Health Needs - Comparison of Borough of Newham with Borough of Redbridge - Research Proposal Example

Health Needs - Comparison of Borough of Newham with Borough of Redbridge Introduction As Cavanaugh and Chadwick (2005, p. 6) so ably put it, health needs assessment is a systematic method through which the health issues facing a given population are reviewed to result in priorities that are agreed upon by all stakeholders, and appropriate resource allocation for the purpose of health improvement and reduction of health inequalities. This is a proposal to establish health needs assessment (HNA) of two boroughs; Newham and Redbridge. A brief background on the two boroughs will be undertaken followed by an exploration into the five steps of HNA for the two boroughs; getting started, identifying health priorities, assessing the health priority, planning for change and lastly reviewing the entire process. Background on the Boroughs of Newham and Redbridge Newham is the most ethnically diverse borough in London, experiencing the highest birth rate and having one of the highest rates of deprivation, ill health and early deaths (NHS 2009, pp. 91). According to Aston-Mansfield.org (2011, p. 4) the most recent data on employment in Newham indicates that it had the lowest employment rates in London, standing at 56.2% in 2008-09 and 59.5% in 2009-10 in comparison to London’s averages of 62.7% and 68.1% for the two years respectively. The diverse culture and high levels of deprivation and unemployment translate to existence of several health problems and health inequalities in Newham and thus lower health and wellness levels than London’s average. Redbridge on the other hand enjoys a similar or better health and well-being than London’s or England’s average as evidenced by significantly lower levels of most health considerations such as drug abuse, accidental injuries and teenage conceptions and generally a greater life expectancy (JSNA 2008, p. 58). The borough is similarly considerably multicultural, and bears health inequalities and problems (Trust for London and New Policy Institute 2010, Redbridge 2007, pp. 74-75). The decision to select these two boroughs was informed by the fact that they share a lot of considerations in terms of health needs assessment and yet have totally different health achievement profiles. Health Needs Assessment Step 1: Getting Started The considerations for this step include the choice of population and the justification, the objectives of the HNA, the stakeholders to be involved, the resources required, the challenges and ways around them and lastly appraisal of the step (Cavanaugh and Chadwick 2005, p. 23). The populations selected in this proposal are the inhabitants of Newham and Redbridge boroughs. The subpopulations under question in both the boroughs are the children, ethnic minorities and the elderly. The reason for the selection of populations in the two boroughs lies in the fact that they share near similar demographic profiles and hence are faced by the same health challenges, yet their health outcomes are different. The reason for the sub-populations selected is due to their status as being the most disadvantaged and deprived in these societies. The objectives of this HNA are to establish the health needs of the two boroughs and identify the priorities; to plan for interventional measures basing on the health priorities; and lastly to identify why the health outcomes of the two boroughs are starkly different in light of near similar profiles. This inquiry will involve (in each of the boroughs) the public health nurse, community-based nurse, community developer, counselors, members from the subpopulations selected and local health and social workers. The primary resources required include the funding, time according to each of the stakeholders involved, data access from relevant sources and meeting venues. The challenges anticipated include professional boundaries and lack of common language which will be addressed through adequate orientation, familiarisation before the HNA and effective communication throughout the process. Waning of team impetus will be solved through continuous appraisal and highlighting of achievements. Step 2: Identifying the Health Priorities This step involves narrowing down from the potentially huge number of health problems that can be addressed basing on impact in terms of severity and local changeability (Cavanaugh and Chadwick 2005, p. 25). A population profile for Newham will be undertaken through accessing general data and holding workshops to get the community’s perceptions. General data indicates that Newham had a population of 270,000 by 2010, made of a culturally diverse background. It also has the youngest age structure in the UK and a male to female ratio of 49:51. Newham has low employment and low owner occupied housing alongside the 4th highest crime rate in London. On top of this, it has poorer health and lower life expectancy than the rest of London (Aston-Mansfield.org 2011, pp. 5). Child health inequalities (NHS 2010, p. 3), sexual health needs (NHS 2009, 8), mental health and circulatory diseases (Aston-Mansfield.org 2011, p. 11) are some of the most serious health challenges identifiable from data. Redbridge’s health concerns on the other hand include mental health (SCIE.org 2010; Hayward, Martin and Soljak 2009, pp. 55), sexual health needs (Bell 2009, p. 17; Redbridge.gov 2011), cancers, circulatory diseases and child health issues (Redbridge 2007, p. 77). From the categorisation of determinant factors that may affect health conditions in both Newham and Redbridge, it is discernible that socio-economic and lifestyle factors are at play from existing data which will be backed up by on-field research. In Newham, multiple-deprivation ranks which are based on socioeconomic factors rank the borough as the 6th most deprived. These factors include economic ones (income, employment, and education) and environmental ones (housing and living environment) (NHS 2010, p. 2). The determinant factors for Redbridge include economic (income and inequality) and lifestyle ones (Redbridge 2007, p. 77). For the purposes of comparison, those health issues that are common to both the boroughs will be selected for determination of priority. A health triangle will be employed in the assessment of each health problem and its determinant factors so as to end up with establishment of the impacts of these on the selected population (Cavanaugh and Chadwick 2005, p. 34). Based on two considerations; impact and changeability of the shared health problems (child health in terms of low birth weight, mental health and sexual health), the health problem with the highest priority to be addressed will be established as given in the example below: Table 1: Impact and severity Ratings Health Condition/Determinant Factor Impact in Newham Impact in Redbridge High Medium Low Size High Medium Low Size Low Child Birth Weight/child poverty X 55.7% X 9.2% Sexual Health/Inequality X 0.61% X 7.2% (Chlamydia) Mental Health/inequality X 0.91% X 0.16% Likewise, a table for changeability will be filled basing on the following model: Table 2: Changeability of health problems Health/ Determinant Level of Prevention in Newham Level of prevention in Redbridge Occurring Recurring Consequences Total Low Birth Weight/Child Poverty Sexual Health/Inequality Mental Health/Inequality From the existing data, it can be shown that low weight among newborns and its child poverty driving factor are a priority concern for both of the boroughs (NHS 2010, p. 3; JSNA 2008, p. 63), hence low child weight will be used in the rest of the proposal as the model health problem being addressed. Step 3: Assessing the Health Priority for Action This step involves a detailed review of the impact and changeability of the health condition being addressed followed by determining the acceptability of the changes to be implemented and lastly the resource feasibility to back such changes (Cavanaugh and Chadwick 2005, p. 36). This involves stating the section of the population being assessed, in this case, children in the boroughs of Newham and Redbridge and in extension their mothers. The assessment will be done to establish the interventions that can be implemented to prevent low weight child births in the communities in question. A health triangle will be utilised to identify the most important aspects of health functioning among the individuals affected, with each member of the team ranking each aspect followed by establishing a consensus. The health conditions and determinants that have the most significant impact on the selected health priority will be established through determining its severity and size of its impact. For the case of low birth weight, JSNA (2008, pp. 63-64) identifies some of the determinant factors to be maternal health and maternal services. Factors that contribute to low birth weight thus include smoking, poor nutrition and drug abuse during pregnancy. In terms of severity, the considerations are whether the given determinant factors affect the most important aspect of health functioning, affect other health issues, affect long term health or cause death. For example, prenatal smoking may result in neonatal deaths, stillbirths, long term effects in the child such as physical and brain mal-development. Impact in terms of size can be established from the data available on low weight births. Data for Newham indicates that child poverty is strongly associated with birth weights of below 200 grams, and the prevalence of child poverty is 55.7% which indicates that a high proportion of children are at risk of being born with low weight (NHS 2010, pp. 3-4). According to the JSNA (2008, p. 63), the percentage of babies born alive with less than 2500 milligrams in Redbridge is 9.2% compared to the national 7.9%. Since the causal factor for low child weight has been shown to be maternal, the intervention strategies will be targeted at this group especially in the disadvantaged sections of society where low birth weights are mostly observed. The high priority issues identified include drug abuse and smoking during maternity and poor nutrition. All of these can be intervened at the occurrence stage. The first strategy that will be put under consideration is rehabilitation and community care for pregnant women to ensure that smoking and abuse of alcohol and other drugs is dealt with. Evidence to support this is drawn from Lester, Andreozi and Appiah (2004). Community-based care will also be used to ensure that the women receive proper nutrition during pregnancy, as supported by UK national framework (NICE 2008, p. 10). These propositions should be acceptable and within resource feasibility even with what currently exists especially considering the government’s willingness to tackle inequality. Step 4: Action Planning for Change After the first three steps, the team shall then establish the objectives of the intervention strategies planned. The overall aim will be to improve birth weights in Newham and Redbridge. The objectives will be to prevent maternal smoking and drug abuse during pregnancy and secondly to promote proper nutrition during pregnancy. The community developer and community-based nurse will be responsible for increasing awareness of the program and registering women who turn up. Counselors will be sought to educate the women on the dangers of drug abuse during pregnancy alongside regular follow up and appraisal. Awareness on nutrition alongside provision of relief to the financially challenged will be done in collaboration with the local authorities and government agencies. Process monitoring and evaluation of all the registered to-be mothers will be undertaken, and appraisal will be in terms of actual drug abuse control in these women alongside nutritional evaluation. Outcome evaluation will be in terms of the actual birth weights during the entire period of the implementation among the women involved from both boroughs alongside the lessons transferred. Risk management will be undertaken throughout the process. Step 5: Project Review After implementation of the intervention project following the three preceding steps, the members of the team will be requested to reflect upon the entire HNA on a personal level and as an entire team. The considerations here will be whether the action plan was implemented properly, the achievements in terms of improved birth weights and increased awareness, reduction of inequalities, challenges and lessons learnt. The team will analyse whether the health priority still exists, the changes implemented during the project, improvements that could be implemented in the HNA and what a future HNA in the two boroughs may pick from the implemented project. The HNA project will thus come to a conclusion after all these considerations are established. References Aston-Mansfield.org, 2011, Newham: Key statistics, Advance to Deliver, viewed 31 October 2011, Bell, M, Daniel, S, Hansen, C & McDougall, D 2009, Further education sexual health needs assessment: Borough profiles, Michael Bell Associates, UK. Cavanaugh, S & Chadwick, K 2005, Health needs assessment: A practical guide, London: NICE, viewed 31 October 2011, Hayward, J, Martin, S & Soljak, M 2009, ‘Health needs assessment: Stroke in South West and South East London’, PHAST, viewed 31 October 2011, JSNA 2008, Redbridge joint strategic needs assessment, UK. Lester, BM, Andreozi, L & Appiah, L 2004, ‘Substance use during pregnancy: time for policy to catch up with research’, Harm Reduction Journal, vol. 1, no. 5, pp. 1-44. NICE, 2008, Antenatal care: Routine care for the healthy pregnant woman, Guideline 62. NHS, 2009a, Newham sexual health needs assessment 2009 – 2012, London, viewed 31 October 2011, NHS, 2010b, Joint strategic needs assessment, Newham 2010, viewed 31 October 2011, Redbridge.gov, 2011, Health: Chlamydia, viewed 31 October 2011, Redbridge, 2007, Health and social care, Redbridge, London. SCIE.org, 2010, SCIE guide 3: Assessing the mental health needs of older people, viewed 31 October 2011, Trust for London and New Policy Institute, 2010, Newham poverty indicators, viewed 31 October 2011, Read More