Stevens and Raftery (1997) state that the health needs of a population are only worth assessing when something useful can be done about the results. A health needs assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. (National Institute for Health and Clinical Excellence 2005) This health needs assessment aims to establish how, by improving just two key determinants of health, it is possible to positively affect the population of Reading’s health and well-being.
The determinants of health focused on in this paper are, education and individual lifestyle factors – in particularly diet & exercise. By researching the common causes of the health issues raised in the Health summary of Reading (Department of Health (DoH) and Association of Public Health Observatories (APHO) 2010) and using Dahlgren & Whitehead’s Social Model of Health (1991) (see appendix 1. 1) it has been possible to establish links between both the health issues raised and their causes.
By assigning each particular health issue to the appropriate category on the social model of health diagram, it becomes apparent that several of Reading’s health tribulations could be resolved by broadening the content of the national curriculum and also by enhancing the population’s knowledge and interest on the topic of diet and exercise. A valuable source of information used whilst compiling this health needs assessment was the ‘2010 Reading Health Profile’ published by the DoH and the APHO.
The document compares 32 health indicators showing the gap between the Reading average and the England Average, allowing you to clearly see which health issues need addressing to improve the overall health and well being of Reading’s population. With an estimated population of 145,700 (UK National Statistics 2008) Reading has become one of the largest populated urban areas throughout the United Kingdom. Reading is situated within the Thames Valley, sitting about halfway between London and Oxford. Reading has recently been described as having an ethnically diverse population.
Unfortunately, until the 2011 census there is no definitive source of ethnicity data available, as all information from the 2001 census is now unreliable; since Reading has experienced significant population changes. Recent data collected from National Insurance registrations and local school registrations suggest that the non-white populations are increasing in Reading and that there has been an increase of new arrivals from Eastern and Central Europe. Data collected in 2008 from schools in Reading, showed that 39% of pupils were recorded as coming from a non-British heritage background.
Reading comprises of sixteen wards, (see appendix 1. ) with thriving communities in the north, a heavy student population in the east and areas of significant deprivation in the east, south and centre. (Berkshire West Primary Care Trust) When comparing the level of health in Reading to the England average, a mixed picture is painted. (see appendix 1. 3) Hospital stays for alcohol related harm, diagnosis of Diabetes and smoking during pregnancy levels, all rate better than the England average.
However, the infant mortality rate, early deaths from Heart Disease and Stroke, new cases of Tuberculosis and drug misuse are all currently worse than the England average. APHO and DoH 2009) Data collected from the APHO and the Department of Health shows that overall the population of Reading has a good level of health. However there are large inequalities across the area. An example of this is the life expectancy for men and women in Reading. For men the life expectancy of those living in the most deprived areas is over 7 years lower than to those who live in the least deprived areas. For women there is almost a 6 year difference. (Reading Joint Strategic Needs Assessment 2009) In 2009 the main causes of death were Circulatory Disease and Cancer.
Cancer was the main cause of death in those under the age of 75. (Berkshire West Primary Care Trust 2009) Both Circulatory Disease and Cancer have common risk factors that relate to bad lifestyle choices such as smoking, not exercising and eating a poor diet. Reading is a highly commercial area with the main percentage of its employment opportunities in the healthcare service, finance or in high technology businesses: an interesting statement when you look at the 2007 Index of Multiple Deprivation, which saw Reading rank 151 out of 354 local authorities nationally.
Further to this some areas in south Reading are amongst the 20% most deprived in the country. (see appendix 2. 1) The Royal Berkshire Hospital is one of the biggest employers in the town and many renowned companies such as Microsoft, Digital, Hewlett Packard, Oracle and Prudential all have large offices in or near Reading. The future success of the local economy depends greatly upon a highly skilled workforce. (Berkshire West Primary Care Trust 2008) To ensure highly skilled professionals are readily available for these businesses to employ, more young people need to progress into higher education and achieve higher levels of qualifications.
The combination of being brought up in a poor household, having low academic qualifications and lack of knowledge in topics such as diet & exercise, sex education and alcohol or drug misuse can have an adverse effect on young people. In 2008 despite economic growth proved to be strong in Reading and other areas of West Berkshire, the adult skill levels were relatively low. In the 2001 census 22. 8% of adults aged 16-74 had no qualifications and only 26. 1% of adults had degree level or higher qualifications.
Lack of education may mean young people end up living in poverty as they are unable to secure employment. Living in poverty means healthy food allowing a varied diet may become unattainable due to its cost. A poor diet can lead to health issues such as obesity, which in time creates further health issues such as heart disease or stroke and these can lead to an early death. Experiencing poor health could lead to a poor mental health state and issues such as low self esteem and depression may increase the possibility of that person partaking in poor lifestyle choices such as alcohol & drug misuse.
Many health related problems for example, levels of crime, violence and teenage pregnancy rates are fuelled from these poor lifestyle choices and because many young parents are uneducated in the risks and consequences there is a greater chance that their children will grow up repeating the same mistakes and ending up in a similar situation. All the contributing factors above lead to the creation of a repetitive cycle in which young people and their dependants will go on to experience some sort of inequality in health.
The Joint Strategic Needs Assessment for Reading (2009), confirms a link between the areas of Reading that have lower than average rates of educational attainment and the wards with high levels of deprivation. From looking at the categories that each of Reading’s health issues fall into on the social model of health (Dahlgren & Whitehead, 1991), it becomes apparent that the issues regarding high teenage pregnancy rates, unhealthy eating adults, lack of physically active adults and high infant mortality rates, could all be reduced by increasing the level of education provided to the local population of Reading.
In April 2009, whilst analysing Reading’s teenage pregnancy rate, NHS Berkshire West and Reading Borough Council compiled a list of statistics that show wards such as Katesgrove, Abbey, Whitley, Norcot, Church, Minster and Battle, all have elevated levels of deprivation and high teenage conception rates. The majority of teenage conceptions are of girls in the 16-17 year age group. The same investigation also proved rates of termination of those under the age of 18 were shown to have increased in Reading, suggesting that a large proportion of the conceptions were actually unplanned pregnancies.
Comparing the statistics of qualifications held by Reading’s population alongside Reading’s teenage pregnancy statistics, once again strengthens the conclusion that Reading needs to focus on educating people to a higher academic level. Looking at both sets of statistics also instigates a need to broaden the curriculum being taught, to further educate people in the values of making good lifestyle choices. It is also essential that the teenage population receive enhanced education on the importance of safe sex and sexual health.
A recent study by the National Audit Office estimated that obesity costs the NHS at least ? 500million a year and the wider economy more than ? 2billion a year in lost productivity. The levels of physically active and healthy eating adults in Reading are both significantly worse than the England average. (APHO and DoH 2010) Information documented on the NHS Choices website claims that in 2008, nearly a quarter of adults (over 16 years of age) in England were obese with a body mass index (BMI) of over 30. 2 % of women were said to be overweight with a BMI of 25-30 and 42% of men were recorded as being overweight.
Obesity is when a person is carrying too much body fat for their height and sex. Eating excess calories leads to weight gain and without taking part in some form of physical activity on a daily basis, or by reducing the amount of calories consumed, people can become obese. Common health issues caused by obesity are: High blood pressure, Type 2 Diabetes and Heart disease. Obesity and all the health implications mentioned above can shorten life expectancy. NHS Choices 2010) Morris and Hardman (1997) state that regular exercise has both long term cumulative protective effects on a person’s health and also short-term effects on ones cardiovascular fitness. Exercise is also recognised to have mental health benefits. (Morris and Hardman 1997)
It has been shown to relieve depression and anxiety, improve self esteem and improve a person’s mood. Although the level of obesity in Reading for both adults and children is currently not significantly different to the England average (see appendix 1. ), in just one year the level of healthy eating adults in Reading went from being significantly better than the England average to significantly worse than the England average and therefore, it is likely that the level of obese children and adults will also increase if the population continues to eat unhealthily and fail to participate in more physical exercise. By 2050 Foresight (2007) predicts the prevalence of obesity will affect 25% of children, 60% of adult men and 50% of adult women in the UK.
Locally, in an effort to counter the national trend towards obesity, NHS Berkshire West now offers a service aimed at overweight 7-13 year olds. The ‘MEND’ program (Mind, Exercise, Nutrition and Do it! ) is the largest community based child obesity prevention and treatment programme currently available in the UK. “It aims to teach children about nutrition, how to eat a balanced diet and also helps them learn how to be more active. In an attempt to reduce obesity, promote healthy choices and address health inequalities, the government published a White paper in 2004, entitled Choosing Health: making healthy choices easier.
They wanted to show their commitment in providing people with more opportunities, support and information, to enable them to choose health (Scientific Advisory Committee on Nutrition 2005). The White paper was a foundation for future work in ensuring health inequalities were addressed and that effective partnerships were established, meeting the urgent need to develop the capacity and capability of healthcare professionals, particularly those in primary care and community settings.
Within the document there was a specific strategy to help tackle obesity, which included actions such as introducing signposting of food and reform of a previous campaign – The Welfare Food Scheme (1940). The reformed scheme entitled Healthy Start (2005) saw the introduction of a voucher exchange programme in which qualifying pregnant women and families, received fixed face value vouchers, worth at least ? 2. 80 per week and ? 5. 60 for children under one year old. These vouchers could then be exchanged for fresh fruit and vegetables, liquid milk and infant formula at certain retail outlets.
This particular White paper was a real push to improve the access and availability of healthy foods, increase awareness and change the population’s attitude into wanting to live a healthier lifestyle. Funding was allocated to practitioners across the region to aid in the development of the public health workforce and train health professionals. School nurses, health visitors, health trainers, community and practice nurses and exercise specialists were now to be educated in obesity prevention and management.
Since the release of the 2004 White paper (Choosing Health: making health choices easier), a definite increase in the amount of awareness put towards promotion of healthy lifestyle choices can be seen. There is now more advertising in magazines and a wide range of television programs targeted at both adults and children, that explain in ‘simple terms’ how to improve your health, especially health issues resulting from a poor diet. TV series’ such as Jamie Oliver’s 30 minute meals and Honey, we’re killing the kids, make for attractive viewing, but are also educational.
Television is a fantastic tool for capturing a nation’s attention and promoting health. It has been recognized that when television contains positive messages it can have positive effects such as educating and inspiring a variety people from a mixed range of social classes. It’s a valuable source that can be used to capture the interest of people that otherwise, may not intentionally seek to ascertain information on improving their health. 2010 saw a new government elected and with it came promises of radical change that will have a long lasting effect on both health and education.
At the time of writing this paper the government was announcing massive budget cuts to reduce the national debt and hopefully restore the health of the economy. However, health and education were two areas protected from cuts, a clear indication that the government not only still has a commitment to reducing health inequalities but they also recognise the benefits to the economy of having a healthy and well educated population. The Department for Education within the new government is currently looking into how they can ensure all young people receive high-quality careers advice and guidance.
By autumn 2010 the government hopes to release a White paper stating a new vision for education and how they intend to support all young people in making the right choices for learning and work. The need to educate the nation in order to reduce social and health inequalities has been recognised and further aims are being made to ensure personal, social and health education (PSHE) is taught as a high priory topic. Local authorities are also being pushed to develop a comprehensive programme of sex and relationships education (SRE) that will be taught in all schools.
This health needs assessment aimed to demonstrate that by improving on two determinants of health, in this instance, diet & exercise and education, that it is possible to promote positive changes in the population of Reading’s health and well-being. By comparing statistics on the area and establishing links between the key health issues and there common causes, a conclusion was reached that significant improvements to health could be made from broadening the national curriculum to include compulsory education on lifestyle choices.
A key element in improving the level of health and well-being in Reading is by making sure that appropriate strategies are put into place that address the area’s health inequalities. High levels of drug misuse, teenage pregnancy, infant mortality, unhealthy eating in adults, physically inactive adults, early deaths from Heart Disease & Stroke and new cases of Tuberculosis, are all problem areas the town must embark upon improving. In order to improve on these key health issues the areas local authorities must implement changes and increase the level of support given to the local population.
It would be possible to do this by opening centers/clinics around the different communities of Reading that specifically aim to target that areas main health issues. The NHS Berkshire West Primary Care Trust have already set about tackling certain health issues of the area with health centers such as the Baker Street clinic and Reading Walk-in center being established within the last six years. Further to opening future clinics, the local authorities need to focus on increasing the population’s awareness that such facilities are available to the individuals living in the area.
Current health clinics in Reading should increase the amount of campaigns they run and target different age groups and genders separately, as both males and females; old or young have their own individual health needs. Organisations already setup in the area such as Connexions, who offer career and education guidance should concentrate on driving campaigns that inspire and motivate the younger generation of Reading to pursue further education.
They should emphasis the benefits of gaining higher level qualifications for example by securing a well paid job you can greatly improve your quality of life. Finally, In addition to implementing all of the above, the government must continue to fund training of health care professionals, ensuring they are appropriately trained in the ability to deal with the nation’s current demands on health, so they are able to educate their clients in the importance of making healthy lifestyle choices and also warn them against the consequences of making poor lifestyle choices.