This assignment alms to assess and evaluate how social, demographic and environmental factors affect the health status of the chosen community and the individuals living within that community. Through the evaluation and analysis of demographic and epidemiological data it will be possible to discover any health needs which may exist in the local community and discuss how they might be addressed. Demographic factors are those which demonstrate the change in structure of the population such as births, deaths, Immigration and Incidence of disease.
Whereas, epidemiological factors take Into account the Incidence and striation of disease and how these problems can be managed by health care providers (Oxford concise dictionary, 2006). Naiads & Wills (2000) agree with this definition stating that epidemiological factors are indicators of levels of morbidity and mortality and the types of disability or disease and causes of death in the population. Therefore, In order to be able to assess whether there any health needs in a specific area a profile of the community using demographic and epidemiological data must be compiled.
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Community profiling, also referred to as a health needs assessment, is important as it allows health care professionals to identify health needs within a specific area. This in turn allows for appropriate allocation of resources in order to provide the community with the service provisions that are required for the health improvements of the population. The nursing and midwifery council highlight that nurses have a responsibility to participate In community profiling and the Identification of health needs.
According to the NC (2008) code of professional conduct, nurses should protect and support the health of individuals ND the health of the wider community. This is also reinforced by NICE (2005) who state that health needs assessment is a systematic method which should be employed by all community health care professionals when reviewing health issues in that population, allowing allocation of resources and service provisions that will reduce Inequalities and Improve health.
Therefore, It Is clearly an Important role of health care professionals to use community profiling as they all have a responsibility to provide sufficient services to improve the health of the population. Many of the tactics used to profile the community will be taken from the 2001 Census data. However, due to the age of the data it is realized that these statistics may not be as accurate as desired for the same community in 2011 as they are taken before the recession would have had an Impact on the locality.
The data for the area being profiled will be compared to data for Swansea as a whole and to Wales In order to analyses and evaluate the health needs that exist in the population. Geography The community being profiled is Downhill, a small ward in the relatively young city of Swansea located near the MM motorway in South Wales. The area consists of a large council estate spread over a steep hill close to the city centre overlooking Swansea bay (shown on map below). History The city of Swansea is renowned for its role in the industrial revolution.
During the 19th century Swansea metal working trades grew until 90% of the world’s copper was smelted there and the port also boomed through the export of metals and coal. According to Rouser et al (1998) during this huge increase of industry in Swansea the population grew from 6,000 in 1801 to over 65,000 by 1881, most of the population had migrated to the area. This rapid increase in the population was most likely due to the availability of employment in the town. However, following the construction of the docks in Cardiff and the Taft Vale railway line Cardiff overtook Swansea as the leading coal port in South Wales.
Swansea copper smelting industry faced tough competition due to foreign demand. Rapid growth in demand for tinplate during the First and Second World Wars led to a boom in the local economy during the first half of the 20th century. Swansea became a target for German bombing raids due to the importance of the industries, the port and the railway. In February 1941 the town centre and many residential areas, including what is now Downhill, were destroyed by bombing. The industry in the area was affected by this and by 1960 was in rapid decline.
This led to a huge increase in unemployment among the working classes in Swansea which is affecting the population today, even more so following the recession. Population According to the Office of National Statistics (2001) the population of Downhill was 8,443. The population consists of 47. 1% females and 52. 9% males. 29. 3% of the population are under 18 and 13. 5% are over the age of 65. In 2009 the Office of National Statistics (2009) estimated the population to be 8,767. However, this was only an estimate and not an accurate measurement of the population.
It is evident however that the population of Downhill is increasing as according to the Office of National Statistics (2011) the number of deaths in the area is lower than the number of live births every year as shown in Figure 1. Therefore, this shows that the population estimates by the Office of National Statistics (2009) were correct to estimate an increase in population. Figure 1: Live birth and death rates in Downhill Another way in which the population is defined is through social class.
There have always been health inequalities between social classes in the UK. Browne et al (1999) point out that the official government statistics in the I-J highlight the relationship between social class and health inequalities. In the I-J, class had been measured for many years using the Registrar General’s Scale which decides a person’s social class based on their occupation. However, many have argued that the level of skill used at work may not be the most accurate way to measure a person’s access to social resources.
Therefore, in 2001 the NSA-SEC scale was introduced which addressed some of these problems. The NSA-SEC is also an occupationally based classification system but also takes into account employment status and it has rules so that the whole adult population can be classified. Figure 2 shows the NSA-SEC classifications Figure 2: NSA-SEC classifications for Downhill population It is evident that a majority of the population of Downhill fall into categories 6 (semi routine occupations), 7 (routine occupations) and 8 (never worked and long-term unemployed).
The Black Report (1980) found that the health standards of the population were directly linked to social class and it was discovered that ill health increased the further down the social scale an individual was. The Report discovered that the mortality rates of men in social class 5 were double that of men in social class 1. Therefore, because the majority of the population of Downhill fall into the lower social classes it is assumed that they will have poorer health and lower life expectancies than areas with higher social class population.
Although according to Census data (2001) only 18. 77% of the population said they had poor health compared to 57. 54% who classed their health as “good”. However, perception of health is very subjective so this statistic cannot be considered accurate or reliable. Employment and Income: According to MONISM Official labor market statistics (2001) 17. 5% of the Downhill population are unemployed, 22. 5% of which are men and 1 1 . 1% women. However, it was found in the 2001 census that only 8. 4% of the population in Downhill were claiming Job Seekers Allowance OSHA).
The large difference between the percentage of unemployed in the area and the percentage of AS claimants indicates that many people are economically inactive and are not seeking employment. However, these tactics do not define why people are unemployed and fail to account for those who are long-term sick or disabled and those who are caring for others and so are unable to work. During this post recession period in Wales there are few Jobs available compared to the number of people who are currently unemployed. The Job Centre plus Job vacancies summary analysis (2011) found that in October 2011 in Swansea there were 3. Applicants per Job vacancy. Therefore, such a high rate of unemployment should be expected, particularly in an area such as Downhill where a majority of people are poorly educated. Education: In Downhill 53. 6% of people aged 16-74 have no qualifications (Census, 2001). 13. 8% have achieved 5 Gases at A-C grades. 4. 7% have achieved 2 A levels and only 7. 4% have degree level qualifications. There is a strong link between educational achievement and health. Education is highlighted in the Black report as another reason for health inequalities in the lower social classes.
According to POSTED report by Gilligan et al (2000) children from advantaged backgrounds (social class 1 or 2) were three times as likely to gain 5 or more A-C grades at GEESE than their peers in the lower social classes. This lack of education means that lower class children are likely to work in manual or unskilled Jobs in later life, so are likely to suffer poorer health than those children with a good education who tend to fill professional or managerial positions. However, some believe that these factors are linked the opposite way: poor health and diet have an impact on educational achievement.
Bergman (1996, pop. ) states that; “child health and nutrition are strongly associated with educational achievement. ” His study revealed that good health and nutrition leads to less absenteeism and higher grade achievement. It is believed that children in lower social classes eat a poor diet in comparison with their peers from higher low income. Evidence of this is presented in the Marmot Review (2010) which shows that obesity is far more prevalent among children aged 10-11 from the most deprived areas than children from the least deprived areas.
However, the Marmot Review only takes into account statistics for England; therefore it cannot be assumed that the findings of this report are accurate for Wales too. Housing: Quality of housing has a major impact on the health of the population. Branch and Auburn (2010) define housing as being a “fundamental human right” and point out that it has been identified as one of the main determinants for health and quality of life. There are a variety of housing types in the Downhill locality. According to the Census (2001) the most popular type of housing in the area is semi-detached or terraced houses with 47. % and 45. 5% respectively of the population living in these types of housing. The Census (2001) also highlights that 34. 3% of Downhill residents live alone whereas 6. 3% live in overcrowded housing. Thunders (1982) cited in Trawler & Riley (1986) suggests that poor housing can affect health in several ways. Overcrowded housing leads to ill health as contagious diseases are easily transmitted, whereas isolated living leads to stress, depression and a higher suicide rate. He states that living in a poor housing environment can lead the occupants to suffer both physical and mental illness.
Respiratory problems are common in those living in poor housing conditions. Chuddar (2004) points out that asthma is a common respiratory illness which is related to poor housing conditions, together with other health problems such as allergies. As 17. 3% of the population are aged 10 and under another important aspect of housing to consider is provision of outdoor space. It is necessary for children to be able to play outdoors in order to keep socially, mentally and physically active. Many houses in Downhill do not have adequate space for children to play.
The RASA (2008) study revealed that often public areas are not seen to be safe or appealing for children because crime, traffic and bullying have increased dramatically. Unfortunately this mainly affects those children from the poorest families and therefore they are likely to become overweight or obese. Amenities: Downhill is located centrally in the city of Swansea and is close to a variety of amenities including GAP surgeries, schools, shops and transport services. Within the ward of Downhill there are a number of small supermarkets Food prices in these shops are higher than in the larger supermarkets.
However, there are a selection of larger retail outlets in Cartwheel Road, including the Para Forefather Shopping Complex, which are accessible by public transport from Downhill. The Phoenix Centre is a purpose built community centre located at Paradise Park which offers coal people access to children’s play facilities, a fitness centre, cafe and restaurant, a computer training suite, Job club, crychew and nursery, a number of small business units and also houses Downhill library.
There are also 5 other community centers in the area including Mainly Family Centre which also offer services such as playgroups and parenting classes among other community based support services. There are three primary schools and a number of comprehensive schools in the locality. Many people in the area do not have cars and so it is convenient for their children to tend a local school as they are more likely to have fewer absences if it is easy for Swansea Metropolitan University and one college of further education – Swansea College, both of which are easily accessible from Downhill.
There are a number of GAP surgeries and dentists to choose from in the area which is satisfactory for the size of the population. There is good access to public transport in the area. There are many bus routes which run through the community providing easy access to services. This is an important service to many people within the community as according to the 2001 Census (Office for National Statistics) 55. % of the population have no car and are therefore highly dependable on public transport.
Statistics also show that 7. 6% of the working population will travel to work using public transport (Office for National Statistics, 2001). The buses run regularly to the city centre and neighboring wards. There are also three taxi firms located nearby. Health Services in the locality: Reducing inequalities and improving the health of the population is an integral part of any plans for health in Wales. Welsh Assembly policy document “Better health, better Wales” (1999, p. ) highlights the need for strategies in health in order to “bring he level of those with the poorest health up to the level of those with the best health”. There have been many publications from groups and organizations outlining issues that need to be addressed in order to improve the service provision for people in need of health care both in the community and within hospitals. There are a number of primary health care services in the locality. These include access to GAP services, dentists and opticians.
At the GAP surgeries, patients are able to access many types of clinic including diabetic, chronic heart disease, women’s health, baby health, asthma and COOP clinics. These clinics cover the illnesses that are prevalent in the area. Morristown Hospital is the nearest place to Downhill to obtain emergency medical care. Secondary health services involve services which are usually obtained by referral from primary care providers. In the Downhill area there is extensive community nursing by district nurses, community child nurses, mental health nurses, midwives, school nurses and health visitors.
The Welsh Assembly Government has recently published the Community Nursing Strategy for Wales which outlines recommendations to “ensure that all people in Wales are able to access community urging services that both promote good health and provide nursing care for those who need it” (WAG, 2009). The Marmot review (2010) highlights the importance of investing in children to reduce health inequalities at all ages. Health data is collected by various organizations to evaluate health needs to be addressed in that particular community.
This process is most often carried out in less affluent communities as these are the places which depend highly on grants and funding to be able to receive and access health services that are required by the population. The most well known revive is “Flying Start” which is aimed at children in disadvantaged areas. The service provides a range of free services including part time child care, a bigger health visiting service and access to parenting programmer and play sessions (WAG, 2010). However, although most areas of Downhill are classed as being deprived not all areas are covered by “Flying Start”.
Therefore, equal services are not provided for the whole community. The Children and Young People’s Partnership (COPY) is an organization which has published a strategic plan aimed directly to improve the health of children in Swansea. The partnership works in conjunction with eave the opportunity to develop to their full potential and have the best start in life, through health, education and a positive social life within the wider community (COPY, 2010). However, as 13. 5% of the community are over the age of 65 it is important to consider the availability of services to the older population.
Along with the provision of medical care by Gaps, district nurses and hospitals there are many volunteer and charity organizations which offer services to the older population. Age Cymae (2011) provide volunteer befriending services, free transport to social activities and a shopping service. A study carried out by Tomato et al (2006) found that there was a strong causal link between social isolation of the elderly and health outcomes. Therefore these services are highly beneficial to the health of the recipients as it reduces the risk of social isolation and depression.
However, the sample size for this study was small and so the results may not be reliable. Local Health Needs: By looking at local GAP surgeries GOFF database statistics (2010) it is possible to see that local health needs can be identified as obesity, smoking, asthma and depression. All of these health needs are highly relevant in today’s society; however obesity and asthma are more likely to apply to all ages from early childhood through to adulthood. According to Department of Health (2011) obesity has a severe impact on the health of the population and increases the risk of type-2 diabetes, various cancers and chronic heart and liver disease.
By tackling the problem of obesity, especially childhood obesity, it is likely to reduce cases of other chronic illnesses and therefore improve the health of the population in the long-term. Therefore, reducing obesity in the community of Downhill will produce the biggest health gain for the population. Obesity is not only a health issue in Downhill but also in Swansea as a whole. According to the Welsh Health Survey published by WAG (2010) 56% of the city’s population is classed as overweight or obese. 34% of children in Wales were estimated to be overweight, with 19% of these classed as obese.
Wales has the highest rate of obesity in children within the I-J (figure 3). Figure 3: Percentage of child obesity Welsh Health Survey (2010), Scottish Health Survey (2010), Health Survey for England (2009) Obesity is a problem which needs to be addressed worldwide. According to World Health Organization (2011) there are 1. Billion adults and 43 million children under the age of 5 who are classed as overweight. There are many takeaway shops in the Downhill area which provide food which is low in nutrition and high in saturated fats, sugar and salt.
Takeaway food is often cheap and easily accessible, however if a person eats takeaway food often they are at risk of becoming overweight which is health need within the community. Also, as previously discussed, many members of the population are poorly educated and so may not understand the importance of nutrition and a healthy diet. Many households in the area have a low income or are lamming benefits and therefore may find it difficult to have a healthy diet on a small budget. The “Healthy Start” (2010) scheme has been running in the area for 5 years.
If you are pregnant or have a child under the age of 4 and are claiming income support or Job seeker’s allowance then you are provided with vouchers which can be redeemed for healthy foods such as milk, fruit, vegetables and infant formula. This scheme would be very helpful to much of the Downhill population as it would allow them to provide a healthy, nutritional diet to their family even if they were on a low income, therefore this would decrease the risk of obesity. Unfortunately, it has been found that many people are unaware of the scheme and so it has not been used to its full potential.
Also, for those who are not eligible for “Healthy Start”, Mainly Community Centre provides a “community fruit and vegetable service”. Instead of traveling to the shops to purchase fresh food it is possible for people to order it a week in advance and obtain it at a lower price. This is likely to encourage people to eat more fruit and vegetables as it is easier and cheaper for them to buy food this way than to travel to the supermarket. Tackling obesity in the community is more official that other health problems as very often obese people do not recognize that they are leading an unhealthy lifestyle.
Although there are a wide variety of clinics in the local GAP surgeries there are no clinics for weight management and no means of weighing yourself at the surgery. If there were a clinic it would give people the opportunity to obtain advice and support in order to lose weight healthily. However, there are three Westchester groups within a mile of the community. Westchester (2011) provide a combination of healthy eating, activity, small changes in behavior and group support to aid weight loss. Although many people in the area could benefit from Westchester but at El 5 per month most could not afford to pay for this service.
Recommendations: The provision of a weight management clinic at the GAP surgeries would be hugely beneficial to those wanting to lose weight as it would provide them with free, confidential support and advice. If the budget of the surgery would not allow for the provision of another clinic, even providing a weighing scale for people to monitor their own weights would be helpful in motivating individuals to lose weight. Volunteer services within the community could set up a support group to help overweight members of the population.
A variety of activities and support services could be offered in order to make the prospect of losing weight an appealing one. This method would also be affordable and therefore encourage more members of the community to participate. Education is an important factor to consider. It is necessary to educate both adults and children about nutrition and healthy lifestyles. Although children are educated in schools about eating a balanced diet and participating in exercise, often this is not reflected in their home lives.
Therefore it is equally important to educate adults. The provision of cookery classes to teach how to eat healthily on a small budget would be hugely beneficial to many parents in this locality. However, not all parents would be able to attend classes if it meant they had Centre and Gorse Avenue and the sports facilities at Swansea College are available to the public. However, these areas are not very appealing to children and are not very safe to use in the evenings or night time. Therefore this limits the spaces available for people to exercise without having to pay.
The provision of a safe space for the community to use for free would encourage people to undertake exercise more often ND therefore would be less likely to become overweight. Through creating a community profile of the Downhill area it has been possible to gain a better understanding of the population and socio-economic factors affecting their health. By doing so the health needs of the population have been revealed and it has been possible to evaluate the areas which would provide the greatest health gain for the community.
Evaluation has also revealed possible reasons why obesity exists in the community and has also exposed gaps in the services that are currently available to address the problem. Although a number recommendations have been made for the revision of services to reduce the level of obesity in the area, which in turn may reduce cases of diseases such as type-2 diabetes and heart disease, it is not possible to evaluate whether these services would have a long-term impact on the health of the population. References: Age Cymae (2011) Your local Age Cymae.