The Role of NHS in Keeping People Healthy - Essay Example

?Concepts of Health and the Role of NHS in Keeping People Healthy Introduction Almost every country in the world has a health policy and a healthcaresystem to attend to the health needs of the population of that country and also those who have come as foreigners. In United Kingdom, the health care system is the National Health Service (NHS). NHS is publicly funded. There are 3 healthcare systems with that name, the NHS, NHS Scotland and NHS Wales (NHS, 2010). Each of these healthcare systems operate independently and are accountable politically to their relevant governments. NHS has played a major role in keeping people of UK healthy and continues to do so. In this essay, the role of NHS in the health of people of UK will be discussed with reference to various concepts, determinants and models of health and through a suitable example. Concepts of Health During its creation, the World Health Organization (WHO) in 1948 defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Critics argued the completeness of this definition and in 1986, in the Ottawa Charter for health Promotion, the WHO modified the definition of health and defined it as "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities." Even this definition has not been accepted completely and thus several models of health have come up in an aim to provide complete definition of health. Examples of models of health are the biomedical model, biopsychosocial model and public health model. Biomedical model is a very primitive model of health and is considered as the most traditional model of health and illness. The concept of biopsychosocial model is much advanced than the biomedical model and is currently being used in the field of medicine, nursing, sociology, health psychology, psychiatry, clinical social work and chiropractic medicine. According to the biomedical model of health, physical illness is caused by a particular "pathogen" or disease causing organism (Curtis, 2000). The pathogens cause the disease because of which some physical changes occur within the body. The causative factors are not only organisms but some chemical imbalances and genetic predisposition. According to the biopsychosocial model, illness is caused due to an interplay of a multitude of factors and that most of the times illness results from an interplay of biological factors like pathogens, psychological factors like beliefs and behaviors and social factors like economic status and employment. This model of health was developed by Engel in the 1970s. The psycho aspects of health which this model proposed were cognitions like expectations of health, certain emotions like fear of treatment and important health-related behaviors like consumption of alcohol, smoking, diet and exercise (Curtis, 2000). Emotional turmoil, lack of self-control and negative thinking have been incriminated in the development of disease. The social aspects of health which this model proposed were social drinking, peer group pressure and expectations, social values of health, ethnicity, parental pressure and expectations and social class. The biopsychosocial model of health is basically based on the social cognitive theory (Curtis, 2000). While the Medical model stresses on the treatment of the individual with the problem, the Public Health model emphasizes interventions in target populations (Taylor et al, 1999). There are 3 types of interventions according to this model. 1. Primary prevention: efforts to reduce the incidence of the problem before it occurs in the population. The nurse or any other public health personnel shall visit the families at home for intervention. 2. Secondary prevention: The public health personnel start interfering during the early stages of domestic violence or at just the suspicion of it. 3. Tertiary prevention: The public health personnel get involved once there is definite evidence of domestic violence. Public health model has several limitations. It is difficult to guess the target population and it is not practical to intervene at primary prevention. Lack of resources hampers activities of public health model. Also, progress will depend on the level of public interest and commitment from the Government side. Health is determined by an interplay of several factors which are known as health determinants. The main determinants of health are social factors, environmental factors, physical environment and; various behaviours and characteristics of the individual. While some of these determinants are in the control of the individual, many factors are beyond the scope of direct control of the individual. These factors contribute to health inequalities in a society. Some such factors include social status and income, education status, physical environment of the individual at home and work place, "social support networks", individual genetics, accessibility to various health services and gender (WHO, 2010). Higher the income, higher is the health status of an individual. Thus, poverty is a major contributor for health inequality. Individuals with lower education levels have poorer health status, lower levels of self esteem and decreased self confidence when compared to those with higher education status. Physical environment constitutes of clean and safe air, water, environment and food at home and workplace. Those who have better support form friends, family member and various community groups enjoy better health than those who do not have established social networks. Genetics often influences health -related behaviours like smoking, alcohol, coping skills and balanced intake of food and thus indirectly influences health of an individual (WHO, 2010). Public health researchers have identified social determinants as the main cause for health inequalities in many parts of the world including UK. Of these, the most important is poverty. In fact, tackling poverty is the main issue raised by the Millennium Development Goals which include reduction in child mortality (Marmot, 2005). Thus health inequality is a complex interplay between socio-economic status, genes, antenatal factors, lifestyle behaviours like smoking, exercise, diet and stress and inter-generational causes of health related behaviours (HC, 2009). Important lifestyle factors which influence health are nutrition, exercise, weight, smoking, consumption of alcohol, stress, sexual behaviour and drug abuse. Various policies which have been implemented to tackle health inequalities include Sure Start of 1999, Targets of 2000, Cross cutting review of 2003, Spearhead areas of 2004, National support team of 2006 and Health inequalities intervention tool kit of 2006. The first policy introduced was Health Action Zones launched in 1998 with objectives to "identify and address the public health needs of the local area; increase the effectiveness, efficiency and responsiveness of services; and develop partnerships for improving people’s health and relevant services" (HC, 2009). Most of the initial policies and programmes stressed on improvement of health by promotion of various health related aspects like lifestyle behaviours, employment, education, housing and tacking substance abuse. However, this programme was terminated in the year 2003 due to poor resource, insufficient support and lack of clear direction. Currently, National Health Service has a major role in curbing health inequalities through different parts of system like "primary care teams, Strategic Health Authorities and Primary Care Trusts, Secondary care and specialist services and Early years NHS services" (HC, 2009). Other approaches to tacking health inequalities implemented by the government of UK are appropriate school meals in schools, food labelling, health promotion in schools and educational institutions, improvements in built environments and control of intake of tobacco. Role of NHS in controlling health issues related to smoking Like in other countries, smoking is a major public health challenge in UK. According to 2006 statistics, in England alone, more than 24 percent of population above 16 years of age smoked. Smoking contributes to several debilitating and potentially fatal conditions like heart disease, carcinoma of the lung, stroke and chronic obstructive pulmonary disease. Between 2007 and 2008, 1.4 million hospital admissions of NHS were caused due to smoking. Infact, in England, it has been estimated that 1 in every five deaths in adults above 35 years of age is because of smoking. Statistics have shown that 50 percent of chronic smokers suffer from premature death related to smoking related disease. The estimated cost to NHS because of smoking is ?1.5 billion a year (NHS, 2008). Smoking also happens to be primary cause of health inequality between the rich and the poor. Both active and passive smoking cause health problems in people (NHS, 2010). Because of such negative repercussions, smoking has been prohibited in certain places by law in England. Since the 1st of July, 2007, workplaces and public places that are enclosed have been smoke-free. Such a law was made with intentions to protect employees and also the public from harmful effects of smoking. Also, since October, 2007, in Wales, Scotland and England, selling tobacco to anyone under 18 years of age has been considered as illegal (NHS, 2010). Several government policies and private and public agencies have encouraged those who smoke to quit smoking. Actually more than 65 percent of smokers say that they want to quit smoking. However, only a few are able to do it. NHS, through its 'Stop Smoking Service' or SSS has helped several smokers quit smoking and is continuing to do so. Through various steps and measures taken by the NHS, the rates of smoking dropped dramatically over the years. In 1980, about 1 in 3 adults smoked and figures in 2007 have shown that 1 in 5 adults smoke. The NHS offers free treatment, support and advice to those who want to quit smoking. Estimates have shown that the NHS SSS has saved more than 70,000 lives since its launch in 2000 (NHS, 2010). NHS SSS provides services for those referred to it for quitting smoking. It also provides guidelines to the general practitioners so that they can treat individuals who do not want to be referred. Several treatments for quitting smoking have been devised and advocated. They are nicotine replacement therapy (NRT) and medication therapy. NRT is the most commonly used cessation therapy. The component of addiction in smoking is nicotine. Nicotine therapy releases nicotine steadily into the blood at levels that are much lower than cigarette and without dangerous substances like tar and carbon-monoxide which are present in smoking. Constant release of nicotine controls the craving for smoking and thus helps the smokers quit smoking. There are several forms of NRT. Transdermal patches are those which can be stuck to the skin. These patches release nicotine every 16- 24 hours. Chewing gums, which are available as 2 mg and 4 mg nicotine release nicotine when chewed. Inhalers are plastic cigarettes through which the desired dose of nicotine is inhaled. Nicotine is available also as tablets and lozenges which can be placed under the tongue. Nicotine nasal sprays also are available and citone enters blood through nasal epithelium. All forms of NRT are effective and these can be prescribed by the general practitioner on individual basis. They are also available over the counter. NRT is usually taken between 8-12 weeks, after which the dose is gradually reduced and then stopped. NRT is effective and there are no severe side effects. Medication therapy involves use of bupropion or verenicline orally. However, these medicines are associated with significant side effects. In 2008, NHS (NHS, 2008) released comprehensive guidelines for doctors, nurses and other health practitioners about encouraging people to quit smoking. The NHS have posted nurse counselors who runs stop-smoking clinics and give prescriptions for stopping smoking directly. The guidelines mainly target 3 areas, i.e., public health, health technologies and clinical practice. For public health, the guidance is mainly on the health promotion strategies, prevention of illness of those working for NHS, local authorities and public and voluntary sector. For health technologies, the guidance is on the use of machines that are already existing and also the new ones, with reference to treatments and procedures at NHS. In the clinical practice arena, the guidelines are for appropriate care and treatment for specific conditions. NHS has also issued guidelines for quitting smoking in children and pregnant women. Through these guidelines, policies and approaches, NHS has caused a significant drop in the smoking rate among adults, pregnant women and children, thus decreasing risk of premature death, development of potentially devastating diseases and cost to health care. It has also decreased health inequality (NHS, 2008). Conclusion The definition of health by the WHO has been criticized and this has led to development of several models of health. Health is determined by several factors and hence even in the world's most developed countries health inequalities exist. In UK, NHS is the health care system that addresses the health needs of the population of UK. Through its guidelines, policies and accessibility, it has played a major role in keeping the health of UK population. It has addressed health through primary and secondary prevention and tertiary health promotion. Addressing the issue of smoking-related disease through various, strategies, guidelines and policies is a classical example of the role of NHS in keeping health of UK population. \ References Curtis. A.J. (2000). Health Psychology. London: Routledge. House of Commons Health Committee. (2009). Health Inequalities [online]. Retrieved on 15th February, 2010 from http://www.parliament.the-stationery- office.co.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf. Marmot. M. (2005). Social determinants of health inequalities. Lancet, 365, 1099- 1104. NHS. (2010). Smoking (quitting). Retrieved on 15th February, 2010 from http://www.nhs.uk/conditions/smoking-%28quitting%29/Pages/Introduction.aspx NHS. (2008). Press Release: NICE advice on the best way to quit smoking. Retrieved on 15th February, 2010 from http://www.smokefreenorthwest.org/pdf/NICE_advice_on_the_best_way_to_quit_smoking.pdf Taylor, P., Peckham, S., and Turton, P. (1998). A public health model of primary care—from concept to reality. 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