INEQUALITIES IN HEALTH

Introduction

Health inequality is referred to the difference between health status or distribution of health determinants between different socio-economic groups in the population. In the UK, smoking is vital health equality present among the population which is evident as increased smoking prevalence among the deprived social groups is seen who are experiencing deteriorated health condition compared to the middle class and the rich individuals. Moreover, it is found that in the UK the death rates are two or three times higher among the people of the disadvantaged group compared to others (cancerresearchuk.org, 2018). Thus, in this assignment, the health inequalities regarding smoking in the UK are to be discussed to determine the extent to which the inequality is present and the factors influencing the inequalities. The policies and interventions for addressing health inequalities regarding smoking in the UK are also to be explained. Moreover, critical reflection regarding the topic is to be discussed.

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Health Inequalities related to smoking in the UK

The statistics in the UK regarding smoking informs that men and women from the deprived areas are twice likely to suffer from lung cancer and respiratory diseases compared to the rich people and individuals living in the least deprived areas as a result of smoking (ons.gov.uk, 2018). This informs that people from the lower socio-economic classes in the UK are more prevalent to face deteriorated health consequences due to smoking compared to the people of the higher classes. According to the reports collected in 2017, it was mentioned that increased number of people from ethnic communities are involved in smoking in Great Britain compared to white individuals. This is evident from the statistics which indicates 23% of men from mixed ethnic communities, 23% men from other ethnic communities, 16% Asian men, 12% Chinese men and 15% Black men are involved in smoking compared to only 17% white men showing involvement in smoking tobacco in the UK (ash.org.uk, 2019). Moreover, increased number of ethnic women is found to be more involved in smoking compared to white women in the UK. It is evident as 19% of women from mixed ethnic communities smoke compared to 14% of white women (ash.org.uk, 2019). In the UK, health inequality regarding smoking prevalence is also existent as per age of the individuals. In 2017, in the UK it is reported that adults who are between 25 and 34 years of age represent 19% of the total smoker population in the country representing the highest among all age groups. However, 8% people above 65 years in the UK are found to be involved in smoking indicating they are the least likely people of age to get involved in smoking (ons.gov.uk, 2019). Thus, it indicates that the younger population in the UK are more involved in smoking compared to the older population. In regard to gender, the UK statistics from 2017 shows that 16.4% of men are found to be involved in smoking compared to 12.6% women from the population (digital.nhs.uk, 2019). Moreover, mortality rate among the men in the UK due to smoking is found to be 20% whereas among the women is 12% (ash.org.uk, 2018). This indicates that men in the UK are more prevalent to get involved in smoking compared to women and men are more vulnerable to face deteriorated and fatal health consequences as a result of smoking compared to women. The smoking prevalence inequality is also found to be existent in the UK based on marital status of the people. This is evident as 9% of the adults who are married are found to be involved in smoking whereas the smoking prevalence among people who are single, divorced, separated, widowed or cohabiting is found to be between 16-21% (digital.nhs.uk, 2019). This indicates that married people are least likely to get involved in smoking compared to people who are in unstable marital status or living without any partners. On the basis of employment status, it is found that 29% of the unemployed population in the UK are involved in smoking compared to only 15% of the employed individuals and 12% of the inactive individuals (digital.nhs.uk, 2019).

Factors affecting health inequalities regarding smoking in the UK

In the study by Kaufman et al. (2016), it is mentioned that people from multi-ethnic and black communities in the UK suffer from negative psychological conditions such as lack of identity, ambiguity and lack of normal reception in the society. This is because they are found regarded not to fit the proper categories of white individuals and their communities. It leads the ethnic individuals to face isolation and alienation in the society making them develop increased stress and anxiety along with failure to progress in life. This makes them develop substance abuse such as smoking to get relief and overcome psychological distress being suffered due to inappropriate treatment in society (Keith et al. 2016). As criticised by Tabb et al. (2020), smoking is regarded in few ethnic communities as the way to develop social communication. This indicates that the customs among the ethnic communities regarding smoking makes the individuals show greater prevalence regarding substance abuse. The men are found to be involved in smoking because they try to use tobacco as the way to overcome their deteriorated emotions and frustrations in life (McNeill and Robson, 2018). The fact is evident as nicotine present in the tobacco is found to provide sense of relaxation to the brain along with lower anxiety and stress by promoting the release of dopamine which the hormone released to happiness feeling among individuals (Srinivasan et al. 2016). The women are found to be involved in smoking because they try to overcome stress and anxiety regarding family management, hindered relationship with the spouse during divorce, loneliness and others (Liu et al. 2017). In the study by Hult et al. (2018), it is mentioned that unemployed people are more involved in smoking activities compared to employed individuals to cope psychological distress out of unstable future. This is evident as unemployed people experience depression, stress and anxiety regarding their ability to develop proper status and have finances to support their and family needs at the present as well as in future. The young people are more likely to smoke tobacco due to varied reason such as peer influence, experimentation, stress and others. The study by Rozi et al. (2016) informs that influence from peers and friends makes young people involved in smoking. This is because they avoid being humiliated in society and get accepted among the groups in the society the young people initiate to smoke. The peers also influence young people to smoke for experimentation mentioning they are not going to develop addiction which later makes the young people avoid having intention to quit smoking (Idris et al. 2016). The young people mention they are involved in smoking to overcome stress and anxiety regarding their unstable future, hindered career development, pressure from academics and others (Idris et al. 2016). (Refer to Appendix 1)

Policies/ Interventions to address health inequalities regarding smoking in the UK

to achieve effective smoking cessation through current intervention as they inform thIn order to address the health inequalities regarding smoking in the UK, various intervention and policies are developed. For instance, the QUIT Youth Program has been developed in the UK who delivers assistance to different Local Councils and youths in the UK to make them develop informed choices regarding smoking. The program also delivers support services for smoking cessation to the young people from 8-18 years in the UK to help them avoid the habit. The program is found to be quite successful as by 2019 it has mentioned offering their services to more than 1 million youths in the UK to help them avoid smoking (quit.org, 2020). Thus, it informs that the program is successful to some extent to provide services to young adults in the UK to quit smoking. The National Centre for Smoking Cessation and Training (NCSCT) is developed in the UK which is a social enterprise that supports providing proper evidence-based tobacco programs at the local and national level by offering training to the service providers and delivering support services in establishing local and national campaigns to create smoking cessation among individuals (ncsct.co.uk, 2018). This indicates that the NCSCT acts as the statutory body to take active parts in promoting skills of service providers and health professionals to ensure the common people are involved in the smoking cessation program to develop change in their behaviour to quit smoking. A Tobacco Control Plan has been developed by the NHS England which has the key objectives to lower 15-year-old individuals and above who regularly smoke from 8% to 3% or less, lower smoking prevalence among adults to 12% or less from the current rate of 15.5% and lower prevalence rate of 10.7% to 6% or further lower figures among the women who are involved in pregnancy. The plan aims to achieve the objectives by 2022 (gov.uk, 2018). This indicates that effective tobacco control plan has been developed by the UK government to overcome increased prevalence of tobacco smoking among the youth and adults in the UK. The National Health Services (NHS) in the UK is seen to have developed a free helpline number allowed to be accessed by all individuals to gain support for smoking cessation services. In addition, NHS is found to develop smoking cessation programs and policies through which they deliver non-discriminative care to all individuals to quit smoking. The NHS provides recommendation of using nicotine replacement therapy along with other nature of medication to be used for smoking cessation (NHS.UK, 2019). This indicates that the NHS is performing effective development of care services and assistance to ensure all the individuals in the UK can overcome smoking activities with their assistance. However, irrespective of the present wide number of interventions and programs for smoking cessation in the UK yet no considerable reduction in inequalities regarding smoking in the country is seen. This is because smokers from deprived communities report that even though they can access smoking cessation services but due to lack of effective support and finances they are unsuccessful in their attempt to quit smoking compared to affluent people (ash.org.uk, 2019). Moreover, the people from lower socio-economic communities and unemployed people in the UK report failureat the key factors influencing their habits are not resolved to make them unable to cease smoking (cancerresearchuk.org, 2018).

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Critical Reflection on the topic

The critical reflection regarding the topic is to be presented by following Rolfe's reflective cycle. The Rolfe's reflective cycle includes three steps which are what?, So What? and Now What? (Scates and Dening, 2018The benefit of using Rolfe's reflection mode is that it allows presenting information with clarity and simplicity allowing effective information of the strength and weakness in experience being faced to be shared easily (Porter et al. 2018).

What?

Previously, I had the concept that employed people are the key smokers. This is because employed people are seen required to deal with increased stress at work due to which they use tobacco smoking as recreation to overcome the anxiety and negative emotions (Chamik et al. 2018). However, researching the topic led me to understand that unemployed people are more vulnerable to develop smoking addiction. This is because it is reported they have greater stress of financial instability, career development, family management and others (Hult et al. 2018). The research led me understand that most of the young people in the UK are unable to neglect peer influence due to which they develop zeal to smoke. My previous belief was that people in ethnic communities develop smoking as they feel it is the way they can showcase their personality. However, researching the topic led me to understand that increased bullying and lower respect of the people in the ethnic communities by others are the key reason which initially influences them to develop smoking. This is because nicotine in the smoke is seen to act as mood enhancers for individuals due to its ability to promote dopamine secretion that is the happy hormone (Srinivasan et al. 2016). The research led me to understand that people of the poor and deprived class in the UK are one of the vulnerable groups to be affected by risks related to smoking. I have identified that there are many health policies and programs within the UK to support smoking cessation and allow people to overcome smoking. However, researching the topic led me understand that lack of reach to the services and polices by people is the reason behind they not being able to effectively reduce smoking prevalence. Moreover, from the research, there was hardly any information available that was taken to resolve issues such as unemployment, mental health and others for reducing smoking prevalence. The execution of the module has influenced me to think that I have effective ability to research information and effective critical ability to analyse them for developing ideas regarding the way facts are to be presented. This is evident as while presentation of facts in each case I have provided effective explanation regarding what it means and way it influences the content presented in the topic. However, in the module, I perceived that I lack effective communication ability. This is because I barely discussed the topic with my tutor or my friends. The execution of the module influenced my thought of trying to execute teamwork in gathering information but was unable to do it due to the development of conflicts with other members.

So What?

The experiences have influenced my thoughts that mental health issue of stress, anxiety, depression and others are key instigators among various classes of people to develop intention to smoking. This is because stress regarding lack of job, financial management and others are found to be key issues influence people of deprived and least deprived class to smoke (Jiang et al., 2018). Moreover, my values to show respect towards people in the ethnic communities has been further rose after I understood how discriminating is mentally affecting them engage in smoking. The research has led me to feel that effective approach as shown is not been taken through the smoking cessation programs of the UK government for deprived classes due to which they are suffering from increased impact and prevalence of smoking. I also felt that there was lack of effective social steps to resolve inequality factors contributing to smoking prevalence in the UK. The experience led me to feel that no all individuals are equally able to overcome peer pressure for smoking due to which many youths may be facing addiction tobacco. The lack of effective communication ability in the module led me to be unable to gather more diverse information that could have improved the presentation of the findings. The lack of ability to teamwork led me unable to include diverse ideas regarding the way the topic could be presented in further enriched manner.

Now What?

On the basis of the research, I have deduced that effective mental health intervention in the smoking cessation program is to be included so that the psychological issues which are root cause to influence smoking are resolved. This would ensure better health of the individuals and reduce inequality regarding smoking in society. Moreover, effective actions are to be taken by the UK government to resolve social inequality, unemployment and financial issues as they are contributing to raise inequality regarding smoking. It is suggested that current smoking cessation policies and programs are to be made more powerful and stringent so that it reaches to all nature of individuals mainly the deprived class so that smoking cessation can be achieved in holistic manner in the UK. Further, I would access training regarding communication establishment and gain team working skills so that in next phase I can provide a more enriched study with better researched information through extensive communication and shared ideas from team involvement.

Conclusion

The above discussion informs that smoking is key health issues in the UK and men compared to women are found to be more vulnerable and people of the deprived class are found to be at increased risk to get affected by smoking. The issues such as stress, depression, bully, peer pressure, unemployment and others are contributing to the health inequality in the UK for smoking. The QUIT Youth Program, Tobacco Control Plan, NHS Smoking Cessation Program and others are present to lower smoking incidence in the UK but their ineffective promotion strategies have made it unable to create effective smoking cessation and lowering of smoking tobacco incidences in the UK.

References

ash.org.uk 2018, Smoking statistics, Available at: https://ash.org.uk/wp-content/uploads/2019/06/Smoking-Statistics-ASH-fact-sheet-November-2018-v2.pdf [Accessed on: 4th April, 2020] ash.org.uk 2019, STOP SMOKING SERVICES AND TOBACCO CONTROL IN ENGLAND, Available at: https://ash.org.uk/wp-content/uploads/2019/03/2019-LA-Survey-Report.pdf [Accessed on: 4th April, 2020] ash.org.uk 2019, Tobacco and Ethnic Minorities, Available at: https://ash.org.uk/wp-content/uploads/2019/08/ASH-Factsheet_Ethnic-Minorities-Final-Final.pdf [Accessed on: 4th April, 2020] cancerresearchuk.org 2018, STOP SMOKING INEQUALITIES, Available at: https://www.cancerresearchuk.org/sites/default/files/stop_smoking_inequalities_2018.pdf [Accessed on: 4th April, 2020] Chamik, T., Viswanathan, B., Gedeon, J. and Bovet, P., 2018. Associations between psychological stress and smoking, drinking, obesity, and high blood pressure in an upper middle‐income country in the African region. 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Appendix

Appendix 1

Further studies led to identify that people in the UK who belong from the routine and manual socio-economic status are more involved in smoking compared to individuals who are at the managerial posts, unemployed or involved in immediate occupations. This is evident as 25% of the individuals involved in routine and manual work are found to be included in smoking activity compared to 10% of people who are at the managerial post (digital.nhs.uk, 2019). Thus, it indicates that people who belong from the lower socio-economic classes in the society are more involved in smoking compared to people of the higher class. However,


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