Effect of public health interventions in reducing health inequalities

Introduction

Public health interventions are described as organised efforts in health sectors that are aimed at improving the physical, mental and emotional health in patients (Thomson et al, 2018 p 4). This intervention may be run by government or non-governmental organizations that are related to health care. They include epidemiology and surveillance, outreach, screening, heath teaching, social marketing and policy development (Johnson et al, 2018 p 20). These interventions are grouped into three levels of prevention which include the primary prevention which includes improving the overall health of the population, secondary prevention which focuses on improvements and the tertiary level which improves the treatment process and the recovery process. Each of these three levels of intervention plays a significant role in disease control.

An intervention in public health sectors becomes a policy when they meet the required criteria of preventing diseases on both individual and community level hence impacting positively on public health (Brunton et al., 2017 p 7). These interventions can operate at different scales such as global, national or community level. The national public health strategy for infectious diseases in the UK with reference to north Ireland focuses on combating infectious diseases and prioritises strategic priorities for a period of 5years(2020-2025). The infectious disease strategy was designed to direct, plan, allocate resources, development and to deliver on infectious diseases for the 5 year selected time frame (Pottie et al, 2017). This strategy is centred on six core functions that describe the day to day work. These functions include, prevent and protect, protect and control, prepare and respond, build and apply, advise and collaborate and finally generate and share. Mental health illness is the main cause of disability in Northern Ireland. In an effort to improve mental health, a program was drafted in 2014 for the government of Northern Ireland and later adopted in 2016 for a period of five years (2016-2021) (Friedrich and Mason, 2017)

This report discusses the effect of public health interventions in reducing health inequalities in Northern Ireland with reference to the three main health issues which are mental health and well-being, alcohol use and diabetes. Mental illness is a diagnosed clinical condition that involves changes in the emotional behaviour and distress. Northern Ireland has the highest prevalence of mental disorders in the UK, with an incidence of around 16 deaths per 100,000 individuals per year (O‘Neill and Rooney, 2018). National Health Service, community and voluntary service providers are trying to deliver evidence based services; however the demand for this services keep increasing hence the need for public health interventions to reduce the health inequalities.

Alcohol misuse and alcohol related morbidity places a significant burden on our acute hospitals. Alcoholism has been widely known through different terms such as alcohol abuse and alcohol dependence. It is caused by drinking too much alcohol that the body becomes addicted to (Popham, 2019). These people continue drinking despite the negative consequences; however the main cause of this disorder is unknown and develops gradually over time. In Northern Ireland, there is a steady increase in the prevalence of alcohol related illnesses. Hospital admissions have increased steadily between 2000/01 and 2009/10 by 61% (Holmstrand et al, 2018 p 173). The number of alcohol related deaths in the region doubled between 1994 and 2012. The health and social care services have made an effort to solve these challenges. Alcohol misuse services are completely underfunded hence in dire need of phase II funding.

Diabetes is a disease that occurs as a result of increased blood sugar levels as the body fails to make enough insulin or cannot effectively use the available. There are two types of diabetes (type 1 and type 2) and more than 100, 000 people in Northern Ireland are living with this condition (Morgan et al, 2018 p 168). The prevalence is over 5.7% in Northern Ireland, and has led to massive complications due to inadequate care. The quality of life can be improved with adequate support and intervention.

General Public health interventions and strategies

Since 1854, the application of evidence based public health interventions and strategies have helped to save millions of lives. Dr, john snow was the first to identify cholera outbreak emanating from public water wells in London (Kayode et al, 2021 p 205). These strategies included, vaccination, motor vehicle safety, control of infectious diseases, family planning, recognition of tobacco use as a health hazard and decline in deaths from coronary heart diseases and stroke. Preventive and responsive interventions include epidemiology and surveillance, outreach, screening, heath teaching, social marketing and policy development.

These strategies have saved lives and improved care provision in the UK at large. The passage of seat belt laws was advocated for by the public health intervention strategy that centred on motor vehicle safety. There was a 90% adherence to this laws which helped in saving more than 15,000 lives each year according to the national highway traffic safety administration (NHTSA) statistics (Bunchanan, 2019 p 77). Outbreaks of small pox and paralytic polio were completely wiped-out. The general achievements in public health issues have made working environments safer.

Cardiovascular complications were the leading causes of deaths in the Northern Ireland, however, public health intervention strategy such as healthier foods and early diagnosis programs have led to drastic reductions in these deaths. According to Centre for Disease Control and Prevention (CDC), there has been a decline of 60% in age adjusted deaths for cardiovascular patients since the adoption of health intervention strategies (Walsh and Leva, 2019 p 402).

Epidemiology and surveillance is a general intervention in public health that focuses on causes and distribution of infectious diseases and how to prevent them from spreading. Diseases are monitored by physicians, nurses or public policy makers and research from health epidemiologists has impacted on responses to substance abuse and bioterrorism (Cailes et al, 2018). Outreach programs have helped to identify populations that are at risk and have provided possible solutions to health care. It aids in recognition of health risk factors as well as asymptomatic diseases, which is important as patients can begin early treatment.

Health teaching interventions have helped to disseminate ideas, skills and facts that have changes the attitudes, behaviours, beliefs and community practices. They can be conducted in hospitals, schools or community health care centres (Thompson et al, 2018 p 5). Education facilitates understanding of health risks and relevant concerns in care provision. In an effort to promote health care practices to the community and workplace, social marketing is used. By analysing of similar policies, development of partnership and promoting and implementing evidence based health interventions, public health professionals have played a role in policy making process.

Interventions and strategies for the selected illnesses

Given appropriate health and social policies, these health inequalities can be tackled without difficulty by application of different interventions and strategies. Multi-stakeholder approach involving the government, community groups ranging from local to a global scale may help to solve the differences (Walsh and Leva, 2019 p 407). These inequalities have risen as a result of resource allocation in different health care sectors. Evidence based public health interventions over time have helped to save millions of lives as they play a fundamental role in enhance longevity and overall health in the community.

In addressing the issue of mental illness in Northern Ireland, families, social services, institutions and communities have been involved at large. Multi sectoral and community based mental health have helped to address the health inequalities that had previously recorded massive deaths in the past years (Graham et al, 2020). The chronic care model has its roots embedded in the collaborative care models for management of chronic illnesses. It has involved the combined efforts of health care systems and the community resources to aid in mental care support.

An initiative in Northern Ireland early intervention strategy which was focused on decreasing the duration of untreated psychosis resulted in an increase in the number of community referrals. In a research conducted by Castillo et al (2019), on community involvement in early interventions suggests that adaptive community treatment is an evidence based service delivery model that has helped to solve the mental health inequalities observed (Castillo et al, 2019).

According to the NICE guidelines, all patients that have been admitted to acute hospitals should be screened for alcohol use disorder. In Northern Ireland, brief intervention strategies such as brief advice have been used to reduce the observable health inequalities in alcohol abuse (NICE, 2018). Members of staff working at these acute hospitals have been delegated with the responsibility of briefly advising these patients on the negative impacts of alcoholism. Other extended brief interventions are delivered by the substance misuse liaison nurse (SMLN), which are located in all hospital trusts in Northern Ireland.

The current diabetes strategic framework in Northern Ireland has set out a direction for local diabetes care until 2027. The development of quality care along these guidelines has been able to provide better support to in the management of type 2 diabetes (Legisetty et al, 2017 p 71). This has helped to regulate the significant complications providing these patients with better quality lives. It has been proven that 75% of the local diabetes patient in the UK were treated using the best care practice, which significantly reduced the observable health inequalities (Galaviz et al, 2018). In Northern Ireland, population based screening is considered a significant aspect in public health intervention. Screening is the most fundamental intervention in diagnosis mental health, alcoholism and diabetes. Through screening, there is detection of asymptomatic diseases and the associated health risks. Early detection of these illnesses is important to patients as they may begin an early treatment plan before the disease further ad verses.

The role of statutory bodies in developing health protective strategies

Local authorities and public health faculty in Northern Ireland have played a significant role in the development and implementation of public health protective strategies and interventions. Health protection includes infectious diseases as well as environmental hazards and contamination (Jawoniyi et al, 20180. The responsibility to protect the health of these populations was transferred to the secretary of state for health from the health protection agencies in April, 2013. Some specific powers such as giving of information and advice on health protection were also delegated to the local state which was only limited to their locality.

Provision of specialist health protection functions was transferred from health protection agency to the public health faculty of Northern Ireland (King et al, 2017 p 47). The director of public health, will on behalf of the local authority prepare and lead these local authorities in their line of duty. Incidences that may present themselves as threats public health are handles by the local authority under the supervision of the director. Districts are in charge of environmental health protection within their local vicinity and reports to the director of public health. The Health and well-being Board ensures that all the leaders of these statutory bodies are working towards improving the general health as well as the well-being of individuals.

Challenges of effective intervention in public health

The main challenge of public health intervention programs is the cost. In most of the processing nations in the modern world, public intervention solutions are cost effective. in northern Ireland, the current diabetes strategic framework is local care based till 2027 (Graham et al, 2020). The nation is expected to incur higher expenditure costs of at least 4 billon sterling pounds during this period. The future cost burden is estimated to be even greater if this system fails in preventing type2 diabetes mellitus.

Additionally, there is increases pressure resulting from the ever rising number of diabetes patients in the world (Legisetty et al, 2017 p 76). As a result, health care professionals are under pressure as they strive to cope with these cases. Te current care model is estimated to become unsustainable before the designated time frame.

Northern Ireland had its own government; however the government structure was disassembled in January, 2017 (Galaviz et al, 2018). Absence of the government weighs heavily on mental health service. Most of the key development programs and projects such as suicide prevention strategy have been put o hold. Other strategies have remained unimplemented due to lack of leadership and the most hit strategy is the psychological workforce which has been under-resourced hence restricted access to patients.

Recommendation

On the basis of evidence on increased suicide due to mental health and well-being in Northern Ireland, adequate screening programs and timely provision of suicide specific interventions are recommended (Legisetty et al., 2017 p 77). It is important for all leaders to work together to address this issues and implement life protection strategies and delegate funds towards providing appropriate psychological therapies for patients in need (Graham et al., 2018). To address the issue of future monetary loss, additional upfront investments should be enforced. This will increase the availability of cash flow, and address important health public health intervention programs that are affected by inadequate resources.

Conclusion

Public health interventions are efforts that are geared towards promotion of specific behaviours and habits that can improve the emotional and physical well being of patients. There are different types of interventions and strategies which have been implemented in an effort to overcome the health inequalities that have been observed. This discussion focused on three public health issues in Northern Ireland which were mental health and well-being, alcohol use and diabetes which were among the most prevalent health issues in the region. Different statutory bodies have come together in public health by performing adjoined functions that have improved health care provision and the public general’s well-being. However, there have been various challenges that affect the implementation of public health intervention programs and projects by which suggested recommendations have been elaborated to ensure health care systems operate at maximum.

Bibliography

Buchanan, D.R., 2019. Public Health Interventions: Ethical Implications. The Oxford Handbook of Public Health Ethics, p.77.

Brunton, G., Thomas, J., O’Mara-Eves, A., Jamal, F., Oliver, S. and Kavanagh, J., 2017. Narratives of community engagement: a systematic review-derived conceptual framework for public health interventions. BMC Public Health, 17(1), pp.1-15.

Cailes, B., Kortsalioudaki, C., Buttery, J., Pattnayak, S., Greenough, A., Matthes, J., Russell, A.B., Kennea, N. and Heath, P.T., 2018. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Archives of Disease in Childhood-Fetal and Neonatal Edition, 103(6), pp.F547-F553.

Friedrich, B. and Mason, O.J., 2017. “What is the score?” A review of football-based public mental health interventions. Journal of public mental health.

Galaviz, K.I., Weber, M.B., Straus, A., Haw, J.S., Narayan, K.V. and Ali, M.K., 2018. Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care, 41(7), pp.1526-1534.

Graham, A.K., Lattie, E.G., Powell, B.J., Lyon, A.R., Smith, J.D., Schueller, S.M., Stadnick, N.A., Brown, C.H. and Mohr, D.C., 2020. Implementation strategies for digital mental health interventions in health care settings. American Psychologist, 75(8), p.1080.

Holmstrand, C., Bogren, M., Mattisson, C. and Brådvik, L., 2018. First and Subsequent Lifetime Alcoholism and Mental Disorders in Suicide Victims With Reference to a Community Sample—the Lundby Study 1947–1997. Frontiers in psychiatry, 9, p.173.

Jawoniyi, O., Gormley, K., McGleenan, E. and Noble, H.R., 2018. Organ donation and transplantation: awareness and roles of healthcare professionals—a systematic literature review. Journal of clinical nursing, 27(5-6), pp.e726-e738.

Johnson, J., Hall, L.H., Berzins, K., Baker, J., Melling, K. and Thompson, C., 2018. Mental healthcare staff well‐being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International journal of mental health nursing, 27(1), pp.20-32.

Kayode, O.R., Babatunde, O.A., Adekunle, O., Igbalajobi, M. and Abiodun, A.K., 2021. COVID-19 Vac-cine Hesitancy: Maximising the Extending Roles of Community Pharmacists in Nigeria in Driving Be-havioural Changes in Public Health Interventions. J Infect Dis Epidemiol, 7, p.205.

King, R., Tod, A. and Sanders, T., 2017. Development and regulation of advanced nurse practitioners in the UK and internationally. Nursing Standard, 32(14), pp.43-50.

Lagisetty, P.A., Priyadarshini, S., Terrell, S., Hamati, M., Landgraf, J., Chopra, V. and Heisler, M., 2017. Culturally targeted strategies for diabetes prevention in minority population: a systematic review and framework. The Diabetes Educator, 43(1), pp.54-77.

Morgan, E., Black, C.R., Abid, N., Cardwell, C.R., McCance, D.R. and Patterson, C.C., 2018. Mortality in type 1 diabetes diagnosed in childhood in Northern Ireland during 1989‐2012: A population‐based cohort study. Pediatric diabetes, 19(1), pp.166-170.gh

O'Neill, S. and Rooney, N., 2018. Mental health in Northern Ireland: An urgent situation. The Lancet Psychiatry, 5(12), pp.965-966.

Popham, R.E., 2019. Alcohol & Alcoholism. University of Toronto Press.

Pottie, K., Mayhew, A.D., Morton, R.L., Greenaway, C., Akl, E.A., Rahman, P., Zenner, D., Pareek, M., Tugwell, P., Welch, V. and Meerpohl, J., 2017. Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: A protocol for a suite of systematic reviews for public health and health systems. BMJ open, 7(9), p.e014608.

Thomson, K., Hillier-Brown, F., Todd, A., McNamara, C., Huijts, T. and Bambra, C., 2018. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health, 18(1), pp.1-21.

Walsh, C. and Leva, M.C., 2019. A review of human factors and food safety in Ireland. Safety Science, 119, pp.399-411.