Mitigating health inequity through healthy foods network development

SDU Res. J. : Jan-Dec 2015 Mitigating Health Inequity Through a Healthy Foods Network Development

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Mitigating Health Inequity Through a Healthy Foods Network Development

Thira Woratanarat*1, Ubol Chuensumran2,

Chanchana Siripanwattana2 and Patarawan Woratanarat4

1Department of Preventive and Social Medicine, Faculty of Medicine,

Chulalongkorn University, Thailand 2School of Culinary Art, Suan Dusit University, Thailand

3Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Abstract

Background: Health inequity is among the most important problems in the global setting. One of the very pertinent problems is inadequate access to healthy foods for patients and health workforces in public hospitals in urban setting due to over-crowdedness of junk foods and bakery shops.

Objective: To address a new and effective operational model, multidisciplinary and inter-professional experts from health and food educational settings have formed “Healthy Foods Network” to mitigate the healthy foods inequity problem in public hospitals in Bangkok, Thailand.

Methods: With the support from the Thai Health Promotion Foundation, the network has been established during the last trimester of 2013 by collaborators from Chulalongkorn University, Suan Dusit University, and a group of patients with chronic diseases from King Chulalongkorn Memorial Hospital (KCMH).

Healthy foods availability, channel of accessibility, and consumer behavior were three main strategies. The investigation team comprised professional foods industry expert that willingly modified their food products in consultation with health professionals and nutritionists to match healthy foods criteria in regards to the amount of calories per portion, fiber, sugar, fat, and salt.

* Corresponding Author e-mail: [email protected]

Mitigating Health Inequity Through a Healthy Foods Network Development SDU Res. J. : Jan-Dec 2015

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Results: More than 46 menus have been created and prepared for sale to the patients and public at KCMH. Advocacy from KCMH administrators has been granted through lobbying with the brand image and corporate social responsibility issues. Consumer surveys were done with the support from a chronic disease patient group at KCMH to reassure appropriate healthy foods menus and taste. From September 2014-March 2015, the food kiosk has operated 3 hours in the morning from Monday to Friday. Healthy foods have been delivered to the patients, general population as well as health workforces for a total of more than 25,000 portions with a high satisfaction rate. At present, several large public hospitals have expressed their interest to adopt this collaborative model to their settings. Additionally, small and medium foods enterprises have been invited to co-create more healthy food menus in order to participate in future plans to scale up to “Healthy Foods in All Public Hospitals in Bangkok”. Mass media also regarded this approach as a new way for the hospitals to practice their social responsibility.

Conclusion: KCMH model has been considered as a new effective way to create healthy foods equity to the population through a hospital setting in a metro area of Thailand.

Keywords: Health inequity, Healthy foods, Multidisciplinary network, Health promotion, Population lifestyle

Introduction

The World Health Organization defines “health” as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1946). Nowadays, health inequity is among the most important problems in the global setting. Health inequity issue, mostly involve avoidable inequalities in health between groups of people within countries and between countries. These arise from inequalities within and between societies. Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them from becoming ill or for treating illness when it occurs.

Thailand is inevitably among countries facing with this problem, which has been generally expressed in light of the inadequacy of resources with or without quality issues, not enough channels of accessibility, and inability of existing choices to serve consumers’ needs. The easiest way to understand the health inequity problem is to see it through the lens of population lifestyles.

Woratanarat T has proposed the concept of population lifestyles in 2011 by explaining that everyone on earth always has their activities of daily living in 7 dimensions: eating, using products/services, living/inhabitation, sleeping/relaxation, communication,


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working, and learning (Woratanarat and Woratanarat, 2012; Woratanarat, Woratanarat, and Angsanantsuk, 2014). Most inequities in life that affect population health are among these dimensions.

At the national and international levels, every aspect of government and the economy has the potential to affect health and health equity – finance, education, housing, employment, transport, health, etc. While health may not be the main aim of policies in these sectors, they have strong bearing on health and health equity. Hence, policy coherence and congruence are crucial – different government departments’ policies must complement rather than contradict each other in relation to health equity. For example, trade policy that actively encourages the production, trade, and consumption of foods high in fats and sugars to the detriment of fruit and vegetable production is contradictory to health policy.

When focusing into a more micro-level at the grass root, let’s say in health services system especially in government sector, health inequities are also easily found in various forms such as crowdedness, long waiting lines, etc. One of the very pertinent problems is inadequate access to healthy foods for patients and health workforces in public hospitals in urban setting due to over-populating of junk foods and bakery shops. This result, in creating an unhealthy environment for those patients who are in need of “health”, as well as for those health personnel who are socially accepted to be experts in “health”, resulting in lesser choices to achieve healthy eating. Many hospitals in Thailand have already tried to counteract this emerging problem by promoting healthy foods through hospital dietitians and nutritionists with high rates of unsuccessful responses.

To address a new and effective operational model, multidisciplinary and inter-professional experts from health and food educational settings have formed “Healthy Foods Network” to mitigate the healthy foods inequity problem in public hospitals in Bangkok, Thailand.

Research Methodology

With the support from the Thai Health Promotion Foundation, the “Healthy Foods Network” has been established since the last trimester of 2013 by collaborators from a) R&D Office for Health Research Translation, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, b) Suan Dusit University, and c) administrators, health educators, and a group of patients with chronic diseases from King Chulalongkorn Memorial Hospital (KCMH).

Healthy foods availability, channel of accessibility, and consumer behavior were three main strategies exercised to establish a model of “Healthy foods for all” at KCMH, aiming to test drive and being a learning resource for other government hospitals in Thailand.


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The investigation team comprised professional food industry experts that willingly modified their food products in consultation with health professionals and nutritionists to match healthy foods criteria in relation to the amount of calories per portion, fiber, sugar, fat, and salt.

Results

Starting the aforementioned processes in June 2014, more than 46 ready-to-eat healthy food menus have been created and prepared for sale to the patients and public at KCMH. Recommended daily intake (RDI) was calculated and labelled with color shading attached to every food package so that the consumers could easily understand and make rational choices that suited their needs. Branding process was collaboratively done. “Kin Dee Yoo Dee” was generated for use as a brand for healthy foods to be sold in the hospital. The logo was crafted by the team with the altruistic assistance from an industrial designer as demonstrated in Figure 1.

Figure 1: Food packages with labels


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Advocacy from KCMH administrators has been granted through lobbying with the brand image and corporate social responsibility issues. Consumer surveys were done with the support from chronic disease patient group at KCMH to reassure appropriate healthy foods menus and taste. (Figure 2)

Figure 2: Consumer check for healthy food menus and taste

From September 2014-March 2015, the food kiosk has operated 3 hours in the morning (09.00 - 12.00 hr) from Monday to Friday as shown in Figure 3. Healthy foods have been delivered to the patients, general population as well as health workforces more than 25,000 portions with high satisfaction rate. Consumers were regularly assessed in the following topics: reasons to buy, satisfaction rate regarding foods, place, time, and price, as well as additional services that they need and their most favorite menus. This information was then compiled and reported in the monthly meeting in order for the team to better plan and more effectively operationalize the system.


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Figure 3: Food kiosk at M floor, KCMH

After opening the first kiosk for a month, hospital administrators requested an additional kiosk at another building to mainly serve hospital administrators and hospital personnel. At present, several large public hospitals have expressed their interest to adopt this collaborative model to their settings. Additionally, small and medium foods enterprises have been invited to co-create more healthy food menus in order to participate in future plan to scale up to “Healthy Foods in All Public Hospitals in Bangkok”. Mass media also regarded this approach as a new way for the hospitals to practice their social responsibility.

Conclusion and Discussion

From our developmental study, the KCMH ready-to-eat healthy foods model was very well adopted by not only patients but also healthcare personnel in the hospital. Most foods were sold out within operation hours and there were requests to the team to establish the pre-ordered system as well as delivery services.

Although our KCMH model is a method of promoting healthier foods in the healthcare facilities, like the earlier philosophy in some western countries that have prior attempted to obesity i.e. “Hospital healthier foods initiative” and “Healthy hospital choices” in the US4-5), (Hospital healthier Foods initiative, 2012; Wiseman e.t.al., 2012) we believe


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that our approach is different. Collaboration among food professionals, health professionals, dietitians and nutritionists, and network of chronic disease patients, together with using the food manufacturing industry to move forward the process and deliver the products, are among key success factors in our model.

An additional promoting factor is the negotiating mechanism that has been applied during this period to persuade the hospital administrator to recognize that it is feasible and invaluable for the hospital to express their social responsibility not only through medical services. Fostering a healthier eating environment is another way for the hospital to objectively demonstrate firm commitment on “Health in all policies” to the public in accordance with the global call for action from World Health Organization6 (WHO, 2014).

From our perspective, health problems, at the present time, cannot be more effectively controlled unless we find alternative ways to replace an old belief that “health problems should be solved only by health experts”. We are pinpointing that it is a time for “Health by All”. And yes, this is a concept for global action from our Thai model.

KCMH model has been considered as a new effective way to create healthy foods equity to the population through a hospital setting in a metro area of Thailand.

References

Preamble to the Constis tution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

Woratanarat T. and Woratanarat P (2012). New approach in health promotion. Chulalongkorn University, Bangkok.

Woratanarat P., Woratanarat T., Angsanantsuk C., et al. (2014) Lifestyles and musculoskeletal disorders. Charansanidwongse Publishing, Bangkok.

Wiseman, A., Boothe, A., Reynolds, M., et al. (2012) Healthy hospital choices. National center for chronic disease prevention and promotion. Center for disease control, USA.

Hospital healthier foods initiative. (2012) Partnership for a healthier America, USA.

Health in all policies: Helsinki statement framework for country action (2014). World Health Organization.


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Authors

Assistant Professor Dr. Thira Woratanarat

Department of Preventive and Social Medicine, Faculty of Medicine,

Chulalongkorn University, Thailand

e-mail: [email protected]

Assistant Professor Dr. Ubol Chuensumran

Department of Food Processing Technology, School of Culinary Art,

Suan Dusit University, Thailand


Mrs. Chanchana Sirirpanwattana

Department of Culinary Technology and Service, Schol of Culinary Art,

Suan Dusit University, Thailand


Associate Professor Dr. Patarawan Woratanarat

Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital,

Mahidol University, Thailand


Mitigating health inequity through healthy foods network development

Health & Medicine

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