The childhood obesity epidemic can be best tackled by means of an integrated approach, which is enabled by integrated public health policies, or Health in All Policies. Integrated policies are developed through intersectoral collaboration between local government policy makers from health and nonhealth sectors. Such intersectoral collaboration has been proved to be difficult. In this study, we investigated which resources influence intersectoral collaboration. The behavior change wheel framework was used to categorize motivation-, capability-, and opportunity-related resources for intersectoral collaboration. In-depth interviews were held with eight officials representing 10 non-health policy sectors within a local government. Results showed that health and non-health policy sectors did not share policy goals, which decreased motivation for intersectoral collaboration. Awareness of the linkage between health and nonhealth policy sectors was limited, and management was not involved in creating such awareness, which reduced the capability for intersectoral collaboration. Insufficient organizational resources and structures reduced opportunities for intersectoral collaboration. To stimulate intersectoral collaboration to prevent childhood obesity, we recommend that public health professionals should reframe health goals in the terminology of nonhealth policy sectors, that municipal department managers should increase awareness of public health in non-health policy sectors, and that flatter organizational structures should be established. 1. Introduction Childhood obesity is currently considered an epidemic. Prevalence rates have doubled over the last three decades. Globally, approximately 180 million children (<18 years) are estimated to be overweight or obese [1–3]. In 2010, 43 million of them were under the age of five [3]. This rapid development has focused much attention on the problem (e.g., [4, 5]), especially since childhood obesity is associated with many health problems [6]; it often tracks into adulthood [7] and causes huge rises in health care costs [8]. The childhood obesity epidemic shows predictable patterns in almost all countries, due to similar systemic drivers (policies and economic systems) and environmental drivers (marketing of energy-dense foods and facilitation of passive transport) promoting overconsumption and physical inactivity [4]. Interaction between individual factors (e.g., genetic predispositions) and the environments in which children grow up (e.g., their neighborhoods) lead to behaviors that cause a positive energy balance
References
[1]
T. Lobstein, L. Baur, and R. Uauy, “Obesity in children and young people: a crisis in public health,” Obesity Reviews, vol. 5, no. 1, pp. 4–104, 2004.
[2]
World Health Organization, Childhood Overweight and Obesity, World Health Organization, Geneva, Switzerland, 2012, http://www.who.int/dietphysicalactivity/childhood/en/.
[3]
M. de Onis, M. Bl？ssner, and E. Borghi, “Global prevalence and trends of overweight and obesity among preschool children,” American Journal of Clinical Nutrition, vol. 92, no. 5, pp. 1257–1264, 2010.
[4]
B. A. Swinburn, G. Sacks, K. D. Hall et al., “The global obesity pandemic: shaped by global drivers and local environments,” The Lancet, vol. 378, no. 1, pp. 804–814, 2011.
[5]
R. Schepper, Let's Move Cities and Towns: Toolkit for Local Officiald, The White House, Washington, DC, USA, 2011, http://www.villageoffranklinpark.com/DownloadTracking.aspx?DocumentId=542.
[6]
J. C. Han, D. A. Lawlor, and S. Y. Kimm, “Childhood obesity,” The Lancet, vol. 375, no. 9727, pp. 1737–1748, 2010.
[7]
K. M. Herman, C. L. Craig, L. Gauvin, and P. T. Katzmarzyk, “Tracking of obesity and physical activity from childhood to adulthood: the physical activity longitudinal study,” International Journal of Pediatric Obesity, vol. 4, no. 4, pp. 281–288, 2009.
[8]
D. A. Mayer-Foulkes, “A survey of macro damages from non-communicable chronic diseases: another challenge for global governance,” Global Economy Journal, vol. 11, no. 1, p. 6, 2011.
[9]
B. Swinburn, G. Egger, and F. Raza, “Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity,” Preventive Medicine, vol. 29, no. 6, pp. 563–570, 1999.
[10]
S. L. Gortmaker, B. A. Swinburn, D. Levy, et al., “Changing the future of obesity: science, policy, and action,” The Lancet, vol. 378, no. 4, pp. 838–874, 2011.
[11]
I. Kickbusch, Policy Innovations for Health, Springer, New York, NY, USA, 2009.
[12]
I. Kickbusch and D. Gleicher, Governance for Health in the 21st Century, World Health Organization, Geneva, Switzerland, 2012, http://www.euro.who.int/__data/assets/pdf_file/0019/171334/RC62BD01-Governance-for-Health-Web.pdf.
[13]
I. Storm, L. Zoestand, and L. den Broeder, Integraal Gezondheidsbeleid: Theorie en Toepassing, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands, 2007, http://www.rivm.nl/bibliotheek/rapporten/270851003.html.
[14]
D. T. Finegood, T. D. N. Merth, and H. Rutter, “Implications of the foresight obesity system map for solutions to childhood obesity,” Obesity, vol. 18, no. 1, pp. S13–S16, 2010.
[15]
Public Health Agency of Canada, Crossing Sectors-Experiences in Intersectoral Action, Public Policy and Health, Ottawa, Canada, 2007, http://www.phac-aspc.gc.ca/publicat/2007/cro-sec/pdf/cro-sec_e.pdf.
[16]
M. Steenbakkers, M. W. J. Jansen, H. Maarse, and N. de Vries, “Challenging health in all policies, an action research study in Dutch municipalities,” Health Policy, vol. 105, no. 2, pp. 288–295, 2012.
[17]
M. W. J. Jansen, Mind the Gap: Collaboration between Practice, Policy and Research in Local Public Health, Universitaire Pers Maastricht, Maastricht, The Netherlands, 2007.
[18]
J. Woulfe, T. R. Oliver, S. J. Zahner, and K. Q. Siemering, “Multisector partnerships in population health improvement,” Preventing Chronic Disease, vol. 7, no. 6, p. 119, 2010.
[19]
J. Harting, L. Paauwe, and K. Stronks, Theoretische Perspectieven op Intersectorale Samenwerking en Integraal Beleid. Een Thematische Review, AMC Sociale Geneeskunde, Amsterdam, The Netherlands, 2011.
[20]
A.-M. Hendriks, M. W. J. Jansen, J. S. Gubbels, N. K. de Vries, T. Paulussen, and S. P. J. Kremers, “Proposing a conceptual framework for public health policy making at the local governmental level-the Behavior Change Ball,” Implementation Science, 2013.
[21]
S. Michie, M. M. van Stralen, and R. West, “The behaviour change wheel: a new method for characterising and designing behaviour change interventions,” Implementation Science, vol. 6, no. 1, p. 42, 2011.
[22]
A.-M. Hendriks, S. P. J. Kremers, M. W. J. Jansen, J. C. Seidell, N. K. de Vries, and J. S. Gubbels, “Interventions to promote an integrated approach to public health problems-an application to childhood obesity,” Journal of Environmental and Public Health, vol. 2012, Article ID 913236, 14 pages, 2012.
[23]
M. J. Aarts, M. P. J. Jeurissen, H. A. M. van Oers, A. J. Schuit, and I. A. M. van de Goor, “Multi-sector policy action to create activity-friendly environments for children: a multiple-case study,” Health Policy, vol. 101, no. 1, pp. 11–19, 2011.
[24]
A. M. Thow, B. Swinburn, S. Colagiuri et al., “Trade and food policy: case studies from three Pacific Island countries,” Food Policy, vol. 35, no. 6, pp. 556–564, 2010.
[25]
M. B. Schwartz and K. D. Brownell, “Actions necessary to prevent childhood obesity: creating the climate for change,” Journal of Law, Medicine and Ethics, vol. 35, no. 1, pp. 78–89, 2007.
[26]
M. Nestle, “Food industry and health: mostly promises, little action,” The Lancet, vol. 368, no. 9535, pp. 564–565, 2006.
[27]
C. L. Peeler, E. D. Kolish, M. Enright, and C. Burke, The Children's Food & Beverage advertising Initiative in Action, Council of Better Business Bureaus, Arlington, Tex, USA, 2010, http://www.bbb.org/us/storage/0/Shared%20Documents/BBBwithlinks.pdf.
[28]
P. Verduin, S. Agarwal, and S. Waltman, “Solutions to obesity: perspectives from the food industry,” The American Journal of Clinical Nutrition, vol. 82, no. 1, pp. 259–261, 2005.
[29]
A. M. Thow, C. Quested, L. Juventin, R. Kun, A. N. Khan, and B. Swinburn, “Taxing soft drinks in the Pacific: implementation lessons for improving health,” Health Promotion International, vol. 26, no. 1, pp. 55–64, 2011.
[30]
S. Allender, E. Gleeson, B. Crammond et al., “Policy change to create supportive environments for physical activity and healthy eating: which options are the most realistic for local government?” Health Promotion International, vol. 27, no. 2, pp. 1–14, 2012.
[31]
S. Allender, N. Cavill, M. Parker, and C. Foster, “Tell us something we don't already know or do! the response of planning and transport professionals to public health guidance on the built environment and physical activity,” Journal of Public Health Policy, vol. 30, no. 1, pp. 102–116, 2009.
[32]
M. Caraher and J. Coveney, “Public health nutrition and food policy,” Public Health Nutrition, vol. 7, no. 5, pp. 591–598, 2004.
[33]
C. Bovill, “Rhetoric or reality? Cross-sector policy implementation at the UK government Department for International Development,” Policy and Politics, vol. 37, no. 2, pp. 179–199, 2009.
[34]
B. W. Head, “Wicked problems in public policy,” Public Policy, vol. 3, no. 2, pp. 101–118, 2008.
[35]
S. Allender, E. Gleeson, B. Crammond et al., “Moving beyond “rates, roads and rubbish”: how do local governments make choices about healthy public policy to prevent obesity?” Australia and New Zealand Health Policy, vol. 6, no. 1, p. 20, 2009.
[36]
J. Nishant, B. S. Trivedi, J. Fields, et al., “Lack of correlation between anti-obesity policy and obesity growth rates: review and analysis,” American Association of Clinical Endocrinologists, vol. 18, no. 5, pp. 737–744, 2012.
[37]
L. Dorfman and L. Wallack, “Moving nutrition upstream: the case for reframing obesity,” Journal of Nutrition Education and Behavior, vol. 39, no. 2, pp. S45–S50, 2007.
[38]
J. D. Klein and W. Dietz, “Childhood obesity: the new tobacco,” Health Affairs, vol. 29, no. 3, pp. 388–392, 2010.
[39]
M. M. Phillips, K. Ryan, and J. M. Raczynski, “Public policy versus individual rights in childhood obesity interventions: perspectives from the Arkansas experience with act 1220 of 2003,” Preventive Chronic Disease, vol. 8, no. 5, pp. 96–103, 2011.
[40]
M. S. Merry, “Paternalism, obesity, and tolerable levels of risk,” Democracy and Education, vol. 20, no. 1, 2012.
[41]
C. Alter and J. Hage, Organizations Working Together: Coordination in Interorganizational Networks, Sage, Newbury Park, Calif, USA, 1993.
[42]
D. J. Hunter, “Leading for health and Wellbeing: the need for a new paradigm,” Journal of Public Health, vol. 31, no. 2, pp. 202–204, 2009.
[43]
M. Warner and N. Gould, “Chapter 5- integrating health in all policies at the local levels: using network governance to create ‘virtual reorganization by design’,” in Policy Innovations for Health, I. Kickbusch, Ed., Springer, New York, NY, USA, 2009.
[44]
K. R. Isett and K. G. Provan, “The evolution of dyadic interorganizational relationships in a network of publicly funded nonprofit agencies,” Journal of Public Administration Research and Theory, vol. 15, no. 1, pp. 149–165, 2005.
[45]
M. Steenbakkers, M. W. J. Jansen, H. Maarse, and N. K. de Vries, “Sturing op integraal gezondheidsbeleid: de rol van gemeentelijke afdelingshoofden,” Tijdschrift voor Gezondheidswetenschappen, vol. 89, no. 5, pp. 266–273, 2011.
[46]
R. Axelsson and S. B. Axelsson, “Integration and collaboration in public health-a conceptual framework,” International Journal of Health Planning and Management, vol. 21, no. 1, pp. 75–88, 2006.
[47]
S. Bowen and A. B. Zwi, “Pathways to “evidence-informed” policy and practice: a framework for action,” Policy Forum, vol. 2, no. 7, pp. 600–605, 2005.
[48]
W. B. Schaufeli, “Work engagement. What do we know and where do we go?” Romanian Journal of Applied Psychology, vol. 14, pp. 3–10, 2012.
[49]
S. W. Fraser and T. Greenhalgh, “Coping with complexity: educating capability,” British Medical Journal, vol. 323, pp. 799–308, 2001.
[50]
A. K. Sen, Commodities and Capabilities, Oxford University Press, Oxford, UK, 1985.
[51]
J. Yip, S. Wong, and C. Ernst, “The nexus effect: when leaders span group boundaries,” Leadership in Action, vol. 28, pp. 13–17, 2008.
[52]
R. Yin, Applications of Case Study Research, Sage Publishing, Newbury Park, Calif, USA, 1993.
[53]
D. Stone, Policy Paradox-The Art of Political Decision Making, W.W. Norton & Company, New York, NY, USA, 1997.
[54]
M. McGuire, “Collaborative public management: assessing what we know and how we know it,” Public Administration Review, vol. 66, no. 1, pp. 33–43, 2006.
[55]
M. O. Kok and A. J. Schuit, “Contribution mapping: a method for mapping the contribution of research to enhance its impact,” Health Research Policy and Systems, vol. 10, no. 21, pp. 1–16, 2012.
[56]
N. Milio, “Evaluation of health promotion policies: tracking a moving target,” in Evaluation in Health Promotion: Principles and Perspectives, I. Rootman, M. Goodstadt, B. Hyndman, et al., Eds., WHO Regional Publications, Copenhagen, Denmark, 2001.
[57]
J. P. Unger, J. Macq, F. Bredo, and M. Boelaert, “Through Mintzberg's glasses: a fresh look at the organization of ministries of health,” Bulletin of the World Health Organization, vol. 78, no. 8, pp. 1005–1014, 2000.
[58]
H. Giesbers, Steden in Het Grotestedenbeleid-Volksgezondheid Toekomst Verkenning, Nationale Atlas Volksgezondheid, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands, 2006, http://www.zorgatlas.nl/thema-s/grote-steden/steden-in-het-grotestedenbeleid/.
[59]
D. Yanow and P. Schwartz-Shea, Interpretation and Method: Empirical Research Methods and the Interpretive Turn, M.E. Sharp, New York, NY, USA, 2006.
