Targeting healthy weight? How the ... - Flinders …

1 Targeting healthy weight? How the ideologies and discourses underpinning the policies addressing South Australia's healthy Weight Target (2007) affect health equity. Louise Townend BA, Ass. Dip. Court & Parliamentary Reporting, B Soc Admin. Southgate Institute for Health, Society and Equity Flinders university of South Australia July 2015. 1. TABLE OF CONTENTS. List of figures .. viii Summary .. ix Declaration .. xi Acknowledgements .. xii Glossary .. xiii CHAPTER 1: 1. Overview of this study .. 1. Research questions .. 3. Research approach .. 3. Context and contribution of this research .. 5. Key concepts .. 7. Outline of chapters .. 8. CHAPTER 2: LITERATURE REVIEW EVIDENCE FOR THE OBESITY. PROBLEM' .. 9. Overview .. 9. Literature search strategy .. 9. The obesity problem' .. 9. Establishing obesity as a health problem .. 9. Obesity globally .. 9. Obesity in Australia.

2 11. Obesity in South Australia .. 12. Health risks .. 13. Establishing obesity as an inequity 14. Population distribution of obesity in 14. Equity in health the social 14. The social gradient of obesity .. 16. CHAPTER 3: EXPLANATIONS AND POLICY RESPONSES TO THE OBESITY. PROBLEM' .. 20. Overview .. 20. Literature search strategy .. 20. Contested concepts: Energy Equation' and BMI' .. 21. Explanations for the social gradient in obesity .. 22. Explanations for the obesity epidemic and its distribution .. 24. Health promotion framework: three approaches to obesity .. 25. The medical frame .. 25. The behavioural frame .. 26. Moral deficit discourse .. 27. Lifestyle 29. Market choice discourse .. 30. The socioenvironmental frame .. 31. ii Critique of market choice discourse .. 31. Development of the socioenvironmental frame .. 37. Variants within the socioenvironmental frame.

3 38. The role of ideology in framing obesity .. 43. The policy response to obesity .. 47. Global obesity 47. National obesity policies for Australia .. 48. The context of Australian governance .. 48. National policies .. 49. South Australian obesity policies .. 51. The neoliberal ideological context of obesity policy .. 53. 57. CHAPTER 4: METHODOLOGY .. 58. Overview of chapter .. 58. Philosophical foundations .. 58. Social constructionism .. 58. Critical theory and key concepts: ideology, discourse and equity .. 60. Power: Productive or oppressive .. 61. Ideology .. 62. Hegemony .. 63. Discourse .. 64. Equity .. 66. Methodology .. 66. Qualitative research .. 66. Research design .. 67. Research 67. The What's the Problem Represented to be? (WPR) approach .. 67. WPR approach transparency and reflexivity .. 72. Sampling strategy .. 72. healthy weight policy document analysis.

4 73. First stage: Familiarisation with the data .. 73. Second stage: Descriptive account .. 73. Third stage: Interpretive stage Discourse analysis and identification of themes .. 73. Fourth stage: Interpreting the themes: synthesised discourse analysis .. 74. OPAL program document analysis .. 75. selection of 75. OPAL program data analysis .. 76. OPAL interview analysis .. 77. Interview schedules .. 77. Ethics and recruitment .. 78. Analysis of interview data .. 80. How the research methods chosen relate to the purpose of this study .. 81. Data generation .. 81. Multiple methods of data generation .. 82. Research rigour .. 83. Credibility .. 83. Transferability .. 83. Dependability .. 84. Confirmability .. 84. 85. CHAPTER 5: FRAMING OF OBESITY IN healthy WEIGHT STRATEGY. 86. Overview of chapter .. 86. Descriptive accounts of healthy Weight Strategy documents.

5 86. Eat Well Be Active healthy Weight Strategy for South Australia 2006 . 2010 (EWBA) .. 86. Background and context .. 87. Evidence and consequences .. 87. Principles, aims and objectives .. 87. Strategic directions .. 88. Eat Well South Australia Public Health Nutrition Action Plan 2006 . 2008 Summary (EWSA) .. 88. Background and context .. 89. Evidence and consequences .. 90. Principles, aims and objectives .. 90. Strategic Directions .. 91. Be Active Physical Activity Strategy for South Australia (BA) .. 91. Background and context .. 92. Evidence and consequences .. 92. Principles, aims and objectives .. 92. Eat Well Be Active healthy Weight Strategy for South Australia: Priorities as at November 2009 ( Priorities') .. 94. Background and context .. 94. Evidence and consequences .. 95. Principles, aims and objectives .. 95. Strategic directions .. 96. Discourse analysis.

6 97. Overview .. 97. Representation of the problem of obesity: Primary 98. Representation of the problem of obesity: Secondary problematisations 102. Shared characteristics of the problem representations .. 103. Representation of the causes of this problematisation .. 108. Representation of the solution to this 109. The public .. 111. Government .. 113. Corporate sector .. 115. Framing of responsibility in this problematisation .. 118. Implications for health equity .. 119. Eat Well Be Active .. 119. Eat Well South 120. Be Active .. 121. Priorities .. 121. Summary of chapter .. 122. CHAPTER 6: FRAMING OF OBESITY IN OPAL DOCUMENTS .. 124. Overview of chapter .. 124. selection of OPAL and OPAL 124. Descriptive accounts of 125. National Partnership Agreement on Preventive Health .. 125. Origins, funding, targets and theoretical underpinnings .. 125. Structure and implementation.

7 128. Evaluation .. 130. OPAL in public presentations .. 130. Summary of changes in research design from 2009 to 2011 .. 135. Website and social marketing materials .. 136. Discourse analysis of documents .. 138. Representation of the problem .. 138. Representation of the causes of this problematisation .. 138. Representation of the solution to this 139. The framing of responsibility in this 139. Implications for health equity .. 139. Themes from discourse analysis .. 140. Construction of responsibility through the commercial sphere in OPAL. public presentations .. 141. Construction of responsibility through the commercial sphere in OPAL. website and social marketing 142. Principle of 144. Construction of responsibility through the principle of choice .. 147. Summary of themes and chapter .. 148. CHAPTER 7: FRAMING OF OBESITY BY KEY ACTORS IN OPAL .. 149. Overview of chapter.

8 149. Introduction: How OPAL represents a solution to unhealthy weight .. 149. Descriptive account of the community-based component of OPAL .. 150. Overview .. 150. OPAL as a complex community-based program .. 150. A complex response to a complex problem .. 150. Working through local government and existing stakeholders .. 151. OPAL as a program premised on a socio-ecological approach .. 153. Environmental and individual change .. 153. The role of the commercial environment .. 156. Equity and 162. selection of project sites .. 162. Perspectives on equity .. 165. Descriptive account of the social marketing component of 169. Overview .. 169. Background to strategy of changing norms through social marketing .. 169. OPAL as a program based on the French EPODE franchise .. 169. Applicability of EPODE to South Australia .. 171. EPODE's private partnership model .. 172.

9 Implementing the strategy of changing norms via social marketing .. 175. Changing the normative 175. Using a social marketing strategy .. 177. Changing the normative environment in the home .. 179. Not stigmatising any product or industry .. 184. Discourse analysis of interviews .. 185. Representation of the problem .. 186. Representation of the causes of this problematisation .. 186. Representation of the solution to this 186. Representation of the framing of responsibility in this problematisation 187. Implications for health equity .. 188. Summary of chapter .. 190. CHAPTER 8: DISCUSSION .. 191. Overview .. 191. How the problem is represented .. 192. How unhealthy weight is problematised in the data .. 192. Comparison with how unhealthy weight is problematised in the literature192. Causes of this problematisation .. 194. How the causes of unhealthy weight are represented in the data.

10 194. Comparison of how the causes of unhealthy weight are represented in the literature .. 195. Solutions to this problematisation .. 198. The solutions to unhealthy weight identified in the data .. 198. Comparison to how the solutions to unhealthy weight are identified in the literature .. 198. Social marketing .. 199. Targets .. 201. Partnerships and community .. 201. Regulation .. 202. The framing of responsibility in this problematisation .. 202. How responsibility is framed in the data .. 202. Comparison with how responsibility is framed in the literature .. 204. Self-responsibilisation .. 207. Making sense of my observation .. 210. How individual responsibilisation is evident in the findings .. 213. How the ideology of individual responsibility takes the focus off corporate responsibility .. 214. How this framing is likely to affect health equity .. 218.