When the NHS was established in 1948, one of its founding principles was that it should improve health and prevent disease as well as providing treatment for those who are ill. In November 2004, the government produces a white paper choosing health, and one of its main purposes was to improve health of the national by setting goals, putting strategies and guidelines that would have the effect of increasing the general standard of the Public health (Choosing Health 2004). Although this white paper has many strands but the one which will be looked on this assignment is obesity as a Public health issue.
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This essay will start by looking the concept of health and it will look Public health and how it relates with overall care of obesity. A scenario will be used to describe the physiology of obesity’s patient and how it is affecting psycho social perspective of their life. The essay will also explain the roles of nurse in supporting individuals with health problems within the community setting as a part of inter-professional team. Government policies and frameworks in relation to patient needs will be provided. Different sources of information such as internet, books and journals to demonstrate the points will be used. Any name mentioned in this scenario has been changed in order to respect individuals’ confidentiality and comply with the code of NMC (2008).
Health has been seen as a complex concept. It means that health has different things to different people and is affected by a wide range of factors such as lifestyles, social, economic and environment such as whether people live in as a free society, what social support network are available, and how they live in terms of employment, income and housing (Simnett et al 2003). Health has two common meanings, one is negative which is the absence of disease or illness and is the meaning of health within the western scientific medical model. The other meaning of health is a state of complete physical, mental and social wellbeing, not merely the absence of disease or illness (Naidoo et al 2000). Other writer such as Seedhouse suggests that health is about improving people’s quality of life by enabling them to fulfill their own potential and empowering them so that they are capable of becoming (Simnett et al 2003). According to Ottawa Charter of November 1986, a conference primarily was response for growing expectation for new Public health movement around the world has seen health as a resource of everyday life not the objective of living (W.H.O 2000).
There are huge ranges of factors that affect health. Health can be affected by genetic, gender, lifestyle and behavior, housing, environment, food policy and many more. In Acheson report into inequalities in health on socio economic model of health, it shows the main determinants of health as layers of influence one over another. At the centre are individuals with their inbuilt genetic, age and gender related factors. Surrounding the individuals are layers of influences that in theory could be modified to allow the best possible of health. The inner layer is their personal behavior or lifestyle, with factors such as smoking and drinking habits, and physical activities with the potential to promote or damage health. Individuals are seldom alone; they interact with friends, relatives and community and come under social and community influence. This model emphasizes interaction between these layers. The model has been used to guide research for example it shows that the social environmental people live is related to their health behavior, patterns of eating, drinking, smoking and physical activities. The model also demonstrates the various interventions on attempting to change individuals’ risks by encouraging people give up smoking and change diet (Acheson 1998).
Obesity is a condition which weight gain has reached a point where it causes a significant risk of health (NICE 2006). World Health Organization defined obesity as abnormal or excessive fat increase that may impair health; this means BMI (Body Mass Index) is equal to or more than 30. (BMI is defined as the weight in kilograms divided by the square of the height in meters) World Health Organization indicated that, globally approximately 400 adults and 20 million children under the age of 5 were obese on 2005 and by 2015 the number will reach more than 700 million. Obesity is one of the most Public Health challenges of the 21st century in the world and is already responsible for 2 to 8% of the health cost and 10 to 13% of deaths indifferent parts of the region. Obesity is also a major contributor to the global burden of chronic disease and disability (WHO 2010). Public health is a social and political concept aimed at the improving health, prolonging and improving quality of life of the population through promotion, prevention of disease and other forms of interventions (Acheson Report 1988).
According to the Department of Health guidance of March 2006, obesity is one of the biggest public health issues facing England. Estimates suggest that more than twelve millions adults and one million children will be obese by 2010 if no action is taken (NICE 2006). Obesity has grown up almost by 400% in the last twenty five years and it will entail levels of sickness that will put huge pressure on the health services (The House of Common 2004). According to the government study of 2007, half of the population could be obese within 25. Obesity has a substantial human cost by contributing to the start of the disease and premature mortality and it has serious financial consequences for the National Health Service (NAO 2001). It suggests the cost of epidemic, in terms of health care provision could reach 45 billion a year by 2050 (BBC 2007). There is also a cost to society and economic mostly on sickness absences which reduce productivity (DOH 2010).
The cause of Obesity is complex, and can be grouped into different areas. Individual’s genes may play an important part in influencing metabolism and the amount of fat tissues in the body. Genes could also affect individual’s behavior, inclining individual towards lifestyle choices that may increase the risks of obesity. The risks of excess weight also can be contributed by the pattern of growth during early life. The growth of the baby’s rate in the womb, following the birth is the part determined by parent’s factors especially with regards to mother’s diet and how she feed the baby (DOH 2008). The availability of more variety, cheaper and testes processed food with bigger size portion has also contributed obesity. More people are eating pre package food, fast food and soft drinks which are regularly high in calories, salt, fat and sugar. These foods are heavily advertised especially to children (Cancer Research UK 2009). The modern physical environment has contributed to increasingly inactive lifestyle over the past fifty years because of changing in work and shopping patterns from local to distant that has results people dependence on motorized transport. Other factor is UK has changed from an industrial to a service based-economic therefore fewer jobs are now requiring physical work. Obesity has also been contributed by poor urban planning where pedestrians and cyclists have lower priorities than for motor vehicle. Most people now spend less time on active games and more time in sitting at the computer, watching TV and playing video games. Our exercise, eating and drinking habits also are greatly influenced social and psychological factors (DOH 2008).
This example relate to an obese and a type two diabetes patient whom has been referred to District Nurse by a General Practitioner following her health condition. Her name is Maria, sixty two years old and she lives alone in a one bedroom flat. Maria is hardly walks because of her condition; she spends more time sitting in a chair and sleeping on her bed. She depends on Carer for her personal hygiene and preparing meals. A District Nurse visits her twice a day to administer insulin. Maria sometimes looks to be confused. She has been advised several times by Dietician and District nurse on her habits of eating unhealthy food, but she says she is not bothering and she does not feel sorry with her condition. Maria background shows that her father was obese and a diabetic, he dead from heart failure.
Obesity is a central player of pathophysiology of diabetes mellitus and insulin resistance. It is a major contributor to the metabolic dysfunction involving lipid and glucose. It influences organ dysfunction involving liver, endocrine, pulmonary and reproductive functions. It also increases the chances of myocardial infarction (Redinger 2007). Diabetes can cause heart disease, amputation, kidney failure and more death than cancer (Diabetes UK 2080). The case study shows that Maria father had died from heart disease.
People like Maria needs support to improve their health. The support could be treatment, a promotion activity, or a care services. According to the Ottawa Charter, health promotion is a strategy that aims to integrate skills and community development and to create supportive environments for health, make efforts to build healthy public policy and look at re orienting health services (WHO 1986). The Jakarta declaration on leading health promotion into the 21st century confirms that this strategy and action areas are relevant to all countries including cities, municipalities, local communities, schools, workplaces and healthcare services. The declaration identifies priorities on promoting health social responsibility, expand health promotion partnership, empower the individual and expand community capacity and secure health promotion infrastructure (WHO 1998). The WHO global strategy on diet, physical activities and health urged all the stake holders to take action to support healthy diets and physical activity global, regional, and local levels to reduce the prevalence of chronic disease and their common risk factors, primarily unhealthy diet and physical activities (WHO 2010).
In 1999, the UK government document Our Health Nation, has identified a three way partnership for a better health. The government, local communities and individual have to work together in partnership to improve our health. Partners include the government, health authorities, local authorities, business, voluntary bodies and individuals (DOH 1999).
Locally, Community care means to provide the right level of intervention and support to people and enable to achieve maximum independence and control over their own lives (Titterton 1994). The Acheson report on Public health, it defined public health as the science and art of preventing disease, prolonging life and promoting health the organized effort of society (Naidoo et al 2000). NHS original goals of providing a comprehensive health service, improving physical and mental health and to prevent, diagnose and treat illness is much in common with the health promotion. Use of the health services is universal so that everyone at some point in their lives comes into contact with the health service providers. Primary health care is the first level of contact of individuals and community with the national health system bringing health care as close as possible to where people live (MacDonald 1993). Primary health care provides a setting where health promotion at primary, secondary and tertiary levels takes place (Naidoo et al 2000). The primary prevention is to delay or prevent the beginning of disease. Joyce treatment of diabetes would have started at this point by screening and advising on changing diet and her lifestyle (SIGN 2007). The secondary and tertiary prevention is sought to reduce the occurrence of relapses and the establishment of chronic conditions through example, effective rehabilitation (WHO 1998). At secondary stage patients are vulnerable and require regular monitoring such as weight monitoring, signs of deterioration, etc.
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One of the aims of the district nurses in the community is to improve health of the population by reducing obesity and increase the awareness of the positive healthy behaviors in community. Nurses delivering public health by influencing public policy and health promotion and are working to create the opportunity for people to live positive healthy lives (RCN 2007). The first visit of District nurse to Maria’s home was to assess the needs and prepare a care plan. The plan will include advice and educate on health eating and blood sugar management. District nurse visits will include administering of insulin depend on how serious the diabetes is. Because Maria spends more time sitting, the chance of developing pressure sore and leg ulcer is higher, a District nurse will advice Maria on how to avoid possible break of skin. The district nurse will refer Maria to dietician for advice on Maria’s diet, physiotherapist to help her on physical problems and occupational therapist who will work to improve her ability to perform daily tasks. A district nurse will do referral to social service if required. The general practitioner will be involve in the care of Maria on prescribing insulin and losing weight medicine such as orlistat which works by blocking the action of enzymes that is used to digest fat ( NHS choices 2010).
On the government side, Department of Health is responsible for policy on public health aspects of diet, nutrition and physical activities. It ensure that public and others have the information they need to improve health. It sets national priorities to improve health and reduce health inequalities. It also commissions research on the effectiveness of interventions. Department of Health works together with the Department for Education on promoting education and health school also encourage young people to be active by participating in sports within and beyond school. Schools provide a healthy diet and education and nutrition so that young people can eat a balanced nutrition diet. Department of health also works with other department such as the Department the culture, media and sports to promoting walking and cycling, facilitate active leisure and to improve quality of life for sporting activities so that more people to participate in sports( NAO 2001).
Many people like Maria do not even know that obesity as a problem because they have no access to health information services or support for individuals need’s for information is sometimes underestimated. It could be even health practitioners do not use their skills to promote health of individuals. Health professionals need to work face to face to with individuals so that to provide advising and persuading them to make them change their lifestyles. Accurate and appropriate information about people’s health should be provided and what social and behavior factors can affect their health. People should be made aware of important of health benefits associated with active lifestyle for examples, improve their self efficacy and confidence and enhanced their social opportunity. They should be aware that food high in fat, sugar and salt are not necessary and should be avoided or eaten in minimum (SIGN 2010).
To summing up, obesity is possibly dominating the public health issue in UK today and its effect can not be seen as an individual but is a society a whole. Communities, individuals and other groups need to work together in tackling obesity epidemic and work together in promoting health and well being.
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