Meaning of Public Health

Public health is concerned with improving the health of population, rather than treating the diseases of individual patients. If a condition has been discovered -they want to make sure they live longer by promoting and preventing diseases and complications. Public health is everyone around you and the involvement of the community. If public health is really effective then it will also help the NHS save money.

Monitoring the health status of the community:
When we are monitoring the health status of the community we are trying to identify and solve the certain problems of the community. We will be looking for the trends and patterns which will then be compared to other communities. This will help us to see if any changes have been made. Some of the conditions that may be monitored are diabetes, obesity and breast cancer. Some of the ethnic groups are at more risks of developing diabetes such as Asians and Black African. Monitoring the health status of the community is when we are tracking down the changes in the health of the community and notifying people to their potential problems they may come across. When we are monitoring the health status of the community the data is collected geographically this is because we are looking at a particular area so we can compare the results of one area to another area.

The types of information that may be collected are age groups, backgrounds and medical history. This type of information will be held at your local G.P. or hospitals which will help to get a holistic view of health in the UK. When we are monitoring the health status of the community we are trying to improve whether we may need to put in more services and whether we need provide more information for the community to get hold of. The health needs of the community are monitored by a number of people in the UK such as doctors, nurses, district nurse, health visitors, epidemiologists and many more.

Identifying the health needs of the population:
Identifying the health needs of the population is really important to identify the trends and patterns this is because once the trends and patterns are established; implications for service users and the population can be identified. Identifying the population’s needs takes a big part towards the contribution of evidence. Once evidence has been found improvements towards the patient’s outcomes can be made and what needs to be done next. Identifying the needs of the population helps to improve and develop communication with the population. An example of this in relation to obesity is assessing other condition such as diabetes that is likely increase support service for this condition will be available.

Developing programmes to reduce risk and screen for early disease: Developing programmes to reduce risks and screen for early disease is all about the attempt to decrease ill health and most common conditions, this is done by introducing programmes which identify people who are in danger of a conditions, this will help to engage them to do something about it and to go to preventative programmes. An example of this is that a doctor recognises that a service user or an individual is at risk of developing diabetes due to their obesity, the doctor will then refer the patient to a weight management programme which will give the patient support in losing weight. Screening is a procedure to identify the risk of a disease or a condition. This can be done before they are experiencing any symptoms or knowing that they are at risk. The screening programme for breast cancer is a mammogram, a mammogram is an x-ray of the breast and is used to screen for breast cancer. Each breast is placed between two small flat plates of the x-ray machine. In order to take a clear a picture of the breast the plates press the breast firmly between them for a few moments. The range of people in the population that are offered mammograms free of charge by the NHS are women aged 47 to 73. Women’s who are age 73 or over are offered a mammogram every three years.

Controlling communicable disease:
Some of the examples of communicable disease are malaria, meningitis, mumps, influenza and HIV/Aids. Immunisation and other control measures are put in place to control them so that the diseases do not affect the whole population. This also may include food hygiene measures in restaurants and takeaways to control the spread of food poising. Communicable disease is carried out by microorganisms and then transmitted through people, animals, foods and pollution. In the UK, the government promotes health related points such as five-a-day this promotes to eat five fruit or vegetable a day, do regular exercise, eat a balanced diet. When people have a baby they are advised that they should take their child too regular check-ups and it is important to get their immunisation as it will protect the child from infectious disease.

A way the government control diseases in the population is by planning and evaluating the health and social care provision, they do this by assessing the services that are being provided and see if they are helping problems that take place. It is also important that when infectious diseases have come up, it is a legal requirement that it is reported to the appropriate people, by doing this measures can be put in place to stop them spreading. An example for this is when diseases such as Tuberculosis (TB) and Measles are diagnosed or suspected, the local medical officer is responsible for monitoring the disease and sending the information they collected to the national centre for monitoring the spread of communicable diseases.

Government and government agencies – Department of Health: The department of health offer planned leadership for the public, the NHS and social care in England. Their purpose is to improve the health and well-being of England and to achieve better health and care for the public. Their responsibility is to promote and protect the public’s health, the safety of medicines and how to take them, they set the considered for adult social care and they take the lead issue such as environmental hazards to health. They have a responsibility of finding the best way to develop and support the health and social care system to bring improvements for the public and patients. They lead a combination of health and well-being into a wider government policy; this includes working with other sectors which they do not have a direct relationship with.

The department of health work with international partners such as World Health Organisation. The department of health work with the wider public sector, private and the third on issues such as lifestyle choices and health protection with other Government agendas. They run campaigns to support and promote their work such as Change4Life and Stoptober. The stoptober campaign is a campaign to stop smoking for 28 days. It encourages smoker to take up the challenge to stop smoking for 28 days across England. Change4Life launch a smartphone drinks tracker app. This app will help people and drinkers to see the impact of alcohol and how it can have an effect on their health and finance. There are many more campaigns on their website to help other disorders such as obesity and dementia.

Pressure groups – Friends of the Earth:
Friends of the earth are an environmental pressure group which seeks to influence policy and practice. Friends of the earth campaign to challenge the influence of the global free trade system, they work to reduce the impact on the environment of the movement of people and they campaign to fight climate change, expose poor business practice and protect wildlife habitats. The health role of friends of the earth is precisely shown by their work on greener farming and demonstrating the increased recycling and reduction of waste. Friends of the earth stand for a beautiful world, a good life and a positive relationship with the environment. Some of their current campaign is the bee cause, the bee campaign is about the numbers of bees in Britain and how it’s fallen over the recent years. The solution to this campaign is us humans this is because if we plant bee friendly flowers we can help bees. Friends of the earth look for the best solution, if they can or if we can find a better way, they back up their ideas with facts and latest science and working together make them stronger.

International Groups – WHO
The world health organisation also known as WHO was first established in 1948. It was established in response to an international desire for a world free from disease. WHO collects information about national and international health and then makes comparisons between other countries. The role of who is to shape the research agenda and motivating the generation of valuable knowledge. Their role also is to monitor the health situation and assessing the health trends. WHO provide leadership on matters that are critical to health and they engage partnership where joint action is needed. WHO have six agenda these are promoting development, fostering healthy security, strengthening health systems, Harnessing research, information and evidence, Enhancing partnerships and improving performance. The world health organisation has a responsibility to provide leadership on global health matters.

National groups – Cancer research UK
Cancer research UK is the dedication to cancer research and is the world’s leading independent organisation. They are the European leader in developing new anti-cancer treatments. Cancer research UK is a charity committed to beat cancer through research. Their work is funded by the public through donation and support. They work with other bodies to ensure that they make the best use of the funds they receive. Their ambition is to cure all cancers but they are waiting for that day to come and are their long term vision. On May 2007 they introduced ten goals in order to shape up their work for the next decade and further. The ten goals are: ⦁People will know how to reduce their risk of cancer

⦁The number of smokers will fall dramatically
⦁People under 75 will be less likely to get cancer
⦁Cancer will be diagnosed earlier – Two-thirds of all cancer cases will be diagnosed at a stage when the cancer can be successfully treated
⦁We will understand how cancer starts and develops. There will be better treatments with fewer side effects
⦁More people will survive cancer
⦁We will especially tackle cancer in low income communities
⦁People with cancer will get the information they need
⦁We will continue to fight cancer beyond 2020
Their aim is to provide information and support patients with cancer. They help patients to go through their treatment and tell them they have nothing to be scared of with evidence on their website. They have special events that provide friends and families the chance to eat drink and enjoy live entertainment. Another one of their event is to race for life, Race for Life is the largest women-only fundraising event in the UK. Every year it brings thousands of women across the UK together to help beat cancer.

P2: Describe the origins of public health policy in the UK from the 19th Century to the present day

18th Century

The Poor Law of 1834:

The Poor Law Commission examined the system of the poor law in Britain. In 1834, they published a report, with many recommendations. In 1834 the Poor Law Amendment Act was passed by Parliament. This was designed to reduce the cost of looking after the poor as it stopped money going to poor people except in exceptional circumstances. Now if people wanted help they had to go into a workhouse to get it. The poor were given clothes and food in the workhouse in exchange for several hours of manual labour each day. Families were split up inside the workhouse. People had to wear a type of uniform, follow strict rules and were on a bad diet of bread and watery soup. Conditions were made so terrible that only those people who desperately needed help would go there.

When this law was passed, the following were implemented and put into place:

⦁Anybody who is able to receive money or any other help from the Poor Law authorities, except in the case of a workhouse
⦁The women were separated from their children and husbands
⦁The children got an education, but had to work harsh hours, in harsh conditions, to earn the food that they were given
⦁The women worked in factories, long and difficult hours

Despite the fact that the workhouses conditions were harsh, the Act did not make sure that the poor people were, housed, clothed and fed. The condition that all of this was done for the poor was that they had to work several hours a day.

The First National Public Health Act 1848:

During the nineteenth century led to concern about environmental problems as all the cities began to expand very rapidly, in the 19th Century such as, ‘air pollution’, poor housing conditions. This impact resulted in the introduction of the sanitary movement, which was an active campaign such as Edwin Chadwick, resulted in several public health issues, which include, poor housing, working conditions and sanitary reform. Chadwick’s report on an inquiry into the sanitary conditions of the labouring population this report suggested that a single local authority should be established, which will be supported by an expert medical and civil engineering advice. 6 years later, The National Public Health Act 1848 was established.

Smallpox Vaccination 1853:

This came about because of the work of Edward Jenner. Jenner was an English country doctor who implemented the vaccination initiative. In the year 1796, he discovered that there was something, which gave individuals immunity from smallpox. This work was done following earlier observations that dairymaids and cowmen did not catch smallpox although they did catch cowpox. Benjamin Jesty (1737-1816) protected his family in a similar way before Jenner reported the first scientific attempt at immunization from a hut near his home in Berkeley, Gloucestershire. Jenner scratched material from a cowpox pustule into the arm of a young local boy, James Phipps, who subsequently developed a pustule and a fever. He remained healthy when subsequently Jenner inoculated him with smallpox. “Vaccinae” means “of the cow” and “vaccination” means “protection from smallpox”. At this time there were 23,000 deaths per year from smallpox in England and many more across Europe. The case fatality rate was between 20% and 60%. In 1853 compulsory smallpox vaccination was introduced and, in December 1979, the Global Commission for the Certification of Smallpox Eradication declared the world free of smallpox. In 1980 this was ratified by the World Health Assembly. There is now no indication for routine smallpox vaccination.

This was a huge medical breakthrough, which resulted in countless lives being saved. A law in the Parliament was made in 1853, which made it obligatory for all residents of the UK to get a smallpox vaccination, the disease which leads to countless people dying in the 18th Century. Legislation was made to obligation for everybody to make sure that they get their children vaccinated if they were born after the beginning of August in 1853. This legislation also indicated that the vaccination on these children was compulsory within the first 3 months of the child’s life. If anyone refused to or failed to comply with this legislation, it would result in the parents receiving a fine. However this vaccination was proving its success, there were many people who failed to have or refused to have their children vaccinated and would prefer to pay a fine instead of having their children vaccinated.

John Snow and the Broad Street Pump 1854:

John Snow was interested in the role of drinking water in the spread of cholera and had observed that people who drunk water provided by one water company were more likely to contract the disease than those who had not. By plotting the cases of cholera on map, Snow established that all those falling ill were getting their water from a single pump, which drew its supplies from the sewage-contaminated. River Thames; people using nearby wells to obtain their water had escaped infection. The connection between cholera and contaminated water was therefore established, before bacteriology was able to identify the causative organism. Having identified the source of the infection as polluted water, he went on to remove the handle of the Broad Street water pump and halted the outbreak of cholera in Soho, London. Before this outbreak, everyone assumed that Cholera was an airborne disease. Snow did not agree with this, and argued that it entered the body through the mouth. In 1849, he published his ideas in an essay about ‘The Mode of Communication of Cholera’. A few years later, this theory was proven, when there was a Cholera outbreak in 1854. After an investigation took place, it was included that the plotting of the cases of Cholera on a map of the area. He was also able to identify.

John Simon and the 1866 Sanitary Act:

John Simon was third ‘founding father’ of public health. He succeeded Edwin Chadwick in his role in public health administrations; he was instrumental in helping several towns install their first sewage systems throughout the 1850’s and 1860’s. In 1866 the sanitary Act placed a duty of inspection on local authorities and extended their range of sanitary powers. This Act obliged the local authorities to improve the local conditions and removing of health hazards. They also became responsible for the provision of sewers, water and street cleaning. This Act applied the connection of all houses to a new main sewer.

Public Health Act 1874:

In 1875 a public health Act enforced laws about slum clearance, provision of sewers and clean water, and the removal of nuisances. In order to diminish the diseases being spread due to this.

19th Century

1906:

In 1906 local councils were told to provide free school meals for poor children as they are less unfortunate and cannot provide food for themselves. This will ensure all the poor children get a good healthy meal throughout their school hours in order for them to stay fit and healthy during their lunch time.

1907:

In 1907 school medical examinations were ordered for all children.

1908:

In 1908 Old-age pensions were introduced for the elderly.

1911:

In 1911 this Act was introduced so all the workers who were ill could receive free medical treatment, and also National insurance.

The Beveridge Report 1942:

The coalition British Government has unveiled plans for a welfare state offering care to all from the cradle to the grave. The Beveridge report proposes a far-reaching series of changes designed to provide a financial safety net to ensure a “freedom from want” after the war is over. Everyone of working age would be expected to pay a weekly national insurance contribution. In return benefits would be paid to the sick, widowed, retired, and unemployed and there would also be an allowance for families. Beveridge identified the five things that need to be addressed in order to have a good social welfare system, these were called the five ‘Giant Evils’, which were, squalor, ignorance, want, idleness and disease.

The National Health Service (NHS)
The NHS is funded through the tax of the population, instead of through national insurance.

The National Health Service (NHS), 1948

The National Health Service was one of the major achievements of Atlee’s Labour government. The National Health Service (NHS) was introduced in in 1948. This service provided free medical treatment for everyone. The driving force behind the NHS was Aneurin Bevan, Minister of Health. In 1911, the National Health Insurance system provided medical care for 21 million people (according to Bevan) but left the rest of the population having to pay for medical treatment. It became clear to both Beveridge and the Labour Party that people were being denied medical help simply because they could not afford to pay. The majority of doctors were opposed to the introduction of the NHS as they believed that they would lose money as a result of it. Their main opposition to the NHS was their belief that their professional freedom would be jeopardized i.e. that they would treat fewer private patients and,
as a result, loses out financially. They also believed that the NHS would not allow patients to pick their doctor – though this proved to be an unfounded worry.

Once the NHS was introduced, it did prove to be popular with most people. 95% of all of the medical profession joined the NHS. In fact, the NHS proved to be too popular as it quickly found that its resources were being used up. From its earliest days, the NHS seemed to be short of money. Annual sums put aside for treatment such as dental surgery and glasses were quickly used up. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million. However, the popularity of the NHS meant that in the 1950 election, the Conservatives promised to keep it – though this was of little importance as Labour won that election. In 1951, the Labour government introduced a charge for some dental treatment (free false teeth) and for prescriptions for medicine. Aneurin Bevan resigned from the government in protest at this. Bevan wanted a free health service and nothing else.

The Black Report 1980:

The Black Report, published in 1980, showed that there had continued to be an improvement in health across all the classes (during the first 35 years of the National Health Service) but there was still a co-relation between social class, (as measured by the old Registrar General’s scale) and infant mortality rates, life expectancy and inequalities in the use of medical services. The National Statistics Socio-Economic Classification (NS-SEC) has been introduced since then. Chandola and Jenkinson have it together with the Short Form health survey (SF-36), (a measure of health outcomes), to show that correlations between social class and health inequalities continue to be significant.

The overall finding of this report was that the inequalities were because of the gap in social inequalities in influencing the health of the population, which were: income, education, housing, diet, employment, conditions of work.

Acheson Report into inequalities in health 1998:

The Acheson Report, fully titled the Independent Inquiry into Inequalities in Health Report, was a report published in 1998 by a United Kingdom inquiry headed by Donald Acheson. Like earlier reports on health disparities in the United Kingdom including the Black Report and the Whitehall Study, the Acheson report demonstrates the existence of health disparities and their relationship to social class. Among the report’s findings are that despite an overall downward trend in mortality from 1970–1990, the upper social classes experienced a more rapid mortality decline. The report contains 39 policy suggestions in areas ranging from taxation to agriculture, for ameliorating health disparities.

It had some influence on the 1998 government green paper Our Healthier Nation: A Contract for Health which had a stated aim of reducing health inequalities; and the 1999 white paper Saving Lives: Our Healthier Nation, he identified a number of ways for the developing of the policies in order to reduce the number of areas, which were a priority. That there should be an evaluation of the policies, which have had a significant impact on the inequalities in health The priority of health should be given to families, where there are young children Drastic measures need to be done in order to improve the standards of the poor populations households, this can be done by reducing the inequalities in the income of households

Saving Lives: Our Healthier Nation 1999:

This was linked to the Acheson Report and made recommendations of the following main causes of ill health:

⦁Air pollution
⦁Unemployment
⦁Low income
⦁Crime
⦁Poor housing conditions
⦁The main focus of this report was to prevent the major illnesses, which include:
⦁Cancer
⦁Coronary heart disease
⦁Stroke
⦁Accidents
⦁Mental illnesses

21st Century

The 21st century had an independent organisation that was known as Health Protection Agency, this organisation dedicated and authoritative information on health protection issues to the public, professionals and the government. The health protection Agency works with the international, national, regional and local levels and also links with many other organisations around the world. They also identify and respond to health hazards and emergencies caused by infectious diseases, hazardous chemicals, poisons or radiation.

Public Health White Paper – Choosing Health: Making Healthy Choices Easier 2004: This report acknowledged that there was a rapid increase in the need and want for health. In answer to this, a new strategy was propose, which was ‘The Public Health Strategy’, which reflected on the development of technology within society. This report also made it clear that it was very important to empower people to make changes to their own lives.

The Health Protection Agency (HPA):

The Health Protection Agency (HPA) is a non-departmental public body. Its role is to help protect UK public health by giving support and advice to the NHS, local authorities, emergency services, the Department of Health and any other organizations that play a part in protecting health. The Health Protection Agency role in the UK is managing communicable disease and preparing for emergency situations has already been mentioned. For examples the HPA provided national information and guidance in 2005/6: The HPA reported that homeless people increase the risk of infection for injecting drug users; three-quarters of infecting drug users have been homeless at same point; and those who have been homeless have higher levels of injecting risk and associated infections, primarily through the sharing of needles. An estimated 73,000 adults are now living with HIV in the UK, according to the HPA`s report on the UK`s sexual health. The HPA operates from four major centres:

⦁HPA Colindale
⦁HPA Porton
⦁The Centre for Radiation, Chemical and Environmental Hazards in Chilton
⦁The National Institute for Biological Standards and Control in Potters Bar There are also local and regional offices across England, the HPA Act requires the agency to be accountable for the standards of the healthcare services it provides as if it were an NHS authority. This means that the agency is subject to the Care Quality Commission’s Annual Health Check and measured against the Department of Health’s Standards for Better Health. This organisation is independent and its main focus is the protection of the health of individuals in the UK. This is done through guidance and information on the issues regarding the health protection of individuals in society.

The National Institute for Health and Clinical Excellence (NICE):

The National Institute for Health and Clinical Excellence (NICE) is an agency of the National Health Service charged with promoting clinical excellence in NHS service providers in England and Wales, by developing guidance and recommendations on the effectiveness of treatments and medical procedures. NICE also produces “clinical guidelines”, providing wider guidance on the management of whole diseases or clinical conditions, which cover several different treatment options.

The Institute is also responsible for assessing the safety and efficacy of interventional procedures for diagnosis and treatment. It is tasked with conducting assessments and drawing up guidelines by the Department of Health and the National NICE is constituted currently as a Special Health Authority, and is accountable directly to the NHS chief executive – the permanent secretary at the Department of Health – and the Secretary of State for Health.

This is an independent organisation which has the responsibility and duty to provide national guidance on the promotion of good health as well as the prevention and treatment of the ill health of individuals in the population.