Evaluating Epidemiology and Inquiry - Essay Example

Evaluating Epidemiology and Inquiry Public Health is a challenge faced by all the major Governments of the world. Ensuring improvements in Public Health is an indicator that the government is showing care and consideration for its people; as it is agreed that public health finds its basis in its focus on the population and not individual patients or clients (Orme, Powel, Taylor & Grey, 2007). The new Health and Social Care Act 2012, is one such efforts by the British Government. The act will not be a replacement for the National Health System (NHS), but will lead to four radical changes in the way the NHS operates, by changing its focus from Health care and Treatment to Disease prevention and reduction (Robins, Hernán and Brumback, 2000). Measuring health and knowing about different indicators that influence and define health is critical in determining our point of view of health and how we cater the problems and issues that surround it, and naturally the information resulting from measurements regarding health helps in determining policies of local and national level (McDowell, 2006). It has been said that the income, employment and housing all play a very important role when it comes to mental health. (Rothman, Greenland, & Lash, 2008) Lewisham Public Health Annual report is prepared by Dr. Danny Ruta, the Director of Public Health for Lewisham. The annual report encompasses the changes implemented as a result of new JSNA process in 2011 and the study conducted by Ruta, in which he analyses the effects of the crisis and socio-economic factors on health and what these factors mean for health in Lewisham (Ruta, 2012). In the report, Ruta also presents suggestions to the shadow Health and Wellbeing Board in Lewisham. According to the statistics extracted from the Lewisham report it has been estimated that more than 500 additional people are mostly like to be a victim of mental illness and the main reason behind this being the on growing issue of unemployment. Unemployment has been found out to be an instigating factor for increase in mental illness. The unemployment rate has boosted the rate of mental illness among people. (MacMahon and Trichopoulos, 1996) Study conducted by Ruta The study revolves around the effects of the “great recession” on the socio-economic conditions in the UK and the resulting consequences of these conditions on the health of people in Lewisham (Ruta, 2012). It has also been found out that Lewisham residents will be affected by the changes in a very disproportionate manner. Due to change in the salaries, employment rate and other housing changes the health of the children is most likely to be severely affected by all these factors. Racism is still a problem in this area. Black people are estimated to face unemployment more than the other people. This however will result in an exponential increase in the mental problem, which however can lead towards very harmful consequences such as suicide. Almost 1000 people have been estimated to be exposed to downfall in their household allowances, and approximately 1400 household are most likely to add more fuel to the on growing poverty level. The study is theoretically based in the social model of health (Health, 2013); and having the study based in theory is an important determinant in promoting health; as theory is an important source of evidence, careful planning, and an indicator of likely success as opposed to studies not based in theoretical framework (Araujo, 2009). The study is based in the theory that focuses on the determinants of society and environment as being significant factors along with biological elements in achieving improved health and well being (Health, 2013). Design of the Study The study is observational analytical, and utilizes an Ecological (aggregate/ecological co-relational) study design (Vetmed, 2010), which studies the link between the financial crisis and the resulting socio-economic consequences for health (Ruta, 2012). Like any other ecologic study the study conducted by Ruta does not focus on individuals for comparison or gathering data, rather it rests its focus on group comparison (Morqenstern, 1995). The observational unit in the study is the population and the community of Lewisham (BMJ, 2013). The study gathers aggregated secondary data on the prevalence of diseases and the risk factors from the population of Lewisham and Britain, which is then compared over the time period to highlight ‘associations’ (Vetmed, 2010). For example an analysis of data, conducted over the time period of 1970-2007 in the European Union found that as unemployment rose by 1%, an associated increase in suicide rates was seen at 0.79%, and an increase in homicide rate by 0.79% (Ruta, 2012). Another example comes from the data gathered on the unemployment rate on Lewisham; which found association between job displacement and mortality rate which is expected to rise in Lewisham after the economic recession. An increase in death rates by 15-20% has been seen during the 20 years following job displacement (Ruta, 2012). Critical Analysis Since, the study gathers all the data in an aggregate and at the group level, therefore the study fails to determine empirical relationships at the individual level, increasing the chances of ecologic fallacy and rendering the empirical evidence weak (Vetmed, 2010). The Lewisham study is conducted by gathering data from published statistics in not time consuming or expensive and allows for the population to be measured and defined in one of number of ways (BMJ, 2013); a mixed study, allowing for the populations to be grouped by place and time. The study can be helpful in generating new hypothesis and risk factors (drcath, 2008). The study has many drawbacks, and methodological problems associated with it, like ecologic fallacy, cross-level bias, confounding, misclassification within group, lacking adequate data, and collinearity (Morqenstern, 1995). Association and Cause and Effect The study analyses associations between the socio-economic conditions and the effects these conditions have on the health and well being of people; Ruta in the study study also states that it is an association that is present between the factors and the occurring effects and is not necessarily the proof that these factors are actually a factor of causation; as the study may apparently evaluate a cause and effect relation between the desired factors like unemployment and murder; but does not study relation between murder and other factors which might be responsible for murder (Ruta, 2012). The study thus develops the socio-economic factors as the component causes of health and well being of people (Kramer, 2001). It is also referred to as an ecologic fallacy, where there appears to be a cause and effect relation/corelation between two variables but infactit has efffects of confunding factors (drcath,2008). Confounding occurs when the effects of a risk factor are distorted by the presence of another independent risk factor (Vetmed, 2010) Peoples Meaning and Lewisham Study Lewisham study is a quantitative study and does not account for people’s meaning. The data that is gathered is quantitative in nature, and is expressed in numerical form; the study does not utilize direct quotations from the people and thus does not account for the interpretations that people attach to themselves, other people and the environment (Eysenck, 2004). Data Comprehensiveness and Representativeness The data is secondary, as the data was gathered in two distinct steps from broad and wide range of already available and published sources (Vetmed, 2010). The first part presents a link between the crisis and what impact it has had on the economic and social living in UK; like the crisis has lead to a cut in Government spending on staffing, leading to job cuts e.g. Since the recession the civil services have had a 10.5% reduction in its numbers (Ruta, 2012). The secondary data gathered by the study is obtained from multiple sources. The evidence gathered by BBC and ONS is type 2 and promising evidence, as the evidence is not formally reviewed by peers but is a part of state reports (Brownson, Fielding, & Christopher, 2009). Using reliable and valid statistics from two government-based offices, the study has gathered best available data. Evidence based public health can present a real challenge but it is not about gathering the best possible evidence rather compiling the best evidence that is available to the researcher (Maniadakis and Gray,2000). The first part aims at analyzing the factors that have resulted in the financial crisis due to which the health. For Example, the Loss of discretionary income is one of the most important factors that have contributed towards financial crisis. The average wages of the people have decreased tremendously. It has been estimated that the average salaries is £2000 pounds lower than what it is in London (Ruta, 2012). Another example being that, the numbers of people who are recipients of benefits have also increased by almost 8% (Ruta, 2012). Some of the benefits recipients had to face some serious problems as they lost income. People who were generally working in the public sector lost more income than other sectors. Due to the loss of discretionary income there are most likely to be more and more suicide rates. Due to this financial crisis the people will be unable to properly look after their health and as a result they can be a victim of the fatal coronary heart diseases (Stewart, et al., 2004). The data in the next part elaborates on the effects that these socio-economic factors have had on reduced health, and how the more deprived places like Lewisham have been more affected due to financial inequalities; to gather data for the socio-economic factors effecting health the evidence was gathered by an elaborate research on online and printed sources (Ruta, 2012). Initially the information was gathered irrespective of designed study and provided a large base of literature (Ruta, 2012). Than the studies were filtered out to empirical qualitative and quantitative researches to narrow the factors to unemployment, job insecurity etc. and to validate the evidence (Waxman, 2004). The data was obtained from authentic and respectable sources like British nursing Index, CINAHL, HMIC etc.; and to keep relevance was timed from the year 1990 onwards (Ruta, 2012). Utilizing both quantitative and qualitative studies to gather data is known as triangulation of data and is particularly beneficial; as the information base is wide and complimenting (Brownson, Fielding, & Christopher, 2009). Sample Gathering evidence from the studies conducted over the period of a decade also gave the study a large sample base, with representation from both, the provided and deprived class (Ruta, 2012). The sample can be regarded as a Stratified random sample, in which the people were stratified on the basis of being residents of Lewisham and being influenced by the recession (Vetmed, 2013) Validity and Reliability The evidence was gathered from both valid and reliable studies that were aimed at studying relevant variables, and were published by and in authentic sources; and were specifically grounded in the social health model. The content of the study was valid as it was comprehensive and was adequately addressing the key issues (McDowell, 1987), like financial crisis, unemployment, discretionary income etc. and its effects on the factors affecting health and wellbeing of people like alcohol use, and tobacco consumption (Ruta, 2012). Internal validity ensures external validity or generalizability of the study (Vetmed, 2010). The study is considered externally valid if the conclusions derived by the study can be applicable to the target population, as the population under study and the target population show similarity in significant characteristics (Vetmed, 2010). External validity can only result from internal validity, which can only be ensured if the study was not subjected to any bias, chance, and confounding because of the design of the study (Vetmed, 2010). The study cannot be regarded as one that is internally valid as the data that is used in the study is subjected to confounding and ecologic fallacy, which acts as a significant bias and leads to invalidating the study (Vetmed, 2010), and making it difficult to generalize the findings of the Lewisham study (jrwpsychology, 2011). For example, the study iterates that men and women who are heads of households in Lewisham are estimated to have deteriorated mental health as a result of having unsustainable housing commitments (Taylor et al. cited in Ruta, 2012). The measure is not valid as the deteriorated mental health can be resulting from a number of other factors like family background, childhood experiences, genetics, etc and not just unsustainable housing commitments. Another example would be as the study predicts an increase in EWD’s (excess winter deaths) in Lewisham; by respiratory disease (40%) and circulatory disease (33%), because of living in cold homes during cold weather (Power et al. cited in Ruta, 2012). The validity comes into question due to the fact that there can be many other factors contributing to the respiratory diseases and circulatory disease other than cold homes. It is one of the greatest drawbacks of ecologic validity that controls are difficult to manage, thus leading to low ecologic validity (jrwpsychology, 2011). Reliability of a study signifies if the results from a study can be replicated or not; it is actually the ability of the system of the study to perform and maintain consistency under any circumstances; routine as well as hostile (Bryman, 2004). A study although may be lacking in ecologic validity but that leads to its increased reliability resulting from its easiness to replicate; this also adds to the scientific nature of the Lewisham study (jrwpsychology, 2011). For example, In 2011 as a result of the recession an increased loss of jobs was seen in all sectors of the government, and more than double that of the central government in the local governments; factors like that are influential for Lewisham as its council is the largest employer in the borough (Ruta, 2012). Another example would be that Lewisham exceeded the 2011-12 health check expectations by 3%, where 7100 health checks were expected and 7224 health checks were provided (Ruta, 2012). The study uses already established facts which would lead to generating same statistical results and would highlight same associations between factors from the data, thus significant of heightened reliability (Bryman, 2004). Positive Health Indicators The study also presents positive health indicators which when addressed will play an important role in the health planning of Lewisham. The study emphasizes on increased rate of immunization in young children, tackling tobacco consumption, promoting healthy weight among children and adults, effects of increased physical activity, improved sexual health and decrease in other sexually transmitted diseases (Ruta, 2012). e.g. tackling tobacco in terms of smoking, the aim is to reduce consumption from 19.6% in 2010 -11 to 17.3%, and 15% by 2015. Another example would be the rate of fall in teenage pregnancies; the target being 50% reduction in 50 years, Lewisham (39%), out-performed England (24.6%), London (27.6%) at this target (Ruta, 2012). Read More