In the 1850’s, John Snow began the first surveillance project identifying the source of a breakout of cholera in London, England. His studies and findings encompassed the foundations of the field of epidemiology. Now, in the 21st century, this field is being used to understand and find solutions for an array of public health problems never before experienced in the history of man. The rapid aging of the global population is leading us into a future where the number of older adults will exceed the number of children in many areas of the world. And how are the children? In the days of John Snow, many children were not able to get enough food to be healthy, let alone to survive. Now, in the times of mass agriculture and advertisement, an obesity epidemic has promulgated through schools, households, playgrounds, places of worship, and neighborhoods, and is threatening the current and future health of the most vulnerable yet most powerful group in our society: our kids. There is a lot at stake in terms of our ability to curb this epidemic, and it will take a concerted collective effort on behalf of elected officials, community leaders, parents, and dedicated public health professionals.
One of the shortcomings of many public health programs is a lack of research that supports their efficacy. Close to 90% of all public health interventions fail to reach their objectives. Failure of public health interventions is often caused by the inability of the research team to administer the intervention in manner that encompasses the customs, language, and overall culture of the target population. Culture defines our identity. Behavior defines our culture. How then can one attempt to change health behaviors without incorporating culture? It is imperative that public health interventions are able to “meet people where they are” in order to be successful.
It is for these reasons that Dr. Olajide Williams, the founder and president of Hip Hop Public Health, applied the successful HHPH model to address the childhood obesity epidemic with the program Hip Hop H.E.A.L.S. (Healthy Eating and Living in Schools). The Hip Hop Stroke program, the inaugural program of the HHPH model, incorporates Hip Hop music and related multimedia to effectively communicate stroke knowledge to elementary school children. The child-to-caregiver study that was conducted for the Hip Hop Stroke program demonstrated that children that participated in the Hip Hop Stroke program did indeed share the information with their parents and family members, causing their stroke knowledge and literacy to improve. The implications are astounding. Children participating in Hip Hop Stroke have even saved lives by recognizing the symptoms of stroke and calling 911. It was only logical that, if children can learn and teach about the signs and symptoms of stroke, they can also learn and teach about a health topic that affects them most directly: how to balance between food and exercise in the fight against obesity. The concept of teaching children who in turn teach their family members is novel. However, it represents the kind of innovation that is needed to attack a complex public health problem. Dr. Williams has diligently evaluated and presented the efficacy of the Hip Hop Public Health model. However, what sets HHPH apart is that the HHPH team has aggressively followed in the footsteps of John Snow to conduct innovative and original research with members of its target population: low-income, urban-dwelling children and their families, in addition to the evaluation of its programs to more concretely identify the source factors and various dynamics that play a role in perpetuating the epidemic.
A key educational objective of the Hip Hop HEALS program is caloric literacy. Our team members have found that many children do not know exactly what calories are. For many of them, calories have a negative connotation, and are automatically linked to “bad” foods. In 2008, New York City passed legislation to require chain restaurants to post the calorie content of all of the food items they served. However, there is little evidence to suggest that these menu boards have been interpreted well enough by the public to positively impact food purchasing behavior. An intervention put in place that does not give the tools needed by the people it is targeting to properly access the intervention is fruitless. Hip Hop H.E.A.L.S. aims to facilitate the power of calorie postings on menu boards by providing calorie literacy education.
The approach of the Hip Hop H.E.A.L.S. program is akin to harm reduction. People eat at fast food restaurants for many reasons. In low-income neighborhoods within New York City, consuming fast food is sometimes a matter of taste, but more often a matter of finances. The HHPH team recognizes the economic realities facing parents, families, and individuals in these communities. Therefore, instead of demonizing the fast food restaurants, which is one of the few ways that many parents can afford to feed their families, we encourage children to ask for healthier items on the menus of these restaurants that contain fewer calories.
The HHPH team has also analyzed the snacking behavior of children. In our study of low-income children in Harlem, we found that 56% reported snacking between one and three times per day, while 17% reported snacking four or more times a day. Much of this snacking occurs while watching television or commuting, during which children are exposed to a bombardment of advertising for high-calorie, low-nutrient, good tasting snack foods. Choosing high calorie snacks can easily cause a person, young or old, to exceed their daily caloric requirement. Hip Hop H.E.A.L.S. focuses on giving children their daily calorie number, and giving them pertinent information about food (calories in) and exercise (calories out) needed to make the decisions that will allow them to stay within that healthy range and avoid putting on extra weight.
Recently, The Hip Hop HEALS research team began studying the food purchasing behavior of children and their parents to determine the amount of influence that children have over the parents in terms of what kinds of food they buy. The HHPH team has conducted food sales before and after administration of the Hip Hop HEALS program to determine if children are more likely to purchase GO or SLOW foods post-intervention. The initial pilot data of this research indicated that the Hip Hop HEALS program did indeed influence the purchasing behavior or the children. The goal is that our efforts to teach children to distinguish between low-calorie, high nutrient foods (GO foods), high-calorie, high nutrient foods (SLOW foods), and high-calorie, low nutrient foods (WHOA foods) and to have a desire for GO foods upon being educated on the benefits of consuming them may lead children to ask their parents to purchase GO foods for them more often, thereby influencing the eating habits of the entire family unit.
Hip Hop HEALS is a real movement of the people in that it recognizes and acknowledges the power of children to affect change. It aims to give young people that are susceptible to generational curses of poverty and ill health the self-efficacy and pride needed to make positive changes for themselves, their families, and their future children. It is hoped that the information offered by the Hip Hop HEALS program will reach children worldwide so that in the future the childhood obesity epidemic can be looked upon historically as the cholera epidemic during the time of John Snow is looked upon today: a turning point.