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With regards to this assignment the aims are to analyse patterns of health within the adult population regarding health disease and exclusion, whilst also having the ability to assess the health needs and the impacts they have on individuals and their communities. The assignment targets to analyse and investigate public health perspectives, ideologies, with the use of current legislation and policies. Public health aims to help people avoid becoming ill with strategies to help stay healthy, this is defined by the Department of Health (2012) which states a variety of policy areas of concern, these include immunisations, alcohol, drug users, sexual health, pregnancy, smoking, alcohol and a child’s health (DOH, 2012). The health issue chosen for this assignment will be smoking in pregnancy and the implications smoking can have with regards to health issues and the problems faced globally, nationally and within a chosen demographical area. In order to clarify what is meant by the term ‘health’ an understanding must be achieved
and although according to the World Health Organisation (1986) health being ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’.
Although this is a highly thought of definition according to Macaulay & Herbert (2011) the (WHO, 1986) definition of health is no longer appropriate and should be changed towards ‘the ability to adapt and self-manage in the face of social, physical, and emotional challenges’ (Macaulay & Herbert, 2011). This effectively could make sense as the department of health are continually promoting, encouraging and helping to self-manage smokers who want to give up in forms of support groups and services supporting these decisions (DOH, 2012). However, the (WHO, 1986) see the proposed definition of health as unrealistic as social determinants may prevent the ability of people and their communities to alter their circumstances.
Within health care it is hard to determine what a health need consists of as it has many definitions and meanings which vary over time and proves difficult to define due to natural complications World Health Organisation (2012). Health needs include social care, health care, personal, housing, funding, learning, transport, leisure and employment and these are all part of a health need. Health needs change and vary for the individual, some health needs being more complex than others (WHO, 2012). Also highlighted within National Institute for Health and Clinical Excellence (2005) health needs can be opinions and expectations, the need felt and communicated and the health need varying depending on the circumstance, person and situation.
As stated by the World Health Organisation (2005) a health needs assessment is an organised system, in which systematically addresses issues that the population face, it’s a guide to establish the main concerns in order to prioritize and implement strategies to improve and reduce inequalities. Assessment is the first part of the nursing process, it allows and delivers the evidence to establish and identify past, present and future problems, alongside strategies put into place to reduce the space within health regarding the different economic and social groups and areas (NICE, 2005). A community profile investigates and informs local government and health services the results in which data is collected by means of a community survey, this then describes lived examples or the profile of the population in your community in order to identify problems, which then decides how to tackle them (DOH, 2012).
It also states and features people, households, age, gender of the population, death, birth rates, income, relating to economic and social factors, which include advantages, disadvantages, community, social needs, access to services whilst having the knowledge, and being educated about health issues affecting the population Christakopoulou, et al (2001). A good community health profile and as stated by Christakopoulou, et al (2001) requires effective community involvement and require s active community involvement.
Within this assignment the chosen area will be Sefton. The network of public health observatories (2012) provides a full and detailed profile in respect to Sefton, this compares it with England’s average, giving statistics with regards to the health and social determinant within Sefton. It also states that the population is 273,000 with regards to the health of the population ‘Sefton’ being mixed in comparison to England’s average, deprivation is higher and around 10,000 children are living in poverty, men and woman’s life expectancy has dropped men by 11.9 years and woman 9.4 this is also lower than England’s average. Mortality rates have dropped, premature deaths regarding heart disease, cancer and stroke are also lower, and 20.7 % of children are obese by the time they reach year 6 an age of around 9-11.
The number of hospital admissions due to alcohol under the age of 18 has risen, and with regards men and woman and alcohol consumption hospital admissions have also risen. 19.6 % of adults smoke and 23% are obese, also smoke related deaths are higher. Breast feeding initiation and smoking in pregnancy has risen with statistics dating 2012 for Sefton being 17.4 and England’s average being 13.7 rising significantly from 2010 which statistics confirm for Sefton where 15.4 with England’s average being 14.6 (The Network of Public Health Observatories, 2012).
The chosen health issue for this assignment is smoking within pregnancy, smoking in pregnancy is an important health issue and as evidence states a number of issues and health problems it can cause, with regards to smoking in pregnancy Better Health Channel (2012). Smoke free (2012) state that chemicals such as carbon monoxide, which is extremely dangerous gets into your blood stream, restricting oxygen to your unborn child, therefore making the babies heart have to work harder to pump. National Health Service (2011) also confirms that fertility plans may prove difficult, risks of premature labour, under weight babies, asthma, cot death can occur. Evidence states that every cigarette you smoke harms your unborn child, as toxins enter your bloodstream, as this is your baby’s only source of oxygen and nutrients (NHS, 2011).
Smoke free (2012) highlight a number of health issues regarding a person who smokes which underlines the risks of developing an illness, disability and possible death, the chances of circulatory problems resulting in gangrene or possible amputation are a common health issue which can prevented by not smoking. Smoking can also affect the community as a whole and as confirmed Smoke free (2012) discuss the effects second hand smoke can have on not just the community but the population, diseases such as heart disease and at least 60 cancer causing compounds can be developed from second hand smoke, as well as children at risk of bronchitis, pneumonia, ear infections, asthma attacks and meningitis (Woolston, 2012).
Smoke free (2012) also confirms second hand smoke increases the chances of developing lung cancer by 24% and also heart disease by 25%. Over 300,000 children visited there General practitioner with a staggering 9,000 being hospitalized, all being linked to smoking National Institute for Health and Clinical Excellence (2012). Smoking in pregnancy brings greater complication with the risk of miscarriage increased by 25% with the risk increasing the more a woman continues to smoke The Department of Health (2007). Other factors linked to being exposed to smoke can be psychological, resulting with children having attention and hyperactivity problems (Button et al, 2007).
With regards to the chosen target group being woman who smoke during their pregnancy, the health needs of this target group are important when ensuring needs are met and the outcome to be reducing the amount of woman who smoke during their pregnancy. Marmot, (2010) in a review stated that ‘Fair Society, Healthy Lives’ highlights the importance of taking charge in order to reduce inequalities through a child’s whole life, with particular concerns and focusing on pre-birth and the early years of the child. Within this report Marmot, (2010) suggests that with regards to this statement the aims are, and supports the fact that pregnant woman who are continuing to smoke throughout their pregnancy are the main priority whilst tackling health inequalities. NHS Stop Smoking Services are local services which are funded by the Department of Health along with other services available that offer the help needed to encourage, support and guide people who want to stop smoking NHS Stop Smoking Services (2010).
The National Health Service Sefton offers a wide range of services to help, and although pregnant woman might not want to disclose that they smoke, reasons being they may feel embarrassed, maybe they don’t want to be judged or have a lack of confidence or knowledge about the effects smoking in pregnancy may have, it’s important to encourage and reassure at all times that your there to help and that confidentiality is always kept National Institute for Health and clinical excellence (2008). forming a relationship of trust is important and may aid a person to quit smoking and the professionals involved specially trained midwifes who have been specially trained in order to help pregnant woman stop smoking and are the ones who often receive the most referrals for pregnant smokers (NICE, 2008).
Causes of early death can be prevented with regards to smoking within Sefton, 20% of all deaths being smoke related and 15% of Sefton’s adult population smoke, smoking is the cause of half the inequalities between the wealthy and the poorest areas in the North West and in order to improve the health within Sefton the need to reduce the number of people who smoke is of great importance and already the improvements made such as the smoke free laws which seen a drop in 2% and between the years of 2003 and 2007 18% – 20% leaving Sefton as a whole lower than the England’s and North Wests averages. In Sefton 17% of woman smoke during pregnancy and as a whole the need to focus on doing more to help pregnant woman stop smoking National Health Service Sefton (2011).
Behaviour change methods such as the work of (Prochaska and DiClemente (1986) who invented and developed a transtheoretical model of behaviour change than consist of six stages and can be appropriately associated with giving up smoking. The first stage called precontemplation which would mean people have no intention of changing, which many smokers don’t want to give up and quite simply refuse Netdoctor (2005). Then contemplation when the person admits and sees the need to change and agrees to plan and take action, then the preparation to stop smoking with the intention of changing their behaviour, small steps can seem achievable Netdoctor (2005). Action is then taken, individual alter their behaviour, and they want to change in order to meet their goals, the final stage is when relapse can occur and strategies to prevent a relapse National Health Service (2010).
There are a number of health promotion approaches to help woman stop smoking before and during pregnancy, it’s essential that the support is out there The Royal College of Nursing (2007). Strategies out are out there to help not only pregnant woman but all people who smoke and the National Health Service (2010) can help people with advice on stopping smoking. Referrals to quit smoking groups, numbers to call such as Pregnancy Smoking (NHS, 2010). Information should be provided to pregnant about the risks to the unborn child of smoking when pregnant. They should also provide information on the dangers of exposure to second hand smoke for both the mother and baby and on the benefits of stopping smoking (NHS, 2010)
A number of initiatives are in place in order to help and promote healthy lives, stopping smoking proves to be one of the major health issues communities are face with Business in the community (2009). Within healthcare there are a number of initiatives in order to encourage, help and succeed in stopping smoking, the NHS provide a free online service SmokeFree (2012) this offers advice, cutting costs, why to quit and ways in which to get help with a Freephone telephone number for advice. Another service is called NHS Sefton this offers a free service to give up smoking which includes support, Sefton’s Stop Smoking Service a specialist nurses, advisors and support workers who can offer the advice needed to take the steps in order to stop smoking and enjoy a healthier future NHS Sefton (2010). The team will enable you to achieve a suiting plan, offer support and advise and suitable Nicotine Replacement Therapy (NRT) with other treatments available, this proves beneficial to people who want to quit and targeted at the appropriate population group within the chosen area Sefton.
The National Health Service and other health professionals are responsible for smoking cessation service National Institute for Health and clinical excellence (2008). (NICE, 2008) states that all pregnant woman should be assessed with regard to smoking and referrals should be made with respect to giving up smoking. Smoking cessation interventions reduce the occurance of low birth weight and aid woman who smoke during early pregnancy helps reduce smoking in later pregnancy by on average 6% as stated by the (NICE, 2008). The (NICE, 2008) highlights the trials in progress for the success of nicotine replacement theropy for smoking cessation, alongside exercise and behavioural support an increased number of Pharmacies within Sefton are offering quit smoking services. One initiative being a magazine called ‘talk’ the magazine aims to help pregnant woman understand the danger to themselves and their un born child.
Sefton primary care trust aims to lower the number of people who continue to smoke and offers pregnant woman and their families a chance to change and make a difference to the health of Sefton. 2011 a staggering 2’399 people throughout Sefton alone with the help of the many of the initiatives that the NHS offer in order to give up smoking. National Health Service Sefton (2012). The support is out there, The NHS Sefton also have a stop smoking servise that incourages and helps pregnant woman and the National Health Servise Sefton (2012) states that research indicates that a person is more likely to quit smoking if the support, ability to have someone to talk to and be educated about the benefits surrounding quitting is in place and in Sefton the number of woman accessing and gaining the support has risen and in 2011 alone 106 pregnant woman had quit smoking which proves such initiatives are proving vital and the initiatives being used are working slowly but surely for a healther life style for Sefton with families feeling the benefits National Health Service Sefton (2012).
Barriers that can prevent a person and there family accessing healthcare resulting in people unable to ask or get the help needed due to reasons of Poverty, lack of available services within their area, fear of shame and discrimination and possible poor system referrals or connections to other services, these are all potential barriers when accessing health care, proving difficult when ensuring family’s access the services on offer and which will enable them to live a healthier life Health Support (2008).
Are there any barriers to accessing these initiatives? What wider determinants of health might influence or affect the uptake of the services provided.
Finally, are the initiatives working? If not, why do you think this is
In conclusion and with regards to this assignment