Smoking, a diet high in fat and salt, insufficient physical activity, high blood pressure and high cholesterol, type 2 diabetes are amongst the many factors which put a person at increased risk of coronary heart disease.
Under the National Institute of Clinical Excellence (NICE) (2007) guidelines recommendations have been put into place to help, support, recognise and prevent individuals whom are at risk of CHD and enable them to make changes to their lifestyle before it is too late.
Chemicals in cigarettes are extremely damaging to the cardiovascular system and nicotine can also act as hypertensive which may cause heart failure and stroke (Hart, Smith, Hole, 2006). According to British Heart Foundation (2011) the carbon monoxide in the cigarette also means that less oxygen is in the blood when circulating the heart. The township of the selected area has a high rate of adult smokers with a total of 26.2% of the overall population which is above average for England which is 21.2% (DH, 2011c).
The selected township in which the author is discussing has had a great success in the stop smoking campaign, figures from the NHS Information Centre (2011) show that 3541 (40%) people gave up smoking between 2010 and March 2011, the third highest in the North West of England.
The DH guidelines suggest that a balanced diet should include 5 portions of fruit and vegetables a day, with at least 2 portions of fish, whole grains, lean meat and a reduction of red meat to maximise protection from Coronary Heart Disease (DH, 2000).
Levels of obesity in the township are known to be very high. 25.8% of the townships population are obese, compared to 24.2% of the national average this is also reflected in healthy eating adults locally being 23.3% and nationally 28.7% as stated by (DH, 2011d).
Alongside smoking and obesity the selected township also has a low number of physically active adults at 10.7% compared to an average across England at 11.5% as recognised in DH (2011d); which once again is a major risk factor for individuals to become obese and therefore be more susceptible to contracting coronary heart disease. Research has shown that High levels of saturated fat contribute to high cholesterol levels in the blood, overall contributing to heart disease (*****, ***** & **** NHS Foundation Trust, 2009).
It is recognised that bad diet and lack of exercise were major contributing factors to heart disease. Information recently released by *****, ***** and ***** Primary Care Trust (ALWPCT) (2009) stated that they felt the lack of affordable nutritious food and subsidised facilities to exercise would prevent people especially the more impoverished residents from changing their behaviour. The research also highlighted that the residents who took part in the research has a definite absence of knowledge in relation to health condition and the cause of them.
Coronary heart disease is responsible for more than 70,000 deaths a year in England every
Year reported Department of Health (2010). Statistics and figures show a clear indication that individual lifestyle choices in the area are a concern and has a clear impact on their lives and health.
The National Service Framework (NSF) for CHD was launched in 2000 aimed to reduce coronary heart disease deaths by 40% this was achieved in 2005 (DH, 2000).
The NSF was set out to provide high quality treatment and care to those people who should become ill. This involves early diagnosis, prompt and effective ambulance and emergency services, high quality medical, surgical and nursing care. Specialist services including heart surgery and rehabilitation to help those who have has a heart attack or heart operation to recover more quickly and to stay well. On release of the NSF for CHD, the secretary of state for health quoted that ‘this framework will transform the prevention, diagnosis and treatment of coronary heart disease, It will help professionals to give a better, fairer and faster care everywhere, to everyone who needs it’ (DH, 2000).
The NSF for CHD has helped raise standards for the detection, treatment and management of all heart disease. The NSF's clear focus in the treatment of heart disease has delivered improvements in most areas of cardiac services.
Because of the NSF set out nationally, the particular area that is being looked at had to implement many strategies that would reduce the number coronary heart disease cases.
The author will now discuss and analyse some of the health promotion strategies in place that are in place in current practice throughout the township to aim to individuals live a healthy lifestyle and therefore dramatically cut the number of cases of coronary heart disease.
One service that launched in the area in 2007 was the Health Trainer’s Service; this was launched in the area in March 2007. They work with the clients for up to 6 months and appointments are available within a wide variety of accessible venues. Their aim is to work on a one-to-one basis with individuals wanting to make a lifestyle behaviour change, such as stopping smoking, changing diet or taking more exercise. They key aims of the health trainers are to tackle local health inequalities by offering personalised support to people at risk of developing poor health. They also provide additional support to those who need it to enable people to make healthier choices, access the services they need and take greater control over their health and well being. Another one of their aims is to increase skills, knowledge and capacity for the promotion of health and well being within local communities, they want to develop their knowledge on what causes certain illness and diseases (*****, ***** and ***** Community Healthcare Trust, 2011a).
Also on the agenda for the local township is to get individuals active, **** Leisure and Culture Trust (WLCT) (2011a) was set up in 2004 and is a charitable trust working on behalf of the local council to manage and support leisure and cultural facilities, initiatives and events for residents across the borough. The trust is responsible for many events and activities, however, for the purpose of this study the author will just comment on two services they offer.
The Community Weight Management service, Lose Weight Feel Great (2011), an NHS service which aims to help people who are heavier than they should be to lose weight. The Community Weight Management service provides healthy eating, physical activity and behaviour change advice and support through group sessions, and is provided by WCLT working in conjunction with Slimming World. Individuals whom have a Body Mass Index of 25 or over are eligible for a free 12 week programme.
On 1st April 2006, WLCT (2011b) introduced Lifestyle, a new membership scheme. The membership is £1.60 per year and with the card members will get free swimming and discounts on gym memberships this is to encourage individuals to get active and take up regular exercise.
As the author recognised earlier smoking is also a huge issue that needs to be tackled in this township, so to help reduce this, the government proposed a strategy to reduce the number smokers in disadvantaged groups. The PCT in the selected township was aware that heart disease was particularly poor in some parts of the selected borough. As smoking is a major contributing factor in developing coronary heart disease and is linked to deprivation, the PCT thought it was a very good idea to target disadvantaged groups as one way of tackling health inequalities.
A strategy to help reduce the prevalence of smoking in the area was The Stop Smoking Service which is a key part of tobacco control and health inequalities policies both at local and national levels (DH 2008a).
Evidence has shown that a combination of behavioural support from a stop smoking adviser plus pharmacotherapy can increase a smoker’s chances of stopping by up to four times (West, McNeill & Raw, 2000).
The NHS Stop Smoking Service was set up using an evidence based approach to the most successful treatments, targeting of particular geographical areas and client groups and also engaging local partners to help address some of the previous access barriers. To overcome the access barrier they decided to use accessible venues, such as pharmacies, health and community centres which could also be accessible at varied times including weekday afternoons, evenings and Saturday mornings.
The team in the borough consists of 17 team members who provide advice and support who want to stop smoking, ******, ***** and ***** Community Healthcare Trust (2011b); it is a step by step tailored approach to meet the client’s needs, provides individual support with a stop smoking advisor and enables access to nicotine replacement therapy at prescription prices. Stopping smoking can be one of the most worthwhile things an individual can do but it is also one of the most difficult. This is what the stop smoking service aims to help with. They want to provide a service that incorporates specialist support from trained professionals, and provides people with the correct information and support to make stopping smoking easier. The service in the borough is available to all individuals not just the deprived.
As well as helping and supporting the community with lifestyle choices *****, ***** and ****** Community Healthcare Trust (2011c) implemented ‘NHS Health Check Programme’ in April 2009, the programme is aimed for people in the township aged between 40 to 74 who are not already known to have CHD and is used as a preventative measure to reduce morbidity rates of CHD. The system uses data held by their General Practitioner (GP) such as smoking status, weight, last blood pressure recording and calculates their risk score - which is the probability of them having a stroke or heart attack in the next ten years. If individuals are found to have a high risk score of 20% or above they are then invited for a health check with their GP or nurse for a full medical and will receive advice or be referred to the appropriate services.
Throughout the assignment a community has been described; the selected township has also been looked at in detail to see what factors influence people’s health. Research was undertaken to see the main cause of health inequalities in the selected area. This was found to be coronary heart disease. The main causes of coronary heart disease were stated and the statistics of these were researched, including the percentage of smokers in the area and the percentage of people who are obese in the township.
Overall, in the authors’ opinion the health authority and council in the community are making radical changes and using the powers of health promotion and health education to help reduce the numbers of smokers and obese adults therefore reducing prevalence of CHD in the area. This is due to the Government having plenty of strategies and campaigns in place (DH, 2011e). Throughout the township individuals are becoming a lot more self aware. There are posters on billboards advertising Lose Weight Feel Great campaign; there are posters and leaflets in doctors’ surgeries and hospital settings.
There are also importance health professionals to get involved with health promotion and education. The role of a nurse is not just to treat ill patients it is also working towards the prevention of them becoming ill with conditions such as coronary heart disease. The nurse’s duty of care is to ensure patients are educated into the causes of certain disease and most importantly educate the patient on how they can improve their lifestyle to help reduce the number of cases disease such as CHD.
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