Strategies to Improve Health in Glasgow

Strategies to Improve wellness in Glasgow astir(p) the wellness of the citizens of Glasgow.wellnessThe World wellness Organisation (WHO) definesHealth is a state of complete physical, psychical and social well-being and not merely the absence of disease or infirmity. This definition is unchanged since 1948.1Demography of GlasgowAccording to the 2002 census, Glasgow has a population of nearly 580,000. This is more than than 10% of the total population of Scotland that is just over 5 million. The metropolitan atomic number 18a of Glasgow houses close to 1.7 million people. It is the largest city in Scotland and 4th largest in the UK. moderately fewer than 24% of the population of Glasgow atomic number 18 below the progress of 20 and slightly more than 15% are aged over 65 with about 7% over 75. This is similar to the rest of Scotland.2The ethnic mix is 96.5% white, 2.5% Asian, 1% Black, Chinese and other ethnic groups.3Indices of wish were updated in 20074 for England hardl y slightly divers(prenominal) indices are used for the four home nations of the UK. The Scottish index was produced in 2006.5 Although there are slight differences in the criteria, eastern Glasgow has the most deprived areas in the whole of the UK. However, Glasgow is a mixed conurbation with many affluent areas too.Health InequalitiesThe NHS was supposed to remove health inequalities but has failed to do so. The Black Report, commissioned in 1977 and published in 1980 found that little had changed in terms of health inequalities.6 Sir Donald Achesons Report of November 1998 found little evidence of make better workforcet.7 A seminal authorship by Dr Julian Tudor Hart in 1971 coined the inverse boot law.8 In areas with most sickness and death, general practitioners have more work, larger lists, little hospital support and inherit more clinically ineffective traditions of consultation than in the healthiest areas and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings and conform to recurrent crises in the availability of beds and replacement staff. These trends nookie be summed up as the inverse care law that the availability of good medical care tends to vary inversely with the need of the population served.Tackling health inequalities is a major component of the Governments health policy. There are plenty of publications9 but little evidence of change. Health and life expectancy have improve through all strata of society but the gradient down the social classes corpse or has expanded. well-nigh argue that this is a disgrace whilst others say that provided that there is improvement in all sections that this is an achievement.The WHO Commission on the Social Determinants of Health10 was chaired by Sir Michael Marmot and looked at health inequalities not only in poor nations but also in the rich. It found that children born in the Calton area of Glasgow will live, on average, 28 years less than a person living eight miles awayinLenzie, East Dumbartonshire. There the life expectancy is 82 years compared with 79 for the whole of the UK. A Calton resident has a life expectancy of 54 years. The report said adult death rates were generally 2 times higher in the most deprived parts of the UK than in the most affluent. Throughout the country and through all social classes, women live, on average, five years longer than men.11deathrate rates are high in Scotland, higher in Clydeside and even higher in Glasgow. They are especially high in areas of deprivation. declinationreases in deaths from coronary thrombosis heart disease (CHD) have been offset by increases in deaths from liver disease and suicide.12The challengeGlasgow is probably the most challenging city in the UK to improve health, if not the most challenging in the European Union (EU). The incidence of CHD and stroke is the highest in Western Europe and most of this is attributable to modifiable risk of exposure factors.13 Rates of cancer are also high. The incidence of lung cancer is 77 per 100,000 in Western Scotland compared with 49 per 100,000 in the rest of the UK and most of this is accounted for by skunk habits.14 Glasgow has been called the UKs fattest city15 Obesity is well known as a risk factor for CHD and diabetes but it also contributes to the risk of many cancers. The WHO says that obesity is arcsecond only to smoking as a cause of cancer.16If improvement in the health of Glasgow was aimed purely at reducing smoking and obesity it could have a major impact on health. Other areas where there whitethorn be significant benefit are a reduction in do drugs and alcoholic beverage abuse and safe sexual practices. Substance abuse and sex are related. or so prostitutes work to fund a drug habit and much imprudent sex occurs when intoxicated by drugs or alcohol. Intravenous drug use and promiscuity spread hepatitis B and HIV. Hepatitis C is rattling commonalty with intravenous drug use but is les s commonly sexually transmitted. Accidents and much violence solution from intoxication, especially with alcohol. Between 1960 and 2002, the death rate from cirrhosis in men rose by 69% in England and Wales and 106% in Scotland. Amongst women it rose by nearly half.17 Improving mental health is also extremely important.18 It is often linked to substance abuse but it is difficult to decide if mental illness is caused by drug or alcohol abuse or a result of it.People often have more than one risk factor. This is why doctors use tables that examine several parameters to assess an psyches risk.19 Those in visit social classes are more likely to have multiple risk factors. For males, 30% in social class V have at to the lowest degree two or three high risk behaviours compared to fewer than 10% in social class I. For females, the figures are 20% and fewer than 5% respectively.20Some benefit whitethorn be obtained from improved medical services. Governments whitethorn help with allevia ting poverty and economic regeneration but most intervention will be aimed at getting the individual to take responsibility for his own health. He has to understand the problem. He moldiness want to change. He moldiness be charge for his own good. There is a vast amount of health promotion material that is readily available.21A single agency is limited in what can be achieved. It is important that many agencies and all levels of society should feel part of this great challenge to change the ways and the attitudes of the people of Glasgow.Government actionImproving medical services to cope with those who suffer from the important diseases should improve outcome but disease prevention offers hope of a much greater improvement. Most of the risk factors for illness and premature death are modifiable and amenable to change by the individual.Legislation may come from the EU, UK or Scottish Government. It may change behaviour as in banning smoking in public places or it may address povert y and mischievousness housing. Poverty is bad for health but poverty applies only to the lowest in the social scale whilst there is a gradient of health and life expectancy accountability across the social classes.22 The benefit of giving money to poor families is unclear.23Laws may aim to curb tobacco plant or alcohol use. Raising tax revenue reduces tobacco consumption24 and there are a number of ways of other ways of reducing alcohol consumption too.25 Subsidy as well as taxation may make brawny food more attractive and unhealthy food less so.26Governments must assure funding for health promotion campaigns and may help with coordination across various departments. The NHS is an obvious department to be involved in both health promotion and provision of medical services. Education may be important in trying to change both knowledge and attitudes amongst five-year-old people. It can help to develop an interest and knowledge in healthy eating and cooking. It can aim to change attitudes to tobacco, alcohol and drugs and encourage an ethos of exercise. The subdivision of Trade and Industry may be involved in economic regeneration. both the police and courts may be able to direct people with problems related to drug or alcohol abuse towards care rather than just a punitive system.The process of changeHealth promotion aims to get individuals to change to a healthier lifestyle. This is not easy to achieve. Change is rarely easy. It involves the individual loss through several steps on the way to achieve a lasting change in habit and attitude.Health promotion initiativesThe mechanism for health promotion is normally mass media campaigns. They seem to work for smoking cessation27 and even in changing sexual behaviour in young people.28 However, there is very little evidence about long term effects.Campaigns may be aimed at one facet or multiple risks. For example, diet, weight and exercise are intimately entwined. This may spill over into smoking, alcohol and drug abuse. Health promotion may be at a national, community or individual level. The individual level is usually when a patient is seen in a medical setting, especially general practice.Simply exhorting people to change is not enough. It must be facilitated. Most general practices have antismoking clinics where support, advice and even prescriptions to help withdrawal may be had. The subject has been extensively reviewed by both CKS29 and NICE.30 People must be helped to appreciate what is healthy food and that it is not more expensive than their traditional diet. Fun runs are of limited value as they are an isolated event. Changes in diet and exercise must be for life. The individual must find a form of exercise that he can manage and he likes or he will not persevere. Counselling and support for substance abusers must be available. Methadone can give stability to the life of a heroin user31 and acamprosate can reduce the craving for alcohol32 but counselling must not be ignored .Long term changeIn Europe it is usually suggested that inequalities in health are the result of inequalities in income. In the USA they focus on health literacy33 and suggest that it is inequality in education that is responsible. As income and education tend to be related it is possible that one is a surrogate for the other. Health is worse in those of lower intelligence but this does not account for all the discrepancy.34.People from poorer backgrounds are more likely to smoke.35 Smoking is the main cause of differences in death rates in middle age across socio-economic groups. In men between 35 and 69 years, it accounts for 59% of social class differences in death rates.36 They are more likely to be obese37 and this may be linked to the higher incidence of diabetes.38 Abuse of alcohol is more prevalent as is drug abuse. They are more likely to insure teenage pregnancy39 and to be involved in accidents.40 Accidents are a major cause of death and disability in those under 45.41 T hey are more common in lower social classes and in males more than females. This is not just due to high risk jobs as both poverty42 and lower social class43 are risk factors for children too. There is also a relationship between poverty and poor mental health.44 However, as poor mental health causes social declination the question of cause and effect arises.Perhaps the most important aspect of long term health improvement is improvement in general education. Health literacy is closely related to general literacy.45 People of poor health literacy have poor lifestyles, they present late with disease and are poor in contour with management. Those with poor educational achievement have a dead end job or no job. They have low self esteem and are more likely to abuse drugs and alcohol, to smoke and have a poor diet. Teenage pregnancy is more common in low achievers. Improved education, improved job prospects and improved standard of living are the key to improving health.BibliographySo cial Determinants of Health by Michael Marmot and Richard Wilkinson. Oxford 2005.Promoting Health A Practical Guide by Linda Ewles and Ina Simnett. Balliere Tindall 2003.Challenging Health Inequalities From Acheson to Choosing Health (Health Society). Elizabeth Dowler and Nick J. Spencer. University of Bristol 2007.Footnotes1 World Health Organisation. WHO definition of Health. http//www.who.int/about/definition/en/print.html2 Upmy street.com. http//www.upmystreet.com/local/my-neighbours/population/l/Glasgow.html3 DirectGlasgow.co.uk http//www.directglasgow.co.uk/glasgow-information/glasgow-information.asp4 Indices of Deprivation 2007. http//www.communities.gov.uk/communities/neighbourhoodrenewal/deprivation/deprivation07/5 Scottish Index of Multiple Deprivation. http//www.scotland.gov.uk/Topics/Statistics/SIMD/6 The Black Report. http//www.sochealth.co.uk/history/black.htm7 The Acheson Report. . http//www.archive.official-documents.co.uk/document/doh/ih/contents.htm8 Tudor Hart J The inverse care law. Lancet 27 Feb 1971. 1(7696)405-12.9 Department of Health. Search on health inequalities. http//www.dh.gov.uk/en/AdvanceSearchResult/index.htm?searchTerms=health+inequalities10 WHO. Commission on Social Determinants of Health Final Report. 2008. http//www.who.int/social_determinants/final_report/en/11 piece of discipline Statistics. http//www.statistics.gov.uk/cci/nugget.asp?id=88112 Leyland AH, Dundas R, McLoone P, Boddy FA. Inequalities in Health Inequalities in mortality. MRC http//www.inequalitiesinhealth.com/public/index.php?cmd=smartyid=1_len13 Scottish Government Health Directorates. Coronary heart disease/ stroke task force report. September 2001 http//www.sehd.scot.nhs.uk/publications/cdtf/cdtf-05.htm14 field Cancer tidings Network. News release. 7th October 2008. http//www.ncin.org.uk/press/UKIM1008press.pdf15 The Scotsman. 10th March 2003. http//news.scotsman.com/obesity/Glasgow-digests-UKs-fattest-city.2409145.jp16 World Health Organisation. 20 08. Cancer diet and physical activitys impact. http//www.who.int/dietphysicalactivity/publications/facts/cancer/en/17 Leon DA, McCambridge J Liver cirrhosis mortality rates in Britain from 1950 to 2002 an analysis of routine data. Lancet. 2006 Jan 7367(9504)52-6. abstract http//www.ncbi.nlm.nih.gov/sites/entrez/1639915318 Scottish Public Health Observatory. Mental Health form _or_ system of government Context. http//www.scotpho.org.uk/home/Healthwell-beinganddisease/MentalHealth/mental_keypolicy.asp19 British Hypertension Society. Proposed Joint British Societies Cardiovascular Disease. http//www.bhsoc.org/resources/prediction_chart.htm20 Department of Health. Health Survey for England 2003. Published December 2004. http//www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_409871221 Health Promotion. PatientUK. http//www.patient.co.uk/showdoc/16/22 Office of National Statistics. Variations persist in life expectancy by social class. October 2007. http/ /www.statistics.gov.uk/pdfdir/le1007.pdf23 Lucas P, McIntosh K, Petticrew M, Roberts HM, Shiell A. Financial benefits for child health and well-being in low income or socially disadvantaged families in developed world countries. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No. CD006358. http//www.cochrane.org/reviews/en/ab006358.html24 Leverett M, Ashe M, Gerard S, Jenson J, Woollery T. Tobacco use the impact of prices. J Law Med Ethics. 2002 Fall30(3 Suppl)88-95. http//www.ncbi.nlm.nih.gov/pubmed/1250850925 Scottish Government. Effective and Cost Effective Measures to Reduce Alcohol Misuse in Scotland An Update to the Literature Review. 2005. http//www.scotland.gov.uk/Publications/2005/01/20542/5023226 Caraher M, Cowburn G. Taxing food implications for public health nutrition. Public Health Nutr. 2005 Dec8(8)1242-9. Review. http//www.ncbi.nlm.nih.gov/sites/entrez/1637291927 Bala M, Strzeszynski L, Cahill K. Mass media interventions for smoking cessation in adults. C ochrane Database of Systematic Reviews 2008, Issue 1. Art. No. CD004704. http//www.cochrane.org/reviews/en/ab004704.html28 Delgado HM, Austin SB. Can media promote responsible sexual behaviors among adolescents and young adults? Curr Opin Pediatr. 2007 Aug19(4)405-10. Review.http//www.ncbi.nlm.nih.gov/sites/entrez/1763060329 CKS Library. Smoking cessation. 2007. http//www.cks.library.nhs.uk/smoking_cessation30 NICE. Smoking cessation. March 2006 http//www.nice.org.uk/guidance/index.jsp?action=byIDo=1137531 Department of Health. Drug misuse and dependence. UK Guidelines on clinical management. http//www.nta.nhs.uk/areas/Clinical_guidance/clinical_guidelines/docs/clinical_guidelines_2007.pdf32 Kranzler HR, Gage A. Acamprosate efficacy in alcohol-dependent patients abridgment of results from three pivotal trials. Am J Addict. 2008 Jan-Feb17(1)70-6. Review.http//www.ncbi.nlm.nih.gov/sites/entrez /1821472633 Committee on Health Literacy, Institute of Medicine, Nielsen-Bohlman LN, Panzer AM, Kindig DA, eds. Health Literacy A Prescription to End Confusion. Washington DC The National Academies Press 2004.34 Batty GD, Der G, Macintyre S, et al Does IQ explain socioeconomic inequalities in health? Evidence from a population based cohort study in the west of Scotland. BMJ. 2006 Mar 11332(7541)580-4. Epub 2006 Feb 1. full text http//www.bmj.com/cgi/content/full/332/7541/58035 Jefferis BJ, Power C, Graham H, Manor O. Changing social gradients in cigarette smoking and cessation over two decades of adult follow-up in a British birth cohort. J Public Health (Oxf). 2004 Mar26(1)13-8. http//www.ncbi.nlm.nih.gov/pubmed/1504456736 Jha P, Peto R, Zatonski W, Boreham J, Jarvis MJ, Lopez AD. Social inequalities in male mortality, and in male mortality from smoking indirect estimation from national death rates in England and Wales, Poland, and North America. Lancet. 2006 Jul 29368(9533)367-70.http//www.ncbi.nlm.nih.gov/pubmed/1122635537 James WPT, Nelson M, Ralph A et al. Socioecono mic determinants of health the contribution of nutrition to inequalities in health. BMJ 1997314(7093)15451549.http//www.bmj.com/cgi/content/full/314/7093/154538 Office of National Statistics. Prevalence of diagnosed diabetes mellitus in general practice in England and Wales,1994 to 1998. http//www.statistics.gov.uk/CCI/article.asp?ID=1519Pos=1ColRank=1Rank=22439 McCulloch A. Teenage childbearing in Great Britain and the spatial concentration of poverty households. J Epidemiol Community Health.2001 Jan55(1)16-23. http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrievedb=PubMeddopt=Abstractlist_uids=1111294640 Khambalia A, Joshi P, Brussoni M, Raina P, Morrongiello B, Macarthur C. Risk factors for unintentional injuries due to falls in children aged 0-6 years a opinionated review.Inj Prev. 2006 Dec12(6)378-81. Review. http//www.ncbi.nlm.nih.gov/pubmed/1717018541 Royal Society for the Prevention of Accidents. General Accident. January 2007. http//www.rospa.org.uk/factsheets/general_ accidents.pdf42 Khambalia A, Joshi P, Brussoni M, Raina P, Morrongiello B, Macarthur C. Risk factors for unintentional injuries due to falls in children aged 0-6 years a systematic review.Inj Prev. 2006 Dec12(6)378-81. Review. http//www.ncbi.nlm.nih.gov/pubmed/1717018543 Kemp A, Sibert J. Childhood accidents epidemiology, trends, and prevention. J Accid Emerg Med. 1997 Sep14(5)316-20. Review. http//www.ncbi.nlm.nih.gov/pubmed/931593544 Payne S. Poverty and Mental Health in the Breadline Britain Survey. 1999. http//www.bris.ac.uk/poverty/pse/99-Pilot/99-Pilot_4.pdf45 Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of Americas Adults Results From the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC National Center for Education Statistics, US Department of Education 2006.