Written assignment that critically examines the effectiveness of policy, frameworks and assessment tools in public health disease management. Discuss the role of the community nurse and multidisciplinary team in empowering individuals and populations in r

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Public health is concerned with, reducing health inequality minimising health risks and improving the health status of populations’ (Brocklehurst, 2004). Wanless (2004, p23),  defines public health as, ‘The Science and art of preventing disease, prolonging life and promoting health through organised efforts and informed choice of society, organisations public and private, communities and individuals”. Throughout this paper the author will critically discuss the effectiveness of policies frameworks and assessment tools, used in public health disease management; in relation to the prevention and management of adults at risk of or with type two Diabetes Mellitus (DM) in the United Kingdom (UK). The Author will consider how environmental, epidemiological and demographic data can be used to highlight the underlying social determinants of a population’s health, influencing policy making, and public health frameworks. Key issues to arise at local level following strategic plans to reflect government policy will be identified, and the role of the nurse and Multi Disciplinary Team (MDT) in implementing such policies will be examined. Within this strategy’s employed in the authors’ local area will be identified. The focus will then turn to empowerment, and the effectiveness of nursing frameworks and assessment tool, used to enable individuals and groups to become responsible for their own health.

Type 2 DM occurs when the body ceases to produce adequate levels of insulin, and or when the action of the insulin that is produced becomes less affective; this is termed insulin resistant (Becker, 2003). It is most prevalent in ethnic minorities and older age however, there is a growing number of younger people and children developing DM (Roberts, 2007). Another factor that may increase an individual’s susceptibility to DM is mental illness, in particular depression and schizophrenia (Holt, 2005).

There are numerous underlying reasons for the growing prevalence of DM in the UK including, industrialisation and urbanisation leading to changes in lifestyle and eating habits (Helms, et al 2003). The results of these changes can be seen in the escalating level of obesity within the UK. In 2006 twenty-four percent of adults and sixteen percent of children, aged between two and fifteen, were classed as obese. A dramatic rise when compared to, fifteen percent of adults in 1993 and eleven percent of children in 1995 (National Statistics, 2008). Diabetes and obesity are closely linked; eighty percent of patients that are diagnosed with diabetes are obese at time of diagnosis (Diabetes UK, 2006).

Policies that have been implemented to reverse this trend include the five a day program, and the school fruit and vegetable scheme. These policies were introduced following recommendations outlined in the white paper Choosing Health (DoH, 2004a) and aims to raise the consumption of fruit and vegetables by raising awareness and increasing accessibility.  In 2006, front of pack signpost food labelling was also proposed by the Food Standards Agency (FSA), to reduce poor dietary intake by providing clear, easy to understand information concerning the nutritional content of food. The FSA also recommends that a traffic light system is used to denote low medium and high levels of fat, saturated fat, sugars and salt in food (FSA, 2007). However, these recommendations are not compulsory or consistent, and although it has been supported by a number of major supermarkets and retailers, many have individual hybrids of this system, which may cause confusion. Furthermore, the information shown is often only accessible to those able to read English, meaning that a large proportion of the public may fail to benefit due to the presentation of the information. In addition to this, the list of participating supermarkets provided by the FSA seems to suggest that the scheme has not been adopted by the majority of budget supermarkets, meaning that it may fail to impact on lower socioeconomic groups (FSA, 2007).

There is a strongly association between lower socioeconomic groups and increased levels of obesity, this is thought to be due to, poor diet and low levels of physical activity. In addition to this, there are also increased levels of smoking and poor blood pressure control in lower socioeconomic groups; all of which contribute to the onset of DM, creating inequalities. Meaning that within the UK the most deprived are 2.5 times more likely to develop DM, and at a 3.5 times increased risk of developing severe complications such as heart disease, stroke and kidney damage. (Diabetes UK, 2006)

The Saint Vincent’s declaration (1989) was the first major move towards reform within DM services, recognising that diabetes is a massive and growing public health concern throughout Europe. The declaration resulted in the setting of five year targets to achieve reform at European, government and local levels. Reform within the UK began much later than this, with the National Health Service (NHS) plan in 2000, which aimed to modernise services, rise standards, tackle under funding and make a shift towards patient centred care (DoH, 2000). One of the key strategies to emerge from the NHS plan was the introduction of National Service Frameworks (NSF) in 2001. NSF’s provide national standards to reduce variations in care (Dimond, 2008). The NSF for DM (2001) set out a ten year agenda, based on twelve standards, covering all aspects of DM care and prevention. To improve standards, increase quality and reduce inequalities; with the aim of reducing the cost to individuals, the NHS and society, by reducing incidence and complications (DoH, 2001) this was supported by a delivery strategy in 2003 (DoH, 2003). The government did initially face some criticism regarding funding when the NSF  was published, as although it did offer funding for retinal screening no other finical support was initiated (Cavan, 2005). This was addressed in 2004, with the introduction of General Medical Service. A fundamental component of this is the Quality Outcome Framework (QOF) which offers financial reward for target attainment. Numerous aspects of the QOF support the NSF for Diabetes for example, the maintaining of a practise based register. However, it is important to note that participation in the QOF is voluntary (NHS, 2004).

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In 2001 when the NSF was published there were 2,002,000 people living with diabetes in the UK (Forouhi et al, 2006). This figure has now increased to 2,321,532 (Diabetes UK, 2007). However, this is not necessarily an indication that the strategies implemented following the introduction of the NSF are failing. The increase may be related to increasing longevity. Life expectancy at birth in the UK has risen from 71.7 in males, and 77.6 in females, born between 1984-86 to 76.9 and 81.3 respectively in those born 2004-06 (National Statistics, 2007). Which may be significant when considered in relation to the ...

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