Deprivation-Related Health Issues in North East London - Essay Example

?Deprivation-Related Health Issues in North East London: Focus on Barking & Dagenham Are health priorities by local units immediately above the boroughs reflecting the needs of the boroughs, especially those with relatively high incidence of poverty? This question is an urban health issue because urbanization may advance but poverty can persist with the urbanization (Mitlin 2005). Worst, poverty remains chronic even with urbanization (Mitlin 2005). Because of this, morbidity and mortality associated with poverty persist even with the urbanization---implying that urban health programs must continue to be attuned to the state of poverty in their localities even with urbanization (Barten 2010). Indeed there are ailments associated with poverty (Stevens 2004). We explore the issue of whether urban health programs are cognizant of urban poverty; in particular, whether urban health programs of the boroughs are cognizant of urban poverty. We shall use the cases of North East London and a borough under North East London---the Barking and Dagenham Borough. Barking & Dagenham Borough is populated by 179,900 people in 3,611 hectares (London Council, 2013). In turn, the North East Boroughs covers a fairly wide area that includes the boroughs of Waltham Forest, Redbridge, Havering, Barking & Dagenham, Newham and Tower Hamlets. Last January 2011, several committees organized by National Health Service arrived at six key decisions on what services to emphasise in North East London (Health for North East London, 2011). The document explicitly identified that the Barking & Dagenham Borough is under their jurisdiction. The priorities of the health program are in the following areas. First, there is a consensus to provide medical and surgical inpatient and critical care in five hospitals of the locality. Second, there is a decision to develop models of maternity care in five hospitals. Third, planned surgery was moved from Queen’s Hospital to King George Hospital and there is a decision to establish dialysis services. Fourth, various committees agreed to provide more specialist care for children and an assessment system was established to decrease admissions and unnecessary lengths of stay. Fifth, a vision for King George Hospital was developed emphasising on 24/7 urgent care and general services, short stay assessment and treatment for children and adults, diagnostics, child health, outpatient facilities and diagnostic services cancer day care, and renal dialysis. Finally or sixth, complex vascular surgery was to be consolidated in two sites---Royal London and Queen’s Hospital. It may be appropriate to assess the appropriateness of the January 2011 decisions in the light of health and socio-economic figures of the area. As we can see in Figure 1, North East London is one of the areas of London with a high degree of “deprivation” compared to all the areas of London and second only to City and East London based on the state of “deprivation.” Figure 1. London and level of deprivation Source: Rogers (2012) Figure 2 also show that many localities of North East London have a high child poverty rate as shown by the red and light shades of Figure 2. North East London can be ranked third compared to City & East and Enfield & Haringey for having large areas with very high rates of child poverty. It is reasonable to expect that the high child poverty rates reflect themselves on the area’s state of health and the types of diseases and ailments which have high incidence and prevalence in the locality. Further, it is likely that the impact on people’s lives of a particular ailment and diseases would be different based on their state of deprivation and non-deprivation. Figure 2. Child poverty Source: Rogers (2012) A word of caution in using the Rogers (2012) data, however, is that the methodology for the estimates is not immediately available. Rogers (2012) attributes to Alasdair Rae of the University of Sheffield his source of data. Rogers (2012) reported that Rae used government indices for his graphics: the graphics are found in Rogers (2012) bur Rogers said Rae produced the graphics. Meanwhile, looking at the socio-economic data and health profile of Barking & Dagenham, we note several points. First, latest employment and unemployment data available indicate that figures for Barking & Dagenham are worst compared to London and UK figures. Based on the NOMIS official labour market statistics in 2006, Barking & Dagenham had an unemployment rate of 9.6% in 2006 while the London had 7.0% and United Kingdom had 4.8% on the same year. Barking & Dagenham had an employment rate of only 62.8% compared to London’s 69.1% and UK’s 75.5% for the same year. Employment and unemployment figures do not appear to be consistent because there is a third category that distorts the fit between employment and unemployment---the data category “self-employed.” Second, “men and women in Barking and Dagenham live nearly two years less than the average for England” (NHS 2007, p. 1). Third, although the deaths on the road are less than the England average, the death rates from the major causes are higher in Barking and Dagenham compared to the entire England (NHS 2007). Fourth, homelessness in Barking and Dagenham is four times worst compared to England as a whole (NHS 2007). Fifth, the incidence of smoking in Barking and Dagenham is 25% higher than England (NHS 2007). Sixth, “the majority of areas within Barking and Dagenham are within the most deprived fifth in England” (NHS 2007, p. 1). Seventh, early death rates from heart disease, strokes, and cancer are consistently higher in Barking and Dagenham compared to England between 1996 to 2004 (NHS 2007). Finally or eighth, the state of homelessness and Barking and Dagenham is more than four times the United Kingdom’s average. All these imply that the health strategies that both the North East London and Barking and Dagenham health authorities apply must be more imaginative than the current level. For instance, it is easy to see that the articulation of the health authorities covering the North East does not reflect a strong recognition of the state of health deprivation of the North East as well as Barking and Dagenham. It is likely that if we review the health programs in other parts of the United Kingdom and London, the health programs that we will see will be similar to the health program of the North East as well as Barking and Dagenham. In other words, the health program of the North East that we have discussed does not factor the worse state of deprivation of the North East as well as Barking and Dagenham. Looking at the local priorities for health care in Borough and Dagenham, we see that they are reasonable but inadequate: “increasing the uptake of breast and cervical screening; increasing smoking quitters, halting the rise childhood obesity; reducing teenage pregnancy; reducing emergency admission for long-term conditions; and increasing equity for health care“(NHS 2007, 1). The health program is adequate because, for instance, there are no clear statements on how the health program can exactly address the problem of universal health access of citizens. Note that it is clear in Figure 1 that life expectancy data for people in Barking and Dagenham are consistently below life expectancy data for England, be it for men and women, strongly indicating that the state of health deprivation in Barking and Dagenham is not simply “accidental” but chronic. Figure 1. Life Expectancy at birth, Barking and Dagenham versus England Source: NHS 2007, p. 3 How can a pro-poor or more inclusive health program in the North East as well as Barking and Dagenham be exactly advanced? First, there must a stronger focus on children’s health in a state of poverty. It is obvious from our discussion that while data are available that indicates child poverty in the North East covering Barking and Dagenham, health programs do no appear to be factoring in the fact. Second, health programs in the North East as well as Barking & Dagenham (and other areas which reflect “strong deprivation”) must emphasise on health access more than any other locality in the United Kingdom. There is no such emphasis on health access by the poor in both the North East and the Barking and Dagenham health programs. Third, programs specifically targeting the health of children in poverty and homeless people in both the North East and Barking and Dagenham must be advanced. There is no such articulation of a focus on the health of children and poverty and people who are homeless in both the North East and Barking and Dagenham. Finally or fourth, we must study experiences and factor in the best practices in advancing a more inclusive health program in both North East London and Barking and Dagenham. One locality which is reported to have an advanced experience in developing a more inclusive health program is Bromley (Develop 2013). Based on the articulations of Develop (2013), it may be a good idea to review their experiences and find out how more participatory approaches can bring about a more socially-inclusive health program. Another experience that can be reviewed is the experience of Netherlands (Mackenbach and Stronks 2004). According to Mackenbach and Stronks (2004), in Netherland’s experience, tapping schools, developing community-based interventions, and peer education played important roles in developing a more socially inclusive health program. References Barten, F., Akerman, M., Becker, D., Friel, S., Hancock, T., McGranahan, G., Mwatsama, M., Rice, M., Sheuya, S., and Stern, R., 2010. Governance for health equity in urban settings. Global Research Network on Urban Health Equity. Available from www.ij-healthgeographics.com [Accessed 2 February 2013]. Develop, 2013. Social inclusion. Available from http://www.developbromley.com/inclusion/services [Accessed 4 February 2013]. Health for North East London, January 2011. Health for north east London: Delivering high-quality hospital services for the people of north east London. National Health Service: Health for North East London. London Council, 2013. Barking & Dagenham. Available from http://www.londoncouncils.gov.uk/londonfacts/londonlocalgovernment/londonmapandlinks/BarkingDagenhamstatisticalprofile.htm?showpage=1 [Accessed 4 February 2013] Mackenbach, J. and Stronks, K., 2004. The development of a strategy for tackling health inequalities in the Netherlands. International Journal for Equity in Health, 3 (11). Available from http://www.equityhealthj.com/content/3/1/11 [Accessed 4 February 2013]. Mitlin, D., 2005. Chronic poverty in poverty in urban areas. Environment and Urbanization Brief-12. London: Human Settlements Programme, International Institute for Environment and Development (IIED). NHS, 2007. Barking and Dagenham health profile 2007. London: Department of Health. NOMIS, 2006. Official labour market statistics. London: His Majesty’s Stationery Office. Rogers, S., 2012. Deprivation and poverty in London: Get the data. The Guardian: Datablog. Available from http://www.guardian.co.uk/uk/datablog/2012/apr/12/deprivation-poverty-london#zoomed-picture [Accessed 3 February 2013] Stevens, P., 2004. Diseases of poverty and the 10/90 gap. London: International Policy Network. Read More