The Circumstances of Life and the Way People Live Largely Determine Their Health - Essay Example

The circumstances of life and the way people live largely determine their health. In an essay of 3,000 words critically analyse and evaluate ways in which the wider public health workforce can identify and address adverse life circumstances to improve health. There are many environmental details that can have an effect on the health of an individual, although genetics indubitably play a role. It is obvious to the modern day audience, for example, that smoking leads to lung cancer. Similarly, obesity is one of the most pressing concerns for health workers today (Dowler & Spencer, 2005), and one of the major factors involved is the amount of exercise that an individual takes as well as their diet (Wing, 1999). It is these types of circumstance which can lead to significant health problems, and it is these that the wider public health workforce needs to identify and address to improve public health. There are also much more secretive factors that are involved in health outcomes, such as marital status, income and the area in which you live (Blas et al, 2010). These types of areas also need to be involved in any significant discussion of the topic, as a good understanding of these factors could lead to an improvement in public health provisions as well as a reduction in hospitalizations and bad health for the general population. Taking this into account, it should be noted that the purpose of this essay is to cover the circumstances which affect public health outcomes, and how these are tackled by the literature. It will use this information to analyse and evaluate ways in which public health workers can build upon the knowledge provided to help prevent these problems and improve general public health, with further references to relevant literature in the field. By doing this, it will become evident that there are areas in which public health workers can operate to tackle adverse life circumstances to improve the general health outcomes of the public. I Identifying Lifestyle Risk Factors It has long been known that there are lifestyle factors that either decrease or increase personal risk of disease and mortality. These have been an object of some interest by the public health community, as this type of epidemiology is in theory preventable and could bring several different benefits to the population, not least economically (Shaw, 1999). Research in this area is important because a focus on preventable health outcomes is one major way in which the wider public health force can identify and address adverse life circumstances to improve health. Health cannot be improved without first identifying the adverse conditions under which certain health conditions can develop or be worsened. Perhaps one of the most important examples of this relates to lung cancer and smoking (Peto et al, 2000), particularly as this still remains highly relevant today. It could be argued that the link between smoking and lung cancer is one of the most important aspects of epidemiology, as prior to this date, epidemiology was primarily concerned with infectious diseases (White, 1990). However, in the 1920s and 1930s, it became evident that lung cancer and heart disease were on the rise, primarily amongst young men, but on a slower and steadier level than would typically be expected of an infectious epidemic (White, 1990). From here, research went on to do statistical studies that showed a link between smokers and lung cancer that was not present in non-smokers (Peto et al, 2000), which led the medical world to believe that there was likely some link between smoking and incidences of certain chronic diseases (White, 1990). This type of lifestyle choice can also be linked to adverse life circumstances and situations that are beyond the population’s control, which can also be of interest to those working in public health. One interesting factor of the link between smoking and lung cancer in the new millennium is that smoking is found more commonly in low-income areas (Arnold et al, 1001). Indeed, Scotland has one of the highest rates of smoking-related lung cancer in the Western world (Parry et al, 2002), and also has high levels of poverty and low levels of income (Bramley et al, 2000). Investigating these types of statistics is important for public health workers, as identifying the links between certain health conditions and lifestyle factors of those affected is one of the major ways that the public health workforce needs to address improving public health (Sim & McKee, 20111). Indeed, inequality in income has been identified as one of the most important determinants of good or bad health multiple times in the literature (Marmot & Wilkinson, 1999). The WHO Global Burden of Disease Study has been used to argue that many of the inequalities in health are not due to the provision of healthcare itself but due to different societal factors, such as stressors, income, lifestyle, access to water and food, and education (Marmot & Wilkinson, 1999). This idea has been echoed by other scholars (Sim & McKee, 2011), and suggests that there may be a place for involvement of public health workers to look into this area rather than focusing purely on traditional epidemiology, as outlined in White (1999), and on focusing in healthcare provisions, although these still remain important. Much of the information about lifestyle risk factors and how these affect those within certain social and economic groups can be found in the literature (Blas et al, 2010). This means that the public health workforce can use this resource to conduct thorough literature reviews and publish their findings to increase awareness of such links (Lucas & Lloyd, 2005). This type of research is less time-consuming than conducting practical research using recruitment techniques (Porter & Coles, 2011), but can still provide a wealth of information about correlation. The importance of this form of study is illustrated by the example of tobacco use and lung cancer used above, as initially this link was discovered merely by correlation (White, 1990). After these have been identified using research, public health workers can go on to tackling the problems and making others aware that such a link does exist and should be investigated to reduce health problems for certain groups. II Targeting Lifestyle Risk Factors After the collection of data regarding lifestyle factors, causal links can be determined between lifestyle factors and disease burden in several groups. After the risks have been identified, it is evident that a plan must be developed to tackle the risk factors and therefore begin lowering the burden of disease. There are several different ways that have been identified to do this, some in the context of general public health information which have been used in many different areas of public health, and some which are more specific to public health and social determinants and lifestyle factors. These interventions will be outlined in the section below, taking into account particular case studies where links between lifestyle and disease have been proven in the scientific community to illustrate the case. II.i Community Mobilization After having identified which groups are likely to be at risk, it can be possible to use an intervention known as community mobilization. In this way, the intervention can be tailored to the specific group suffering from ill-health (Lucas & Lloyd, 2005) and therefore can be more effective (Watterson, 2003). Alcohol use and abuse is a prominent cause of ill-health, and has been estimated to be a burden of 36.48 DALYs per 1000 adults in the European and Asian communities (Green, 2007). Additionally, there is a proven link between alcohol-related illness and lower socioeconomic groupings, suggesting that there are lifestyle factors involved with this risk factor (Green, 2007). In the United States, one program has highlighted the problems with drinking and enforced community laws related to public drunkenness and invoked public alcohol zoning with some success, simply by focusing on a lower socioeconomic community that tended to have high risk of health problems from alcohol (Blas et al, 2010). Community mobilization can also be used to prevent promotion of alcohol (or another lifestyle factor) to vulnerable communities. In this sense, alcohol advertising would not be available to, or would be highly adapted for, those who are in high-risk groups (Blas et al, 2010). There would, therefore, be some kind of protection for communities at high-risk, and public health workers could campaign for this type of absence advertising to prevent ill-health. However, there are numerous legal problems with this approach, particularly in the United States where freedom of speech and advertising bills prevent this type of action on a nationwide scale (Watterson, 2003). It would, however, be an area to look into for public health campaigners, although unlikely to be relevant in the very near future. II.ii Education Education plays multiple roles in a discussion of this form, as it can be used to refer to educational attainment as a risk-factor for certain diseases, and education used for the prevention of disease in a public health context. In this scenario, it plays multiple roles. It is a commonly recognized fact that, for people to gain as much information as possible from a public health campaign, they will need to have attained ‘at least a primary school education’ (Blas et al, 2010, p38). This is particularly evident in the case of cardiovascular disease (CVD), which is a multifactorial chronic disease which particularly affects those who fall into certain categories (Green, 2007). The three most commonly cited ways in which one can lower their chance of heart disease involve losing weight (as obesity is a risk factor), taking regular exercise, and quitting smoking (Green, 2007). To understand that all these factors play a role in the development of CVD and how they may interact needs some form of understanding of CVD and its effects on the human body (Green, 2007). Additionally, to purvey this message to a population in the current public health format, it is likely that the population will need to have a reasonable standard of reading (Blas et al, 2010), which may make things much more difficult for those in low-income areas or those who have less access to education. To take this into account and to ensure that public health initiatives reach the targeted population, a public health worker must ensure that the message that needs to be put across is done in such a way for maximum patient involvement and understanding (Lucas & Lloyd, 2005). This is a commonly recognized fact across the entire public health sector (Green, 2007), although many patients remain confused by public health directives and advice from physicians and nurses regarding their condition (Green, 2007). Although the majority of people in the Western world do receive this level of education (Green, 2007) and therefore this may not be the biggest hurdle to public health workers, it does highlight the importance of ensuring that public health workers understand that some people may not be as well-equipped to understand and implement lifestyle changes (Lucas & Lloyd, 2005). II.iii Tackling Inequalities Many diseases, particularly chronic diseases, share a pattern of affecting those who live in worse housing and have less disposable income at a younger age and more frequently (Watterson, 2003). Returning to the example of cardiovascular disease, there is a clearly acknowledged social gradient that affects the incidence and prevalence of CVD (Green, 2007). Additionally, studies have shown that a lack of control over life circumstances and personal environment greatly increases the chance of CVD (Blas et al, 2010) and therefore this is something to be acknowledged by the public health sector when trying to reduce incidence. There are a number of ways in which this type of inequality can be tackled, although it requires involvement from politicians as well as the greater public health workforce. Firstly, it is important to acknowledge that differences in housing do make a difference to incidence of CVD (and many other lifestyle factors that lead to disease, as well as disease itself). By doing this, public health workers can use this information to help identify those at risk (Ewles, 2005), meaning that they can issue preventative medicine and advice. Issuing this information to the public could also make them more aware of their situation and therefore prompt them into avoiding some of the more dangerous lifestyle factors (smoking and alcohol) where possible (Green, 2007). Acknowledging this link could also make those who issue public health policy more aware of the situation (Pawson, 2006), and to investigate economic policies to prevent the problems associated with low-grade housing, poverty and worries about money (Green, 2007). Blas et al (2010) also stress the importance of understanding inequality, and highlight the fact that this situation starts from a very young age. Children are also victims of inequality with respect to their health. Blas et al (2010) stress that public health workers and policy makers can also reduce the effects of inequality by prioritizing the diseases of the poor, particularly by choosing interventions that are most appropriate for the socioeconomic characteristics of the targeted geographical area. Another method, which may be more simple than tackling the root causes of inequality, is to simply improve services that are relevant to diseases of the poor in areas which are inhabited by a number of people of lower socioeconomic status (Green, 2007). Again, this information can be ascertained by simply understanding the links between socioeconomic status and disease and pinpointing the geographical area certain illnesses and risk factors are more prevalent. II.iv Health Seeking Behaviours One area which has always presented a challenge for healthcare workers is that those who are ill may not always seek medical help (Blas et al, 2010). It is a well-established fact that many different elements are associated with health seeking behaviour, including gender, socioeconomic status and ethnicity (Adamson et al, 2003). Although not directly linked to an increase in ill-health, certain lifestyle factors do make it more difficult for some individuals to seek treatment and therefore still pose a challenge to those working in healthcare policy. Targeting those who are unlikely to seek help for a multitude of reasons should be high on the agenda for public health workers (Adamson et al, 2003) as this can have a serious impact on mortality and morbidity. One recent effort to change the health seeking behaviours has been a campaign targeted at encouraging men to have regular prostate exams with the aim to reduce incidence of prostate cancer in men (Ewles, 2005). To do this, targeted advertising was made to encourage men to do this, who are statistically less likely to visit a healthcare worker if something is wrong (Adamson et al, 2003). This type of campaign has had some success (Ewles, 2005), and therefore again shows the benefits of targeting certain groups with the aim of improving healthcare. This way of addressing adverse life circumstances (both avoidable and unavoidable) shows serious promise, and is definitely one of the best ways in which policy-makers can tackled the problems that have been identified by thorough research, as outlined above. III Public Health Outcomes As noted above, there are several ways in which adverse life circumstances can affect health, and their identification and solution can be difficult and needs to be attacked in multi-faceted ways. However, there is promise that by doing this, there will be an improvement in health. The Scandinavian countries, for example, have some of the lowest income-equality statistics in the world, and have famously good health (Lucas & Lloyd, 2005). This suggests that by tackling inequality, or at the very least tackling the inequality in provision of healthcare services, policy makers can help reduce the incidence of the ‘diseases of the poor’ and make a real impact on healthcare in general. Additionally, Blas et al (2010) extensively covered the links between certain life circumstances and disease and the possible interventions that could lead to a reduction in incidence. This paper was multi-faceted in nature, but one area which was continually repeated was the need to tailor services and advertising more specifically to different risk groups. Promoting anti-smoking campaigns more heavily in areas with a high incidence of lung cancer may be more beneficial and cost-effective than targeting the entire population (Blas et al, 2010) and may also allow for information to be presented in a more geographically and socioeconomically appropriate way for maximum uptake. Again, the public health outcomes from this type of program have shown an immense amount of promise and could be as successful for the prostate cancer campaign for men if executed correctly (Lucas & Lloyd, 2005). IV Conclusions It is evident that lifestyle circumstances are a very difficult area to tackle for healthcare workers and policy makers, as there are so many different elements to consider and many ways of targeting problems. Firstly, it is important to identify any correlation that there may be between adverse life circumstances, bad habits and disease. This can be done by conducting thorough research through the literature and ensuring that any statistical evidence is taken seriously, as was done when uncovering the link between lung cancer and smoking. After doing this, patterns (expected and unexpected) will become apparent and therefore can begin to be analysed and targeted. There are several different factors that affect the health outcomes of people, including health seeking behaviour, inequality, community and education, and these elements need to be taken into account by health policy makers. Health seeking behaviour differs between individuals, and therefore can be targeted to improve health. Inequality is a difficult problem to tackle, as it runs deep in society, but beyond tackling the root cause it is possible to tackle healthcare provisions directly and make sure that they are appropriate for the geographical location and demographics. Education is important both for understanding healthcare information and ensuring that people know how to reduce their risk, but again can be tackled by ensuring that information is specific for geographical location and demographic. Finally, community is important as it can be used as a tool for dispersing appropriate information and again, as a tool for ensuring healthcare policy is appropriate. The common theme here seems to be tailoring healthcare services and tackling diseases of the poor for excellent provision of services and a reduction in the amount of lifestyle-related diseases. 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