Cardiovascular Disease in UK Populace

Introduction:

This Essay will focus on public health policy on ‘cardiovascular disease’ (CVD), will address the clinical issue cardiovascular disease among the populace residing at the United Kingdom. It will also identify and critically discuss about the policy documents and the relevant approaches to health promotion mentioned within the identified policy initiatives of international, national and local sources to encounter the above mentioned issue.

Cardiovascular disease

Cardiovascular disease is a major health problem that troubles health care professionals and policy makers, and therefore it is a public health challenge, for a number of years, been high on the health agendas of the government around the world. The cardiovascular related diseases that include coronary heart diseases and stroke are the most common non-communicable disease throughout the globe (WHO, 2017). Cardiovascular diseases (CVD) refers to the disease of the heart and due to improper circulation , that results in the development of varied clinical condition for instance coronary disease, angina, heart attack, hypertension, stroke, congenital heart disease and vascular dementia. According to (Stanner, et al, 2005) cardiovascular disease (CVD) is refer to disease of arteries supplying blood to the muscle of the heart (coronary heart disease,) the brain (cerebrovascular disease) Leg (peripheral vascular disease, heart failure). This might be due to the condition of atherosclerosis (deposition of lipid substances along the walls of artery) and thrombosis (blood clotting). The coronary heart disease (CHD) is also a major cause of illness and disability, including angina and heart attacks. This occurs when coronary arteries become narrowed by a build-up fibrous fatty material. The pain that develops due to the clinical pathophysiology of the condition such as narrowing of the artery is called angina and with the occurrence of a blockage it can eventually lead to a heart attack (WHO, 2016). British heart foundation (BHF, 2018) expressed that after heart attack, heart failure can occur when the heart is not pumping blood in a regular fashion throughout the body as it should be due the damaging of the heart muscle because of the absence of oxygenated blood supply to the muscles.

Prevalence

The UK demonstrates the highest mortality rates from CVD in the world, with more than one in three people dying from the disease (BHF, 2020) and around 7.4 million people living with heart and circulatory diseases. Moreover, according to BHF, 2020 heart and circulatory diseases caused more than 27 per cent of the deaths among the ageing and growing population in the UK which represents 170,000 deaths each year.

Risk Factors

The rapid growth of urbanization, to seek better quality of life health services and education, have contributed to adoption of unhealthy lifestyles in our personal and professional settings (World Heart Federation, 2017). Constant exposure of common people to polluting gases for instance ammonia, carbon monoxide due to heavy traffic flow are significantly associated with the increase of CVD in the urban areas. According to WHO, 2019 estimated 4.2 million deaths every year as a result of exposure to air pollution. The other identified risk factors for CVD includes smoking, high cholesterol, high blood pressure, unhealthy diet, uncontrolled drinking and physical inactivity. It is also linked with environment and social factors, such as pollution and financial inequalities (PHE, 2017). It is estimated that nearly 44,000 deaths occurs due to heart and circulatory diseases each year among people within 75 years in the UK (BNF, 2020). However, there is a reduction in the annual death rate among people of the UK due to CVD since BHF was established 1961, by around a half that indicates towards the major steps that had been taken to manage CVD, which includes lifestyle modifications and clinical treatment management plan, the later one, have played an important role in this progressive declination (Frayn, 2005). However, the treatment of CVD by pharmacological or medical intervention costs billions to health care systems of the UK. The (British Heart Foundation, 2003a), estimated that the cost of prescriptions, for lipid lowering drugs and stains is about £440 million. Therefore, the government is taking measure to tackle the disease, by encouraging changes to diet and lifestyle which can prevent CVD and this will exclude the side effects associated with surgery and drug therapy (Stanner, et al, 2005).

Policy documents from international, national and local sources that tackle this issue

While identifying and discussing the policy documents of national and international aspects to tackle CVD issue it was found that billions of money are spent due to escalating cost of health care because of the underlying pathology of atherosclerosis (WHO, 2002), acute coronary and cerebrovascular events. The WHO, 2007 believe that a significant proportion of this morbidity and mortality could be prevented through population based strategies, by up taking cost-effective interventions which will be accessible and affordable, both for people with established condition and at high risk of developing the disease . To address the rising clinical issue, in May, 2000 the 53rd World Health assembly adopted the WHO global Strategy with an aim to prevent and control the CVD. With this approach, WHO placed the disease on the global public health agenda and had strengthened its efforts to promote population-wide primary prevention of the diseases, through the Frame work Convention. The frame work comprises strategy on tobacco consumption cessation, the Global strategy for Diet, physical activity and health, targeting the risk factors that contribute to CVD. The aim was to make it easy for healthy people to remain healthy, and for those with CVD or at high risk of CVD to modify their behavioural and, lifestyle orientation and prophylactic drug therapies. The WHO, 2003 guidelines provided a frame work for the development of national guidance on prevention of CVD that took into account the political, economic, social and medical circumstances.

The policy documents include part 1 to part 3 within the WHO 2003 guidelines:

Part one discussed about the assessment of risk and the preventive approach to CVD. The guideline addressed the high -risk groups, like people who had suffered a myocardial infarction, transient, ischemic attack or stroke in past. Complementary strategies for the prevention and control of cardiovascular disease and the threshold interventions are routine monitoring of blood pressure, WHO/ISH risk prediction charts and its strengths and limitation, clinical assessment tools for CVD risk, medical history with physical examination. The part two of the guideline includes the following recommendations for preventions of CVD for instance the level of evidence and grades which are recommended, for example in the clinical trials, smoking cessation trials, dietary changes interventions, interventions related to physical activities for weight control or maintenance, policy regarding alcohol consumption, the use of anti-hypertensive drugs, Lipid -lowering drugs (statins), hypoglycaemic drugs, anti-platelet drugs (WHO, 2003). Part three of the guideline, discussed about the basis for recommendations depending on the best available evidences. The discussion was based on evidence on the following topics such as modification of behaviour for improvement of lifestyle for instance reduction or abstinence of cigarette smoking, maintenance of body weight, blood pressure, blood level of cholesterol and glucose . WHO, 2007 updated the collative effort which was provided within the above policy documents guidelines for assessment and management of CVD and its associated risk factors.

Identification and discussion of the national policy documents:

CVD affected around seven million people in the United Kingdom (UK) and is one of the leading causes of disability and death (PHE, 2017-2018). CVD is responsible for one out of four premature deaths in the U K and over 26% of all death throughout England. Due to the serious impact on mortality and morbidity rates, communication on action related to CVD had become the priority of National Health Service and these includes the following documents such as NHS Check programme, which is a health check-up regimen for adults in England aged in between 40 to 74. PHE Academic Health Science Network and NHS 111 also published in the year, 2014 to provide assistance by answering question related to CVD and its associated risk factors via phone.

Saving Lives

Our Healthier Nation was published by the UK Government, Department of Health (DH) in the year 1998, with an aim to address the underlying causes for the health, disease and the inequalities observed in health. The Health Action Zone is another policy document intervention, and another strategy to promote working between local health and social services and tackling the health inequalities. The policy discussed about a variety of activities, such as tacking the root causes of inequalities through regeneration, access to lifestyles behaviours promoting health, employment and education within a community and empowering through information and proper education. The NHS five year forward views helped the local partners to engage and influence the action taken on CVD. The varied Health Improvement Programmes, Public Health Observatories , and Health Development Agency , are all policy documents set up to provide an outstanding opportunity to improve the health of public. NHS, England had initiated varied polices such as NHS long term on CVD to be referred as clinical priority. It had also developed the national CVD prevention programme to formulate customised interventions on risk factors and treatment management plan. They had initiated cardiac rehabilitations and also recently in the year 2019 the GP contract was published as the initial step to implement the long term plan (NHS Digital, 2020).

Identification and discussion of the local policy documents:

The PHE professional resource on Health Matters: Preventing Cardiovascular Disease highlighted about the goals of the Cardiovascular Disease Prevention System Leadership Forum and this and it insisted the local authorities to take part to fulfil their missions (PHE, 2020). The health check intervention of NHS published in 2009 and the kings Health partners (KHP) , Our Vision are all policy documentation that has helped to bring excellence by the local services, with the aid of educating and research and in turn reduced the number of cases of CVD. The Global burden of disease study, (DH, 2013-16) had demonstrated that the UK did not perform well when compared to other countries in term of mortality and disability. The DH, 2013 stated that the there were a lot required to be done concerning CVD, so the department of Health call to action to the health and care system was implemented. The purpose is to provide advice to local authority, NHS commissioners and providers about the taken action in relation to CVD that will assist to deliver care, and believe that improving the outcome will help reduce the mortality and improve the people quality of life. The policy initiative was to tackle and improve the outcomes and reducing health inequalities involve wide range of different organisations, like the Department of Health, the NHS, Public health England and local authorities. To guide the local authorities and NHS commissioners and providers, ten key actions was identified to deliver improvements concerning the patient outcomes which will be cost effective (DH, 2013). The improvement body in the NHS Commissioning Board, NHS improvement Quality are all working together to manage CVD as a family disease approach in the community and hospital. The group developed a tested standardised template that can be used in hospitals and the community; it was incorporated into services specifications, to assess patients fully with CVD problems. On this note, It is argued that more people could live longer and with a better quality of life, if they were supported to adopt healthy lifestyles, particularly cessation of smoking, with healthy diet and being more physically active. (Patel, 2009) stated that risks factors are clustered more in disadvantaged groups of the population. The improvement body believed that making progress in tackling these issues related to CVD will be responsible to Local authorities, and data of prevalence of unhealthy behaviours should be updated to the government in other to tackle CVD.

The NHS Health Check Programme is considered to be one of the potential step to prevent CVD through early identification and management of risk factors, which might reduce the disability and surviving rates, and NHS health uptake programme is another policy initiative . It enabled the general practitioners (GP) and other primary Care staff to identify those patients at risk. Tackling CVD, PHE will continue to improve acute care services, working together with the Resuscitation Council, the British Heart Foundation to promote external defibrillators (AED) to increase training in cardiopulmonary resuscitation (CPR) by using AEDS. PHE provides awareness of the signs and symptoms of CVD by promoting campaigns such as ACT FAST which was on stroke management, during emergency and new campaigns too. Policy initiatives to gear the tackling of these issues should include full cardiovascular assessment, educating about self- support management, psychological support, for appropriate physical activity, rehabilitation or programmes. DH, 2013 stated that several excellent audits had provided good aspects on CVD for example heart attack, and stroke. The government has a number of programmes in action which has helped to reduce CVD. , The Change for Life and other social marketing campaigns are also encouraging individuals to make simple changes to their lifestyles to improve health. The National Child Measurement programme (NCMP) also helped to tackle child obesity both at local and national setting. The policy initiatives and responsibilities used had proved out in line with the NHS, public Health and Adult and social Care Outcomes frameworks.

Discussing and Critiquing how relevant approaches, to health promotion are interpreted within the identified policy initiatives

Health is product of social, biological and environmental factors (Naidoo and Wills, 2016) it also noted that improved sanitation and better nutrition , raising good wages also contributed for reduction in mortality. DH, 2013 stated that lifestyle , behavioural risk factors and choices for example smoking, physical inactivity, poor diet, obesity and harmful use of alcohol is also an individual choice, although health workers are promoting health and enabling people to take greater control over their own health. Department of Health, 2013 stated that one of the major factors preventing holistic approach in treating patients with co-morbidities is lack of integrated information. Government has a number of programmes in action which will help to prevent CVD, but there are certain barriers to get access to those programmes, such as language barrier, education, depression or poor mental health. The local Authorities understand the scale of the challenge and are prioritising their action to improve awareness of CVD risk factor. The NHS Health Check programme was implemented in 2009 and is offering routine check up of health every year to reduce CVD cases. According to Next Steps Guidance for primary care Trust, 2008 it was estimated that 2.2 million NHS Health Checks were offered on CVD and 1.1 million were received. Tackling geographical variation could potentially save more lives for patient with CVD by optimising and accelerating treatment pathways, many people is from rural background and lack care services, and they migrate from rural areas and settle in urban zones to seek better quality of life and access to health services (World Heart Federation, 2012). All CVD patients should have access to recognised right treatment which includes special teams and 24/7 services where appropriate. NICE, 2010 provide evidence for what is being referred as right treatment. According to NICE, all patients with cardiovascular conditions whether immediate life threatening or not, deserve information about their specific condition and how the disease is developing, there should be care plan, for anyone with a long term condition. Provided with advice on the following information they can reduce their risk of developing further CVD. The psychological and practical support should be offered where it is necessary. Access to rehabilitation programmes will beneficial to the people living with CVD, (DH, 2013) many patients are not receiving all that aspect of care listed above, the CVD and their carers said that they felt abandoned after the acute treatment of the debilitating condition. They did not receive the relevant information, to live for example self-management.

Evidence suggested that black minority ethnic BME groups are more likely to develop CVD than other population in the UK (British Heart Foundation, 2017) due to lack of physical activities, poor diet, toxic environments, use of harmful substances such as tobacco and alcohol. It stated that, BME groups are worst affected with respect to mental health condition as they are exposed to high stress levels. According to Word Heart Federation, 2017 high levels of stress can lead to the development of CVD. The proportion of the population in Lambeth comprising of black and minority ethnic groups is estimated to be 42.9% Black people have the highest stroke mortality rate (Department of communities and local Government, DCLG, 2011) The public health outcomes frame has an objective of people living with preventable ill health and people dying prematurely, while reducing the gap between communities. The 2009-11 CVD mortality rate in London Borough of Lambeth for all persons was 164.3 per 100,000. This was high in comparison to England (155.6) and significantly higher than London (151.30) (DCLG, 2011). Male CVD mortality rates in Lambeth are significantly higher than female CVD mortality rates, (205.1 men and 128.5 for female respectively). The fact that men are more affected than women may be due to the reluctance of men not seeking health services, not visiting their general practitioner (GP), resulting to late diagnosis. Evidence highlights health inequalities among BME groups suffers more deaths, poverty is directly related to lack of capacity to afford health food. Department of communities and local Government ( DCLG, 2011) stated that deprivation and poverty among this group together with higher stress levels and smoking behaviour can increase the likelihood of premature death due to CVD. This magnitude amount of money is putting burden on the tax payer and enormous strain in NHS. Following this issues, NHS health check was introduced in 2009 to tackle this problem. The check includes life style risk factors such as smoking and alcohol, physical inactivity, physical risk factors, like blood pressure check, blood sugar and cholesterol check., all are above are known risk factors which contributed to CVD, which the aim is to prevent the disease.

Current evidence regarding the impact of this intervention is a subject of much debate NHS health checks, 2015 For example Nordic Cochrane Centre, 2016 claimed that it is a waste of resources and should be discouraged, it offers very minimal benefits they believe that poor review could be because doctors already detect high-risk patient in their daily practice, and those people might not come forward. Also said that patient might be over diagnosed and might be receiving unnecessary treatment for the conditions that would not have cause problem.

Conclusion

The present assignment had discussed about the clinical issue of cardiovascular diseases among the populace of the UK. The varied international, national and local polices had been reviewed and discussed. The trigger factors for CVD were identified and policies in regard to those factors till date were also discussed within the assignment.

References

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