heart disease health promo essay.docx

17

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 comprehensiveness
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 main 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, exercise and personal attitudes towards health.

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 charter 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 and 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).

There are many other models used such as Ajzen, I. (1985). Theory of reasoned action this is used for behaviors that are within a person's control, behavioral intentions and to aid in predicting actual behavior. Marlatt's (1985) Model of relapse prevention, Although this is used more for addiction it can be adapted to run alongside other models. Self-empowerment model. Also known as the self-actualisation model Maslow, A.H. (1943). seeks to develop the individual's ability to control their own health status as far as possible within their environment. The model focuses on enhancing an individual's sense of personal identity and self-worth and on the development of 'life skills', including decision-making and problem-solving skills, so that the individual will be willing and able to take control of their own life. People are encouraged to engage in critical thinking and critical action at an individual level. This model, while often successful for individuals, is not targeted at population groups and is unlikely to affect social norms. While there is a plentiful supply of models the health belief and stages of changes appear to be the most popular ones used.

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).
Historically British cardiology in the 20th century began with Sir James Mackenzie whose work attracted other physicians interested in heart disease and around 1910 Mackenzie suggested that they should form a small club, but the first World War intervened. After the war, there were many soldiers with war related cardiac problems and to assess their eligibility for pensions the Ministry of Pensions appointed cardiac consultants in all regions of Britain to give advice.
These consultants held a conference in 1921 and clinical as well as administrative matters were discussed. This was so successful that in 1922, William Hume of Newcastle suggested that they should reconvene at the Association of Physicians' meeting in Oxford. They did this on April 22, 1922 and created the Cardiac Club, which was the start of organised British cardiology. There were 15 members and Sir James Mackenzie was an honorary member. The club met annually thereafter on the day before the Association meeting and the topics presented included infective endocarditis, angina pectoris, heart block, the heart in influenza, hypertension and syphilis.
Mackenzie and Lewis founded the journal, Heart, in 1909, but in 1933 it changed its name to Clinical Science. It was obvious that a new cardiac journal was needed, so the Society launched the British Heart Journal. It was published by the British Medical Association (Dr A Hollman, British Cardiovascular Society) http://www.bcs.com
In the year 1960 there were around 166,000 deaths from coronary heart disease (CHD) in Great Britain. With more than 50% of deaths in the UK being due to cardiovascular disease (CVD) In response to this a group of medical professionals selected by the council of the British cardiac society got together and on the 28 of July 1961 The British Heart Foundation became a reality. These professionals (Dr Maurice Campbell, Dr Paul Wood, Dr Evan Bedford and Dr William Evans) were concerned about the increasing death rate from cardiovascular disease. They wanted to fund extra research into the causes, diagnosis, treatment and prevention of heart and circulatory disease. This included patient welfare and education. By 2009 this figure had decreased to 80.000 deaths or 32%( Matthews DN 1990)
Today the British heart foundation are a major funder and authority in cardiovascular research, education and care, and relies predominantly on voluntary donations to meet its aims. In order to increase income and maximize the impact of its work, it also works with other organizations to combat premature death and disability from cardiovascular disease. Who we are". Www.bhf.org.uk .
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 twenty five percent 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 impacts 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 three 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. This is a gold standard example of how successful health promotion and prevention can be when every stage is managed effectively.

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)
Even though the main focus of the British heart foundation is research. They also help to raise awareness of the issues surrounding heart disease, Fund postgraduate education and fellowships and work with other professional bodies. Their latest campaigns focus on shock tactics, giving people an emotional punch and runs with the tagline 'Heart disease is heartless' and looks to show the affect it can have on individuals at any time.
It centers on a spot – which will run on TV and cinema – called 'Classroom' where a young boy in a school lesson is suddenly seen talking to his dad. The son is confused as his dad tries to say goodbye before the lesson is interrupted because the boy is taken into a room with his upset mother. This advert divided opinion in the online community with some saying it was disturbing and others saying it was perfect.it appears to have done what it set out to do that is raise awareness of heart disease and the multiple and distinct risk factors involved in this topic.
Health promotion is a complex subject and must include patient's views and beliefs if it is to be successful. research has shown that perceptions of risks are a well-established factor associated with preventive health behaviours. Several health communication models (The transtheoretical model, referred to as the stages of change model, Prochaska and Diclemente 1983).and the (health belief model Becker 1974) explicitly consider perceptions of risk to be a determinate of preventive health behaviours. Generally speaking, when risk perceptions are low, people are unmotivated to change pre-existing behavioural patterns. However, the relationship between perceptions of risks and adaptive responses is not linear. Excessive risk perceptions may lead to destructive or avoidance behaviours. Strong fears about their health may lead a person to delay consulting their doctor and therefore miss opportunities for early interventions.
Therefore, campaign messages should be designed to stimulate appropriate levels of concerns while also considering the receivers' beliefs about themselves and the recommended action. Techniques that may be applied to either stimulate risk perceptions or feelings of concern are needed to motivate change, but excessive depictions of risk in health messages can lead to avoidance, denial, and other dysfunctional responses.
Health promotion has both strengths and weakness these include Cutting down cost for the economy by tackling health problems such as obesity, cardiovascular disease and cancer Lack of understanding of health promotion – Godden (2008) states that 'staff and management can sometimes be identified as lacking in understanding of health promotion.' Godden also found that a lack of skills and knowledge amongst staff as a weakness and several members of staff at the NHS suggested that there was an unjustified assumption that anyone can just do health promotion without appropriate training. Some sectors do not understand or recognise health promotion and neither does the community.



Achieving and maintaining a healthy weight throughout life are critical factors in reducing CVD risk in the general population Increased emphasis should be put on prevention of weight gain, because achievement and maintenance of weight loss, although certainly possible, require more difficult behavioral changes (i.e., greater calorie reduction and more physical activity) than prevention of weight gain in the first place In the subject of diet and nutrition the majority of research studies have focused on individual nutrients and foods, but it is well recognized that multiple dietary factors influence the risk of developing CVD and its major risk factors. To a much lesser extent, research has examined the health effects of the whole diet; both observational studies and clinical trials. These data have documented that healthy dietary patterns are associated with a substantially reduced risk of CVD, ( Knoops KT et al 2004 ) CVD risk factors, and non-cardiovascular diseases. (HALE project. JAMA. 2004) An emphasis on whole diet is also appropriate to ensure nutrient adequacy and energy balance (US DOH 2005). Hence, rather than focusing on a single nutrient or food, individuals should aim to improve their whole or overall diet. Consistent with this principle, the AHA recommends that individuals consume a variety of fruits, vegetables, and grain products, especially whole grains; choose fat-free and low-fat dairy products, legumes, poultry, and lean meats; and eat fish, preferably oily fish, at least twice a week. (N Engl J Med. 1997) http://circ.ahajournals.org














In summing up the ideas discussed in this essay it has been demonstrated that health promotion does indeed work and is effective but that its ultimate success is largely dependent on a multitude of variable factors with the most unpredictable of them being human understanding and education as well as the willingness of the patients to interact and be concordant with any advice that is presented to them. (Institute of medicine. health and behaviour 2001). The nine broad prerequisites for health as set out by the Ottawa charter are, Peace, education, Food, shelter, income, a stable ecosystem, sustainable resources, social justice and equity. For health promotion to be totally effective it needs to incorporate all of these,it needs to be easy for the lay person to understand and transparent in its message, it also needs to be relevant to the target group and be adaptable to a broad spectrum of the population. It should clearly demonstrate that the benefits outweigh the cost.
As health care providers we have a long way to go before we have the perfect method of health promotion that would suit a changing society and its complex needs. Health education needs to be addressed to include health promotion and awareness of what it is Ultimately the overall goal of health promotion is to develop awareness, understanding, education and improve the lives of the groups that it is focused on. The end result of good health promotion is less people need to access the NHS so saves resources and money and helps the population to lead a healthier lifestyle.

Word count 3591.










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Appendices

Figure 1 Lifestyle risk factors in England with international comparisons

Risk Factors
England
Best performing
EU countries
EU average
UK/WHO
recommended
Obesity
(prevalence)
25%
Romania (8%)
17%
NA
Saturated fat consumed
(% of food energy)
13%
Portugal (9%)
–

11%
Fruit & vegetable intake
(g/day)
223g
Spain (766g) Italy (424g)
–
400g
Salt intake
(g/day, urinary sodium)
8.1g
England amongst the best in EU7
–
6g8
Smoking
(prevalence)
19%9
Eg Luxembourg
(17%)10
23%11
NA
Physical inactivity (population below WHO guidelines)12
63%
Greece (16%)
37%
150 minutes/
week


Figure 2 Mortality from cardiovascular diseases (deaths per 100,000 population)

2001
2010
Decrease
All age



All CVD
251
160
36%
CHD
130
74
43%
Stroke
65
41
37%
Under 75



All CVD
108
65
40%
CHD
65
35
46%
Stroke
21
12
42%
(Source: Compendium of population health indicators, NHS Information Centre Indicator Portal, based on ONS data) Notes:
(1) Rates are directly age-standardised to the European Standard Population
(2) Rates for 2010 are based on population estimates prior to revisions following the 2011 Census
Figure 3 Future roles and responsibilities

Future roles and responsibilities
Relationship to Outcome Frameworks
The DH will:

work closely with industry and other stakeholders to promote healthier lifestyle choices;
keep evidence under review and consider the need for further legislation as appropriate; and

monitor performance against the Outcomes Frameworks, using them to set direction and drive improvement in outcomes and holding the NHS to account for improvements required.
PHE will:
Public Health Outcomes Framework
raise awareness of the benefits of healthy
2 Health improvement – People are helped
lifestyles;
to live healthy lifestyles, make healthy
raise awareness of the symptoms of
choices, and reduce health inequalities
cardiovascular diseases and the benefits of early
2.11 Diet; 2.12 Excess weight in adults;
diagnosis;
2.13 Proportion of physically active and

work with local authorities to maximise the impact of NHS Health Checks;
inactive adults; 2.14 Smoking prevalence
in adults; 2.17 Recorded diabetes; 2.22
Take up of NHS Health Check programme
monitor progress on cardiovascular diseases at population level; and

4.4 Healthcare public health and preventing mortality – under 75 mortality
work with partners across all sectors to develop
rate from all cardiovascular diseases
lifestyle support that will prevent and modify

4.4 Healthcare public health and preventing mortality – under 75 mortality
rate from all cardiovascular diseases

CVD, and maximise health and wellbeing at all

4.4 Healthcare public health and preventing mortality – under 75 mortality
rate from all cardiovascular diseases

stages of disease.

LAs will:

be responsible for full roll out of NHS Health
Check;

engage with their local populations to deliver health improvements;

take action on the wider determinants of health;
and

engage with the NHS on cardiovascular outcomes through health and wellbeing boards.
As per PHE with:

Adult Social Care Outcomes Framework







Future roles and responsibilities
Relationship to Outcome Frameworks
The NHS CB will:

be responsible for commissioning primary care services;

be responsible for delivering the outcomes set out in the Government's Mandate and measured by the NHS Outcomes Framework;

directly commission specialised cardiovascular services;

support Clinical Commissioning Groups in their development;

support the work to develop health outcomes measures at national and CCG levels;

monitor progress on cardiovascular diseases within the NHS; and

through NHS IQ and Strategic Clinical Networks, support the NHS and social care to deliver improved health outcomes.
NHS Outcomes Framework

1.a. Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

1.1 Reducing under 75 mortality rate from cardiovascular disease

2.1 Ensuring people feel supported to manage their long-term condition

2.2 Improving functional ability of people with long-terms conditions

3a Emergency admissions for acute conditions that should not usually require hospital admissions

3.4 Improving recovery from stroke

4a.i Patient experience of GP services

4b Patient experience of hospital care

4.1 Improving people's experience of outpatient care

4.2 Improving hospitals' responsiveness to in-patients' personal needs

4.3 Improving people's experience of accident and emergency services

4.4 Improving access to primary care services

4.6 Improving the experience of care for people at the end of their lives

4.9 Improving people's experience of integrated care
CCGs will:

commission all health services other than primary care and specialised services, in line with
National Institute for Health and Clinical Excellence (NICE) guidance;

work with the NHS CB to support improvements in primary care services; and
engage with LAs on cardiovascular outcomes through health and wellbeing boards.
With thanks to the DOH for providing the Statistics



© Crown copyright 2013
2900853 Mar 2013



Figure 4.


Figure 5

Figure 6

Figure 7