A Health Promotion Perspective

Introduction

According to WHO, Health is referred to the state of proper social, physical and social well-being to ensure an individual is able to live a full life. In this assignment, the health and well-being of Bangladeshi family living in Tower Hamlets, London with one of the members suffering from COPD is to be described. In the family, Hamid is found to be long-term smoker and is detected with COPD in the last year. In Tower Hamlets, it is mentioned that only 2% of the residents follow all the four indicators of health that are avoid smoking, eat fruit and vegetables, avoid alcohol intake and execute physical activity. In addition, healthy activities are found to be least preferred to be taken by Bangladeshi people compared to white individuals (towerhamlets.gov.uk, 2011). In 2019, it is reported that 19.7% of the population in Tower Hamlets smoke which is more than the national average of 14.9% of the population. The smoking and intake of tobacco are also found to be common among Bangladeshi people in the area compared to white individuals (towerhamlets.gov.uk, 2015). In the area, 32% of the population is Bangladeshi compared to 31.2% of white individuals (towerhamlets.gov.uk, 2015). Moreover, it is found that 1.3% of the population in the area is suffering from COPD (towerhamlets.gov.uk, 2019). Thus, the Bangladeshi family is chosen for its health and well-being to be discussed as they belong to the majority of the population do not follow healthy behaviour and are involved in smoking in the area which is one of the key health concerns in the borough. In addition, the presence of COPD in the family which one of the key issue in the area due to which majority of emergency admission in the hospital are made has resulted them to chosen for discussing their health and well-being. The assignment is to be structured by initially providing overview regarding health and illness along with health promotion. The health profile of the family is o be discussed and the role of nurses to promote the health of the family and individuals in the area is to be analysed.

Discussion regarding Health and Illness

Health is regarded as the overall well-being (physical, mental and social) of the individual and not just the absence of any disease or injury in the body. The well-being is referred to the quality of life having positive mental and physical health to live in sustainable communities (Diener et al. 2017). Thus, well-being is considered as progress in the social life and health is inter-related with it as without being healthy a person cannot enjoy their social life. In order to maintain proper health and well-being, effective health promotion regarding the way to avoid and control the disease is required. Health promotion is referred to the process which attracts environmental, biological, psychological, medical and physical sciences for promoting health and prevent diseases through education-driven voluntary activities for changing behaviour among the population (Lavie et al. 2018). The principles of health promotion include equal inclusion of all nature of individuals from the population to enable them to take their own care, act on different determinants of health, involve diverse approaches, aim to involve public participation in healthy activity and empowerment of health professional (McBride et al. 2019). The health promotion is significant to promote good health and prevent diseases because it informs people regarding factors leading to health issues along with the ways to cope with them to lead a healthy life (Griebler et al. 2017).

Health Profile of Family

The health profile to be discussed is regarding a family with two members that include Hamid and Afreen who are husband and wife with no children living in Tower Hamlets, East London. Hamid is found to be 70 years old and Afreen is 65 years old and they are Bangladeshi in origin. Hamid is reported to be working as a clerk in mine who has currently retired and Afreen is used to be the homemaker. The social status of the family is found to be below middle class and they are currently found to living in a small apartment of their own. In case of Hamid, it is reported that he has been smoking 30 cigarettes a day for the past 20 years and has currently reduced it to 5 after being detected with Chronic Obstructive Pulmonary Disorder (COPD). Moreover, Afreen is also found to be suffering from asthma which has worsened after the retirement of her husband as it leads her to feel shortness of breath more often. The epidemiological data from Tower Hamlets informs that 1 in 10 people who are within the age of 64-75 years are affected by COPD (towerhamlets.gov.uk, 2015). This indicates that COPD from which Hamid is suffering is a common health disorder in the locality.

The JSNA Reports regarding Tower Hamlets informs that emergency COPD admission rate from the area in London is nearly 5.1 per 1000 GP population. This nearly equates to 599 patients in 2012-13 which accounts for 95% of admissions made from Tower Hamlets regarding COPD (towerhamlets.gov.uk, 2015). This indicates that the majority of COPD emergency admissions are done from the area. In the study by Lee et al. (2018), it is mentioned that emergency admission regarding COPD occurs as a result of lack of timely care and management. This is because improper health management and lack of timely intervention in COPD patients make them experience shortness of breath and exacerbations leading them to immediately require hospital admission. Thus, it indicates that Hamid by living in Tower Hamlets may be prone to face emergency admission for his COPD condition as a result of untimely and lower quality care availability.

The rate of readmission regarding COPD within 30 days in 2013-14 is found to be 23% and in 2014-15 it is found to be 19% in Tower Hamlets (towerhamlets.gov.uk, 2015). This indicates that the relapse rate of COPD is comparatively lowering in Tower Hamlets but the numbers still show an alarming condition. The readmission rate of patients increases as a result of an error in care along with lack of proper follow-up of care (Alshabanat et al. 2017). Since Hamid is suffering from COPD, thus it can be determined that he is at a vulnerable situation as the healthcare management regarding the COPD is found to be of lower quality due to which the rate of readmission is found to be at concerned numbers in the area. The mortality rate for people suffering from COPD in Tower Hamlets is found to be quite high comparative to London and England. This is evident as in 35.6% people in Tower Hamlets were seen to die from COPD compared to 17.1% in London and 17.6% in England (towerhamlets.gov.uk, 2015). This indicates that the quality of care regarding COPD is quite poor in the area due to which increased mortality regarding the illness is seen in the area.

The Tower Hamlets is regarded as one of the areas which have the highest smoking rates in the country. This is evident as in 2019 it is reported that 19.7% of the individuals out of the total population in the area smokes tobacco compared to 14.9% nationally (towerhamlets.gov.uk, 2015). This informs that wide numbers of people in the area are involved in smoking. As mentioned by Fell et al. (2018), second-hand intake of smoke causes individuals with asthma to face severe and continuous asthma attacks. This is because the harmful substances in the tobacco smoke cause irritation in the airways leading the person experience shortness of breath. In the case of Afreen, it is already seen that she is suffering from asthma and it has worsened with the presence of her husband at home after retirement. Thus, it can be determined that exposure to secondary smoke in the home as her husband smokes 5 cigarettes a day at the present has led her to face worsened condition regarding asthma.

The study by Ranjita et al. (2016) informs that long time working in the coal mines leads individuals to develop COPD. This is because the inhalation of the coal dust leads the airways of the people to be damaged by the deposition of the dust on the healthy tissues within the lungs. The lungs trying to get rid of the coal dust particles develop inflammation inside the airways which leads to develop issues in breathing making the individuals gradually show symptoms related to COPD. In case of Hamid, it is seen that exposure to coal dust while mining may have acted as a contributing factor towards the development of his COPD. As asserted by Terzikhan et al. (2016), the harmful particles present in the smoke contribute to the development of COPD. This is because the particles damage the tissues of the lungs leading the individual developing shortness of breath and coughing that are key symptoms related to COPD. In case of Hamid, it is seen that he has been smoking for 20 years and even after detection of COPD he is involved in smoking though at a lower rate. This indicates that smoking tobacco may have been the key contributing factor which has led him to develop COPD as harmful agents in the smoke such as nicotine, carbon dioxide and others have contributed to damage his lung tissues.

The treatment for COPD is found to include increased expenses to be bored by the patients as well as the government. This is evident as nearly £9.9 billion is seen to be spent directly on the NHS and in private costs by the patients for treatment of lung disease. Among it, nearly £ 1.9 billion is spent on the treatment of COPD and £3 billion spent for treatment of asthma (blf.org.uk, 2018). This indicates that the cost for the treatment of COPD and asthma is quite huge. In the case study, it is seen that Hamid and Afreen at the present do not have any steady mode of income and therefore in this condition, they would experience financial constraints to bear the cost of treatment for COPD and Asthma. This would lead them to avoid accessing proper care due to lack of money, in turn, influencing to deteriorate their health.

The reports published by the British Lung Foundation (BLF) informs that 36% of the Bangladeshi men in the UK are found to be involved in smoking compared to 26% of the white women. The prevalence of smoking is not frequently seen among Bangladeshi women (blf.org.uk, 2017). As mentioned by Williams et al. (2017), in Bangladeshi culture it is seen that smoking is supported among the men socially. This would influence Hamid to be face deteriorated health condition because the cultural support and norms regarding smoking would make him avoid develop the initiative to quit smoking in turn further worsening his condition of COPD. As argued by Collins et al. (2018), people from the most deprived areas are found to have greater severe incidences of COPD compared to individuals living in the least deprived areas. This is because the people in the most deprived areas have the least access to green spaces and the areas are found to be more polluted. Thus, Hamid and Afreen being living in most deprived areas in the Tower Hamlets within a small apartment would influence them to experience deteriorated condition regarding their health condition as the environment in which they are living is not healthy to promote their well-being.

The initial health need for Hamid to control COPD is to quit smoking. This is because smoking is regarded as the key harmful activity that worsens the COPD condition and eventually leads the patients unable to breathe properly (Hagens et al. 2017). Therefore, Hamid is required to be included in the smoking rehabilitation program where the individual would be taught strategies to overcome addiction regarding smoking. Moreover, the health need for Hamid to have improved well-being is that proper medications are provided to him to overcome the health complications faced due to the illness. This is because in COPD it is seen that people experiences increased shortness of breath along with coughing up of sputum which makes the individual face breathing trouble that interferes with their execution of everyday activities. Hamid also needs to be referred to as a proper diet by the dietician to help him improve his condition with COPD. As mentioned by van de Bool et al. (2017), the intake of proper nutrition helps the patient to develop physical strength to cope with their health issues. This is because the nutrients help in effective body functioning that is degraded by the illness in turn leading the individual to show improved health and well-being.

The COPD patients are referred to intake large amount of water so that the sputum can be diluted and this makes them easier to cough it (Daga et al. 2018). Therefore, the health need of Hamid is that he is to intake large amount of water so that the sputum can be diluted and it helps him to cough it up to clear his throat for breathing easily. In case of Afreen, the initial health need of her is that she is to be avoided from getting exposed to secondary smoke. This is because smoke causes irritation in the airways of the lungs as a result of which people with asthma faces increased breathlessness (Milanzi et al. 2017). In addition, she is to be exposed to intake fresh air as confined spaces make individuals get suffocated leading the people with asthma face hindrance with breathing (Greener, 2018). Afreen also needs to maintain her health properly so that she can avoid getting cold. This is because cold or flu worsen the symptoms of asthma as cold leads the increased build-up of sputum in the airways which blocks the passage of air leading individuals to face asthma attacks (Davis, 2017). Therefore, the health need of Afreen is that she is to be provided information regarding the way to remain safe and avoid flu.

The proper knowledge among the individuals regarding whom to access for the health complication helps the individual take early approach in protecting them from worsened health condition (Fertman and Allensworth, 2016). This is because the immediate intervention required for improving health is made available. Therefore, the health need of Hamid and Afreen is that they are to be provided proper information about the healthcare services and the way to approach them so that the individuals are informed regarding the authorities to be approached in case of worsened symptoms to ensure their well-being. Hamid and Afreen also need to provide free healthcare for the treatment of their condition as they are financially poor to bear the cost of care to ensure their health and well-being.

The priority areas in which health promotion intervention for the family to be made is regarding their lifestyle, living environment, managing everyday action, intake of diets and informing regarding healthcare services. This is because it is seen that Hamid and Afreen are not aware of the way their lifestyle of smoking and not intake of proper food is hindering as well as worsening their health complications. Moreover, promotion regarding the changes required in the living environment of the group is to be informed so that they can understand the way modifications is to be made for their positive health and well-being.

Nurse role and opportunities to promote health

The role of nurses in health promotion at the initial stage is to offer general health education to patients and individuals (Hoekstra et al. 2016). This is because the nurses have effective qualification regarding the way to inform and provide knowledge related to wide range of health topics. The health education can be provided by nurses in different ways and the nurses are responsible based on the nature of population to be educated to choose the proper educational mode (Darch et al. 2017). The nurses in health promotion have the role to make use of patient visits and inform them in detail through showcasing of evidence regarding the way health complications faced by them develops and the risk factors to be avoided to remain healthy. In health promotion, the nurses also have the role to identify the at-risk patients who are to be targeted in the promotional activity (Yousefi et al. 2019). This is because identifying the key patients or individuals who are suffering from the disease for health promotion is essential and delivery of information to all these individuals leads to create better awareness regarding the disease in turn leading to develop overall health and well-being, in turn, lowering the prevalence of the disease.

The patients are often found to be unaware of the nature of healthcare services available for them. The nurses in this respect in health promotion have the role to inform the patients in details regarding the nature of services that are available related with their health condition and the way they can access them to ensure better health. Moreover, the nurses have the role to connect the specific individuals with the services during health promotion so that the individual receives proper information to make them aware regarding the steps to be taken regarding their illness (Loan et al. 2018). The following of the mentioned role by the nurses creates opportunity in health promotion to attract proper number of target patients and group who are to be educated regarding their health condition. Moreover, following the roles creates opportunity to promote health by spreading detailed information regarding causes, risk factors, pathophysiology and treatment strategies regarding diseases. The role by the roles develops opportunity to promote the health of many communities as well as the individuals who are made aware of the health information acts as word-of-mouth to further spred the data to wider groups in need.

Conclusion

The above discussion informs that health is the state of physical, mental and social well-being of the individuals. The family considered in this case is seen to have two members who are husband and wife and each of them is facing respiratory issues such as COPD and asthma. The discussion informs that the state regarding COPD prevalence in the UK is in a worsened condition in Tower Hamlets as most of emergency COPD admission is seen from the area. In addition, the readmission rates for COPD are also found to be at increased level in the Tower Hamlets region which indicates that quality of care and health environment in the area is deteriorated nature which is going to negatively influence the health condition of Hamid who is suffering from COPD. The health needs to be focussed regarding Hamid and Afreen are changing their living environment, making Hamid quit smoking, making Afreen avoid flu and cold and others. The smoking would hinder the health of Hamid as the tobacco smoke contains wide number of harmful agents which damages the lung tissues leading to worsen the symptoms of COPD. In addition, the continued smoking who also expose Afreen to secondary smoke which would also increase her symptoms regarding asthma. The role of the nurses, in this case, is to provide health education to the family to help them make changes in their lifestyle to improve their health.

References

Alshabanat, A., Otterstatter, M.C., Sin, D.D., Road, J., Rempel, C., Burns, J., van Eeden, S.F. and FitzGerald, J.M., 2017. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. International journal of chronic obstructive pulmonary disease, 12, p.961.

blf.org.uk 2018, Lung disease costs the UK a staggering £11 billion every year, Available at: https://www.blf.org.uk/policy/economic-burden [Accessed on: 21st January 2020]

Daga, M.K., Singh, S. and Mawari, G., 2018. Medical Nutrition Therapy: An Essential Component of COPD Care. Current Respiratory Medicine Reviews, 14(3), pp.149-155.

Darch, J., Baillie, L. and Gillison, F., 2017. Nurses as role models in health promotion: a concept analysis. British Journal of Nursing, 26(17), pp.982-988.

Davis, S., 2017. A cold or the flu-why is it important to know?. SA Pharmacist's Assistant, 17(2), pp.8-10.

Diener, E., Pressman, S.D., Hunter, J. and Delgadillo‐Chase, D., 2017. If, why, and when subjective well‐being influences health, and future needed research. Applied Psychology: Health and Well‐Being, 9(2), pp.133-167.

Fell, A.K.M., Svendsen, M.V., Kim, J.L., Abrahamsen, R., Henneberger, P.K., Torén, K., Blanc, P.D. and Kongerud, J., 2018. Exposure to second-hand tobacco smoke and respiratory symptoms in non-smoking adults: cross-sectional data from the general population of Telemark, Norway. BMC public health, 18(1), p.843.

Fertman, C.I. and Allensworth, D.D., 2016. Health promotion programs: from theory to practice. John Wiley & Sons.

Greener, M., 2018. A breath of fresh air in asthma diagnosis. British Journal of Healthcare Management, 24(6), pp.270-273.

Hagens, P., Pieterse, M., van der Valk, P. and van der Palen, J., 2017. Effectiveness of intensive smoking reduction counselling plus combination nicotine replacement therapy in promoting long-term abstinence in patients with chronic obstructive pulmonary disease not ready to quit smoking: Protocol of the REDUQ trial. Contemporary clinical trials communications, 8, pp.248-257.

Hoekstra, B.A., Young, V.L., Eley, C.V., Hawking, M.K. and McNulty, C.A., 2016. School Nurses’ perspectives on the role of the school nurse in health education and health promotion in England: a qualitative study. BMC nursing, 15(1), p.73.

Lavie, C.J., Laddu, D., Arena, R., Ortega, F.B., Alpert, M.A. and Kushner, R.F., 2018. Reprint of: healthy weight and obesity prevention: JACC health promotion series. Journal of the American College of Cardiology, 72(23), pp.3027-3052.

Lee, J.S., Lempp, H., Srivastava, V. and Barley, E., 2018. Reasons for Accident and Emergency department attendance by people with chronic obstructive pulmonary disease or heart failure: recipients and providers’ perspectives. An exploratory study. BMJ Open Respiratory Research, 5(1), p.e000244.

Loan, L.A., Parnell, T.A., Stichler, J.F., Boyle, D.K., Allen, P., VanFosson, C.A. and Barton, A.J., 2018. Call for action: Nurses must play a critical role to enhance health literacy. Nursing outlook, 66(1), pp.97-100.

McBride, K.A., MacMillan, F., George, E.S. and Steiner, G.Z., 2019. Health promotion and social determinants of health. Social Determinants of Health, pp.131-152.

Milanzi, E.B., Brunekreef, B., Koppelman, G.H., Wijga, A.H., van Rossem, L., Vonk, J.M., Smit, H.A. and Gehring, U., 2017. Lifetime secondhand smoke exposure and childhood and adolescent asthma: findings from the PIAMA cohort. Environmental Health, 16(1), p.14.

Ranjita, R., Hankey, A., Nagendra, H.R. and Mohanty, S., 2016. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: a randomized controlled trial. Journal of Ayurveda and integrative medicine, 7(3), pp.158-166.

Terzikhan, N., Verhamme, K.M., Hofman, A., Stricker, B.H., Brusselle, G.G. and Lahousse, L., 2016. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. European journal of epidemiology, 31(8), pp.785-792.

towerhamlets.gov.uk 2011, Health and Research Lifestyle: Tower Hamlets Primary Care Trust, Available at: https://www.towerhamlets.gov.uk/Documents/Borough_statistics/Health_and_social_care/Tower-Hamlets-Health&Lifestyle1.pdf [Accessed on: 21st January 2020]

towerhamlets.gov.uk 2015, Chronic Obstructive Pulmonary Disease: Factsheet, Available at: https://www.towerhamlets.gov.uk/Documents/Public-Health/TH-JSNA-Factsheet-COPD-2015.pdf [Accessed on: 21st January 2020]

towerhamlets.gov.uk 2019, Make 2019 the year you quit smoking for good!, Available at: https://www.towerhamlets.gov.uk/News_events/2018/December_2018/Make_2019_the_year_you_quit_smoking_for_good.aspx [Accessed on: 21st January 2020]

van de Bool, C., Rutten, E.P., van Helvoort, A., Franssen, F.M., Wouters, E.F. and Schols, A.M., 2017. A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD. Journal of cachexia, sarcopenia and muscle, 8(5), pp.748-758.

Williams, L., Ralphs, R. and Gray, P., 2017. The Normalization of Cannabis Use Among Bangladeshi and Pakistani Youth: A New Frontier for the Normalization Thesis?. Substance use & misuse, 52(4), pp.413-421.

Yousefi, H., Ziaee, E.S. and Golshiri, P., 2019. Nurses’ consultative role to health promotion in patients with chronic diseases. Journal of Education and Health Promotion, 8. pp.23-45.

Continue your journey with our comprehensive guide to A Global Perspective on Mental Health.