POLICY BRIEF-2015

Community-Based Obesity Prevention Policy, a Citizen-

Centered Approach to Tackle the Prevalence of
Childhood Obesity in South Australia.
By Aulia Rahim
667208

1. Title
Community-Based Obesity Prevention Policy, a Citizen-Centered Approach to Tackle the
Prevalence of Childhood Obesity in South Australia.

2. Introduction
The occurrence of overweight and childhood obesity has considerably incremented over the
past three decades and according to estimation, almost 170 million children below the age of
18 are now overweight (Lobstein et al., 2004). The bad effects of obesity on psychological and
health welfare have been extensively explained and they are quite considerable. For ailments
like type 2 diabetes, cancer that includes colorectal cancer, kidney cancer and oesophageal
cancer and cardiovascular disease, the increased body mass index (BMI) is the most important
risk factor. To eliminate this fissure between the practical application of important lifestyle
changes and awareness of the issue is the basic requirement that needs to be fulfilled.
There is a possibility that obesity and overweight are the only biggest danger to the health of
Australian children (Olds et al., 2010). In 2007, More than half of the adult population in South
Australia were overweight or obese and almost one in every five 4 year olds children in South
Australia was suffering from obesity (Chittleborough et al., 2007). The social, emotional and
physical growth of children is affected by being obese and as a result, the South Australian State
Government with the help of the funding from their Federal NPAPH Healthy Children’s Funding
has decided to devote their attention to the healthy lifestyles initiative at a societal level (Borys
et al., 2012). With the goal to enhance the physical activity and nutrition levels of children, the
Obesity Prevention and Lifestyle (OPAL) program was started in 2009. This aim was to be
achieved in the families and communities in the OPAL areas and as a result incrementing the
proportions if 0 – 18 year olds in the healthy weight range (Jones et al., 2011). The ideology
behind this was to develop the capability of the community to develop its very own solutions
and methods to encourage healthy weight, physical activity and healthy eating (Swinburn and
Wood, 2013).

3. Development of Policy
Regarding the dangers of obesity and the significance of healthy diets and physical activity, a
consistent message has been delivered by the public service announcements and medical
society to the masses for almost two decades (Story et al., 2009). Nonetheless, public
awareness has not proved to be a successful tool in the eradication of demonstration of obesity
outbreak. To solve this issue, old and conventional methods are being adopted by many
policymakers and public health speakers once again. These archetypes include the assumption
that such public health problems are the ones that can be handled by individual doctors and
physicians.

The interventions that include community at every step of the program while tackling the
outbreak of obesity are regarded as more successful and likely to have more capabilities
(Hargreaves et al., 2013). The act of tackling maximum fundamental behavioural and
environmental reasons behind obesity at the same time is considered as a comprehensive
technique to eradicate obesity. The main hypothesis behind this is that single strategy
techniques like single setting approach or public education regarding healthy choices are not
enough for acquiring the ‘intervention dose’ necessary to change the latest trends in obesity.

The WHO (2010) argues method that involves various techniques in various settings and areas
available on both sides of the energy balance equation are the ones with the highest
maintainable impact. These techniques include social marketing, policy alterations, behaviour
and environmental change, handling latest overweight and obesity and community capacity
building. According to lessons from other outbreaks, there is a need for attention to socio-
economic context, political obligation, utilization of various strategies in multiple levels, areas
and settings, significance of collaborations, involving community in decision making and an
extensive method.
Before the establishment of the OPAL project, majority of obesity prevention practices in South
Australia had focused mainly on single settings, such as schools or religious settings, basic
health-care settings and without proper community participation. Additionally, a large amount
of the initiatives in the past were short-term and did not last for a year. Such interventions have
been proven have restricted advantages as well as costly and unsustainable (Richards et al.,
2014).

Evidence- Based Consideration

Evidences show the highly successful and efficient interventions are the ones that have various
elements and familiar with the local context (King et al., 2011, Bogart and Uyeda, 2009, Minkler
and Wallerstein, 2011). There is a high possibility that the interventions that are more suitable
in terms of culture and environment will be maintained and executed. Moreover, the obstacles
in the way of the execution are minimized by the interventions that utilize the present social
structures of a community. Most importantly, considerable involvement and participation of
every important stakeholder team through the act of ‘co-design and co-production’ in every
step of the procedure is the key element of every efficient intervention (Kok et al., 2012). These
participations consist of the execution of interventions that have an impact on the religious and
community settings and the contribution of the headships of the community in the process of
planning. Whether the interventions have fulfilled the requirements of the target groups
depends on listening and learning from these target groups. “Community-based interventions”
are usually defined as the interventions that include strong community that connect and
involve mentor participation or in other word embracing the value of citizen-centered model.

South Australia government was prepared to gain more knowledge on the importance of
community-based interventions after two French towns of Laventie and Fleurbaix
demonstrated how whole-of-community method can majorly affect the process changing
childhood obesity. Through the establishment of EPODE(translated as ‘together we can prevent
childhood obesity’) program in 1992, the situation of childhood obesity did not worsen in those
two pilot towns but in two comparison towns, where there was lack of community level
lifestyles initiatives, the level of obesity increased two times (Borys et al., 2012).

The physical activity augmented among the children in the EPODE towns who also had a sound
knowledge regrading nutrition and they made important transformations in their eating habits.
According to the findings of the French approach, the involvement of the entire society that
includes pharmacists, shop keepers, local government, cultural connection, sports, schools,
local GPs and families plays a vital role in the success of this program (Borys et al., 2012). At the
present moment, the achievement of this program that is community based cannot be
overlooked and it is functional in almost 250 societies (Hartwick et al., 2014).

In 2009, consequently the OPAL program was created by the South Australian government.
With the aim of minimizing child obesity, OPAL consists of a harmonized, capacity-building
initiative. OPAL utilizes societal procedures that include showing direction to the local
environments, family traditions and childhood settings and they are supported to provide
facilities to adopt healthy lifestyle in children. The pleasure of healthy eating, active play and
leisure are included in this lifestyle. A sound technique to handle obesity that involves non
cultural and societal stigmatization, procedural coaching and an experience of healthy lifestyle
habits are some of the various elements that make up the foundation of the OPAL ideology.
Children between the age of 0-18 years along with their families were the main OPAL target
groups and the local stakeholders were also the aimed for. Moreover, healthy lifestyles is
cultivated and endorsed by the stakeholders with the help of long-term programmes and
schemes in a sustainable way among families.

To develop behavioural change in the community following six goals are the main focus of
OPAL: (HEALTH, 2009)
1. Active travel journeys
2. Active leisure participation alternatives
3. Utilization of spaces, places and parks
4. Healthy meals that are home made
5. Healthy food choices that are provided at food outlets.
By gathering reviews from the most preferable obesity prevention proof and evidence on a
global level, these goals were set and it particularly includes the community based
interventions. Social marketing, ecological systems and community development are three
theories utilized to enlighten the programs. By utilizing the yearly social marketing themes, the
aforementioned goals are revived and the centre of attention for these themes is a single
behaviour that particularly has a positive effect on healthy weight. A positive and hopeful
approach to confront the social traditions and customs that encourage unhealthy behaviour are
provided by the information and activities that are related to every theme. On the basis of
many aspects that incorporate the index of relative social disadvantage, the OPAL initiative
includes twenty-one communities and according to COPAL, twenty of them were in South
Australia and one in Northern Territory (HEALTH, 2009).

4. The Implementation of the Policy

The concept of co-production which enable Opal community to collaborate with the
government in designing and implementing the policy was employed to the Opal project. The
government collected data and information from local areas, gathered opinion from the
expertise and acquired the most relevant data by utilizing the proof summaries and reviews as
much as they could. This was done to obtain understandable knowledge regarding the health
status of children in the selected societies and to acquire sound understanding of the societies
themselves.

In order to guarantee that the requirements of the local community were fulfilled and the
network of the governance were present in their designated places, the OPAL project planned
this venture in the first six months that was also a segment of the procedure. The initiation
point of the project includes gathering expert opinion from the main groups and communities
and after that a stakeholder workshop to prioritise every achievable actions.

The uniformity among every OPAL Communities is guaranteed by utilizing the OPAL Single
Platform (outputs monitoring devices and online project planning) in the process of recording
the communities commenced yearly planning along with that the structures are prepared and
local investigation is started. For the purpose of providing information regarding the
implementation of the OPAL program, the South Australian government utilized the proof
reviews along with the EPODE technique (France Community-Based Interventions). A sequence
of pillars including social marketing, local implementation, political and scientific are the
fundamental factors involved in the working of the EPODE: (HEALTH, 2009)

 OPAL State Coordination Unit (SCU) was created to supervise the programme at the
state level
 To give advice on the evaluation and social marketing themes, the OPAL Scientific
Advisory Committee was created at a state level.
 Put into practise in every OPAL community, the social marketing themes whose main
focus is the behaviour change are established on yearly basis.
 An advisory committee is created in every local community or they are affiliated to a
system that is already established
Themes and subsequent intervention designs are built through the social marketing. By utilizing
the CATI (Computer Assisted Telephone Interviewing), the themes and brands were organized
and managed on yearly basis. For the purpose of assuring that the goal-related transformation
in attitude and themes particularly evolve with every target society, they were applied on a
public level. By the following seven intertwined techniques, the OPAL objectives and themes
were accomplished:
 Chances to perform activities- programs and services
 Policy and planning
 Awareness- via targeted messages
 Education- creating labour force capacity and incrementing knowledge of the masses
 Alteration in the environment or the system
 Investigation and evaluation
 Partnerships and cooperation – with a variety of social groups incorporating health
services, council, sports clubs, private business ( for instance grocery stores), NGOs and
schools (HEALTH, 2009)

Stakeholders’ Engagement
OPAL State Coordination Team (SCT) was employing various social marketing and logistic
methods to bring EPODE methodology into effect, by training local project managers who are
assigned to each community by the mayor (Magarey et al., 2011). Other local leaders can also
administer the programme other than mayor. The local project manager is subjected to activate
the local stakeholders who may play an influential role in urging families and children to take
part in various activities. These patrons may be in schools, pre-schools, extracurricular
organizations and any social networking forums. In order to do so the local project manager
formulates a local committee comprising of local representatives from various fields (elected
representatives, heads of municipal services, school professionals and local partners). The
committee communicates regularly and formulate decisions, promote the execution of
activities and actions, and generate mobility among masses. Building inter-sectoral partnership
and collaborations has been the main priority of the project. For instance, OPAL local project
managers have built a strong partnership with local transport and town planners’ authorities in
encouraging active living and transport spaces and routes throughout the OPAL communities
(Magarey et al., 2011).

Empowerment of Local Project Manager and Local Stakeholders

The SCT pays an annual visit to each OPAL site to:
 keep up with the development in the area
 train the local project managers
 communicate with the local community
Regular training sessions were arranged at a central level three times a year for the local
project manager, which are based on the themed campaigns. The project managers were
provided with capacity building documents which may help them to
 generate the local dynamics such as making partnerships and networks etc.
 enable local stakeholders to introduce local projects and activities (roadmaps, adaptable
action sheets)
 develop local communication and relations with relevant media
 collect information on evaluation indicators (e.g. body mass index [BMI] measurements)
The local project managers also have relations with the SCT for counselling and advice
regarding various projects and actions which are planned to be initiated with local stakeholders.

5. Management of the Policy

Organization at Central Level

The Opal programme was developed and initiated by the South Australian government and
scientific organizations. Ensuring the compliance of the said programme with official
regulations regarding diet, physical activity and health was a difficult task (Magarey et al.,
2011). Therefore, to supervise the programme at central level, the State Coordination Team
(SCT) was employed which was subjected to regulate various skills relevant to public health
issues including social marketing, network organization, professional training, general public
communication and press relations (Borys et al., 2012). Moreover, the SCT helps in promoting
the programme at central level and synchronizing the evaluation and monitoring systems. A
committee comprising of experts belonging to various fields such as of paediatrics, nutrition,
psychology, physical activity, marketing, sociology, health communications and educational
methods etc. is liable of operating the overall functions of the SCT. The committee vows to
facilitate the required level of scientific support to the programme particularly in determining
the preferences of topics for action, monitoring and evaluation. In addition, the SCT formulates
a long-range budgetary plan, which helps to maintain deployment of human and technical
resources at central level. It also manages the division of operating cost at central level on the
basis of nature of planned activities (Olds et al., 2010).

Organization at Local Level

A significant amount of funds is provided to the organisation by the local authorities as the
presence of an OPAL local project manager, performing responsibly in the field tends to
generate local group dynamics. The local project manager is subjected to supervise the
management of the local committee of professionals which plays a significant role developing
positive peer-to-peer dynamics and speeding up the execution of the various plans by local
stakeholders. The local project manager also holds political support of an elected
representative of the community council who serve to be a local decision-maker and
spokesperson for the programme. The local leader ensures the
 involvement of all municipal or local council departments
 the establishment of local partnerships
 the effective execution of actions

OPAL communities can take up financial support from private partners for development and
execution of different projects or activities. Moreover, government allowances provided from
the federal, national, state or regional levels are employed as well for the carrying out the local
activities. Privately donated finances are variable for every community. Such endowments
make it difficult to formulate an average budget.
Evaluation
A wide-ranging assessment plan which includes polices regarding data sharing and
dissemination procedure etc. has been formulated keeping in view the requirements of the
stakeholders. The plan includes the following evaluations:
 yield censorship on all 21 countries
 results (long, medium & short term)
 profitability (cost effectiveness)
 course of action (reach, dose, integrity (fidelity and adaptation), equity and program
theory)
 circumstances (soft (policy and program) and hard (built and spatial) environments)
 contacts (network ties, community capacity, reflexive praxis) and
 universality (transferability)

Different methods and methodologies are employed including:

 Anthropometry
 Surveys
 interviews and focus groups
 CATI
 case studies
 geo‐spatial information systems
 ethnography
The research dissemination strategy includes publication plans with infographic information
sheets for local community and stakeholders (Jones and Williams, 2010)

The Success Story

In the first 6‐12 month span stakeholders’ interviews were conducted and focus groups were
made in 20 OPAL intervention communities making up a total of 41 interviews and 19 focus
groups. The initial results provided that, the stakeholders satisfied with
  the five‐year term of the program
 the branding of OPAL
 working with OPAL owing to the flexible response mechanism towards local needs
 the additional funding to support local healthy eating and physical activity programs

A satisfaction survey was conducted with local government stakeholders, which provided
that:
 34 of 40 mayors, line managers and CEO’s described OPAL as a flourishing and
profitable organisation.
 37 of 40 mayors, line managers and CEO’s highlighted the importance of SA Health’s
investment in OPAL for the local government
 Just over two thirds of the 40 mayors, line managers and CEO’s mentioned of
receiving a high or very high return for their investments in the project from the process
evaluation (Jones and Williams, 2010)
In the second span of research 284 strategies were implemented in 205 projects in four
different communities. The obtained results provided that 68% of strategies were executed
loyally while in executing 29.6% of strategies various obstacles were reported (Jones and
Williams, 2010). One of the most pertaining barriers was to work with other organisations. It
was suggested that the staff had to employ large properties, give more time and to use more
financial resources, to prevail over these barriers. In addition, in 2012 compared to the year
before, the project had successfully reduced the amount of screen time and increased the
consumption of fruit and vegetables among school-children throughout the Opal sites (Pettman
et al., 2014).

6. Broader Lessons
Specific Lessons
From the above discussion, it can be drawn that in order to implement effective Community-
Based Interventions, the policy or programs need to be understand and diffused in the social
settings of the community. In other words, significant number of community members must
take part in such ventures. To ensure such a practice, the respective strategies may include:
 the use of an ecological (community-wide) rather than individual approach
 partnerships with major stakeholders
 inclusion of multiple interventions with a greater focus on interventions aimed at
organisations and policies along with individuals and groups

The projects must be designed as such to effectively address the pertaining needs and
circumstances of the community. Moreover, the respective strategies must be able to cater to
all major and sub-groups of the community including even the underprivileged populations.
With active participation and engagement from all level of actors, community-based obesity
preventions are more likely to be both sustained and effective.

General Lessons

The Opal project clearly draws some basic differences between citizen-centered models with
conservative public administration approach. As such, it shows how a citizen-centered model to
integrating obesity prevention interventions not only advances the responsiveness of the
policy, but also improves the effectiveness and efficiency of such programs. In addition, it also
highlights the imperative role of citizen collaboration in this regard. A lesson learned from the
Opal project shows us how a citizen-centered approach is leading governments in new
directions in achieving their expected policy outcomes and goals.

7. Conclusion

The ultimate success of the OPAL project in preventing childhood obesity within the South
Australia regions was highly rely on the value of citizen-centered policy making through the
implementation of ‘client co-production’ in achieving the desired goals and outcomes of the
project. It proves that placing citizens at the center of policy making can generate maximum
outcomes. Broader lesson that we get from the Opal case study is about how citizen-centered
policy making can turn governments to do a better job in making their programs and services fit
their citizens, rather than expecting their citizens to fit into the government programs and
services. By embracing the citizen-centered model, it can also ensure that those programs or
services will be inline across jurisdictional boundaries.

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