The Health Equilibrium Initiative-Is it Possible to Prevent Intervention- Generated Inequality? Magnusson M * , Pickering C and Lissner L Department of Public Health and Community Medicine, Institute of Medicine, Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden * Corresponding author: Maria Magnusson, PhD, RD Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Specialized in Public Health, RN, Angered hospital, Sjukhuskansliet, Box 63, S-42422 Angered, Sweden, Tel: 46-733-763-157; E-mail: maria.b.magnusson@vgregion.se Received date: May 31, 2017; Accepted date: June 16, 2017; Published date: June 20, 2017 Copyright: © 2017 Magnusson M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Introduction: Obesity is unequally distributed between socio-economic Groups. Public health interventions may, unintentionally, contribute to widen health gaps. The approach Community based participatory research (CBPR) offers potential to narrow such gaps. CBPR needs to be adapted to the Nordic context and thus tested in appropriate settings. The aim was to examine the potential for a CBPR intervention to decrease childhood obesity in an underserved community in a major Swedish city. Methods: Activities were planned together with target groups, using Social Cognitive Theory. Activities were documented by structured reports aiming at developing knowledge and minimizing risk of harm. From determinants for healthy behavior (reciprocal determination, self-efficacy, learning by observation, facilitation and expectations of outcome) strategies for health promotion were formed. Viewpoints from collaborators were collected. Families in schools in areas where many had low education, low income and where many were recent immigrants, were invited to examinations that were discussed in the context of the participatory intervention. Examinations included anthropometric measurements, interviews on life style habits and neuropsychological assessments. Data were analyzed by independent sample t-test, Chi-square tests, one way Anova, content analysis and the CANTAB protocols, respectively. Results: Changes on structural levels were initiated during the intervention. Guidelines to remove sweets from schools were difficult to implement. 35% (n=119) of the initially invited sample participated at follow-up. At follow-up there was no difference between children in control and intervention schools. There was no evidence for links between weight and cognitive development in children. Conclusion: For participatory public health interventions time must be allocated to develop them in concert with target groups. To justify efforts and costs all steps should be thoroughly documented, transparent and evaluated. Policies to minimize sweets in schools need increased support from management levels. Participatory interventions can provide insights that cannot be obtained by traditional methods. Keywords: Childhood obesity; Cognitive function; Community based participatory research; Health Equity; Intervention-generated inequality; Self-eicacy; Schools; Empowerment; Program planning and evaluation; Social cognitive theory Abbreviations ADHD: Attention Deicit/Hyperactivity Disorder; BMI: Body Mass Index; CANTAB: Cambridge Neuropsychological Test Automated Battery; CBPR: Community Based Participatory Research; HEI: Health Equilibrium Initiative; MOT: Motor Screening; RVP: Rapid Visual Information Processing; SCT: Social Cognitive heory; SWM: Spatial Working Memory Introduction Health is improving in Sweden on a population level but this difers by subgroups. In some respects, health inequity continues to increase [1]. As in other wealthy and middle income countries, obesity represents a growing threat to health, unequally distributed between groups with diferent education and income [2]. Explanations for this are suggested on societal as well as individual levels. For example, Otero et al. argue for an association between political and economic regime on one hand and obesity prevalence on the other, describing the neo-liberal diet as especially obesogenic in poorer groups [3] while a common approach within the ield is to explore individual life style habits without relating them to societal context. Given the stigmatization of obesity, reversed causation may also play a role by discrimination of people with obesity [4]. Eforts have been made to counteract obesity by primary and secondary prevention or treatment. Counter intuitively, these interventions may widen the clets between groups, particularly individuals already having better health and better conditions in life, and those who have not [5,6]. Bambra et al. found that community capacity building was one factor that supported leveling out of inequalities [7]. his aligns with the paradigm that empowerment is pivotal in a range of contexts such as improving health for underserved groups [8] or managing care for patients with CVD and diabetes [9]. he signiicance of empowerment, closely connected with participation Journal of Community Medicine & Health Education Magnusson et al., J Community Med Health Educ 2017, 7:3 DOI: 10.4172/2161-0711.1000531 Review Article OMICS International J Community Med Health Educ, an open access journal ISSN:2161-0711 Volume 7 • Issue 3 • 1000531