Maximising Health in the Community - Essay Example

MAXIMISING HEALTH IN THE COMMUNITY Background Adolescents accomplish their full physical, emotional and psychological expedition to adulthood in an extremely dynamic world where both opportunities and dangers abound. Most adolescents are full of enthusiasm and represent a positive force in society, an asset now and for the future as they grow and develop into adults. When supported, they can be resilient in absorbing setbacks and overcoming problems. However, adolescents today are being confronted and are exposed to risks and pressures on a scale not faced by their parents. Globalisation has picked up the pace for change while the systems that protected previous generations of young people have become battered and worn out. Young people nowadays obtain conflicting messages on how to tackle and cope with the everyday options available to them which have lifelong repercussions for their healthy development. Millions have been denied the vital support needed to become knowledgeable, confident and skilled adults. Most of these adolescents miss out on schooling for economic reasons or because their communities are displaced or disrupted by war or conflict. And, while most young people have loving families who protect and care for them, many grow up with no adults committed to their welfare or their health or where the ability of caring adults to support them has been damaged. Countless adolescents are at risk of early and unwanted pregnancies, of sexually transmitted infections (STIs) including HIV and AIDS, and susceptible to the dangers of tobacco use, alcohol and other drugs. Numerous young people are exposed to violence and fear on a daily basis. Some of the pressures adolescents are under, or the choices they make, can change the course of their young lives, or even end them. These outcomes represent personal tragedies for young people and their families. Likewise, there are unacceptable losses that put the health and prosperity of society at risk. Addressing the needs of adolescents is a challenge that goes well beyond the role of health services alone. The legal framework, social policy, the safety of communities and opportunities for education and recreation are just some of the factors of civil society that are major components in achieving excellent and successful adolescent development. Although health professionals perform a crucial function in taking care of adolescent patients and enhancing their health, welfare and well-being, the education they have may not sufficiently prepare them for this role. Researchers have found that pediatric residents and house officers frequently have very limited exposure to adolescent medicine (Rosen, 1996; Strasburger, 1997). Several factors affect adolescents' access to health services. These include ethnicity, lack of insurance coverage, problematic clinic hours, poor means of transportation, disposition and conduct of health professionals, and the lack of assurance for confidentiality (Australian Health Ministers, 1995; Ryan, Millstein, Greene, 1995; Society for Adolescent Medicine, 1992). An extensive understanding of theoretical frameworks in preventive health care, health promotion (WHO, 1986) and counselling is important for health professionals to be able to enhance adolescents' self-esteem and their use of internal and external resources in reducing potential risks and improve their health status. The counselling centers on the promotion of adolescents' social skills and emotional competencies, decision-making proficiencies, self-management capabilities, refusal or resistance dexterity and coping strategies (Fischhoff, Crowell and Kipke, 1999; WHO and UNICEF, 1999). In essence, health practitioners must recognize and contemplate on their own beliefs and values regarding adolescent sexual activity so as to promote responsible behaviour of adolescents and to prop them up in avoiding adverse consequences from sexual activity like STIs and unplanned pregnancies (Focus on Young Adults, 2001). Northenden, South Manchester Northenden is a 508-hectare area that accommodates 12,662 people, of which 1,166 are adolescents, between the ages of 11-19 (Northenden Census, 2001). It is an area of South Manchester surrounded by motorway networks. The ethnic race within the Northenden area is a mixture of white people, Pakistani, Indian, Blacks and Chinese. Northenden is a well maintained area; however, traffic in this place is worse in the morning rush hour. Traffic calming measures are being put in place to reduce accidents happening especially to children and elderly people. Northenden provides a wide range of services for school children up to the age of 11 and there are 5 primary schools around the area for younger children. Socialisation, Belief Systems, Bahaviours and Social Well-Being Apparently, young people do not see health as purely being ill or being well in a physical, or mental sense. They see it as a manifestation of their lifestyle and well-being and place strong emphasis on feelings and emotions. Health in this sense is strongly influenced by their relationships and friendships and also affected by the environment, that is, the local neighbourhood, as well as schools and other settings in which they live. Numerous researches have tackled children's and young people's views and understanding of health (Chapman et al, 2000; Stockdale & Katz, 2002; Stansfeld et al, 2003), and obviously, even fairly young children are well able to provide their own insights. The majority of investigations infer a close association between healthy living and perceptions of health. In one study, 11 to 24 year olds cited a balanced diet, exercise, and non-smoking or non-drinking, as significant for their health and are well able to express the prevailing Western health tenets and messages (Chapman, et al, 2000; Burrows & Wright, 2004). What comes through particularly strong from young people is a holistic view of health. Researchers investigating pupils' experiences of health services exhibited how young people thought that health must be regarded as everything to do with keeping well and not just about being ill (Cant et al, 1999). The young respondents viewed as positive actions and can make their lives healthier practices such as balanced diets and regular visits to the doctor or hospital. Interestingly, it was clear that even if they say their health is good, many young people still experience significant problems. Many put great stress on relationships, feelings and emotions. Several qualitative studies suggest that "stress" is a specific problem for many young people (Chapman et al, 2000; Kings Fund, 2000; Healey, 2002; Percy-Smith et al, 2003), with bullying playing a major role (Healey, 2002). It appears that stress among young people is caused by many, and often inter-connected, circumstances that can include bullying, exam pressure, pressure from families, concerns about body image, peer pressure, and a lack of emotional support (Stockdale & Katz, 2002). Factors Affecting Adolescent Health A relevant link between young people and their families, neighborhoods, and schools provide effective protection against the risk of problem behaviours and are closely associated with healthy outcomes for youths (Ewalt, Freeman, & Poole, 1998). Research has shown resilience of young people in avoiding health-damaging behaviour when they have a sense of physical, emotional, and economic security and are connected with caring adults and peers. Strong relations with those within school environment and the anticipation of opportunities for education and employment, parental supervision and involvement in systematized and meaningful activities are also correlated with better health outcomes for the youth. However, the opposite is also true, that is, social and environmental risk factors are closely associated with risk taking and poor health outcomes, these include: Low neighborhood attachment and community disorganisation, poor family management practices, and social and economic deprivation (Ewalt, Freeman, and Poole, 1998). Poverty (Office of Juvenile Justice and Delinquency Prevention, 1999). Lack of resources; young people coming from single-family homes and ethnic minority groups are more likely to be poor. Socioeconomic differences, to a large extent, result to racial and ethnic health disparities among young people and society as a whole Ethnic and cultural diversity are crucial aspects that need to be considered; the adolescent population is more ethnically diverse than any other segment of the population, and all ethnic minority groups are anticipated to grow. These demographic shifts make requisite the need for culturally competent, appropriate, and specific health care services and providers. In the field of social work philosophy, these concepts are expanded beyond race and ethnicity to include gender, socioeconomic, religion or spiritual belief, age, disability, and sexual orientation, recognising that all are significant and have an effect on health outcomes. Various circumstances may increase young people's susceptibility to health-related problems. Countless young people are confronted with alienation, disenfranchisement, and discrimination from the families, communities, and social and health establishments, the very institutions responsible to support their development. Changing Healthcare Delivery System In addition to socio-cultural and environmental influences on health, young people's appropriate involvement in and access to health care delivery systems, or lack thereof, is an important indicator of health outcomes. Traditionally, health care systems have had difficulty serving adolescents sufficiently for a number of reasons. Despite the multitude of health problems affecting the adolescent population, they are a severely underserved sector of society. Adolescents have low rates of health care usage, an occurrence that can be attributed to the lack of health insurance coverage, as it is, an estimated 17% of adolescents have no health care coverage (Mackay, Fingerhut, & Duran, 2000). This is a key factor for youths, particularly those not able to qualify for Medicaid-a key concern in immigrant communities. Historically, there has been a lack of providers for this population - this has been a factor for adolescents covered by Medicaid, as reimbursement rates are often significantly lower than private insurance. The implications for reimbursement under managed care are often low capitation rates. Many policies do not cover or have limits on some preventive health services and substance abuse treatment. It is approximated that adolescents 11 to 21 years of age incur direct annual medical costs of roughly $33.5 billion or $859 per adolescent to treat selected preventable health problems (Adolescent Health and Managed Care Project, 2000). It appears that prevention is clearly cost-effective. There are also disparities in the coverage of mental health services. Social workers understand that good mental health is a part of overall health and well-being, and health services must integrate both. Other systemic and policy-related issues regarding the provision of health services can create additional barriers for teenagers. Most states have confidentiality laws that require parental consent for various treatments. This makes service delivery challenging in certain arenas, including reproductive health and substance abuse, or for youths not connected to stable family systems. Current federal proposals may further erode or ultimately eradicate adolescent protections for patient confidentiality. Major welfare and health care reforms are also current national focus and may very well change traditional health and social programs in an adverse manner. Shifts in traditional federal roles in the governance, allocation, and administration of social programs to states may alter, dilute, or fragment services to young people-the lack of centralised guidance may produce variations and inequities in eligibility requirements, benefits, resources, and service availability. Do Existing Services Meet the Needs of Adolescents Researches in several countries imply that when young people are looking for urgent treatment for what they think are sensitive conditions, public sector health services are often their last resort. Health service providers are often disappointed by these findings, as they want to be a resource for young people- but they do not know how. Yet adolescents can be excluded by poor service delivery or their own lack of awareness, a combination of legal, physical, economic and psychological barriers. Lack of knowledge on the part of the adolescent Most young people do not have the knowledge or experience to distinguish between conditions that go away of their own accord and those that need treatment. They do not understand their symptoms or the degree of risk they may be taking. They do not know what health services exist to help them, or how to access them. Legal or cultural restrictions Reproductive health services, such as family planning clinics or abortion services are often restricted. Abortions may be illegal, although the health system deals with the consequences of unsafe abortions. Even if condoms are available, health workers may hold them back from adolescents. Young people need consent from their parents for medical treatment. Physical or logistical restrictions Services may be a long way from where the young person lives, studies or works, or available only at inconvenient hours. Some services may be inaccessible to the general public - for example, it may only be possible to access a drug treatment programme via the criminal justice system. Poor quality of clinical services Quality may be poor because health care providers are poorly trained or motivated, or because a health facility has run out of medicines or supplies. Unwelcoming services Of special concern is the way in which services are delivered. Young people are very sensitive to privacy and confidentiality, and do not want their dignity to be stripped away. Adolescents are more likely to be deterred by long waiting times and administrative procedures than more mature people, especially if they are made to feel unwelcome. Unfriendly health care providers who do not listen or are judgmental, make it difficult for young people to reveal concerns. They may not return for follow up care. High cost Young people usually cannot afford to pay for health services but must ask an adult to support them. When desperate, young people will 'beg, borrow or steal' money for treatment, but may then seek help in the private sector so as to protect their privacy, even if this treatment is more expensive and less effective. Cultural barriers In many countries a culture of shame discourages adults and children from talking about their bodies or sexual activity. This can inhibit parents from discussing sensitive issues with their children, and make a young person reluctant to use sexual or reproductive health services. It may also be difficult to seek help after violence and sexual abuse within the family. Not every adolescent has the same concerns and not all services are equally sensitive, but these factors are widely applicable across cultures, for both sexes and especially among adolescents who have low self-esteem or who feel vulnerable. Gender barriers Some obstructions are especially associated with the gender of a young person. Adolescent girls are very reluctant to be examined by males, while young men may find it difficult to discuss intimate symptoms with a female health care provider. The sensitivities mentioned may be especially powerful disincentives for girls to use services. There are many cultural barriers associated with gender. It is very difficult for a 16-year-old girl to attend a local clinic for a pregnancy test or for contraception, if she knows that she will be seen by a relative or neighbour. Girls who do not leave the house much may have less access to information and in some cultures have to seek consent from a parent or spouse before treatment. Girls may even be denied treatment by health workers, despite being legally entitled to them. Maximisation and the Promotion of Adolescent Health in the Community While families are the principal source of support for adolescents, other adults with whom young people interact with in schools and communities play a viral role in helping adolescents take advantage of their potential (Pittman, 2000). "It is society's job to make it possible for youth to do what they need to do when adults are no longer there to prompt them." Adults provide opportunities for youth to experience challenges, through which they develop competence and autonomy, thereby experiencing vitality, motivation, and well-being (Deci, 1995). Organisations foster youth development most successfully when methods and tactics synchronise with the outcomes they seek to promote (Connell et al., 1999). Young people can do more and learn more than they thought possible when they have age-appropriate opportunities to make choices, take responsibility, connect with caring adults, and experience challenges. And though it is not easy for adults to engage young people fully in inherently interesting tasks, they can learn how to involve these young people in meeting the challenges rather than simply depending on external rewards that motivate behaviour (Deci, 1995). Organisations that work closely and exclusively with young people, as well as churches, schools, and community-based groups, enhance adolescents' positive development and social capital by following practices that support independence, at the same time, organisations mobilize communities on behalf of adolescents. Essentially, organizations provide support where there's a weak or missing link and augment families' social capital networks (Connell et al., 1999). In like manner, organisations provide opportunities for youth to stretch themselves with age-appropriate risks, challenges, and leadership opportunities. Interactive, enjoyable, practical learning (including structured introductions to the world of work) and service learning help expand youths' skills, engagement and horizons (Grotberg, 1995; Schulenberg et al., 1997). As they participate in community clusters, young people engage in pro-social activities, experience higher levels of monitoring, and potentially, make stronger personal connections with positive adults. All of these experiences help them learn to value themselves, to regulate themselves, and to believe in their own capacities for success. This not only reduces problem behaviours but also increases their capacity to be loving and competent adolescents and adults. By engaging in community development activities such as neighborhood clean-up campaigns and home renovations for the elderly, youth develop not only their own skills and capacities, but also enhance their communities. With experiences like these, youth learn to recognise connections between themselves and adults and gain public recognition for positive contributions and pro-social behaviors (Hawkins et al., 1992). "The strategy is to fix through developmentnot fix first, then develop" (Pittman & Irby, 1996). Policies and their Impact on the Health Agenda So, who does serve as the "voice" for the health of children and adolescents In 1996, an initiative instigated by the Conservative government, the special advisory group on NHS research and development priorities to improve the health of mothers and children sought comment from the 260 bodies it identified to have interests in children and their health (DOH, 1996). In 1997, the parliamentary health committee, in seeking evidence on the specific health needs of children and young people sought advice from over 50 bodies and many individuals (House of Commons, 1997). Royal colleges and other institutions speak for children by being the custodians of standards for training and professional competence. Likewise, the British Medical Association has produced an authoritative report focused on the impact of social and economic inequality on child health (British Medical Association, 1999). The public supports the health of children through highly successful charitable fundraising. There is no lack of public interest or commitment to children's health. Proposed strategies for improving the health status of children and adolescents (Aynsley-Green et al, 2000) include the following: Children and adolescents should be seen as a defined and specific client group in all hierarchies of responsibility An independent children's commissioner or ombudsman for England working with others in Scotland, Wales, and Northern Ireland should be responsible for integrating and evaluating the impact of all threads of government policy that relate to children and adolescents and for protecting their rights A national strategy for children's and young people's health should be informed by multiprofessional strategic forums that have direct access to the management executive, chief medical officer, and chief nurse and implemented by designated officials with identified responsibilities for children Individuals should be appointed at regional, district, and trust level to be responsible for defining local health policy, priorities, and practices relating to children and adolescents. This is particularly important to ensure that the opportunities provided by the development of primary care groups and trusts are not compromised by the creation of new functional barriers between service providers Authority should be given to implement change and to deliver effective services in the light of specific budgets for children and adolescents and their health needs within the framework of local health improvement programmes for young people Children's health improvement programmes should be truly inter-sectorial embracing other joint children's planning devices, particularly children's and young people's services plans Local multi-professional forums between education, social services, and health should be created to inform strategy, monitor performance, and develop joint commissioning Effective leadership is needed at all levels to facilitate joined up working, with effective inter-sectorial communication, collaboration, and working practices Improving the health of children should be a key priority for research and development in the NHS The views of parents, children, and adolescents together with those of clinicians dealing with young people urgently need to be incorporated into the formulation of strategy and delivery of services Further, children's centres are considered to be the key to the integrated delivery of services through children's trust arrangements. It is envisioned that work with local authorities will be set up to establish up to 2,500 children's centres by March 2008. The Government's longer-term ambition is to create and mainstain a children's centre in every community. Children's centres are initially being developed in the 20% most disadvantaged wards and many children's centres are based on Sure Start local programmes. The Child Poverty Review stressed the significance of enhancing access to mental health care for children and young people. There is now evidence to demonstrate that the prevalence of mental disorders in young people has been slowly increasing, but provision for the mental health needs of 16 and 17 year olds often falls in a gap between services for children and those for adults. Self-harm in young women and suicide rates among young men are of particular concern. Child and adolescent mental health services (CAMHS) and adult mental health services have worked hand in hand to make sure that arrangements at the interface between services properly take the interests and needs of young people into account. Such initiative requires services to be flexible in their approach in order to facilitate easier access to services and recognition of the importance to young people of being able to make choices about how and where their mental and physical health care is delivered. Another component of the strategy for integrated service delivery is the development of extended schools. The Government's expectation is for all primary and secondary schools to develop as extended schools over time. In partnership with PCTs and other agencies, extended schools can provide, or offer referral to, accessible health and social care to pupils, their families and the community. Extended schools can also provide opportunities for children and their parents to practice healthy lifestyles through opportunities for physical activity and classes, for example on cooking, outside school hours. One-stop shops and multi-agency health centres located on a school site enable health professionals to work alongside education and social care professionals, sharing both information and expertise. The evaluation of the Extended Schools Pathfinder Project indicates that delivering health services in schools not only improves school attendance but gives health workers ready access to children and families who might other wise not have attended clinics or doctors' surgeries. Conclusion Several current revolutions that are taking place in today's health care system, as well as the complexities in their structure and funding, both challenge everyone's efforts to institute effective policies for reducing threats to adolescent health and provide fresh opportunities. 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