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The community whose health profile has been profiled is in the Southwark community. Southwark is a district of Central London. The selection of the community was because of its uniqueness in terms of several features or characteristics. The people residing in this community are of different religious backgrounds, including Christianity, Islam, Hinduism, and others have no religion. The community has areas perceived to be for the rich and those for the poor. The ethnicity of the individuals in this community varies from White Irish, White British, White & Black Caribbean, White & Black African, White & Asian, Indian, Chinese, Black African, and the Black Caribbean, among others such as Arabs. These diverse characterising this community was the primary rationale for its selection.
The profile of the Southwark community has been structured in five parts including the introduction, a brief discussion of the definitions of health and illness and health promotion, the health profile of Southwark community, the role of the nurse and opportunities for promoting health and preventing ill health, and finally, the conclusion.
The significance of this particular topic is that it allows understanding of the social determinants of health and inequalities for purposes of implementing principles of health promotion, protection and improvement, and prevention of ill health among the members of the community. In doing so, health and wellbeing are enhanced with contributes to productive and independent individuals.
The concept of health and wellbeing has been defined as the absence of mental distress, disease, and physical illness (Larkin, 2013, p. 7). This can also be referred to as the maintenance and achievement of mental stability and physical fitness. On the other hand, health promotion is defined as the process that enables people to improve and attain control over their health. This is regarded to be a positive concept whose emphasis is social, personal, institutional, and political resources in addition to physical capacities. Health promotion is the combination of any political, education, health, organisational or spiritual initiative/ mechanism designed and implemented to achieve positive social, behavioural, or environmental changes appropriate for the improvement of the health and wellbeing of the population; in this case, the Southwark community. There are five principles of health promotion, including equity in health, a settings perspective, action and action competence, a positive and broad health concept, and finally, participation and involvement. The importance of adhering to these principles for health promotion cannot be underestimated as it improves the health status of families, individuals, communities, and the nation at large. Achievement of health promotion guarantees enhancement of the quality of life for both children and adults and reduces or eliminates the chances of premature deaths.
The selected community being profiled is the Southwark community governed by the Southwark council occupying an area of 28.8 km2. The community has an estimated population of 317,256. Some of the landmarks characterising Southwark include the London Bridge, Borough market, the Shard, and the Tower Bridge. The community has a presence of colleges, secondary and primary schools, as well as universities serving the residents. Other things which can be found in Southwark include parks, places of worship, town halls, dental and healthcare facilities, museums, libraries, and homeless people. The figure below is a representation of Southwark’s community population compared to England.
Figure 1 Southwark population numbers and structure in 2017 compared to England
Source: Southwark Council (2018)
To determine the health needs of the Southwark community, examining the critical facts related to the health and wellbeing of the people is vital. First, the male expectancy in this community is 78.2 years as compared to the overall 78. Five years in England, while for females, it is 83.4 years compared to 82.5 years (Southwark Council 2014). The rate of infant mortality has been decreasing over the years (death of babies under one year). To be precise, the rate is 6.17 per 1000 born children compared to 4.29 in England. The significant risks of the health and wellbeing of the people in this community are associated with lifestyle factors like unhealthy diets, smoking, and substance abuse. Annually, it is estimated that about 270 people in the community die due to illness related to smoking a rate that is higher than regional and national levels.
Nonetheless, there has been a reduction in smoking prevalence over the years, wherein in 2012 it was 23%, but in 2017, it was 12.2% (Southwark Council 2014). In the Southwark community, children who are obese or overweight are about 3 out of 10 children in the reception age, and this often increases to 4 in 10 before they reach the age of six (Southwark council 2019). According to the Southwark government, it is estimated that half of the adults, both male and female, in the community are either obese or overweight. The diagram below provides for the statistics on child obesity in the Southwark community.
Figure 2 Childhood obesity in Southwark
Several factors have been affecting the Southwark community and could be categorised into determinants of health, behavioural risk, as well as the inequalities of health. In relation to the health determinants in Southwark, domestic abuse, natural and built environment, and household food security are the critical factors. Domestic abuse comes in various forms and has a direct effect on the victim and their families, regardless of sexuality and gender. The forms of abuse include physical, psychological, sexual, emotional, and financial abuse. Estimates show that about 13,000 people in Southwark face the risk of domestic violence and abuse. As a result, there are high cases of mental health in this community. The health and wellbeing of people are determined by the environment in which they work, live, and grow. The natural and built environment is a contributing factor to inequalities as the latter refers to transport, housing, and food outlets, while the natural environment includes blue and green spaces. Air pollution in Southwark is high caused by the busy roads. Mortality rates from air pollution are about 72 deaths annually (Southwark council, 2019). Household food insecurity is another factor that determines the health of the population in a community. When families are unable to secure healthy and nutritious foods, children growing up are affected at each stage of their lives, which impacts their wellbeing, development, and life chances. Chronic conditions, depression, and asthma are associated with food-insecure households. Another impact of this is financial costs, where treating malnourished individuals is more costly. In a 2019 survey, it was depicted 1 out of 4 people in Southwark faced low food security, which translates to about 75,000 people (Southwark council 2019).
The behavioural risks factors, in particular, lifestyle factors, have an impact on the health and wellbeing of people (Rollnick, Mason, and Butler 2010). The consumption of alcohol, drug and tobacco use, physical activities, sexual practices, and the diet consumed have health consequences. Changes in behaviours can positively affect the prevalence rates of cancer, diabetes, respiratory and cardiovascular health conditions.
Health inequalities in a community often affect the health outcomes of the population, and they arise from the interaction between cultural, geographic, and socio-economic factors. Subsequently, they influence the life expectancy of the Southwark residents, as demonstrated in the figure below.
Figure 3 Overview of health inequalities in Southwark Community
Source: Southwark Council (2019)
Out of the 32 local authorities in London, Southwark is ranked as 32 in terms of deprivation and 40th out of England’s local authorities. Below is an image showing the most deprived areas in Southwark community.
Figure 4 Deprivation
Source: Southwark Council (2019)
Deprivation has a significant adverse effect on the health of the people residing in this community. These residents face multiple health problems and they have 60% high prevalence rates of suffering from long-term conditions compared to the rich. The more an area is deprived, the more deaths are witnessed as compared to those less deprived. The pie charts below provides a breakdown of the excess deaths between the least and most deprived quintiles.
Figure 5 DEPRIVATION – EXCESS DEATHS
Source: Southwark Council., 2019
Based on this analysis of the health and wellbeing of the Southwark community, it can be concluded that the priority areas for health promotion interventions in Southwark are multiple. Possible areas for interventions include diagnosis owing in no small number of people living with undiagnosed diabetes, rehabilitation for people caught up in the abuse of drugs such as tobacco and alcohol, and health education on lifestyle factors because of the cases of overweight and obese. The health needs equate to the development and implementation of specific health promotion interventions to prevent, protect, promote, and improve the health of the Southwark Community.
First, because of the inequalities and behavioural risk factors in Southwark, the consequence has been higher cases of emergency hospital admissions associated with abuse of alcohol, and the rates of teenage pregnancy and HIV is high. The most appropriate health promotion intervention for this particular issue is behaviour intervention, where the residents are taught on the importance of changing attitudes for purposes of adopting a healthy lifestyle (Hubley, Copeman and Woodwall, 2018; Upton, and Thirlaway, 2014). Through this intervention, members of the community are often encouraged to adopt a healthy lifestyle.
The community also struggles with the problem of premature deaths caused by cancer and other cardiovascular diseases. Mental illness of the people residing in this community is highly prevalent. The top three primary conditions causing death among the population in this community are respiratory diseases, malignant neoplasms (cancers), and Coronary heart disease. Prevalence models of diseases have depicted that within the community, there is a high number of heart disease, hypertension, and diabetes cases, which remains not detected, making the populace vulnerable to death. Statistics show that 1 in 5 people living in Southwark have encountered a mental disorder, which equates to about 47,000 people making the prevalence to be 1.4%. The direct effects of mental illness have been witnessed in the rise of suicide cases. Between 2013 and 2015, Southwark was among the London boroughs reporting high rates of suicide compared to the national average. Cancer is the primary disorder causing death in the Southwark community as it accounts for about a third of the total deaths. Concerning diabetes, the prevalence of diagnosed cases is 5.9% meaning a high number of people living with diabetes that is not diagnosed. About this, an appropriate health promotion intervention for consideration is the education intervention, where people are provided with information equipping them with understanding and knowledge of health issues. An education program would help people understand the need for diagnosis and learn on health risks that expose them to these types of conditions (Gottwald and Goodman-Brown, 2012).
Finally, a possible health promotion intervention can be societal or community change response where modifications to the social and physical environment are done to have it more appropriate for good health. This could be done by incorporating health as a political agenda where stronger policies could be developed to have the environment improved. For instance, policies can be developed to try to minimise air pollution in Southwark.
Nurses have an absolute role in the promotion of health and prevention of ill health within the communities that they serve. Nurses interact with people daily, and they have the responsibility of ensuring that each interaction counts. The interactions of nurses with patients provide them with the perfect opportunity of advocating for living healthy lifestyles by eating balanced diets and engagement in physical exercises. For instance, Kreausukon, Gellert, Lippke, and Schwarzer (2012) concluded that self-efficacy and planning could increase the consumption of vegetables and fruits. Therefore, nurses have to educate members of the community on the need for behavioural changes to promote and prevent ill health.
Additionally, for experienced nurses, they have the role of being involved in the development and implementation of health promotion interventions and campaigns within their community. Implementation of these models means nurses inform people on the importance of early diagnosis for diseases such as diabetes. As noted by Tilford (2017), by being examples and promoting resilience, patients can learn from them on matters of health and wellbeing. Nurses can become advocates for better policies and facilities, especially in the areas which are deprived. Becoming community advocates for better health leads to increment in resources budgeted for promoting health and preventing ill-health. Nurses can also work and liaise with charity, voluntary, and statutory organs by providing expert advice on health promotion (Cranmer, and Nhemachena, 2013).
In conclusion, the Southwark community, like any other community in England, has its share of problems arising from behavioural risk patterns, social health determinants, and health inequalities. Cancer is the leading cause of death in the community. The abuse of substances like alcohol and tobacco is prevalent in this community. Overweight and obesity among adults and children is also a concern. These are some of the areas that health promotion interventions can focus on to prevent, protect, promote, and improve the health of the people. Health promotion interventions such as behavioural change, education, and community change, among others, can help in enhancing the health and wellbeing of Southwark residents. At the same time, nurses within this community have a role in placing to improve health promotion and prevent ill health. Nurses can work with the local government to develop health intervention programs that are effective and educate residents upon interacting with them on the need for adopting healthy lifestyles. Nurses can also work to advise volunteer groups within Southwark on how to design and implement effective health promotion programs.
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