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Critically analyse examples of Public Health practice with reference to the models, approaches and practice covered in the module
Critically evaluate these examples in a political/historical & ethical context
About 9 million people worldwide die from coronary heart disease (CHD) each year, making it a significant public health issue (Hemmo et al., 2021). Heart disease is the leading cause of death in the UK, accounting for over 73,000 yearly fatalities (Nowbar, 2019).
The term "coronary heart disease" (CHD) describes a narrowing of the coronary arteries, which supply the heart muscle with blood. Due to arterial obstruction, this can cause angina (chest pain) and, in severe cases, a heart attack. Risk factors for coronary heart disease include smoking, inactivity, poor diet, and extra body fat.
The core tenets of public health's CHD strategy are prevention and management. Treatments focusing on modifiable risk factors include initiatives to encourage a healthy lifestyle and reduce exposure to environmental dangers. Access to healthcare, particularly for those at risk, is another top need.
The fatality rates from CHD have decreased significantly in the UK in recent decades (Dragano et al., 2017). Although there are still significant geographical variances, the death rate is higher in the country's poorest regions.
Inequalities in health are primarily due to coronary heart disease in the UK. Public health programmes must take into consideration and aim to reduce these discrepancies if they are to tackle CHD in the UK effectively.
This report aims to review and assess the UK's public health approach to coronary heart disease. This report aims to evaluate the effectiveness of public health initiatives in lowering CHD risk factors and pinpoint the condition's root causes. The report will look at recent and earlier policy support for CHD medicines and evaluate their ethical implications. The research will conclude with a succinct summary of the key topics covered.
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Healthcare disparities depending on socioeconomic status
Socioeconomic status (SES) significantly impacts health outcomes, notably CHD. The prevalence of CHD is higher among those from lower SES backgrounds due to factors such as restricted access to healthcare, poorer educational attainment, and higher levels of psychological stress (Taylor et al., 2019). Some sections of the population have a disproportionately high prevalence of CHD as a result of socioeconomic disparities in the delivery of healthcare. To overcome these disparities, focused initiatives that aim to enhance socioeconomic circumstances and eradicate inequity in access to healthcare are required.
The accessibility of essential medical care
A hindrance to CHD prevention and treatment may be inadequate access to healthcare. More extended wait periods for diagnosis and treatment may affect a person's health and well-being if they do not have access to primary care, preventive screenings, or specialised cardiac care (Hemmo et al., 2021).
These variations in CHD outcomes result from unequal access to healthcare, especially for historically underserved and minority communities. Better access to affordable, high-quality healthcare services, such as preventive screenings, cardiac rehabilitation, and quick treatments, is necessary to lower CHD incidence and death.
Socioeconomic variables and the causes and consequences of coronary heart disease
In order to prevent and cure coronary heart disease (CHD), factors including income, education, work, and social support are crucial because chronic stress, a lack of access to resources for making healthy lifestyle decisions, and a lack of social support are all related to lower socioeconomic levels, CHD risk is increased (Steele et al., 2018). The effects of socioeconomic determinants of health on CHD can be lessened by policies that foster income equality, education, and community support.
Social networks
Strong social support networks are associated with lower rates of CHD and better cardiovascular health, according to research. Social support may provide emotional, practical, and educational assistance while promoting healthy behaviours and lowering stress levels (Calder, 2017). Peer support groups and community-based projects, for instance, can be crucial in preventing and treating CHD because they strive to develop social support systems.
Government interventions against coronary heart disease
Government policies have a significant influence on how well CHD prevention strategies work. Examples of public health strategies that have effectively reduced CHD rates include tobacco control initiatives, the pricing of unhealthy foods, and restrictions on promoting unhealthy products (Davison, Frankel, & Smith, 2018). However, to get the optimum outcomes, it is crucial to routinely evaluate the alignment between official policy and evidence-based CHD preventive measures.
Economic expenditure on public health
Public health initiatives need adequate funding and resource allocation in order to prevent and control CHD effectively. Lack of finance for public health systems, investigations, and interventions may obstruct the diffusion of best practices backed by scientific data (Grant et al., 2021). Giving CHD prevention initiatives top priority when allocating resources for public health makes it feasible to lower the disease burden dramatically.
Air pollution and coronary heart disease
An increased risk of coronary heart disease (CHD) has been linked to high levels of air pollution, particularly PM2.5 and NO2 (Khan et al., 2020). These kinds of pollutants may lead to endothelial dysfunction, inflammation, and oxidative stress, all of which contribute to the development and progression of atherosclerosis (Khan et al., 2020). Adopting regulations to lessen air pollution, encourage sustainable transportation, and enhance indoor air quality can help prevent CHD.
The impact of one's built environment on their degree of physical activity
Examples of how the built environment may impact people's inclination to get up and move about and, consequently, their risk of coronary heart disease include neighbourhood layout, green space accessibility, and pedestrian friendliness. Easy access to parks, bike lanes, and pedestrian-friendly infrastructure can lead to healthy lifestyles and decrease the incidence of CHD (George et al., 2017).
Urban planners, transportation specialists, and public health experts must work together to create environments that promote physical activity and cardiovascular health (George et al., 2017). This section employs critical analysis to highlight the complexity of CHD's aetiology and the need for comprehensive public health policies and treatments. It also discusses specific causes and their effects on CHD.
A lack of mobility and inactivity in daily life
Living a sedentary lifestyle is one of the primary causes of coronary heart disease. In today's culture, more and more individuals participate in sedentary activities like sitting still and not moving about enough (Hartley et al., 2016). Studies have shown that sitting for extended periods increases the risk of coronary heart disease independently of other lifestyle factors (Hartley et al., 2016). Regular physical activity is related to a lower risk of developing CHD in people who engage in it due to its positive effects on cardiovascular health, such as improved blood pressure, lipid profile, and insulin sensitivity (Calder, 2017). For people to avoid CHD, they must make exercise a regular part of their life.
Poor nutrition and eating habits
Salt, trans fats, added sugars, and saturated fats are all components of the poor diet that causes coronary heart disease. According to Bui et al. (2019), these eating habits raise the chance of acquiring CHD risk factors such as dyslipidemia, hypertension, obesity, and insulin resistance. Unsaturated fats, lean meats, whole grains, fruits, and vegetables are associated with a decreased risk of coronary heart disease. Critical public health initiatives include promoting healthy eating through educational campaigns, expanding access to nutrient-dense meals, and passing laws to reduce the sale and promotion of unhealthy food substitutes (Caleyachetty et al., 2021).
Risk Factors' Impact on the Development of Coronary Heart Disease
Several environmental and behavioural factors raise a person's risk of developing coronary heart disease (CHD). This risk is influenced by lifestyle choices like smoking and eating poorly and biological and genetic factors like hypertension and dyslipidemia (Caleyachetty et al., 2021).
Additionally, an increased risk of coronary heart disease has been linked to mental health conditions such as chronic anxiety and despair. The development of CHD is characterised by atherosclerosis, a deposit of plaque in the artery walls that reduces blood flow to the heart by constricting the arterial lumen (Aragram et al., 2022). A blood clot may form as this plaque disintegrates, obstructing blood flow and resulting in a heart attack.
Pathogenic mechanisms
Chronic inflammation is one of the most crucial pathogenic processes that contribute to the initiation and development of CHD. Other key pathogenic processes include endothelial dysfunction and oxidative stress. Chronic inflammation that harms the endothelium, the blood vessel's inner lining, can lead to atherosclerosis (Aragram et al., 2022).
Another risk factor for atherosclerosis is endothelial dysfunction, which is the inability of blood vessels to dilate correctly. The imbalance between free radicals and antioxidants in the body, known as oxidative stress, may contribute to atherosclerosis by damaging the endothelium and promoting inflammation (Caleyachetty et al., 2021).
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An examination of the political support and policies in place in the UK to fight coronary heart disease (CHD) reveals a nuanced picture. Even though CHD is universally regarded as a significant public health problem, the level of policy support and political commitment varies. The Public Health Outcomes Framework and the
Cardiovascular Disease Outcomes Strategy are two national health agendas prioritizing CHD prevention and control (Beauchamp et al., 2022). These institutions' main objectives are to improve cardiovascular health and reduce health inequities.
Close examination, nevertheless, needs to be more consistent with the policy's support. Since financing for CHD preventive and control initiatives has not always matched the severity of the issue, interventions have only sometimes been as effective as they could be (Tillman et al., 2017).
The possibility of combating CHD using a reactive rather than proactive approach has been a concern, and the emphasis on treatment-focused procedures rather than upstream prevention measures has yet to help (Beauchamp et al., 2022).
Government and World Health Organisation (WHO) policies on CHD exhibit both areas of alignment and mismatch when compared to the research on causes and interventions. Government initiatives like the National Institute for Health and treatment Excellence (NICE) guidelines have made evidence-based recommendations for clinical treatment and CHD prevention (Adamson et al., 2019).
These restrictions emphasise the need to do risk analyses, alter behaviour, and employ medicinal treatments. Similarly, the Global Hearts Initiative of the World Health Organisation employs a comprehensive strategy to prevent and manage cardiovascular diseases like CHD (Beauchamp et al., 2022).
According to Hyseni et al. (2017), specific policies may need to adequately address the structural causes of CHD, such as socioeconomic disparity and the social and environmental factors influencing health behaviours.
The policy's emphasis on individual behaviour change without addressing the more significant socioeconomic reasons limits the effectiveness of treatments (Beauchamp et al., 2022). Policymakers must adopt a comprehensive strategy considering individual risk factors and the broader social, economic, and environmental variables influencing CHD.
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The trajectory of policy measures to prevent CHD has changed because of changes in scientific understanding, societal needs, and political objectives. Preventive initiatives have been increasingly popular recently, although programs have historically focused on acute care and treatment (Poon et al., 2020).
This policy change is the consequence of a growing understanding that, in order to minimise the burden on healthcare systems and improve public health, it is essential to address the underlying causes of CHD.
Additionally, according to Marmot and Mustard (2018), policy frameworks emphasize multidisciplinary and cross-sectoral collaboration. Now that politicians are more aware of the complexities of CHD, they are actively working to incorporate groups, including healthcare professionals, public health organisations, communities, and the business sector (Beauchamp et al., 2022).
When stakeholders collaborate to pool resources, discuss what has worked for them, and create a positive environment, evidence-based therapies may be more easily adopted.
The fight against coronary heart disease (CHD) requires a multipronged approach that involves policy, client-centered practices, and group effort. Policy interventions for social change are necessary to promote a culture that supports healthy lifestyle choices (George et al., 2017). There are several potential remedies, including regulations on food labelling, restrictions on advertising unhealthy products, and greater chances for physical activity at work and school (Beauchamp et al., 2022).
Interventions prioritizing the client's needs are more likely to lead to long-term behaviour change that reduces the risk of cardiovascular disease. Counselling, making goals, and accessing educational resources can all help (Madhavan et al., 2018). These courses motivate individuals to make positive lifestyle changes, such as eating healthier and exercising more frequently, by boosting their self-assurance in their capacity to do so (Adamson et al., 2019).
Interventions that promote community participation and empowerment while considering social and environmental factors can aid in lowering the prevalence of CHD. In order to lower CHD risk, interventions must engage residents of the impacted areas in determining what services they require and how to get them (Van Der Werf et al., 2016). Community gardens, exercise programmes, and other strategies for creating social support networks could promote healthy lifestyle choices and stave off feelings of loneliness (Adamson et al., 2019).
The health promotion models developed by French & Adams, and Tannahill offer helpful frameworks for contrasting the range of CHD therapy.
The paradigm put forward by French and Adams states that creating enabling conditions, supporting community action, and developing personal skills are necessary for empowering individuals to take control of their health (Hartley et al., 2016).
This approach aligns with the objectives of community-based and empowerment initiatives that seek to address underlying socioeconomic problems and inspire cooperation among individuals to bring about good change.
Tannahill's paradigm, however, places equal focus on all three phases of medical care: prevention, treatment, and recovery. It emphasises the need of cross-sectoral collaboration and the requirement for interventions at different phases (Raingruber, 2016).
Through Tannahill's paradigm, the discourse may evaluate policy approaches for social change and client-centered therapies for behaviour modification (Raingruber, 2016). Client-centered interventions encompass the complete range of care, from treatment to rehabilitation, whereas policy interventions are consistent with prevention efforts.
There are a few points to bear in mind while critically assessing therapies. To begin with, the concept of health in these therapies must encompass whole well-being in addition to the absence of illness (Hartley et al., 2016). Given the impact of socioeconomic factors on CHD, efforts should concentrate on these determinants and pursue health equity.
Second, the success of policy interventions intended to bring about societal change depends on confronting and modifying the existing social order. The argument against this strategy is that politicians should instead focus on altering people's behaviours rather than only on structural issues that contribute to the issue (Yang et al., 2022). Interventions should also involve communities in their conception, implementation, and evaluation by respecting their expertise and providing agency over these processes.
Finally, it is essential to consider the benefits and drawbacks of the various theories that underpin the therapies. These theories, which provide direction for client-centered treatments but whose applicability may differ depending on environment and demographics, include those of behaviour modification (Yang et al., 2022). It is vital to have a solid understanding of the underlying theories to optimise the efficiency of treatments and address the numerous factors that contribute to CHD.
By critically assessing therapies based on their health conceptualization, focus on social change and participatory approaches, public health professionals can successfully address the complex nature of CHD (Handyside et al., 2021).
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Several prevention models can guide public health initiatives for CHD. These models provide a roadmap for identifying possible threats, creating preventive measures, and evaluating the effectiveness of such efforts (Yang et al., 2022).
Only a few examples are the precede-proceed model, the social-ecological model, and the transtheoretical model. These models highlight the complexity of CHD and the demand for preventive actions that consider individual, social, communal, and societal factors. These models can help public health experts develop effective therapies considering personal and environmental characteristics.
The precede-proceed model is an effective public health paradigm for planning and evaluating activities to lower the prevalence of coronary heart disease (CHD) (Handyside et al., 2021). It directs the development of specialised remedies to address the predisposing, reinforcing, and enabling factors influencing health habits and results. The social-ecological model recognises that individual, interpersonal, communal, and societal factors all shape health practices and outcomes in the context of CHD (Yang et al., 2022).
By highlighting the intricate relationships between people and their social, physical, and policy contexts, it offers a framework for comprehending and addressing the multiple causes of CHD. When applied to coronary heart disease, the transtheoretical model sheds light on how individuals alter their behaviour by recognising distinct stages of getting ready to adopt healthier lifestyles and guiding personalised therapies to promote long-term behavioural gains (Li et al., 2020).
In order to avoid coronary heart disease (CHD), it is crucial to focus on the four pillars of public health: surveillance, health protection, health improvement, and service quality (Li et al., 2020). Surveillance systems monitoring CHD trends, risk factors, and disparities offer crucial data for developing and evaluating therapies to lower CHD.
Health protection measures, such as those to reduce cigarette use, regulate the marketing of unhealthy foods, and improve air quality, can diminish the burden of CHD by addressing environmental and behavioural risk factors (Yang et al., 2022). The three main health promotion objectives are increased adoption of healthy lifestyle choices, increased access to healthful knowledge and resources, and strengthened social support (Yang et al., 2022).
Last but not the least, ensuring high-quality services through evidence-based recommendations, educating healthcare workers, and providing all required care is one of the keys to effective CHD management.
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For evaluating the moral implications of public health policies and activities, the Nuffield Ladder is a valuable resource. It has five levels representing increasing moral behaviour: prohibiting, discouraging, permitting, encouraging, and supplying. The discourse may assess the balance between individual freedom and social responsibility using the Nuffield ladder for CHD prevention measures (Hillier-Brown et al., 2017).
For instance, steps to restrict the availability of high-sugar and high-fat foods may be considered at the ban level. The government's interference in people's lives, on the other hand, is allegedly invasive and even paternalistic, according to critics (Hillier-Brown et al., 2017). Examples of initiatives that use discouragement to modify behaviour while respecting people's autonomy include public health campaigns that draw attention to the risks of inactivity and poor nutrition (Kumar, Shanker, & Verma, 2018).
People who get permission-based therapies have the information and resources to make thoughtful decisions. Women, Bock, and Fritsch (2020) note that making it easier for individuals to get wholesome foods and creating environments that promote physical activity may influence their decision-making.
Communities may actively encourage healthy lives by providing financial incentives for exercising and subsidies for nutritious meals. Last, provision-based interventions ensure that individuals from all socioeconomic strata access crucial resources and services, including cardiac rehabilitation courses and preventative healthcare.
In terms of public health ethics, it is not only about the individual. Avoiding stigmatising people and focusing more on systemic issues like socioeconomic inequities can enhance health outcomes. In the context of CHD, commercial interests and public health concerns may conflict (Kumar, Shanker, & Verma, 2018). For instance, the dominance of the food industry creates moral challenges when pushing unhealthy products that raise CHD risk (Coylewright et al., 2017).
Careful consideration and transparent decision-making processes are necessary to find a balance between preserving the general welfare and upholding private property rights and economic interests.
Public health initiatives should promote environments where healthy alternatives are more easily accessible regarding people's freedom of choice (Coylewright et al., 2017). This approach recognises that people's immediate cultural, economic, and geographic contexts impact them. However, interventions must preserve people's independence and not infringe upon their rights.
Finding a balance between promoting good health and defending human liberty is essential for CHD prevention measures to be ethical. By critically assessing interventions through the Nuffield ladder and considering ethical dimensions like victim blaming, interests, and choice, public health professionals can successfully navigate the complexities of CHD prevention while upholding the principles of justice, equity, and individual autonomy.
This report has covered much territory in its examination of CHD from the perspective of public health. The discourse learned from the background why CHD is so significant for public health, particularly in the UK. The report identified the leading environmental, political, social, and economic factors that affect the issue. The discourse focused on the importance of awareness of CHD risk factors and promoting healthy behaviours by examining pathogenic and salutogenic variables.
The analysis of policy support revealed the necessity for extensive and fact-based measures to prevent CHD when looking at government policies and how they have evolved. The discourse evaluated a wide range of public health efforts using health promotion models, from legislative reforms to community empowerment. Regarding ethics, the discourse examined the Nuffield scale and spoke about problems with blaming, setting priorities for interests, and exercising free choice.
The report's conclusion included the importance of the report's three main themes—prevention, screening, and the modelling of public health work—in lowering the risk of CHD.
Most of the report's interventions align with the most significant underlying reasons. Given the complexity of CHD, policy solutions must consider several elements, including societal changes, client-centered methods of behaviour modification, and community-based efforts. It is essential to consistently assess these therapies' efficacy and equity to adequately address the social determinants of health, environmental factors, and socioeconomic disparities contributing to CHD.
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