This is solution of Role of Public health in health and social care Assignment, given in St. Patrick college. In this assignment role of public health has been described with the reference of increasing number of patients for breast cancer in UK

Task 1

1.1 What are roles played by WHO, Department of Health (DH) and Local Authorities in identifying levels of health and diseases in the population?

Roles played by World Health Organization –

• WHO is a specialized agency of United Nations (UN)
• It is majorly concerned with international public health
• WHO has played a major role in eradication of many diseases worldwide with its programs such as, Smallpox
• The present main focus of the agency lies in dealing with the communicable diseases like HIV/AIDS, malaria and tuberculosis
• It is also active in management of non-communicable diseases like heart ailments, diabetes and cancer
• It is also very active in managing, sexual and reproductive health, development and aging, nutrition, food security, healthy eating, occupational health and substance abuse, among world populations
• It is also responsible for international health surveys and publishing World Health Reports
• WHO’s role in defining public health policies have been based on –
• Providing leadership on matters critical to health and engaging in partnerships where joint action is needed
• Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge
• Setting norms and standards and promoting and monitoring their implementation
• Articulating ethical and evidence-based policy options
• Providing technical support, catalysing change, and building sustainable institutional capacity
• Monitoring the health situation and assessing health trends (WHO, 1959)

Roles played by Department of Health (DH) –

• Department of Health is the department of Government of UK
• It is primarily responsible for various policies related with health and adult social care services in England
• It is also responsible for the National Health Services of England
• NHS England can be considered as an organization which oversees and acts as an Overseer of the implementation of the Health and Social Care Act 2012 of England
• It plays a multi-facet role through budgeting, planning, delivery and day to day operation of the NHS in England
• It is directly observed by the NHS commissioning board and was setup as special health authority of the NHS in 2011 in England
• The sole purpose of the NHS England is to implement the National Health Scheme in England
• It does it through implementing and overseeing the implementation of the clauses and lines of Health and Social Care Act 2012 of the English government
• The primary responsibility and vision is to have a proper Health and Social Care setup in England as per the guidelines setup by the 2012 act (England, 2013)
• The department of health (DH) is responsible for overseeing the work of ten strategic health authorities and local trusts and bodies under the aegis on NHS in England
• The working of various NHS trusts run by NHS and its ten SHAs, like NHS Hospital Trust, NHS Ambulance Services Trust, NHS Care Trust, NHS Mental Health Services Trust and NHS Primary Care Trust comes under the aegis of DH. (Understand about: Health Promotion in Health and Social Care)

Roles of Local Authorities –

• Local Authorities in England work under the aegis of NHS in direct supervision of various SHAs of NHS which are ten in number based on geographical divides/boundaries all across the England
• Local Governments and Councils are responsible to implement the health and social care policies in their areas under the NHS SHA of that geography and is directly monitored by DH
• The transition of implementation and monitoring is done to various local agencies
• Local Government Association is an organization which collectively works for better public health transformation in the grass-root levels in England
• LGA’s major role and responsibilities are –
• Provide support to local authorities and health and wellbeing boards on embedding and utilizing the local health reforms, engendering future innovative practice
• Develop the Health and Wellbeing System Improvement Program, grant funded by the Department of Health, in partnership with NHS England, Public Health England, Health-watch England, and the NHS Confederation.
• Support Peer Challenge as a cornerstone of the system improvement program, applying the sector led improvement approach
• Bring together national and local stakeholders to develop a program of exploratory and forward thinking health and wellbeing challenges (England, 2012)

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1.2 Explain, using statistical data, the epidemiology of HIV and breast cancer in the UK.

Major findings of epidemiology of HIV in UK –

• Approximately 98,400 people were living with HIV in UK, as per 2012
• 22% of these people were unaware of their infection status
• There are approximately 7000 new cases detected in UK every year since, 2011, hence at the end of 2014, it is concerned that there will be almost, 1, 10,000 persons with HIV infections (Sullivan, 2005)
• The status of AIDS patients in UK is almost one-third of the number of people suffering with HIV, i.e. almost 30,000 at the end of 2012 (HPA, 2013)
• There has been almost similar number of deaths within people suffering from HIV/AIDS in the year 2012 in UK, though not necessarily due to causes of HIV/AIDS
• There has been a constant rise in epidemic in the number of new cases detected every year in UK, up-till late 2000s, with a considerable decline after that, but maintaining the overall number of HIV infections at all-time highs after that
• Apart from various categories of HIV infected groups of patients, UK authorities have devised three new groups to identify new HIV infection detections, they are men who have sex with men (MSM), injecting drug users and people who receive blood products
• Though the epidemic management efforts of UK government and authorities have bear results in terms of decline in number of patients suffering with AIDS over the years (Hamill, 2007)
• A combined and multi-pronged approach with Combination Antiretroviral Treatment (CAT) and advanced genetic engineering has proved to be beneficial
• Among various transmission routes of the infection heterosexual sex was on rise up-till late 2000s, but since after that it has declined and making MSMs as the chief responsible agent of viral transfer (PHE, 2013)
• Some of the statistics and findings –

Major findings of epidemiology of Breast Cancer in UK –

• Breast cancer has been the most common type of cancer in the UK since 1997
• It is almost at the levels of 31% of all the new cases of cancers detected in females in the UK
• There were almost 50,000 new cases of breast cancers in UK in the year 2010
• The frequency of occurring of breast cancer is almost 157 new cases per 100,000 females in UK
• The general status of new occurrences of cancer cases is being associated with old aged females
• Approximately 80% new cases detected in females were for the age group of 50 and above, whereas, almost half of the incidents occurred in the age bracket of 50 – 69 (Key, 2001)
• The incident occurrences is lower in lower income groups in UK
• The lifetime expectancy risk for breast cancer in females in UK is 1 out of 8
• As per the four stages of cancer, generally the new found breast cancers are detected in their early stages of Stage I to II with almost 90% cases being in those two zones and hence early detection leads to better prognosis (McPherson, 2000)
• Breast cancer also affects men, but it is rare – around 350 men are diagnosed each year
• Around 55,000 people are diagnosed with breast cancer each year in the UK. That’s one person every 10 minutes
• Just under 12,000 people die from breast cancer in the UK every year
• Breast cancer is the most common cancer in the UK (around a third of all new cancers diagnosed in women in the UK are breast cancer)
• There are an estimated 550,000 people living in the UK today who have had a diagnosis of breast cancer (Brinton, 2014)
• Some of the statistics and findings –

1.3 How effective are different approaches and strategies adopted by NHS to control HIV and breast cancer in the UK.

Approaches and strategies adopted by NHS to control HIV and Breast Cancer in the UK –

• NHS setup under the aegis of Department of Health has various programs and schemes going on for the prevention of both HIV and Breast Cancer incidences in UK
• NHS for Breast Cancer –
• Setup Cancer Screening Program under the aegis of Public Health England (PHE)
• Supporting various local governments and agencies on Research & Development (R&D) and Clinical Researches on breast cancer, govt run a research project for this.
• A full-fledged website and information registry under Cancer Screening Program (CSP)
• NHS CSP includes three cancer screening programs
  • NHS Breast Screening Program
  • NHS Cervical Screening Program
  • NHS Bowel Cancer Screening Program
• Supporting various Breast Cancer related studies under NHS BSP, like –
  • Absolute numbers of lives saved and over-diagnosis in breast cancer screening (Gunsoy, 2014)
  • Age at which women are screened for breast cancer
  • Second All Breast Cancer Report 2007
  • Age Trial
  • Non-Invasive Breast Cancer Report
  • Million Women Study
• In England, the breast screening program is now estimated to cost around £96 million a year (ACBCS, 2006)
• Supporting various Charities, Non-Government Organizations (NGOs), Research Facilities etc. like Breast Cancer Care and Against Breast Cancer
• NHS for HIV –
• Setup HIV Screening Program under the aegis of Health Protection Agency (HPA), which comes under PHE
• Supporting various local governments and agencies on Research & Development (R&D) and Clinical Researches on HIV
• A full-fledged website and information registry under HPA
• Supporting various Charities, Non-Government Organizations (NGOs), Research Facilities etc. like AIDS Alliance, Avert and Positively UK etc. (Rayment, 2014)

Task 2

2.1 What are the current priorities for prevention and control of diseases and risk factors in the UK?

Some of the current prevention and control of diseases priorities in UK are as follows –

• Most people used to go for a diagnosis only when any disorder actually affected or troubled those people (Munn-Giddings, 2013), hence, generally the ill-informed and neglect ridden patients, hence an active early screening program for diseases like Breast Cancer and HIV was required
• Early HIV and Breast Cancer Testing is the gateway to both treatment and prevention
• Patients with a diagnosis of HIV infection before moderate to severe immune-suppression occurs should plan for a normal life expectancy with effective access to antiretroviral therapy. The UK HIV epidemic continues to grow and remains marred by a high proportion of cases (50%) diagnosed at a late stage in the clinical course of the infection, and a persistent undiagnosed fraction (22% of patients living with HIV are unaware of their status)
• Ensuring that, since every clinician can and hence they should offer patients with HIV Test in lines with national guidelines
• Primary HIV infection should be considered, and an HIV test offered to all patients with a mononucleosis-like illness and also, All patients living with HIV infection should be encouraged to disclose their HIV status to other healthcare providers, especially their general practitioner (Rayment, 2014)
• Universal HIV testing is recommended in all of the following settings –
• Genitourinary medicine or sexual health clinics
• Antenatal services
• Termination of pregnancy services
• Drug dependency program
• Healthcare services for those with a diagnosis of tuberculosis, hepatitis B, hepatitis C, and lymphoma etc.
• NHS Breast Screening Program provides free breast screening every three years for all women aged 50 and over
• NHS Breast Screening Program had lowered mortality rates from breast cancer in the 55-69 age group
• Measurement and metrics of any intervention or technological support activity going to be implemented, beforehand so as to be doubly sure and be cost, time and health benefits effective for the patients
• Deployment and withdrawal symptoms and milestones be clearly marked and explained to all the stakeholders, for any aid associated with the or during the ongoing prognosis

2.2 What impact lifestyle choices have on future needs for health and social care services?

Impact of recent and emerging technological developments on, Health and Social Care Services-

• Ease in implementing and fulfilment of the National Health Scheme in England
• Proper implementing and overseeing the implementation of the clauses and lines of Health and Social Care Act 2012 of the English government
• Fulfilling its primary responsibility and vision to have a proper Health and Social Care setup in England as per the guidelines setup by the 2012 act
• Effective budgeting, planning, delivery and day to day operation of the NHS in England
• Considerable impact in terms of knowledge production and in informing national and international policies
• Various specific care mentioned being taken care of, various training, learning modules and exercises being implemented, Full trained and NVQ level 3 qualified support staff and Capability enhancement
• Socially acceptable and compliant behaviour being imparted

Impact of lifestyle choices on, Health and Social Care Services –

• Lifestyle choices like, Smoking, Alcoholism, Obesity, Drugs Abuse, Lesser Physical Activity, Dental Health and Teenage Pregnancy have and will have huge impact on future health and social care services (Veenhoven, 2008)
• Services and/or interventions need to be in place to support individuals to reduce risk factors for long term conditions and should be targeted effectively at those people who are in greatest need
• All local partners should be active in promoting healthy lifestyles and  health and other professionals should be enabled to deliver consistent messages and support as part of their day to day work
• Need to ensure that services deliver positive health outcomes and benefits to individuals as well as improving the health of local communities
• Ensure treatment services are effective and cost compliant (Kawachi, 1997)
• Primary prevention to ensure that the right support is in place to prevent or reduce the risk of future disease. More must be done to support children who may be at risk in the future, and a whole family approach is required to support healthier lives etc. (Wanless, 2004)

Task 3

3.1 What are the health and wellbeing priorities for people in London?

The health and well being priorities for people in London are governed by the Health and Wellbeing Strategy devised by the Health and Well being Board of the City of London. The City’s shadow Health and Wellbeing Board involves representation from the following partners-

• Elected members of the City of London Corporation
• Officers of the City of London Corporation, including the Director of Community and Children’s Services and the Director of Environmental Health and Public Protection
• The Director of Public Health for City and Hackney, NHS East London and the City
• City and Hackney Clinical Commissioning Group
• The City Local Involvement Network
• The City of London Police

Wellbeing is a positive physical, social and mental state is more than just an absence of illness. When a person feels well, they are more likely to value their health and do positive decision making about the way they live. Good mental wellbeing can lead to reduced risk-taking behaviour (such as excessive alcohol intake or smoking), and may improve educational attainment and work productivity (Cavill, 2001).

As per the Health and Wellbeing strategy, the people of London can take care of their health and big improvements in overall health can be achieved from following certain priorities in lifestyle-

• Not smoking or breathing others’ smokehttps://indecissive.demojoomla.com/administrator/
• Eating a healthy diet
• Being physically active (Stathi, 2002)
• Achieving and maintaining a healthy weight
• Moderating alcohol intake
• Preventing harmful levels of sun exposure
• Practicing safer sex
• Attending cancer screening
• Being safe on the roads
• Managing Stress

Some other priorities of people are –

• Good Life Expectancy
• Diseases and ailments free life and lifestyle
• Avoiding conditions that can lead to death (fewer death from avoidable conditions)
• Lesser poverty and economic sustainability with lesser mortality rates all across (Morris, 2000)
• Good overall education attainment
• Lesser unemployment (Coleman, 2014)

3.2 How effective are the strategies, systems and policies for ensuring health and wellbeing of London population?

Strategies, systems and policies for ensuring health and wellbeing of London population –

Health and wellbeing strategy influence the Public Health, NHS and Social Care Outcomes, and the Children and Young People’s Outcomes, that will make the most difference to the lives of people in the City. Acknowledging and supporting good work already undertaking, whilst helping meet up-coming challenges, including an ageing population, a reduction in household income for many families in the area, and an uncertain economic outlook is the new strategy of health and wellbeing board of London city (Almond, 2014)

Some of the priorities under this strategy are determined through –

• The number of people affected
• The severity or impact of the issue
• Can we do anything about it – are there cost-effective, evidence based steps we can take to tackle the issue?
• Does it tie into the objectives of the City’s Corporate Plan, which aims to support businesses and communities?
• Will the City be a better place to live and work if we tackle this issue?
• Is there a current gap in provision or service that we have identified?
• Do we have the resources to tackle this (or are there resources that we can get)?

Three new systems or policies to be followed by Health and Wellbeing board of London –

• Bedding-in the new system – maximizing opportunities for promoting public health amongst the worker population, and taking on broader responsibilities for health
• Improving joint working and integration, to provide better value
• Addressing key health and wellbeing challenges, such as, people with mental health issues can find effective and joined up help, more people in city take advantage of Public Health preventions and interventions, City is healthier to breathe and people in the city are more physically active etc. (Coleman, 2014)

3.3 What changes could be made to improve the health and wellbeing of people in London?

Some of the changes that can be made to improve the health and wellbeing of people in London are as follows –

• Adopt healthy lifestyles
• Quit or Limit usage of Smoking and Alcohol
• Adopt physical activeness
• Control the pollution levels for better livelihood in the city
• Control the epidemic of diseases by informing and communicating
• Signing up more and more people for prevention and intervention schemes of the government under NHS
• Have economic independence and sustainability
• Availability of healthcare opportunities and affordability
• Treating all the patients with equality, especially those with specific needs
• Stricter legislation for proper implementation of all the health and social care policies of the government
• Proper planning and implementation at workplaces and organization for health and safety
• Providing proper infrastructure, including information technology, social media, newer technological advancements, with the existing infrastructure, i.e. Hospitals, Service Homes, Care centres, Labs etc.
• The quality of life of patients can be improved through more effective and efficient treatments
• Remote testing and diagnosis with treatment (Wanless, 2004)

3.4 How effective is ‘Smoking Cessation Programme’ implemented to encourage people to quit smoking in London?

“Smoking Cessation Program” in London, specificity and its effectiveness –

Some of the recommended treatments as per the National Institute of Health and Care Excellence (NICE) UK, that have been proven to be effective, either separately or combined, include –

• Brief interventions by a GP and other practitioners working in a GP practice or the community (including advice, self-help materials and referral for more intensive support)
• Individual behaviouralcounselling
• Group behaviour therapy
• Pharmaco-therapies (for example, nicotine replacement therapy (NRT), varenicline or bupropion)
• Self-help materials
• Telephone counselling and quit lines
• Mass-media campaigns to get the stop-smoking message across – using a combination of, for example, TV, radio, newspaper and social media advertising (Brown, 2014)

Smoking Cessation program under NHS in London is being implemented by Commissioning Support for London (CSL) and some of the steps and guidelines are as follows –

• Implementation of training modules by National Centre for Smoking Cessation and Training (NCSCT)
• Providing Free Quit Kit under NHS Smoke-free campaign
• Face to Face Support (Counselling sessions) (Lancaster, 2005)
• Free Mobile App (under Smoke-free)
• Free Email and Text Support (under NHS Smoke-free)
• Offering Nicotine Replacement Therapy (NRT) under (NICE)
• Free Smoking Advisors
• Stop Smoking Ads
• Preventing Relapses (Sinclair, 2004)

All these efforts have led to 31% decrease in smoking quit number of people and number of cases, as per 2011 (Coleman, 2014)

References

Advisory Committee on Breast Cancer Screening. 2006. Screening for breast cancer in England: past and future. Journal of Medical Screening, 13(2), 59-61. Almond, M. 2014. Participation in the New Public Health Landscape. In Decentralizing Health Services (pp. 147-159). Springer New York. Brinton, L. A., Cook, M. B., McCormack, V., Johnson, K. C., Olsson, H., Casagrande, J. T., ... & Thomas, D. B. 2014. Anthropometric and Hormonal Risk Factors for Male Breast Cancer: Male Breast Cancer Pooling Project Results. Journal of the National Cancer Institute, 106(3), djt465. Brown, T., Platt, S., & Amos, A. 2014. Equity impact of European individual-level smoking cessation interventions to reduce smoking in adults: a systematic review. The European Journal of Public Health, cku065. Cavill, N., Biddle, S., & Sallis, J. F. 2001. Health enhancing physical activity for young people: statement of the United Kingdom expert consensus conference.Paediatric Exercise Science, 13(1), 12-25. Coleman, A., Checkland, K., Segar, J., McDermott, I., Harrison, S., & Peckham, S. 2014. Joining it up? Health and Wellbeing Boards in English Local Governance: Evidence from Clinical Commissioning Groups and Shadow Health and Wellbeing Boards. Local Government Studies, (ahead-of-print), 1-21. England, N. H. S. 2013. Putting Patients First: The NHS England business plan for 2013 (Vol. 16, p. p16). 14–2015. England, N. H. S. 2012. The CCG outcomes indicator set 2013/2014. Gunsoy, N. B., Garcia-Closas, M., & Moss, S. M. 2014. Estimating breast cancer mortality reduction and overdiagnosis due to screening for different strategies in the United Kingdom. British journal of cancer. Hamill, M., Burgoine, K., Farrell, F., Hemelaar, J., Patel, G., Welchew, D. E., & Jaffe, H. W. 2007. Time to move towards opt-out testing for HIV in the UK. BMJ, 334(7608), 1352-1354. HPA 2013‚ ‘United Kingdom - National HIV data surveillance tables’

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