Over the past year Politudes has reported on several systematic reviews of evaluations of social interventions and programs.
One of the questions that we began to speculate about was whether some kinds of issues can be better tackled by locally-coordinated community and multi-agency action, whereas other problems might be especially difficult to tackle in that way, no matter how well-intentioned the intervention. We reported on evaluations of programs in France, Canada and the USA, where comprehensive interventions were made in low income areas – neighbourhoods, cities, regions – to reduce poverty and bring about long-lasting improvements in economic conditions. (1) The results achieved by these localized interventions were in general “mixed” – a way of saying “not good”. While the injection of special funds and organizing assistance usually had some short term benefits for those who got involved, long-term change in the prevalent conditions was not achieved.
We speculated, (since our review was not itself large scale or systematic) that perhaps poverty and economic disadvantage are better tackled by population-wide programs like the Earned Income Tax Credit in the USA, or the Old Age Security/Guaranteed Income Supplement in Canada, or child tax credits, all of which are credited with significant reductions in poverty.
But we did note in another posting (2) a study indicating that obesity and its concomitant problems might be successfully tackled by organizing community action and involvement, coupled with special efforts to coordinate the various program resources available in the community through health, education, recreation, social services and municipal planning organizations. The evidence in this area is mounting.
The University of Wisconsin has collected and reviewed a mass of systematic reviews and meta-analyses (3), focussing on “multi-component interventions” to prevent childhood obesity. Obesity in childhood being firmly linked to longterm problems of acute and chronic disease, development problems, and overall well-being of the individual, it has been targeted as a critical area for health intervention.
Citing extensive reviews carried out in the USA, Europe and the UK, the researchers come to firm conclusions that multi-component interventions are likely to be successful, and they identify the results which are most consistently reported.
……….Multi-component interventions include a combination of educational, environmental, and behavioral activities such as: nutrition education, aerobic/strength training and exercise sessions, training in behavioral techniques, and specific dietary prescriptions.
The review collected evaluations of programs, based on measuring Body Mass Index, which lasted at least twelve weeks, and were provided for children of age groups 0-5, 6-12, and 13-18 years, corresponding to developmental stages.
The researchers found that most programs were successful, and especially for children in the 6-12 age range. Moreover there were very few negative results, such as body image problems, under-nutrition, dietary issues, etc. Because of the great variety of program components it was difficult to sort out which components were most consistent. However they were able to identify the following as showing consistent results:
school curriculum that includes healthy eating, physical activity and body image
increased sessions for physical activity and the development of fundamental movement skills throughout the school week
improvements in nutritional quality of the food supply in schools
environments and cultural practices that support children eating healthier foods and being active throughout each day
support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)
parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities
The authors recommend “embedding the successful programme activities into everyday practices in homes, schools, child care settings, the health system and the wider community”
We might also note the frequent central role of the school system, not only for direct implementation of programs, but also as a kind of hub for multi-agency, community and parental involvement. Successful child development requires school systems which are integrated into the community and work cooperatively with parents and families. The fact that the outcomes in this instance are health-identified does not take them out of the realm of education.
1. See the following Politudes postings: Have the US Empowerment and Enterprise Areas benefitted from Federal Intervention; Targeted Geographic Anti-poverty Interventions: France’s Sensitive Urban Zones; Neighbourhood Influences and Place-based Intervention; The Impact and Potential of Community on Well-being
2. See Politudes: Stanford Innovation Review: Community action to Reduce Obesity and Depression
3. http://www.whatworksforhealth.wisc.edu, Interventions for Preventing Obesity in Children the successful programme activities into everyday practices in homes, schools, child care settings, the health system and the wider community”