Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages

Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages
Health Issue and Advocacy Assignment
The purpose of this assignment is to identify a health issue requiring advocacy from the nursing
profession on a local, regional, state, national, or international level. This topic can be related to
health promotion, population health, disease management, or patient safety in the community or
other healthcare setting. You are assuming the role of advocate in various capacities. The topic
you select for this paper will be the subject of your Policy Brief and Advocacy Letter
Assignment. Therefore, research thoroughly your topic of interest to ensure that it can be applied
across both assignments. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages.
In this paper you will identify a health issue which may or may not already be represented in the
form of legislation or health policy. Individuals may just take a position on an issue affecting
local policy with decision makers.
An example of this with legislation includes:
• Health issue: primary care access for patients
• Health policy: increasing primary care providers using nurse practitioners; support of PA
HB 765 for CRNP independent practice
An example of this without legislation includes:
• Health issue: increased chronic back pain from integration of technology in healthcare
• Health policy: ergonomic evaluation of work environments for all employees; letter of
support to employers for new healthcare organization policy
This assignment is worth 25% of your grade. Using APA format and criteria from the Grading
Rubric for Written Assignments, in 5 double spaced pages (excluding the title page and reference
page) present the following details:
Criteria for Your Advocacy as a Nursing Professional
Outline of health issue and existing or necessary health policy
and/or politics. Why is this significant to nursing?
List and discuss any other stake holders who would be concerned
with the health issue, in favor or opposition.
Propose a plan on this health issue advocacy:
• Effect of the health issue on health policy and politics
• Interventions to be implemented in this advocacy to enact
change; incorporate health politics as pertinent
• Identify opposition which can be encountered.
Sweetened Beverages: The Health Issue
There is growing concern for the overall health of the United States.  Despite advances in medicine and the increasing amount of money expended on healthcare in the United States, chronic diseases are prevalent.  Not only do chronic diseases result in preventable premature death and reduce the quality of life of those who experience them, they place an economic burden on our healthcare system (Centers for Disease Control and Prevention, 2009).  According to the Centers for Disease Control and Prevention, (2009) 75% of health care costs are spent treating chronic and most frequently preventable conditions.  The incidence of chronic diseases are proportionally higher amongst minority groups. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages
Excessive consumption of sweetened beverages is linked with obesity, diabetes, hypertriglyceridemia, cardiovascular diseases, amongst others (Centers for Disease Control and Prevention, 2010).  Diabetes is linked to many other health complications including kidney failure, amputations, and blindness (Centers for Disease Control and Prevention, 2009).  Excessive consumptions of sweetened beverages is also proportionally higher amongst certain demographic and ethnic groups including adolescents, non-Hispanic blacks, Mexican-Americans, those of low socioeconomic status, and those who are obese.  It is estimated that amongst these groups up to 16% of daily total caloric income is from sweetened beverages (Centers for Disease Control and Prevention, 2010).
Prevention of chronic and preventable disease, such as those mentioned above, has been the focus of attention for the healthcare community and our policy makers in an effort to make our healthcare system more affordable and increase the quality of life of Americans.
Public Policy to Address Issue
On June 16, 2016 the City of Philadelphia passed the, “Sugar-Sweetened Beverage Tax,” which amended Title 19 of the Philadelphia Code, Finance, Taxes and Collections (City of Philadelphia, 2016).  Philadelphia has modeled its new policy on other cities and countries that have enacting similar policy measures aimed at improving the health of the country including; Arkansas, Tennessee, Virginia, and West Virginia (Drenkard, S., 2011).  This policy attaches and additional one and one-half cent per fluid ounce tax to be paid to the city of Philadelphia for the purchase of all beverages sweetened with the following ingredients: sucrose, glucose, or high fructose corn syrup.  Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages  The tax also includes sugar substitutes including: stevia, aspartame, sucralose, neotame, Ace-K, saccharin, and advantame (The City of Philadelphia, 2016).  This includes non-alcoholic syrups that contain any of the above sweeteners.  Excluded from this tax are baby formula, “medical food,” products that are more than 50% milk, juices that are more than 50% fresh fruit or vegetable juice (The City of Philadelphia, 2016).
The Effect of Consumption of Sweetened Beverages on Politics and Policy
Based on the above public health concerns including the overwhelming stress chronic disease places on the healthcare systems, policy makers are exploring methods of reducing the public’s consumption of products that are correlated with chronic disease and obesity when consumed regularly through taxation.  These taxes are likened to sin taxes placed on items such as alcohol and tobacco products (Letcher, Frisvold, & Tefft, 2011).
Contrary to other sales tax whose profits are considered general revenue for the city and state, the City of Philadelphia and Mayor Kenny, a supporter of the policy, pledge to use the revenue to support publically funded universal pre-kindergarten programs (Kennedy, 2016).  In fact Mayor Jim Kenney was quoted The Christian Science Monitor (2016, para. 4) as attributing the successful passing of the legislation to his plans for the revenue, “if you want to tax something and people know where the money’s going to, then it’s easier for them to get behind it.”  Interestingly the use of the revenue for the tax does not appear in the body of the legislation.
Opposition to Plan
There are numerous critiques of such legislation.  Developing policy aimed to reduce rates of obesity is difficult to measure.  Research connecting improved health outcomes associated with the excise tax seems controversial.  Research generated from places that already introduced the tax has not yet been able to establish a connection between reduced sweetened beverage purchases and improved health outcomes (Shekhtman, 2016; Fletcher et al., 2011; & Colchero, Popkin, Rivera, & Wen Ng, 2016).  Berkeley, California passed a similar policy in 2014, however it has not yet been established that this has reduced obesity rates (Shekhtman, 2016).
Cabera Escobar, Veerman, Tollman, Bertram, & Hofman (2013) in their meta-analysis found only 6 articles based on research conducted in the United States that supported a possible connection between decreased purchasing of Sugar-Sweetened Beverages and a reduction in BMI.  However, none of these studies were not able to establish a statistically significant reduction in BMI when rates of purchasing sweetened beverages fell (Cabera Escobar et al., 2013).   Fletcher et al., (2011) examined current obesity trends in the United States and compared that data to areas of the country that have enacted such taxes.  Their research revealed a positive correlation between obesity rates and a sweetened beverage tax, however, the reduction in obesity rates were only minimal. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages,
Research has also been done to examine the impact of similar taxation in Mexico.  This is distinguished from the Philadelphia legislation in that it is a federal tax.  Mexico, too, was interested in creating a tax in effort to reduce consumption of sugary beverages and its associated health problems.  Mexico not only has high rates of overweigh and obese individuals; 33% in the 2-18 age group and 70% in the over 18 age-group.  Between 2000 and 2006 rates of obesity increased another 12% throughout the country (Colchero et al., 2016).  Mexico also rendered the highest consumption of soft drinks by 2011. Colchero et al. (2016) compared consumption in 2012 and again in 2014.  By December of 2014 the average monthly purchase for sugary beverages decreased by 12%.  The tax in Mexico resulted in an approximate 10% increase in price for sugary beverages.  The Mexican government invested the revenue to programs that decreased health disparities in their country, which may potentially service to expand the impact of the program on the overall health of the Mexican population (Colchero et al., 2016).  This study also has limited impact, as it does not make a correlation in the reduction of the purchase of sugary beverages to improved health outcomes Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages.
Opponents also argue that the tax is regressive, meaning it will affect the lower income individuals and families more heavily that it will affect the affluent population. This is due to the fact that a larger portion of their income is spent on food products. While this may be true, it is also important to note that because Sugar-Sweetened beverages are not necessary to sustain life.  Proponents also argue that because obesity and diabetes affect the lower income in greater proportions that population will benefit the most (Wang, n.d.).
The introduction of the excise tax on Sugar-Sweetened Beverages is an effort of the government to discourage the excessive consumption of sweetened beverages such as soft drinks.  Proponents believe this change in eating behavior will cause individuals to have improved health and in turn reduce healthcare costs.  According to several studies research has demonstrated sugar-sweetened beverages are price elastic, meaning that as prices raise consumption will decline in similar proportion (American Health Association, 2016; Escobar, Veerman, Tollman, Bertram, Huffman, 2013; & Wang, n.d.)
In their research, The Centers for Disease Control and Prevention (2010) found that in order to modify obesity rates and improve the overall health of a population, more action must be taken.  Not only should a form of discouragement be placed to deter individuals from purchasing sugary beverages, access to safe and flavorful drinking water must be ensured, access to and consumption of alternatives must be promoted and encouraged, there must be a decrease in cost of healthier alternative beverages, marketing for sweetened beverages must be minimized particularly for children, screen and counseling about the dangers of sweetened beverages must be provided, and medical providers must have increased training regarding how to educate their patients on the dangers of sweetened beverages. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages.
Several sources identify the excise tax is only one step necessary to address the current health care crisis from conditions such as obesity, diabetes, and heart disease (Centers for Disease Control and Prevention, 2010 & American Public Health Association, 2016).  While the legislation has not yet gone into effect in Philadelphia, there has been little discussion regarding increasing prevention efforts and making healthier options more available and affordable for low-income consumers.  It is also concerning that Philadelphia has not included prevention efforts in its use for the revenue.
While most healthcare professionals, including nurses, will agree that excessive consumption of sweetened beverages contributes to health problems, it is questionable if imposing an increase in tax on those items alone will produce the intended effect of improved health. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages While some research has linked an increase in taxes to a reduction in the consumption of those items, similarly to taxes imposed on tobacco and alcohol products, research has not yet established that this reduction in consumption of sweetened beverages leads to improved health outcomes.  It seems that without meaningful intervention to both motivate the American Consumer to engage in healthier behaviors and without increasing access to healthier products across all socioeconomic backgrounds, the effect of a sweetened beverage tax will not produce the marked improvement in health it promises.

American Public Health Association. (2016). Taxes on Sugar-Sweetened Beverages.  Retrieved from
Cabera Escobar, M.A., Veerman, L.J., Tollman, S.M., Bertram, M.Y., & Hofman, K. (2013).  Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis.  BMC public health, 13 :1072.  doi: 10.1186/1471-2458-13-1072
Centers for Disease Control and Prevention. (2010) The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages.  Retrieved from
Centers for Disease Control and Prevention: National Center for Chronic Disease Prevention and Health Promotion. (2009). The power of prevention: chronic disease…the public health challenge of the 21st century.  Retrieved from
City of Philadelphia. (2016). Sugar-Sweetened Beverage Tax.  Retrieved from
Colchero, M.A., Popkin, B.M., Rivera, J.A, Wen Ng, S. (2016). Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study BMJ 2016; 352 :h6704 Retrieved from
Fletcher, J.M., Frisvold, D., & Tefft, N. (2010).  Can soft drink taxes reduce population weight.  Contemp Econ Policy; 28(1): 23–35. doi:10.1111/j.1465-7287.2009.00182.x.
Kennedy, M. (2016, June 16).  Philadelphia Becomes the 1st Major U.S. City to Pass a Tax on Soda.  The two-way: Breaking news from NPR.  Retrieved from
Novak, N.N. & Brownell, K.D.  (2012). Role of Policy and Government in the Obesity Epidemic.
Shekhtman, L. (2016, June 17). How Philadelphia Passed a Soda Tax.  The Christian Science Monitor.  Retrieved from
Wang, Y.C. (n.d.).  The Potential Impact of Sugar-Sweetened Beverage Taxes in New York State: A Report to the NYC Department of Health & Mental Hygiene.  Columbia University. New York, NY: Author. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages

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