CASPHER is an East Riding Chlamydia Screening Programme whose aim is to raise awareness of Chlamydia throughout Hull and East Riding. They offer a free programme to all individuals between the ages of 13-25 year olds. ‘The test is free and very simple, and we would encourage as many people as possible to get themselves screened as soon as possible in order to protect their sexual health.’ Individuals are required to carry out a urine sample which is then sent of for examination by health professionals. This is an example of a developed programme in Hull which is aimed at reducing the risk of Chlamydia and also screening for earlier diagnosis. CASPHER have put the testing kits in youth clubs, drop-in centres, pharmacies, schools, colleges, universities and GP practices.
The CASPHER team situated in Hull was recently placed 7th out of 152 Chlamydia screening sites in the country for the number of people screened. 4,900 15-24 year olds were screened in Hull in a period of nine months, representing 12.6% of the population overall and 15.7% of Hull’s sexually active population. http://www.hullpct.nhs.uk/templates/page.aspx?id=4703
‘Screening is the generic term used to test, examine and identify potential health problems.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 6 Disease and illness can be detected through various screening programmes. Once screening has been carried out and a diagnosis has been made, prevention and treatment can then be given in order to reduce the spread of infection or reduce the potential health risks. A range of screening programmes can be carried out across the whole population. Screening usually starts throughout pregnancy, birth, childhood and adulthood also. Physical, emotional and mental health is screened through examination by relevant health care practitioners. Various methods of screening may include;
- Blood screening/tests – to detect any abnormalities within the blood
- X-rays – to detect skeletal problems, normal/abnormal growth development and also internal body functions e.g. heart, lungs, liver, kidneys etc.
- Blood Pressure tests – to detect any normal, abnormal functioning of heart and blood supply.
The above screening methods can be used to treat and detect illness/disease.
- Control communicable disease
Controlling communicable diseases is an important aspect in public health strategies within the UK. ‘Key aspects of this involve planning to include screening and early detection, isolation and treatment, containment, prevention and cure eradication where possible.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 7 Early detection of a disease is also beneficial as it provides details of the cause and also spread as well as highlighting the potential risks the illness may cause to individuals or groups of people; in particular vulnerable individuals such as; young children, babies and elderly. Individuals who I have mentioned above are much more susceptible to disease due to their immune systems been much weaker and it is therefore very important for early detection of an infection.
Isolation of individuals that have communicable diseases will also enable it to remain controlled as it has been known to reduce the spread of the disease. For example, in a residential care home if a patient was diagnosed with tuberculosis for instance, they would be moved to a room on their own and be cared for individually. This would be essential in ensuring the disease was not passed on to any other service user within the nursing home. Health care workers will be required to wear relevant Personal Protective Equipment depending on the type of care they were carrying out.
The Containment of disease can happen at national and local levels and occurs once the source of the infection has been identified and plans have been developed and put in place to reduce and prevent further occurrences of the disease. The measures which are taken in relation to the containment of the disease can range from short, medium, and long term measures. ‘Short term measures might be to reduce the amount of spread by limiting visiting, unnecessary travel, treatment and isolation.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 7
Medium and long term measures may include an immunisation programme, for example the cervical cancer vaccination. Medium and long term measures may also include medical treatment as appropriate, educating people about risks and eradicating incidence of disease where possible.
Using the example of increasing rates of sexually transmitted infections in the Hull and East Riding area; Chlamydia in particular certain measures have been considered and put into place as a result of these increasing rates. Unprotected sex is primarily the cause of Sexually Transmitted Infections. The medium and long term measures developed in Hull include; education around sex and different methods of contraception. CASPHER which I have previously discussed within this assignment educates all individuals between the ages of 13 – 25 years of age about all they are required to know about Chlamydia including the causes, the treatment and most importantly the prevention of the disease. The short-term treatment and containment problem of STI’s is that in certain circumstances where various contraceptive methods cannot be used exceptions need to be considered to ensure the diseases are prevented and controlled appropriately.
Eradication of disease is becoming more possible as scientific research and technology advances. Due to the advances in technology more is known about the causes of illness and disease and also about how disease organisms are developed and spread. Evidence to prove this statement is that today’s generation now live longer than the ones in the past. ‘The key aspects of public health that have made this possible are;
- Early detection and surveillance
- Monitoring and screening
- Treatment and immunisation programmes
- Health education and promotion
- Improved social reforms to ensure health is available for all.’
Baker L, 2008, BTEC National Health and Social Care Book 2, page 8
- Promote the health of the population
It is the responsibility of health promoters throughout the UK to promote the health of the population on both local and national levels. Health promoters are based in a wide range of settings, for instance; GP surgeries, drop-in-centres, schools and via media sources like TV, radio and also magazines. Priorities are based on local need and availability of funding and resources. Priorities can be identified from the number of reported diseases and illnesses from local statistics. If any of these illnesses or diseases are life threatening or cause the individual to spend a considerable amount of time in hospital then these will become main focuses of health promotion. An example of this is the effects of being overweight could potentially lead to coronary heart disease in later life. The role of the health promoter would be to ensure that healthier diets and exercise regimes were promoted locally and nationally. ‘The health of the population is said to be healthy when there are fewer deaths and life threatening illnesses per population size and area.
Hull promote their awareness of the increasing rates of STI’s by going to GP surgeries, schools and drop in centres for instance and they also promote their screening campaign for Chlamydia (CASPHER) in GP surgeries within the city. Also, it is also promoted through the use of the radio, internet, TV and also on public transport where posters are displayed in aid of promotion.
- Plan and evaluate the national provision of health and social care
The National provision of Health and Social care in the UK is planned and evaluated by the National Health Service and Social Services. It is based on information which is provided by health and social care professionals at local, regional and national levels throughout the UK. ‘The government have produced guidelines and information to state how they will tackle the problems controlling and preventing infectious disease spread.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 8 The strategies outlined in the guidelines produced by the government sets out a series of proposed actions to create a system to prevent, investigate and control the infectious diseases threat and address health protection on a larger scale.
P2
Within this assignment I will look closely at the historical perspectives of the public health system in the UK. Public health has developed considerably over many years and the changes occurred over time reflect the health concerns of the nation during each time period. It is these changes which have produced the Public Health System which we have in place to this present day. ‘Early reformers of social and economic conditions played a huge part in balancing the health status of the nation so that everyone had a chance to benefit.’ Baker, L. (2008). BTEC National Health and social care book 2 page 13 Throughout the year’s medical knowledge amongst health professionals increased greatly in relation to how diseases were spread and also many advances were made in helping to reduce the incidence of infectious diseases which killed many people.
Lisa Swenarski, a spokes woman for the national Centres for Disease Control and Prevention (CDC) states that; ‘Since 1900, average life expectancy in the United States has increased from 40 to 76.7.’ She also explains that the public health efforts over the years has lengthened the lifespan by 25 to 30 years, and medical advances like improvements in surgery account for the other added years.
As part of my previous assignment I discussed the key aspects of the public health strategies in the UK. The key aspects included; monitoring the health status of the community, identifying the health needs of the population, developing programmes to reduce risk and screening for early disease, controlling communicable diseases, promoting the health of the population and planning and evaluating national provision of health and social care. Many of the changes which have taken place within the Public Health System are a result of awareness campaigns and awareness which is raised in general by individuals and groups across the nation. The government take into account the health needs of the population and acts on the findings illustrated through national statistics. The government act on these findings by passing laws that are designed to influence the overall health and well-being of the nation. ‘In the 19th century, scientists discovered that micro organisms were to blame for killer diseases like cholera and tuberculosis, and officials launched public health efforts to provide clean water supplies and waste-disposal systems.’ http://www.nurseweek.com/features/99-12/public.html
The Poor Law System in the UK can be traced back to 1349 when the black plague killed approximately 30 – 40 % of the population. ‘The Poor Laws passed during the reign of Elizabeth I played a critical role in the country's welfare.’ Due to the increasing amount of individuals living in poverty a series of laws were introduced by the English Parliament in 1563, 1572, 1576 and 1597 culminating in the 1601 Poor Law. It was administered at Parish level from local rates (money, food, clothes etc.) Workhouses were introduced in 1631 where people who were unable to support themselves could go to live and work. The conditions in the workhouses were dreadful in order to prevent the poor from relying on them. ‘Men and women were segregated and children were separated from their parents. In many ways the treatment in a workhouse was little different from that in a prison, leaving many inmates feeling that they were being punished for the crime of poverty.’ Workhouse conditions began to improve throughout the nineteenth century. Many people living and working in the workhouses died as a result of the harsh conditions and poor health. Below are two diagrams illustrating the horrendous conditions of the workhouses in 1631;
Photographs taken from; & http://images.google.co.uk/imgres?imgurl=http://www.epsomandewellhistoryexplorer.org.uk/OliverTwist.jpg&imgrefurl=http://www.epsomandewellhistoryexplorer.org.uk/WorkhouseChristmas.html
The Poor Law Act (1834) was established in 1834. It was an act of parliament made under Lord Earl Grey who reformed the country’s poverty relief system. ‘The new Poor Law was meant to reduce the cost of looking after the poor, prevent scroungers and impose a system which would be the same all over the country.’ The industrial revolution led to the development of towns and cities within the UK. The nation’s population increased rapidly once the Poor Law Act was implemented. The country’s poverty relief system had not been amended since 1601 and came into place as a result of the findings of social reformers; Edwin Chadwick, John Snow and John Simon who I will look at in more detail within this assignment.
The Public Health Act was implemented in 1848 to ensure that adequate sanitary conditions were provided in populated areas throughout the United Kingdom. The background to this act was research carried out across the nation relating to the rates of mortality and morbidity which I have discussed previously. In response to the Public Health Act 1848, ‘The General Board of Health’ was developed which ensured that public health policies were administered and carried out effectively across the country. ‘Edwin Chadwick was the first commissioner of this board and the Public Health Act is strongly associated with him and his proposed reforms.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 14 The implementation of this act enables single authorities working with civil engineers and medics to improve sanitation.
Edwin Chadwick (1800 – 1890) was an English social reformer who was accredited by his work on reforming The Poor Laws. In 1837 and 1838 they were influenza and typhoid epidemics; Edwin Chadwick was appointed by the government to carry out new investigations and research into sanitation. Chadwick developed a report outlining his findings; ‘His report, The Sanitary Conditions of the Labouring Population was published in 1842. In the report Chadwick argued that disease was directly related to living conditions and that there was a desperate need for public health reform.’ Shortly after this report was produced new measures were taken in promoting the safe disposal of human waste and rubbish. Edwin Chadwick strongly believed that poor sanitary conditions lead to disease.
John Snow (1813 – 1858) was a British physician who is considered one of the founders of epidemiology for his work relating to the cholera outbreak in 1854. Snow was a valued anaesthetist and epidemiologist who was very interested in cleanliness and hygiene practices put in place to prevent disease. As I have mentioned previously, Snow worked closely with the cholera outbreak in London and linked it to contaminated water. In 1854, Snow identified a water pump in Broad Street located near one of the cess pits where the disposal of waste took place. The pump however, was discovered to have leaking faeces waste draining onto it and therefore contaminating the water. Snow linked the Broad Street pump with the outbreak of disease. Snow investigated further after his findings at deaths in areas where water from water pumps upstream of sewage and also those from downstream and found a correlation. Higher mortality rates where linked to the pump on Broad Street. ‘He had the handle of the pump removed, and cases of cholera immediately began to diminish.’ http://www.bbc.co.uk/history/historic_figures/snow_john.shtml
Joseph Lister (1827 – 1912) discovered antiseptics and it was not until he did this that the link between hygiene and cross infection became widely known. Lister based his work and discoveries on the work of Louis Pasteur. ‘Pasteur founded the science of microbiology and proved that most infectious diseases are caused by micro-organisms.’ http://www.zephyrus.co.uk/louispasteur.html This became known as the "germ theory" of disease. He was the inventor of the process of pasteurisation and also developed vaccines for several diseases including rabies. Lister was the founder of aseptic techniques. He believed regular hand washing, cleaning surgical instruments and wards with carbolic acid and also the use gloves would reduce the spread of infection. He believed a sterile environment would not allow bacteria to live therefore preventing cross contamination.
Florence Nightingale (1820 – 1910) was known for her contribution to health care in the 19th century, she was famous for linking poor hygiene and sanitation to ill health. It was during the Crimean War where she trained nursing staff to care for wounded soldiers, she noticed these patients were dying as oppose to recovering. Nightingale collated statistics on incidence of death and discovered that in addition to poor sanitary conditions, diet and nutrition contributed to poor recovery. She made changes improving the conditions around the patients she was treating through safe disposal of waste, better hygiene practices and she paid particular attention the diet of the patients. The chances of survival increased dramatically once the changes took place. ‘Nightingale's theories, published in 'Notes on Nursing' (1860), were hugely influential and her concerns for sanitation, military health and hospital planning established practices which are still in existence today.’
Throughout the 20th Century there were yet more Acts and Reforms implemented in order to reduce the risk of spreading infection causing illness and disease amongst the UK population. For instance; Beveridge Report (1942), NHS (1946), Black Report (1980), Acheson Report (1998), Our Health Nation (1997), Saving Lives: Our Healthier Nation (1999). I will look at each of these acts in more detail.
Lord William Henry Beveridge (1879 – 1963) was a social reformer and economist in the 20th century. He produced ‘The Beveridge Report’ in 1942 which became the basis of a series of reforms after the Second World War, looking to reduce inequalities in health care provision. The development of this report has been used as a basis for most social legislation. The Beveridge Report was also influential in the introduction of The Welfare State and also the appearance of The National Health Service which started in 1949. The report proposed all working people gave a share of their wages to in aid of those who do not work.
The government asked Beveridge took charge in developing a report based on the ways that Britain should be rebuilt after the Second World War. ‘He published his report in 1942 and recommended that the government should find ways of fighting the five 'Giant Evils' of 'Want, Disease, Ignorance, Squalor and Idleness'.’ http://www.bbc.co.uk/history/historic_figures/beveridge_william.shtml
In 1948 the National Health Service began as a result of the white paper which was produced in 1943. ‘It appeared at a time when Britain saw health care as crucial to one of the "five giants" (want, disease, squalor, ignorance, idleness) that Beveridge declared should be slain during post-war reconstruction.’ It was funded by general taxation not national insurance as it is today. As of the 5th July 1948 every UK citizen became eligible for free health care without been means tested which was the case in recent years. ‘The National Health Service has provided health care and has helped many people over the years.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 17 The NHS is a fundamental part of society as people in recent years were not able to afford assessments and treatments, it has therefore had a big impact on the lives of individuals.
The Black Report was developed in 1980 after been commissioned in 1977 by a labour government. The report showed that there had continued to be an improvement in health across all the classes (during the first 35 years of the National Health Service) but there was still a link between social class and infant mortality rates, life expectancy and inequalities in the use of medical services. The Black Report was not issued until 1980 by the .
The Acheson Report was developed in 1998 by Sir Donald Acheson and he identified there were still many inequalities in health. Acheson’s report identified that he was able to link increased mortality rates with lower social classes and deprivation. The Graph below shows these differences between class and mortality rates;
http://news.bbc.co.uk/1/hi/health/222649.stm
‘Statistics revealed that people in Social Class V (partly skilled workers and unskilled workers) were more likely to die from coronary and lung related illnesses due to lifestyle choices such as smoking, drinking and inadequate or poorly nutritious diets than people in Social Class 1.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 17
The Acheson’s report was the most influential social policy paper since the Black Report was produced in 1980 which I am going to discuss within this assignment. The report made 75 recommendations in 39 categories to the government; the report requests for an increase in benefit levels for women of childbearing age, expectant mothers, young children and older people.
In 1997 a Green Paper known as ‘Our Healthy Nation’ was developed based on The Acheson’s report produced by Sir Donald Acheson in 1998. The aim of this green paper was to address social inequalities that led to ill health in order to improve the health of the nation.
The government then introduced the White paper ‘Saving Lives: Our Healthier Nation 1999’ which was aimed at addressing the major causes of ill health and death in the UK by the year 2010. This white paper was produced based on the Acheson Report which I have discussed previously within this assignment. Following on from the Green Paper which I have mentioned previously; ‘Our Healthy Nation 1997’, targets were made specific in relation to the major killer diseases in the UK and related factors. These are;
- ‘Cancer: to reduce the death rate in people under 75 by at least a fifth
- Coronary Heart Disease and Stroke: to reduce the death rate in people under 75 by at least two fifths
- Accidents: to reduce death rate by at least a fifth and serious injury by at least a tenth
- Mental Illness: to reduce the death rate from suicide and undetermined injury by at least a fifth.
Baker L, 2008, BTEC National Health and Social Care Book 2, page 18
From this white paper the government is addressing inequality in health with different initiatives on education, housing, neighbourhoods, transport and the environment which will help improve health. The initiatives which are produced in this country in promoting better health are co-ordinated by Health Development Agency.
During the 21st Century the Government set out a ten-year programme of reforms in a white paper called ‘The New NHS’. ‘This is a Plan for reform with far reaching changes across the NHS. The purpose and vision of this NHS Plan is to give the people of Britain a health service fit for the 21st century: a health service designed around the patient.’ http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4055863.pdf
In 2003; Tackling Health Inequalities: a programme for action (2003) was produced focusing primarily on smoking and teenage pregnancies. The programme was aimed at equalising mortality rates between social classes.
‘It establishes the foundations required to achieve the challenging national target for 2010 to reduce the gap in infant mortality across social groups, and raise life expectancy in the most disadvantaged areas faster than elsewhere.’ http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019362.pdf
The white paper ‘Choosing Health: Making Healthy Choices Easier’ was developed in 2004 its main aim being to enable and empower people to make healthier lifestyle choices. The white paper states that health is determined by lifestyle choices, education and the environment. ‘The Government will provide information and practical support to get people motivated and improve emotional wellbeing and access to services so that healthy choices are easier to make.’ As a result of this white paper the health of individuals throughout the United Kingdom has improved dramatically over the last century.
There are three principles;
- Informed choice – including protecting children and preventing the action of one person affecting another, for instance; passive smoking.
- Personalised support
- Working in partnerships.
By the year 2010 certain aims which were proposed in 2004 hope to be met. These include;
- All schools throughout England have active travel plans
- 7000 miles of new cycle lanes
- NHS health trainers (accessible at local gyms, GP surgeries etc)
- Trained NHS health promoting teams
- The NHS will become a model employer
I have discussed a range of public health strategies which have been put in place in the past to tackle current health problems within the UK. Other groups and individuals have also made contributions to the health of the nation and influenced health policy. For example, pressure groups such as Greenpeace and Friends of the Earth have drawn attention to the treatment of the environment in relation to pesticides over fishing and farming etc. Also, banning harmful toxic substance such as nuclear waste, which could be potentially harmful. ‘Recent research has shown that there is a significantly higher increase of cancers in people living near nuclear power plants.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 22 Power plants can be potentially harmful if explosions were to occur for instance. The cost to people living around the power plant and almost certainly to the workers who work on the power plant is unacceptable.
The environment is very important in relation to the health of the nation and id therefore essential that any health and social reforms produced take the environment into account. Current health and social reforms have attempted to reduce the ‘carbon footprint’ we produce as a result of flying, to use non-leaded fuels, to recycle plastics, paper and wood: to eat ‘red meat’ in moderation; and to decrease packaging of food products. ‘In 2006, a UK government advisory panel, the Sustainable Development Commission, concluded that if the UK’s existing nuclear capacity were doubled, it would provide an 8% decrease in total UK CO2 emissions by 2035.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 22 The above quote can be used in comparison with the nations aim of reducing green house gas emissions by 60% by 2050.
The World Health Organisation (WHO) is an international group who influence public health policy. It is the directing and coordinating authority for health within the United Nations system. ‘It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.’ The World Health Organisation aims to improve the health on an international scale in reducing the incidence of disease and promoting immunisation and sustainable health programmes and campaigns.
Individual organisations such as Cancer Research UK are dedicated to the control and annihilation of disease throughout the country as it helps to promote the health of individuals relating to social, physiological and mental health. Cancer Research is a charity who rely solely on donations to help fund their research. ‘We support research into all aspects of cancer through the work of more than 4,500 scientists, doctors and nurses.’ http://www.cancerresearchuk.org/aboutus/whoweare/
In 2003, the Health Protection Agency was formed. It is an independent UK organisation which was enforced by the government in 2003 in order to protect the public from threats to their health from infectious diseases and also environmental hazards. The Health Protection Agency describes itself as; ‘an independent body that protects the health and well-being of the population. The agency plays a critical role in protecting people from infectious diseases and in preventing harm when hazards involving chemicals, poisons or radiation occur.’ Baker L, 2008, BTEC National Health and Social Care Book 2, page 22 The HPA also works in partnership with others who have health protection responsibilities, providing support and advising, through the DOH, all government departments and also administrations within the United Kingdom.
The National Institute for Clinical Health and Excellence (NICE) is an independent organisation who is responsible for providing national guidance on promoting good health and preventing and treating ill health. The role of NICE was outlined in the white paper; ‘Choosing Health: making healthier choices easier’ which was developed in 2004. The aim of this white paper was to enable and promote people make healthier and more informed choices about their health.
‘NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
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clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.’ http://www.nice.org.uk/aboutnice/
On 1 April 2055, the HDA was transferred to the National Institute for Clinical Health and Excellence. NICE guidance is developed using the expertise of the NHS and the wider healthcare community including NHS staff, healthcare professionals, patients and carers, industry and the academic world. http://www.nice.org.uk/aboutnice/
Overall, within this assignment I have looked in detail at the key aspects of public health practice in the UK. I have taken into consideration the six keys aspects of public health including; monitoring the health status of the population, developing programmes to reduce the risk and screen for early disease, controlling communicable disease, promoting the health of the population and planning and evaluating the national provision of health and social care. I have also described the origins of public health by looking in detail at the historical perspectives of the public health system.
