During the past three decades, the United States has witnessed a dramatic increase in the prevalence of obesity, which has become a public health crisis (US Department of Health and Human Services, Public Health Service 2001, Ogden, Carroll, Curtin, et al. 1999 –2004).

Obese persons have an increased risk for diabetes, (Marmot, 2005), cardiovascular disease, (Kim, Millen, Gershamn, Irwin 2000) cancer, (Tarlov 1996) and mortality (WHO 2007, Summary of proceedings 2006). Obesity and overweight rates are increasing rapidly in the United States (Berkman, Kawachi, 2003, Kawachi, Berkman 2003). In 2000, approximately 20.1% of the adult population was obese and 36.7% was overweight. Similarly, the current National Health and Nutrition Examination Survey (1999–present) found that the percentage of obese adults increased from 22.9% between 1988 and 1994 to 30.5% between 1999 and 2000 (McCarthy 2000). Childhood obesity rates also increased between 1988 to 1994 and 1999 to 2000 from 7.2% to 10.4% among children aged 2 to 5 years (Marmot, Wilkinson 2006).
The southern states were the first to have more than 20% of their adult populations obese, higher rates of obese and overweight adults have spread to all areas of the country (Davis, 2006, Edelman, Mitra 2006). Many of the metropolitan areas that have the highest levels of urban sprawl are located in the South.
This suggest the first links between levels of urban sprawl and the risk for being obese or overweight.
Urban sprawl: is often loosely defined, and complicating these definitions is confusion among causes, consequences, and attributes of urban sprawl. Urban sprawl is idefined as an overall pattern of development across a metropolitan area where large percentages of the population live in lower-density residential areas. The causes of urban sprawl are not well identified but include affluence that enables households to purchase larger houses on larger lots, cultural values that reject urban living and emphasize automobile use, inexpensive land values that support urban sprawl–dependent lifestyles, and government policies that promote urban sprawl (McLafferty, Grady 2005, Last 2001, Collins 2004).
Overweight and Obesity: Obese or overweight status is usually determined by the body mass index (BMI) formula (weight in kilograms divided by height in meters squared); adults are considered overweight when their BMI is greater than 25 and obese when their BMI is greater than 30 (National Institutes of Health (NIH) 1998, Willett W, Dietz W, Colditz G 1999). BMI was calculated with respondents’ self-reported heights and weights.
ll- Public health inequity (5 points)
Creating health equity is a guiding priority and core value of American Public Health Association (APHA). By health equity, we mean everyone has the opportunity to attain their highest level of health. How do we achieve health equity? We address the conditions in which people are born, grow, live, work, learn and age. These social determinants of health are shaped by the distribution of money, power and resources that include employment, housing, education, health care, public safety and food access (Braveman 2011). Inequities are created when barriers prevent individuals and communities from accessing these conditions and reaching their full potential. Inequities differ from health disparities, which are differences in health status between people that are related to social or demographic factors such as race, gender, income or geographic region. Health disparities are one way we can measure our progress toward achieving health equity.
lll- Relationship between Country and Public Health Inequity (10 points)
Health inequalities in the United States as a nation are the worst of all wealthy developed countries: Americans die younger and suffer worse health than people in over 30 other nations. The situation is not improving despite enormous expenditures on medical services, with the US paying close to half of the world’s health care bill. The reasons for these health inequalities relate to the political economy of the nation, rooted in its founding history and overlaid with recent changes wrought by neo-liberalism. Sixty years ago the nation was one of the world’s healthiest, but as a consequence of political choices that have increased the wealth of a few, everyone’s health has suffered. The US provides many lessons for other countries that want to avoid this health catastrophe.
lV – Description of Social Determinants of Health in the country
(list at least four social determinants of health in that country you selected. Please be very specific (10 pt.);
The complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world (Commission on Social Determinants of Health 2008).
Determinants of Health