Essay: Health inequalities and Public Health intervention

In spite of significant progress in England’s public health over the previous century and beyond, health inequalities remain a consistent and contemporary feature. This report explores the factors that contribute to current public health issues. The second part explains the different levels of public health intervention. The next part will review national strategies aimed to prevent and manage ill-health. The final part of this report will evaluate the role of healthcare professionals in preventing and controlling the spread of disease.
Introduction
‘’Public health refers to all organised measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole’’. (WHO, 2018)
“Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. For example, differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes”. (WHO, 2018)
Regardless of successive government initiatives in the post-war period, data show that there are still significant health inequalities in England today, particularly between various socio- economic groups.
The purpose of this report is to:
• Examine the factors that contribute to public health;
• Explain the different levels of public health intervention;
• Review national strategies used to prevent and manage ill-health;
• Evaluate the role of healthcare professionals in preventing and controlling the spread of disease.
The first part of this report explores the factors that contribute to public health issues in England and Manchester today.
Factors in public health
According to Public Health England (2018), we now live longer than ever before as a population. However, the number of people living with a range of complex co- morbidities and some 40 percent of premature deaths correlated to behavioural factors today is increasing (Global Burden of Disease Study, 2014). Likewise, there is also a marked social degree of health, with those from poorer socio- economic backgrounds suffering from a much greater burden of disease than their wealthier counterparts (Marmot, 2016).
A number of local and national initiatives to address these concerns are currently in place.
Public Health England (2014) set out seven key priorities to help people live as well as possible, for as long as possible.
The seven priorities are:
• Tackling obesity, particularly among children
• Reducing smoking and stopping children starting
• Reducing harmful drinking and alcohol-related hospital admissions
• Ensuring every child has the best start in life
• Reducing the risk of dementia, its incidence and prevalence in 65-75 year olds
• Tackling the growth in antimicrobial resistance
• Achieving a year-on-year decline in the incidence of tuberculosis
Each of these priority areas was established by means of rigorous epidemiological data analysis.
Tackling obesity, particularly among children
In 2015 to 2016, 19.8% of children between 10 and 11 years of age were obese and an additional 14.3% were overweight. Of children between 4 and 5 years of age, 9.3% were obese and a further 12.8% were overweight. This implies that a third of ten to eleven years of age and over a fifth of four to five years of age were overweight or obese. (PHE, 2017)
‘’Obesity increases the risk that a whole host of diseases will develop. Obese individuals are: At increased risk of certain cancers, including being 3 times more likely to develop colon cancer, more than 2.5 times more likely to develop high blood pressure – a risk factor for heart disease and 5 times more likely to develop type 2 diabetes.’’ (PHE, 2017)
Reducing smoking and stopping children starting
The majority of smokers begin as adolescents: two thirds before the age of 18. The reasons why they start from peer pressure to behavioural problems are complex. Children are more likely to smoke if they live with smoking people (PHE, 2015).
Some demographic groups, including Bangladeshi, Irish and Pakistani men and Irish and Black Caribbean women, have relatively high levels of smoking. Smoking during pregnancy increases the risk of abortion, stillbirth or a sick baby and is a major cause of health inequalities for children. At birth, more than 1 in 4 pregnant women are registered as smokers in Blackpool, however less than 2 out of 100 in Westminster London Borough (PHE, 2015).
A wider range of social, economic and environmental factors affecting human health are important determinants. These factors are influenced by the distribution of power and resources at local, national and international levels that shape everyday life. They decide the degree to which diverse people have the physical, social and personal resources to recognise and accomplish goals, to fulfil their needs and manage changes to their conditions. The Marmot Review, published in 2010, highlighted the profile of broader health determinants by emphasising the strong and persistent connection between social inequalities and health outcome disparities (PHE, 2017).
There are a variety of factors contributing to health (for example genes, diet, lifestyle factors). In particular, socio- economic deprivation is strongly linked to poorer health outcomes (Marmot, 2010). National problems such as smoking, obesity in children and mental health are particularly acute in Manchester, which is also one of the most socio- economically deprived areas in the United Kingdom (PHE, 2016).
The health of individuals and communities is affected by numerous factors. Whether or not people are healthy depends on their environment and circumstances. To a great extent, factors such as where we live, the condition of our environment, genetics, income and education, our relationships with friends and family all have significant health implications, while the more generally considered factors, for example, access to and use of health care, regularly have less of an effect (WHO, 2018).
Manchester has high levels of socio-economic deprivation compared to the rest of England. ‘’More than a twentieth of Manchester (6.4%) is made up of areas in the bottom 1% of deprived areas of England, with a quarter of the area (24.8%) made up of places in the bottom 5%’’. (Manchester Evening News, 2018).
Over the past 25 years, the rate of obesity has more than doubled, leading to an obesity epidemic in the United Kingdom (UK). According to the Health Survey for England (HSE), obesity among 2-10 year-olds increased from 10% in 1995 to approximately 13% in 2010- 2012. ‘’The percentage of obese children in reception and year 6 in Manchester in 2013/14 was higher than the National and North-western averages. 11.7% of children were classified as obese in reception, with levels more than increasing by year 6 to 25%.’’ (HSE, 2013).
D1 Many interrelated factors, such as socio- economic status, lifestyle choices, diet and genetics, determine health. More than 40% of premature deaths are associated with behavioural factors today. Current population health strategies are progressively aimed at addressing all the factors that impact our health, with the ultimate goal of preventing disease and reducing inequalities in health.
As the demand for health and social care services rises as the nation ages and distresses, contemporary public health strategies are progressively focused on preventing ill health through the promotion, screening and early intervention of preventive health.
Community asset-building, economic prosperity and the integration of health services and social care are also seen as the means to make sure the long- term sustainability of the health and social care systems.
Different Levels of Public Health Intervention
(P3) Disease prevention and management strategies can be categorised as primordial, primary, secondary and tertiary prevention.
Primordial prevention – Seeks to anticipate at a beginning time, frequently before the hazard factors is available in the specific setting, the exercises which energize the rise of ways of life, practices and presentation designs that add to expanded danger of malady. For example, a child who sees their parents smoking cigarettes may mistakenly consider this is a decent direction for living for later life: encouraging parents to stop smoking in such conditions can be viewed as primordial. (Health Knowledge, 2017)
Primary prevention is aimed at preventing illness or injury before it happens. This is done by preventing exposures to disease or injury-causing hazards, altering unhealthy or unsafe behaviours that can result in illness or injury and expanding resistance to disease or injury should exposure happen. Law and enforcement prohibiting or controlling the use of perilous products (e.g. asbestos) or mandating safe and healthy practices (e.g. seatbelts and motorcycle helmets).
Secondary prevention is aimed at reducing the effect of an already occurring disease or injury. This is done by detecting and treating disease or injury at the earliest opportunity to stop or moderate its progress, urging individual to avert reinjury or repetition and to implement programs to bring individuals back to their unique health and capacity to avert long-term issues. For example, female cervical screening detects early changes which can lead to cervical cancer.
Tertiary prevention – The application of measures to decrease or take out long-term impairments and disabilities, to reduce the suffering caused by existing health departures and to promote adjustments to the patient’s condition. For example, an individual who has type 2 diabetes will have regular blood glucose checks to monitor their diabetes and to prevent disease complications.
(Institute for Work and Health, 2015)
(P4) The international response to the Ebola outbreak in Western Africa in 2016 and the multi- agency Fresh initiative to fight Chronic Obstructive Pulmonary Disease (COPD) in the North East of England are two examples of recent disease management strategies in action.
The Ebola outbreak in West Africa that began in March 2014 was the biggest since the discovery of the Ebola virus in 1976. In Guinea, Liberia and Sierra Leone more than 28,600 cases of Ebola have been reported and more than 11,300 people have died. (ActionAid, 2016)
The Ebola epidemic in West Africa is now over. The World Health Organisation (WHO) has declared that it is no longer an international public health emergency. The WHO announced the end of human-to-human transmission of the virus in every one of the 3 of the most exceedingly terrible influenced nations – however there will be little flare-ups of the disease. (GOV.UK, 2016)
The Ebola virus can be found in the blood, body fluid or organ of an infected person or animal.
The WHO and other partners are working with the Governments of Guinea, Liberia and Sierra Leone to ensure that survivors have access to medical and psychosocial care and persistent virus screening, and also advising and educating them to reintegrate into family and community life, decrease stigma and reduce the risk of transmission of Ebola virus. (WHO, 2018)
In a trial conducted in Guinea by the World Health Organisation (WHO) and other international partners in 2015, an experimental vaccine called rVSV- ZEBOV was found to be highly protective against the virus (Centers for Disease Control and Prevention, 2018)
In England, there are nearly 1.1 million individuals diagnosed with chronic obstructive pulmonary disease (COPD) in a group of lung conditions that cause difficulty in breathing, such as emphysema and chronic bronchitis. This is nearly one in every 50 individuals registered with a GP, or about 1.9 percent of the population, and the NHS costs over £800 million every year. The COPD rates in the north and in poor areas and areas with higher smoking rates are higher throughout England.
(House of Commons Library, 2018).
There are three main ways in which the NHS can avert individuals from dying prematurely:
Identify earlier and correctly – making sure that individuals get the right diagnosis and treatment.
Prevent progression – by evidence-based treatment, rapid and efficient management of exacerbations and interventions for example, cessation of smoking
Prolonged survival – making sure that individuals with progressively serious COPD get non- invasive ventilation and long- term oxygen therapy interventions.
((Department of Health, 2012).
(M2) There are various number of challenges that can hinder the effectiveness of interventions in public health. These can be classified as barriers to the individual, family, community, society and structure. For example, an individual whose friends and family smoke and drink intensely might be increasingly disposed to do likewise.
The government’s austerity program introduced in the wake of the global economic downturn that began in 2007 is a societal/structural factor currently affecting public health outcomes. Austerity measures focused on reducing public expenditure as the primary means of debt reduction. While more prominent research is required on the effect of austerity on public health, this has undoubtedly coincided with an increase in population poverty and a significant reduction in public spending throughout Europe (Stuckler et al, 2017).
In conclusion, any successful prevention and management strategy of disease needs a combination of interventions (i.e. disease prevention, detection and treatment) to be available so as to be effective. Be that as it may, it is additionally obvious that numerous barriers can possibly obstruct the ambitions of any disease control plan – not slightest the resourcing and capacity of services to fulfil their core functions.
National and Local Strategies aimed at reduction or prevention of disease
Measures to tackle health inequalities date back to the 19th Century, when Edwin Chadwick and John Simon introduced sanitation in English towns and cities. Recently, following the 1980 Black Report, which highlighted major mortality and morbidity differentials based on socio- economic background, successive governments have introduced a range of measures to tackle health inequalities with variable success.
In 2010, the independent review of health inequalities in England commissioned by the government and carried out by Professor Sir Michael Marmot of University College London, Fair Society Healthy Lives (Institute of Health Equity, 2010) found that we all are living longer as a whole than ever before, individual’s health and well- being vary considerably throughout England. There is also a social degree of health- the lower the social position of a person, the worse the health of the person. People in poor areas have a shorter life expectancy and are more likely to experience a greater burden of ill health – and across the socio- economic spectrum there are differences in life expectancy and life expectancy in health.
According to Marmot, the underlying social factors affecting an individual’s health and well-being – the causes of the causes – drive this inequality. The report identified six themes that are important for reducing inequalities in health:
• Best start in life
• Maximise capabilities
• Fair employment
• Healthy standard of living
• Sustainable places and communities
• Ill health prevention (Marmot, 2010)
Today in England, the Marmot report continues to play a key role in shaping public health strategies. In addition, current strategies likewise recognise that untimely death rates (deaths below 75) are excessively high, particularly in comparison with other European countries such as Sweden, Switzerland, Italy, Norway and the Netherlands. A large number of the deaths from the five major killer diseases (such as cancer, heart disease, stroke, respiratory and liver disease) are also regarded as ultimately preventable (GOV.UK, 2107).
Living Well for Longer: National support for local action (2014) details the actions of the Department of Health, Greater Government, NHS England and Public Health England (PHE) in the prevention, early diagnosis and treatment of the five major killer diseases and the reduction of health inequalities
NHS England (Five Year Forward View 2014) and Public Health England (From Evidence to Action, 2014) have published long-term plans that reflect the need to prioritise and mainstream prevention as fundamental to improving the health outcomes of the population and ensuring the sustainability of the health and care system.
(P5) Locally, the Greater Manchester Population Health Plan 2017-21 (GM Health and Social Care Partnership (2017) links to the National Devolution Agenda and the Manchester Strategy, leading to greater local autonomy in decision-making and/or managing budgets for local councils and NHS organisations. The plan covers broader areas and wider health determinants for example economic prosperity, policing, transport and health care. Its main focus is on addressing premature mortality and health inequalities through the following:
• Greater integration of services – health and social care
• More individual’s to be upheld to remain well and live at home for whatever length of time that conceivable
• Focus on improved community-based care in the vicinity of people’s homes
• Focus on prevention, early intervention and support for long- term living conditions
While the plan is still in its earliest stages, data published by Public Health England (Longer Lives, 2017) shows that Manchester still performs poorly on a range of health indicators, including untimely death rates, in the central region in particular, compared to the national average.
In summary, government-reported trends (GOV.UK, 2017) demonstrate that, in spite of the long-term trend of improved life expectancy, infant mortality and the rates of premature cancer and cardiovascular disease deaths in England between 2001 and 2003, there are still severe inequalities. This proposes that national public health interventions to date have at best limited their capacity to address health inequalities in a meaningful manner. Undoubtedly, there is still considerable room for improvement.
The role of healthcare professionals in preventing and controlling disease
All health and social care professionals have a role to play in preventing and controlling diseases by’ making every contact count’ in the words of NHS England (2014). Some expected behaviours are common to all professionals, for instance; role modelling, keeping up good personal hygiene, following approved infection control practices, providing advice and help and support to people, etc.
However, roles and responsibilities can also vary depending on the professional’s specific task. A General Practitioner, for instance, typically undertakes the following:
• Providing vaccinations
• Disease screening and sending patients to specialist secondary care services
• Prescribing medicines and social prescriptions for treatment of disease
• Providing healthcare advice / health coaching
• Monitoring the progress and impact of disease and treatment systems
• Enabling treatment and patient recovery
On the other hand, a healthcare assistant has a smaller role. However, they are expected to provide health advice, to be a positive role model and to implement care and support plans with the consent of the patient / service user. They will also typically inform other professionals and services where a matter is outside their competence and pass on relevant issues of concern to their superiors (e.g. accident, incident and disease reporting under RIDDOR regulations, 2013).
A key requirement for all professionals is that approved infection control practices should be followed and promoted. This can simply be achieved using agreed handwashing guidelines and personal and protective equipment (e.g. gloves and aprons) as per policies and procedures. All professionals must also adhere to acceptable food hygiene practices and guidelines for the safe disposal of various waste categories. In a clinical context, it may be relevant for professionals to take further precautions, such as the use of nursing barriers, to prevent infection from spreading.
Challenges faced by healthcare professionals in preventing disease spread include the increasing prevalence of antibiotic-resistant ‘superbugs’ such as MRSA and CDifficile- addressing anti-microbial resistance is indeed one of the key priorities identified by Public Health England in From Evidence into Action, 2014.
Poor hygiene and infection control standards can have a serious effect on a person, especially if they have a compromised immune system because of their age or health status. It is therefore imperative that all health and social care professionals (including staff at home, cleaning and catering) follow approved infection prevention and control guidelines and make the best use of equipment for this purpose. In addition, it is important to encourage patients and service users (plus visitors) to observe infection control practices in settings or in contact with individuals who may be particularly susceptible to infection.
In summary, all people working in health and social care, regardless of their status, play an important role in promoting disease prevention and spread. Some areas of responsibility coincide, while others are more specific to the individual practitioner’s designated role and responsibility. It is absolutely essential to maintain good personal hygiene and comply with agreed infection control protocols, as every contact with the public counts.
Contemporary government data show that, in spite of the long-term trend of life expectancy improvements, infant mortality and rates of premature cancer and cardiovascular disease deaths in England, serious health inequalities continue between various socio-economic groups. In spite of various number of progressive measures in recent years, public health interventions at national level have at best been limited in their ability to tackle health inequalities significantly. While we are more aware than ever of the determinants of health, treatment and disease prevention, there is growing concern among some commentators about the impact of the government ‘s austerity policies in response to the world economic crisis.