Communities found in England

  Middlesbrough, a local community found in England, has been chosen as a sample to review their health profiles. Health profiles help communities to keep a planned view of individuals' health status and factors that affect health in a community (Public Health England, 2017). According to Public Health England, there are 20% deprived communities in England and Middlesbrough is one of the most deprived areas or districts in England, and the health of the people is worse than the average in England (Gov.UK, 2018). The rationale behind selecting this community for the health profile review is to analyse important data and learn how individuals and families are affected by socioeconomic, demographic and health care plans. Furthermore, the exploration of these factors will help determine how positively or negatively people's health patterns are influenced. This essay will outline the demographic area of the community, its social determinants of health compared to England as a whole, its inequalities and health status. Public health refers to private or public interventions that help prevent diseases, promote health, and improve the quality of life (Acheson, 1988). The World Health Organization (WHO) describes health as a comprehensive physical, social, and mental wellbeing of an individual, not considering the absence of diseases (World Health Organisation, 1948). Whilst oxford dictionary defines individual wellbeing as having general good health, either economically, mentally, or physically. Emphasising that uncertainties in health are not the only factor to consider (Reference). The aim of the WHO is to improve health and well-being. To achieve that aim, they introduced health promotions. The WHO defines health promotion as the process of allowing people to develop control and improve their health. Health promotion goes beyond concentrating on human behaviour towards a broad range of environmental and social interventions (WHO, 2005). Due to this the WHO set key principles and values urging health promotions; they include health promotion being content-driven, it focuses on the economic and social influence for considering socioeconomic, ethnic gaps and gender patterns in health and diseases. Health promotion incorporates physical, mental, and social measures associated with health. It also puts accountability on all forms of government to have the responsibility and to be accountable for keeping, protecting, and improving the health of its citizens (WHO, 2005). Disease prevention programs like health promotion activities help individuals make healthier choices, which helps reduce the risk of diseases. It also helps communities to recognise their population’s health issues and centre their attention on those specific health issues (Durch et al.,2014). Demographic Data The chosen sample for this review is a town found in North Yorkshire, North East of England called Middlesbrough, it is the largest urban settlement in the region. according to the Office of National Statistics, their population in 2020 was 387,000. Their current population is 389,000 a 0.52% increase from 2020 with a projected 0.75% increase by 2025. (www.ons.gov.uk, 2014) The population of Middlesbrough has more younger people compared to the national average. 20.58% of the population are children and teenagers between 0-to-15-year-old which is higher than England's 19.05%. Furthermore, there are 15.90% older people over 65 years old, this is less compared to the 17.88% England rate. 63.56% of the population are of working age, this is between 16 and 64 years old. This percentage is higher than England's 63.07%. Their population is made up of more females than males. 50.85% were evaluated as female and 49.15% as male. The female and male percentage is nearly equal to that of England's rate of 50.6% and 49.40% respectively. (Rachel L, 2016) Middlesbrough is a diverse community, according to United nations urbanization prospects, over 88% of the residents are classed as White British. This is higher compared to England's rate of 79.18%. Also, an estimated 7.78% are Asians, being slightly lower than England's 7.82%. Whilst 1.25% identify as Black or African and Caribbean residents. This rate is lower compared to England's 3.48%. 1.71% of the population identify as mixed or multi-ethnicity. This is lower than England's 2.25% rate. There are diverse religions, this includes Judaism, Christianity, Islam, and Hinduism. 94% of the population speak English, whilst the remaining group speak other languages (Un.org, 2018). Social Determinants of Health. Unemployment The impact of the current COVID-19 pandemic has had an enormous impact on employment and have increased the rate of unemployment in the United Kingdom as a whole. It was reported in April 2010 that more than half of working-age adults in Middlesbrough were not employed, out of this number only 16% claimed Job Seekers Allowance and counted as unemployed. The chronicle live reported in 2020 that the North East part of the United Kingdom has the highest rate of unemployment. It reported that unemployment had risen to 6.7% which is above the England rate of 4.8%. Middlesbrough was named among the highest areas of unemployment in the North East (Whitfield, 2020). The table below unemployment rate of Middlesbrough between April 2020 and March 2021. Employment and unemployment (Apr 2020-Mar 2021) Middlesbrough (Numbers) Middlesbrough (%) North East (%) Great Britain (%) All People Economically Active† 60,300 67.5 76.0 78.7 In Employment† 57,300 64.2 71.2 74.8 Employees† 51,000 57.2 63.7 65.0 Self Employed† 6,000 6.6 7.4 9.6 Unemployed (Model-Based) § 4,300 7.0 6.2 4.9 Males Economically Active† 30,600 71.0 78.8 82.4 In Employment† 28,900 67.1 72.9 78.0 Employees† 24,600 57.4 63.4 65.5 Self Employed† 4,300 9.7 9.3 12.2 Unemployed§ # # 7.4 5.2 Females Economically Active† 29,700 64.3 73.2 75.1 In Employment† 28,400 61.5 69.6 71.6 Employees† 26,400 57.1 63.9 64.5 Self Employed† 1,700 3.6 5.5 6.9 Unemployed§ # # 4.9 4.5 Source: ONS annual population survey # Sample size too small for reliable estimate (see definitions) † - numbers are for those aged 16 and over, % are for those aged 16-64 § - numbers and % are for those aged 16 and over. % Is a proportion of economically active (www.ons.gov.uk, n.d.) The table above explains the employment and unemployment rate in Middlesbrough compared to the Northeast and Great Britain. Education A report from the Office for National Statistics ONS 2011 showed 29.9% of individuals between 16 to 74-year-old of Middlesbrough population are without any qualification. This is higher compared to the national rate of 22.7%. Also, ONS found 18.5% of the population of Middlesbrough between 16 and 74years had achieved NVQ 4 qualification (equivalent to undergraduate standard). This compared to the national average of 27.2% shows a difference of 8.7% (Ons.gov.uk, 2011). The table below represents education levels reported by ONS in 2020. The table is a representation of individuals between 16-64 years. The table shows that there is a low qualification level in Middlesbrough compared to the national average. Qualifications (Jan 2020-Dec 2020) Middlesbrough (Level) Middlesbrough (%) North East (%) Great Britain (%) NVQ4 And Above 27,000 30.8 34.5 43.1 NVQ3 And Above 42,800 48.8 55.1 61.4 NVQ2 And Above 61,600 70.3 75.5 78.2 NVQ1 And Above 70,400 80.3 86.7 87.9 Other Qualifications 6,200 7.1 5.2 5.7 No Qualifications 11,100 12.7 8.0 6.4 Source: ONS annual population survey Notes: For an explanation of the qualification levels see the definitions section. Numbers and % are for those of aged 16-64 % is a proportion of resident population of area aged 16-64 Table source (www.nomisweb.co.uk, n.d.) Income and poverty According to end child poverty, Middlesbrough's child poverty rate is 34%, which is extremely high compared to the national rate of 21.3%. Half of the children's population in Middlesbrough are from a single parent Household (Endchildpoverty.org.uk, 2019). The number of households without jobs in Middlesbrough is 23.8%, this is higher than England's 13.9%. Since many people in Middlesbrough are unemployed it causes poverty for adults and children. The average income for England is £31,461 yearly, whilst that of Middlesbrough is £2600 yearly. The recorded number of homeless and rough sleepers by Shelter in the North East is 2,273. Out of this figure, Middlesbrough had the highest number, they recorded 122 homeless people (Shelter England, 2019). There are 19,983 social housing units in Middlesbrough, with 62,000 households. As per their strategic plan, they are aiming to achieve 19% of privately rented households and aiming to accommodate 34% of the total population to occupy social housing by 2023. They also have 4200 people on a waiting list for social housing. Middlesbrough local authority has been ranked the 5th most deprived area in the United Kingdom for disability and health. Although there is the availability of health services, they experience worse access to health in terms of distance. Due to the distance involved there is a decreased use of services involving public health, General practitioners, dentists, hospitals, and other health facilities. (Healthy Living, 2017) Environmentally Middlesbrough has a high rate of population satisfaction. The only form of pollution they experience is traffic. The table below details how high or low some environmental factors rank. Environmental factor Extremely low (%) Low (%) Moderate (%) High (%) Inaccessibility of drinking water and pollution 12.50 Dirty and disarray 12.50 Light and Noice pollution 29.17 Water pollution 20.83 Level of crime 51.79 Drugs and drugs related crime 62.50 Inequalities Index of Multiple Deprivation IMD identifies areas of deprivation in every local authority in England. The IMD 2015 measures deprivation based on diverse kinds of indicators. The IMD specifies areas that have more significant factors of deprivation. The combined indicator for Middlesbrough includes. Indicator Score attained Employment Deprivation Domian 22.5% Education, Training and Skills Domain 13.5% Income Deprivation Domain 22.5% Disability and Health Domain 13/5% Barriers to Service and Housing Domain 9.3% Crime Domain 9.3% Living Environment Deprivation Domain 9.3% In accordance with the percentage acquired. The IMD (Index of Multiple Deprivation) 2015 ranked Middlesbrough an average of 6 out of 326 English districts and boroughs, which was an increase from 8 in the IMD 2010 report. This makes Middlesbrough the 6th most deprived local authority in England (James, 2016). Adult health The ONS annual population survey estimated that 0.4% of Middlesbrough population identify as bisexual, 1.3% identify as lesbian or gay and 94% identify as heterosexual. The Life expectancy is 12.0 years lower for women and 12.6 years lower for men (Pyle, 2019). There are various factors regarding hospital admissions in Middlesbrough. Self-harm hospital admission average rate stands at 391, which is worse than England's average. This represents 560 yearly admissions. The average rate of alcohol-related harm admissions is 964. The smoking prevalence in adults 18 years and above is worse compared to England. The average of physically active adults is worse than England average. The average hip fracture injuries in people 65 and above is also worse than England's average. Furthermore, the rates of under 75 cardiovascular and cancer mortalities are worse than England's average. The rates of sexually transmitted diseases and mortality or injuries caused by road accidents is less than England's average (Rachel L, 2016) (See appendix for table) Child health Children under 18years of age have an average of 41 alcohol related hospital admissions which is worse than England's average. This represents 13 admissions yearly. Furthermore, 24.7% of children in year 6 are classified as obese. There is a 43.8% teenage pregnancy rate in under 18, this is worse than England's 17.8%. Whilst breastfeeding and smoking in pregnant teenagers are worse than England's average. (See appendix for table). Health needs Some key health needs that can help improve the health and wellbeing of Middlesbrough residents include addressing the main causes of poor health, creating a secure and healthy standard of living for all residents, developing sustainable and healthy communities and educational accomplishment, and creating fair employment opportunities for all. Furthermore, Middlesbrough council’s wellbeing strategy published some health needs for the community. The document stated that to improve the health and wellbeing in the community, there must be a provision of strong early help focusing on young people and their families. Also, investing in family support to improve the outcomes of early years and maternal health reducing early deaths and preventable diseases. To improve emotional health and wellbeing, it was indicated that there is a need for a multi-agency approach to improve people's choices and lifestyles. This will increase the acceptance and understanding of early intervention and preventive programs. Furthermore, the use of joined and sustainable health services, where social and wellbeing care providers will integrate and manage patients long term illnesses and deliver the right care when needed at the right time and place. (Health, 2013) Deprivation causes life changes and has different effects on health and wellbeing. Factors that affect the Middlesbrough community causing deprivation and poor health include conditions like poverty, poor housing, unemployment levels, lower education accomplishment. Certain lifestyle behaviours, like lack of physical activity, binge drinking, smoking, and poor nutrition contribute to their ill-health. Furthermore, factors including inadequate and insufficient use of available services such as immunisation, early diagnosis programmes that prevent illnesses and the travel distance to receive health contribute to the deprivation status of Middlesbrough. To improve these factors the use of health promotion can help reduce and prevent the health and wellbeing of the people of Middlesbrough. Areas that may receive help from health promotion will include smoking and alcohol intake. This will help reduce injuries and hospitalization associated with alcohol and long-term diseases like cancer for the smoking population. Promoting health and reflecting on the importance of early diagnoses will help prevent many early deaths as help and medication will be received at the right time decreasing preventable deaths. Health promotion on mental health will improve the population’s general health and wellbeing. A sound mind affects all aspects of living and can motivate people to seek employment and education to improve general wellbeing. Nurse's associates and nurses have a responsibility to promote health, they have a responsibility to support and improve the physical, behavioural, and mental health and well-being of people, communities, and populations. They also help and encourage people in all care environments and stages of life to make good and informed choices and manage challenges of health to increase their quality of life. Nurses are incredibly involved in protecting and preventing diseases, they are actively involved in public health, global health, community development and reducing inequalities of health (Nursing and Midwifery Council, 2018). Nurses also play a role in building resilience at all levels and care settings to provide the best health care. There are many ways nurses can promote health, they include teaching the correct handwashing procedures, promoting, and running immunisations. Nurses and nurses associate interact with patients and people every day, they must always make use of their interactions. Every encounter or conversation with people is an important opportunity to help them improve their health and wellbeing. Nurses can use risk assessment and evidence-based practice to promote health to this community. Nurses can also take advantage of their home health visits to discuss the care of a newborn. It is the right opportunity to discuss vitamins and childhood vaccination programs. Nurses can also work with communities to identify their health needs. They can use evidence-based practice to plan interventions that will benefit the community. Nurses can also advise on health conditions and help make necessary referrals to patients and influence healthy behaviours by advising patients (Royal College of Nursing, 2021). The Information available can help nurses indicate critical aspects where health promotion will be vital. According to the above profile, the community can benefit from the National Health services NHS Better Health promotion and Stoptober health promotion to help improve smoking-related illnesses. In conclusion, health promotion can be used to identify a community's social and economic needs, health profile identifies areas that need improvements and vital attention. Knowing the health profile of a community, family or county helps the leaders of the local authority and government as a whole draw up strategic plans to help improve living conditions such as education, health, crime rate, pollution and life expectancy. Health profiles also help to create and decide specific health promotion strategies that will help the community. Health profiles also set indicators of basic socioeconomic and demographic characteristics, health risk factors, health status, and the use of health resources in a community. It helps build a safer and healthier community, family and region as a whole and improves life expectancy and health. Furthermore, the improvement of health and wellbeing is an important priority in a nurse's life as it prolongs life expectancy, improves health and wellbeing and general satisfaction for the population. Reference list Acheson (1988). Public health services. [online] www.euro.who.int. Available at: https://www.euro.who.int/en/health-topics/Health-systems/public-health-services [Accessed 8 Oct. 2021]. Durch, J.S., Bailey, L.A. and Stoto, M.A. (2014). Measurement Tools for a Community Health Improvement Process. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK233011/ [Accessed 22 Sep. 2021]. Endchildpoverty.org.uk. (2019). End Child Poverty | Improving the lives of children and families. [online] Available at: http://www.endchildpoverty.org.uk/ [Accessed 25 Sep. 2021]. Gov.UK (2018). Chapter 5: inequalities in health. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-5-inequalities-in-health [Accessed 8 Oct. 2021]. Health, M. (2013). Making Middlesbrough healthier together. [online] Available at: https://www.middlesbrough.gov.uk/sites/default/files/Health_Wellbeing_Strategy_2013-2023.pdf [Accessed 8 Oct. 2021]. Healthy Living. (2017). [online] Available at: https://www.communityfoundation.org.uk/wordpress/wp-content/uploads/2017/10/Vital-Issues-Vital-Issues-Tees-Valley-2017-Healthy-Living.pdf [Accessed 27 Sep. 2021]. James (2016). Index of Multiple Deprivation 2015. [online] www.middlesbrough.gov.uk. Available at: https://www.middlesbrough.gov.uk/open-data-foi-and-have-your-say/about-middlesbrough-and-local-statistics/index-multiple-deprivation-2015 [Accessed 29 Sep. 2021]. Nursing and Midwifery Council (2018). Future nurse: Standards of Proficiency for Registered Nurses. [online] Nursing and Midwifery Council. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nurses/future-nurse-proficiencies.pdf [Accessed 8 Oct. 2021]. Ons.gov.uk. (2011). Education and childcare - Office for National Statistics. [online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/educationandchildcare [Accessed 9 Oct. 2021]. Public Health England (2017). 2017 Health Profiles. [online] GOV.UK. Available at: https://www.gov.uk/government/statistics/2017-health-profiles [Accessed 8 Oct. 2021]. Pyle, E. (2019). Annual Population Survey regression models. [online] Ons.gov.uk. 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[online] Who.int. Available at: https://www.who.int/westernpacific/about/how-we-work/programmes/health-promotion [Accessed 8 Oct. 2021]. www.nomisweb.co.uk. (n.d.). Labour Market Profile - Nomis - Official Labour Market Statistics. [online] Available at: https://www.nomisweb.co.uk/reports/lmp/la/1946157060/report.aspx?town=middlesbrough#defs [Accessed 25 Sep. 2021]. www.ons.gov.uk. (n.d.). Labour market in the regions of the UK - Office for National Statistics. [online] Available at: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/regionallabourmarket/july2020 [Accessed 23 Sep. 2021]. www.ons.gov.uk. (2014). Subnational population projections for England - Office for National Statistics. [online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/subnationalpopulationprojectionsforengland/2014basedprojections [Accessed 23 Sep. 2021]. Appendixes Life expectancy and causes of death Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 1 Life expectancy at birth (male) All ages 2016 - 18 n/a 75.3 77.9 79.6 2 Life expectancy at birth (female) All ages 2016 - 18 n/a 80.0 81.7 83.2 3 Under 75 mortality rate from all causes <75 yrs 2016 - 18 1710 508.9 394.7 330.5 4 Mortality rate from all cardiovascular diseases <75 yrs 2016 - 18 396 118.6 82.8 71.7 5 Mortality rate from cancer <75 yrs 2016 - 18 614 184.8 152.6 132.3 6 Suicide rate 10+ yrs 2016 - 18 54 15.6 11.3 9.64 Injuries and ill health Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 7 Killed and seriously injured (KSI) rate on England’s roads All ages 2016 - 18 107 25.4 35.3 42.6 ~ 8 Emergency hospital admission rate for intentional self-harm All ages 2018/19 560 391.3 279.1 193.4 9 Emergency hospital admission rate for hip fractures 65+ yrs 2018/19 170 771.7 616.2 558.4 10 Percentage of cancer diagnosed at early stage All ages 2017 300 51.9 52.4 52.2 11 Estimated diabetes diagnosis rate 17+ yrs 2018 n/a 79.0 82.5 78.0 12 Estimated dementia diagnosis rate 65+ yrs 2019 1125 79.7 * 75.2 * 68.7 * Behavioural risk factors Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 13 Hospital admission rate for alcohol-specific conditions <18 yrs 2016/17 - 18/19 40 41.2 60.0 31.6 14 Hospital admission rate for alcohol-related conditions All ages 2018/19 1238 964.2 907.9 663.7 15 Smoking prevalence in adults 18+ yrs 2018 18843 17.4 16.0 14.4 16 Percentage of physically active adults 19+ yrs 2017/18 n/a 57.9 62.7 66.3 17 Percentage of adults classified as overweight or obese 18+ yrs 2017/18 n/a 64.9 66.5 62.0 Child health Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 18 Teenage conception rates <18 yrs 2017 103 43.8 24.7 17.8 19 Percentage of smoking during pregnancy All ages 2018/19 347 19.3 15.7 ~ 10.6 20 Percentage of breastfeeding initiation All ages 2016/17 941 47.9 59.0 74.5 21 Infant mortality rate <1 yr 2016 - 18 24 4.20 3.35 3.93 22 Year 6: Prevalence of obesity (including severe obesity) 10-11 yrs 2018/19 450 24.7 22.8 20.2 Inequalities Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 23 Deprivation score (IMD 2015) All ages 2015 n/a 40.2 - 21.8 24 Smoking prevalence in adults in routine and manual occupations 18-64 yrs 2018 n/a 24.4 26.3 25.4 Wider determinants of health Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 25 Percentage of children in low-income families <16 yrs 2016 9450 31.8 22.6 17.0 26 Average GCSE attainment (average attainment 8 score) 15-16 yrs 2018/19 65254 42.2 44.9 46.9 27 Percentage of people in employment 16-64 yrs 2018/19 57000 64.6 71.1 75.6 28 Statutory homelessness rate - eligible homeless people not in priority need Not applicable 2017/18 6 0.10 0.56 0.79 29 Violent crime - hospital admission rate for violence (including sexual violence) All ages 2016/17 - 18/19 320 73.3 62.0 44.9 Health protection Indicator Age Period Count Value (Local) Value (Region) Value (England) Change from previous 30 Excess winter deaths index All ages Aug 2017 - Jul 2018 119 25.1 30.4 30.1 31 New STI diagnoses rate (exc chlamydia aged <25) 15-64 yrs 2018 569 629.0 639.7 850.6 32 TB incidence rate All ages 2016 - 18 46 10.9 4.40 9.19