Category: Public health

Women and Violence are two such terms that can be synonymous with each other. Every day, end number of women go through different forms of violence, be it intimate physical and sexual violence, female genital mutilation, rape, sex trafficking, early and forced marriages, domestic violence, or so-called ‘honor’ crimes. Mostly persisting expressions of violence against women lies in the remote areas of India where cultures and customs do not allow such cases to be dealt legally. One such example is Dowry Death, where a married woman is tortured over money demanded in the name of rituals that eventually lead to either suicide or forced murder via hanging, poisoning or burning. Adding to this, women are also prone to exorcism and possession by local witches that defies science and promotes superstition. A considerable number of deaths have been recorded out of this in the past decades in India. Nonetheless, violence against women gives rise to physical, psychological, sexual, and economic tortures. It is one of the most serious and widespread contraventions of basic human rights and has a much stronger impact on the lives of not only an individual but on the societal and community level as well. It is high time to say that we take a lesson from it and take our self, families, societies, and communities to a whole different level of mutual love, respect, ownership, education, and employment. However, all of us frequently cross paths with this but there is a substantially low number of people who are distinctly aware of the root causes and the impact of it on the WOMEN.

Attitudes justifying violence, limited women’s autonomy, unequal power relations and multiple disparities between men and women, societal notions of gender and rights that lead to gender inequality, discrimination based on property ownership, marriage and divorce, illiteracy, economic dependence, and patriarchal society are some of the root causes of the violence. It is manifested in limiting the women’s freedom, choices, and opportunities in public as well as private spheres of life. Every individual has the basic rights to live their life the way they want, put-forth their views, and contribute to society; but women are deprived of all these rights because primarily they have to suffer the dominance and undergo violence. If we go back to our roots in the general gender-biased nature of our history, there are elements of proof that women were prohibited from their basic rights but at the same time, there have been some revolutionary exceptions too. Rassundari Devi, a Bengali lady, wrote her life story in 1876 named Amar Jibon. Then there is a case of Pandita Ramabai, whose father followed the saying ‘Charity begins at home’ and educated his wife Lakshmibai even after facing the extreme consequences for this. Lakshmibai, as a result has made her daughter educated in forests as written down in the book of Ramabai ‘The High Caste Hindu Woman’, which talks about persecution of women, faith, and imperialism .We can have as many examples where women have come out to be as leaders in the struggle for women’s rights, despite all the prevalent social customs and practices. The elementary phase of feminism in India was between the years 1880-1940. At this time many organizations gave women space and chance to stand out ,and to procure the desired changes. On the contrary, when it comes to giving equal privilege to women in the private spheres of life the case was not the same, for instance: inheritance rights, issues relating to domestic violence, marriages, and divorce. The Hindu Code Bill comprises of section which spoke about same rights to property to women, those which criticizes polygamy, which are in favor of legalizing inter-caste marriages and divorce were not welcomed. The following statement in the draft “the State shall endeavor to secure that marriage shall be based only on the mutual consent of both sexes and shall be maintained through mutual cooperation, with the equal rights of husband and wife as a basis” has not ever been able to take its place in the Constitution.

Globally, efforts are being made to deal with this public health problem by several means. First, taking the case of the Health sector which can do wonders in mitigating this issue but they somehow lag in addressing the violence against women. Apart from healing the consequences of the violence, health workers can make women understand that they are victims of the violence and they have to raise their voice against it. They can be more than just a physical healer to their patients particularly women. This life-saving response requires empathy, support, compassion, regular training, a supportive system, protocols, and referral networks. They can even provide greater benefits at the community level just by creating awareness about the benefits of postponed marriages for girls.

Second, ‘Prevention is better than cure’, but we have to start it in the early stages of life by educating young boys and girls as it is a crucial time when they learn and inculcate values and norms. It can be done by creating a sense of mutual respect, by making them aware that they can’t go away with disrespecting and hurting each other as it is the most basic right of each individual irrespective of their gender. We need to teach them to respect and embrace diversity. Implement programs that work with youngsters and teens for timely arbitrations. Third, use a participatory approach by engaging and involving men in the prevention activities, we can nip the cause of the violence in the bud. Engaging them as participants in education programs, as policymakers, gatekeepers, and as activists and advocates will also prove helpful. Fourth, laws formulation that promotes gender non- discrimination, women’s access to authorized and approved employment, and address gender based violence. Fifth, we need to promote coordination by supporting coalitions across sectors and firms at regional and state levels. Transformation of the communal environment, social customs, codes and preconceived notions and stereotypes is needed. Sixth, be certain of what a survivor has to say of her experience, never ever doubt the words and intentions of a victim, rather question gender presumptions and roles. All we can do to hold them up is respect their decisions in order to survive.

Besides all this, we have to build political commitment in terms of strict enforcement of laws and policies from leaders and policymakers against it. Allocate resources by investing in all types, kinds, and sizes of women’s organizations.

Violence in any form and against anyone is unacceptable and should be brought to a halt. To move in this light, mitigation of the risk factors and amplification of the protective factors is the initiating step. We ought to craft a theory of change by applying the directive principles of prevention. Adapt and scale-up to what works followed by monitoring, evaluating and measuring the progress.

The vital ingredients to this soup of revolution are a sight of grace, mutual respect among all the genders, basic moral education, choices of opinion, and the liberty to follow that opinion. To add to it, recognize, observe and celebrate all the facets of manhood including tenderness and sensitivity. This is the sole path through which we can bring in change keeping harmony & non-violence alive. My parting words lie with the thought of the great Albert Einstein-

“The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.”

INTRODUCTION

“Yoga is skill in events – Lord Krishna.

‘Yoga’ is a Sanskrit term meaning ‘to join, bond or yoke together’, and the essential purpose of yoga is to convey together body, mind and spirit into a pleasant whole. Physical Education may provide the right direction and desired actions to look up the health of members of any community, society, population and the world as a whole. An educational system encompassing the mental, emotional, social and physical scope of health becomes very important to bring about all around development in children.

DEFINITION OF YOGA

Yoga is the system of philosophy and practice of cryptic meditation having as object the union of the entity human spirit with that of the world.

Yoga is method by which one can remove lack of knowledge the cause of main folders and thus attain union with. Absolute nature.

Yoga is the science of right living and, as such, is wished-for to be incorporated in daily years. It works on all aspects of the individual: the physical, vital, mental, emotional, telepathic and religious.

AIM AND OBJECTIVES

The aim of yoga is control over the brainpower. A man who can- not control his mind will find it difficult to attain godly close association, but the self-controlled man can attain it if he try hard and directs his vigor by the accurate means. The main aim of yoga is integrating the stiff, wits, and thoughts so as to job for first-rate ends. Modern life style leads to diseases, which are as a rule due to meager food lifestyle, heavy daily routines and to air and water pollution in go round easily have an effect on the soul body. The main objectives of the Yogic practices are to craft one free since diseases, lack of knowledge, egoism, miseries the affiliations of mature age, and horror of decease etc.

YOGA AND PUBLIC HEALTH EDUCATION

As a public health graduate student at UNC-G and a trademark-new yoga instructor, I find many of my passions and welfare from the two arenas have collided to create a greater thoughtful of both subjects. In fact, public health and yoga have many of the same ‘objectives.’ the majority markedly is promoting and encouragement the health of individuals and communities through culture and live out. Just like public health is a open, encompassing subject, yoga is the matching. It is hard for a person to describe in a little words the meaning or idea of yoga or public health.

Both public health education and yoga are alert on creating knowledge of and a chary nature about our communities and ourselves. While many people maybe think of yoga purely as the physical practice, also known as ‘asanas’ or corpse postures, it is much deeper than that. Asanas are very soon one limb of yoga. Other ‘limbs of yoga’ take in: collective ethics, personal observances, and agriculture of perceptual responsiveness. In our health education courses, our professors hold close the same large-scale awareness that yoga fosters. This is a huge expert and own ‘skill’ that is important in our world and which will compose us wonderful, feeling health educators.

After completing the first year of the MPH plan, it is obvious to me that each character in our cohort has a passion to edify their community on various public health issues and concerns, whether it be advocating for sexual health sentence a make well for Alzheimer’s sickness or promoting athlete wellness. The diverse gifts and strengths that both students brings to the series contributes to a more entire understanding our community’s, states, countries, and world’s circumstances of health.

YOGA A PREVENTATIVE METHOD

Yoga practitioners often tout the health profit of yoga: better body alignment and position stronger might strength, increased self-awareness, greater flexibility, lower blood pressure, and more supple mental and corporal capacities. Indeed, yoga has develop into to be regarded as a universal remedy for whatever ailments one may have, but what claims can be substantiated? What pre-emptive reimbursement does yoga offer?

Due to the rapid growth in the popularity of yoga — going from qualified obscurity in the western humankind to near ubiquity in almost 30 years — one must pore over the many popular claims of the health remuneration or the conventional interpretations of yoga. Toni Mar, a yoga mentor at UC Berkeley, explains that due to inexperienced yoga instructors moderately recognized to the rapid rise in yoga’s attractiveness, yoga can be very different experiences for special people. While the experiences and styles of yoga tutoring vary widely, what can be held invariable in properly taught module are the health benefits of yoga. Subterranean and breathing, known as the “ujjayi gasp”; correct posture and back configuration; and mindfulness are all trial that have affirmative downstream things on our health.

Additionally, Dr. Marlon Maus, a former physician, current assistant professor at the UC Berkeley School of Public Health and longtime yogi, explains that yoga provide lifelong tools individuals can use to combat continual diseases like cardiovascular disease and diabetes that evident as a self grows older. He also explain that yoga can build up cognitive function by given that a intellect of community and socialization during group-led behavior. Through these practices, yoga can aid remodel the growing scourge of obesity and technology-driven common remoteness that plague today’s society. While these features are good-looking, they are without doubt not select just to yoga. Other forms of physical actions, such as swim or other exercise classes, also provide this profit. However, one of the notable aspects of yoga is that anyone can chip in in it. Dr. Maus explains, “We can adjust the level, the passion of yoga, depending on age and faculty, [which] is very imperative. Someone that’s in great physical health will at a standstill benefit from yoga since it helps keep them in that [health], but an important person with disabilities or boundaries can also erect very much from yoga because it helps recover the wealth that they already have, and uses those resources to recover it.” Indeed, this sentiment of universality is echoed by Mar as well, who explain that yoga provide the preventative measures for healthy folks to protect against ailment while also given that “the prescription for a big name who does have a dilemma or health condition.” “We’ve got the alike principles that we should be keen anyway,” Mar says.

Another differentiating factor of yoga is its holistic backing in wellbeing; aside from physical benefits, yoga also provides mental and even virtuous benefits. Although less studied, there is rising evidence that yoga can present mental physical condition benefits, such as concern and anxiety control. According to Dr. Natalie Nevins, osteopathic family general practitioner and certified yoga trainer from the American Osteopathic relationship, “Stress can reveal itself in many ways, counting back or neck pain, resting problems, headaches, drug abuse, and an inability to think over.” Yoga can help administer that stress by “increasing coping skills and success a more helpful outlook on life” in a personality, elaborating that “regular yoga carry out creates mental clarity and peace; increases body awareness; relieves chronic stress patterns; relaxes the mind; centers concentration; and sharpens concentration.”

Note that while there are studies attesting to the psychological benefits of yoga, these are prelude; Dr. Maus caution that there needs be more study before convincing statements can be made at a populace level. However, firm mental habits from yoga can be said to assistance overall wellbeing. A clear case in point is the raise in “body- and self-awareness” that can, as Dr. Nevins states, “help with early recognition of physical problems and allow for early deterrent action.” Another, as mention by Dr. Maus, is the use of intervention as a “way of industry with wer daily usual … [by] learning to be in the jiffy, something that helps we with the lot else in life, whether it’s philosophy or doing research or doing surgery.”

Indeed, yoga provides a unique holistic bustle — lifestyle even — that does not separate based on physical ability. However, before stepping up off to sign up for the nearest yoga class, Dr. Maus cautions that “yoga is unmoving a physical activity: before we board on doing yoga, we have to be positive that we are incapable of doing it.” Yoga is not a harmless activity and injuries can occur when it is unacceptably done. Those who are new to the carry out, recommends Dr. Maus, should notify the instructor of any “substantial problems or disabilities that they should be attentive of so [the instructor] can Salter the exercise to wed.”

HISTORY OF YOGA

Yoga has a rich history accomplishment back more than 5,000 years. On the other hand, it is only recently that this earliest practice has reached Western notice. Whenever folks roll out their yoga mat and twist their body into poles apart poses, they are also reaping immeasurable health benefits. Practicing yoga is not just a usual; it’s a rich recitation of history, a development of mental and corporeal resiliency, a revisiting of near spirituality — all contained in the four corner of a yoga mat.

The Role for Mindfulness in Public Health

The definition of mindfulness is “to pay mind with abiding faith in a affectionate universe,” from mediation from the Mat by Rolf gate. Put more simply, mindfulness is a perform of first observe and then leasing go of a mixture of thoughts and stance. It takes put into practice to learn to rein our wits in, but research is ever more signifying that learning is connotation our effort.

Mindful modalities like yoga and deliberation have been calculated at length and praise for their capability to make available relief from the toll anxiety takes on our health. They can diminish job-related stress, improve bone health in as little as 12 minutes, and surely impact mental health. Continual stress has been given away to impact a wide series of hot topic health outcomes, together with pimples birth, falling our inflammatory response, which contributes to the health of our invulnerable system (among other things), and plumpness. When review the recent top 10 causes of demise in America and compare it with the laundry list of remuneration fond of to mindfulness, it looks more and more like great public health should take critically.

There’s been a noticeable shift in topical years, especially with the push towards accreditation for public health agency, to actively engage in population health management and be a smaller amount paying attention on providing direct services. Many public health agencies, above all at the state and local level, take their path (and their funding) from the centralized health agencies, like the CDC. The CDC is taking a cleft approach to prevent continual disease:

• Monitor trends and progress from first to last epidemiology and examination;
• Support change to our environments that carry healthy behaviors;
• Promote quality experimental care; and Link the people programs with quantifiable services.

The link between community-based programs and clinical services is where mindfulness can have the most impact. We have community-based programs that help people with arthritis establish a walking regime, teach diabetes prevention, and provide people with counseling and tools to quit smoking. We use public health nurses, home visiting staff, community health workers, and community pharmacists to provide a range of services like medication adherence counseling and education to new parents. Why not incorporate a little mindfulness into the mix?

Yoga and mindfulness are both a practice of noticing. What could be more helpful than developing an awareness of were stress level, and learning to approach those stressors with a different mindset than weighed down? To notice when a trigger to smoke or engage in another harmful behavior arises with curiosity, to forgive an impulse decision that is counter to a goal, to observe the outcome of a behavior without judgment…these are all lessons we can learn from a mindfulness practice.

I’d like to promote these practices from a place of learning to be more compassionate and emotionally healthy communities, which can also help meet the goals of public health.

Yoga – public health benefits

Public health is in crisis, warns the NHS, because of obesity. One in four British adults is obese, according to a UN Food and Agriculture Organization report in 2013, and the UK has the highest level of obesity in Western Europe, ahead of countries such as France, Germany, Spain and Sweden. As a result, the country’s health system is buckling under the pressure of obesity-related conditions including type 2 diabetes, high blood pressure, heart disease, stroke and cancer, leading to needless deaths and disabilities from avoidable diseases.

Stress has also been described as an epidemic, with a 2010 survey by mental health charity Mind showing that more than 20% of workers phone in sick because of stress. There is no doubt about the physical and mental benefits of yoga to the individual, not least in terms of increased fitness, reductions in stress and anxiety and general improvements in wellbeing.

And public health gains in equal measure, not only from specific benefits of regular yoga practice but because yoga generally promotes a healthy lifestyle of eating well and exercising regularly, which is music to the ears of health chiefs.

Generally, yoga is a safe way to increase physical activity. It may also have many health benefits.

According to scientific research, yoga may:

• reduce stress
• relieve anxiety
• help manage depression
• decrease lower back pain
• improve quality of life in those with chronic conditions or acute illnesses
• stimulate brain function
• help prevent heart disease

When trying yoga for the first time, join a class for beginners under the direction of a qualified instructor to avoid injuries.

Never replace doctor-recommended medical treatment with complementary or alternative therapies

Yoga as a Tool for Public Health

Of all the major health threats to emerge, none has challenged the very foundation of public health so profoundly as the rise of non-communicable diseases (NCD). Encouraging a holistic health approach encompasses the community’s wellbeing. Competent public health grounded with holistic health approach can lay a better foundation in the modern world. Yoga has been increasingly explored as an adjunct therapy to major disorders. This study explores the efficacy of Yoga as a tool for public health. A survey was administered to 5500 adults, and 300 teens were selected from 25 states of India.

The study explored the difference in health, happiness, and sustainable living between Yoga-practitioners and Non-yoga practitioners. The study also explored the practice and habits of yoga practitioners (frequency, place, reasons to practice) and Health, Happiness, and Sustainable Living. The subjects were grouped based on age, education, experience in yoga (years of practice), and occupational background. The study population comprise of 54% males and 46% females. Majority of the respondents (59%) were from 18 to 30 years age group. The study indicated that 96.4% of the total respondents have heard of Yoga.

However, only 46.8% of the total study population practice yoga (YP) and the rest 53.2% were non-practitioners (NP). From a perspective of how Yoga and health, 72.7% yoga practitioners asserted a peaceful and happy life, 71.9% yoga practitioners felt satisfaction in life, and 70.2 % yoga practitioners had suitable health. 61.9% of yoga practitioners report being vegetarian, not eating junk food, and not drinking alcohol than 38.1% Non-Practitioners population. 47% of yoga practitioners found themselves to be more sensitive to the environment compared to only 40% of non-practitioners. India has been witnessing an unprecedented rise in the NCDs, accounting for 61% deaths. The importance of yoga as an adjunct therapy for various disorders and diseases is gaining momentum across the globe. There are various studies on yoga that have indicated benefits of yoga as a unique holistic approach towards lifestyle and a consistent, matching solution that could be adopted for long-term viability for a well being. The comprehensive study is the first of its kind that takes a holistic look at the prevalence of Yoga for public health in India. Our study is unique and stands out as it is detailed during its outlook with extensive coverage of almost the whole country (surveying 25 out of 29 states) and contemplates on the benefits to an individual at the grass-root level – physical, mental and social outlook. The insights from the study will enable the health care systems and grassroots organizations to make the holistic practice of Yoga accessible to spread sustainable living for a healthy community.

CONCLUSION

Standard practices of yoga and exercises contributed to development of physical fitness by bringing about significant improvement in the components namely, flexibility, strength, speed and agility, endurance and body composition. In as much as training continued for a period of twelve weeks, both yogic and physical exercises done by the subjects might have improved efficiency of the various body systems and mental faculties and development of which depended on the above machinery. In the case of body composition, speed and agility, the reason for physical exercise group showing better performance as compared to yoga, could be due to the fact that yoga program me might not have adequately emphasized on the vigorous movements. While in the exercise group there might have been sufficient exercise developing mobility of joints.

REFERENCES

1. https://www.realbuzz.com/articles-interests/fitness/article/introduction-to-yoga/
2. http://stjosephcollegeooty.org/wp-content/uploads/2016/03/YOGA.pdf
3. https://shodhganga.inflibnet.ac.in/bitstream/10603/45232/1/c1.pdf
4. https://pha.berkeley.edu/2017/04/07/yoga-a-preventative-method/
5. https://www.globalhealthnow.org/2017-03/role-mindfulness-public-health
6. https://publications.waset.org/abstracts/111844/yoga-as-a-tool-for-public-health
7. https://www.medicalnewstoday.com/articles/326414.php#summary
8. https://shodhganga.inflibnet.ac.in/bitstream/10603/85782/14/14_summary%20conclusions%20and%20recommendations.pdf

Intro

It is estimated that two to three million people are saved every year due to vaccinations, therefore it is hailed as one of the best achievements in public health. Vaccines have been used to successfully eradicate smallpox in 1979 as part of the first successful mass vaccination programme. Vaccines have been used to almost eradicate polio and measles which used to be deadly. There are over 30 different infectious diseases, and many can be prevented with a single vaccine.

Importance of vaccine: small generic statement

Vaccines induce a protective immune response to the targeted pathogen without the risk of contracting the disease leading to morbidity and mortality in some cases.

The aim of vaccination produces memory cells that can produce antibodies to fight of the pathogen if it invades the body without getting the disease and suffering from its potential harmful complications.

Importance 1

In addition to protecting the individual against the pathogen, vaccines also protect people who are unvaccinated such as people who are not able to be vaccinated due to weak immune system. This is because the more people are immune to a specific pathogen the lower the chance of transmission from one person to another, this limits the number of vulnerable people exposed to the pathogen. This indirect protection, called herd protection, however it requires that a large portion of the population (75–95% depending on the disease), or a special group that plays a key role in transmission of the disease, is vaccinated. Herd protection is often essential for the success of vaccination programs, such as for measles.

Vaccination of pregnant women can also indirectly protect infants in their first months of life through transfer of maternal antibodies from the mother to the foetus across the placenta. This concept has been successfully established for tetanus, influenza and pertussis. This is essential as fetus do not have as memory cells as an adult. (I don’t know why I wrote this cut it out if it isn’t good)

Vaccinates can protect certain high-risk populations from the infection so they do not suffer the complications. However, the vaccines are not effective with every segment of the populations. Therefore, the herd effect is important as it means that people who are not directly targeted by the vaccination programme also benefit, because there is a prevalence of immunity it prevents the circulation of infectious diseases as there are less people to pass it on to and spread it. Infectious diseases such as small pox was eradicated using the idea of herd immunity as there was high uptakes of the vaccination most of the population became immune to it so the smallpox could not be passed on and became eradicated. Herd immunity gas also decreased the transmission of pertussis and against influenza and pneumococcal disease. Therefore, it is essential that there is a high uptake of vaccines so that the chance of disease spreading is reduced.

Importance 2

Cost benefit of vaccine influenza https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521706/

Background

Seasonal influenza is the cause of a substantial cases of morbidity and mortality in people of all ages, and influenza vaccination is recommended to be given to everyone over the age of 6 months since the year 2010. A study was done into the averted outcomes due to influenza vaccination for influenza seasons 2005-06, 2006-07, 2007-08, and 2008-09, and age cohorts 6 months-4 years, 5-19 years, 20-64 years, and 65 years and above. Costs were calculated according to a payer and societal perspective (in 2009 US$) and considered medical costs and productivity losses.

Results

When taking the cost per patient into consideration, influenza vaccination was cost saving for individuals over the age of 65 in seasons 2005-06 and 2007-08. In the same study it is stated that, influenza vaccination cost $US 1.7 billion in total in the year in 2006-07 and $US 1.8 billion in 2008-09. However, when looking at the socioeconomic perspective when including the lost earnings due to premature death the vaccination lead to cost savings for all ages overall combined in season 07-08. However, this does not consider that the older age group may affect the results

Discussion

Influenza vaccination was cost saving in the older age group (65≥) when considering productivity losses and, in some seasons, when taking into account medical costs only. Averted costs vary significantly per season; however, in seasons where the averted burden of deaths is high in the older age group, averted productivity losses due to premature death tilt overall seasonal results towards savings.

In this study the indirect vaccination effects such as herd immunity and the potential fewer cases and therefore more cost savings resulting from this was not furthermore this study does not take the extra burden on patients if they are vaccinated and then contract, this could mean the benefits of the influenza vaccine may be greater than what is mentioned in this study.

Influenza vaccination has been recommended for all persons aged six months of age and older since 2010 [1]. In the U.S. each year, seasonal influenza has been estimated to cause 31.4 million outpatient visits, >200000 hospitalizations, 3000–49000 deaths, and is responsible for 44.0 million days lost ([2] estimations based on 2003 population) [1,3]. While most morbidity occurs in persons ≥65 years of age, all age groups are affected.

Importance 3

Measles was the single most lethal infectious agent widespread use of live attenuated measles vaccine discovered in 1963. In the early 1960s, as many as 135 million cases of measles and over 6 million measles-related deaths are estimated to have occurred yearly globally. Additionally, measles supressed the patients’ immune system leaving them vulnerable to other diseases such as pneumonia, diarrhoea, and acute encephalitis. Pneumonia, either a primary viral pneumonia or a bacterial superinfection, is a contributing factor in about 60% of measles-related deaths. The introduction of routine measles vaccination in most developing countries during the 1980s as part of the Expanded Programme on Immunization had a major effect on global measles mortality. By 1987, WHO estimated that the number of deaths from measles worldwide had been reduced to 1·9 million. This shows the importance of a good vaccination programme

Implication 1

Many country lacks sufficient vaccination coverage. In WEIRD (Western, Educated, Industrialized, Rich, and Democratic) societies, opposition to vaccination has a long story (Poland and Jacobson 2011). Certain people question being vaccination, because they perceive it to be unsafe because of the abundance of widely available poor science and claims of harm related to vaccines. This leads to hesitancy leads an increase in vaccination delay and refusal, which leads to an outbreak of of vaccine-preventable infectious disease which can sometimes lead to fatalities. A fall in the level of vaccinations lead to a measles outbreak in Europe in 2018 lead to 41,000 cases of morbidity and 37 mortalities (WHO 2018). Measles is still an endemic disease in WEIRD countries (Altpeter et al. 2018). Refusal or delaying the vaccination not only puts the individual under risk but it also puts the whole community at risk as there are some segments of the population who cannot be vaccinated. The ethical dilemma is whether to respect the patients autonomy or acting in the best interest of the public’s safety.

Implication 2

In developing nations in Africa for example, the vaccination coverage has historically been low despite parents wanting to vaccinate their children against infectious diseases which are vaccine preventable. Routine childhood vaccination programs lead to a decline in the cases of morbidity and mortality, however this leads many people to then question the point of vaccinating as the actual disease is not very common people do not realise the dangers of not vaccinating. Immunization has significantly improved public health in the African Region, including the elimination of many life-threatening infectious diseases. This has lead to a decrease in the number of hospitalisations in relation to vaccine preventable diseases since the introduction of new effective vaccines. However, optimizing the benefits of immunization by achieving high universal coverage has met with many challenges. The Regional immunization coverage, though raised from its low 57% in 2000 to 76% in 2015 has remained below expected target(1). However the rate of immunization has stagnated around 70% for a prolonged period(1). Cases of unequal access to immunization service continue to be a problem in the area.

Vaccination of vulnerable populations

Migrants and refugees are extremely vulnerable, due to their lower vaccination coverage than the host community, because they face many more barriers to vaccination (e.g., socioeconomic inequalities. They have a reduced immunization rate, similar to their country of origin where they lack access to immunization service. As a result of this the refugees or migrants are not inoculated against parasites in the UK.

Some groups of vulnerable people suffer from a disproportionate amount of cases of vaccine-preventable diseases. The low vaccination coverage among migrants can decrease herd immunity and this will lead to more of the public getting infected as there are more people the pathogen can transmit by. This will then lead to people with weaker immune system getting infected and therefore dying. As there is a high immunization uptake and because migrants are often proactive about their health (Hargreaves et al. 2018), there are promising opportunities of successful catch-up vaccination.

Reaching migrants is challenging, so all opportunities for catch-up vaccination should be used. This includes free vaccination in areas with a large number of people who are not vaccinated, such as in a migrant centre. These vaccination programmes should be extended to adults as they are also likely to contract and disseminate vaccine-preventable diseases.

Morbidity and mortality vary per season, depending on the types, subtypes and phenotypes of the circulating influenza viruses, levels of prior natural immunity, as well as on the antigenic match between the seasonal vaccine with the circulating viruses.

People used to be vaccinated separately for each disease. However now thanks to further research it is possible to create combinations vaccines, reducing the number of injections required for immunization against certain diseases. The most commonly used combination against measles today is MMR, which covers measles, mumps and rubella.

Multiple studies have disproved the link between the MMR vaccine and autism. The most recent example is a large Danish study: The study accompanied more than half a million Danish children over ten years and couldn’t find any increased risk for autism caused by the MMR vaccine. Out of 657, 461 children 6,517 children were diagnosed with autism. Comparing MMR-vaccinated with MMR-unvaccinated children gave a result of 0.93 for the autism hazard ratio, therefore there is no significant risk. Furthermore, there was no increased risk for autism after MMR vaccination in children with sibling history of autism and autism risk factors or other vaccinations during their childhood. However, despite this the hypothesized link between the MMR vaccination and autism, due to the retracted Lancet paper from 1998 written by Andrew Wakefield the amount of vaccine hesitancy increased.

Conclusion

All the cases morbidity and mortality prevented by the direct and indirect effects of vaccination will save money in healthcare, which can then be used to treat other medical conditions. Therefore, it is imperative that we stop the spread of misinformation and instead circulate of scientifically proven facts and help people understand the basic concepts of vaccines so the public understand their high benefits to risk ratio and the outcome if they or their child gets infected as a result of not being vaccinated so that a higher proportion of people who can be vaccinated are being vaccinated. So that herd immunity is achieved and segments of the population who cannot be vaccinated are also protected. Education and information strategies should emphasize on vaccines’ safety and effectiveness.

New vaccines types of vaccines are required to immunize people against pathogens with multiple serotypes such as dengue. Another issue is antigenic hypervariability such as with HIV (human immunodeficiency virus) and current vaccines do not work for this as the vaccine will only immunise people against the pathogen with a specific antigen and any memory cells produced from that vaccination. The more effective the vaccine the more people will agree to be vaccinated as they see all the positives it is doing.

This essay is going to explore the contemporary issue of suicide in adult males. I will be using epidemiology to justify this; epidemiology is the study of the determinants and distribution of population diseases. It is the key quantitative discipline that supports public health, this is often defined as the efforts taken to prevent disease and promote health by society (Cambridge University, 2010). Within this essay, the Joint Strategic Needs Assessment (JSNA) and the Clinical Commissioning Process (CCG’s) will be used to gain an understanding of whether suicide prevention campaigns are advantageous or disadvantageous in reducing suicide rates. This assignment will discuss and debate policies that are local, national and international levels to give a greater insight of how much of a public health issue suicide really is. The essay will include a public health campaign. There are many campaigns set up to reduce the number of adult males committing suicide but this essay will focus on one campaign only. The effectiveness of disease prevention, health protection and prevention methods of this campaign will be discussed and evaluated. This assignment will use public health framework to explore the effectiveness of the chosen campaign. The framework is used to appraise the effectiveness of the vision they have to ensure they maintain and enhance health. National policies will be looked into to see how the chosen campaign reflects these and within the World Health Organisation’s (WHO) health 2020 framework.

Public health manages the services and the activities that are in place to improve the standard of health in the overall population (Collins Dictionary). Suicide in adult males is a large public health issue, the statistics evidence this. According to the Office for National Statistics, males are continuing to account for three-quarters of deaths that are caused by suicide in the United Kingdom. The definition of suicide is when a person takes their own life intentionally (Collins Dictionary). The world health organisation states that people commit suicide in many different ways, an estimated 20% of global suicides are due to self-poisoning using pesticides, these mostly occur in rural agricultural areas of countries that have a high density of the population on low or medium incomes. Suicide is a public health issue as the rise in numbers is becoming critical. It has been known for many years that inequality and gender issues have led to suicide, this is particularly prevalent in middle-aged men (aged 45-49) in communities that are disadvantaged. Despite being aware of this there is still no comprehensive, cross-departmental government workplan that gives clear actions of how to reach the two-thirds of people who die by suicide, and who are not in touch with any mental health services (Samaritans, 2018).

As the statistics show more males than females commit suicide, The Samaritans looked at six main trends that may lead to suicide one of the trends is relationship breakdowns are more likely to lead men rather than women to suicide. Another trend is personality traits that can react with contributing factors that may lead a male to suicide, these factors are unemployment, deprivation, social disconnection. There are also triggers such as losing a job. Masculinity is another trend as men are more likely to turn to drugs and alcohol than women are to deal with their problems (The Samaritans, 2019). A main reason as to why more males commit suicide is men are less willing to talk about their feelings, they won’t express or show suicidal feelings. Therefore, they suffer alone (The British Psychological society, 2018). Suicide is an increased risk with people that have been diagnosed with a mental health problem as there may be an increase in suicidal thoughts or behaviours. A behaviour could be self-harming, the majority of people that self-harm do not wish to die the risk or attempting or completing suicide is increased (Mental Health Foundation, 2019). Although there are many methods of committing suicide, 4.4% of suicides take place on the railway. In 2018/19 279 fatalities on the UK railways were suicides or suspected suicides (Network Rail, 2019).

Dahlgren and Whitehead’s model of health determinants describes an approach to health that is social ecological. This is done by linking an individual with the environment and also the disease. The individual is placed in the centre and the influences then change the structure to suite each individual. Layer one is the ways of living such as whether an individual is unemployed, this can either promote or damage health. Layer two is social and community influences that can be had on an individual, these again can promote or damage health. The final layer includes an individual’s lifestyle factors such as; access to services and facilities and their housing situation (Dahlgren and Whitehead, 1991). By modifying this framework to an individual it can be used to see the link between the health inequalities and suicide. The definition of health is a state of complete social, mental and physical well-being. Health refers to not only the absence of disease but physical and mental weakness too (WHO, 2019).

Public health is about protecting people from threats to their health and keeping them healthy. Public health activities can sometimes help individuals or other times the activities are aimed at helping larger groups of people such as ethnic groups, certain age groups and countries. The National Health Service (NHS) has three main domains, these are protecting people’s health from things like environmental threats. The second domain is health improvement by helping people stop drug using for example. The third domain is by ensuring that England’s public health services are the most efficient, effective and accessible equally (NHS, 2019).

Public health England exists because it was established on 1st April, 2013 to protect and improve the health and well-being of the nation, it also reduces the number of inequalities in health. This was done by bringing together public health specialists from more than seventy organisations and putting them all into one public health service. Public Health England is responsible for making the public healthier and reducing the number of health differences between different groups. This is done by promoting healthier lifestyles, giving advice to the government and supporting local government, the NHS and actions from the public. Public health England is there to protect the public from health hazards, prepare for any public health emergencies and to respond to them. By collecting information such as research, collecting and analysing data Public health England are able to improve their understanding of public health and can therefore come up with answers to any public health problems. Public Health England works alongside national and international professionals to help provide the government, NHS and the public with evidence-based support which is scientific and professional. Public health England is currently supporting the cross-governmental strategy that is in place for suicide prevention by creating resources for healthcare professionals and local authorities. This is to help them to understand and be able to prevent suicides in their areas. Public Health England work hand in hand with the National Suicide Prevention Alliance (NSPA), this is an England wide coalition which is committed to reducing the number of suicides in the country and improving help for those affected by suicide in any way (Public Health England, 2019).

Public Health England has a framework of outcomes, this is a vision aimed on the health of the public. The framework has two main outcomes, the first one is increasing health expectancy and the second is reduce differences between communities and people with different backgrounds (Public Health England, 2019). The government has a public health strategy, this is called Healthy Lives Healthy People. The White Paper outlines the government’s commitment to protecting the public from any health threats that are serious, it is also in place to help people live for longer, healthier and have more fulfilling lives. Health of the poorest and fastest will also be improving (HM Government, 2010). In November 2008 Professor Sir Michael Marmot was asked to chair a review that was independent and would propose the best evidence-based strategies for reducing the number of health inequalities in England 210. Marmot produced a strategy called Fair Society Healthy Lives’. Within this strategy Marmot states that life expectancy has gaps of up to 7 years between the richest and the poorest communities (Marmot, M, 2010). The local governments and communities have agreed to address issues to help prevent these avoidable inequalities to improve the heath of the overall population (Public Health England, 2019).

In 2012 the health and social care 2012 act was put into place and introduced the first ever legal duties regarding health inequalities. Health bodies including Public Health England, The Department of Health, Clinical Commissioning Groups (CCG’s) and NHS England were given specific duties, these require the bodies to consciously consider reducing health inequalities within the people of England. The act also made changes for local authorities on public health functions (Health and (social Care Act, 2012). The healthy people, healthy lives and the our health and well-being today policies are two policies that pull together and contribute to The Health and Social care Act, 2012). Both of these policies recognise that a person’s health isn’t just the presence of disease or illness but how well an individual actually is. The policies take the input from the public to be able to understand potential threats to health and identify ways to identify approaches that provide health services that will meet the needs of the public (Department of health, (2010).

Clinical Commissioning Group’s were put in place as part of the Health and social care act 2012. The CCG’s replaced primary care trusts on 1st April 2013. Groups of general practices (GP’s) come together to form CCG’s and they commission the best services for the population and their patients. CCG’s purchases services from their local community from any provider of service that meets the standards of the NHS and costs. Examples of these are NHS hospitals, voluntary organisations or private sector providers. This is done to provide better care for patients that is designed with knowledge of the local services and has been commissioned to the response of their needs. CCGs are responsible for about 60% of the NHS budget, a wide range of services are commissioned by CCGs these include mental health services, emergency care and community care (NHS, 2019).

The Joint Strategic Needs Assessment (JNSA) states that 1-12% of all suicides take place intentionally by collision with a train and that 94% of attempts have resulted in death (JSNA, 5.1.3). There is evidence to say that some prevention methods will work on railways for example, suicide pits and restricting access to the track by using sliding door (JSNA, 5.1.4). Other prevention and protection methods have been put in place by railways, one of these is Gatekeeper training, this teaches specific groups of people to be able to recognise people that may be high-risk of suicide and then refer them for treatment. This can be aimed at family members, community members as well as professionals in health and social care. This method has already been identified as a successful prevention method for suicide. Small Talk Saves lives trains the public to become gatekeepers so therefore the campaign is advantaged by the JNSA.

In 2016 there were more male suicides than there were female suicides, this is backed up by WHO data. The data shows that the international Male:Female ratio of age-standardized suicide rates was 1.8 per 100,000 people (WHO, 2017). In the United Kingdom there was a recorded 15.5 male suicides per 100,000 people in 2017, 24.8 deaths per 100,000 were males aged between 45 to 49 (Office for national statistics, 2017). In 2018 these figures increased even more. This is why the Small Talk Saves Lives bystander campaign was initiated. This campaign was set up by the rail industry which is working in partnership with The Samaritans and The British transport police. The campaign was first launched in November 2017, to date there has been no other campaign like this (Network rail, 2017). Small Talk Saves lives was put in place to empower the public to help prevent suicide on the railway’s and in other environments. Suicidal thoughts can be interrupted by a simple observation or question, they are usually temporary. This means that suicide is preventable. Small Talk Saves lives aims to give bystanders the skills to recognise a person when they are vulnerable and at risk of suicide and give them the confidence to approach them. It is a reminder to those who know how to start a conversation that they can be confident enough to approach and help a person in need (The Samaritans, 2019).

Background:

According to a World Health Organization (WHO, 2019), “every year, more than 8 million people die from tobacco use, and more than 1.2 million people die from secondhand tobacco smoke-related diseases, including heart disease, cancer, and other diseases.” (WHO). Furthermore, smoking costs the global economy more than $1 trillion a year. when reflecting on the extent of tobacco use and diverse products and harms including but not limited to (smoking-related illness, lost productivity, passive smoking issues, agricultural, environmental). The extent and consequences of tobacco use (combustion, smokeless) are far-reaching. Inevitably imposing a heavy economic toll on households and governments from the loss of human capital and productivity.

With such an extent in damages, one reflects upon all the efforts towards the anti-tobacco initiatives available in the world today. In 2005, a significant effort against tobacco products harm entered into force with the Framework Convention for Tobacco Control (FCTC). In 2008, in order to expand the fight against the tobacco epidemic, WHO introduced MPOWER, a package of six measures that correspond to one or more of the FCTC provisions (Hoffman et al: 2015). These policies are, (1) Monitoring tobacco use and prevention policies (FCTC article 20); (2) protecting people from tobacco smoke (FCTC article 8), assisting to quit tobacco use (FCTC article14); (4) awareness on the dangers of tobacco (FCTC article 11-12); (5) enforcing bans on tobacco advertising and sponsorship (FCTC article 13); (6) raise taxes on tobacco (FCTC article 6), capitalizing on Harm reduction, and limiting availability through taxation. (MPOWER, 2008), Nonetheless, there are about 1 billion daily smokers around the world still. I intend to put this framework under scrutiny, with a focus on the smoking cessation intervention (WHO, encouraging stopping smoking,2001), and find the reasons behind the resilience to remedy this epidemic. Also it is important to point out the growing use of nicotine products that are not combustible and how is this going to develop a nicotine dependent population.

II. Aim:

If successful, the research should yield the following:

1. advocate for more assistance and helping methods for nicotine users, and find better ways to remedy this issue.
2. influence people and healthcare professional to evolve their practice in regard to this subject.
3. persuade decision makers to focus more on the point of service intervention and increase their level of awareness and anticipation around the hazards of a nicotine dependent population.
4. improve point of service intervention.

III. Research question:

What is hindering the realization of a comprehensive smoke cessation intervention at the point of service and what are the individual factors affecting the quitting of nicotine products?

IV. Methods:

In my study design I chose the inductive approach to produce the theory along the study process.

Phenomenology approach for a qualitative type of study is used to study certain phenomenon.

Using the grounded theory utilizing the ability to obtain in depth knowledge about the subject besides the systematic data collection and analysis allowing a sufficient read through the research question. However, this method has some issues as time, personal interests resulting in posible bias and also encountered obstacles while performing the interviews.

Participants selection:

The best way to my knowledge is to capture the perception of both informants and experts in this subject. This study will include nicotine users of all socioeconomic status (SES). Also, the languages used will be English and Arabic, due to that the sample is heterogeneous. Additionally, to build rapport I will be keen to familiarize myself with the participants, and be polit, respectful, humble, appreciative, interested and engaged.

1. Respondent interview

The interview will take place at hospitals, mainly treating illness related to smoking this might include the emergency department, primary healthcare, cancer centers. Also, considerations will be at mind to where the participants think they are more comfortable to have the interview.

2. Informant/expert interview

This will include healthcare professionals engaged in examining, treating or referring patients. The same etiquette will be extended. Their main contribution will be in finding out if they ask about nicotine use or only smoking during patient history taking, and the steps taken to help these patients quit in regard to advice, counseling, and management. Finally their perspective about a nicotine dependent population.

How to find the participants:

1. A list of hospitals and primary healthcare units as well as cancer and cardiology centers well be developed. A scheduled visit will be done after approval of the study and acquiring appropriate documentations, as well as coordinating with these establishments representatives to help introduce me to the environment.
2. “Snow-Ball methods”, after reaching out to these leaders in the first step, they might refer to others who might like to participate in this study.
3. Number of participants: This cannot be accurately predefined as it depends on the participants’ cooperation and the quality of the information, therefore concept of saturation will be applied. The study will run until the needed information are received.

V. Data Collection:

Semi-structured individual Interview:

Mainly face to face in-depth interview using semi-structured interview guides

which will take 45-60 minute for each interview. The study chose an in-depth interview process to obtain an understanding of what’s hindering the smoke cessation programs within healthcare, as they are the point of service generating valid medical dialogues with the target population of this study. Also, because the topic itself is very resistant to change with unique individual experience , as well as a fairly high level of relapse with multi factorial causes that might be related to private events, all of which lead me to assume that having a focus group interview would risk the credibility of one’s answers due to the peer pressure or discomfort in sharing private or emotional information with others.

• I will be conducting the study in English and/or Arabic as I speak these languages, therefore there’s no need for a translator for it might affect the study.
• The study will be recorded with permission from the participants, and notes will be taken during the interview.
• After the interview is done, I will thank them for their time and that unfortunately I won’t be able to provide the participants with any type of gift because I am a student.
• Semi-Structured interviews will be more beneficial to probe and divulge information that might be brought up during the interview and could be forfeited if committed strictly to a structured questionnaire interview.

VI. Interview guide questions:

• What are the barriers/challenges they encounter?
• What are the most effective methods to remedy the issue of nicotine dependency?
• how can the point of service intervention become more effective?
• What are the reasons around starting the use of nicotine products?
• What are the reasons around relapse after quitting?

VII. Data analysis:

1. First phase is the data collection(inductive phase); all the interviews will be recorded(audio/video)if the participant consent to that, all data will be organized and recorded according to theme with a time/date stamp then backed up on a cloud storage dedicated for this research, I will also learn how to organize a field note.
2. “Transcription analysis”: then handling the data by transforming the full records into written texts “transcription”. To avoid any bias that might be resulting from the lack of experience or subjective interpretation, I will then ask another expert researcher for example my supervisor(s) and if they refer me to a sociologist, or a specialist in a field related to my study that they recommend, to read the transcription and help deduct the most important notes.
3. “Content analysis” will be performed based on these notes. Categorization (formation of themes and subthemes) of the information will be done depending on the type of the information and its description, “coding” as explained in the participant’s selection part above. And then looking into the data if there’s any intersectionality, links in between these categories.
4. during data interpretation if I suspect any confusion in the interpretation, these will be discussed with my supervisor(s) to reach a consensus.
5. Last, latent level of analysis (deductive phase), at this phase interpreted data will be analyzed in relation to the (WHO encouraging stopping smoking, 2001) recommendations which consist of (Address the topic of smoking – Assess smoking status – Advise the patient to quit smoking and determine willingness – Assist, if the patient indicates s/he is ready to attempt quitting or has already taken action to quit – Arrange follow-up – prevent relapse). Afterward this information will be presented to the expert researcher i.e. research supervisor for further validation of the analysis, to be put into the final paper of the study result.
6. finally after the interpretation phase, these interpretations will be sent back through email or other methods of communications with the participants, including a time frame of 15 -20 days for them to review it and share any concerns.
7. in regard to time frame, this will have to depend on the situation and number of participants.

VIII. Ethical issues:

Before starting the research, approval will be obtained from both Central Ethical Review

Board at University of Gothenburg, and the administration concerned in the hospitals in the study.

Informed consent will be obtained and provided to all the volunteering participants. The informed consent will be clear, brief, and accounts to the privacy and confidentiality required. Furthermore the informed consent will have to cover these elements (title of the study, researcher information and contact information as well as academic affiliation, the purpose of the research, study procedures , risks and benefits, confidentiality, compensation, contact information, voluntary participation, recording of data, sharing of results, length of time, their right to stop whenever they need to , the right to ask me to clarify if they find something in the consent that they don’t understand). Participants are anonyms so there won’t be any identification at the individual level, however it will be made clear in the consent that coding will be made for the categorization according to the criteria described in the participant’s selection part (heterogeneity) above. Additionally, their comments will be given a code to provide anonymity.

Ethical considerations:

number of participants willing to volunteer, participants’ approval on recording the interview, access to the intended interview places or the interviewee’s acceptance to do the interview in the suggested locations, all matters mentioned here will be asked and agreed upon on the consent before conducting the interview.

IX. Quality and trustworthiness of the study: according to Lincoln and Guba, and Malterud.

• Clarity: the clarity of the paper will allow for peer review, which will help the credibility and validity of the paper.
• Credibility: the truthfulness in the findings. This can be achieved through techniques such as (triangulation, prolonged engagement, peer debriefing, negative case analysis, referential adequacy, member-checking)
• Validity:

1. internal validity: how good is the causality
2. external validity: how good are the generalizations and can we generalize from a smaller sample to a larger sample.

• Reflexivity: identifying and declaring any bias and preconceptions and engaging in active listing during the interview and avoiding “the knower’s mirror”.
• Relevance: it is very important to identify the value and relevance of this issue in the scientific field.
• Transferability: which is closely related to external validity and implies the application beyond the study setting.

References

1. Georgia State University, “Regulators should not consider ‘lost pleasure’ of quitting smoking, 2001”. Retrieved from https://www.sciencedaily.com/releases/2017/11/171128160437.htm
2. Malterud, Qualitative research: standards, challenges, and guidelines
3. WHO, “WHO Report on the Global Tobacco Epidemic, 2019 Country Profile Sweden.” World Health Organisation: 2019, www.who.int/tobacco/surveillance/policy/country_profile/swe.pdf. Retrieved October 16, 2019.
4. WHO, “WHO Enocouraging People To Stop Smoking, 2001”. Retrieved from https://www.who.int/mental_health/evidence/stop_smoking_whomsdmdp01_4.pdf

Introduction: What is Critical Race Theory?

Critical race theory (CRT) is a framework for examining the effects of race and racism. We use CRT to dissect the systems of racism, including how it affects those being oppressed by cultural representations of race. This theory understands the social construct of race as well as intersecting discriminations behind it (Daftary, 2018). Comment by Whitney Olsen: I would use “a” unless it’s the sole definitive framework for this. Comment by Whitney Olsen: Two “it”s in this paragraph can be confusing. Do you know how your professor feels about pronouns? “We use CRT to dissect the systems of racism, including how racism affects…” might be a stronger sentence, but if your professor is a hardcore no-pronouns-in-academic-writing type, that won’t work. 😛 Maybe “Analysts apply CRT to dissect…”?

Racism is defined in the Merriam-Webster Dictionary as a “belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race.” Under this definition, racism is explicitly intentional and a conscious thought process where people decide they are superior to others based on race. CRT challenges this broad idea to investigate the implicit biases that constitute racism today. A better current definition of racism in our society comes from Gillborn (2005),

‘The collective failure of an organization to provide an appropriate and professional service to people because of their color, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behavior which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.’

This description of racism better explains that a racist intent isn’t necessary to produce a racist outcome.

Critical race theory emerged as “an attempt to expose the ways in which racism continues to affect every aspect of the lives of people living in the United States” (Daftary, 2018). CRT is important because it demonstrates how racism continues to impact our society today in more implicit ways. Critical Race Theory may appear pessimistic, with its central focus on racism, but CRT’s purpose in uncovering racial discrimination is to identify racial inequity and promote change in the system (Gillborn, 2005). With CRT, we can identify the social factors behind biased attitudes and attempt to diminish the extent of oppression experienced in our society today. Comment by Whitney Olsen: Be careful to be consistent. In other places you capitalize all three words when you write it out, so make sure it’s capitalized the same way whenever you write it out throughout the document. Comment by Whitney Olsen: But what IS CRT? As jane is off the street, I don’t understand at this point how CRT is done or how it is used to analyze things. What is the framework/system?

Setting

For this paper, I have chosen to use critical race theory to examine our current healthcare practice and its impact on the black American population. Black Americans have reported prejudices and discrimination within the healthcare community for decades. There is a significant difference in how well the black community fares regarding major health indicators in comparison to other racial/ethnic backgrounds in this country (Lewis & Van Dyke, 2018). The health of black individuals and their healthcare outcomes are much lower than those of white Americans or other minorities in the United States. I aim to examine where this disparity came from, and whether there is a deeper cause behind the significant difference in healthcare received by black Americans versus Americans of other racial and ethnic backgrounds. Comment by Whitney Olsen: Are you examining CRT, or using CRT to examine the healthcare situation?

I will use critical race theory to look at the effects that discrimination in health care has had on the black population in America as well as some of the possible reasons behind this discrimination. I will also examine the types of healthcare discrimination that affect the black community as well as the intersecting points of gender, age, and socioeconomic status.

Nearly everyone needs healthcare at some point in their lifetime. Stepping into a doctor’s office, going to an emergency room, or making any other attempt to receive health services creates a power dynamic between the healthcare professionals and the person seeking aid. The healthcare professionals have a great deal of social power on their side: they have a degree, specific knowledge, and the necessary experience to provide a patient with the appropriate services and healthcare outcomes the patient needs. However, when a person of color seeks help from a healthcare professional, the outcome that person receives varies greatly depending on the implicit biases of the professional. When a black patient steps into the office of a white healthcare provider, the power dynamic between professional and patient is even larger – and larger in different ways – than compared to a white patient stepping into that same office.

Identification of Practice: Narrative

Many studies have shown poor patient-provider interactions when a patient is a person of color; these studies have also shown that patients of color have less authority and decision-making power in healthcare settings. In a national survey, 32% of Black Americans reported having experienced racial discrimination in a healthcare setting (Attanasio, 2019). Black patients are frequently given less control over their treatment, given fewer alternative options, and are rarely given the freedom to make decisions regarding their own treatment (Escarce, 2005).

Primary care doctors treat many minorities differently than their white counterparts, including providing poorer medical care and longer wait times for office visits. This has led to many people of color seeking out hospitals and emergency services for care rather than having a regular primary care physician (Hollar, 2001). Unfortunately, this only leads to further discrimination; the chances of being marginalized and dehumanized are higher in an emergency, especially one where the doctor-patient rapport is weakened by the short-term nature of the relationship.

Studies have further shown that a patient’s race can contribute to their diagnosis. Black males are significantly more likely to be diagnosed with schizophrenia than they are with other affective disorders (Hollar, 2001). This marginalization has been occurring for decades and the over-diagnosis of schizophrenia in black males is growing. Whether this over-diagnosis stems from the stereotype itself (Hollar, 2001), or from black males’ cultural mannerisms – i.e., how they express themselves or express certain other mental health issues in ways that are unfamiliar to most white physicians – it is still occurring. Comment by Whitney Olsen: I know it’s late in the game, but if you could get a source for the stereotype of black men being schizophrenic, that would go great here.

Black men are not the only ones experiencing discrimination in our healthcare system. The care of black children is also greatly impacted by the healthcare system. Black children are twice as likely as white children to be born prematurely, die before the age of one, and suffer low birthweight (Hollar, 2001). This may be due to the poor care given to their mothers during childbirth and pregnancy. Comment by Whitney Olsen: I kind of want to say “almost certainly” here, but you probably would need a source for that 😛

Black women in healthcare situations have even less authority than black men, especially when in a childbirth setting. Black women aren’t allowed to have an active role in their own care and perceive discrimination from healthcare providers (Attanasio, 2019). Stereotypes abound of black women being promiscuous, aggressive, and having children to gain government financial support. Clinicians could dismiss an assertive black woman as an “angry black woman” and may perceive behavior from a black woman as more aggressive and non-compliant than the same behavior from a white woman. These stereotypes bring implicit, widespread discrimination from practitioners. Black women also tend to be pressured more frequently into cesarean sections, as well as given fewer options in their general healthcare. When these women try to refuse certain care options, clinicians do not react well and often label them as “problem patients,” further adding to the stigma (Attanasio, 2019).

Being questioned or treated differently in a healthcare setting can be further affected by the patient’s insurance. Black women have been exploited and have reported receiving poorer care than white women due to their insurance (Attanasio, 2019). The insurance that a black patient has can be restricted by financial resources and socioeconomic status. If financial resources are limited, the range of healthcare choices (both in insurance and in care providers) may also be limited.

Black Americans are three times more likely than white Americans to have a lower income (Hollar, 2001). This can contribute to the available quality of care for people in these communities. Lack of safe and reliable transportation is also higher in communities of low socioeconomic status (SES), which greatly decreases the ability to get proper care when needed. While socioeconomic status is a contributing factor to our current healthcare crisis, that status also leads back to racism. It circles back to the black communities in this country having fewer resources and lower SES due to the continuous oppression those communities have experienced. Comment by Whitney Olsen: Define

Critical Race Theory Applied: Counter-Narrative

These narratives of the discrimination received by black people in healthcare all appear to follow implicit biases – whether a stereotype, stigma or miscommunication. Further in-depth, this discriminatory treatment could be due to the narrow-minded process of practitioners. The lack of ability to communicate brings physicians to fall back on a routine instead of taking a more individualized approach to breaking communication barriers. Comment by Whitney Olsen: This needs… something.

While doctors tend to report lower empathy towards black patients. Jose´ Escarce (2005), found that “White doctors perceived black patients as more likely than white patients to abuse drugs and alcohol, to be unintelligent and uneducated, and to fail to comply with medical advice, even controlling for patients’ observable characteristics.” This dehumanization of black patients oppresses them into a powerless state when they try to receive healthcare.

The white providers might question a black patient’s ability to make decisions or what they would consider as a “smart choice,” and may view their medical knowledge as making them superior to their black patient. Whether this is intentional or not, these implicit views greatly impact the care given to the patient. When healthcare providers are making choices for their patients instead of presenting the patients with options and information and allowing them to determine their care, the providers exploit the power dynamic in a patient-provider setting.

Black patients will usually choose black healthcare providers when the option is available to them. When being treated by a provider of the same race, black individuals report better quality of care, higher satisfaction with their care, and greater trust in their doctor (Escarce, 2005). While this is a better situation for black patients when the option is available, it is not ideal. Black patients should receive the healthcare they deserve regardless of the race of their provider.

Conclusion

At present, three potential ideas appear to be the best available options to help improve equity and diminish discrimination in the healthcare setting. First, we can and should provide interventions and education on cultural competence for healthcare professionals, as well as acknowledge implicit biases and microaggressions to improve communication between white doctors and patients of color. Second, we need to empower patients of color to strive for better communication with their healthcare providers and be more involved and informed with getting the healthcare that they need despite these oppressive barriers. Third, increasing the number of healthcare providers of color and of different cultural backgrounds in the healthcare field will create a better perspective for those working in healthcare and give patients more options when selecting a healthcare provider (Escarce, 2005).

While race is a social construct, racism is permanent. Implicit and explicit racism affects the lives of minorities in healthcare as well as their everyday lives throughout our society. It is this constant weight of oppression that Critical Race Theory strives to alleviate by determining the causes so that we may prevent further discrimination and undo the damage that has already been done. As a terrible sort of irony, living under consistent oppression leads to greater stress, which increases health risks; the racism in our healthcare systems is working against the people who may need proper healthcare the most. This is a cycle that our society hasn’t yet broken, but I am hopeful that with further analysis and application of CRT, we can develop ways to decrease racial discrimination in our healthcare system. Comment by Whitney Olsen: confusion

References

1. Attanasio, L. B., & Hardeman, R. R. (2019). Declined care and discrimination during childbirth hospitalization. Social Science & Medicine, 232, 270–277. https://doi-org.du.idm.oclc.org/10.1016/j.socscimed.2019.05.008
2. Daftary, Ashley-Marie Hanna (2018) Critical race theory: An effective framework for social work research, Journal of Ethnic & Cultural Diversity in Social Work, DOI: 10.1080/15313204.2018.1534223
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The topic of racial and ethnic differences in healthcare is one of the key importance to address in medical sociology. The problem is that minority populations, both globally and in the United States, are not receiving the proper healthcare they need to survive and treat health problems and diseases that arise. The idea of this is very confusing and frustrating to me since I feel that everyone should have the basic right to receive healthcare, health insurance, and treatment for any health-related problem. Further, I feel that when looking at this problem you can start by analyzing it on the global level and where the disparities in healthcare and coverage are seen, but then I looked deeper into where the disparities exist in the United States alone. It’s in the US that we see such great disparities between populations of majority and minority in not just the healthcare received but also the level of care that can be afforded and the quality of care that is given. This problem needs to be addressed in order for it to be fixed and equal for all populations.

Disparities in the quality, affordability, and presence of healthcare for minority populations is a problem that needs to be addressed and solved. On a global level, this problem is manifested on a few different levels. One problem is that populations in low-income nations don’t have adequate healthcare since they lack the equipment and personnel to handle higher volumes of cases that come up (Barkan, 2017). Further, the populations of these countries aren’t getting access to the healthcare they need, but also are going to have issues affording it when they can find it. The second problem is that since they can’t afford the care in their own country if they try to get it somewhere outside of the country, where a higher quality of care may exist, they lack the ability to travel, whether because of cost, availability, or timing (Johnston, 2010). Another reason why this is an issue globally is that diseases that should be curable, like the flu or the common cold, are the causes of many deaths because of the differences and disparities seen in healthcare, and further, there are health problems caused by things that shouldn’t be as big of a problem like environment-related health consequences (Barkan, 2017). I feel as though these things are reasons why this is a problem on the global level. Of greater concern to me is what happens in the United States.

A major problem in the United States is the disparity in the quality, availability, and cost of healthcare. I feel the main issue that has to be addressed is related to the inability of minority populations to access and afford healthcare. People are not given a proper chance to receive the healthcare they need to survive, whether it’s because they don’t have enough to cover the costs of doing so, or the technologies and ways to help them aren’t offered or considered. I think social inequality has a lot to do with this. Social inequality involves the unequal distribution of wealth related to race and ethnicity, and because of this, lower-SES populations are getting worse healthcare than wealthier people (Barkan, 2017). I think the problem of disparities in healthcare among minority populations based on race and ethnicity needs to be solved.

In terms of the problem I’ve outlined, I feel that there are three main social causes. In general, minority populations are more likely to work in stressful work conditions and live in polluted areas, things that have great consequences on their health. Further, differences in socioeconomic status are reflected in the ethnic-racial differences in that people of color suffer from a ‘double jeopardy’ in that they have a worse quality of health from both their lower social class and their race and ethnicity. The first social cause I feel is important to understanding and explaining the problem is that people of color receive inadequate medical care because of their lack of health insurance and the bias that is seen in the healthcare system. Another social cause I think is important to the problem is the poorer nutrition seen in minority populations, whether it’s because of a lack of available healthy foods or cultural dietary norms since diet is a key player in a person’s health, well-being, and healthcare. A final social cause I think is important is racial segregation. Racial segregation plays a role because the lower quality of health is correlated with people in highly segregated areas, and usually having a concentration in poverty, and more exclusion creates a lessened importance on schooling and high quality of health, culminating in poor health consequences (Barkan, 2017).

Of these three social causes I’ve outlined as being important to the problem, I feel that the first one – people of color receiving inadequate healthcare – is the most important. When specific minority populations are not receiving the quality of health that they deserve to survive and treat any medical issues that arise, it’s wrong. People deserve to have a good quality of life no matter what race or ethnicity they are, and when there’s a blatant bias in the care received, the quality of a person’s life is going to diminish. A bias is seen in the healthcare system usually when a person of color presents with medical problems to a white doctor. The patient is usually not taken seriously, or their problems are discounted, and sometimes they are even made to feel like they are wasting the doctor’s time. I think this social cause is the most important one to address when trying to figure out a solution to the problem since it affects a majority of the minority population and is something that shouldn’t be too difficult to fix.

One sociological way this problem can be addressed is by looking at the health behaviors of people of color and minority populations. African Americans, Latinos, and Native Americans are the most likely populations to engage in risky health behaviors. The inherent problem behind this is that they have lower socioeconomic statuses and are much poorer and less educated, leading to a pattern where when these individuals live in urban areas, they have poorer nutrition and a lack of access to exercise and healthy foods, and therefore they have worse health (Barkan, 2017). This is important when thinking about solving the problem of people of color and minority populations receiving inadequate healthcare because to address and solve the problem you have to start at the bottom, and this would be a good place where I would start.

When thinking of ways that I would address and try to solve this problem, I would start with addressing the quality of life that these individuals live. The first step would be to attempt to amend the way they live now and try to introduce healthier food options to help their health from the bottom, where if they don’t eat unhealthy food, they won’t have as many health problems, to begin with. The second thing that needs to be addressed is the type of care they have access to and the care they receive. One of the main problems is that minority populations aren’t offered the care that they need, whether it’s because of a bias in the medical field or it isn’t provided in the areas they live. If this could be worked on, for instance, if more clinics opened up with recent technologies and ways to treat conditions, then the populations would have access to those treatments and it would create more equal access to healthcare. The final thing that needs to be addressed is the cost of healthcare. This is a trickier one to handle because it’s difficult to make everything cheaper or free because the technologies do cost money and the doctors and medical professionals have to make a salary. Something I think that could be done is some sort of screening where everyone gets to have the opportunity to apply and interview for a hardship plan to help to pay for the tests or care they need. This might help some people who really are not able to afford healthcare and would still allow them to get the care they need to treat any diseases they have or regular check-up visits they need. Addressing the disparities that minority individuals see in healthcare in the United States, where they are not receiving the proper healthcare they need to survive and treat health problems, is something that needs to be done. If this can be done, solutions can be brought up and an attempt can be made to implement them, and hopefully, they can last and create a better situation for minority populations when it comes to healthcare.

The role of the public health practitioner is multifaceted. In the instance of Suffolk, and the proposed interventions, this involves overcoming a complex problem which requires partnership working across a range of stakeholders (The Open University, 2019d). Public health professionals can play a vital role in championing the needs of the local resident population (Bunton et al., 2003). This is particularly true for vulnerable populations such as children, as included in this proposal, who are not always able to have their own voice in policy decisions (Freire, 2018). Importantly, reducing health inequalities is a central role of public health practitioners (The Open University, 2019e). This means the avoidable differences between groups which could be the richest and poorest, oldest and youngest, or different races, religious groups, or those with a protected characteristic such as mental or physical disabilities. Compared to other stakeholder groups such as trading standards, public health stakeholders have a more clearly defined role relating to health inequalities (Naidoo et al., 2000).

Central to public health is the monitoring and surveillance of health data, and this should include continual monitoring following any policy intervention (Bunton et al., 2003). This enables an evaluation of the possible impact of any interventions or policies. So, following the initiatives relating to challenge 25 and parental provision of information in Suffolk, continual monitoring of the under 18s alcohol-related hospital admissions should be undertaken. It is likely that we would see decreases in the number/rate with time, however if there is no change, the role of the public health actor should be to understand why no change is occurring. It may be that the proposed interventions are not effective or are not being implemented as intended. It is their role to identify why this might be occurring (e.g. facilitators and barriers) and find ways to overcome this, involving all relevant stakeholder groups (Bunton et al., 2003). It may be worth ascertaining patient or public experience (PPE), since public opinion on policy plays an important role in ensuring policy is acceptable and feasible and is grounded in the realities of local-level human behaviour (Freire, 2018). What may be effective in one local area may not be in a second, and public health professionals need to use local data to guide and understand their own populations.

The ‘challenge 25’ intervention requires multiple stakeholders and actors to be effective which can become quite complex (The Open University, 2019f). The police, trading standards, retailers, responsible licensing authorities (including public health, child protection, crime and public order) will all need to liaise and work together (Dean et al., 2014). Though the primary responsibility falls on retailers, if the retailer violates the law and sells to someone under the legal age, then the responsible authorities (public health, health protection, crime and public disorder) will need to work together to present a legitimate legal case for the premise to have their licence revoked or the conditions of sale altered (Jones and Douglas, 2012). This can be challenging where resources or priorities across these different stakeholder groups may not always align (Bert et al., 2015). To overcome these issues, it may be useful to focus on the principle of health in all policies (HIAP) (The Open University, 2019g). HIAP is well established in public health and is increasingly recognised as important to stakeholders outside of public health such as police and crime commissioners (Bert et al., 2015). Ultimately, there is a strong financial disincentive for retailers to serve underage customers (a fine), and this has also been shown to be a powerful behaviour change stimulus.

The provision of information to parents may also come up against some barriers since parents may prefer to permit their children to drink alcohol at home and be supervised by them as opposed to a possible alternative where the children drink unsupervised and away from the home. This, while understandable, could be overcome by educating parents of the harm of alcohol to the developing brain and the finding that age of first use is strongly related to heavy drinking and alcohol problems in later life (Burton et al., 2017). More immediately, underage drinking is known to increase the risk of school truancy, drug use, antisocial behaviour, and acute poisoning (Burton et al., 2017). Again, ensuring the information campaign is effective at conveying these important findings is key to overcome any possible barriers (Jones and Douglas, 2012). The intervention could be delivered in schools and higher education settings, for example, by providing materials in school newsletters or parent-teacher conferences and sending these information campaigns out in the post or online mailing lists. The school would ultimately incur the cost of this, which may be a barrier, so public health professionals could aim to identify if money from the public health grant is available to support this health prevention activity.

Located in Southeast Asia, Vietnam has become one of the fastest-growing economies and has plans on becoming a developed nation within the next decade. With a population of 96.1 million, Vietnam is a densely populated developing country that has been adjusting since 1986 from the rigors of a centrally planned, urban economy to a more industrial and market-based economy, and it has raised incomes significantly. While the government of Vietnam has made commendable efforts in improving the health of the country’s citizens, certain public health issues have the potential to threaten sustained economic progress.

Vietnam has a young population, a stable political system, commitment to sustainable growth, relatively low inflation, stable currency, strong FDI inflows, and a strong manufacturing sector. The overall quality of healthcare is regarded as good, as reflected by 2017 estimates of life expectancy (71.5 years) and infant mortality (17.3 per 1,000 live births – with no difference between male and females). From 1990 to 2017, the maternal mortality rate fell from 233 to 43 deaths per 100,000 live births. However, the life expectancy and infant mortality rates are stagnating, and malnutrition is just very much common in these regions and provinces. As of 2018, the birth rate (15.2 per 1,000) and death rate (5.8 per 1,000) have remained steady in recent years. The current health expenditure in Vietnam is 7.1% of GDP. Government subsidies cover about 40% of health care expenses, with the remaining 60% coming out of individuals’ own pockets. Including government and out-of-pocket spending, a total of $119 was spent on health per person in 2017, which is expected to increase to $362 by 2050. While the 2017 GDP per capita was at a mere $6,143, Vietnam exceeded its 2017 GDP growth target of 6.7% with growth of 6.8% primarily due to unexpected increases in domestic demand, and strong manufacturing exports. These improvements are accredited to a widespread health care delivery network, increasing numbers of qualified health workers, and expanding national public health programs.

Being one of the highest population densities in the world, the population is not evenly dispersed. The biggest clusters of population are located along the South China Sea and Gulf of Tonkin, with the Mekong Delta and the Red River Valley having the lowest concentrations of people. The Healthcare Access and Quality (HAQ) Index in 2017 was 60.3%. The average percent change per year between 1990-2017 was 2% for personal healthcare access and quality. With over 8 million people belonging to ethnic minorities, the majority of live in mountainous and isolated areas of Vietnam. In terms of socioeconomic status (SES), these populations are comparatively more disadvantaged. Small-scale protests led by human rights activists still occur today, with majority of these protests pertaining to land-use issues, calls for increased political space or the lack of equitable mechanisms for resolving disputes. These protests involve various ethnic minorities like the Montagnards, the Hmong and the Khmer Krom. Limited number of health services spread throughout the provinces, especially in ethnic minorities, have substantial gaps resulting in lower health indicators and reduced economic opportunities.

The degree of risk for major infectious diseases in Vietnam is very high. The emergence of drug-resistant tuberculosis, outbreaks of influenza in animals and humans, the continued threat of the HIV epidemic, unstable health systems, and human resource constraints could limit Vietnam’s economic progression in terms of health. Stroke is the top cause of death generally and prematurely. Strokes in Vietnam (2,619.5 per 100,000) are significantly higher compared to countries like Columbia (594.8 per 100,000) and Mexico (683.1 per 100,000). Other major causes of deaths include ischemic heart disease, lung cancer, COPD, Alzheimer’s disease, tuberculosis, diabetes, cirrhosis and road injuries. Risk factors that drive the most death and disability combined are dietary risks, tobacco, high blood pressure, alcohol use, air pollution, malnutrition and high fasting plasma glucose. Insufficient funding has led to delays in planned upgrades to water supply and sewerage systems in some of the poorer regions and provinces. Vietnam has adopted a national strategy to introduce influenza vaccine, targeting health workers first. Vaccines have protected 6.7 million Vietnamese children and prevented 42,000 deaths from deadly diseases. Inadequate finances have also contributed to a shortage of nurses, midwives, and hospital beds. Patients’ average total expenditures with health insurance for both outpatients and inpatients are higher in Hanoi (52 & 1,721) compared to Dien Bien (34 & 588). This is in comparison to patients with no health insurance for outpatients and inpatients in Hanoi (470 & 5,235) and Dien Bien (20 & 1,985). Although there has been an increased significant amount of health workers in the past decade, there are still critical shortages in remote and underprivileged areas.

Vietnam continues to face growing pressure on energy infrastructure and overall, fails to meet the needs of an expanding middle class. Vietnam has demonstrated a commitment to sustainable growth over the last several years, but despite the recent speed-up in economic growth, the government remains cautious about the risk of external shocks. Policymakers, managers, health staff and other health system stakeholders in Vietnam are committed to ensuring that all people attain a level of health that enables them to participate actively in the social and economic life of the communities in which they live.

Public Health – Assignment 1

Public health is a complex subject that has positively affected our communities – it is complex as it does not refer to only one illness or condition’. We exist to protect and improve the nation’s health and wellbeing and reduce health inequalities’ (Public Health England Online). The origins of public health here in the UK started with the establishment of the National Health Service by virtue of influential characters such as John Snow and William Beveridge.

The industrial revolution rapidly gained pace in England in the 1800’s because of the power of steam and by 1870 100,000 steam engines were at work throughout England. Despite growing wealth, people were not prepared for the increase of accommodation needed in towns and cities. Several families would have shared one house due to the shortage of houses. There was no clean water, anaesthetic and no sewage system. All household waste was thrown into narrow streets and black smoke from the chimneys of factories filled the air – overcrowded living and dirty streets was a perfect breeding ground for diseases. Cholera and typhoid are bacterial infections caused by ingesting contaminated food and poor sanitation. Lice would also have been common due to the crowded living situations. Until John Snows contribution to modern epidemiology – it was believed that diseases such as cholera were caused by a miasma, a form of ‘bad air’. This was known as The Miasma Theory. Snow did not accept this theory and proved his theory, that in fact it enters through mouth, through the investigation of the Broad street pump in Soho in August 1854 after another cholera outbreak.

Throughout early 19th Century, the government believed it was not their duty to maintain working and living environments and blamed the poor themselves for their conditions. However, in 1940 attitudes changed. Edwin Chadwick, an English socialist was asked by parliament to investigate living conditions in Britain. The Public Health Act of 1848 was later brought through parliament by Chadwick, it stated the principle that health care should be administered at a local level. Being such globally devastating conflicts in human history, World War I and World War II had a major impact on the development of public health. After WW2, the government constructed a report on how to rebuild Britain. William Beveridge published his report outlining ‘the 5 giant evils’ and Welfare state. Beveridge recommended the government find a way to fight – ‘Want, Disease, Ignorance, Squalor and Idleness’. In 1948 systems were put in place to protect the nation from ‘the cradle to the grave’. Benefits to protect social security were put in place as well as the establishment of a National Health Service to provide free medical care for all.

There are various strategies used for developing public health policy – all of which are vital to ensure its success. For example, identifying the needs of the population. Information will be gathered on the current need in the population, which may be combined with previous trends to project future levels of need. Groups including age, gender, urban/local location etc will be considered in a basic demographic profile to further identify the needs.

The Director of Public Health issues an annual report determining the overall vision and objectives for public health that year. This strategy is important for example in relation to substance abuse. It is beneficial to know where and who is most affected by substance abuse in order to discover more trends in health care and keep people safe. The World Health Organisation states that one modifiable risk factor for suicide, especially relevant for young people at risk, is alcohol and drug use. The link between substance abuse and suicide suggests that by reducing the levels of substance abuse, levels of suicide will also go down.

Another strategy is minimising harm from the environment. This strategy is important as it protects the nation from both communicable diseases and non-communicable diseases. The Department for Environment, Food and Rural Affairs carry’s responsibility for minimising harm from environmental conditions that may cause disease. ‘Poor air quality is the largest environmental risk to public health in the UK, as long-term exposure to air pollution can cause chronic conditions such as cardiovascular and respiratory diseases as well as lung cancer, leading to reduced life expectancy’ (gov.uk online) provides a summary on just how important a healthy environment is.

The study of epidemiology is used to determine patterns of ill health. The Centres for Disease Control and Prevention provides a definition of epidemiology ‘Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data’. Morbidity and mortality rates of diseases are observed to put protective measures in place. In some cases, the government will commission a report on a specific health related matter for example, the Acheson report. Acheson made recommendations organised around key populations, children, elder and ethnic and domains such as tax, benefits and employment. These factors relate to and influence each other, for example your employment will dictate your income. Studies from Making Life Better Framework- Key indicators progress update 2018 illustrates the correlation between lifestyle and health inequalities.

Our health is linked to socioeconomic determinants. These are the conditions in which people are born, grow, work, live and age. They are shaped by the distribution of power, money and resources at a global, national and local level. These determinants are mostly responsible for health inequities. Examples of a health inequity are private and public care, mental and physical health. Illnesses like stress, obesity, cancer and diabetes and the partaking in criminal activity are linked to poor background. Although obesity and drug misuse for example may be life factors affecting patterns of ill health in the UK – they may also be the result of being exposed to health inequities from a young age. The BBC states ‘Access to and the quality of local health services may not always be as good in poorer areas. In deprived areas of Scotland, GPs are more likely to have more difficult caseloads. In disadvantaged areas like this, members of the community may come together to provide facilities such as safe play parks or food banks.

Frameworks have been put in place in the UK to minimise factors affecting ill health. Making Life Better printed in June 2014, is a 168-page framework of strategic measures for public health 2013-3023. It contains themes called ‘giving every child the best start’ and ‘empowering communities’. This framework states ‘“Giving Every Child the Best Start” and “Equipped throughout Life” take account of the particular needs across the life course and have been broadened to cover childhood and adulthood. They address the key social determinants at each stage. Emphasis is given to children and young people, and to supporting individuals’ transitions into and through adulthood and older age. “Empowering Healthy Living” addresses support for individual behaviours and choices and embedding prevention in Health and Social Care services. The next two themes address the wider structural, economic, environmental and social conditions impacting on health – at population level, and within local communities. The NHS provides stop smoking services, not only do they make it easy and affordable to get stop smoking treatment, they provide one to one session with patients or drop-in services.

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