A report describing and analysing the public health contribution of an organisation or initiative of your choice.
‘Greenwich Primary Care Trust’
The contribution to public health made by an organisation or agency can be evaluated in relation to a number of features. These can be the range and scope of activities, the relevance for the local area, the effectiveness of the interventions, and their foundation within the boundaries of evidence-based practice. However, public health can also be measured in relation to how well the agency addresses key aspects of public health, including inequalities in health, what these constitute and their impact, and what is being done to address specific inequalities. In addition, known areas of public health need can be assessed in terms of progress made so far and amount of services provided to meet identified targets.
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This report explores the public health contribution provided by Greenwich Primary Care Trust in their ‘The annual Public Health Report 2007 – 2008’. In this report, which introduces itself using the following frames of reference, “providing the most up-to-date and local information; thinking ahead as the population is due to grow and change; and making evidence-based recommendations to help prioritise local actions on the key health challenges for the borough” (GPCT, 2008 p 3).
Public health is generally focused on significant health factors and issues which are important to the wider population, rather than to the individual, and impact upon society and social structures and social life, not just on the lives of single people (Pomerleau and McKee, 2005; Orme et al, 2007). Pomerlau and McKee (2005) describe public health as “the science and art of promoting health and preventing disease through the organized efforts of society” ( p 7). Therefore, it is not surprising that the report focuses very much on language surrounding the identification of key elements of public health which are subject to health promotion within the locality, as being the specific focus of the Trust. Pomerleau and McKee (2005) cite the Ottawa Charter which was concerned with building healthy public policy; creating supportive environments; strengthening community actions; developing personal skills; reorienting health services ; and demonstrating commitment to health promotion (p 9). These could be considered as signposts to understanding the value of a public health policy published by a specific agency.
The report is a clear, detailed and comprehensive report clearly and effectively outlining key areas for health which are viewed as priorities. These include: Improving mental health (especially depression); Reducing cardiovascular disease (chiefly heart attacks and strokes); and reducing cancers (especially lung, bowel, prostate and breast) (GPCT, 2008). The report provides statistics on morbidity and mortality for the borough which demonstrate that in relation to health and disability over the lifespan, these are the most significant health problems and the ones which are, it can be assumed, most urgently requiring attention.
All of these foci are very much about health promotion, but when looked at in the context of what is known about these kinds of diseases, all of the other elements of the Ottawa Charter cited above can be seen to affect these health issues. In line with health promotion principles, the report does focus on living longer, on quality of life, and on wellbeing issues, all of which are laudable in relation to public health because they relate both to the individual, and individual desires, and to the aspects of public health which will support and benefit the state (Iphofen, 2003). One of the drawbacks, however, of such a sweeping approach to public health policy, however, is seen in this report as frequently as it is seen in the national, governmental health promotion campaigns, that of over-simplification, and, arguably unconscious, marginalisation of certain individuals. For example, the report, like government public health campaigns, does not take enough notice of the individual factors which not only influence health but are not so easy to eradicate, such as the genetic factors influencing health and health behaviours (Hall, 1951).
In relation to health promotion in the key health areas identified, the report does acknowledge the issues of lifestyle factors and socio-economic factors affecting health and disease, morbidity and mortality. The report states that both current and historic socio-economic factors, and the diversity of the local population, especially in relation to ethnicity, are considered significant in relation to the most important public health issues. There is a wide range of literature which links social life, socio-economic status and health, and which demonstrates that those who experience inequalities in health are those who are most disadvantaged in social and economic life (Bury and Gabe, 2004). It is also well known that health inequalities increase as the gap between advantage and disadvantage widens, and that certain social or cultural groups are more likely to experience disadvantage and the concomitant inequalities in health (Freund et al, 2003). GPCT (2008) acknowledge this, and focus on some important social groups as most suffering disadvantage in the locality, including Black African and Irish populations. They argue that their policies have been designed to demonstrate “greater targeting of groups at greatest risk of poor health outcomes, and working with these groups to develop approaches that will really work, with
a particular focus on the Black African and Irish populations in the borough who have poor outcomes across the major causes of early death and ill health” (p 7). The report also addresses a range of ethnic issues and differences in health. However, it does not go far enough in describing and discussing policy responses to these issues, and to outlining constructive ways to make real progress in these areas. Plenty of literature shows the ethnicity based inequalities in health and the spectrum of disadvantage related to ethnic diversity (Spector, 2002).
These kinds of inequalities, which are often racially demarcated, are reflected in global communities, and are no new occurrence (Goeslin et al, 2004). Yet there are ongoing discussions about the ability to address such problems through public health initiatives, even with the inclusion of and best use of healthy public policy (Bury and Gabe, 2004; Pomerleau and McKee (2005). Issues which continue to reflect the cross-sectorial problems surrounding public health include homelessness and poverty (Ryan and Sarikoudis, 2003). The report does address the statistics around economic inequalities and poverty, showing that the borough has a higher proportion of people in lower-paid occupations, which significantly impacts on health. It also addresses some specific issues which emerge from the social health spectrum, including sexual health and young people (Bergmann and Scott, 2001). The report does focus on behavioural aspects of health, and illness, across specific social groups, including young people’s health. Some of the issues presented are similar to those found nationally and internationally, including teenage pregnancy and teenage social isolation (Bergmann and Scott, 2001; Goesling and Firebaugh, 2004).
However, there is very little focus on, for example, homelessness as a public health issue, one which affects many of the key points which are being raised in the report. Shah and Cook (2001) for example, show that in one of the key indices of cardiovascular disease, that of hypertension, factors influencing this disease the most are not socioeconomic status but actually social isolation, and homelessness is one of the most severe forms of social isolation that exists in our society.
The report cites a number of initiatives which have positively affected health and wellbeing within the borough, but it does not really present any radical or innovative initiatives to address what are ongoing, predictable and somewhat repetitive and recurrent health and lifestyle issues which impact upon morbidity and mortality. There is a great need for different approaches to public health which build upon existing knowledge and incorporate, perhaps, more concrete information. For example, including service user input in the collection, analysis and use of these kinds of data, and in the development of public health policy, should be a significant part of public health activities such as these, and should feature more strongly in these kinds of reports. Yet models of health and social care continue to exclude the patient voice, though in this circumstance it may be complicated by the ethnic and cultural diversity fo the borough (Gagliardi et al, 2008).
The report discussed identifies the specific public health concerns of this London borough, and demonstrates not only what the most challenging issues are, but how the public health data of mortality and morbidity statistics intersect with some of the socio-economic and cultural statistics of the area. It identifies key areas for health promotion, but does not go far enough in addressing individual differences and the genetic factors which can complicate sweeping statements about causal and affecting factors in health and illness. It demonstrates that public health policies must be focused on local need, and that ongoing concerns are cardiovascular disease, mental illness and cancer. All of these are related to lifestyles, and therefore public health policy also relates to social policy. However, the links between these two could be made much clearer.
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Spector, R.E. (2002) Cultural Diversity in Health and Illness Journal of Transcultural Nursing 13 197.
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