Tackling Health Inequalities In the UK - Coursework Example

CHD Inequality Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecture Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Contents Stage 1: CHD Epidemiology 3 Stage 2: Policy Addressing the CHD inequality in the city of Manchester and in England 4 Stage 3: Theories of Inequality 6 Stage 4: Intervention to Tackle CHD inequality in Manchester City 8 Stage 5: Evaluation of Interventions 10 Conclusion 12 Bibliographies 13 Stage 1: CHD Epidemiology Health inequalities can be defined as the higher presence of health disorders among groups that are disadvantaged in society (World Health Organization, 2010). Health is the wellbeing of a person both mentally and physically (World Health Organization, 2000). A person may have his health impacted negatively by a number of factors including where he or she lives, the type of food she eats and where he/she works (Rose, 1985). Contributors to health inequalities include biological and free choice factors that are within the control of an individual while factors in the external environment cannot be controlled by an individual. Inequalities can be analyzed in terms of events that lead to poor health for people belonging to a certain population group, these events are characterized by differences in groups: (1) effects of an individual environment, (2) the ease of accessing services that can improve his/ her condition, the quality of services accessed, (3) the health status, (4) Scrutiny of a certain health outcome (Willacy, 2010). Among the factors thought to contribute to higher levels of CHD include poverty and ethnicity of individuals. Poor individuals have a higher more likely to survive on unhealthy diets which contribute to CHD. In the City of Manchester ethnic minorities are poorer than their white counterparts and thus levels of CHD among this group are high (Labarthe, 1998). This paper addresses health inequalities in City of Manchester, UK by examining the factors that lead to high incidence of Coronary Heart Disease among some population groups in this area. Coronary heart disease (CHD) refers to the constriction or obstruction of the coronary arteries as mostly a result of plaque (fatty acids and Cholesterol) coalescing in an artery causing it to become harder than usual. This build-up means blood flow to and around the heart is constrained, consequently leading to it getting lower delivery of Oxygen and other nutrition it needs to carry out its function in the body (Berenson, Wattigney, and Bao,1995). Patients with the condition usually experience pains around the cavity of the chest. According to British Heart foundation (2012) CHD accounts for the highest percentage of mortality than any other disease affecting the people of England; it causes more than 100,000 fatalities every year. Every year it causes chest pain problems to more than 1.4 million people with more than 250,000 individuals are victims of heart attacks related to CHD. Nationally 3 per cent of people are hospitalized as a consequence of CHD every year. It is noted that CHD is the leading cause of death in the City of Manchester. CHD also reduces the life expectancy of men from this area by 18% compared to the UK national figures. Women CHD mortality rates are lower with 14% of all female deaths accounted for by CHD. CHD mortality rate in the city of Manchester has increased sharply from 47.6% recorded in 1993 to a gap of 76.2% in 2004 (Manchester City Council, 2009) Management and treatment of CHD is a very costly affair; the British Government spends over 1.7£ billion every year to combat CHD related health problems a significant part of which is spent in the regions with High CHD incidence including the City of Manchester. (The British Heart Foundation, 2004).These figures show that the threat of CHD is real concern and its prevalence and mortality rates are higher in the city of Manchester than in other regions of England. In this paper we will analyze the factors contributing to this disturbing health inequality. Stage 2: Policy Addressing the CHD inequality in the city of Manchester and in England The National health framework has recognized CHD as one of the major Health issues that need to be addressed and given significant priority in policy and Budget making. The National Social Framework for Coronary Heart Disease (NSF, CHD) is a significant policy response to the prevalence of CHD in the city of Manchester and the United Kingdom as a whole (Prashar, 2005). NSF, CHD seeks to create benchmarks for prevention of CHD among people who have an elevated probability of getting CHD diagnosis and management of it in diagnosed cases. NSF, CHD sets objectives for the immediate establishment of tobacco abuse cessation clinics, rapidly accessible angina clinics and a reduction of the time between making of an emergency call and the injection of the drug that leads to clot dissolution. It also aims at increasing the efficiency of medication after a patient has suffered a heart attack. NSF, CHD also aims at having more revascularization processes and updating the services for CHD through a new systematic perspective of care delivery (Prashar, 2005). The NSF, CHD is to be delivered to the population by local collaboration units such as the Manchester Joint Health Unit. The city of Manchester has several initiatives that meet the NSF, CHD standards 3-12. The CHD collaborative projects are some of the NSF, CHD initiatives aimed at tackling the problem of CHD through ‘prevention, diagnosis, treatment and care’ (Prashar, 2005). One of the projects in this initiative is the secondary prevention project which aims at making sure the prevention protocols the framework proposes are fully used by all the individuals who have had a first cardiac event (Prashar 2005). The projects targets an efficient delivery of home based care for CHD patients equal to that provided in hospitals. It particularly focuses on enabling patients manage their own health at home. The Acute Myocardial Infarction (ACI) another project under the initiative that aims at providing rapid care to patients suffering heart attacks. The ACI aims at reducing ‘call to needle time’ to a maximum of 60 minutes and make sure 85% of CHD patients have booked follow-up tests when they leave hospital (Prashar, 2005). According to Prashar (2005), the collaborative initiative has four other projects: a) the Angina project is meant to provide people suffering with Angina fast treatment, b) the heart failure project that targets better care for patient of heart failure and those at risk of heart failure, c) the Revascularization project that ensures patient’s access to revascularization treatment and also reducing the waiting time for the procedure. d) the Rehabilitation project targeted at delivering better cardiac rehabilitation services that connect with minority groups and the disabled. Stage 3: Theories of Inequality Individual lifestyle is one of the theories that associate a certain population with the prevalence of certain health condition in the population (Rose, 1985). In Manchester the high incidence of CHD may be credited to the way the residents of this area decide to live their lives. Lifestyle factors closely associated with the prevalence of CHD include the diet of an individual, the alcohol and tobacco usage and the physical activity of an individual (Berenson, Wattigney and Bao, 1995). Alcoholism at the extreme end of consumption generally tends to put an individual at higher risk of CHD though moderate drinking is thought to reduce the prevalence rate. Alcoholism is an issue of concern in Manchester city due its large population (William and Littman, 1996). Manchester city has a fairly high population of dangerously high alcohol consumers with 30% of men and 17% of women drinking over the recommended weekly limits. Further heart disease accounts for the life expectancy gap between Manchester city and the North West; the local alcohol profile for Manchester city lists that the alcohol specific mortality for males is at 33.4 while that of the North West is 19, on a scale of 1 to 326. That of women is at 13 while the regional average is 10(LAPE, 2011). Smoking and CHD CHD is a common cause of death among heavy smokers with the toxins contained in being responsible for hardening of the arteries; a leading cause of CHD. Manchester city has a high prevalence of smokers (Lynch et al, 1996). The number of deaths related to smoking in this area is also quite high and cutting down on the number of smokers would be significant in reducing the number of CHD related deaths. Cultural and behavioral theories are also significant in determining the health of the community around which they are centered. Key aspects of this theory that would determine the prevalence of CHD in a community include eating and drinking habits, belief systems as well as stressful living. The culture of smoking and alcoholism common among young adults once they join colleges and universities is an example. Stress at work is thought to put the majority of the working population at a high risk of CHD though unhealthy behaviors such as substance and drug abuse and lack of exercise as well as elevated blood pressure result from work related stress (He, 1999). This is a common occurrence in Manchester city with a large number of teachers staying out of work and visiting the doctor due to stress. Studies show that areas predisposed to low income earners have a higher mortality from CHD (Lynch, Kaplan and Cohen, 1996). Material well-being also has a significant impact on dietary habits which have an effect on blood cholesterol level which is a determining factor of the risk of CHD (Guilbert, 2003). Those well off can afford recommended diets and afford to keep their cholesterol level in check as opposed to those at a material disadvantage whose diets are determined by what they can afford irrespective of the health benefits they derive from such diets and the risk at which it places them in relation to CHD. The city of Manchester has a high prevalence of CHD and there is a consistent pattern between low income earning households and CHD. Low income earners in Manchester are more prone to physical and mental illnesses than high income earners (Chow, Pell and Walker, 2007). Stage 4: Intervention to Tackle CHD inequality in Manchester City Appropriate Diet in Tackling CHD The people and health authorities can reduce CHD prevalence in Manchester city by adopting a diet that is low in cholesterol and saturated fats. Studies have shown that Dietary intervention can lower the risk of CHD significantly. According to the theory of individual lifestyle poor dieting contributes to higher CHD incidence in a certain region. Dietary intervention is one of the best strategies to tackle CHD as it can be applied to the whole population and is relatively inexpensive (World Health Organization, 2003). In Patal, Cohn and Willerson (1997) the nurses’ Health Study (NHS) give further evidence to support the hypothesis that healthy Diet can bring down the risk of CHD. The NHS involved 18 128 females of ages between 30-55 years whose health was monitored for 14 years. The study also investigated other factors alongside diet this included smoking, alcohol consumption, exercise, and Body mass index. The NHS found out that Diet can lower the risk of CHD moderately. However research points at that lowering the amount of fat that one ingests will not lower the risk of CHD. For one to lower their risk of CHD they have to lower their intake of trans-fats (unsaturated fats mostly found in animal product) (Mozaffarian, 2006). An increase in polysaturated fats has been shown to lower the risk of CHD. By using information gathered from the above studies and others the health authorities the city of Manchester can carry out a campaign that promotes good diet. The campaign can take the form of door to door campaigns by community health workers. Health workers should take advantage of every visit by a resident of the area to a health facility to inform them about the diet they can adopt to reduce CHD. The media part of the campaign should be named ‘Don’t be another CHD mortality, Prevent eat, Eat Healthy’. With a healthy diet with lower trans-fat and cholesterol levels the risk and mortality rate of CHD can be reduced and consequently the CHD inequality in the City of Manchester (Department of Health 2005). Measures for Cessation of smoking Smoking is one of the factors closely associated with the high occurrence of CHD in Manchester city. By making sure people quit smoking or reduce the number of cigarettes consumed daily they can bring down the CHD levels to manageable levels. According to individual lifestyle theory of health inequality smoking habits and the presence of tobacco smoke in the environment are major contributors to an individual’s eventual CHD diagnosis (Law, Morris and Wald, 1997). This strong correlation between smoking and CHD occurrence has been the subject of multiple studies with each supporting the individual lifestyle hypothesis of smoking as the largest risk factor for CHD. Statistics indicate that people exposed to cigarettes smoke are 5.06 times more likely to be diagnosed with CHD than none smokers (Department of Health 2003). This intervention should stop all smoking in overcrowded public places as secondary cigarette smoke is considered more lethal than the primary smoke. The public places to be considered in this criterion include bars, public transport and schools (Department of Health, 2005). Another strategy to reduce smoking would be the use of child ambassadors to influence smoking attitudes in adults they come in contact with on a daily basis. Health workers can visit schools with highly visual messages on the danger of smoking and encourage children to deliver this message to the neighbors and their parents. The health community can also organize annual walks to raise awareness to the effect of smoking linked to a CHD risk. The Campaign should be dubbed ‘Crush you cigarette and Live’. The authorities should also establish smokers rehabilitation centers to enable many people move smoothly through the process of ceasing smoking. By use of this strategy to bring down the number of cigarettes consumed in the city of Manchester, the risk and future incidences of CHD can reduce significantly, thus closing the CHD inequality gap between City of Manchester and the rest of England. The smoke free Manchester is one such service. It offers professional assistance to those willing to quit as well as free/ subsidized Nicotine Replacement Therapy. Stage 5: Evaluation of Interventions The process of implementing appropriate diets and smoking cessation within a population with the aim of reducing the risk of CHD faces many challenges before it can be deemed a success. Evaluation should begin with the formation of teams that are well equipped to come up with an effective solution based on the evidence available. In this case, the team would consist of medical practitioners, community service workers and the arm of the government responsible for the provision of medical care. The second step would be the choosing of an appropriate framework for use in the implementation of interventions within the Manchester city community; the social learning theory is one of the most appropriate frameworks. This is an important theory that would help in molding the behaviors of the community as well as help disseminate information on the benefits of adopting appropriate diets and smoking cessation aim reducing CHD prevalence. In the Third step, observational learning models are used such as the live model where an actual person helps pass on the benefits of adopting heart friendly diets in helping to reduce the risk of CHD; Verbal instruction which would involve medical practitioners advocating for healthy diets in favor of those that put persons at a higher risk of CHD; and the use of the media to educate the population on the need to adopt healthier diets (Thomas, et al, 2008). This process would have significant impact in institutions where the diets are under the control of the institutions such as schools that provide meals to students and also in hospitals. The diets on offer in such institutions are all uniform and this will help in reducing inequalities that exist in dietary patterns as a result of cultural, social and economic factors. Food futures are an initiative that aims at improving health, tackling health inequalities and reducing the environmental impact of food. The goal of this initiative is to provide good food to persons in the city of Manchester irrespective of where they live, level of income or background. It continues to advocate for healthy diets in school meals and markets (Manchester public health annual report, 2009). Cessation of smoking population based interventions focus on individual as well as environmental factors that influence the smoking population. They target to have a community based impact irrespective of individual’s lifestyle, belief systems, material well being or career. This will help in narrowing the gap that exists in health inequalities that exist in the greater Manchester population. In the final step various measures of the intervention outcome are recorded annually, these include CHD prevalence census at hospitals, number of individuals who have quit smoking, levels of cholesterol in individual’s blood, number of people who have adopted a healthier diet, number of deaths related to CHD and number of hospitalization related to CHD. An innovative initiative combining efforts of the Manchester Smoking Cessation Service and a credit union aimed at accumulating savings for quitting smokers recorded significant enrollment rates. Other successful community based cessation smoking interventions include an initiative by Manchester, Salford & Trafford HAZ that involves general practitioners offering advice and support while also accessing free nicotine replacement therapy (Prashar, 2005). This intervention is prone to fail as there is a downward secular trend towards dietary and behavioral change in general. Cultural and social changes as such that might encourage high risk behaviors such as smoking and the popularity of fast food chains are a larger force than the urge to modify lifestyles (Akers, 2009). Most people view behaviors that put them at a high risk of CHD such as the need to adapt healthier diets and cessation of smoking as easily modifiable and voluntary decisions. They fail to quite grasp the enormity that diet has on the risk of CHD. Success of this intervention also heavily relies on ones’ self efficacy and desire to change irrespective of what secular trends might indicate. Conclusion CHD is preventable in any place in the world although it depends on an individual’s ability to fully take up intervention measures. Though CHD inequality exists in Manchester city appropriate population based interventions can address this inequality and see the quality of life of the people of Manchester improve significantly. The theories of inequality point at the underlying factors contributing to the higher occurrence of CHD in Manchester therefore indicating to the government what policies can be implemented to reduce CHD levels in the area. Although the government and health authorities can propose and initiate certain health intervention their final implementation mostly lies with individuals. Bibliographies Akers, R (2009). Social Learning and Social Structure: A General Theory of Crime and Deviance, New York: Transaction Publishers. Berenson, G., Wattigney, W. & Bao, W. (1995). Rationale to study the early natural history of heart disease: The Bolugsa heart study. Am J Med Sci. Vol.310, pp.22-28. British Heart Foundation (2005).Coronary heart disease statistics 2004. [Internet]. Available at http:// www.bhf.org.uk/. [1st May 2012]. British Heart Foundation (2012).Coronary heart disease statistics 2010. [Internet]. Available at http://www.bhf.org.uk/research/statistics.aspx. [1st May 2012]. Chow, K., Pell, C. & Walker, A. (2007). Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention. BMJ. Vol. 335, pt.481-5. Coventry, P. (2011). Multicondition collaborative care intervention for people with coronary heart disease and/or diabetes, depression and poor control of hypertension, blood sugar or hypercholesterolemia improves disability and quality of life compared with usual care. BMJ 2011, pp. 343 Department of Health (2005).Choosing a better diet: a food and health action plan.London: Department of Health Department of Health. (2003). Tackling health inequalities: A programme for action. London: HMSO. Guilbert, J. (2003). The world health report 2002 - reducing risks, promoting healthy life. Educ Health (Abingdon).vol.16 (2) pp. 230. He, J., Vupputuri, S., Allen K. (1999). Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies. N Engl J Med. Vol. 340, pp.920-6. Labarthe, R. (1998). Epidemiology and Prevention of Cardiovascular Disease, a global Perspective. Gaithersburg, MD: Aspen Publishers LAPE, Manchester. (2011). North West Public Health Observatory.[Internet]. Available from http://www.lape.org.uk/LAProfile.aspx?reg=b.[1st May 2012]. Law,R., Morris, K.& Wald,J. (1997). Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ. Vol.315. Lynch, W., Kaplan, G., Cohen, B. (1996). Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all cause mortality, cardiovascular mortality, and acute myocardial infarction?. American Journal of Epidemiology. Vol. 142, pp. 1538-1539 Manchester City Council. (2009), Joint Stratergic Needs Assessment.[Internet]. Available from http://www.ic.nhs.uk/webfiles/Services/in%20development/jsna/JSNA%20Supplement%202009-10%20v5.pdf [15th May 2012]. Manchester public health annual report. (2009). The importance of the early years. [Internet] Available from http://www.manchester.gov.uk/download/13855/manchester_public_health.[1st May 2012]. Mozaffarian, D., Katan, B.& Ascherio A. (2006). Trans fatty acids and cardiovascular disease. N Engl J Med. Vol. 354, pt.1601-13. Patal, S., Cohn, N. & Willerson, T. (1997). Handbook of Cardiovascular Clinical trials. New York: Churchill Livingstone. Prashar, A. (2005). Tackling coronary heart disease in the North West region. Policy and Practice, Salford: Manchester UK. Institute of Health Research & Policy University of Salford. Rose, G. (1985). Sick Individual and Sick populations. International Journal of Epidemiology, Vol. 14, pp. 32-38 Thomas, S., Fayter, D., Misso, K., Oglivie, D., Petticrew, M., Sowden, A., Whitehead, M. & Worthy, G.(2008). Population tobacco control interventions and their effects on social inequalities in smoking: Systematic review.BMJ. vol. 17, pp. 230-237. Willacy, H. (2010). Epidemiology of Coronary Heart Disease|Doctor|Patient UK. [Internet]. Available at http://www.patient.co.uk/doctor/Epidemiology-of-IHD.htm [1st May 2012]. William, B. & Littman, B. (1996).Psychosocial factors: role in cardiac risk and treatment startergies. Cardiol Clin, Vol. 14, pp.97-104 World Health Organization (2000), Glossary of terms used.[Internet]. Available from http://www.who.int/hia/about/glos/en/index1.html. [1st May 2012]. World Health Organization (2003). Diet, Nutrition and the prevention of chronic diseases: Report of a Joint AHO/FAO Expert Consultation. Read More

Stage 2: Policy Addressing the CHD inequality in the city of Manchester and in England The National health framework has recognized CHD as one of the major Health issues that need to be addressed and given significant priority in policy and Budget making. The National Social Framework for Coronary Heart Disease (NSF, CHD) is a significant policy response to the prevalence of CHD in the city of Manchester and the United Kingdom as a whole (Prashar, 2005). NSF, CHD seeks to create benchmarks for prevention of CHD among people who have an elevated probability of getting CHD diagnosis and management of it in diagnosed cases.

NSF, CHD sets objectives for the immediate establishment of tobacco abuse cessation clinics, rapidly accessible angina clinics and a reduction of the time between making of an emergency call and the injection of the drug that leads to clot dissolution. It also aims at increasing the efficiency of medication after a patient has suffered a heart attack. NSF, CHD also aims at having more revascularization processes and updating the services for CHD through a new systematic perspective of care delivery (Prashar, 2005).

The NSF, CHD is to be delivered to the population by local collaboration units such as the Manchester Joint Health Unit. The city of Manchester has several initiatives that meet the NSF, CHD standards 3-12. The CHD collaborative projects are some of the NSF, CHD initiatives aimed at tackling the problem of CHD through ‘prevention, diagnosis, treatment and care’ (Prashar, 2005). One of the projects in this initiative is the secondary prevention project which aims at making sure the prevention protocols the framework proposes are fully used by all the individuals who have had a first cardiac event (Prashar 2005).

The projects targets an efficient delivery of home based care for CHD patients equal to that provided in hospitals. It particularly focuses on enabling patients manage their own health at home. The Acute Myocardial Infarction (ACI) another project under the initiative that aims at providing rapid care to patients suffering heart attacks. The ACI aims at reducing ‘call to needle time’ to a maximum of 60 minutes and make sure 85% of CHD patients have booked follow-up tests when they leave hospital (Prashar, 2005).

According to Prashar (2005), the collaborative initiative has four other projects: a) the Angina project is meant to provide people suffering with Angina fast treatment, b) the heart failure project that targets better care for patient of heart failure and those at risk of heart failure, c) the Revascularization project that ensures patient’s access to revascularization treatment and also reducing the waiting time for the procedure. d) the Rehabilitation project targeted at delivering better cardiac rehabilitation services that connect with minority groups and the disabled.

Stage 3: Theories of Inequality Individual lifestyle is one of the theories that associate a certain population with the prevalence of certain health condition in the population (Rose, 1985). In Manchester the high incidence of CHD may be credited to the way the residents of this area decide to live their lives. Lifestyle factors closely associated with the prevalence of CHD include the diet of an individual, the alcohol and tobacco usage and the physical activity of an individual (Berenson, Wattigney and Bao, 1995).

Alcoholism at the extreme end of consumption generally tends to put an individual at higher risk of CHD though moderate drinking is thought to reduce the prevalence rate. Alcoholism is an issue of concern in Manchester city due its large population (William and Littman, 1996). Manchester city has a fairly high population of dangerously high alcohol consumers with 30% of men and 17% of women drinking over the recommended weekly limits. Further heart disease accounts for the life expectancy gap between Manchester city and the North West; the local alcohol profile for Manchester city lists that the alcohol specific mortality for males is at 33.

Read More