Health is “a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.” (World Health Organization, 1998). In accordance to the Public Health report, the health of people in Bolton in Greater Manchester is generally worse than the England average. (PHE,2017). The primary aim of this essay is to identify and discuss the factors, that determine the experience of health of the people in Bolton. Furthermore, the essay will be stressing on the factors that contribute to the health and wellbeing of the individual and Bolton as a community, as reported worse compared to England average; key factors which can hinder or be conducive to health; political, economic, social, cultural, environmental, behavioural factors (WHO 1986). It will also consider the relationship between nursing intervention and contributions to the health and wellbeing of the people in Bolton.
In Bolton, premature death, obesity, mental illness, lower life expectancy, depression, accident, teenage pregnancy, alcohol misuse, social isolation and eventually death are all identified as health problems, that come about in the combination of the health factors. Inequalities in health have been extensively researched and, there is evidence to support that the gap between the rich and the poor still exists in society. Life expectancy is 10.2 years lower for men and 10.4 years lower for women in the most deprived areas of Bolton than in the least deprived areas. (PHE, 2017). Marmot (2010) highlighted the lower social classes had the poorest health and identified social factors such as low income and deprivation as the root causes which affect health and well-being. Bolton is one of the 20% most deprived unitary authorities in England and about 25% (14,900) of children live in low income families. Life expectancy for both men and women is lower than the England average. Increased smoking levels were found to be more prevalent in this cohort. Bilton et al (2002) suggests the environment, individual lives in, can have an adverse effect on health in that it can influence patterns of behaviour. For example, families living in poor housing conditions, in poverty or in an environment away from a social support network can suffer psychological stress; which in turn can prompt coping behaviours such as tobacco smoking (Blackburn 1991, Denny & Earle 2005). Approximately one third of adults who regularly smoke have been diagnosed with a mental health condition. In addition, Cancer Research UK has stated around one fifth of cancer cases in Britain are connected to tobacco smoking (either direct or passive) and this includes a shocking 37,000 instances of lung cancer.
Estimates for Bolton suggest that 22% binge, 23% drink hazardously and 7% of the population drink harmfully. Bolton had the highest percentage self reporting hazardous drinking in Greater Manchester and had the fourth highest percentage reporting harmful drinking. Both were above the North-West averages. (Michael Burrows, Michela Morleo and Penny A. Cook, 2010). The rate of alcohol-related harm hospital stays is 709*, worse than the average for England. This represents 1,884 stays per year. The rate of self-harm hospital stays is 268*, worse than the average for England. This represents 765 stays per year. Data from the Trading Standards survey (of 14?17 year olds) show that Bolton had a higher percentage of young people reporting drinking once or more a week than Greater Manchester in 2009. Currently rates are the same as Greater Manchester (51 per 1000), though higher than the North West (46) and the national averages (40). Alcohol consumption is linked to unplanned pregnancy in young people (Bellis et al, 2009). There is an association between poor school performance, road traffic accident, sexually transmitted diseases and infections and risky drinking. In a Norwegian study, alcohol intoxication was linked with fewer hours spent on homework and poorer school grades (Wichstrom, 1998).
Bolton is higher than average for smoking attributable mortality compared to England average. Depression and mental illness is experienced by approximately 1 in 4 people in Bolton. Between 30 and 40 people take their own life in Bolton each year. Self-harm is a significant challenge and the cases of TB are on the rise. All these factors impact the lives of many more than those directly affected. (Wellbeing JSNA, BOLTON). Smoking has greater impact on people living with mental health. The negative effects of smoking are now widely recognised, with those who smoke regularly being at higher risk of developing breathing problems, heart disease and even cancer. Researchers at Action on Smoking and Health (ASH) have identified the consumption of tobacco-based products as being the primary contributing factor for people suffering with mental health issues living an average of 10 to 20 years less than the general population. Bolton has a higher rate of smoking -related deaths, due to heart disease, cancers, stroke and chronic obstructive pulmonary disease (COPD) and other cerebrovascular disease than the North West and England.
Cigarette smoking is the greatest single cause of illness and premature death in the UK. Smoking increases the risk of developing several other diseases. Many of these may not be fatal but they can cause years of unpleasant symptoms. (Dr Y Loomba,2015). Such as the Sexual and fertility problems. Smokers are more likely than non-smokers to have erection problems (impotence) or difficulty in maintaining an erection in middle life. This is thought to be due to smoking-related damage of the blood vessels to the penis. Fertility is reduced in smokers (both male and female). On average, women who smoke have a menopause nearly two years earlier than non-smokers. Smoking in pregnancy increases the risk of miscarriage and complications, including bleeding during pregnancy, detachment of the placenta, premature birth, and ectopic pregnancy. Babies born to women who smoke are on average 200 grams (8 oz) lighter than babies born to comparable non-smoking mothers. Premature and low-birth-weight babies are more prone to illness and infections, poorer growth, development and health of the child. On average, compared with children born to non-smokers, children born to smokers are smaller, have lower achievements in reading and maths and an increased risk of developing asthma and are more likely than average to become smokers themselves when older. Smoking during pregnancy increases by one-third the risk of stillbirth or death within the first week of life. (Bellis M, Morleo M, Tocque K, et al. (2009)
The contributions of nurses to the health and wellbeing of the people and the community at large cannot be compromised. Central to the improvement of health of the individual, families, groups and communities are health promotion and disease prevention activities. As a key member of the health care team, nurses have important role to play in promoting health in a wide range of settings, including schools, workplaces, hospitals and local communities, health centres and home calls, as well as at a broad societal level. People/patient/service users spend relatively small proportion of their total lifespan in direct contact with nurses, more than any other health care professionals. (WHO, 1998). Hence, according to IPSOS MORI (2008) nurses are the most respected and trusted health professional. An important component of health promotion is health education which aims to change behaviour by providing people with the knowledge and skills they require to make healthier decisions and enable them to fulfil their potential. Healthy Lives Healthy People (2010) highlight the vital role nurses play in the delivery of health promotion with specific attention on prevention at primary and secondary levels. Nurses have a wealth of skills and knowledge such as communications skills, keeping eye contact with patient, listening and reassurance in other to empower people to make lifestyle changes and choices. This encourages people to take charge of their own health and to increase feelings of personal autonomy (Christensen 2006). Smoking is one of the biggest threats to public health, therefore nurses are in a prime position to help people to quit by offering advice, reassurance, providing information and refer to smoking cessation services. Another critical role that nurses play in promoting health is to encourage members of the community to attend regular screenings and early detection diagnostic tests (Blais& Hayes, 2011). The motivation helps in early detection of terminal illnesses such as cancer before reaching life threatening level.
In this essay, it has been shown that the health of Bolton is generally worse than the England average. And factors such as the environment, culture, economic and social status all contribute to the health problems, choices and lifestyles of the people in Bolton, such as alcohol, drugs, smoking, obesity contribute to the high rate of morbidity and mortality. It went further to emphasize the significant roles nurses, rather than other health professionals play in the intervention and promotion of health in Bolton.