A Health Needs Analysis of Children and Families in Disadvantaged Areas - Literature review Example

? Sure Start By of Introduction In the execution of their duties to patients, health care professionals always employ certain systematic techniques to assess and review the health issues and circumstances surrounding the lives, health conditions and the well-being of individual patients or groups of patients. In essence, these reviews and assessments target the general population but specific patients such as children from disadvantaged background may be targeted in certain situations. One benefit of these health need assessments is that they assist professionals and governments to prioritize health care and allocate resources appropriately so that communal and individual health is improved besides the accompanying reduction in health care inequalities (Freeman et al., 1989). Health professionals should therefore equip themselves with the right guidelines before engaging in a Health Need Analysis/Assessment (HNA) exercise. Professionals in this context would refer to health care facilitators, strategic managers at regional, national and local levels and practitioners in the government, the voluntary, and community and primary care sectors. The disparities in the provision of health services in the modern society have been the driving force behind the drive to carry out health need analysis among disadvantaged populations (Wilkinson, 1994). In the contemporary society, most of the services or needs provided by the government through its various agencies are rather fragmented and unequally distributed. This situation has made the rush towards attaining a joined up thinking and collaboration by the stakeholders in the provision of services such as education, health and welfare-related services. Of particular interest in this regard is the health care sector, which faces a lot of challenges as far as the diverse patient needs are concerned. Consequently, there is a need to analyse the health needs of each patient or group of patients so that health care professionals may identify the best interventions for these patients or groups of patients (Cantor, 1995). The main objective of such strategies should be to avoid the exclusion of particular patients from the main stream population. That is, the health needs of all disadvantaged patients should be accorded equal effort to that of the general population. One of the most common strategies used by governments and health authorities to prevent health and other forms of seclusion of people in marginalized areas is the Sure Start intervention (BMA, 1999). This intervention targets patients/patient groups, more so children and families in socio-economically disadvantaged areas. This paper explores the subject of health needs analysis of children and families in disadvantaged areas, proposing the Sure Start intervention strategy for such a segment of the population. Elements of Health Need Analysis To formulate and implement a health need analysis of disadvantaged children, there are certain core elements that those involved should be conversant with and address conclusively. First, HNA must identify the unmet health care and health requirements of these children and their families so that only the interventions that would provide for such needs are formulated and implemented. In other terms, a HNA should serve to improve the health of children and families in disadvantaged areas by allowing for the effective planning of health service provision. Importantly, HNA should enable health care providers to set their priorities and develop their policies according to the health needs of the target patient or group of patient. It should be apparent by now that a HNA should not be implemented for the mere purpose of establishing the health status of disadvantaged children; rather, HNA seeks to improve the health of these children and their parents by emphasizing the concept of increasing the capacity of a patients to benefit from intervention strategies (Cunningham & Kemper, 1998). Regarding disadvantaged areas, health needs would refer to a population’s abilities and capacity to benefit from whichever health interventions recommended, formulated and implemented by the authorities. Researches have confirmed that socio-economic disadvantage is largely associated with health and health needs of a population. However, the association between socio-economic status and health is quite complicated and surrounded by quite a number of factors such as place of residence, education, income, health beliefs and behaviours and access to health services (Franks et al., 2001). HNA thus requires that health care professionals define the health needs of the socio-economically disadvantaged patients. The three forms of health needs that are observed in disadvantaged children/patients include the felt, normative and expressed health needs. These needs may interact at different levels in patients. For instance, while a health need may be felt and expressed by a patient, it may not necessarily be normative. In the same manner, a need may be felt and defined as normative but not expressed by a patient. For an illustration, psychiatric interventions due to felt psychological needs that are not expressed are not normative or prescriptive according to many a professional. A health need may also be felt, expressed and identified as normative altogether. The three major approaches that health care professionals use in assessing the health needs of disadvantaged children-patients from disadvantaged areas are comparative, corporate and epidemiologically based approaches. While the comparative approach compares and contrasts health care services between among locations or socio-economically defined areas, the corporate-based analysis focuses on the demands, wishes and perspectives of stakeholders such as professionals, doctors, patients and the public (Bell et al., 2002). The epidemiological approach on the other hand entails considering patients’ perspective in assessing the time- and cost-effectiveness of health care services. An Analysis of Health Needs of Disadvantaged Children There are a number of findings that an analysis of the health needs of socio-economically disadvantaged children have revealed that are worth discussing. The uniqueness of these needs is that they are yet to be met by many government agencies and private providers. Besides the unmet medical needs, health service delays and inaccessibility are the other health issues affecting disadvantaged children. In fact, most children in disadvantaged communities fail to access the right preventive as well as curative health services, not to mention the fact that the full range of the available services is rarely delivered to such areas (Gough, 1993). Particularly affected by the inability to access the full range of the clinically recommended services are children suffering from acute and chronic diseases. A core element in HNA of children from disadvantaged areas is therefore the understanding of the various factors that result in delayed health care services and the unmet health needs. Among the negative outcomes of unmet needs and delayed health services in socio-economically disadvantaged communities are costly care, late diagnosis and misdiagnosis, poor treatment/therapies and premature deaths. In these disadvantaged areas, it has been ascertained that among the factors that contribute to poor access to and lack of utilization of health services by children are income type, lack of insurance cover for treatment and the absence of or the presence of few providers (Johnson & Moiloy, 1995). Among the factors that professionals and researchers use in defining and describing the health care needs of children in disadvantaged areas include the seriousness and type of illnesses, perceived symptoms and the health status of the children. There are also other predisposing factors such as preferences for health care, lifestyles, gender, age, education, race and ethnicity. Nonetheless, health care cost has been found to be the most frequent and serious barrier to access and utilization of health care among patients from disadvantaged areas. The other health need among children in disadvantaged areas that has hindered access and utilization of health care services is poor patient-physician relationship. Nevertheless, the role of patient-physician relationship in health care is generally poorly understood. One aspect of patient-relationship that has been the main focus of past and current studies is patients’ fiduciary trust towards their physicians. According to the definition of fiduciary trust, patients often believe that their physicians will always act in patients’ interests but not take undue advantage over them (Anderson & Dedrick, 1990). Among the factors that would promote and ensure patient-physician trust include patient satisfaction, high acceptance, good communication, adherence to treatment regimes and compliance with professional and ethical standards (Pilling, 1990). Moreover, closely associated with physician consumer relationship are lower potential disenrollment, greater continuity of the physician–patient relationship and better health outcomes. Health Care Strategies The health policies established in many countries continue to discriminate against people living in disadvantaged areas, necessitating the need to create strategies that would enable the reaching of very poor with the recommended health care services. Importantly, all the institutional challenges that are associated with health care interventions should also be up-scaled to cover the broader disadvantaged segment of the population (Pearson et al., 2000). Health needs analysis of disadvantaged children and families have revealed that poverty has a lot of implications and impacts on the health of the very poor people, characterized by lack of information, inability to pay for services and inadequate services. Provider conduct has since been identified to be a rather central factor in health care accessibility and utilization in disadvantaged areas besides the absence of appropriate and quality services near such disadvantaged children. To ensure that quality health care services are available to patients in disadvantaged areas, complementary supply-side interventions are recommended. Notably, there are certain programmes such as those aimed at improving staff skills, protocol treatments and those focused on the provision of supplies and environmentally friendly health services that may be established to ensure sufficient health services to children and families in disadvantaged areas (Parker et al., 1991). It is now quite apparent that there are a number of interventions that could be used to improve the effectiveness, accessibility and utilization of health care services by children and families from disadvantaged areas. One of the most common and effective interventions to apply in such scenario is the Sure Start intervention, commonly used by the UK government to provide equal social services to children across the country. The Sure Start Intervention Sure Start refers to a strategy commonly used by the UK government to promote the provision of its services to the public without social seclusion. Mostly targeted by Sure Start strategies are school children and families in disadvantaged areas. One area in which Sure Start has achieved considerable success is in the reduction of weight-related health issues among disadvantaged children and families in poor neighbourhoods (Oakley et al., 1997). In addition, these children have been found to have better health and live in homes that are less chaotic than before. Although Sure Start has been flouted as a rather exciting approach to health service provision in disadvantaged areas, there is a lot of criticism of the approach by many a stakeholder. First, most professionals are of the opinion that Sure Start should be standardized. The issues of outcome measures and generalisation have also featured prominently in debates about Sure Start. Sure Start should therefore be expected to have both positive and negative outcomes. Nevertheless, Sure Start registers more positive and negative results if the outcomes of past scheme are anything to go by (Glass, 1999). A government initiative geared at making every child’s early life as comfortable and fulfilling as possible, Sure Start would go along way in addressing the health needs of children and families from disadvantaged communities. The appropriateness of Sure Start is supported by the fact that it is an initiative that emphasizes family care, improved well being and early year’s development and education for children of four years and below. There are however certain principles upon which Sure Start intervention should be based to improve the health status of children in disadvantaged communities. Generally, Sure Start aims to coordinate, add value to and streamline the provision of the available and necessary health and other social services to children and their families within their localities (Barker et al., 1994). The first principle upon which the success of Sure Start hinges is the direct involvement of parents and guardians in health care provision. Second, Sure Start ensures that the provision of health care services to children is does not result in stigmatization and ensures lasting support to the target population. The third principle of Sure Start that makes it a rather effective intervention in the provision of health services to disadvantaged children is its sensitivity to local families’ health needs. The other major pillars of Sure Start relate to the type and nature of services provided under the strategy which include the need to add value to both existing and planned services (Barker et al., 1994). Furthermore, Sure Start’s services are based on evidences that such interventions would be successful by imaginatively responding to the needs of the local communities. In other words, the health services offered under the Sure Start initiative are informed by sound strategic directions. The above principles have been particularly helpful in ensuring that Sure Start initiatives achieve high level outcomes of health children who enjoy learning, playing and achievements while living in stable and safe surroundings. In addition, Sure Start makes certain that families experience economic and environmental well-being, allowing them to contribute positively to their community and the society (Wadsworth, 1991). There are numerous examples that support the positive effects Sure Start would have on the health and well-being of disadvantaged children. These examples appear in the service delivery of Sure Start initiative. Among the services offered under Sure Start are home visits and outreach programmes. The main objective of these visits is to contact children and their families regarding health and educational services as early as possible in their lives. Second, Sure Start would provide family support by offering parenting information to group and individual parents. The other vital services delivered by Sure Start are child care and learning experiences and quality play for groups and individual children. Besides providing primary and community healthcare and advice, Sure Start also supports children with special needs by indicating their more specialised services to the target patients. Worth mentioning is the fact that Sure Start provides home-based ante natal care, breastfeeding support, advice, support and information on health issues if properly designed and its outcomes evaluated (Department for Education and Employment, 1999). Designing and Evaluating Sure Start Policy Effectively For a Sure Start intervention to be effective in providing health services to disadvantaged children and their families, it should be designed and rolled out in a manner that allows for a rigorous evaluation. Such an intervention should therefore allow for the measuring of clearly set goals, baseline information, cost and comparison of individual patients and groups of patients (Tidikis & Strasen, 1994). The government should therefore not invest a lot of money in health interventions that are merely characterized by rich descriptions of what stakeholders are doing to provide health care to disadvantaged children. Sure Start evaluations should aim to assess the government’s policies that address health care inequalities. However, evaluating health care inequalities has been hampered by the recurrent lack of evidence, reported by witnesses who state that despite government efforts and the long-term drive to invest in equal health care, the intervention that really works is yet to be identified. Inadequate intervention has been cited as the main reason for the lack of evidence on the success of Sure Start and other strategies and policies targeting equality in the provision of health service. Ethical considerations have also featured prominently in Sure Start evaluation debates. There certain ethical issues that have arisen due to the implementation of the Sure Start initiatives by the government. These issues not only regard health care but also the equitable provision of education and other social service to disadvantaged children and families. Although there are certain interventions by the government such as education and behaviour change programs that have little or no ethical issues, health care is marred with a number of ethical concerns that must be addressed by the government and the professionals involved (Andersen & Newman, 1993). In other terms, well intended health interventions have certain unanticipated harm to patients and their families, even the non-invasive ones that may only seek to educate disadvantaged children/families on their health and well-being. The other ill effects that a Sure Start intervention may have on patients could be the diversion of resources to interventions that are unevaluated and thus their benefits not well known. For example, it may be unethical to give interventions that have delayed advantages in one area while other areas are fast benefited. In other words, randomized government interventions should not be implemented. However, it is more unethical to spend resources on ineffective and inconclusive intervention than to choose a few of the worst health situations and address them with the meager resources. Conclusion Sure Start is a social service provision initiative that seeks to ensure that all children in the country access and utilize all the necessary social services without exclusions. It thus provides educational, health and other social services to children and their families whenever they are in the country to help them have a healthy and fulfilling start in life. A Health Needs Analysis (HNA) of children and families in disadvantaged areas is one tool that could be used to support the application of the Sure Start intervention in the provision of the appropriate and effective health care to such disadvantaged groups of patients. References Andersen, R. M., and Newman, J. F. (1993) Societal and Individual Determinants of Medical Care Utilization in the United States. 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