Employment and Social Class
The ward has poor socio-economic characteristics, which leads to poor economic status. For example 60% of 16-74 year olds of the population living in the ward are under grades D and E of the social profile being semi/ skilled workers or unemployed and on state benefit. This can be easily supported by looking at the City council’s Ward profile or the area which stated that the average median household income for the Ward based on CACI’s 2008 ‘PayCheck’ is £17,586, which is 29.9% below the Cities median of £25,088.’ (Research and Information Unit, City and County of ‘City’, September 2010)
The Acheson report (1998) clearly demonstrated the link between poor socio – economic status and mortality rates. Unskilled workers have a higher mortality rate compared to people in professional or managerial roles; this could be due to poorer working conditions and less health benefits. Conversely the Black report (1980) considered the effects of poverty and poor living conditions on people of different social class. The report found that people of lower class are more likely to become ill as a consequence of poverty. Both these reports conclude that the residents of the Ward are at a greater risk of becoming ill due to their lower social status.
Housing
The ward consists of four types of accommodation, terraced housing (46%), semi-detached houses (42%), detached houses (5%) or flats (7%). Housing in the area is priced well below the city’s average with semi-detached and terraced housing being between £75,000 – £90,000. The highest level of housing in this area is terraced or semi-detached which is elevated compared to the city’s average, it can be argued that the close proximity of living can be a contributing factor towards ill health within the ward, for example the closeness promotes the spread of infection and disease.
The graph in appendix 3 shows the breakdown of housing ownership. Only 15.2% of residents out rightly own their property. With 17.9% paying a mortgage and over half paying rent to the local authority. Not having overall responsibility of the property that residents live in it suggests that the upkeep and condition of the homes can become poor with damp being a detrimental factor. Better Homes for People in Wales (2001) highlights how housing impacts on a populations health and quality of life. Poor housing can lead to an increase in asthma, accidents, anxiety and depression.
Appendix 4 shows the number of individuals that live within households in the Ward. It shows another problem for the ward is overcrowding, and many of the houses in the area have more than 5 people living in one household which could contribute to health complications, including a higher mortality rate as well as a higher risk of respiratory conditions like asthma and tuberculosis.
Crime
The Ward has an extremely high crime level within the city and has gained a reputation for being a hardened area. Appendix 5 shows the types of crime undertaken within the Ward between 2004 and 2010. The table shows that Criminal damage and violence are still amongst the highest crimes in the area although they have decreased in number from 2004 to 2010. Whereas drug offences have remained the same level which suggests that more may be needed to be done to combat drug crimes and use within the area. As with housing, education, and social class have an impact on health so does crime. A report, Wales: A better country suggests that a population’s health is affected by the level of crime and safety, as an unsafe area with high unemployment, social exclusion and poverty causes additional stress and insecurity. (Welsh Assembly government 2005) The high incidence of drug crime suggests that drug use within the area is big and can cause many health implications such as emergency treatment in the case of and overdose. The high levels of criminal damage and violence in the area has a physical effect on the residents as many could be injured and harmed causes health problems. Children leaving school at the age of 16 with no qualifications in this area may turn to crime as an answer to daily living instead of working in an unskilled environment with low benefits, low appeal or a chance to better one self.
Transport
Out of 3,689 households in the Ward 2,040 don’t own any transport. Wellbeing in Wales (2002) acknowledges that transport is a fundamental part of everyday life, and affects health both positively and negatively. Transport allows the individual to access health services as well as education, leisure facilities and social networks. However owning a car also has a negative impact on the environment as well as health by causing pollution, noise and injuries. Many individuals in the Ward use other means of transport mainly bus or on foot. Buses within the area are frequent and travel to the city’s town centre, whilst also giving access to primary and secondary health services.
Amenities and facilities
Within the Ward the facilities vary considerably and cater for a number of needs the community may have. There are a number of playing fields and parks with large open areas for anybody to use. This could encourage fitness and outdoor type activities. There is a large community centre situated within the ward which offers a huge Varity of activities such as music lessons, a library, IT suite, crèche and outdoor play facilities. The Centre also houses 13 business units which directly provide a service to the community by supplying parenting classes and the opportunity to meet new people and learn new skills.
Shopping facilities within the area are limited and consists only of 2 small supermarkets, a butcher and a newsagent. These can impact on a community in many ways, for example the supermarkets offer limited choice of food which offers little nutritional value to its customers. Fruit and vegetables are expensive in small supermarkets along with fish and meat, which can deter individuals from buying such products and going for the cheaper less healthy option. The lack of option and poor diet will eventually lead to health complications. Whilst the Ward is only a short distance from the City centre families with young children or older members may find it difficult to get about.
The Doctors surgery isn’t based directly in the Ward, but in the City centre, yet people with difficulty reaching the surgery are probably the people that need it the most. Hart (1971) stated,
"The availability of good medical care tends to vary inversely with the need for it in the population served.” This tends to run true for most deprived Wards as GP’s do not have enough incentive to set up practices in these areas although they have the greatest need.
Epidemiology & Health Need
To fully understand the health needs of the Ward area the epidemiology as well as the demographic needs to be looked at. Complete accuracy is difficult to achieve however as a multitude of sources need to be used and may skew some of the results. Gray (2001) acknowledges that evidence-based comparisons are seldom exact, and results need to be expressed as a probability.
Within the Ward there are various health services available to the residents, the primary health care team consisting of District nurses, Health Visitors: Chronic conditions Nurses, Doctors, Social workers and a Dentist. Although there is no GP Surgery within the Ward the area is covered by teams working primarily out of a nearby surgery.
There are also two Hospitals that serve the Ward which are controlled by the local health board, one of the Hospitals offers services such as a maternity ward, minor surgeries such as ENT as well as well equipped palliative care facilities. The second offers a large Accident and Emergency Department, a busy renal unit, a range of surgical units as well as all the secondary paediatric health services in the area. The maternity ward in this hospital has gained full accreditation from the Baby friendly initiative for breastfeeding. (UNICEF 2010)
Having worked alongside the Health Visitor and other members of the primary health care team within the ward it is clear that there are a number of health needs outlined within the area. Appendix 7 shows that the ward suffers from a high number of cases of Depression along with hypertension, Asthma and smoking with chronic disease. As well as high levels of obesity, although the number of incidences in the ward has decreased from 2008. Appendix 8 however states that in 2007 9% of children were suffering and being treated for asthma in Wales.
In 2009 the percentage of children being immunised against diphtheria, tetanus, Pertussis, Polio and Hib by their first birthday in the City was 96.3% with Meningitis C uptake being 95.7% along with pneumococcal being 95.8%. MMR uptake in the city has gradually risen and now stands at 91.7%.
However the main health need that was identified by spending time with the Health visitor was the lack of breastfeeding mothers within the ward.
The ward has very low incidences of breastfeeding and very high incidence of weaning at 3-4 months. Looking at the demographics of the area in conjunction with research into breastfeeding inequalities, this is unsurprising as evidence states that women who breastfeed the longest are over 30 years of age, have higher socio-economic status and stay in education to the age of 18. Whereas in this Ward a high proportion of new mums are under 30 with no qualifications implying that they would be less inclined to breastfeed.
In accordance to the UK Baby friendly initiative developed by UNICEF and WHO in 1997 support should be given to every mother’s right to choose breastfeeding as a positive option that is best for the baby. Also the initiative aims to ensure breastfeeding is a positive experience for everyone. Breastfeeding therefore is a health need throughout Europe and not just in the Ward.
Although breastfeeding is a natural process it is also a learnt skill, and the success relies upon the support and teaching of the midwife, health visitor and family support networks (Gunther 1955.) Many factors can disconcert a mother from breastfeeding even before birth, when asked why some of the mothers did not breastfeed some answers were: lack of knowledge, no past experience, lack of support and also lack of encouragement from family and partners. Traumatic births / pregnancies can also affect breastfeeding rates. Henderson (2003) suggested that post natal depression has an impact on the duration that a mother will breastfeed for. Post natal depression has no evident cause, however certain stress’s such as lack of money, relationship troubles cramped living conditions and lack of resources are all apparent in this Ward.
Breastfeeding has a huge impact of the health of the baby as well as the mother and could postpone weaning to the required 6 months if enough support and encouragement was given. Both breastfeeding and delaying Weaning till six months (DH 2003) can benefit the child and lower the risk of becoming obese. The frequency of obesity in children aged 2 to 10 years has increased from 9.6% in 1995 to 15.5% in 2002 (Health Survey for England 2002). Obese children, especially girls, are more likely to come from lower social groups.
This increase in obesity can be from many factors however there is some evidence that babies who are not breastfed are more likely to become obese in later childhood (DH 14 2004a; Li et al. 2003; Michels et al. 2007). Obesity in this area is accountable for 6% of health care which is why eating healthy from an early age has many health benefits. As well as lowering the risk of obesity, breastfeeding lowers the risk of allergies and asthma as well as childhood illnesses such as ottis media along with added health benefits for the mother, helping to return to the pre baby weight faster and reducing the risk of osteoporosis.
The Local support group which has been set up in the neighbouring Ward by the Welsh Assembly Government meets once a week to discuss any individual issues plus give parenting advice, tips and experiences. However there is a lack of homecare due to staff shortages and shortfalls in the budget.
Health Services
Health services are frequently developing and reorienting within the City, due to the rising cost and pressure on secondary services there is an increased need for primary care provision.
Within the Ward the surgery offers its practice population to 8,443 clients through a team of skilled staff, resources and facilities, disabled and pram access is provided and has a benefit of being based in the town centre easily accessible by bus, on foot or by car. The surgery offers a drop-in surgery every morning Monday-Friday as well as afternoon appointments. The surgery also offers an on-site pharmacy as well as physiotherapy gym equipment.
The core team consists of receptionists, healthcare support workers, practice nurses, health visitors, district nurses, chronic conditions nurse, physiotherapist, midwife and doctors. Additional services are also brought in and these include chiropodist, phlebotomist and dietician.
Many clinics are run at the surgery:
As well as an immunisation clinic for childhood vaccinations, this is run by the Health visitors at the surgery. The well baby clinic is run as a drop-in service one afternoon a week, and encourages parents to bring their children in for weighing in addition to advice and support for any issues they may have.
Multidisciplinary teamwork is paramount to ensure seamless patient care and support. The Ward and the surgery works with secondary, tertiary and voluntary services to ensure patients needs are met. (Ewles and Simnett 2003)
A Welsh Assembly Government initiative ‘Flying Start’ set up in the city works within deprived areas and gives additional help. Fifteen Health visitors work over seven different Wards. The programme also gives free part-time quality childcare for eligible 2 year olds in addition to parenting groups and services. The team helps parents and guardians access all health services, detect potential health problems and refer for other support agencies. They also carry out health promotion, however only certain areas of each Ward qualifies for this service which is a negative against the initiative. The local school in the Ward has a ‘flying start’ crèche attached to it which is good for continuity of care and allows educators to get to know their children and parents in the community from an early age.
Shortfalls in service provision
- New breastfeeding group within the Ward for easier access, as well as better health promotion and antenatal education.
- A wider understanding of all issues of perinatal depression.
- “Healthy eating” courses to help tackle obesity within the area, cooking classes for parents and help with food nutrition on a budget.
- ‘Flying Start’ to look at a needs basis as opposed to an area specific group.
- Well baby clinics run by Flying start Health visitors in the Ward at the local centre and not at the surgery, due to transport issues and difficulty, to encourage more mothers to ask for help and support.
- Continuing increase in MMR uptake for children through raised awareness.
- Peer support groups for breastfeeding from previous breastfeeding mothers.
- Youth groups and clubs run at the local centre to encourage teenagers to stay away from crime and do something productive.
- Antenatal groups for expectant fathers to give them a chance to engage with a professional and ask advice without pressure from partners.
- More sports groups/clubs for young children to discourage obesity and encourage exercise.
- Raise the importance of breastfeeding to teenagers at an early age. As education to key to change.
- Incentives for teenagers to stay on to higher education and gain qualifications.
Conclusion
Overall this community profile has analysed the demographic as well as the epidemiological needs of the Ward population.
Demographically the essay has looked at the geography, the people, housing, employment, socio-economic factors, crime and transport. The essay also looked at the amenities of the area which allows us to look at the shortfalls of the area. References to the Acheson report (1988) as well as the Black report (1980) has allowed the author to look at the impact of inequalities in health.
The Health needs of the area have also been evaluated and the morbidity in key health areas has been compared to the city as a whole and then Wales. In response to the demographic the health needs are relevant and enforces the need for focus health promotion and education into the benefits of breastfeeding. In the essay some of the main health benefits were identified as well as recommendations on how to encourage new parents to breastfeed alongside the need for more support groups.
The role of the primary and secondary health services highlighting government initiatives and key workers in the support and care of children’s health in the Ward.
In summery the Ward is a well known area of deprivation in the city and more needs to be done to improve the health and well-being of the individual. The ward has limited resources in regards to shopping and health eating options, plus a minimal incentive to gain a higher education.
APPENDICIES
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 4
Appendix 5
Appendix 6
Appendix 7
Appendix 8
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