The Specific Health Needs of Merseyside - Essay Example

?Analysis of Specific Health Needs of Merseyside Introduction Merseyside, a metropolitan county, is located in the North West England. The populationof the county is 1,365,900 as of 2009 statistics (Worldfacts.org). It comprises of 5 metropolitan boroughs, city of Liverpool, St. Helens, Wirral, Sefton and Knowsley. Though the land use is urban, there is a mix of urban, rural, semi-rural and suburb locations. The central business district of this county is the Liverpool City Center. Like any other part of England, smoking is one of the identified health issue in this country. Of concern specially is smoking among adolescents which can contribute to several health problems and birth defects in babies born to pregnant women who smoke. Thus, the community selected for critical analysis of health needs in this essay is adolescent smokers. The extent of problem and the impact and effectiveness of public health in the primary care setting with reference to this community will be discussed through review of suitable literature. The Community According to the 2009 statistics, 29 percent of pupils have tried smoking atleast once and the prevalence of smoking in young people was 6 percent. Though this proportion is the lowest since the time the survey began in 1982, it continues to be a significant problem for both health authorities and public. The prevalence of smoking between 11-15 years old has been estimated to be 6 percent. The prevalence is more among girls (7 percent) when compared to boys (5 percent). Another important finding of the survey is that the prevalence of smoking increases with age. At 11 years of age, the prevalence is 0.5 percent and at 15 years of age it is 15 percent. Ethnicity has an influence on the prevalence. It is more common in White pupils when compared to Black of Mixed ethnicity pupils. It is also more prevalent in pupils coming from lower socioeconomic strata (Smith et al, 2009). According to the Smoking, Drinking and Drug Use survey of 2006 (NHS, 2007), nine percent of pupils in England are regular smokers and a further 5 percent are occasional smokers. The survey defined regular smokers as those smoking atleast one cigarette per week and occasional smokers as those smoking less than one cigarette a week. Pupils who smoked regularly smoked an average of 6 cigarettes a day, approximately 43.5 cigarettes a week. 74 percent of the regular smokers smoked cigarettes from a packet and 6 percent smoked from rolled tobaccos. Girls were more likely to smoke from a packet (NHS, 2007). Regular smoking in this age group has been associated with drug abuse, alcohol intake and truancy and school exclusion. The dependence of smoking by children is mainly related to the time they spend as regular smoker. Those who have smoked for more than a year as regular smokers have reported that they find it difficult to not smoke each day. However, more than 50 percent opined that they knew the ill effects of smoking and thus would like to give up. Most pupils knew that smoking caused lung cancer. But two-thirds of them reported that they felt relaxed because of smoking. Thus, the immediate benefits of smoking outweighed the future potential hazards of smoking. According to the survey, majority of pupils were aware of the fact that their families had negative attitude towards smoking. One third of the pupils who smoked did so secretly and occasional smokers were more likely to be secret smokers. Also, households of pupils who smoked were more lenient that those who did not smoke (NHS, 2007). Since most adult smokers begin smoking at young age, it is every important to ascertain and understand the causes of smoking in young children so that predictors of smoking can be evaluated and targeted for prevention. Several risk factors have been studied in this regard. According to the Liverpool Longitudinal Smoking Study (Smith et al, 2009), deprivation at both school and home was strongly associated with smoking among adolescents. The trial of smoking is influenced by several school-related environmental factors like peer groups. Smoking trial at the age of thirteen is most associated with the amount of time spent in smoky places. It is also predicted by the smoking rules of their respective house hold. From 14-16 years of age, both school deprivation and household smoking rules predicted smoking trial. Public health impact Smoking has become a public health menace in England including Merseyside. It contributes to increased First Consultant Episodes or FCEs with primary diagnoses related to smoking. According to NHS (2007), "around six per cent of FCEs for all diseases in England among adults aged 35 and over are estimated to be attributable to smoking. Almost three in ten of all FCEs with a primary diagnosis of respiratory diseases are estimated to be attributable to smoking. A larger proportion of FCEs among men were attributed to smoking than for women." In the year 2005, 20 percent of deaths in England were related to smoking. Smoking is associated with many health-related problems and hence is a major health-related issue. It is a leading cause of illness and death all over the world and also in Merseyside. A smoker is at risk of developing cancers of the throat, mouth, lungs, bladder and esophagus and also heart attack. Research has shown that smoking increases the risk of lung, throat and mouth cancers by 14 times, cancer of the esophagus by 4 times, chances of death through heart attack by two times and chances of bladder cancer by 2 times (Bernstein, 2006). Other health-related problems occurring due to cigarette smoking are emphysema, chronic bronchitis, peptic ulcer disease, pneumonia, cancer of the lip, cancers of the larynx and pharynx, malignancies of the abdomino-pelvic organs like pancreas, bladder and kidneys and also cancer of the cervix. Cigarette smoking can also increase the risk of burns (Bernstein, 2006). Smoking among pregnant adolescents is associated with certain health effects on the fetus like preterm birth, low birth weight, congenital anomaly and infant mortality (Delpisheh, 2005). As discussed before, consumption of tobacco, especially in the form of smoking is a leading cause of death and causative factor for many other conditions. Other forms of tobacco also lead to various health ailments. Research has shown that both active and passive smoking can produce health related hazards. Highest rates of passive smoking exposure is seen in cafes, restaurants and bars, followed by work place and then homes of relatives, friends and acquaintances. The quality and lifespan of smokers depends on the severity and number of smoking related illness and other associated comorbid conditions. Consumption of alcohol and other illicit drugs, sedentary lifestyle and stresses life can increase the mortality and mobility related to smoking (Bernstein, 2006). Public health policy with regard to smoking There are 3 levels of prevention: primary, secondary and tertiary. Primary prevention includes "efforts to control the underlying cause or condition that results in disability," secondary prevention is "preventing an existing illness or injury from progressing to long-term disability" and tertiary prevention is "rehabilitation and special educational services to mitigate disability and improve functional and participatory or social outcomes once disability has occurred" (DCPP, 2006). There are many anti-smoking campaigns which have gained ground in England including Merseyside. The health authorities have prevented the tobacco companies from advertisement in the public, especially on television. Many restaurants and hotels too have banned smoking.. The UK government has signed an antismoking pact with the World Health Organisation. The employment law in UK at the federal level protects employees from passive smoking by directing employers to provide non-smokers with smoking-free zones. The law also outlaws smoking in enclose workspaces and public spaces which is shared by several people. Though small bars and restaurants, who cannot afford a smoke-free zone, can continue to allow smoking, this must be done only after their staff has explicitly agreed to work in smoking establishments. As per the mandatory rule of Federal government, all tobacco product packets started to display strict warnings against tobacco consumption like "Smoking kills”, “Smoking when pregnant harms your baby", etc. Since 2008, these warning notices are being accompanied by “Stop Smoking Hotline” numbers. In addition to these, harmful substances also are being listed in the packet. The government of UK has been actively introducing policies to combat smoking since the year 2001. Though the movements against tobacco are gaining momentum, consumption of tobacco continues to be highest in Europe (Ch.Ch, 2008). Smoking in public has been prohibited in England including Merseyside. The law has been extended further since the 1st of July 2007, when public places and workplaces that are enclosed are smoke-free. This law was made in order to protect employees and the public from the hazardous effects of smoking. Since October 2007, selling of tobacco to any individual below 18 years of age has been made illegal (NHS, 2010a). Other than law, several private and public agencies have come up openly and encouraged quitting smoking. The National Health Service, which is the publicly funded healthcare system in England has played a significant role in curbing the magnitude of problem due to 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, both in adults and adolescents. The NHS offers free treatment, support and advice to those who want to quit smoking. 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). The WHO (2003; cited in IRC, 2009) orders that: "Healthcare providers should not miss any opportunity to advocate and advise treatment strategies to people wishing to quit. The role of policy-makers, professionals and researchers will also be imperative in putting smoking cessation on the agenda.” According to the International Union Against Cancer (IRC, 2009), "health-care professionals have a duty to provide counseling and treat tobacco dependence as they would any other disease or addiction." The New Zealand National Advisory Committee on Health and Disability (2002; cited in IRC, 2009) states that “there is good evidence that even brief advice from health professionals has a significant effect on smoking cessation rates.” Every primary care physician must identify all tobacco users at every visit. The identification must follow a systematic process. After identification, the physician must strongly urge the individual to quit. During the process, smokers willing to quit must be identified and helped with a quit plan. Pharmacotherapies and supplementary materials must be provided. A follow-up contact schedule must be elaborated (Sharma and Lertzman, 2009). Physicians and other health professionals must educate the smokers who come to them about benefits of smoking cessation and also the process of cessation. Details of withdrawal syndrome must be explained to them. Various cessation methods like nicotine replacement therapy, antidepressant medications, group therapy, behavioral training and hypnosis must be mentioned to them. The World Health Organization Framework Convention on Tobacco Control or FCTC is a treaty ratified and signed by 145 countries all over the world. According to the treaty, "all governments must incorporate the diagnosis and treatment of tobacco dependence and counseling services on cessation of tobacco use in national health and educational programmes." The FCTC states that "given the diversity of countries’ economic situations, regulatory regimes and health care systems, the effort to treat tobacco dependence requires a multi-faceted approach. Therefore, a tobacco control program should not only encourage tobacco users to quit but also provide assistance in doing so." The services which have been recommended to be introduced are health education in the form of tobacco product packaging, counseling services like intensive behavioral support by appropriate specialists, and maternal and child health clinics. The FCTC also recommends to "level the regulatory playing field” between tobacco and pharmaceutical products, "provide protection from secondhand smoke" and "present cessation-oriented messages on all cigarette packages." The WHO promotes cessation of smoking through 3 strategies: the public health approach, the health systems approach and the surveillance, research and information approach (WHO, 2009). According to the Liverpool longitudinal study (Smith et al, 2009), though school-based initiatives and public smoking bans do have some impact on the adolescent smoking trial, what is most effective is the smoke-free home initiatives taken by the parents of the adolescents. The study has opined that school-based interventions and various educational programmes are not effective in preventing smoking among youngsters. 83 percent of schools in England, including Merseyside have a written policy on managing various incidents related to smoking of pupils within the premises of the school. The action that is taken most frequently is contacting parents. Other actions include detention from schooling after providing a written or verbal warning and putting a note on the progress report of the pupil. Less than 3 percent of the schools reported that they even take extreme measures like contacting police or excluding from school (NHS, 2007). Despite aggressive measures by various governments, private agencies and health organizations, smoking and the ill effects of smoking continue to be a problem. Research has shown that only about one third of smokers attempt to quit smoking every year and of these hardly 3% have long-term success. According to the WHO (2003; cited in IRC, 2009), "public health sector in many countries is not investing in smoking-cessation services, and in most countries only limited steps have been taken to provide treatment, train health-care providers, and release financial resources and smoking cessation is very often not seen as a public health priority, or included in governments' tobacco control strategies." The governments of all the countries need to implement some supportive environment to facilitate cessation of smoking like advertising bans, higher tobacco taxes and smoke-free public places. The strategies must aim to raise awareness and also to decrease access to the products of tobacco. Key areas in which research is going on for cessation of smoking is evaluation of various policies and interventions for tobacco control, influences of environments on smoking and also smoking-related behaviors, relationship between use of tobacco and health inequalities, impact of passive smoking on health and modes of controlling passive smoke, regulation and behavior or tobacco and tobacco-related products industry and finally investigation of formation and implementation of various tobacco control policies (Signal et al 2001). Conclusion Thus, smoking among youngsters is a major public health issue in England including Merseyside. Smoking in youngsters contributes to adult smoking and various health related problems. In adolescent women, smoking is associated with pregnancy related problems. Thus, it is very important to prevent and tackle adolescent smoking. Since most adult smokers begin smoking at young age, it is every important to ascertain and understand the causes of smoking in young children so that predictors of smoking can be evaluated and targeted for prevention. School-based policies, laws and health policies have been effective in decreasing the magnitude of the problem, but more efforts and understanding are needed to optimize public health in this regard. References Bernstein, S.L. (2006). Cigarette smoking. EmedicineHealth. Retrieved on 13th March, 2011 from http://www.emedicinehealth.com/cigarette_smoking/page12_em.htm#Authors%20and%20Editors Ch.Ch. (2008). Prevention of Smoking. Retrieved on 13th March, 2011 from http://www.ch.ch/private/00987/01052/01054/01556/index.html?lang=en Disease Control priorities Project or DCPP. (2006). Three Levels of Prevention. Retrieved on 13th March, 2011 from http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.7367 Delpisheh, A., Attia, E., Drammond, S., and Brabin, B. (2005). Adolescent smoking in pregnancy and birth outcomes. Eur J Public Health, 16 (2), 168-172 Forey, B., Hamling, J., Hamling, J., and Lee, P. (2007). International Smoking Statistics: England. Retrieved on 13th March, 2011 from http://www.pnlee.co.uk/Downloads/ISS/ISS-England_071216.pdf International Resource Center or IRC. (2009). Fact Sheet: Tobacco Cessation and Treatment. Retrieved on 13th March, 2011 from http://www.tobaccofreecenter.org/tobacco_cessation_treatment -Martin, T. (2008). The Effects of Smoking on Human Health. About.com. Retrieved on 13th March, 2011 from http://quitsmoking.about.com/od/tobaccostatistics/a/CigaretteSmoke.htm NHS. (2010). Smoking, drinking and drug use among young people in England in 2009. Retrieved on 13th March, 2011 from http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/smoking-drinking-and-drug-use-among-young-people-in-england/smoking-drinking-and-drug-use-among-young-people-in-england-in-2009 NHS. (2008). Press Release: NICE advice on the best way to quit smoking. Retrieved on 13th March, 2011 from http://www.smokefreenorthwest.org/pdf/NICE_advice_on_the_best_way_to_quit_smoking.pdf NHS. (2010a). Smoking (quitting). Retrieved on 13th March, 2011 from http://www.nhs.uk/conditions/smoking-%28quitting%29/Pages/Introduction.aspx NHS. (2007). Statistics on Smoking: English, 2007. Retrieved on 13th March, 2011 from http://www.ic.nhs.uk/webfiles/publications/Smoking%20bulletin/Smoking%202007/Statistics%20on%20Smoking%20England%202007%20with%20links%20with%20buttons.pdf Sharma, S. and Lertzman, M. (2009). Nicotine addiction. Emedicine from WebMD. Retrieved on 13th March, 2011 from http://emedicine.medscape.com/article/287555-overview Signal, L., Blakely, T., Howden-Chapman, P., and Crampton, P. (2001). Current Research :: Tobacco Control Research. Retrieved on 13th March, 2011 from http://www.uow.otago.ac.nz/academic/dph/research/heppru/research/tobacco.html Smith, D., Smith, H., Woods, S., and Springett, J. (2009). Smoking environments and adolescent smoking: evidence from the Liverpool Longitudinal Smoking Study. JEHR, 9(1). Retrieved on 13th March, 2011 from http://www.cieh.org/jehr/adolescent_smoking_liverpool.aspx WHO (2009). Policy recommendations for smoking cessation and treatment of tobacco dependence. Retrieved on 13th March, 2011 from http://www.who.int/tobacco/resources/publications/tobacco_dependence/en/index.html Read More