Cardiovascular disease is a term used to describe a large group of diseases that all have common risk factors and this term covers conditions such as chronic kidney disease, vascular dementia and Heart failure. (Gov.uk) Because of the vastness of the subject this essay will focus on the topic of health promotion in heart disease.
Heart disease can have a major impact on the long term health of any individual person as this can often lead on to other related conditions developing. (British Heart Foundation) Because of the increased stress on finance and the increased loss of life the department of health put a plan together to help promote awareness and the importance of keeping your heart healthy. Over the last ten years or so there has been a marked decrease in the number of people dying from cardiovascular disease in 2004 there was 70,000 deaths reported to be linked to chronic heart disease however in 2011 this number had fallen to 55,000 deaths. (British Heart Foundation). But despite this decrease cardiovascular and heart disease is still responsible for around a third of all reported deaths each year. (British Heart Foundation).
Correct nutrition and exercises play an important role in staying healthy and keeping your heart working and a poor diet and lack of exercise can lead on to conditions such as obesity and diabetes, this in turn may lead to an increased risk of developing Cardiovascular disease or exacerbating a preexisting heart condition.
The aim of this essay is to focus on how health promotion is planned and implemented and what factor influence its success, what local and national policies come in to play when prioritizing health promotion campaigns. It will analyze all these factors and also focus on risk factors that can have an impact on Cardiovascular and coronary heart disease such as diet and exercise.
Until the last 20 years health promotion was more commonly known by the term health education, this term emphasised the structuring of learning experiences to facilitate a voluntary action conductive to health (Green et al.1980).
Some authors (Steckler et al 1995) consider both terms to be synonymous but distinguish between them thus health education is now seen as a facet of health promotion and as a whole is defined as, the combination of educational and environmental supports for actions and conditions of living conducive to health.(Green and Kreuter 1991). Health promotion is the process of increasing the functional capacity of all people hence promote the sense of well-being. Health promotion is in other words the process of enabling people to increase control over and improve their health” (World Health Organization). According to the Ottawa charters health is therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being. (World Health organization-Ottawa charter)
Health is defined as a state of physical, mental and social wellbeing and not merely the absence of disease or infirmity” (World Health Organization). The features of health promotion are that it is based on a holistic view of health; it uses participatory approaches it focuses on the determinants and addressing of health not just health problems and conditions. These include the social, behavioral, environmental and economic conditions that are the root cause of poor health, wellbeing and illness such as education, income, employment, working conditions, social status. Health promotion builds on existing strengths and assets and it uses multiple, complementary strategies to promote health for the individual, community and population level. These may include models such as the health belief model (G.M. Hochbaum, 1958) (Becker & Rosenstock, 1984) or the Stages of change (Trans theoretical model) ( Prochaska & DiClemente, 1983).
When planning a health promotion campaign it is useful to use an evaluation framework. This would take you from the planning stage, learning from other similar health campaigns what would be the best ways to address the needs of a targeted group of people. The design and pilot of the campaign using the theory of change (Weiss, 1972) how feasible is it, will it work and if so how, can it be adapted for other areas. Implementing and early start up, quality assurance, monitoring and reviewing, does anything need improving. This then follows with establishment, who will this have an impact on and how much, are the target group being reached. To the final stage of having a fully operational status, looking at outcomes and effectiveness how were they achieved and in which groups/settings are the greatest benefits shown.
Moving on from this we have the Dissemination stage, can the outcomes be replicated in other areas to achieve the same results. Morgan A (2006). Wimbush E & Watson J (2000).
For a number of years the British heart foundation has been a leading light in the battle against heart disease and produce some of the most hard hitting campaigns of all the leading charities, they are designed specifically to play on the emotions and fears of the population and have had a lot of success despite criticisms from people about some of their television commercials being too unnerving to show before the water shed however as these reactions prove they have had the affect intended as people are moved by them.
The British heart foundation also petition both the local and national government to change their plan on heart disease. In 2010 they petitioned for a new Government plan to tackle heart and circulatory disease in England. The old ten year plan for England (known as the National Service Framework) reached its tenth anniversary. The Westminster Government Then confirmed that there will be a new heart plan put in place to tackle heart and circulatory disease. In Wales the back the beat campaign is calling for a national strategy to prevent premature deaths by 25% by 2025, all Welsh pupils to have CPR and public access defibrillator (PAD) awareness training. And improved patient support through better integrated services. These are focused in 3 key areas, prevention, survival and support. Along with the help and support they give to other organization’s their research helps to develop strategies to target the most vulnerable people at risk of developing heart disease.
There are a number of government policies that affect health promotion campaigns and they all play an important role in the type, area and target population.
The many factors that affect the successful implementation of such programs are
national planning, political factors and capacity availability of data about the target population and intervention impacts, influence of socio-economic factors and special considerations regarding the age of target population, burden of the health problem to society, family and the individual, use of intervention in a multifactorial setting, communication strategies through media and school to reach vulnerable and minority groups and the willingness to engage at all levels of the society (from government to individual) in the process.(world health organisation).Where inequality exists both on a national and local level, government policy should have political support to ensure any interventions will be successful. Political support in terms of resources and public support for specific public health interventions are both crucial to their success.
One approach is to look at specific risk factors for a specific health outcome, for example, obesity, hypertension and lack of exercise, which give a greater risk of atherosclerosis and therefore higher risk of coronary heart disease, however this approach puts the onus of responsibility for change on the individual rather than on the government or on society as a whole, (Truett J, Cornfield J, Kannel W.)
The evidence suggests that promotion and prevention programmes aimed at influencing the underpinning influences on health are more successful than those aimed at dealing with the risk factors. (Spencer N. 2000).
In one case study, Tower hamlets in inner London ranked fourth in England for premature cardiovascular death. From 2009 onwards the NHS in that area spent two million per year on primary care to improve quality the introduction of the managed clinical networks was associated with moving from the bottom national quartile of performance to the top national quartile in three years across a range of outcomes. Improvements over 3 years included, a 10% increase in high blood pressure prescribing an improvement of 6% in reaching the target of less than 150/90mmHg for those on hypertension registers compared to less than 2% improvement in England overall, an 18% greater reduction in chronic heart disease (CHD) mortality 45% in Tower Hamlets versus 25% nationally Tower Hamlets was the highest ranked of the 221 CCGs in England in the 2013 to 2014 Quality and Outcome Framework for blood pressure control in people with coronary heart disease and diabetes. Improvement in Tower Hamlets took place at a faster rate than England, London, or comparable areas after the implementation of networks. This has shown a faster rate of decline in deaths from heart attack in the 3 years since 2008 than neighboring areas, London, or the national average with male mortality from CHD in Tower Hamlets was fourth highest in England in 2008. It reduced substantially more than any other area in the next 3 years: a reduction of 43% compared with an average of 25% for the top 10 PCT in 2008 ranked by mortality. (gov.uk). this shows that when the correct policy is put in place and resources are put to good use, any health authority can make a significant difference to people’s health.
In Wales the NHS have put together a plan to prevent heart disease, to improve early diagnosis and to provide fast and effective treatment, the heart disease delivery plan deals with, coronary heart disease, heart failure, arrhythmia management and atrial fibrillation, congenital heart disease in children and adults, inherited or idiopathic cardiac conditions including cardiomyopathies. Their plan will help health boards and their partners to, prevent heart disease for those most at risk, to quickly diagnose those with a heart condition, to provide fast and effective care and to help people live with their condition. Because of the implementation of this plan together for Wales have produced their second all Wales annual report on NHS heart disease this highlights the progress they have made the services they provide for those with heart disease and identifies areas for future improvement.
Previous reports have already been produced by health boards, setting out local progress against Together for Health Heart Disease Delivery Plan. This report provides a national overview. Taken together, the reports demonstrate their commitment in Wales to the improvement of cardiac services. This report states that in 2013, 4,363 people died from coronary heart disease (CHD) in Wales, this is almost 14% of all deaths that year. CHD is responsible for almost 17% of deaths in men and almost 11% of deaths in women . In recent years CHD death rates have been falling more slowly in younger age groups. In 2013, there were around 2,460 premature deaths (deaths before the age of 75) from cardiovascular disease (CVD) in Wales. This represents about 23% of all premature deaths in Wales and 19% in women. This shows that Cardio vascular disease continues to be one of the major causes of inequality in health outcomes.
Good progress has been made in implementing the actions set out in the Heart Disease Delivery Plan and this is reflected through the outcome and assurance measures. They show that premature death rates are falling and survival rates are improving. The percentage of those treated for heart disease is much higher for those aged 65 and over, emergency admissions for cardiovascular disease decreased by almost 5% between 2013-14 and 2014-15 and there has been a reduction of over 8,000 patients being treated by their GP for CHD over the last five years (British Heart Foundation Cardiovascular Disease Statistics 2014)