Introduction
The aim of this Community Profile is to assess the needs of the population within a geographically determined area. It will evaluate the resources that exist, and assess the needs of those within the community, to help improve the quality of life for the individuals across the age continuum. (Hawtin and Percy-Smith, 2007) The word ‘community’ is often used as an umbrella term to describe a group of individuals that share a collective affinity, it is used to describe the relationships and identities that connect a group of individuals. However, communities are complex and change over time. (Nice.org.uk, 2016)
The geographical area on which this report is based is Hartlepool; it will focus on the specific health improvement issues within this community. I have chosen to focus on Hartlepool as it is a potential area of future practice; therefore, it is important to understand the wider detriments of health within this community. Dahlgren and Whitehead created a model to assess wider factors that influence the health of a community; suggesting you must assess all factors such as population size, living conditions, and lifestyle choices. (Dahlgren and Whitehead, 1999) By implementing this model it will give a holistic view of the community, and help assess the role of the nurse in relation to promoting wellbeing, preventing ill health and meeting the changing needs of people throughout the age continuum. (NMC, 2018)
1.1 Population
Hartlepool’s population has not dramatically changed in recent years, in 2011 there were 92’028 (Localstats.co.uk, 2011) residents, and in 2017 the population had only grown to 93’000 (Ons.gov.uk, 2017). The population gender breakdown is estimated to be made up of 51% females and 49% males. (Localstats.co.uk, 2011). It is important to consider the statics of Hartlepool’s population in order to understand the health needs of the population, especially in relation age. The median age of the population is 40 (iLiveHere, 2019); Hartlepool has a higher proportion of people aged 75 to 84 at 6.1% than the national average of 5.5%. However, the amount of people aged over 85 is 2%, lower than England at 2.3%. This data is important as the care needs are different for elderly patient as the risks of certain detriments of health increase. Similarly, the ethnicity of individuals plays a large role in their susceptibility to different health issues; within Hartlepool there is a small diversity of ethnic backgrounds of 1.2%, significantly below the National Average of 13.6% (Teesjsna.org.uk, 2018). This needs to be taken into consideration when assessing the wider determinants to health of the community.
1.2 Social and Place
It is important to consider factors such as; employment, education and crime rate, as these play an important role not only in physical health but mental health. Employment plays a large part in peoples wellbeing, as it enables individuals to socialise and have economic independence (Goodman, 2015). Hartlepool has the 4th lowest employment rate between the ages 16 to 64 at 63.4%, significantly below the National Average of 74.4%. (Teesjsna.org.uk, 2018) This low employment rate impacts on the number of individuals who need to claim benefits, with 1 in every 14 people claiming benefits such as ESA (Employment and Support Allowance) (Teesjsna.org.uk, 2018). In Hartlepool, 7.4% of residents claim ESA, this is higher than the National Average of 5.4%; similarly 7.1% of people in Hartlepool are claiming Jobseekers Allowance, this is significantly higher than the average across England at 3.3%(iLiveHere, 2019). This must be considered in relation to health of the community, as without economic stability it will impact on an individual’s ability to access services and engage in activities.
Educational Attainment plays a role in not only in an individuals employability but in their self-esteem. Within Hartlepool, 30.7% of residents have no qualifications, this is significantly higher than the national average of 22.5%(iLiveHere, 2019). This is reflected stastics for different sectors of employment with only 9.4% of job roles being managerial (Teesjsna.org.uk, 2018). This data shows a correlation between educational attainment and employment levels. It is often suggested that the education levels within an area can link the amount of crime, as it is believed that education is a form of crime prevention (Criminal Justice, 2019). The data reflects this correlation as when assessing the crime rate of Hartlepool in comparison to surrounding areas. The rate of crime was higher in Hartlepool with an estimated 121 crimes committed per 1’000 residents, compared to 90 crimes per 1’000 residents in Stockton-on-Tees. The crime rate has increased in Hartlepool over the years, between 2015 to 2018 the crime rate has increased from 21.91% to 32.50% (Police.uk, 2018).
1.3 Lifestyle Determinants of Health
During the 2011 Census the residents of Hartlepool were asked to rate their health, the number of people that classed their health as ‘very good’ was 43.27%; whereas, the national average was 47.17%. This suggests that in Hartlepool the community as a whole view there health as worse than a general community in the UK. This is further supported as 1.85% of people in Hartlepool that rated their health as ‘very bad’ compared to England at 1.25%(iLiveHere, 2019). When analysing data related to the lifestyles of the residents is it clear why health was viewed as being worse in Hartlepool; with only 60.9% of people being physically active. This is significantly below the national average of 66.0%; Hartlepool is also the second lowest area for physical activity in the North East. Pretty et al. suggest that exercise not only improves physical health, but has psychosocial benefits (Pretty et al., 2005). However, it is argued that a healthy diet and exercise together have more health improvements than separately (Elliot and Hamlin, 2018). Similarly, to exercise rates, the percentage of adults eating their recommended portions of fruit and vegetables between 2016 and 2017 was only 49.6%, whereas, the national average was 57.4%. This could correlate with the affluence of the area, as it is suggested that low income areas have reduced access to healthier diets. (Drewnowski and Darmon, 2005)
Furthermore, it is suggested that social and economic factors make individuals more at risk of substance misuse (Recovery First Treatment Center, 2019), the prevalence of smoking in Hartlepool is 24%, significantly higher than national averages of 18.4%. Similarly, alcohol use in Hartlepool is prevalent, with 750 per 100’000 of the population having hospital stays relating to alcohol, whereas the national average 645 per 100’000 people. (Fingertips.phe.org.uk, 2015)
1.4 Epidemiology
Deprivation in Hartlepool is prevalent at 48.2%, compared with the National average of 20.4% (Fingertips.phe.org.uk, 2015); Marmot stated that individuals in higher socioeconomic positions will have better health (Marmot, 2010). This is supported when comparing life expectancy’s between deprived and more affluent areas in Hartlepool. When analysing the data from the most and least deprived areas in Hartlepool, it showed a life expectancy gap of 11.7 years for males and 10.2 years for females. This data supports Marmots theory, that the environment in which individuals live plays a large role in their lifestyle, health and wellbeing.
When analysing data in relation to prevalent diseases in the population, the highest long term condition responsible for the death of both men and women in Hartlepool is cancer; it caused 52.1% of all female deaths between 2012- 2014 and 31.4% in men; the second largest cause is respiratory and circulatory problems (Teesjsna.org.uk, 2018). World Health Organisation (WHO) suggest that it is not just a genetic predisposition but also epigenetic influences that cause illness (World Health Organization, 2019). This is reflected in the low screening uptake in Hartlepool of 56.4% lower than the national average of 58% (England screening uptake rates, 2015); suggesting the socioeconomic environment can lead to a lack of knowledge around the health benefits of screening. (Bellis et al., 2012)
The Health Improvement Issue
This profile will focus on the detriment of obesity within the community of Hartlepool. It is a growing issue with 68.5% of the adult population classed as ‘overweight’. This growing trend is prevalent throughout the age continuum, Hartlepool is the 2nd highest area for childhood obesity in the North East (obesity JNSA 2017/18). WHO define obesity as ‘abnormal or excessive fat accumulation that presents a risk to health.’ A measurement tool can be used to determine if an individual is classed as overweight by comparing their weight against their height, this is called Body Mass Index (BMI). To be considered obese you must obtain a score higher than thirty (World Health Organization, 2019). The BMI of Year 6 Children in Hartlepool classed as obese is 24.4%, compared to 19.1% for the National Average (Fingertips.phe.org.uk, 2015). This could be due no only to genetic factors but also environmental, such as parental influences (Bhadoria et al., 2015). It is suggested that the pattern of obesity is a ‘conveyor belt’ (obesity JSNA 2016), suggesting a child with excess weight will become an overweight adult.
The social and environmental influences in relation to obesity must be considered, as Hartlepool’s statics have highlighted a high proportion of deprivation and low educational attainment. Research has suggested that deprivation correlates to diet choices (Drewnowski and Darmon, 2005); in Hartlepool there is a high density of fast food restaurants, ‘1.70 takeaways per 1000 residents’ (Kommenda, 2017). Therefore, when considering the correlation between deprivation and diet, it suggests that the community has an abundance of cheap accessible food, which is calorie-dense and contain high saturated fat and salt content. This poses the risk of weight gain and the increased likelihood of developing related disease. (Tedstone, 2016).
This rising prevalence of obesity leads to increased health risks, both physically and mentally. Obesity has been linked to conditions such as; hypertension, cardiovascular disease and Type 2 diabetes. With seven out of ten adults in Hartlepool being classed as overweight the community is at risk of increased health issues. The prevalence of hypertension in Hartlepool is 16.9% of the population, this is 3% higher than the National Average (Teesjnsa.org.uk, 2018). Hypertension is defined as a constantly higher blood pressure, this means the heart has to pump harder in order to get blood around the body (World Health Organization, 2019); resulting in damaged arteries which have narrowed, increasing the potential for circulatory diseases to occur(Touyz, Delles and Padmanabhan, 2015). Cardiovascular diseases are a prevalent cause of death in Hartlepool. It cause the deaths of 91.7 per 100,000 residents under the age of 75; this is significantly higher than England at 78.2 (Fingertips.phe.org.uk, 2015).
Not only does obesity increase the risk of circulatory problems but also two diabetes, non-insulin dependent; this is where the body produces insulin that cannot perform its function correctly. If left unmanaged the disease can lead to many complications such as; nerve damage, extremity issues and even blindness (Diabetes UK, 2019). In 2016 6.5% of the population were diagnosed with type two diabetes, but it was estimated 8.9% of the population were still undiagnosed. The growing prevalence of type 2 diabetes puts an economic stretch on the NHS, as hospital admissions relating to diabetes rose 56.7% between 2017 and 2018 (Teesjnsa.org.uk, 2018). The statistics have shown continued growth of obesity and an increase in related conditions, it this trend continues it will put further economic strain on the services available. Currently the estimated annual cost to the NHS due to these conditions is £30.4 million. (Teesjsna.org.uk, 2018)
Obesity does not only affect an individual physically but also psychologically, research has linked weight gain to poor self-esteem, anxiety, and depression (Teesjsna.org.uk, 2018). Tomiyama et al. suggest that there is a ‘strong culture of weight stigma’ this is further supported by Brewis et al., who imply that individuals who are stigmatized due to their weight ‘can suffer extreme emotional distress’ (Brewis, SturtzSreetharan and Wutich, 2018). It is not just the percieved stigma that causes emotional distress but obesity itself, the disease is linked in a bidirectional relationship with depression. Therefore, suggesting that as one increases so does your risk of the other (Milaneschi et al., 2018).
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Service Provision
Hartlepool has a growing network of services aimed at addressing obesity. However, barriers affecting accessibility must be considered when assessing the success of the service at tackling this health issue.
Within Hartlepool there are multiple services available that aim to increase physical activity and promote healthy lifestyle changes. A service called EDAN (Escape Diabetes Act Now) is a six-week programme; which includes supervised exercise and healthy eating workshops for adults who have been regarded as at risk of developing type 2 diabetes by their GP (Gethartlepoolactive.co.uk, 2019). The aim of this service it to provide advice and bring people together in an informal group setting; this allows individuals to have a sense of community and support. However, there is financial barriers to consider as the two weekly sessions have a fee of £2.30, on top of the cost of transport i.e. parking or public buses, may put potential clients off. With this service there is the potential for psychological factors to play a role in an individual’s attendance; it has been shown that those with obesity has a bidirectional relationship with depression and self-esteem. Therefore, the group setting may be overwhelming (Milaneschi et al., 2018). After completing the programme the clients are given an Active Card allowing them to access leisure facilities for free for 12 months. However, some individuals may not engage with this programme they may feel stigmatised for using the facilities for free.
Similarly, a service called HELP (Hartlepool Exercise for Life Programme) is an adult scheme, which offers introductory courses in a broad range of activities. The aim of HELP is to encourage people to have a more active lifestyle, and reduce health risks such as; cardiac problems, mobility issues as well as improving mental wellbeing. (Gethartlepoolactive.co.uk, 2019) This service gives the option of self-referral minimizing barriers for individuals who cannot access or do not wish to go through a General Practitioner (GP).
Hartlepool does also offer services that are accessible to individuals throughout the age continuum, with schemes suitable for adults as well as children. A programme aimed at families is Fiit Hart, a free course promoting exercise and introducing new food options specifically for children identified as being overweight. (Gethartlepoolactive.co.uk, 2019) However, a barrier to this service would be that the child would have to be brought by their parent, research has suggested that parents often perceive their child’s weight lower than it is, therefore, may not seek this service. (De La O et al., 2009)
A potential barrier to all these services is to access you may be required to be referred from a health professional; there are numerous reasons individuals may avoid going to the GP, for example financial reasons, having to access transport, another could be a low perceived need to go, finally, individuals may not want to risk getting bad news due to previous medical experiences (Taber, Leyva and Persoskie, 2014).
The Hartlepool council have also been trying to tackling the prevalance of obesity by raising awareness using marketing strategies; such as the publication of the obesity infographic poster, ‘Obesity in Hartlepool’(Duffy, 2016). This was posted around the local area in GP surgeries, leisure facilities and was also published in the ‘Hartbeat’ magazine; which is circulated to 40’000 homes every 3 months (Council, 2019). However, not everyone is health literate, therefore, may not understand or act on the message of the poster. Furthermore, the magazine does not go to every house therefore some people may not be aware of the poster. However, Hartlepool council also implemented a ten-year health weight strategy in 2015. It consists of three-tier prevention scheme; which includes improving the environment to encourage healthy lifestyles, giving information and support to aid making healthier decisions, and implementing services to reduce the prevalence of obesity (Healthy Weight Strategy for Hartlepool 2015-2025, 2015).
It is not just within Hartlepool that services have been put in place to reduce obesity, the government has also made steps in trying to reduce childhood obesity. One way in which they have done this is the National Child Measurement programme (NCMP), introduced in 2013. NCMP requires children’s BMI’s to be measured when aged between four to five and then again aged ten to eleven (Files.digital.nhs.uk, 2014). The programme has been widely accepted in schools throughout the UK; its aim is to raise awareness to parents, with the results and advice communicated to home. This helps form a partnership between government, schools and parents, working together to reduce childhood obesity. By raising awareness of the health implications excess weight causes, it helps encourage lifestyle changes to reduce weight improve health. However, the accuracy of the results must be questioned as BMI does not consider the growth of children, especially in relation to factors such as; muscle mass, height, and degree of sexual maturation. (Cdc.gov, n.d.)
The Role of the Nurse
A nurses role is diverse and complex, needing to not only be an advocate for patients but also advise and inform them, enabling them to be empowered to be independent in relation to their health. Every nurse must be registered on the NMC, which is responsible for setting out the professional standards that each nurse is required to adhere to. The NMC code is used to guide safe practice and promote effective care, encouraging nurses to work in partnership with clients and their carers, sharing information and advice as long as it is evidence based. (Nmc.org.uk, 2018). The 6 C’s were implemented as part of the Leading Change, Adding Value framework; they include Care, Compassion, Competence, Communication, Courage and Commitment, with a similar aim to make sure all nurse were giving out the consistent high standard care resulting in service users having better experiences (Leading Change, Adding Value, 2016).
A nurse in any job role must uphold the values of the NMC, however, the skills required to meet the needs of the patient change depending on where the client is in their lifespan. As needs change throughout the age continuum nurses develop different strategies when communicating and planning care. The Model of Living is often used to inform the care plan, it assesses which activities of daily living are affected to determine what care is required, it also helps nurses promote independence (Williams, 2015). However, to implement care, nurses must be able to communicate, the SURETY acronym, shows the importance of non-verbal communication and states the importance of therapeutic touch and each nurse’s own intuition (Stickley, 2011). A nurse must overcome barriers with communication both verbal and nonverbal these barriers could range from cultural difference to fear. Barriers in communication may lead to the patient receiving inappropriate care, however effective communication allows the nurse to build a therapeutic relationship with the patient, enabling person centred care resulting in patient empowerment and independence. (therapeutic relationship ref)
There are multiple regulations and guidance available to improve nursing care. Many through encouraging health promotion this is a key aspect to the nursing role; it is defined as sharing information with patients to improve their health (NICE, n.d.). ‘Making Every Contact Count’ (MECC) strategy was implemented to help assist health professionals to use every opportunity to promote health, to be an advocate and combat reluctance to change, this is turn helps create holistic individualised care (Varley and Murfin, n.d.). It highlights that it is every nurse’s responsibility to promote health. If all nurses implemented MECC it would not only help on an individual level but also the community as a whole.
Similarly, NICE introduced brief interventions guidelines, this method involves allowing the client to share their personal story. The role of the nurse is to be non-judgmental and to give choices, meaning the patient is independent in their choice to change. (Nice.org.uk, 2013). Furthermore, the acronym FRAMES was published, Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy. To show the importance that the service user is aware it is their responsibility to change but the nurse has set clear pathways that they can choose. Therefore, the patient will leave the interaction feeling a sense of belief in their ability to change. This is accomplished using the ‘Three A’s’, which help guide nurses in their role by reminding them to Ask, Advise, Assist. (Sipler, n.d.) However, within health promotion each nurse must consider that their advice is underpinned by the four ethical principles; nonmaleficence, beneficence, autonomy and justice (Beachamp and Childress, 1994) ensuring their advice has no judgement and will cause no harm.
Although it is the role of the nurse to promote change and health, it is also important to assess if the client is ready to change. There are many ways in which nurses can help implement behavioural changes; one method is systematic motivational approaches, this will change the clients view of failure and they will leave feeling positive (Miller and Rollnick, 2003), as well as tools such as scaling, and setting goals. When nurses set goals with client them must ensure they are SMART (specific, measurable, achievable, relevant, time); however, most importantly they should be realistic as the aim is for the patient to succeed at reaching the goal they have set (NICE Systems, 2016).
The stages of change model is often used when implementing behaviour change with patients; it helps nurses assess where the patient is in relation to change so they can support them effectively. The stages involve; pre-contemplation, this is when the nurse can use strategies such as brief interventions to start the patient thinking about change. Contemplation is the next stage this is generally caused by a trigger, such as personal circumstances, realizing their behaviours might be impacting their health; it is important for the nurse to find out what has triggered this stage. The preparation and action stages then occur, this involves planning and starting to make lifestyle changes. Following this is the maintenance stage occurs showing the behaviour change is embedded over a long period of time. After this stage the patient will either have a stable improved lifestyle, or they could potentially relapse. If a patient relapses they will need support such as a motivational approach to start again. (Rcni.com, n.d.)
To continually improve care nurses must all have the skill of reflection, Gibbs reflective model is often used to assist nurses in analysing the care they give and seeing which areas need development.
Conclusion
This report has assessed the prevalence of obesity with relation to the health effects, both physical and psychological. The profile has looked at why obesity is growing within the population of Hartlepool through assessing the environment in which this community is based. By analysing data such as, educational attainment, financial influences and lifestyle determinants of health. Furthermore, the review of what Hartlepool and the government have put in place to combat this growing epidemic and the role of the nurse in relation to promoting health throughout the age continuum of this community.
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