Improving Uk Public Health Health And Social Care Essay
Improving health of the population is high on the government’s agenda to tackle health inequalities (‘HI’) in the United Kingdom (‘UK’). Public health nutrition (‘PHN’), concerned with promoting good health and preventing nutrition related diseases, is the focus of many policies +Book ref.
The geographical region assigned to the group was Luton. A key priority and on-going objective for Luton’s National Health Service (‘NHS’) and the Luton Borough Council (‘LBC’) has been to reduce HI in Luton .
The purpose of this project was to identify a health issue and target population and develop a PHN intervention to improve health outcomes, following a comprehensive needs assessment and review of UK policies.
Research for the needs assessment was conducted by defining Luton’s population. Information from the Office for National Statistics and Association of Public Health Observatories identified Luton as an ethnically diverse town with a population estimate of 194300. 35% of the population is of Black and Ethnic Minorities (‘BME’), mainly Pakistani, Bangladeshi and Afro-Caribbean communities and ONS. 28% of the population consists of children and young people under 19, which is above the national average .
The 2007 Index of Multiple Deprivation (‘IMD’) highlighted the level of deprivation in Luton. Luton is ranked the third highest deprived area in the East of England and 87th out of 354 local authorities nationally. Three of its super output areas, Dallow, Biscot and Northwell wards, are in the top 10% of the most deprived for the country 2007 Indices of Multiple Deprivation.
The annual public health report revealed Luton to have a worse health status and shorter life expectancy than the England average (2009 annual public health report) . HI include childhood obesity, cardiovascular disease (‘CVD’), diabetes, tooth decay and breastfeeding (‘BF’). Infant mortality and low birth weight are higher compared to the England average . 2009 annual public health report) . Inequalities in child health are a serious concern, particularly childhood obesity, which is also high, at 12.7% compared to national average of 9.6% (2009) .
Giving children the best start in life, is one of the public service agreement (‘PSA’) targets. The department of health (‘DOH’), also set this out in ‘A programme for Action’, where supporting families, mothers and children is identified to help break the "inter-generational cycle of HI" .
Based on Luton’s needs assessment, the chosen intervention was to improve BF rates. BF is a recognised proxy indicator in infant mortality . The absence of a clear strategy may be responsible for the low BF initiation rates (‘IR’), despite significant investment to improve BF . There is also lack of targeted antenatal and postnatal education, and support in Luton, which is a recommendation of the UNICEF UK Baby Friendly initiative and NICE guidelines .
The priority wards initially targeted for the intervention were Dallow and Biscot, as their BF rates were the lowest in Luton due to the level of deprivation . Luton’s BF IR currently stands at 63.2% compared to the England average of 72.5%. However, prevalence at 6-8 weeks is 58.2%, which is above the national average of 48.2% .
The ‘Fair society, healthy lives - The Marmot review’, states that disadvantage starts before birth, leading to a cycle of deprivation. This is proven by the highest rates of poor health and hospital admission for the under 19 population in the highly deprived areas of Luton .
Efforts to reduce HI should commence early to help break links between early disadvantage and poor outcomes throughout childhood. Other benefits include improved long term health and reduced costs to the NHS .
Populations in these wards are predominantly Pakistani and Bangladeshi communities and nearly 40% are under 19 . BF is the cultural norm in BME groups, although initiation is delayed due to cultural beliefs about colostrum being dirty or harmful to the infant .
In addition, White British women in deprived areas are least likely to initiate and sustain BF, particularly young mothers and teenagers with low income and lower educational attainment . However, peer influence from ethnic communities is shown to have positive effects on BF.
Although antenatal care guidelines by the National Institute for Health and Clinical Excellence (‘NICE’) suggest a universal approach, they also recommend targeted action towards those less likely to BF .
Exclusive BF until six months is the national recommendation. It is supported by WHO, UNICEF UK and NICE and is included in DOH policies such as the ‘Infant feeding recommendations’ . This is based on the acquired health benefits to mother and child . BF also contributes to targets of the PSA, such as reducing infant mortality rates and preventable infections and improving childhood obesity rates .
The benefits of breast milk (‘BM’) have positive short term effects in reducing occurrence of gastroenteritis and respiratory infection . BF is also associated with improved long term risk of CVD, diabetes and childhood obesity (WHO, 2003; UK Department of Health, 2008). An improved BF intervention is therefore warranted to achieve the PSA target of improved initiation and sustained BF at six to eight weeks, with a 2% year on year increase . .
Advocating BF encounters many challenges in the implementation stage. Common problems stem from political, cultural and individual issues .
Inappropriate promotion of infant formula despite the ‘international code of marketing for BM substitutes’ can have detrimental effects on BF promotion, causing confusion to the women .
Returning to work strongly influences the decision to BF as these variables may appear mutually exclusive and lack of support from employers may deter mothers from breastfeeding despite the BF intervention .
Poor BF initiation may occur following problematic labour, which may impact on ability to BF and discouraged mothers may decide to formula-feed. Staff support will be vital at this crucial stage .
In BME groups, family members and elders have strong influence over decisions to feed infants. Where BME women have chosen to formula feed, the decision has often resulted from conflict between family members. The risk of conflict will be addressed prior to piloting the programme .
Males in many cultures find exposing the breast to be socially and/or culturally unacceptable. Gender ideologies constrain the male ability to embrace BF positively. This is a major challenge for young mothers and those from Pakistani and Bangladeshi backgrounds where how they are viewed by their peers has more impact than education and support .
Another issue is staff resistance to change e.g. mothers suffering with low levels of BM or mastitis are often advised to use formula milk, which is the easiest option for mother and health professionals . A supportive attitude towards BF and recognising its contribution to reduce HI is essential for a successful intervention. .
There is also the risk that formula-fed babies may be overlooked. Healthcare providers are still responsible for the health of formula-fed babies and parents must not be made to feel guilty about their decision .
The policies reviewed throughout this project were useful and clear in their aims although many documents were repetitive and failed to provide practical suggestions. NICE guidance was most useful as there were actions provided to develop BF programmes. However, the complexity of PHN cannot be ignored. It is not sufficient to provide advice or education, all populations have varied requirements, hence the need to target interventions accordingly, without being discriminatory . Regular evaluation of the programme is required to determine success rates and justify cost implications .
Department of Health (2003) Infant Feeding recommendation. London: The Stationary Office www.breastfeeding.nhs.uk/pdfs/FINAL_QA.pdf
UNICEF UK Baby Friendly Initiative (2005) Coordinated introduction of best practice for breastfeeding across a local authority area www.babyfriendly.org.uk
NHS National Institute for Clinical Excellence (July 2006). Promotion of breastfeeding initiation and duration. Evidence into practice.www.nice.org.uk/download.aspx?o=346169
Department of Health (2005) Choosing a better diet: a food and health action plan.
Department of Health, London www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4105356&chk=Dm0eqU
Department of Health (2004). Choosing Health: making healthier choices easier. London:
The Stationary Office.
Department for Education and Skills (2004). Every child matters: change for children
(outcomes framework). London: The Stationary Office.
Department of Health (2004) National Service Framework for Young People and Maternity
Services. London: The Stationary Office
Department of Health (2003) Priorities and planning framework 2003-2006. London: The Stationary Office. www.dh.gov.uk/assetRoot/04/07/02/02/04070202.pdf
Luton Borough Council. (2008). 2007 Indices of Multiple Deprivation. Luton: LBC.
NHS Luton and Luton Borough Council. (2009). Annual Public Health Report 2008/2009. Luton: NHS Luton.