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Well, it’s Mel here - happy to be home after 5-weeks away and feeling quite energised about getting back to work on Monday…
My job is very topical at the moment - one of the major foci of my work as a Nutrition Health Promoter is the prevention of obesity. Rates of overweight and obesity, and the associated costs to the health system, are rising in New Zealand (and in the States). So obesity is a primary concern for many organisations, groups and individuals. While I’ve been away the issue has been in the media often, both here and in Missouri.
The way my vocational days were structured obesity was also the main issue I studied; I was grateful for the chance to visit many schools and city/county health departments which offered very relevant comparisons to the work I do at home. Vocational days on a GSE trip such as ours are not scheduled as rigorously as a traditional working week, thus enabling some sightseeing and other touring. BUT, because obesity is not caused in health department offices, it was my experience that each day of the 5-weeks we were in Missouri carried an opportunity to learn. EVERY Group Study Exchange experience represented a vocational experience for me; every meal eaten, every trip made, every workplace visited and every recreational experience - even baseball games were enlightening!
At the risk of offending the culture of a group of people who could not have done more for us in terms of hospitality and to whom I am grateful for making the GSE experience so amazing, I would like to share some observations I made during the trip about why obesity is topical in America. By way of mitigating the risk of offence, I feel it is important to note that in throwing such stones I run the risk of showering myself with glass - New Zealand is not ‘holier than thou’; we have our own obesity epidemic and share some of these phenomena and may yet replicate others. This is why the United States was such an appropriate place for me to undertake a GSE programme and why the experience has offered me so much.
The causes of obesity are much broader than the simple sum of our own good intentions (to eat well and exercise often). My work begins with the premise that the foundations of obesity are laid in our societies and cultures. Marketing, social encounters, physical environments, affordability and federal policies (to name but a few factors) also determine the outcome of our personal and population obesity equation:
energy in > energy out = OBESITY
Briefly on the ‘energy out’ side of the equation I would like to offer some tongue in cheek observations on how to minimise personal energy expenditure:
• Build freeways that make the car a super effective means of traversing the city and make inter-suburb walking/cycling impossible
• Don’t include sidewalks/footpaths in a residential subdivision
• Install a button in cars so passengers don’t have to pull the door shut themselves
• Do away with stairs - install elevators and escalators
• Build superstores which sell everything you might ever need in them and make sure there’s heaps of car parking right outside the door
• Keep petrol ridiculously cheap (versus $US6.30/gallon in NZ)
• Sell veggies pre-cut to minimise the need for a workout with a knife
• Ensure all goods and services are available with a drive-thru option - donuts, burgers and flu vaccinations included
• etc
On the ‘energy in’ side of the equation, large portion size, high soda pop/soft drink consumption, condiments and fast food were obvious culprits; that we can have too much of a good thing has never been more apparent! It is human nature to want ‘value’ for money.
When we won 12 donuts each just for attending a baseball game, I wrote home about how excessive this concept was. The response from Logan was, “Excessive or not, that sounds like a challenge”. Unfortunately, for too many of us, finishing what’s on offer is not about satisfying hunger, but it is about the challenge. Eating to excess is now a celebrated sport.
Schools were also regularly in the media during our time in the States, coming under the spotlight for their role in contributing to the obesity epidemic and their potential role in fighting it. I learnt a lot about the USDA school food service programme; its origins lie with the failure of many potential army recruits to pass fitness requirements due to malnutrition during war time. However, the US school food guidelines still stipulate a minimum calorie intake - and no maximum.
Nonetheless, positive things are happening in schools. I was invited to attend a school wellness committee meeting and found the group dealing with many similar issues and barriers that NZ schools face. I met with another amazing woman doing much the same job as mine - remarkably I was the first person she’d met who did a job similar to her. We also shared the commonality of not being qualified nutritionists/dietitians (rare in our field). Learning about her work in schools was one of the most inspiring vocational experiences I had and I have returned home with many of her very useful resources.
Soda pop/soft drinks were perhaps the most topical health issue in the media during my time in Missouri. An announcement was made that soft drink giants would restrict the sale of their products to schools - at the schools’ requests. This appeared to be widely (mis)understood as soft drinks being banned in schools (if I had $10 for every time I heard that I might have been able to afford the coveted sightseeing flight for Mary, Nik and myself…) Sadly the move is not the magic panacea it might appear: ‘middle-men’ - who will still be able to buy from the soda giants - supply many of the schools. And any school who does buy direct from the pop giants will have to change their contracts in order to benefit from the much-hyped act of corporate responsibility - at this stage the financial implications of such a move are unknown. So at this stage it’s a case of ‘watch this space’ - the cynic in me feels the announcement by the soda pop giants was a matter of jumping before they were pushed so they didn’t have to fall so far…
Surprisingly, given the concerns over obesity, work in nutrition health promotion did not appear to be widespread, but I had the opportunity to visit with other health agencies and learn about the broader scope of public health activity in Missouri. One of the most significant differences I perceived between public health in our two districts is the greater emphasis placed on health education in Missouri, where in NZ we do more work on environmental modification and legislation. I was advised before departing for the States that American health promoters do not use the Ottawa Charter (the product of a 1986 international conference on health promotion and the foundation of all the health promotion work we do in NZ; see www.who.int). However, I found most public health workers were using Ottawa Charter strategies, albeit without recognising this to be so. Many of the people I met on vocational days were grateful to learn about the framework of the Ottawa Charter - an example of the ‘exchange’ component of GSE.
We were also able to create additional vocational opportunities. A chance meeting with a smokefree worker at a weekend bonfire gave me the chance to learn about some of the awesome legislative work her organisation is doing and about some of the shocking tactics of the tobacco industry (unheard of in NZ - to my knowledge). In another, albeit slightly less accidental, encounter I met a school food director while visiting a cave office and was able to subsequently spend a morning with her; we’re hopeful of being able to pursue an inter-hemisphere physical activity competition during the northern hemisphere spring in 2007.
So there’s a lot for me to look forward to and build on as a direct result of my GSE experience. A busy year awaits; on the day we arrived home, our Finance Minister announced the budget for next year - including an additional $70M specifically for fighting obesity. Bring it on!
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Tony Henderson
non-member comment
Mel, reading your comments and feeling the obvious excitement and enthusiasm you have come back home with reminded me of my own GSE experience and the impact that the vocational visits had on me 28 years ago. There is no doubt in my mind that the GSE scheme is one of the best programmes that Rotary provides. It gives young people the opportunity to learn and have experiences and see aspects of another country's life and systems that normal tourists can not see. It is comforting to see that not too much has changed over the years. Reading your blogg has allowed me to relive my own GSE experience.