This essay will discuss how health promotion contributes to the enhancement of health of my chosen ethnic minority which is South Asians. It will explore how health education leads to positive wellbeing. It will go on to rationalize the importance of health promotion and why it is an imperative component of nursing and other healthcare professionals in both clinical and community settings. The essay will look at different factors affecting health and explore the links between ethnicity and health, as well analyse how social inequalities may possibly exist and could be the reasons for health differences. This essay will discuss and select three diseases that affect South Asians. A rationale will be given for this choice. Relevant literature will be used to support my discussion
Concepts about "health" and "Health Promotion"
In order to present my essay, the understating of health is crucial. It is thought that health is an extended perception which can embody a variety of meanings and can be defined from different perspectives. It cannot be defined merely in terms of anatomical, physiological or mental attributes therefore the precise definition depends on the individual. Davey, Gray and Seale (1995). The view on health can consequently be derived from where the person expressing the view is located in terms of social class, gender, ethnic origin, culture and occupation. Whitehead and Lrvine (2010) agree with statement that the definitions of health are varied and embody numerous different conceptualization of health.
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There are three models that are used to try and reach a profound view of health. These are the Biomedical, Bio physiological and social models. The biomedical model focuses on the directly underlying causes of diseases and treating them. The bio physiological focuses on the attitude and behaviour of individuals, lastly the social model focuses on social influences of health in terms of inequalities such as access to adequate housing and health care.
The western scientific medical model has a negative view on health and describes health as the absence of diseases. Whilst medical model is the most influential ideology in the west it is not all embracing. It relies on a theory of normality that is not broadly been accepted, it also ignores peoples` perceptions on their own health and moreover it focuses on pathology and malfunction which leads practitioners responding to ill health rather than being proactive and promoting health. Naidoo and Wills (2009, p6-7 & p15)
The positive view is described by the Worlds Health Organisation (WHO) (1946) as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. WHO view health as a fundamental human right. This view takes a more holistic view of health. These particular views on health have been openly confirmed by the Jarkata Declaration which linked health to social and economic development (WHO 1997). Naidoo and Wills (2009, p15). Naidoo and Wills (2009) cited that the WHO stirred the meaning of health promotion away from deterrence of specific diseases towards health and well being of the whole population. The aim was to stop experts and professionals entirely defining health issues and let the public define it according to how the public view health not only in terms of anatomy but include social factors as well. Nightingale, 1969 and Ewles, Simnett (2003) also view health holistically. Nightingale defines it as a state of being well and using every power the individual possesses to the fullest extent. Kozier, Erb,Berman, Snyder, Lake and Harvey (2008 p51). Ewles, Simnett (2003) views state that health is seen as resources for everyday life not the objective of living.
With that in mind I will(don't be personal) try to define health promotion. Different authors have expressed their view on health promotion. According to Kemm and Close (1995) health promotion is any activity that intends to prevent disease or promote health. intended to prevent disease, improve health and well being. Health promotion is a process that educates individuals and enables people to take control of their lives and alter life styles to attain positive health. Maville and Huerta (2002) agree and say that health promotion is any attempt directed at enhancing the quality of life lead by different individuals and their well-being. World Health Organisation (2005) define health promotion as the process by which people gain knowledge and understanding of health related issues that affect their everyday lives.
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Health promotion is a significant feature as it raises awareness of wellbeing issues for the general public. This enables them to be in command and be responsible for their lives in terms of positive health and illness (Tones and Green, 2006). Health education aims are to motivate and persuade people to make wiser choices and make changes to their life styles, and importantly equip people with the skills, understanding and self-confidence to make those choices and changes, to in order to achieve or maintain positive health. Allowing people to adopt healthy lifestyles which will enable them to make informed choices and motivate them to become better self-managers of their health, this is affirmed by Young and Hayes (2002). Young and Hayes state that the purpose of health promotion practice is to advance and safeguard health. Health promotion can consequently be seen as movement towards the achievement of health as a basic human right for all.
My chosen ethnic minority:
The ethnic minority I will look at will be South Asians. Ethnicity is a complex belief that is used to cite those with a mutual culture, social back ground, land and or religion. Race is a mere biological marker of difference. This is widely used to describe populations; however there is minor deviation in the genetic composition of the different groups. Naidoo and Wills (2009)
According to Fernando (1991), race is characterised by physical appearance, determined by inherited ancestry and perceived as a permanent aspect that cannot be changed. He also states that culture is characterised by behaviour attitudes, determined by family views and perceived as a changeable effect. lastly he describes ethnicity is characterised by sense of belonging and group identity, determined by social pressures and psychological need and perceived as partially changeable
This essay will look into the health needs for this minority. It will look at Coronary heart disease (CHD) and a few related issues including smoking and Diabetes.
According to Diabetes UK, Diabetes mellitus is a condition in which the quantity of glucose (sugars) in the blood is elevated because the body cannot use it properly. There are two main types. Type 1 diabetes develops if the body cannot generate any insulin. Insulin is a hormone which assist`s the glucose to penetrate the cells where it is used as fuel by the body. Type 1 diabetes usually appears by the age of 40. It is the least common of the two main types and accounts for around 10 per cent of all people with diabetes. It is also known as IDDM -Insulin-Dependent Diabetes Mellitus. Andrew J Krents and Clifford J Bailey (2005). Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is created does not work properly (known as insulin resistance). In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people, it often appears after the age of 25. However, recently more children are being diagnosed with the condition some as young as seven. Type 2 diabetes is the more frequent of the two main types and accounts for around 90 per cent of people with diabetes. It is also known as NIDDM Non Insulin-Dependent Diabetes Mellitus. Andrew J Krents and Clifford J Bailey (2005)
In UK, there are 2.6 million citizens who have been diagnosed with diabetes. (Diabetes 2009) and by 2025 there will be more than four million people with diabetes in the UK. Type 2 diabetes is up to six times more frequent in those of South Asian descent and up to three times more frequent among citizens of African and African-Caribbean origin. DOH (2001).According to the Health Survey for England 2004, the rate of doctor-diagnosed diabetes is approximately four times as common in Bangladeshi men, and almost three times as prevalent in Pakistani and Indian men compared with men in the general population. In women, diabetes is more than five times as likely among Pakistani women, at least
three times as likely in Bangladeshi and Black Caribbean women, and two-and-a-half times
as likely in Indian women, compared with women in the general population. DOH (2001)
According, to Roglic G, Unwin N, Bennett PH et al (2005), diabetes is the fifth most common cause of death in the world. Life expectancy is reduced on average by more than 20 years in people with Type 1 diabetes and up to 10 years in people with Type 2 diabetes.DOH (2001). However good diabetes management has been shown to decrease the threat of difficulties, yet if let undiagnosed it can be associated with serious complications including Heart disease, stroke, blindness, kidney disease, nerve damage and amputations leading to disability and premature mortality.
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Coronary Heart Disease (CHD) can be defined as a disease relating to the process that affects the coronary arterial circulation with consequences for the heart and its ability to function. D. Newby, J. Cockcroft and I. Wilkinson (2005). Dr C. Davidson a cardiologist at Brighton derived a book in order to help public understand heart related complications defined CHD as the clogging up of the arteries with fat through a process called Atheroma. When the arteries become clogged up with fat they become narrow and restrict blood flow which can lead to serious complications.
CHD is said to be one of the major causes of mortality and mobility in the western world. D. Newby, J. Cockcroft and I. Wilkinson (2005). However also state that death rates from CHD have been declining over the past decade. The government report The Boyle Report (2004) backs the writers as the reports imply that individuals are managing CHD well due to the increase in invasive procedures like coronary bypass and angioplasty as well enhanced pharmacology intervention together with cholesterol -lowering statins and improved antithrombotic agents.
Research carried out by the South Asian Health Foundation (SAHF) cited that although Coronary Heart Disease (CHD) is accountable for about one in five men in all deaths and one in six women, South Asians are 50% more likely to die prematurely from CHD than the general population. Though CHD can impinge on every person it affects those from certain groups more than others. CHD is more predominant in South Asians. This includes people from Bangladesh, Pakistan and Indian sub-continent countries of India. It is not completely stated why South Asians suffer from heart disease more than other groups but several theories exist. It is said that South Asians may genetically be more susceptible to developing CHD, also that there are some unconfirmed risk factors including insulin resistance and central obesity. However the relatively disadvantaged socio-economic has been argued to be the under lying cause of heart disease.
Researchers have found that there is a link between CHD with lifestyle. The major determinants of CHD cited by Linda Ewels (2005) are high levels of a particular fat (LDL- Low Density Lipoprotein) in the blood stream, high blood pressure, smoking, lack of exercise and obesity. In terms of smoking, the principal constituents of cigarette smoke are tar carbon monoxide and nicotine. The tar is a complex mixture of substances that is produced as tobacco burns. The carbon monoxide that is released is also harmful to the body system. The impact of smoking goes much further than the direct effects on the individual smoker, it also extends beyond personal health factors, to economic, environmental and social effects. Linda Ewels (2005).
According to (Macodowall, et al 2002), healthiness and illness are impacted by different types of actions such as eating a composed diet or taking medications to reduce the risk of some diseases. The main reason for this is that, most people think of health as absence of disease instead of the overall well-being.
The need for health promotion for South Asians is imperative. From a financial perspective it is costing the government around seven billion a year. D. Newby, J. Cockcroft and I. Wilkinson (2005). Diabetes also has a significant impact on health and social services, people with diabetes are twice as likely to be admitted to hospital and least one in ten people in hospital has diabetes at any moment in time. Sampson MJ, Doxio N, Ferguson B et al (2007). They also cited that people with diabetes experience prolonged stays in hospital. This results in about 80,000 bed days per year.
When looking at life style Insufficient money can have a major impact on ethnic minority. Helman (2007) cites that they might not be able to afford a healthy life style. Healthy food choice are cost more to buy than cheap fast food ,cheaper food tends to be high in sugar and fat content. People who live on a low- income might find it complicated to attain and maintain a balanced healthy diet. Helman (2007) affirm that economic factors remain the key causes of ill health, since poverty at times results in deprived nutrition. Helman (2007) states that poor health is usually related with a income and poverty as this will influences the sort of food, water ,clothing, sanitation, housing and medical care
Insufficient money can have a major impact on ethnic minority. Helman (2007) cites that they might not be able to afford a healthy life style. Healthy food choice are cost more to buy than cheap fast food ,cheaper food tends to be high in sugar and fat content. People who live on a low- income might find it complicated to attain and maintain a balanced healthy diet. Helman (2007) affirm that economic factors remain the key causes of ill health, since poverty at times results in deprived nutrition. Helman (2007) states that poor health is usually related with a income and poverty as this will influences the sort of food, water ,clothing, sanitation, housing and medical care.
How health promotion enhance their health and well-being
The primary health care team give consideration to a screening strategy that both raises awareness of the risks of hypertension among African-Caribbean patients and encourages them to make contact with the primary care service. The approach could be structured and systematic, or opportunistic and informal. According to (Purnell and paulanka 2003) African Caribbean diets are frequently high in fat, cholesterol and sodium. Majority of African Caribbean eat more animal fat, less fibre and few fruit and vegetables.
According to Whitehead and Irvien (2010) cited by Tones and Green (2004), health promotion activities are planned to smooth the progress of health associated education and eventually alter ways of life or conduct for citizens.
Wills (2007) state that education is one of the resources of improving health and is often the main one that is used by health professional. Physical exercises can help them to burn out the excess fat in their body and to prevent the risk of other diseases and illness. However due to the lack of finances it is not possible for people to go to the gym. This will also reduce an individual life expectancy. Nevertheless, the government has put in place different measures so as to meet the health needs of various ethnic groups. Measuring such as, free travel cards and free fitness classes for people with chronic health condition and the elderly people available to them.
Scriven (2005) state that the UK new public health agenda and multi professional understanding and capabilities in the promotion of health is very crucial. As health education prepares patients for their health and well being, it's very important that health care professionals communicate with patients about who to contact in the case of an emergency. According to Nolan (2005) one has to be aware of religious and cultural differences between you and the person you are communicating with. It is therefore important to known the cultural and religious needs of the patient as to meet their health needs. According to Scriven (2005) effective communication, through the use of appropriate language, is an important element in ensuring the success of the therapist-client partnership. It is therefore important that explanation is clear in a language that is understandable to the individual ethnic group. This mean that by giving, significant information on health matters will help people to have more control over their own health as well as factor that affect their health.
According to Wills (2007 )state that health promotion shares many of the characteristics good nursing practice ,this includes spending time listening and talking to client ,meeting an individual needs and using high level of communication skill as well as using different methods. Reflecting back what they have said to check their level of understanding their health needs can be helpful. With further exploration and discussion goals can be set and agreed on. Thomson Hilary (2002) state that education focuses on the individual and explain any activity that promotes health related learning.
Many people can benefit health promotion and disease prevention initiative. Certain Cultural groups especially those who are born from African Caribbean who are at higher risk of developing hypertension and stroke can benefit from health promotion. According to Katz, J et al (2002) health is subject to wide individual social and cultural interpretation. We all experience health and illness as individuals yet it is through influences such as culture, class and gender that these are shaped. High blood pressure can be controlled if an individual follow a healthy eating a plan, which includes food lower in sodium, and also maintain a healthy weight. However this can be prevented if an individual can reduce their intake of salt. People born from topical Country (African Caribbean) have the greatest risk of dying form stroke and also suffer from hypertension than those who are born in the Europeans Country.
Age is one of the key factors of hypertension. As people get older their blood pressure will also increase. Two-thirds of the population over age 60 have hypertension. Older women (60 years and above) currently have the highest rates of hypertension, and mortality rates from hypertension are higher in women than in men (Purnell and paulanka (2003). Scriven (2005)page 23 suggests that it is important to note that an effective health promoting nurse acknowledge the wider socio-political determinants of a client's community based health while, at the same time ,valuing the individual's autonomy at the core of clinical practice. Having hypertension and stroke will have a great impact on your health. Major risk factor for conditions for low life expectancy, including heart, blood vessel and kidney disease, and stroke. However high blood pressure can be controlled and possibly be minimised or prevented but this depends on an individual life style.