Profile a community with the intention of identifying the potential impact of resources available and public health needs using the social model for needs assessment.
Introduction
This project aims profile a community with the intention of identifying the potential impact of resources available and public health needs using the social model for needs assessment. The social model of needs assessment perceives need to be holistic in nature appreciating the wider determinants of health (Fatchett 1998). The needs assessment will compare government health priorities targets against local data. Data will be complied from existing sources as Mammo (1999) suggests that adequate analysis of existing data can measure the social well-being, or quality of life of the community. Discussion will involve one identified health need in detail including associated risk factors, strategies implemented locally to ensure health improvement.
Study Area Profile
Manchester has challenging health problems, of which many are amongst the highest rates in the country (MCC 2002). This results in significant inequalities in health both locally and nationally (DoH 2002). Manchester has been chosen as the area of study due to these reasons.
(Sources: 2001 Census, Office of National statistics, North West Public Health Observatory and Manchester City Council)
Geo-environmental
The city of Manchester is situated within the county of Greater Manchester in the North West of England. The counties bordering Greater Manchester are Cheshire, Merseyside, Lancashire and Yorkshire. The climate is described as temperate.
Population
Manchester has a resident population of approximately 400,000. The female and male proportion equates to 51% and 49% respectively. The main ethnic group is white 91.1% (91.3%). Largest ethnic minority groups being Pakistani 3.0% (1.3%) and Indian 1.4% (2.0%). Christianity is the predominant religion accounting for 74.1% (71.7%) of the population.
Economy and Infrastructure
The unemployment as of October 2003 for the Greater Manchester population between the ages 16 - 74 is 7.3% (2.4%) of this the percentage of long term unemployed (over 52 weeks) as of October 2003 is 19.3% (15.6%).
The average household income of Greater Manchester for 2000 was £16,500 (£21,300).
In receipt of income support was 13% of the population compared to 9% in England.
The average house price in Manchester is £73,961 compared to the average of £119,436 for England and Wales.
Manchester was host to the 2002 Commonwealth games. As a result of this 6300 full time jobs were created. Sportcity Stadium was built purposely in East Manchester assist the regeneration of this dilapidated area. This has viewed Manchester as a desirable city for business and leisure. It is estimated that 300,000 more visitors will visit the area each year generating £12 million annually. Business opportunities generated £22 million annually. Piccadilly Rail station was modernised in preparation and along with Victoria Station provide links to local areas and the UK. The Metrolink tram services Manchester. Plans have been made to extend the network to service Manchester Airport and East Manchester. Manchester coach station has recently undergone extensive modernisation. Manchester Airport accommodates 100 airlines serving 175 international destinations Manchester Airport 2003).
Greater Manchester is serviced by an extensive network of motorways connecting Manchester with other major cities.
Health and Welfare
The life expectancy of a Manchester resident as of the period 1999 - 2001 is 69.8 (75.7) years for men and 76.5 (80.4) years for women. The abortion rate is 18.0% (12.7%). The teenage conception (under 19 years old) rate is 69.4 per 1000 conceptions (44.1 per 1000). Out of the population 21.5% (18.2%) describe themselves as suffers of long term illness. The mortality rate from cancer amongst the 0-74 age group per 100,000 is 198.1 (129.5). Mortality rate from heart diseases and stroke amongst the 0-74 age group per 100,000 is 202.8 (116.0). Accidents cause 26.9 (16.3) per 100,000 mortalities from all age groups.
The Manchester, Trafford and Salford Health Action Zone was established in 1998 with intent to identify and aim to resolve problems faced by young people.
The percentage of households without central heating is 9.0% (8.5%). Of the households, access to a bath, shower or toilet is 0.8% (0.5%). Within Greater Manchester 27 of the 33 districts are in the top 10% most deprived in the country. The Healthy Neighbourhoods initiative aims to reduce the deprivation by neighbourhood regeneration projects improve housing and environment; reduce crime rates and improving the access and quality of primary care facilities. The ...
This is a preview of the whole essay
The Manchester, Trafford and Salford Health Action Zone was established in 1998 with intent to identify and aim to resolve problems faced by young people.
The percentage of households without central heating is 9.0% (8.5%). Of the households, access to a bath, shower or toilet is 0.8% (0.5%). Within Greater Manchester 27 of the 33 districts are in the top 10% most deprived in the country. The Healthy Neighbourhoods initiative aims to reduce the deprivation by neighbourhood regeneration projects improve housing and environment; reduce crime rates and improving the access and quality of primary care facilities. The levels of crime in the area are of higher values than other major cities in England and Wales. Violence against the person equates to 25.5 (11.4) per 1000 of the population, the rate of robbery is 11.0 (1.8) per 1000, burglary 20.7 (7.6) per 1000.
Education
Manchester is resident to three universities along with several Further Education institutes estimated that 57,500 students are studying in Manchester at a higher level. The percentage of the population with qualifications at degree level or higher is 21.4% (19.8%), there are 34.0% (29.1%) of the population that do not possess any qualifications.
Political, Governmental and administrative structures
Manchester City Council is one of the ten local authorities in Greater Manchester.
Teenage Pregnancy
Teenage pregnancy has a profound negative effect on the both the mother and the child (Irvine et al 2000). Subsequently it has been chosen to be discussed in-depth. Within Manchester, rates of teenage pregnancy are approximately 20% higher than the national average (MCC 2003).
The term teenage pregnancy is illustrates the number of live births, stillbirths and abortions. It is identified as a problem not only in Greater Manchester; it is also a problem nationally. The UK has the highest rate of teenage pregnancy in Western Europe (Social Exclusion Unit (SEU) 1999). Research has shown that there is a direct correlation between inequalities in health and teenage pregnancy. Teenage parenthood is more prevalent amongst young people from disadvantaged backgrounds, deprived and poverty stricken areas (SEU 1999). Statistics illustrate the increased risk of becoming a teenage mother in social class V is ten times that of their social class I counterparts (Botting et al 1998). Social exclusion is a cause and consequence of teenage pregnancy (SEU 1999).
The UK government recognises the problem of teenage pregnancies. Consequent to the Social Exclusion Unit's report on Teenage Pregnancy a national strategy to was established. The targets set were to:
* Reduce the rate of conceptions in the under-eighteen age group by 50%,
* Establish a definite downward trend in the under sixteen age group.
* Increase the participation of teenage parents in education and employment. With a view to reduce the possibility of inequalities for teenage parents and their children. (SEU 1999)
The Teenage Pregnancy Unit as part of the Department of Health was founded as a result of the action plan addressed in the Social Exclusion Unit's report in order to implement these proposals. The Independent Advisory Group on Teenage Pregnancy was established in 1999 to provide advice to the government and to monitor the achievement and sustainability of the targets in the National Strategy. At a local government level, it was advised to assess the patterns of teenage pregnancies focusing on areas of high risk (SEU 1999, Teenage Pregnancy Unit 2000). Manchester City Council produced, in collaboration with the Manchester Health Authority and Manchester Healthy City initiative, the local interpretation of the National Strategy: Teenage Pregnancy in Manchester - a Ten Year Strategy (2001). The document highlights the need for interventions, as the rates remain on of the highest in the country despite a decrease in recent years (MCC 2001). It endeavours to provide all young people in Manchester with:
* A comprehensive sexual health education,
* Improved access to information services and contraception
* Support for teenage parents and their children ensuring that education, employment and training opportunities are accessible (Manchester HA 1999, MCC 2001, 2003).
Initiatives to Reduce Teenage Pregnancy
Consequent to the Social Exclusion Unit's report (1999) and the Teenage Pregnancy in Manchester (2001) documents, it was evident that the services and resources available to the young population needed to be expanded and promoted in order to achieve targets at both a national and local level (SEU 1999). Strategies were developed in order to achieve targets. A partnership board has been established amongst the councils, health authority and schools in order to monitor the implementation of these strategies (MCC 2003). These can be divided into sub- groups:
National and Local Campaign
The use of the media to improve awareness and communication for not only teenagers but professionals and parents is recognised as a valuable resource. Utilising television, magazines, radio, and the internet to convey positive messages empowers young people to make choices regarding their sexual activity and health (TPU 2000). In Manchester the use of advertising Brook Advisory centre on the Metrolink is an example of how this was adapted locally (MCC 2001). The national helpline and internet site Sexwise provides a confidential service on facilities available locally including confidential advice on sex, relationships, pregnancy and contraception (Sexwise 2000). Manchester City Council has produced a directory containing information for young people and professionals about agencies that are available in the area (MCC 2003).
Prevention: Sex Education
Sex and relationship education (SRE) is taught in all schools with intent to facilitate the physical and emotional development of young individuals (DfEE 2000). New guidelines were produced in 2000 as proposed in the SEU report. Each school must produce a policy of the teaching of SRE that are accessible to inspectors and parents (DfEE 2000). School nurses are ideally positioned to provide sexual education, their expertise they are able to participate in developing SRE teaching policy from a health promotion perspective (DoH 2001; 1999, Sex Education Forum 1996, A PAUSE, developed by the University of Exeter is a sex education programme that is implemented in seven of Greater Manchester High Schools following an initial successful trial in three local high schools. The programme enables young people to make an informed choice about sexual relations and demonstrates the wide range of contraceptive methods available. Education is facilitated by teaching staff, health professionals and older peers (year 12 educating years 9 and 10) to whom training is provided (A PAUSE 2001). The Family Planning Association stress the importance and quality of sex education in schools and the reduction in teenage pregnancy rates (FPA 2001). It is widely accepted that adequate education can reduce the risk (SEU 1999, Fullerton 1997), however, this does not account for truancy rates. In an individual is absent from a session of SRE how can they benefit? Truancy rates in Greater Manchester are immensely high compared to the national average of 1.0% at 10.9% (DfEE 2000). A comparative analysis of the structure of sexual education UK with The Netherlands shows many similarities (Lewis & Knijn 2003). However, this is not reflected in the rates, the UK has six times more teenage pregnancies than the Netherlands (SEU 1999). The difference is accountable to the approach to which sexual education is taught. The Dutch are more accepting of sex whereas the British still perceive sex to be a 'taboo' subject (Lewis & Knijn 2003). Parents need to be involved in the sexual education of their children. Parentline Plus national helpline and website offers support to anyone parents or guardians (Parentline Plus 2000).
Prevention: Contraception, Advice and Information Services
High proportions of sexually active teenagers do not use contraception. The reasons for this are that they are unaware of how to access contraceptives, advice and the legal issue of underage sex (SEU 1999). The Teenage Pregnancy in Manchester - a Ten Year Strategy (2001), aims to empower young people with the knowledge about contraception and where to obtain it. The under sixteen age group are often apprehensive of seeking contraception and advice as they are confused about the law regarding under age sex. It is assumed that their parent will be informed as they are under age (SEU 1999). The law is unambiguous on under age conception: they are entitled to impartial confidential advice; contraceptive treatment can be obtained without parental permission if they conform to conditions of 'Fraser Guidelines' (Brook 2002) .The Fraser Guidelines or Gillick Competence, are a set of criteria that the health practitioner must observe when providing advice to the under sixteen age group. If they are satisfied that the following conditions are met, then sexual advice or treatment can be given. The conditions are: that an under sixteen is capable of understanding advise given, they are likely to have unprotected sexual intercourse, they will health will suffer unless treatment or advise is obtained, and that the young person is unwilling or would be detrimental to seek parental consent (FNF 2000). The SEU report had recognized that young people were intimidated by visiting the places such as family planning clinics to obtain contraceptives. This was primarily due to their ignorance of the services provided having perceived the image that these clinics were for married or engaged couples (SEU 1999). Provisions were outlined for Manchester to achieve target which included the establishment of services and expansion of existing services. Incorporated into this part of the strategy is guidance and training for health professionals to ensure that they are aware of the law regarding contraceptive treatment and advice for under sixteen year olds. A local publicity campaign was initiated to increase awareness amongst young people regarding the law and services specifically for them. Brook Advisory Centres, specifically for the under twenty-five are advertised on the Metrolink as providing free, confidential sexual health advice (MCC 2001). Fresh is sponsored and publicised by local radio station Galaxy 102, provides free contraception and sexual health advice (Fresh 2003). Publicity of new young people services is collaboration between the family planning service and Brook Advisory in an effort to increase the proportion of young people who access contraceptive services (MCC 2001). Condom vending machines have been installed in various establishments in Manchester. Sponsored by galaxy 102 in partnership with Mates is non-profit programme aiming to provide increased access to contraception so young people can make informed choices (Fresh 2003, DoH 2001). Manchester, Trafford and Salford Health Action Zone was one of the first areas in the country to pilot the over the counter access to the emergency contraception pill (DoH 2001). Access has been improved in the area by increasing the number of pharmacies partaking in the scheme, including major chains such as Boots (MCC 2001). However, over the counter emergency contraception is currently only available to the over sixteen. The under sixteen have access through family planning clinics, GUM clinics, GP's, young persons clinic such as Brook and from hospital A & E departments (FPA 2002). It must be emphasised that emergency contraception is not a substitute for conventional methods or effective protection against sexually transmitted infections. Staff providing it in all settings should ensure that the young person is aware of this and take the opportunity to give advice on contraception if adequately trained (DoH 2001). Services for young boys and men have been highlighted as a significant problem. Young men perceive contraception providing organisations and services for women and staffed by women (SEU 1999). Initiatives in Greater Manchester include Wyse Guys, affiliated to Signpost which is aimed at empowering the young male population about their sexual health. More male workers are to be trained to ensure that young men are confident to access services (MCC 2001).
Support for Teenage Parents
Sure Start Plus initiative has been implemented in Greater Manchester since 2002. It provides support for pregnant teenagers and parents. It aims to reduce the potential for long term social exclusion as a result of teenage pregnancy. The scheme endeavours to provide each pregnant teenager with a personal advisor to offer impartial advice about the options available to them empowering them with the information to make a positive choice about the pregnancy (TPU 2003, MCC 2001; 2003). The Connections service provides information from a holistic perspective. In association with Sure Start Plus, and local schools it aims to provide teenagers with sufficient guidance on issues such as education, employment, housing and health so they can raise ambitions and fulfil potential, reducing social exclusion (Connections 2001, DoH 2001).
Conclusion
The interim report on the success of Teenage Pregnancy in Manchester - a Ten Year Strategy (2001) is not due until autumn 2004. The strategy seeks to actively reduce rates of teenage pregnancy and long term social exclusion as a result. The 2002/03 annual report from the Independent Advisory Group said that the strategy on teenage pregnancy proves to be effective as more young people are confident about accessing sexual health services. Despite these efforts the UK still has the highest rates in Western Europe (DoH 2002). It emphasises that if targets are to be reached by 2010 it is imperative to sustain current efforts to achieve long term results (IAGTP 2003). It would be virtually impossible to stop underage sexual intercourse. Principle to the local and national government agenda is to empower young people to make informed decisions about sexual intercourse without promoting promiscuity (SEU 1999).
( ) = Indicates National average (England & Wales only)
All figures to one decimal place
