Status of Public Health in England

PUBLIC HEALTH IN ENGLAND TODAY

1.0 ABSTRACT

• Public health refers to all organised measures (whether public or private) to prevent disease, promote health, and prolong life aiming the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases.
• The novel research and advances in public health in the last two decades have pertinently improved life expectancy of the entire populace. However, research has revealed the significant difference in the quality of lives of the poorer groups and life compare with those from better-off backgrounds.
• Sanitation, aseptic techniques, vaccinations, the Welfare State, improved diets, screening, treatments and living and working conditions have led to greatly improved life expectancy across the population as a whole. In addition, increasing number of the population are living with complex co-morbidities.
• Many premature deaths are caused by largely preventable diseases (such as heart, lung, liver disease, strokes and cancer), so current public health initiatives are focused on co-ordinated action to address these and wider health inequalities.
• Public health activities in England are led by the government through the Department of Health and Public Health England, with local activities coordinated at local government level.
• Public health is increasingly taking on an international focus with new and emerging challenges and threats such as antibiotic resistance infections, bioterrorism, dementia and global warming. Global responses to public health threats are coordinated through the United Nations by the World Health Organisation.
• Approaches to the management of communicable and non-communicable diseases alike, can be categorised as primary, secondary and tertiary prevention interventions. A combination of approaches is required to successfully prevent and control disease – a fact that is reflected in current national strategies to manage dementia and tuberculosis
• There is a direct link between patterns and prevalence of disease and the need for services. Increasing emphasis is now being placed on interventions that prevent illness and reduce dependency on health and social care services.
• A number of diseases and premature deaths today are directly linked to lifestyle factors such as smoking, diet, exercise or lack of) and drug/alcohol consumption. Thus, initiatives such as Change4life, One You and SmokeFree are focused on encouraging behaviour change that will greatly prevent and reduce the burden of disease across the population both now and in the future.

2.0 DEFINITION AND CONTEXT OF PUBLIC HEALTH

The United Kingdom Faculty of Public Health (2010) defines public health as “the process and study of improving the quality of lives via promoting good health, protecting health and well-being, and preventing any form of ailment, which as a result prolongs the life span via the collective organised efforts of the society”.

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Public Health England (2016) further explained that the above functions are effectively delivered via a ‘core’ workforce, which includes public health professionals such as public health directors, health specialists, academics and practitioners who have competence in all or some of the nine major aspects of public health practice.

Further, Public Health England (2016) classifies the nine areas of Public Health Practice in the UK as: -Surveillance and assessment of the health and well-being status of the entire populace,

-Proper assessment of the evidence of effectiveness of health and treatment of illnesses and diseases,

-Development and application of policy and intervention strategy,

-Strategic leadership and joint activities in working for health,

-Improvement of health,

-Health protection,

-Health and social service quality,

-Public health intelligence, and

-Public health in academia.

3.0 INTRODUCTION

The purpose of this report is to succinctly review the current status of public health in England. In doing so, it will describe the roles of key public health agencies and explain, with reference to epidemiological data, current public health priorities. 

Next, using tuberculosis and dementia as a case study, different strategies for managing disease will be outlined and evaluated.

Finally, the links between current lifestyle choices and the requirement for future services will be analysed.

The first section of this report will explain the role of 4 key public health agencies.

4.0 ROLESIN PUBLIC HEALTH

There has been a pertinent impact in significantly improving the public health policies and interventions by a number of global, national and local organisations. The following organisations are known to have influenced the promotion of good health in the community:

• World Health Organisation (WHO): is a part of the United Nations that focus on global health issues. This organisation has been working for over 60 years on such issues as smallpox eradication, family planning, childhood immunisations, maternal morbidity rates, polio eradication, and AIDS.

The World Health Organisation, (2014) also outlines several leadership priorities, which are a part of the initiatives for better world health. These leadership priorities include:

      Working towards universal health coverage

      Developing international health regulations

      Increasing access to medication products

      Researching factors such as social, economic, and environmental issues as they contribute to health

      Preventing non- communicable diseases

      Putting emphasis on other ‘millennium development goals’ such as combating poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against woman.

• Public Health England (PHE): Public Health England is responsible for improving the health and reducing the disparities between the health status of various groups by enhancing good and quality lifestyle that would improve the health of the entire populace (www.gov.uk, 2018). More so, Public Health England also helps in advising government and also supports local government actions, the NHS and the public responsible for the protection of the nation from public health hazards (www.gov.uk, 2018).

• Local Authorities/ Local Government: local organisations are responsible for

Improving the health of people in their area, addressing the full range of factors determining good health and developing healthy and sustainable communities (Public Health England, 2016).

• The Office of National Statistics: the Office of the National Statistics collate statistics of health issues’ prevalence and prognosis, the cost of treatments considering different therapy and also how life expectancy improves in correspondence to the health status of the populace. Population health data gathered by the ONS and others is analysed and used to inform public health policies and priorities, which will be discussed in the next section of this report.

5.0 CURRENT PUBLIC HEALTH PRIORITIES

In their strategy document From Evidence into Action (2014), PHE set out the seven key priorities that require a coordinated response in order to improve the health of the populace. These priorities are projected for the next five to ten years to improve good health and increase the life-span of the people (NHS Confederation, 2018).

The seven priorities are as follows:

• Tackling obesity, most especially among children: it is noteworthy in that the statistics of obese adult and children are significant in the UK. Correspondingly, in 2015, 58% and 68% or women and men were recorded to be obese, respectively. NHS (2017) further explained that the prevalence of obesity significantly increased from 15% in 1993 to 27% in 2015. More so, NHS data (2017) explains that in 2015/2016, over 1 in every 5 children assessed and 1 in 3 in their 6^th year were assessed and diagnosed as obese or overweight. NHS (2017) further outlines that in 2015/2016, 525,000 health problems leading to admission in NHS hospitals were caused by obesity. These patterns are concerning, given that obesity is a major risk factor in a number of life-limiting illnesses such as heart disease and Type 2 Diabetes (PHE, 2014). Further, obesity has been identified as the second biggest cause of avoidable cancer, hence, the reason for a call for action to alleviate obesity in the community and to improve the quality of life of the entire populace (Cancer Research UK, 2018).

Furthermore, Public health England has strategized plans on how to alleviate obesity via changing the cultural context of obesity (Fenton, 2014; PHE, 2017). Correspondingly, on a quest to tackle obesity, PHE states that the failure to address the problems caused by the obesity epidemic will result in a greater burden on the welfare of the nation (Fenton, 2017; PHE, 2017). Fenton (2017) further explains that £6.1 billion has been spent on treatment of illnesses caused by over-weight and obesity in 2014 to 2015. Fenton (2017) further discloses that obesity has an integrated impact on the economic development via reducing the healthy workforce of the entire populace. Hence, PHE discloses that the overall cost of tackling obesity in the nation is £27 billion (Fenton, 2017; PHE, 2017). PHE further discloses the reason for such enormous expenses on tackling obesity and labelled that the entire populace is living in an environment that is obesogenic, because the society consumes excess food with too much calories, however, physical activities are reduced which in turn affects the health of the entire populace by accumulating excess fat to the body (Fenton, 2017; PHE, 2017). Furthermore, PHE estimated in 2014 the enormous fast food and takeaway outlets to be (50,000), nevertheless, there are said to be more fast food outlet in deprived areas than in wealthy areas (Fenton, 2017; PHE, 2017). In order to enhance good health in the community, PHE advises the following changes to the process of fast food which are;

1. Reduction of portion size,
2. The fats content of the food must be reduced as well as the frying practices,
3. Salt and sugar contents must be reduced,
4. Ensuring the increment of fruit content, as well as vegetables and fibres,
5. Ensure the promotion of healthier options,
6. Ensure the procurement of healthier ingredients and food products from suppliers,
7. Ensure comprehensive information of the calorie content of the food (Fenton, 2017; PHE, 2017).

However, PHE (2017) explain that whilst the rate of obesity increase has slowed down since 2001, the trend is still upwards.

Public Health England’s desire outcome in relation to this priority is to achieve an increase in the proportion of children leaving primary school with a healthy weight, accompanied by a reduction in levels of excess weight in adults.

• Reducing smoking and stopping children starting: Coleman (2004) outlines that the process of significantly reducing smoking habits or addictions among young people is both challenging and difficult for healthcare professionals. The Health Survey for England by NHS (2017) outlines that 15.5% of adults currently in England smokes, which is seen to have reduced from 19.9% in 2010, and from 16.9% in 2015. The report further observed that 26.8% of adult smokers were aged 16 years, and whilst the prevalence in younger age groups has reduced, most adult smokers start the habit in their teen years. NHS in 2017 outlines that annual mortality caused by smoking in 2015 is estimated to be 79,000 that equates to 16% of all mortality in England.

Furthermore, PHE proposes that by 2015, there would be a tobacco-free environment (PHE, 2015). However, PHE explains that despite the declination of the rates of smoking in the society, nearly 1 in 5 adult still continues to smoke and about 90,000 individuals that smokes regularly are seen to be between the age of 11 and 15. Consequently, PHE states that smoking increases and reinforces the inequalities of health in the society, and its not evenly distributed. Correspondingly, during a recent survey, PHE states that individuals in more deprived areas are seen to be more likely to smoke and less to quit than those living in an affluent areas (PHE, 2015). PHE (2015) further states that it has been revealed that most smokers’ starts at their teenage years, with a complex reasons ranging from peer pressure to behavioural challenges. More importantly, PHE (2015) explains that reducing tobacco use is very important in the process of tackling smoking among adults and ensuring that children are unable to start. More so, PHE (2015) advises that the following would help in tackling smoking in the society;

1. Ensuring that tobacco is less affordable,
2. Halts the promotion of tobacco companies
3. Ensure strict and affective regulations on tobacco products
4. Sensitising the entire populace about the harm of smoking tobacco
5. Significantly reducing the exposure to second-hand smoke

Correspondingly, PHE (2015) explains that effective services and treatments, supportive social networks and environments that are smoke free would have a pertinent impact in the reduction of smoking in the entire populace. More so, PHE (2015) further states that local stop smoking services has play a significant role in tackling smoking and has the best chance of success. However, PHE (2015) opines that the number of smokers utilising this services is significantly reducing. PHE (2015) explains that about 450,000 individuals personally set a date to quit smoking via the stop smoking services from April 2014 to 2015. Instead, most individuals that smokes uses the other alternative quitting methods with least effective outcome.

Also, PHE (2015) advises individual that smokes to use electronic cigarette to quit tobacco use and surveys shows that 2.6 million adults use electronic cigarettes in Great Britain, 3 in 5 electronic cigarette users still smokes, and 2 in 5 electronic cigarette users are former smokers who have stopped smoking tobacco for vaping.

Public Health England’s desire outcome in relation to this priority is to achieve a reduction in the proportion of 15-year-olds who smoke.

• Reducing harmful drinking and alcohol-related hospital admissions: NHS (2017) statistics on alcohol, recorded 339,000 estimated hospital admissions caused by alcohol consumption in 2015/2016. The aforementioned statistics on admissions represent a 3% increase on 2015/2016 and 22% on 2014/2015 respectively. The above statistics represent 2.1% of all hospital admissions and have increased steadily over the last 10 years (NHS, 2017). Statistics shows that in terms of the gender profile of admissions, 61% and 39% were male and female, respectively (NHS, 2017). Alcohol consumption is a factor in many cancers; liver and heart disease, and NHS statistics recorded 6,813 deaths caused by excess alcohol consumption, which represented 1.4% of all mortalities in England in 2015.

Furthermore, PHE states that alcohol is associated with a diversified and wide range of illnesses and social harms (PHE, 2018). PHE (2018) reveals that £11 billion is spent on alcohol-related crimes annually, £7 billion lost annually due to unemployment and sickness which affects the healthy workforce of the entire populace which affects the economy of the nation. Against the above survey by PHE, PHE (2018) further reveals that alcohol costs up to £21 billion to the society. PHE (2018) further advises that increasing the investment in interventions of alcohol, which includes specialist alcohol treatment, can enhance and produce a high profit return. PHE (2018) survey reveals that £40,000 is spent on 100 people with alcohol related illness. Hence, improving on the investment of alcohol intervention will save £60,000 and prevent up to 18 accident and emergency visits and 22 hospitals (PHE, 2018).

Public Health England’s desire outcome in relation to this priority is to achieve a reduction in the number of hospital admissions due to alcohol.

• Ensuring children has the best start in life: is to ensure a child gets the best education to prepare them for the future is vital (Korkodilos, 2015). Nevertheless, Korkodilos in 2015 outlines that 2 in every 5 children in England are reported to be not ready to start formal education at age 5; hence, not adequate number of children possess the required skills needed to succeed in school. Correspondingly, Korkodilos (2015) highlights that PHE has priority in ensuring that every child in England has an outstanding start in life and getting ready to start the process of learning at 2 which would be prepare them to start school at age 5. Furthermore, the PHE London recently published a report that is set to improve school readiness, and create a better start for London. This report by PHE seems to be aimed at healthcare professionals, parents and carers. In addition, Korkodilos (2015) outlines that the pertinent impact of early support from parents and carers in ensuring children gets the best starts cannot be overemphasized, which helps the children to acquire the skills needed to be positively effective socially and emotionally.

Furthermore, In 2012/13, 52% of children reached a good level of development at the end of their reception year, with 36% of children eligible for free school meals reaching this level:

      Increasing coverage of meals, mumps and rubella immunisations fpr all children at five years of age

      Leading and coordinating the children Flu Programmed, working with NHS England

      Expanding new-born bloodspot screening to include four new inherited metabolic disorders

      Working with NICE on the implementation of the quality standards and pathways for emotional and social wellbeing in early years

      Expanding the Start4Life information service for parent with 0-2 years and 0-5 years and sign up over 200,000 more parents

Public Health England’s desire outcome in relation to this priority is to achieve increase in the proportion of children ‘ready to learn at two and ready for school at five’.

• Reducing the risk of dementia, its incidence and prevalence in 65-75 year olds: several research have reveal that the biggest risk factors of dementia is age which connotes that older people are at higher risk of developing dementia (Larson, Wang, James, Bowen and Wayne, 2006). However, Larson et al. (2006) further outlines that dementia is not an inevitable part of aging. More so, about 100 people with the age range of 65-69 have dementia, and there has been a significant increase in this figure in five for people with the age range 85-89. Furthermore, NHS (2017) highlights that dementia is continuous growing challenge, hence, the growth of the population and its increase in life-span is directly proportional to increase in risk factors, thereby increases every year. Statistically, about 676,000 people have dementia in England, and it is reported to affect only the elderly beginning from the age 65 and there by doubles its likelihood every half-decade (5 years) (NHS, 2017). However, some types of dementia are reported to have the ability to develop earlier, presenting various symptoms for the affected individual, their carer, and their family (NHS, 2017). Correspondingly, NHS (2017) outlines that dementia is said to record about 540,000 carers for affected people in England. The PHE has decided to significantly reduce the prevalence and incidence of dementia (Public Health England). The Public Health England resource for competent healthcare professionals and local authorities to ensure that action is taken in midlife to enhance healthy lifestyles and alleviate the prevalence and risk of dementia (Public Health England). This disease will be extensively described further to this essay in the next session.

Public Health England’s desire outcome in relation to this priority is to reduce prevalence and incidence of dementia among 65 to 74-year-olds.

• Tackling the growth in antimicrobial resistance: WHO. (2018) Defines antimicrobial resistance as the ability of a microorganism to resist the metabolic reaction of an antimicrobial, consequently resulting in ineffectiveness of standard treatment. Hence, infections remain in its host and proliferate and spread to others. Correspondingly, Shallcross et al. (2015) explains that antimicrobial is the fundamentals of all modern medicine, which includes major surgeries through to caesarean sections and modern cancer treatments.  Also, Shallcross et al. (2015) further explain that these drugs enhanced overtime on how medicine is practiced which has arose to be one of the world’s major challenge.

Furthermore, PHE revealed that between 2010 and 2013, the prescription of antimicrobial drugs such as antibiotics and antiviral drugs was increased by 6% in GPs and hospitals (NICE, 2014). PHE also discovered that over the 4-year period, the prescription of antibiotic in hospital inpatients increased by 12%, and other community prescription, which includes dentists rose by 32% (NICE, 2014).

Public Health England’s desire outcome in relation to this priority is to achieve reductions in the number of serious infections that are resistant to treatment.

• Achieving a year-on-year decline in the incidence of tuberculosis (TB):

PHE (2015) states that TB rates in England continue to experience declination. Nevertheless, the UK TB incidence is four times higher than the US (PHE, 2014). A total of 6,250 cases of TB were recorded and identified in England in 2014, and a significant reduction on the 7,257 cases were reported and recorded in 2013.PHE (2015) further points out that the recent figures shows that there is 12 cases per 100,000 people in England, which is noticed to have reduced from 15.6 cases per 100,000 people in 2011. Correspondingly, PHE (2015) states that these are very welcoming improvement as regards the significant reduction of TB and continue the trend downwardly for the last 2 years. More so, there has been no incidence of TB reduction rate in those born in the United Kingdom. In January 2015, PHE and NHS England committed to develop collaborative plans to alleviate TB.

There shall be an extensive discussion about TB further in this report in the next section.

Public Health England’s desire outcome in relation to this priority is to achieve a year-on-year decline in tuberculosis incidence.

6.0 MANAGING DISEASE

There are 3 recognised strategies for preventing and controlling the spread of disease (WHO, 2011), which are:

Primary prevention

Primary prevention strategy is concerned with the onset prevention of disease, and also helps to reduce the disease incidence (Anstey et al., 2017). More so, primary prevention involves pre-intervention of disease before the symptoms or any form of evidence of the disease or injury (Anstey et al., 2017). Examples of primary prevention can be seen as vaccinations i.e. prevent disease and taking protective measure against health effect of the disease Anstey et al., 2017. Furthermore, public health strategies focused on the prevention of infectious disease that is known as the primary prevention. This strategy by the public health is used to prevent new cases of infection prevalence by blocking the process of pathogens being transmitted into susceptible human hosts, or enhances the host’s ability to resist infections.

Secondary prevention

Public health strategy with secondary prevention is to ensure early detection of new cases of infectious disease and required intervention to prevent or significantly reduce its risk of spreading and proliferation.

Tertiary prevention

The public health refers to tertiary prevention as a strategy to ensure that a disease does not become severe. This prevention strategy is reported to significantly increase the quality of life of the individual.

Next, how these strategies are applied to the prevention and control of Tuberculosis and Dementia will be reviewed.

7.0 TUBERCULOSIS

Infectious disease can be defined as a disease that is contagious, which can spread from one host to another. More so, they are seen to be cause by organism, such as bacteria, fungi or parasites. Tuberculosis (TB) is an example of infectious disease.

Tuberculosis is known to be cause by a type of bacterium known as Mycobacterium (Kleinnijenhuis et al., 2011). It is contagious and spread via coughing, sneezes and another person inhales the droplets that were coughed out of an infected person that contains TB bacteria (Kleinnijenhuis et al., 2011). More so, the method of transmission of TB is majorly through air. TB is widely transmitted when the infected person coughs, sneezes, speaks, or sings. Also, people within the environment of the infected person may breathe in the Bacteria and become infected with TB. The symptoms of TB include;

• Coughing for weeks (2 or 3 weeks),
• Blood-containing coughs,
• Pain in the chest, or during breathing or coughing,
• Unexplained loss of weight,
• Fatigue, fever, sweatiness in the night and chills and loss of appetite.

As the bacterium continues to proliferate and multiply, it has a pertinent impact on the immune system, which eventually overwhelms the immune system to cause the onset of TB. However, research have shown that once TB is diagnosed, effective, adequate and appropriate treatment which includes the administration of tubercular drugs can cure the disease, hence, TB is curable. However, studies have disclosed that there have been cases of drug-resistant strains of Tuberculosis that have greatly enhanced the epidemic and therefore, there are 20% cases of TB caused by TB strain which are seen to be resistant to standard treatments and 2% of the TB strains are reported to be resistant to second-line drugs.

Drug-resistant TB (DR TB) is spread the same way that drug-susceptible TB is spread. TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. (Cdc.gov, 2018)

Latent TB Infection

TB bacteria can live in the body without making you sick. This is called latent TB infection. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria

People with latent TB infection:

• Have no symptoms
• Don’t feel sick
• Can’t spread TB bacteria to others
• Usually have a positive TB skin test reaction or positive TB blood test
• May develop TB disease if they do not receive treatment for latent TB infection

Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have a weak immune system, the bacteria become active, multiply, and cause TB disease.

Tuberculosis Disease

TB bacteria can become active if the immune system can’t stop them from growing. When TB bacteria are active (multiplying in the body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

Many people who have latent TB infection never develop TB disease. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later when their immune system becomes weak for another reason.

For people whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for people with normal immune systems.

Primary prevention of Tuberculosis:The BCG vaccination offers protection against Tuberculosis and is recommended on the NHS for babies, children and adults under the age of 35 who are considered to be at risk of catching TB. However, The BCG vaccination is not routinely given to anyone over the age of 35, as there’s no evidence that it works for people in this age group. (nhs.uk, 2018).

Tuberculosis prevention also includes, managing cases correctly, investigating cases properly and environmental control.

It is also important for individuals to take some of the following precautions to stop the infection spreading to family and friends:

      To stay away from work, school or college until the TB treatment team advises it’s safe to return back to work

      Always cover mouth when coughing, sneezing or laughing

      Carefully dispose of any used tissues in a sealed plastic bag

      Open windows when possible to ensure a good supply of fresh air in the room

      Avoid sleeping in the same room as other people 

Secondary prevention of Tuberculosis: There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST) and TB blood tests.  A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease. However, tests such as a chest x-ray and a sample of sputum are needed to see whether the person has TB disease by conducting various methods of the following tests:

Pulmonary TB– affects the lungs and it can be detected by carrying out test that include having, Chest X-ray or samples of phlegm which is tested for the presence of TB bacteria.

Extra pulmonary TB– which occurs on the outside of the lungs can be diagnosed when the correct test are carried out. These test usually include having MRI scans, ultra sounds or CT scans. The examinations involve using a thin, long, flexible camera tube (Endoscopy).

Detection of latent TB infection (LTBI)

The CDC recommends a strategy to identify those who have LTBI and, if indicated, the use of chemotherapy to prevent the latent infection from progressing to active TB disease.  There are two tests that can be used to help detect latent tuberculosis infection:

1. The Tuberculin Skin Test (TST)

The first is a skin test in which testing material, called tuberculin, is injected intradermal into the individual and in 2 to 3 days, the patient returns to the health care worker who checks to see if there is a reaction to the test. 

2. QuantiFERON-TB Gold (QFT-G)

The second test used to identify LTBI is QFT-G, a blood test that measures how a person’s system reacts to the bacteria that causes TB.

Tertiary prevention of Tuberculosis: People with latent TB infection do not have symptoms, and they are unable to spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection are often prescribed treatment to prevent them from developing TB disease. Treatment of latent TB infection is essential for controlling and eliminating TB. (NHS.uk, 2018)

Treatment of latent TB infection should be initiated after the possibility of TB disease has been excluded. Latent TB medication – Isoniazid medication

Latent TB could develop into an active TB disease at a later date, particularly if the immune system becomes weakened.

Treatment used for active TB will vary depending on whether the tuberculosis is resistant some of the standard TB medications, which are:

• Chemoprophylaxis medication
• Isoniazid (INH)
• Rifampin (RIF)
• Ryrazinamide
• Ethambutol

Tuberculosis treatment is a course of antibiotics that will usually need to be taken for six months. However, Several different antibiotics are used because some forms of TB are resistant to certain antibiotics. If you’re infected with a drug-resistant form of TB, treatment with six or more different medications may be needed.

When a person is diagnosed with pulmonary TB, the person will be contagious for about two to three weeks into the course of treatment.

Countries with high TB rates

Parts of the world with high rates of TB include:

• Africa – particularly sub-Saharan Africa (all the African countries south of the Sahara desert) and West Africa
• Southeast Asia – including India, Pakistan, Indonesia and Bangladesh
• Russia
• China
• South America
• The western Pacific region (to the west of the Pacific Ocean) – including Vietnam, Cambodia and the Philippines

8.0 DEMENTIA

A non-infectious disease is a disease that is not contagious, and does not have the ability to spread from one host to another. More so, non-infectious diseases are not as a result of pathogens, they are as a result of the lifestyle factors, toxic substances from the environment or food, gene mutations. An example of non-infectious disease is dementia. NHS (2018) explains that dementia is described as a symptoms shown when the function of the brain declines. More so, several diseases is responsible to cause dementia, and research have shown that most of these diseases are created through the abnormal build-up of proteins in the brain (NHS, 2018). NHS (2018) discloses that this build-up of protein results in the depreciation of nerve cells function that eventually dies suddenly. The symptoms of dementia vary depending on the part of the brain that is damaged, however, NHS (2018) outlines that the most common early symptoms of dementia are:

• Loss of memory,
• Have low and difficult concentration,
• Confusion,
• Difficulty in following a conversation or finding the right word,
• Confusion about time and place,
• Consistent changes in mood.

Several researches reveal that dementia reduces life expectancy by half. Vorst et al. (2015) explains that mortality of hospital-admitted dementia patient was reported to be higher than those visiting after a cohort study of 10 years. Vorst et al. (2015) therefore concluded that dementia as compared to other illnesses and disease has a very poor prognosis. NHS (2018) outlines that an average people with dementia live eight to ten years starting from the onset of the first symptoms. However, NHS (2018) further explains that life expectancy of dementia patient varies on the age when symptoms begin i.e. a patient diagnosed at 60s will live more years than an older counterpart diagnosed at 90s.

Dementia mainly affects people over the age of 65 (one in 14 people in this age group have dementia), and the likelihood of developing dementia increases significantly with age. However, dementia can also affect younger people too.

Most people with dementia finds it difficult to have common conversation or keep track of their day-to-day bills and activities. However, Alzheimer’s disease is the most common type, followed by vascular Dementia (Alzheimer’s Society, 2018). Dementia mainly affects people over the age of 65 (one in 14 people in this age group have dementia), and the likelihood of developing dementia increases significantly with age. However, dementia can also affect younger people too. Research by (Alzheimer’s Society, 2018) that there is more than 42,000 people in the UK under 65 with dementia.

The most common types of dementia are:

Alzheimer’s disease– is the most common form of dementia that account for 60- 80% of cases. It is a slow progressing disease that an average person with it lives for four to eight years after receiving the diagnosis. Alzheimer’s occurs due to physical changes in the brain and a build-up of certain proteins of nerve damage.

Vascular dementia– is known as post-stroke or multi-infarct dementia, account for about 10% of all cases of dementia. It’s caused by blocked blood vessels. These occur in strokes and other brain injuries.

Dementia with lewy bodies– is a form of dementia that occurs due to clumps of a protein in the cortex. In additional to confusion and memory loss, Dementia with Lewy bodies can also cause: Hallucination, Imbalance, Sleep disturbances. Dementia with Lewy bodies is closely related to Parkinson’s disease and often has some of the same symptoms, including difficulty with movement.

Frontotemporal Dementia- is referred to a group of dementia that often cause changes in personality and behaviour. Frontotemporal Dementia can occur due to a range of conditions, e.g. Pick’s disease and progressive supranuclear palsy. It can also cause language difficulty.

Mixed dementia- is when a person has more than one type of dementia, and a mixture of the symtoms of those types.

Primary, secondary and tertiary prevention of dementia

The prevention of dementia is basically divided into 3 strategies, which are analysed as the following:

Primary prevention of dementia

At present a lack of regular physical activity can increase the risk of heart disease, becoming overweight, obese, or managing conditions like type 2 diabetes, are all of the risk factors for dementia. Correspondingly, older adults who don’t exercise are also more likely to have problems with memory or thinking (known as cognitive abilities). (Nhs.uk, 2018).

A clear message of ‘What’s good for your heart is good for your hand’ is needed throughout preventive public health interventions and campaigns to improve public understanding of how people can reduce their risk of developing dementia.

Evidence also proved that building up cognitive reserve over life could reduce risk of developing dementia. Educational achievement, complex work, social and mental stimulation are all important, as these gives rise to a secondary public health messages encouraging life-long learning, ‘use it or lose it’. (Alzheimer’s Society, 2018)

Secondary prevention of dementia:

There’s no single test for dementia, therefore, to identify dementia a person will have to be diagnose based on a combination of assessments and tests. Either a general practitioner or a specialist at a memory clinic may do these in order to detect the type of dementia at an early stage. This can be achieved through:

Medical history– the general practitioner will ask how and when symptoms started usually do this and whether they’re daily life is affected. Medication and any symptoms will be reviewed including non-prescribed medicines bought over the counter from pharmacies, and any alternative products, such as vitamin supplements

MRI scan– is recommended to help confirm a diagnosis of dementia and the type of disease causing the dementia

Brain scans– such as an MRI scan, CT scan or a single photon-emission computed tomography (SPECT) scan – this can detect signs of dementia and damage to the blood vessels in the brain

Cognitive (characteristic changes in thinking) tests– this test assess a number of different mental abilities through, short- and long-term memory, concentration and attention span, language and communication skills, awareness of time and place (orientation). However, It’s important to remember that the test scores may be influenced by a person’s level of education.

Blood test- these blood tests will check: liver function, kidney function, thyroid function, haemoglobin A1c (to check for diabetes), vitamin B12, and folate levels

Tertiary prevention

There’s currently no cure for vascular dementia and there is no way to reverse any loss of brain cells that occurred before the condition was diagnosed. However, there are options of drug treatments and activities that may temporarily improve symptoms of other dementia depending on its cause.

Drug treatments– there are drugs that can help with the symptoms of dementia, or stop them from progressing for a while. However, most of the medications available are used to treat Alzheimer’s disease, as this is the most common form of dementia. The following medications can be achieved to temporarily reduce symptoms:

• Acetylcholinesterase inhibitors- these medicines prevent an enzyme from breaking down a substance called acetylcholine in the brain, which helps nerve cells communicate with each other. (Nhs.uk, 2018)

• Donepezil also known as Aricept, rivastigmine (Exelon) and galantamine (Re,iny) are all use to treat the symtoms of mild to moderate Alzheimer’s disease. However, research also proves that Donepezil can also be use to treat more severe Alzheimer’s disease. (Nhs.uk, 2018)

• Mematine- is used for moderate or severe Alzheimer’s disease. It’s suitable for those who can’t take or are unable to tolerate acetylcholinesterase inhibitors. It works by blocking the effects of an excessive amount of a chemical in the brain called glutamate.

Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety mostly find in Vascular dementia.

Non-drug treatments and support- there are a range of non-drug treatments available that can help someone to live well within dementia. There are clubs and activities designed to help people in the same situation, which can be rewarding for both the person with dementia and their families and carers. These can be achieved through:

Groups and Community activities– people with the early stages of dementia may enjoy walking, attending gym classes for older people, or meeting up with understanding and supportive friends in their community. A growing number of care homes now offer a sensory garden for residents to spend time in

Healthy life style– includes 5 A Day fruit and vegetable to achieve a healthy, nutritious diet.

Physical activities– to do something creative, some gentle exercise, or take part in an activity helps them to realise their potential, which improves self-esteem and reduces loneliness.

Occupational therapy– occupational therapists work with people of all ages and can look at all aspects of daily life in their home, school or workplace.

They look at activities you find difficult and see if there’s another way you can do it.

Activity for dementia– keeping an active social life is key to helping someone with dementia feel happy and motivated.

Hence, it is noteworthy that a combination of interventions is needed to pertinently alleviate and manage effectively these diseases. Furthermore, This combination of approaches is revealed in the current government TB and dementia strategies.

9.0 LIFESTYLE CHOICES AND THE IMPACT ON PUBLIC HEALTH

This report will now analyse the impact and influence of current lifestyle choices on future demands for services. More so, this report will be in reference to novel and recent researches and studies on dementia. Farhud (2015) explains that lifestyle has a pertinent impact on the public health and it is an important factor of health. More so, according to WHO, 60% of the health conditions of the public is related to the individual’s quality of life (Fahrud, 2015). Recently, Fahrud (2015) explains that there has been a very broad change in the lives of individuals. Fahrud (2015) outlines that malnutrition, unhealthy diet, smoking, excess alcohol consumption, abusing drugs, stress are known to be the presentation of unhealthy lifestyle that are utilised as a lifestyle that has a high risk of poor health.

Furthermore, Elwood et al. (2013) highlights that healthy lifestyle that includes a non-smoking, healthy and normal BMI, diets which includes high fruit and vegetable intake, regular and adequate exercise, low and moderate intake of alcohol are known to pertinently help in the reduction of chronic diseases which also includes dementia. Correspondingly, recent studies on the aged population revealed the association between choice of lifestyle and cognitive impairment (Elwood, 2013; Buchman et al, 2015). However, the likelihood of relapse of the health of individuals is seen as the major challenge of the short-term studies, and in fact, few researches have concluded a cohort study of the middle-age populations to understand the lifestyle that affects dementia over an extended period of time (Elwood, 2013; Buchman et al, 2015). In addition, Whitehall studies have shown that obesity, alcohol and smoking pertinently influenced the cognitive function over 10 years of the entire populace (Singh-Manoux, 2012; Elwood, 2013;Hagger-Johnson et al., 2013). Also, there is a direct correlation between the prevalence of disease and the requirement for a range of health and social care services in order to improve the health of the entire populace and to primarily prevent the occurrence of severe ailments such as dementia.

Furthermore, there has been major concern about the cost of managing dementia, which has called for primary prevention to significantly reduce the prevalence of dementia in late-life. Also, Comas-Herrera et al. (2007) supports this study (Knapp, 2012) that there would be a pertinent impact on the cost of treatment of dementia if primary prevention is taken seriously.

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