Wanless (2004, p.27 [online]) defines public health as “the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, communities and individuals”. From this definition we can establish that the main focus of public health is to reduce health inequalities with the key concepts being to protect the public from transmissible diseases, improving service provision and to promote the health of the population (Naidoo and Wills, 2005, p.8). Health promotion and public health are intricately linked as the idea behind health promotion is to encourage individuals to have greater control over the decisions that affect their overall health.
Health is a difficult term to define as people have different perceptions of what being healthy means and it is linked to the way people live their lives. The most common definition of health was set by the World Health Organisation (WHO) in 1948, which suggests that health is a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2003 [online]).
This definition suggests that health is the achievement and maintenance of physical fitness and mental stability however, each individual is unique so the term ‘health’ varies from person to person and can therefore be a number of ideas that people have in their minds at different times of their lives (Pearson, 2002, p.45).
Health inequalities can be described as the variation in the health status or the ‘health gap’ between the socio-economic classes. Evidence suggests that there is a link between health and wealth, where people in the upper socio-economic classes have more chance of avoiding illness and living longer than those in the lower socio-economic classes and as a result, mortality rates are greater for the lower social classes than for the higher social classes (Marmot, 2010, p.16 [online] ; Acheson, 1998 [online]). Mortality rates are a useful indicator when assessing health inequalities because of its sensitivity to social conditions and even though the life expectancy years of individuals have increased, the life expectancy gap between the social classes has continued to exist (Marmot, 2010, p.45 [online]). The contributing factors to this life expectancy gap includes issues such as poor diet, obesity, smoking and higher drug and alcohol consumption (Marmot, 2010, p.37 [online]) and despite the reduction measures previously taken, this ‘health gap’ between the wealthiest and the poorest continues to increase (Triggle, 2010 [online]).
Access to health care services have also been reported as uneven (Acheson, 1998 [online]) however, an individual’s health can be adversely affected by more factors than just the availability of healthcare and these other factors include gender, ethnic groups, religion, age, geographical location, residential deprivation, education, occupation and economic conditions (Marmot, 2010, p.39 [online]). Many of these factors can independently affect health however, those in the lower socio-economic classes tend to be disadvantaged by most, if not all, of them and the combination of these factors can lead to a significantly higher health burden for those who are living in poverty (DoH, 2010, p.15).
Poverty is when individuals, families and groups do not have the income needed for the minimum standard of living and poverty can be measured as relative or absolute (Alcock, 2006, p.64). Relative poverty is when the income received is less than the average income for the country, where access to goods and services are limited compared to the rest of society and absolute poverty is where the level of income is below the required amount to afford a decent living or be able to sustain human life and as a result, only the bare minimum levels of food, clothing and shelter can be afforded (Alcock, 2006, p.64). Without sufficient money, people are less able to provide themselves and their families with adequate housing, nutrition, clothing and heating. People who live in poverty are also less likely to have the means to travel to specialist clinics and hospitals which may mean that they are less likely to attend appointments or take advantage of health screening opportunities (Kozier, 2008, p.133).
Obesity is a term which is used to describe a condition where an individual is carrying excess body fat (WHO, 2011 [online]). It is a complex modern health problem facing society today which has both personal and economic consequences. In the UK alone the economic cost of obesity prevention, management and its consequences such as, premature death and employment absence is estimated at up to £4.2billion per annum and is continuing to rise (DoH, 2010, p.20). As such, obesity prevention has become a public health priority, with significant focus being given to childhood obesity (DoH, 2008, p.27).
Children who are obese are likely to suffer both short term and long term adverse health effects, such as increased blood pressure and hyperlipidaemia (NOF, 2011 [online]). They are also at greater risk of developing diabetes, coronary heart disease or even metabolic syndrome prematurely (WHO, 2011 [online]) and as a result, they tend to have a shorter life expectancy (DoH, 2008, p.2). Obese and overweight children also have a tendency to suffer poor psychosocial health and are therefore particularly susceptible to emotional stress, stigmatisation, discrimination and prejudice (NOF, 2011 [online]), which also increases the chances of children suffering with low self-esteem, depression and eating disorders (BMA, 2005, p.8 [online]). One of the biggest concerns of childhood obesity is that it is likely to continue on into adulthood (Coleman, 2007, p.71).
The prevention of obesity is easier than the treatment and prevention relies heavily on education, therefore for this issue the education model will be used. The aim of this approach is to give information to ensure that each individual has the knowledge and a basic understanding about obesity, which allows the individuals to make informed choices about their own lifestyles (Ewles and Simnett, 2003, p.44). A good example of this approach is the school health education programmes, which not only increases the child’s knowledge but also helps the child to the learn skills of healthy living (Ewles and Simnett, 2003, p.44).
Educational programmes could also be targeted at the parents and could involve the promotion of breastfeeding, the delaying of weaning onto solid foods to infants and building an awareness of the types of foods that are available within home. Parental education could also focus around building the self-esteem of the child and an understanding of how to address the child’s psychological issues. Education in early childhood could also include information about healthy diets, workshops (which could include food tasting) and physical activity (NICE, 2006, p.75 [online]).
The rise in obesity combined with the increased public awareness has prompted new public health initiatives. The white paper ‘Healthy weight, healthy lives’, in conjunction with the National Institute for Clinical Excellence (NICE) guidance, sets out guidelines for action on obesity (DoH, 2008 ; NICE, 2006 [online]). Policies and strategies were introduced following the recommendations outlined in these papers and were developed with the main focus being to assist in the prevention and management of obesity and to encourage healthy eating and physical activity (NICE, 2006 [online]). These strategies include school based educational and physical activity programmes and public health messages through the media such as, television, radio, poster campaigns and leaflet distribution.
Local authorities have developed strategies which tackle obesity from a local level. A great example of a local initiative within the northeast is Medal Motion, which encourages children to walk or cycle to school whilst also working towards preventing obesity (Local Motion, 2011 [online]). Each locality has different needs and local strategies that are in place have been developed in conjunction with government initiatives and influenced by national policy such as, healthy schools.
National interventions include the five a day scheme which encourages people to eat more fruit and vegetables, extended from this is the school fruit and vegetable scheme which helps increase the child’s awareness of the importance of eating fruit and vegetables (NHS, 2011 [online]). Change4life is another example of a nationwide initiative which was launched to improve children’s diets, increase their physical activity and which, in turn, improves their chances of living longer, healthier lives (NHS Northeast, 2011 [online]). The national child measurement programme is a national strategy which requires school nurses to weigh and measure all four to five year olds and ten to eleven year olds annually, this monitors prevalence and evaluates obesity reduction strategies (DoH, 2011 [online]). Other national initiatives include Sure Start, school sports programmes, simplified food package labelling and the regulation of television advertising on children’s channels.
The WHO has launched a major consultation into the diet-related disease and stated that their global strategy would focus on diet, physical activity and health (WHO, 2004 [online]). This global preventative strategy includes reducing the child’s energy intake and improving their intake of nutritional foods, increasing physical activity and reducing time spent in sedentary behaviour, such as watching television (WHO, 2004 [online]). The WHO developed a framework and implementation toolkit which is used to monitor and evaluate their ‘Global Strategy on Diet, Physical Activity and Health’ (WHO, 2008 [online]). Following on from this framework, the WHO called on governments to take action against food marketing to children and to regulate marketing messages that promote unhealthy dietary practices (WHO, 2007, p.9 [online]).
The recent white paper called ‘Healthy Lives, Healthy People’ (DoH, 2010) sets out guidelines for healthcare professionals to support individuals to make their own decisions and choices about their health. Nurses can optimise their role by offering health promotion to individuals who seek help and support in relation to obesity, whilst acting as an advocate for healthy lifestyles and ensuring the clinical environment supports and encourages children to make healthy choices. Healthcare professionals, especially school nurses, are ideally placed to identify if a child is overweight and screening, parental support and health promotion activities should be routinely addressed where possible. Children and families should be offered support to manage weight sensibly, by discussing small incremental changes in family behaviours, and by making any necessary referrals for specialist investigation, psychological help or specific dietician advice (NICE, 2006, p.49 [online]).
It is vitally important that the nurse possesses the necessary skills and adequate knowledge on healthy eating in order to educate children and their families (NICE, 2006, p.44 & p.101 [online]). Additionally, the necessary resources should be readily available such as advice leaflets, to pass on to parents to aid in the communication and teaching process. Evidence suggests that when talking to children and families about obesity and food behaviours, that problem-solving techniques can have some success (Ewles, 2005, p.95) and as such, nurses can interpret when and where eating patterns become an issue and can therefore offer advice and guidance on how to manage in difficult situations (NICE, 2006, p.148 [online]).
A number of factors can inhibit access to healthcare such as language, age, attitudes to healthcare, disabled access, financial barriers and geographical location (Kozier, 2008, p.133). A geographical barrier can be that some patients may have to travel long distances for certain services or to receive specific treatments. The travel costs for these services may be relatively high and access to transport may also be limited. There is also the issue of the ‘postcode lottery’ of healthcare services where some treatments are only available in certain parts of the country and not in others, such as the ‘Herceptin postcode lottery’ (Kozier, 2008, p.133).
Cost also affects most individuals as some services are not free, such as dental treatment and eye tests and some individuals also have to pay prescription charges which can lead to illnesses being left untreated, as some people afford to pay for their prescriptions. Additionally, due to limited income, some individuals may not have access to the internet and therefore may not be able to access certain services such as ‘Choose and Book’, which is primarily an internet based appointment booking service. Other issues that can inhibit access to healthcare include the cost of health insurance, lack of knowledge and awareness and lack of a support network.
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