Policy and Issues in Public Health - Assignment Example

Policy and Issues in Public Health OF BEDFORDSHIRE M Sc, Public Health Module: Policy and Issues in Public Health Introduction It has been continuously noted that there has been a slow evolution of public health. The concept of public health has evolved as a field of activity that is very intimate with the health of a country in the community level, and the present scenario indicates that it is a prime government agenda. While this change of outlook to public health and related policies has been enormous, the traditional concept of public health related to the epidemiology of communicable diseases and their prevention has changed. With the advent of knowledge and evidence from research, now the health authorities are aware that a much broader agenda need to be included in public health policies any country, and the present strategy imbibes a multidisciplinary focus to the public health problems even including prevention of chronic diseases (Kyprianou, 2005, p14). This journey had witnessed an evolution, and government involvement in active policy making is attempting to harvest the fruit of current knowledge in this area. The most important paradigm shift has perhaps resulted from the increased emphasis on the role and contribution of individual behaviour and lifestyles to disease causation. Consequently, the public health programmes follow the policies and strategies to modify them at the community level, where both population and individual interventions are being increasingly practiced. Obviously, there would be sociopolitical critiques of such policies. Eventually, enhanced research leading to greater understanding of different factors on specific public health problems has revealed that socioeconomic, cultural, and environmental factors may influence health-related behaviour and thus may affect health status (Hunter, 2002). Public health policy relates to several areas of intervention. The health administration and planning processes must recognise these levels since resource allocation would depend on the gravity and level of the problem. Community health and health protection is an important level that deals with people in their social and environmental contexts. It is now known that people's health is determined by not only personal characteristics, biological and genetic endowments, but also environmental influences of physical nature. Some of these influences originate in the community and work through the influence on their behaviour and coping strategies. In the context of the current UK public health scenario, the government is demonstrative of its anxiety to fulfill its commitment to preventative health through different public health policy agenda. Hunter (2005) has indicated that public health and related policies are of central importance. One of the reasons for this growing interest in public health and community intervention strategies is the new knowledge that many preventable chronic diseases, due to lack of definitive public health policies have assumed epidemic proportions. Moreover, these diseases once established would add up to the mounting costs in healthcare services. This led to the need of change of approach towards prevention of these diseases and health improvement of the population. Strong et al. (2005) stated that a low-budget preventive approach would balance the resource allocation in such a manner that the healthcare cost demands might be managed more effectively, and absence of preventative strategies would lead to demise of publicly funded health systems. Although it may appear from this statement that public health interventions and policy changes have brought about the desired changes, in reality there exists a widening gap between the need of chronic disease prevention measures and government responses of implementation. This indicates there are needs of specific action plans and rigorous implementation measures against these problems (Strong et al. 2005). All these are indicative of the fact that during the second half of the twentieth century, public health policy in the UK has undergone substantial transformation. Now, the health data across European Union indicates that chronic disease mortality has assumed epidemic proportions. A current commentary indicates that 86% of the European deaths are due to chronic conditions against the evidence that these deaths are quite effectively preventable. Naturally public health authorities would strive to drive a public health policy that targets reduction of these preventable deaths from noncommunicable diseases. Evidence indicates that community interventions designed to modify health-related behaviour and lifestyles may eliminate 80% of cardiovascular diseases, stroke, type 2 diabetes mellitus and 40% of cancer. In this way health promotion approaches came into vogue, and preventive healthcare became order of the day. This was apparently true due to the finding that existing healthcare system was not able to accomplish good health of the population. The focus at the curative medicine could reduce the infectious or communicable diseases, and the life-threatening infectious disease mortality touched an ebb. While there was still substantial mortality from chronic diseases, a better understanding of these conditions led to the understanding of the facts that individual, social, and environmental factors actually influence such diseases, and a new vision for public health policy was outlined. By that time it was also recognised that government is responsible to ensure the health of its people (Greenway, 2008). Obesity Obesity has been considered as an emerging epidemic, as opposed to simple measures to modify them. Not only public health agencies, the modification of this problem is also related to personal responsibilities towards health. Social environment has important roles to play in reduction of obesity. In the popular media, there are reports about the burning problem of obesity, and this calls for action. To worsen the matter further, there is a trend of social stigmatisation of the obese people including children. Public health managers would need to design and implement programmes of obesity prevention, which can have in-built processes of minimisation of social stigma. Awareness about obesity is important. In the developed world, obesity is the most common disease of childhood and adolescence. In children, obesity is associated with significant ill health with future negative health implications. Unfortunately, this lack of awareness is not only social or populational, in many occasions the physicians also fail to make people aware about this problem. Research has also shown that brief interventions by physicians and healthcare providers on a regular and constant basis may strongly reinforce positive behaviours in the population (James 2008). Obesity is alarmingly rising with implications of a public health problem of epidemic potentials. The proportion of overweight children is higher than the number of obese children. It has been predicted that focused action is needed to control this problem specifically in children. Obesity is a global epidemic, and it is particularly prevalent in the children. The number of obese children has tripled in the last two decades. Obesity results from an imbalance of dietary intake to physical activity. Today's social environment, peer structure, and school curricula are increasingly oriented toward a sedentary life style even for the children where physical activities are minimal. This creates a basement for specific behaviour in children that may continue lifelong. Research has shown that prolonged higher relative energy intake through food and relative lack of physical activity may lead to disproportionate accumulation of body fat (Lvorich 2003). Therefore this imbalance of nutrition may contribute to the several chronic diseases in the future lives of these children. Current research indicates that childhood obesity can be correlated with coronary artery disease, cancer, liver diseases, type 2 diabetes, and chronic diseases of the respiratory tract (Becky, 2006). This could eventually culminate into a diseased nation in the future time. Unfortunately, the reason for persistence of this problem is social and behavioural. Healthcare policy has important measures to impart to control childhood obesity, but public awareness about healthy diet and proportionate physical activity is the first goal to accomplish in order for the public health measure to be successful. The process should be enacted at multiple levels, the prime target area being the children themselves. Community measures can be successful if awareness transcends into the families, schools, primary care providers, and these may eventually result in a change in dietary pattern and eating and exercise behaviours. This approach has been derived from the theories of behavioural modification. If behavioural modification can lead to a situation of prevention of diabetes, it would be better strategy than attempting to provide sure to the obesity related disorders in later life. It may be the fact that the current total burden of obese individuals in the United Kingdom of 31 million as derived from NHS Health and Social Care Information Centre may be the result of childhood obesity in an earlier time which was not intervened adequately with the aim of prevention (NHS Health and Social Care Information Centre, 2005). Such kind of preventive health policy interventions are required to reduce the ill health burden from comorbid disorders. Healthy diet and lifestyle must be promoted. It has been indicated by the researchers that adoption of a healthier lifestyle by families, community, and children is primarily a matter of promotion and motivation through which they can be empowered and encouraged to follow them. Therefore, initiatives to raise awareness about future complications of obesity and benefits of healthy diet and healthier lifestyles may motivate them to adopt such. Health behaviour change is a psychological motivation, and health education and health promotion are important parts of it (Jebb, 2004). A government publication titled Healthy Weight, Health Lives: A Cross-Government Strategy for England (2008) attempts to do so, and five health strategies have been enumerated. At the school level, the children can be educated about the importance of healthy eating and the role of physical activities. These are expected to encourage prevention of early weight problems. As a public health activity, healthier food should be promoted. Although business sector is an important stakeholder, it has been agreed that appropriate labeling of the foodstuff may offer clearer choices about healthy food. Over time, this venture may create a public awareness about the harmful effects of high sugar, high salt, and high fat products and beneficial effects of low fat, low sugar, high fibre, and high vegetable and fruit consumption (Lvorich, 2003). This document also highlights the importance of regular measured physical activity to burn excess calories. This should be a programme that can be implemented at the local and community level so increasing exercise and physical activity become daily routine for all. Health policies must be aligned to positive activities, and people must be incentivised for practicing such behaviour. Increased awareness and knowledge play important parts in this process so there can be a durable effect in people's practices, which if continued for a prolonged period of time may ultimately influence health related decisions to prevent obesity. This does not mean that there is no need of individual care (Wildng, 2001). Health policy must accommodate individual advices in conjunction with preventative care. Influenza Influenza is a communicable disease. The recent reports of SARS and H1N1 pandemics throughout the world have again brought our attention back to the importance of communicable diseases. This communicable disease compromises the immunity of the affected individual, and there is no available vaccine thus far. Current global intercommunications and increased international travel create sufficient ground for such diseases to be pandemic. Thus no country remains immune to this problem. Given the lack of curative agents and high contagiousness of this disease, only preventive measures based on personal hygiene can be effective in producing a durable effect against the great mortality this disease carries. Influenza per se is the most common communicable disease. It spreads very quickly across the globe in the form of seasonal pandemics. The most important characteristic of this viral illness is that it changes its character. Thus the type of virus causing disease in one season, despite giving rise to immunity in the affected individual, would not guarantee protection in the next season with another type of viral infection. Influenza viruses typically cause an acute respiratory infection, which is completely cleared by the host immune system and usually has a limited duration (Natasa & Tadej 2009). There are three known types, A, B, and C. Although the disease is mild, this abrupt illness characterised by mild fever, chills, lassitude, headache, cough, body aches, and fatigue is the cause of loss of many human hours. Moreover, this disease leads to a depressed immunity which may result in other secondary bacterial infection. The usual preventive measure for this flu virus transmission is prevention of droplet infection that spreads through sneezing or coughing from one affected individual to the other. Therefore personal protection of the affected and unaffected individuals is the only certain way to prevent transmission of this extremely contagious communicable disease in the community. It has also been indicated that crowded environment fosters this infection through personal contacts. In the school environments, it is not uncommon that one affected child may spread this infection to a whole group of students in the same class. It has been advised that affected individuals should be isolated. Hygiene measures such as frequent washing of hands, using a cover in the mouth or nose while coughing or sneezing, and using handkerchiefs may prevent transmission of this virus very effectively (Health Protection Agency (HPA) 2009). As a public health policy, in the United Kingdom, there is a programme called enhanced influenza surveillance. During the influenza season, the authority collects information and sends influenza reports which can be accessed by the public and health care professionals (HPA, 2009). This enables the public to have an idea about the load of circulating flu activity in the population. This data may also be used to decide about the need for vaccination, and the health care professionals also use the data to make clinical decisions about antiviral medications. The healthcare policy in the UK also suggests that high levels of immunization in the susceptible individuals such as elderly, very young children, people with chronic illnesses, and/or whole population is the best method of prevention, although the role of the hygiene measures cannot be belittled, specially in high-risk population such as older people, young children, pregnant women, and people with comorbid disorders. Conclusion Meanwhile, it is to be accepted that there were effective public health measures and medical interventions that caused drastic reduction of communicable disease mortality. The epidemiologic indices shifted to chronic disease mortality, and there was an epidemiologic transition. This led to a considerably high chronic disease mortality, which also indicates an ongoing effort by public health departments to control infectious diseases. The current trend of stress on chronic diseases led to absence of a public health policy to control communicable diseases, and this led to fresh challenges to the public health system (Kyprianou, 2005, p14). Thus although it is now evidenced that there are stresses on communicable diseases in the health policy, the preventability of noncommunicable diseases make them centres of renewed focus in public health policies. The economic implications of these diseases must be understood in terms of costs implied in treatment of established diseases, loss in working hours, and loss in premature deaths. Obesity is one of such problems that contribute significantly to causation of many chronic diseases such as coronary artery disease and diabetes mellitus. It has been estimates that obesity related problems contribute to 300,000 annual deaths. Recent reports of pandemics of influenza indicate that there is still threat from infectious diseases. These indicate that based on available information action plans in relation to public health policies are necessary that can help prevent and control these non-communicable and communicable problems. References Becky, C. (2006) diet obesity and cancer- is there a link : nutrition and food sciences 36-2-111 Greenway, J., (2008). Childhood obesity: bringing children's rights discourse to public health policy. Community Pract; 81(5): 17-21. Health Protection Agency (2009) Seasonal influenza, available from "http://www.hpa.org.uk/infections/topics_az/influenza/seasonal/default.htm date accessed December 2009 Healthy Weight, Health Lives: A Cross-Government Strategy for England (2008) available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082378 date accessed December 2009 Hunter, D.J. (2002) England, in M. Marinker (ed.) Health Targets in Europe: Polity, Progress and Promise. London: BMJ Books. Hunter, D.J. (2005) Choosing or losing health Journal of Epidemiology & Community Health, 59: 1010-12. James WPT (2008) The Epidemiology of Obesity: The Size of the Problem: journal of international medicine 263-4-336 Jebb S (2004) Obesity: causes and consequences, available from "http://www.womenshealthjournal.co.uk/article/S1744-1870(06)00010-2/pdf date accessed march 2009 Kyprianou (2005) Protecting Health in Europe, Health Protection Matters, 3, 14 NHS Direct (2008) Obesity, available from http://www.nhs.uk/Conditions/Obesity/Pages/Definition.aspxr=1&rtitle=Obesity+-+Definition, date accessed December 2009 Lvorich, S. (2003) Advertising and Obesity: The research evidence, young consumers 4-2-35 Natasa, T and Tadej, A. (2009) Influenza and Autoimmunity: Annals Of The New York Academy Of Sciences 1173-1-619 Strong, K., Mathers, C., Leeder, S. and Beaglehole, R. (2005) Preventing chronic diseases: how many lives can we save The Lancet, 5 October (published online). Wildng, JPH (2001) Causes of Obesity: Practical database International 18: (18):288 Read More