Health profile to identify health risk and promote the health and wellbeing of an individual living in Brent.

Introduction

Nursing health promotion can lead to many positive health outcomes, including compliance, quality of life, knowledge of patients about their illness and self-management (Bosch-Capblanc et al., 2009; Keleher et al., 2009).

Studies show that nurses have taken an individual approach and a shifting outlook on behaviour, and it seems that the development of the theory health promotion has not changed nurses ‘ realistic practices of health promotion (Casey, 2007a; Irvine, 2007). There has been some discussion on how to include health promotion in nursing programmes and how to redirect nurse education from being disease-orientated towards a health promotion ideology (Rush, 1997; Whitehead, 2003; Mcilfatrick, 2004).

Background

The World Health Organization is a specialized agency concerned with international public health. They defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. (WHO 2014) While this definition has been longstanding, contemporary critics have challenged its dimensions of absolute well-being. Huber and colleagues (2011) argued that with the emergence of chronic illnesses, the definition might not be suitable for the purpose and it might be useful to adjust the definition to entail the ability to cope.

Multitudes of factors combine to affect the health of individuals and population, which challenges their ability to cope. Some of these factors are geographical, biological, socioeconomic and political (NICE, 2007). While biological (age and sex) are fixed and some other factors such as behaviour are associated with individuals’ choice, educational, political and socio-economic factors beyond individual’s control can also determine their health. This is what makes the difference in the distribution of ill –health and mortality between the least and most deprived as detailed in documents such as the Black Report (1980) and Marmot Review (Marmot 2010; Office of National Statistics, 2017).

OVERVIEW OF INDIVIDUAL

For the purpose of this assignment the individual will be referred to as Mr Johnson to maintain confidentiality. Consent has been obtained from the concerned individual.

Mr. Johnson is a 56 year old unemployed individual who lives alone in a council flat in a council flat in Brent. He enjoys a take away 4-5 times a week. He’s very overweight and finds it difficult to get around and often doesn’t leave the house.

Epidemiology data of Brent

Brent is an ethnically diverse borough located in the north-west region of London. As of 2016, the population was approximately 328,800 people with projections to reach 345,400 by 2021 (Brent Joint Strategic Needs Assessment (JSNA), 2015) due to rapid population growth. Brent’s population is characterised by young people aged between 20 t0 39 years representing 35.1% of the whole population, while 11% of the population is made of older adults aged 65 years and over, which is growing at a higher rate than other adult age ranges (Office of National Statistics (ONS), 2011). In Brent, the white group are the majority with 33%, while 65% of the population distributed among the Black, Asian or other minority ethnicity (BAME). Brent has been ranked 15th of the most deprived areas in England. Parts of the borough have high levels of social and economic disadvantages (Brent JSNA, 2015). Socio-economic inequalities affect all aspect of health, ranging from risk factors to health outcomes and access to services (Marmot Review, 2010), resulting in a low level of social functioning in older adults with obesity. The borough has a gap in life expectancy between the most affluent and the most deprived areas. While overall life expectancy is similar to the rest of London, there are significant

health inequalities

within the borough with

mental health

as the largest cause of morbidity (Brent JSNA, 2015). This highlights the detrimental effect of social isolation and loneliness on the health and mental wellbeing of adults in this borough. Brent JSNA (2015) reveals that prevalence of overweight people (including obesity) in Brent was 28.5%. It was higher than England average of 22.4% (Appendix 1).

Determinants of health

Obesity and overweight adults are at higher risk of developing conditions such as type 2 diabetes. Type 2 diabetes rates in Brent compared to other parts of the UK is particularly high. In 2012/13, 7.8 percent of people on GP lists in Brent were recorded as having diabetes (Public Health England, 2014). Without intervention, 60% of men and 50% of women could be obese by 2050 (Wang et al., 2011). Further, according to the Health Survey for England (2015), adults between 55-64 years have the highest prevalence of obesity (37.3% men are obese and 34% women are obese) compared to other adult population age groups. Evidence demonstrates an increased impact of obesity on people with mental health issues (Gatineau and Dent, 2011; Bégarie et al., 2013). The relationship between mental health and obesity is bi-directional as illustrated in a study which found that adults suffering from depression are 58% more prone to becoming obese; while those who are obese are 55% more likely to develop depression (Luppino et al., 2010). Individuals living with depression eat excessively (The British Medical Association, 2014). The complex interplay of social determinants of health such as ethnicity, socioeconomic status, educational attainment, age and gender have all been suggested as possibly important risk factors that could affect the trend or strength of the association between both conditions (National Obesity Observatory, 2011).

In relation to Mr Jonathan there are many determinants that affect his health. Mr Jonathan is unemployed and is not financially secure and does not have disposable income. This affects his self-esteem and the value he holds of himself. His financial situation prevents him from participating in many things, therefore impacting on him social and emotional health. Being single impacts on Jonathan, he lacks interaction with other adults, preferring his own company. Mr Jonathan is overweight and does not think he has a problem. He doesn’t cook and orders take way most days. This aspect of his lifestyle is impacting greatly on his health. His emotional and social health is also being affected, he has low self-esteem, suffers depressive moods, he withdraws and isolates himself. Many of Mr Jonathan physical health troubles are genetic. He suffers from

hypertension

as does his father and brother, he also has a hereditary hypercoagulability disorder. He also has pre-dispositions to other illnesses. Heart disease and cancer are common in the immediate family as are diabetes mellitus and glaucoma. The medications that Mr Jonathan takes have contributory effects that add to the state of his overall health. Many of the determinants that evidently contribute to his health are within his control, given the appropriate support and advice of healthcare professionals Mr Jonathan can take steps to improve her health.

Impact of Health Policy

The Care Act (2014) has vital impact on people with multiple LTCs and complex care needs alongside their carers; and the mandate from the government to the NHS for people to be treated as individuals and not as a collection of conditions (DoH, 2014). Other policy include;‘ No health without mental health’(DoH, 2014) strategy document, which place mental health on the same level with physical health by guaranteeing the access to good-quality services, support, countering stigma and negative attitudes to mental health across the whole of society. The Brent local policy outlined key priorities informed by the JSNA (2015) and National Policy, one of which is concerned with working collaboratively to support the vulnerable adults. Specifically, the strategy for this group in Brent is to improve urgent care as well as integrate health and social care services to help identify vulnerable adults, provide support people with LTC and their carer and reduce rate admissions. Other strategies include care pathways/guidelines, case management and with a single named health or social care professional a care coordinator. (NICE, 2018).

Nurses and other Healthcare professionals are often identified as key contributors and agents of change in many health targets by the government. Making every contact count provides an opportunity to educate and empower individuals to make primary positive choices about their own health. They have a crucial role in understanding the health needs of individuals and population groups, the delivery of care and promoting change in behaviour using appropriate resources as prevention strategy that can empower, educate, and prevent avoidable disease (PHE, 2013; NMC Code, 2015, p.5).

Accessing Health Services

There are several influential factors that affects how health services are accessed by group of people similar to Mr Jonathan in Brent, these factors include; fear of future, stigma, environmental factors and cultural conceptualisation. A qualitative study in Southeast England by Memon et al. (2016) found two broad themes as perceived barriers to accessing mental health services: first, personal and environmental factors which include cultural identity, negative perception of and social stigma against mental health, lack of knowledge to recognise and accept mental health problems, impact of social networks and low economic status. Secondly, the factors influencing the relationship between health provider and service users; which included the effect of long waiting times for initial assessment, and ineffective communication between providers and service users. For strategies to improve greater engagement, additional thought needs to be given to solutions that cater for service users with poor functional and health literacy (NHS Outcome Framework, 2016), communication preferences (Leung et al., 2010, NICE, 2018) and exploring opportunities to encourage co-production (The Health Foundation, 2010). For the older adults in Brent, engaging health services becomes even harder with the bidirectional relationship between physical and mental health problems, whereby individuals with mental health problems are at an increased risk of developing physical health problems (Poblador-Plou, 2014). This suggests specialist support through the Home Treatment Team in Brent.

Role of Nurses

The Royal College of Nursing (2007) identified four nursing role functions as supportive, restorative, educative and life enhancing.

Nolan, Davies, and Brown (2006) suggest that therapeutic relationship should be built, which will allow for natural interaction between all involved in care delivery; carers, family, health and social care staff, and patients. While this requires substantial engagement time that can be a barrier, the nurse is required to prioritise care (NMC, 2015; Skaalvik et al., 2010). A strong Nurse-patient relationship and tailored communication skills facilitates accurate assessment and improved outcomes (Jenkins et al., 2016). Good communication and integrated IT system between and across services —primary, secondary and tertiary care, will allow appropriate management and treatment of any physical and mental deterioration that warrants urgent treatment. Research shows that poor communication can lead to poor care outcomes (Goldberg et al., 2011). Communication strategies should include engagement of patients, their carers and family in shared decision making about the escalation of their care.

Health Promotion

Physical inactivity and an unhealthy diet are closely linked to excess weight and obesity. In the document, ‘Making Every Contact Count’ NHS (2014), obesity was identified as one of the five main public health issues in the United Kingdom, suggesting the urgency in addressing the consequent likelihood of illness or preventable death.

Barry and Yuill (2008) highlight statistics that show that people living in poverty make bad nutritional choices and diets are often high in fat and sugar leading to heart disease and increased risk of certain cancers.

From the SF-36 questionnaire that was given out, it was discovered that there’s a lot of factors that contributes to Mr Jonathan being overweight. From the GP Physical activity questionnaire that was given out, question 1A, it was discovered that Mr Jonathan is unemployed. Mr Jonathan doesn’t do any physical exercise as he doesn’t leave his flat. In Brent, 30.5% of the adults living in Brent are physically inactive and in England, an average of 22.2% of the adults is physically inactive day’ (Public Health England (PHE), 2018) (Appendix 1).

Only 55.5% proportion of the adult population in Brent meets the recommended ‘5-a-day’ on a ‘usual day’. 2.54% average number of portions of vegetables is consumed daily by adults and 2.59% average number of portions of fruit is consumed daily by adults living in Brent (Public Health England (PHE), 2018) (Appendix 1). The UK Diabetes Diet Questionnaire (UKDDQ), question 1, 2, 3, 5 and 11 tells us that Mr Jonathan doesn’t eat any vegetables or fruits. However he often drinks fizzy drinks. He eats a lot of cake, sweets and fast food from restaurants. As a nurse, the advice to Mr Jonathan will be to have a good variety of healthy foods from the five food groups each day. His healthy diet should consist of fruits, vegetables, whole grains, low-fat dairy products and lean meats (Appendix 3). On top of eating well, Mr Jonathan must also minimize your consumption of sugar and saturated fat. Mr Jonathan should only occasionally eat sugary, fatty or salty food, and then only in small amounts. He should drink fresh, clean tap water instead of sugary drinks.

Regular exercise and the having a healthy diet can lead to a lot of benefits, including increased energy, happiness, health and even a long life. It can reduce Mr Jonathan risk of heart disease, osteoporosis, type-2 diabetes, high blood pressure and some cancers. Appendix 2 compares the prevalence of individuals living with Diabetes in England to individuals living in Brent. Exercise and diet are important to determining a person’s overall health, and making them a lifestyle can make a dramatic difference in how an individual look and feel. In Brent, there are 19 outdoor gyms. The outdoor gyms can be used free of charge, seven days a week. This will be suitable for Mr Jonathan. He is unemployed and won’t have to worry about having to pay monthly because it is free. The outdoor gyms have a wide variety of equipment to help manage weight, improve cardiorespiratory fitness, muscle strength and tone and flexibility (Brent.gov.uk, 2019)

Being overweight and depression often goes together. This is the case with Mr Jonathan. He’s overweight and because of this he has low self-esteem, suffers depressive moods, he withdraws and isolates himself. In Brent, Mr Jonathan can get psychological therapies, including CBT, on the NHS. The referral for this service can be done either by a GP or self-referral.

However the extent of waiting for specialist support is a problem. It’s possible that Mr Jonathan might have to wait weeks before he can access psychological talking therapies. There are private therapy sessions for those that can afford to pay for it. This will not be suitable for Mr Jonathan because he is unemployed.

The Therapy for Low Self Esteem will Involve Mr Jonathan discussing with the therapists about the beliefs that he holds about himself and how these affect how he feel and the choices that he make. The therapist will teach Mr Jonathan techniques to reduce self-criticism and doubt and help him learn to build a more accepting, positive and nurturing attitude towards himself. The therapist will help him to deal with any feelings of anxiety, anger or depression associated with his low self-esteem.

Conclusion

One strength to be considered in this resource is the fact that its development was informed by epidemiological statistics and relevant models and literatures. However, its effectiveness might be limited by the lack of involvement and inputs from the target population in its design. Though engaging in physical activities and eating healthy are important health seeking behaviours that can improve the health outcomes of Mr jonathan, but these does not address other determinants of health inequalities ingrained in socio-economic and political aspects of the environment where this individual live, work, and socialise.

References

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Appendix 1: Public Health Profile (2018)

Appendix 2: Brent JSNA Highlight Summary Report

Appendix 3: Five a day