Bicycle Model for Public Health Intervention in Maori Community

This report outlines a public health intervention plan designed to address and reduce obesity within the Maori community of the Counties Manukau district in New Zealand. The plan employs a 'bicycle model' approach to assess the sources of obesity and develop targeted strategies, utilizing SMART objectives to define specific, measurable, achievable, relevant, and time-bound goals. The intervention focuses on community leadership, personal skill development, and government intervention to reduce obesity prevalence. The report details the problem and determinant analysis, capacity analysis, project governance, and the proposed strategies, including rationale and logic modeling. An evaluation plan, timeline, budget, and risk management are included to ensure the intervention's feasibility and effectiveness. The stakeholders involved include the Maori community, healthcare workers, policymakers, and various organizations. The intervention aims to improve health outcomes and reduce the social and economic pressures associated with obesity, with a particular focus on tailoring the intervention to the cultural context and socio-economic factors affecting the Maori population. This report provides a comprehensive framework for a public health intervention aimed at improving the health and well-being of the Maori community.

Running head: BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
Abstract
The aim of this public intervention plan on obesity concerning the Maori community has been
chosen to with the aim to reduce the prevalence and incidence of obesity in the community. It
has been found that due to lack of education and poor socio-economic status the Maori
community, the third largest community residing in the Manukau District have to deal with
overweight and obesity. A bicycle model approach has been adopted that assesses the sources of
obesity in the community and develops plans accordingly. The SMART approach has been used
to identify the goals and the implementation of the goals and objectives to prevent and curtail
obesity. This is followed by the different strategy and rationale behind those strategies. It has
been realized that community leadership, development of personal skills and government
intervention collectively can reduce the prevalence of obesity. To translate the intervention plan
into plan a budget and timeline has been developed and there is also the implementation of the
evaluation plan. Finally, various resources required for the program and the risks have also been
identified to have a holistic understanding about the obesity community model intervention.

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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
Table of Contents
CAPACITY ANALYSIS AND DEVELOPMENT PLAN.............................................................5
PROJECT GOVERNANCE............................................................................................................5
GOALS AND OBJECTIVES- SMART OBJECTIVES.................................................................7
STRATEGY MIX/INTERVENTION RESEARCH/LOGIC MODELLING...............................10
EVALUATION PLAN..................................................................................................................18
TIMELINE....................................................................................................................................20
BUDGET AND JUSTIFICATION...............................................................................................23
RISK MANAGEMENT................................................................................................................24
REFERENCES..............................................................................................................................25

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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
PROBLEM & DETERMINANT ANALYSIS
Obesity poses a great challenge on most of the developed countries and New Zealand is
no exception to the blight of obesity. There has been an enormous rise in the number of obese
people in New Zealand. Children and adults are equally under threat of risk posed due to obesity.
Given, the issue of weight gain becoming a dominant problem, it is important to consider the
different dynamics related to obesity with the objective of seeking the most appropriate solution.
Fat has been defined as excessive flesh in the body whereas obesity is understood be the
condition of being abnormally fat (Ministry of Health. 2018). Obesity and overweight can be
related to the multiple factors that includes genetics and bad behavior. The prevalence of bad
behavior contributing to obesity includes medication use, physical activity, dietary patterns and
the exposure to a sedentary lifestyle. Apart from these, there several factors that contributes to
obesity. This includes physical activity, skills, consumption of particular kind of food and food
marketing. Another concern related to obesity is that it leads to negative mental health. In the
previous assignment the impact of obesity was studied among the population of the Manukau
District. The geographical area of the Counties Manukau Health is part of the territorial authority
of the Auckland Council. The second largest assesses resident population is with the Counties
Manukau Health out of the 20 District Health Board in New Zealand (World Health
Organization, 2018).The ethnicity mix of the Counties Manukau population has found to be
differed by age. The younger population of the District is composed of Asian, Pacific and Maori
peoples whereas the older population who are above the age of 65 years constitutes of two-third
of the population who belong to the European and native NZ ethnicity. In the year 204, twenty-
four per cent of the estimated resident population of the Counties Manukau is aged at 14

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(Swinburn & Vandevijvere, 2016). It has been found that the Maori and the Pacific population
comprises of the highest population. Studies have demonstrated that the adult population of the
Counties Manukau experienced population is obese according to the NZ Health Survey 2011-13.
The rate of obesity among the children are found to be 18.6 per cent among the people from the
Pacific region, 24. 5 per cent among the people from the Maori region and 10. 2 per cent among
the Asian children (Yofee, 2009). The attributable effects and the costs of obesity and
overweight ensues that the health and the well-being of an individual is affected due to the
adversity of obesity. Some of these problems include depression, pulmonary disorders, chronic
musculoskeletal problems, problems in the relationship and infertility. Some of these life-
threatening effects of obesity can be categorized into four categories-these are cardiovascular
diseases, gall bladder disease, certain types of cancer that are triggered by obesity, and insulin
resistance linked to the conditions like Type 2 diabetes (Utter, Denny, Teevale, Peiris-John &
Dyson, 2015). Apart from the damaging and long-term consequences of obesity, overweight and
obesity severe social and economic pressure on the person. This also poses severe economic and
social pressure on the healthcare in NZ. Direct and indirect medical costs are related to obesity.
The measurement of the productivity is done based on absenteeism and presenteeism.
Absenteeism refers to the cost incurred due to the absence of employees at the workplace
whereas presenteeism refers to the reduced productivity of the employees despite the fact that
they are present at work in addition to prematurity and disability. If obesity is not controlled, it
will trigger high blood pressure, stroke, fatty liver disease, osteoarthritis, pregnancy related
difficulties and heart disease amongst others. Increase in BMI may lead to the risk in non-
communicable diseases.

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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
CAPACITY ANALYSIS AND DEVELOPMENT PLAN
The successful healthcare promotional plan needs to be targeted at the community along
with the specific location and the identification of the specific outcomes that may be used for the
location and the communities. Manukau district has been chosen for the implantation of the
healthcare plan on addressing obesity and overweight. The community that will be targeted for
the proposed intervention will be the Maori community. Therefore, the stakeholders for the
proposed healthcare intervention plan would be the Maori community, the healthcare workers
operational in the Manukau distrust, people who would be involved in the in the promotional
campaign, the policy makers, employees working in the healthcare facilities, local government,
ministry of healthcare, labour and the different profitable and non-profitable organizations. At
the stage of the leadership, the proposed intervention would be assessment of the leadership
potential of the Maori community representatives (Williams, Mesidor, Winters, Dubbert &
Wyatt, 2015)It has been found that although the Maori community members were visible in the
Healthcare Ministry and the medical association.

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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
Considering the power of the community in influencing the community
members to pay attention of their health needs, building the capacity of the Maori
members is quite important. This would be done through tapping the potentiality of
the Maori leadership. This is because studies have shown that the New Zealanders
are part of an environment. As it has been recognized earlier, the policymakers and
the healthcare professionals possess the requisite capacity and competence to
generate awareness among the Maori community members about the importance of
curtailing unhealthy eating practices and prevent sedentary lifestyles that
contribute to the prevalence of obesity. The knowledge by the healthcare
professionals would be transferred to the fieldsite volunteers who would be
engaged in door-to-door campaigning in the Manukau district, visiting the schools
where children and the parents will be sensitized about the causes of obesity and
the role of alternative lunch that can go a long way in arresting obesity. Given, the
power and reach of the local government, it has the maximum capacity in the
prevention of obesity through both short-term and long-term prevention plans. Out
of all the stakeholders in this obesity intervention plan, the Maori members initially
may feel reluctant to engage with the project assuming that it is an outside
intrusion and is a state-sponsored strategy to target and label them as unhealthy.
Therefore, there may be initial resistance and lack of cooperation from the
community members. This may also be due to the attitude of previous intervention

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plans that have not kept a track of the outcome of the interventions. In the last 10
to 15 years, there have been a series of interventions in the Maori communities to
prevent obesity and the high-risk diseases that are caused due to obesity. Although
some of the elements were successful, there was no permanent support of these
initiatives of the Government or the DHB funding level. It is difficult for the Maori
community to sustain the benefits of these intervention plans without continuous
and concerted support in the form of financial assistance. Some of the members in
the Maori community are of the view that only a limited section of the elite is able
to sustain the requisite lifestyle that is compatible to obesity. Therefore, the
government possesses the greatest capacity by making the obesity friendly food at
lower cost and food with higher calories at high lost to make it accessible for the
marginalized Maori community at a subsidized rate.
PROJECT GOVERNANCE
At the level of the workforce those workers will be selected based on their knowledge of
health literacy and expertise on obesity and the concomitant risks. Leaders from the Te Puni
Kōkiri community will be involved. This would be done with the aim of tapping their

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potentiality to lead the workforce in the five different locations of the Manukau District. In
addition, 100 people would be recruited for the healthcare program in the Maori community and
would be directed in five locations in the district (Counties Manukau Health, 2015). The local
government and the municipal would be exhorted to be a part of the healthcare programme for
the entire community. NGOs and the governmental organizations would be targeted for the
welfare of the Maori community. The rationale behind the inclusion of the municipal and the
local schools that would be important for arranging the accommodation for the healthcare
campaigns. Inclusion of the municipal would ensure that there is an additional amenities that
would be utilized in the population gatherings namely the safety and security instruments. This
project would feature working along with the synchronization of the leaders and the elderly
members of the community. The thrust would be to educate them about the effects of obesity in
the community by motivating them to veer towards healthy lifestyle. The Maori community
would accomplish the key role in decision-making regarding the utilization of the resources and
the strategies to be implemented for their healthcare needs. In this case, the intervention that
would be used will be based on evidence existent in the society with the aim of the processes and
the decisions to implement in the process. The local government and the municipal officers
would be involved through community prospect, facilitation of the contribution for all the service
providers, including the training personnel in the promotional event and intensifying the
healthcare infrastructure of the local healthcare facilities.
All the above mentioned stakeholders will be part of the advisory team who will lead the
project and will look into the initiation, governance and the successful implementation of the
intervention plan. In addition to the above mentioned stakeholders there will be sponsors
namelycompanies that are known for their obesity friendly food products. Spinsorship will be

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important considering the scale of the project and the finance that will be required in the
implementation of the various activities associated with the project. Their involvement would be
crucial for the long-term success of the project.
GOALS AND OBJECTIVES- SMART OBJECTIVES
Initial Goal
The aim of this public intervention plan on obesity is to reduce the incidence and
prevalence of obesity in the Counties Manukau district in New Zealand. For the purpose of the
study, the Maori community would be selected as the target population owing to the fact that
there has been a rise in obesity among adults and the children in the community. The rationale
behind the selection of the Maori community is that it is the third largest community in the
region after the Asian and the Pacific community (Ministry of Health, 2018). Previous studies
have shown that the important determinant on the social health was the key reason for the rise in
obesity among the members of the community considering they did not have access to good
food, quality healthcare and a healthy compatible environment to control this rise in obesity.
Therefore, the goal of the intervention would be to reduce obesity among the Maori community
through the involvement of the various stakeholders and keeping the Maori leadership at the
forefront to bring in transformation.

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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
1. Specific
As stated earlier, the objective would be reduce and the prevent obesity among the
members of the Maori community. This would be done through collaborating with the different
stakeholders namely the Maori community, the healthcare workers operational in the Manukau
distrust, people who would be involved in the in the promotional campaign, the policy makers,
employees working in the healthcare facilities, local government, ministry of healthcare, labour
and the different profitable and non-profitable organizations (CDC, 2018). I seek to implement
the plan from June as the need assessment and identification of the problem has already been
completed. This s is a goal considering the veracity of obesity identified through the attributable
effects and the costs of overweight and obesity and the price of not doing anything. One
objective would be to reduce the intake of sugar and sweetened beverages among the Maori
community members by 50 % within one year. The second objective would be to increase the
proportion of days during which the at least 30 minutes of exercise would be taken by the
community members by 20 per cent by 2020. Another goal for preventing obesity would be
imposing higher tax on the food products that contribute to obesity thereby curtailing the
consumption of such products by the year 2020.
2. Measurable

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BICYCLE MODEL FOR PUBLIC HEALTH INTERVENTION
To ensure that the goals have been a number of methods will be adopted. A longitudinal research
design would be the most appropriate choice. Firstly a survey would be conducted among the
Maori community to assess the difference in their health outcome post the obesity intervention
plan. The data collected from the survey would be processed and the findings of the survey
would be helpful in indicating whether there has a been a decrease in the incidence of obesity.
Based on the survey if it s found that obesity continues to remain a problem then there would a
restructuring of the intervention plan. Secondly, there would be a routine weight check of the
Maori members who have been earlier diagnosed as obese.
3. Achievable
The public health intervention plan can be translated into reality only through the
capacity building of the different stakeholders involved with the project. As discussed earlier
each of the stakeholders will have specific responsibilities in this intervention plan. Firstly
leadership skills need to be developed among the Maori community members. Secondly, there
needs to be a health awareness education for all the stakeholders of the project to ensure that
everyone is on the same level and to eliminate any discrepancy. The health education programme
would provide an opportunity to all the stakeholders to understand their responsibility in the
intervention plan and also to clarify regarding any issue.
4. Relevant
The goal is relevant considering that obesity leads to a number of severe health
conditions and if it s not addressed at the earliest it will lead to health epidemic. Secondly, the