London Health Issues and Problems - Research Paper Example

London Health Issues and problems Health issues and problems are one of the most significant issues being faced by our society. In London, and the greater part of the United Kingdom, the cold winter weather is one of the issues which are causing the most concern among health authorities. During the winter months, the temperature can dip to up to minus 10 degrees Celsius. During these cold months, various health risks often emerge, including hypothermia, respiratory tract infections, influenza, and similar weather-related diseases (National Health Services, 2009). For those who live with inadequate heating mechanisms in their homes, they are made to endure and bear the risks of very low temperatures. These vulnerable individuals are those who are known to be fuel poor and basically unable to financially support sufficient heating resources for their homes. These fuel poor individuals make up about 18% of UK households (Marmot Review Team, 2011). Among these fuel poor individuals are the elderly residents of London. In a 2002 report by the BBC, it was established that more and more elderly adults are dying during the winter cold months. Based on 2001 data, a 10% increase in winter deaths from the year 2000 was seen; and a total of 27,300 individuals died in 2001 and 25,100 of these belonged to the elderly population (BBC, 2002). Charity groups pointed out that the number of deaths among the elderly population increased because more and more pensioners were unable to afford heating for their homes during the winter months. In 2009, Britain experienced one of its coldest and longest winters. Many deaths due to hypothermia were recorded for that year, and two of these deaths captured public outcry when an elderly couple from Northampton froze to death unnoticed for days in their home (Bingham and Hough, 2010). Many more elderly individuals have continued to endure cold winters due to inadequate heating, and with each passing year, rates of elderly winter deaths have been expected to manifest even higher numbers. In Islington, winter deaths recorded increased to 15% more from 2003 to 2008 and most of the recorded deaths belonged to the elderly population (NHS, 2010). They represented three quarters of the population with elderly adults 75 years and above having died during this time period (NHS, 2010). All in all, the general numbers indicate a dangerous trend for these elderly citizens who often experience difficult economic circumstances which make for difficult winters, making them vulnerable to hypothermia and other weather-related diseases, like pneumonia, flu, cough, colds, and in some instances, strokes and heart attacks. Based on these considerations, this paper shall now discuss the issue of excess winter deaths among the elderly population. Winter deaths in this paper shall refer to the deaths of elderly individuals, primarily attributed to fuel poverty, manifesting through circulatory diseases, coronary heart diseases, stroke, respiratory diseases, influenza and pneumonia, and chronic lower respiratory diseases (NHS, 2009). The excess shall refer to the excess in deaths during winter months as compared to the non-winter months, which manifests at higher rates on elderly individuals. The main concern which relates to excessive winter deaths among the elderly is founded on the issue of fuel poverty which these individuals as well as concerned government officials have not sufficiently prepared for and addressed (Bury, 2011). Addressing the issue of fuel poverty and ways by which this problem can be resolved is the main consideration being evaluated by health authorities. This paper shall now seek to evaluate this health issue based on the situation in the London Borough of Newham. This paper shall first discuss the epidemiology, demography and ethnicity of the health service issue. Next, this paper will then identity, examine, and discuss wider and social determinants of health. Then, it will identify, discuss the policy, strategies, and interventions related to this health/service issue. A discussion on the connections of the various parts of the essay will also be presented. Finally, recommendations and conclusions shall be drawn based on the entire essay article. In the London Borough of Newham, which lies entirely within the authority of the East London as well as the City Health Authority, the incidence of fuel poverty in relation to health indicators was laid out in terms of older citizens, as well as lower income households (Rudge, 2005). The location of these elderly individuals going through cold-related illness was also considered and compared with previous data. Fuel Poverty Risk Index was then used in order to evaluate the data. The risk factors included households receiving Council Tax Benefit (income), age of respondents, poor housing conditions, and under-occupation (Rudge, 2005). These risk factors placed respondents at risk for fuel poverty and for experiencing winter morbidities. Data revealed that in 1993, Newham was considered to be the most impoverished and deprived locality in Britain. Due to its significant fuel poverty among the older citizens, the morbidity for various winter-related diseases was high (Rudge, 2005). A significant number of cardiovascular mortality was seen; and seasonal differences became apparent in these numbers with reduced incidents of elderly deaths observed during the warmer months. With improved heating systems, lesser incidents of winter deaths were also observed (Rudge, 2005). Other elements like smoking, diet, and co-morbid conditions have been considered in the review of older adults in the Newham area, and the results remained consistent (Rudge, 2005). These factors often exacerbate the risk for these older adults, leading to higher death and morbidity risks within this elderly population. The results also emphasize that high winter respiratory morbidity among older adults in Newham is impacted to a significant extent by the Fuel Poverty Risk Index (Rudge, 2005). As part of the normal aging process, elderly adults are more vulnerable to various health issues. For which reason, many of them present with chronic illnesses including hypertension, diabetes, arthritis, and similar health issues (Langley-Evans, 2009). Their normal body processes are also not as dynamic, with their normal agility, flexibility, speed, and dexterity slowed down considerably by their aging muscles and systems (Langley-Evans, 2009). Moreover, their normal thermoregulatory processes are compromised, with their body’s ability to adjust to warm and cold weather also compromised (Gordon, 2009). Their vulnerability to cold weather is especially increased, and early signs of hypothermia may see them presenting at the emergency rooms with altered mental states (Edelstein, 2011). These older adults would also likely present with chronic or secondary hypothermia which in turn makes them vulnerable to accidental deaths (Edelstein, 2011). In relation to ethnicity, the population in Newham is dominantly made of up Caucasians or Whites, followed by Afro-Caribbeans, Asians, and Mixed population. The non-white population is often dominantly poor and are therefore more likely to be unable to afford heating for their homes (Todd and Steele, 2006). For which reason, they are also considered contributors to excessive winter deaths among the elderly population. Economic factors play a huge role in the issue of excessive winter deaths. Even with the milder winters seen in Britain, the winter mortality for the country as compared to other countries experiencing similar winters has been considered high. An average of 40,000 deaths on a yearly basis has been recorded in Britain (Wilkinson, et.al., 2001). These deaths seem to be attributed to the energy management and efficient heating processes made available to the general population, especially the elderly. Many households in Borough of Newham, and in the rest of London are experiencing fuel poverty and this means many households are unable to afford the necessary means to stay warm (Boardman, 1991). Elderly individuals suffer from low incomes. Most of them are retired, living on their retirement savings or living on welfare. With limited financial resources, these elderly individuals are reluctant to turn their heating up or even switch it on because they know that they would not be able to afford the massive power bills which they would likely receive. Millions of elderly individuals in the UK suffer from fuel poverty (Age UK, 2009). These individuals actually spent more than 10% of their income on energy bills and one in three of these older adults do not even have Pension Credit to help defray their expenses (Age UK, 2009, p. 3). What makes the problem even more of a burden to the older adults is the fact that with each year, increases in the rates of electricity have become constantly persistent. Age UK (2009, p. 3) documents that in 2007, about “44 percent of people in fuel poverty did not receive a means-tested benefit, Disability Living Allowance or tax credit – the most common triggers for assistance from the various fuel poverty programmes”. In effect, these elderly adults have not been able to reduce their electric rates which would have motivated them to turn up their heating during cold winters. Financial difficulties impact on the elderly because they are unable to afford adequate heating during the cold winters (Marmot Review Team, 2011). With their limited resources, they have to manage their limited finances to pay for their food, their bills, their transportation, and for many of them with chronic conditions, their medical expenses. Some of these elderly individuals have to choose between food and heating, and naturally, they end up prioritizing their food expenses (Marmot Review Team, 2011). In the process however, they are prompted to skimp on their electricity bills. As a result, they endure extreme cold temperatures, getting afflicted with hypothermia, circulatory, respiratory, and similar illnesses (Marmot Review Team, 2011). As long and cold winters linger with hardly any improvements in their health conditions, excessive winter deaths register among their population. A study by Rudge (2005) was able to establish that there is a strong relationship between fuel poverty and high winter morbidity. This problem is a particularly grave issue among the elderly population, especially those who are living alone (Rudge, 2005). For those over 65 years, the mortality risk is even higher. In a study by Keatinge (2002), the author reviewed how deaths from coronary thrombosis increase sharply during the winter months and peak for about two days after the cold weather also peaks. Respiratory-related diseases also increase and cause deaths and they sometimes increase slowly, often 12 days after the peak cold weather is reached (Keatinge, 2002). Based on experiments where volunteers were subjected to mild cold weather enough to cause shivering, shifts in blood composition were examined (Keatinge, et.al., 1984). The experiment revealed that cold exposure causes blood supply to the skin to shut down. This then decreases the transfer of body heat to the skin leading to a decrease in body heat loss which also causes the shift of a litre of blood from the skin (Keatinge, 2002). This blood would then overload the main organs of the body; the excess would be disposed through the removal of salt and water from the blood by the kidneys and also through the intercellular spaces of the body (Keatinge, 2002). Other elements of the blood would become more concentrated in the process; in effect, the red blood cells, the white blood cells, the platelets, as well as the cholesterol in the blood would increase by about 10%. The viscosity of the blood would also increase by 20% (Keatinge, 2002). As a result, the blood would become more vulnerable to clots. Overall, bodily interactions and reactions are different for older adults. Where the above changes and processes would not significantly affect the younger adults, the older adults become vulnerable to the formation of thrombus in the arteries; this may be exacerbated by the presence of atheroma among elderly adults (Keatinge, 2002). Aside from coronary thrombosis, the risk for respiratory-related illnesses is also apparent during the cold winter months. The actual cause for this vulnerability is not exactly established, however, many scholars believe that when the cold weather starts, individuals usually gather in poorly ventilated and confined spaces thereby increasing their risk for being easily afflicted by infectious agents from other individuals (Keatinge, 2002). There are various remedies which can be applied in order to reduce, even eliminate winter morbidity among the elderly during the winter months or cold season. In the international scene, the World Health Organization, in accordance with its program to address the issues brought on by Climate Change has sought to implement advocacy among nations experiencing cold winters. According to the WHO (2011), this advocacy has sought to increase the awareness of climate change and the impact of such changes to human health. Partnerships with agencies within the UN system with the end goal of ensuring that winter deaths are properly incorporated in national programs have also been established by the WHO (2011). The WHO (2011) has also established the need to coordinate reviews of evidence evaluating the relationship between climate and health. Assistance to countries has also been reviewed by the WHO, most especially those nations with vulnerabilities in relation to climate change and cold winters (WHO, 2011). Assistance has been considered in order to eliminate the health vulnerabilities of individuals to changes in temperature. These global initiatives from the WHO have been established as general principles in addressing health issues which relate to temperature changes – in this case, cold winters – and their impact on vulnerable individuals, including the elderly. These global initiatives have translated to more specific programs for various countries. In the UK, the UK Fuel Poverty Strategy and the Warm Front Initiative have been established to address winter deaths among the elderly and the vulnerable members of society. The Warm Front project as reviewed by the WHO (2008, pp. 1-2) has already implemented remedies which include thermal insulation as well as improvements in the heating of housing units where these elderly individuals live. This project has widely acknowledged the fact that making changes in energy efficiency in the housing would reduce fuel poverty, maximizing the existing housing accommodations for elderly residents, and improving thermal comfort, as well as improving the health of these residents (WHO, 2009). In the UK, some houses have also shown age and these older houses have exhibited less efficient energy management. Many of these houses accommodate elderly adults and the Warm Front Project has assisted in improving thermal insulation in these homes, thereby reducing the cost of heating (WHO, 2009). WHO (2009, p. 3) highlights the fact that “since the year 2000, over a million household have benefitted from Warm Front at a cost of up to £4,000 (approx 6,000 Euros) per dwelling”. The Warm Front project was also implemented in the London Borough of Newham. This program has provided assistance to the various elderly adults through the installation of insulation and heating in their homes (House of Commons, 2009). This scheme has aimed towards decreasing excessive winter deaths among the elderly by improving the structure of their homes and improving their heating (El Ansari and El Silimy, 2008). This program has managed to improve the heating of various elderly adults, reducing their energy consumption and improving their insulations. In general, the UK government has also considered increase allocations for heating and fuel among these elderly adults (Williams, 2008). Smithers (2011) discusses that about 30 million pounds has been allocated by the government in order to ensure that elderly adults are kept warm in their homes during the winter months. Allocations for those who are most vulnerable to fuel poverty have been increased by 10 million pounds and a 20 million pound allocation for authorities and charitable institutions handling cold housing have also been earmarked (Smithers, 2011). These funds have been set-aside to assist the elderly and other individuals most vulnerable to winter deaths. Health authorities have channelled these funds through the Warm Front scheme in order to ensure the availability of support against fuel poverty, setting aside improvements in insulation and heating of elderly homes (Smithers, 2011). Smithers (2011) also discusses that the Warm Housing, Healthy People fund has been set to accept bids from various local authorities as well as charities for the new ways by which assistance to elderly adults can be given. Government authorities have also implemented the Cold Weather Plan which is a program scheduled to jointly be implemented with the Met Office and the Health Protection Agency. It is a plan meant to advice individuals, especially elderly adults on how they can keep warm and healthy during the winter months (Smithers, 2011). In order to reduce winter morbidity for older adults in Newham, the program adopted by Northamptonshire Community Foundation has also been considered for application in Newham. This foundation gathered donations through their Surviving Winter program in order to raise enough resources in order to fill in the needs of the older adults (Evening Telegraph, 2011). This foundation sought to assist the elderly individuals in getting warm during the winter months and to handle the cost of higher energy for their heating. This foundation also sought to increase the awareness of the general population about the risks of winter deaths (Evening Telegraph, 2011). Awareness is important because it can help improve the patient’s control of his life. Moreover, as more people are aware of the problem of winter deaths, they can take the time to be more engaged in assisting the elderly individuals in their community – monitoring them for possible signs of hypothermia and ensuring that they are warm enough in their homes. This foundation has been successful so far since its inception as it was able to raise 17,000 pounds in order to support about 850 elderly adults who have shown vulnerability to winter deaths (Evening Telegraph, 2011). As for upcoming plans to reduce winter deaths among the elderly, the WHO has considered an expansion of its Climate Change programs for the various countries where winter deaths have risen in number. Plans to coordinate with various countries have also been considered by the WHO in a bid to stimulate these countries to take more aggressive actions towards reducing winter deaths among their elderly population (WHO, 2011). In the UK, plans towards improvements in the implementation of the Warm Front scheme have been considered, including increase in allocations for this scheme and improvements in the heating and insulation of buildings housing elderly adults (Department of Energy and Climate Change, 2011). Age UK (2010) is also one of the agencies which have coordinated with the government authorities in order to improve the awareness of the people on the dangers of cold weather and cold homes. Age UK (2010) has also emphasized the importance of working with the localities in order to handle the various priorities which have to be considered for older adults. Challenges for energy providers have also been made with the end goal of establishing tariffs for energy bills, thereby lowering these to affordable rates (Age UK, 2010). In Newham, plans to improve the implementation of the Warm Front scheme have been considered. Improvements have mostly revolved around the promotion of preventative measures for older adults to take during the cold spell (El Ansari and El Silimy, 2008). Encouraging the various sectors within the locality to make the reduction of winter deaths a priority have also been considered for Newham. The Age UK (2009) has also considered the expansion of the Warm Front scheme to cover provisions for emergency heaters, as well as warm thermal clothes, blankets, and similar apparel to help reduce the impact of the cold winters. In reviewing the above discussion, it can be detected that winter deaths is a significant issue among elderly adults in London. Due to the financial issues which elderly adults have they cannot afford adequate heating during the winter months. As a result, they become highly vulnerable to various health issues, eventually leading to their deaths which register as excessive number of winter deaths. Various programs have been implemented in the international to the national and the local scene in order to improve the heating, insulation, and the health of elderly adults during the winter months. Plans to reduce the rates of winter deaths have also been considered. These plans mostly relate to increased allocations for improvements to be made on the housing of these older adults, improvements which are meant to reduce the impact of the cold weather on these elderly adults. The discussion above specifies the elderly situation in Newham borough of London. The elderly population is considered a vulnerable population in terms of health risks. Due to the normal aging process, they are likely to encounter various health issues, mostly chronic diseases like hypertension, diabetes, arthritis, and cancer. Due to the inability of their body to adequately process change in temperatures, they would also likely suffer from hypothermia during the cold winter months. An assessment of the Newham borough in London reveals that many of their older adults have suffered from hypothermia and other respiratory related diseases during the winter months. As a result, they have also been vulnerable to winter deaths. In order to address this issue, various solutions must be based on the improvements in the heating mechanisms for the older adults, in the monitoring of their health, in the increase of their level of activity during colder months, and on increasing awareness for winter deaths among the elderly population. These measures are important remedies towards seeking improved health outcomes among older adults, and reducing winter morbidities and mortalities within this population. References Age UK. 2009. Excess winter deaths: Preventing an avoidable tragedy [online]. Available at: http://www.ageuk.org.uk/pagefiles/2013/excess_winter_deaths_report_oct10.pdf [accessed 14 January 2012]. Age UK. 2010. Reducing winter deaths [online]. 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