (Migratory waterfowl have been implicated in the transmission of the H5N1 strain from Asia to Europe, but little is known as to the species that are capable of this transmission and their ability to remain infected and infective through time). As with the previous factor, FACTOR C was also interested in distinguishing domestic vs. migratory birds (Free-flying birds and birds in captivity in zoological and wildlife exhibits should be viewed as separate compartments from agricultural systems) and was more cautious about the implementation of vaccination programs due to the economic impact on various segments of the population (Before implementing a vaccination strategy, an overall cost-benefit analysis should be performed, taking into account the implications on trade, the impact of movement restrictions, and biosecurity measures to be enforced in the vaccination area? and ?The financial losses due to AI epidemics have been huge for the commercial and public sectors, especially once the AI viruses were introduced in areas with high bird densities?). Finally, the other pole of this factor (FACTOR C-NEGATIVE), which was defined by only one participant, seemed to be more apprehensive, giving urgent emphasis to the following: Given today’s frequent international travel and cross-border flow of goods, once a pandemic strain does emerge, it will be impossible to prevent it from spreading globally, Because of human health implications, control plans must aim at the elimination of AI infection, based on any strategy that is chosen,Recent AI epidemics have created significant human health issues, including the risk of generating a new pandemic virus for humans via the avian-human link,and There is an immediate need to promote international research programs to develop new and better diagnostics and vaccines for AI control.

The Q-methodological application on the final day of the workshop took participants through a decision-making exercise focused on recommendations that might be made to the Thai government about how it could address the problems associated with AI. The Q sample was generated by participants through a nominal group and idea-writing exercise and the resulting Q sorts produced a three-factor solution, one of them being bipolar. One of the factors was dominated by medical participants (including a veterinarian) who emphasized a program of public information rather than government action (e.g., passing laws or establishing an AI agency). The bipolar factor emphasized local vs. national/international action, the one pole recommending an education program at the primary school level and the other pole recommending that the Thai government contribute to the development of standards for an international AI policy. The final factor emphasized comprehensive state action: Implement law or regulation about AI,Improve control of animal movement over borders, and Create a master plan.

The workshop participants, who appeared genuinely interested in Q methodology, asked several questions and many were eager to receive additional information in the way of articles and chapters. The availability of scholarly literature plus the experience of participating in two real-time studies will hopefully enable participants to begin utilizing the methodology in their own settings and on problems of their own choosing.