Finding Your Dissertation Topic

Deconstructing Social Issues to Find the Questions

Walden UniversityAtlanta: Milestone One

Dr. Howard B. SchechterApril, 2008

Ways to Find a Problem

• Vision – “The world would be a better place if . . .

• Political Issues and Problems – where do issues come from? How do they achieve national prominence?

• Linking Social Change to Research

Is the issue real?

Social Issues

• Social issues “live” in the media

• The media present, define, and position everything we think about when it comes to social issues

• The news, TV, radio, newspapers, internet, podcasts, etc. all play a role in how we think about social issues

Obesity as a Social Issue

Dr. C. Everett Koop Launches A New "Crusade" To Combat Obesity in America December 6, 1994, Washington, D.C. -- With mounting evidence that the United States is experiencing an unprecedented epidemic of obesity among both adults and children, Dr. C. Everett Koop -- the former U.S. Surgeon General -- today launched Shape Up America!, his new "great crusade" to place healthy weight and physical activity high on the national agenda.

Obesity

At a White House ceremony on the importance of physical activity and healthy weight hosted by First Lady Hillary Rodham Clinton, Dr. Koop released a new report -- Weighing In For America's Health: Elevating Healthy Weight and Physical Fitness as a National Priority

- December 6, 1994

Obesity – The Spin

Dr. Koop says he derived the statistic from a study called "Actual Causes of Death in the United States" that appeared in November 1993 in the Journal of the American Medical Association.

The study -- a review of death certificates filed in 1990 -- never said obesity killed that many people. It said, rather, that "dietary factors and activity patterns that are too sedentary are together accountable for at least 300,000 deaths each year." It also said what many already knew -- that obesity is "associated with increased risk for cardiovascular disease, certain cancers and diabetes" but stopped short of calling obesity a disease by itself.

Obesity – Creating an Issue

Dr. Koop's declaration at the White House soon found its way into numerous news articles . . . However,

Barbara J. Moore, executive director of Shape Up America! says she warned Dr. Koop that he was misrepresenting the study's findings by making so direct a link between obesity and death.

Obesity - 1994

"As the nation considers reforms to the health care system, no workable agenda can ignore the pressing issue of combating obesity in America," Dr. Koop said.

“. . . especially disturbing, according to Dr. Koop, is that U.S. obesity rates, already among the highest in the world, are continuing to go up -- from 25 percent of American adults in 1980 to 34 percent today.

“. . . "a multibillion dollar drain on the U.S. economy," the report summarizes the calculations of medical researchers who put the cost of obesity at more than $100 billion annually.

Obesity - 1996

• WASHINGTON (CNN) -- Former U.S. Surgeon General C. Everett Koop is trying to enlist doctors in a new battle of the bulge.  Koop's organization, Shape Up America, introduced new medical guidelines. . .

• New guidelines measure obesity• New guidelines are designed to help doctors

determine which patients are obese and what type of treatment they need. The guidelines are based on a patient's body mass index, or BMI . . .

Obesity – Change the Definitioni.e. the sky is falling

Obesity Threshold Will Be Lowered

By Sally Squires, Washington Post Staff WriterCopyright 1998 The Washington Post Company

June 4, 1998

The federal government plans to change its definition of what is a healthy weight, a controversial move that would classify millions more Americans as being overweight.

Under the new guidelines, an estimated 29 million Americans now considered “normal weight” will be redefined as overweight and advised to do everything they can to prevent further weight gain.

Well Guess What?

• The percentage of children and adolescents who are defined as overweight has more than doubled since the early1970s.  About 13 percent of children and adolescents are now seriously overweight. 

And Furthermore. . .

• Recent results of the National Health and Nutrition Examination Survey (NHANES) 1999 indicate that an estimated 61 percent of U.S. adults are either overweight or obese, defined as having a body mass index (BMI) of 25 or more.

Obesity - 1998

Dire Warnings About Obesity Rely

on a Slippery Statisticby Laura Johannes and Steve StecklowCopyright 1998 Dow Jones & Co., Inc.

The Wall Street Journal (February 9, 1998)

BMI Measurement Misdiagnosis

• A significant body of research has been conducted over the past several decades to demonstrate how increased BMI is associated with an increased risk for several leading causes of death in the United States: heart disease, stroke, type 2 diabetes and certain cancers. But while commonly accepted standards use BMI - a mathematical formula based on an individual's height and weight - to identify healthy and unhealthy weight, BMI cannot distinguish fat from muscle.

• Washington, D.C. - (August 28, 2000)

Obesity – 2000 (time to change how we measure)

Aug. 29, 2000 (Washington) -- The numbers on the scale used to be the gold standard measurement of obesity. Then came the body mass index or BMI -- a ratio of height and weight currently used to determine healthy body weight. A new study suggests that body fat measurements may be best. Some experts believe that body fat percentage may be a more accurate indicator of good health than BMI.

Obesity – Money to be Made

Case Studies

HEALTHCARE

The Robert Wood Johnson Foundation Peptor | Brookhaven National Laboratory | IPRO

New York Hospital Queens | Celgene | The Lasker Awards TREX Medical Corporation

THE ROBERT WOOD JOHNSON FOUNDATION Branding Substance Abuse Awards How do you brand a little-known awards program in a media environment that is not "awards-friendly" and in an area that is misunderstood - and perhaps stigmatized - by journalists, policy-makers, and just about everyone else? This was precisely the challenge M Booth & Associates faced when The Robert Wood Johnson Foundation asked the firm to design a two-phased campaign to brand its leadership development and innovators awards for addiction professionals. Booth did just that, with a media relations blitz that resulted in nearly a billion media impressions (ranging from The Wall Street Journal to USA Today), and an event and webcast keynoted by former Surgeon General Dr. C. Everett Koop. This event attracted more than 300 influentials from 50 key stakeholder groups not previously familiar with the awards and led to valuable new program linkages.

Obesity – The Body PoliticObesity – The Body Politic

Obesity deemed an illnessBy Marguerite HigginsTHE WASHINGTON TIMES

July 16, 2004 Obesity is now an illness and can be covered

by Medicare, the federal health-insurance program for the elderly and disabled.     Health and Human Services Secretary Tommy G. Thompson announced yesterday the Centers for Medicare and Medicaid Services would remove language in Medicare's coverage manual that states obesity is not an illness.

Obesity – The CDC Jumps In“. . . obesity contributes to 400,000 annual deaths, according to the CDC.

(Notice that when the CDC jumped in, the number increased 25%)

3/11/2004

America's fast-food industry savoured a victory over consumer activists yesterday after Congress approved a "cheeseburger bill" to shield restaurant franchises and food firms from blame for making customers "dangerously fat".

By 276 to 139 votes Congress on Wednesday night moved to ban lawsuits against the industry that enjoys a grip on America's eating habits and has grown into the country's second largest employer.

The vote, championed by Republicans, has yet to pass the US Senate, but it was hailed by Republican legislators as a boost for "personal responsibility", and received the White House's endorsement.

Obesity – The Presidential Race

• Obesity policy will benefit trial lawyersBy Marguerite HigginsTHE WASHINGTON TIMES

July 17, 2004 • The federal government's decision to begin covering obesity treatment will help trial

lawyers in their quest to blame the epidemic on the food and restaurant industries.

• Supporting Disease Prevention and Health Promotion Programs. John Kerry's plan would disseminate best practices in disease prevention and health promotion, encourage exercise, and invest in preventive care models. To reduce health care costs, Americans also need to be more responsible.

CFNP ReportDecember 2, 2004

• Obesity Round-up

Obesity is still the second leading cause of preventable death among Americans today, but death rates are not as high as reported earlier this year (see CFNP Report of March 17, 2004) due to a statistical error made by the Centers for Disease Control (CDC).  A mathematical mistake at the CDC attributed about 80,000 additional deaths a year to obesity-related causes. 

CDC Admits to Error

April 20, 2005In a report released in the JAMA, the CDC

admits to calculation errors that lower the number of deaths attributable to obesity to 25,814 per year.

Obesity is now #7 on the list of preventable deaths, down from its #2 spot one year ago. “It’s now OK to be a little plump.”

CDC Chief Waffling

June 3, 2005

CDC Chief Dr. Julie Gerberding says “It is not OK to be overweight. People need to be fit, they need to have a healthy diet, they need to exercise. . . The study released in April was misleading”.

Obesity and the Insurance Industry

• May, 2006: Senator Enzi (R-Montana)• S. 1955, the Health Insurance Marketplace

Modernization Act (HIMMA), was introduced by Sen. Michael Enzi (R-WY) and is slated for a floor vote in the U.S. Senate the week of May 8. This legislation, if enacted, will strip away almost all state-enacted consumer protections for people buying insurance individually or through their employers.

Healthy Living = Higher Costs?

• Dr. Pieter van Baal, Netherlands National Institute for Health and the Environment: 2/07

• Life span on average . . . smokers 77, obese 80, healthy 84Cost of care: $417k for thin and healthy $371k for obese $326k for smokers

Dr. Patrick Basham, Johns Hopkins “…this throws cold water on the idea that obesity is going to cost trillions of dollars…”

Inside Obesity

• What are the questions?

• Methods of measurement – BMI, BF %age

• Methods of treatment

• Who pays?

• Who is at risk?

• What is not being considered? What has been left out?

The Dissertation Question

The questions are in the issue.

In this case the issue is “obesity”.

If you look into how this became such a grand “social issue”

You’ll find the same “how to” pattern in almost every other issue

Every Issue that Shapes Your Thinking Every Day

• Education • Reproductive Rights • Gun Control • Same Sex Marriage• The Environment• Terrorism• Smoking• Global Warming

Next Year’s Issues

• The wars in Iraq and Afghanistan

• Illegal immigration

• The economy

• Global Warming

• Foreign aid

• Re-Building the Military

Example: Retirement ReformSeptember 15, 2004Carmakers In for a Long Haul In Paying Retiree Health CareBy DANNY HAKIM

DETROIT, Sept. 14 For G.M., the nation's largest private purchaser of health services and of drugs from Viagra to Lipitor, the projected cost of providing health care benefits to current and future retirees like Mr. Pusey is a staggering $63 billion.

While soaring medical costs are an issue for all employers in the United States, for older domestic manufacturers the nation's health care system is a competitive double whammy. That is particularly true for G.M., the world's largest - but far from the most profitable - automaker.

G.M. covers the health care costs of 1.1 million Americans, or close to half a percent of the total population, though fewer than 200,000 are active workers while the rest are retirees, children or spouses. Not only are such costs escalating rapidly, but G.M.'s rivals, based in Japan and Germany, have virtually no retirees from their newer operations in the United States and, at home, the expenses are largely assumed by taxpayers through nationalized health care systems.

Example: Social Security• Greenspan's Social Security Alarm

• 77 Million Baby Boomers Near Retirement

Aug 27, 2004 10:10 am US/CentralJACKSON, Wyo. (CBS) Federal Reserve Chairman Alan Greenspan said Friday that the country will face "abrupt and painful" choices if Congress does not move quickly to trim the Social Security and Medicare benefits that have been promised to the baby boom generation.

Returning to a politically explosive issue that he has addressed a number of times this year, Greenspan said that it was wrong for the government to hold out the promise of more retirement benefits than it is capable of providing.

Your Question: Social Change

Study the Genesis of the IssueStudy the Basing Assumptions Analyze What You’re Being Told (hint: look

behind the numbers that are repeated)Turn the Issue 180°Who is Framing the Issue?What are You NOT Being Told?Now, What’s Your Question?