This paper will discuss cardiovascular diseases among men in London Borough of Haringey. The report will explain the urban context and determinants of the health issue it will also explain the consequences of the health issue to individuals, the general population and to the public health system. The paper will identify interventions that have been put in place to help reduce cardiovascular diseases in Haringey Borough and recommend other appropriate strategies that can be used.
Cardiovascular disease may be referred to as conditions involving blockage or narrowing of the blood vessels. The narrowing of the blood vessels may lead to stroke, chest pain and heart attack among other complications. Cardiovascular disease is caused by different factors including smoking, obesity and overweight, unhealthy diet and lack of exercise (NHS, 2015).
This topic was chosen because of the high prevalence rates of mortality from cardiovascular diseases among men in Haringey. Cardiovascular it is also the main causes of early deaths in males that contribute to external causes and digestive system.
Life expectancy for females is (83.years) and 79.4 years for men compared to life expectancy in England which is (79.2 years). Haringey has the highest out of 32 boroughs in London. Haringey has experienced a lower life expectancy of men compared to London and England average. The main cause of death among men is heart disease and stroke (Haringey Council, 2015). Cardiovascular disease in London Borough of Haringey cost NHS approximately 10 billion pounds annually (Cebr, 2014).
In summary, cardiovascular diseases is an urban health problem because of the deaths resulting from the disease, the costs of the disease to the public health system and the burden it creates to individuals and communities that may result to disability. This can be related to the concept of urban penalty that may be described mainly by the higher rates of urban mortality. These higher mortality rates are attributed to different factors including concentration of populations, the dirty environments within some areas in urban centres and the fact that towns are centres of propagation of diseases (Reher, 2001). The concept of urban penalty is very applicable to Haringey where there are different risk factors for cardiovascular diseases. An understanding of these factors can help reduce the prevalence of cardiovascular diseases in Haringey. This can also be related to the sick city hypothesis that postulates that due to different risk factors of diseases, the health status of the urban population is poorer than that of the rural population. It is therefore important that the risk factors that promote the sick city hypothesis be identified and reduced among communities.
The London borough of Haringey was created in 1965 after the amalgamation of three former boroughs. This borough covers an area of approximately 28.5km2. There are some regions in Haringey that experience some of the worst forms of deprivation in London and in the UK. According to the indices of multiple deprivations which are an instrument or standard used to measure deprivation across the UK, Haringey ranks 4 among the most deprived boroughs in London. The other more deprived boroughs include Hackney, Newham and Tower Hamlets (Haringey Council, 2015). Deprivation is measured using different aspects including income, employment, health and disability, education skills and training, crime and the living environment (Haringey Council, 2015). According to the 2011 population estimates, Haringey has a population of about 255,500 people. Almost 49.5% of this population is male. Almost 39.5% of this population comprises of blacks and other minority groups like South Asia people. The mortality rate from cardiovascular disease is 206.7 per 100,000 people in males. This figure is higher than the value for entire London which is 191.4 and 195.2 per 100,000 people in England (Haringey Council, 2015). There is a need to identify the risk factors that lead to this high mortality rate from cardiovascular disease so that appropriate prevention strategies are developed (Haringey Council, 2015). Reducing the health disparities in cardiovascular diseases especially for men aged 40 years and above will increase the life expectancy of the male population. Reducing the health disparities will also help in reducing the burden to the public health system.
Urban context and determinants
Urban populations in almost all cities in the world experience common health problems. This is due to the socioeconomic factors that are prevalent in all the cities (Ritsatakis, 2012). These socioeconomic factors act as inequalities and prevent certain population groups from improving their health and well being (Chandola, 2012). Social determinants may be defined as the environments in which people live and work in (Ompad et al. 2007). These social determinants are not unique to the urban environment. However, the social determinants provide insights that help define different urban characteristics including size, density, diversity and complexity (Lawrence, 2006). Most urban populations London included are characterised by density and diversity of populations. Density in the urban context is mainly associated with crowding. Diversity on the other hand increases the cultural richness of the population. However, this may create a problem for the health care system as interventions have to be made to meet the demands of all the cultural groups within an urban setting. The other element is that cities are complex. The complexity is due to the interaction of multiple systems within the cities. The complexity makes it difficult to design interventions that can satisfy the needs of all the socioeconomic classes within the city. This means that the interventions may end up increasing health inequalities (Vlahov et al. 2007).
In most of the urban regions such as London, the poor are separated due to poverty that exists in their neighbourhoods (Ompad et al. 2007). When considering the London borough of Haringey and the high prevalence of cardiovascular disease among men, there are different social determinants that can be considered. These determinants can be grouped into the professional context (that is the working conditions and the access that men have to jobs), social relationships and isolation, ethnicity and the geographical environment. These social determinants of heath have been shown to have a relationship with cardiovascular diseases in different ways (Lang et al. 2011).
When considering London and the borough of Haringey, the first determinant that will be analysed is environment. As has been mentioned, Haringey is one of the most deprived boroughs in London. This means that most of Haringey residents live in crowded settlements thereby increasing their exposure to pollution. Research has reported the relationship between increased risk of myocardial infarction and low temperatures (Bhaskaran et al. 2009). Due to their socioeconomic status, most residents of Haringey are not able to heat their homes. In addition, these residents have low quality insulation in their homes therefore reducing the average temperature in the houses. This increases the risk of myocardial infarction. The other problem with Haringey that increases the risk for cardiovascular diseases is the lack of green spaces (Mitchell & Popham, 2008). Apart from the above, it is important to note that in deprived neighbourhoods like Haringey, residents are usually exposed to nonexistent land tenure system, lack of urban infrastructure (Edelman & Mitra, 2006) and a strained relationship with the government and law enforcement agencies (Ompad et al. 2007).
The second risk factor that is considered is work. Due to their position in the society, most men in Haringey are engaged in works that generate stress. Stress in this case may be defined as a psychological reaction to an agent (Lang et al. 2011). The work environment of the men exposes them to chronic stress and this increases their risk of myocardial infarction (Rosengren et al. 2004). It is expected that most men in Haringey have a large workload yet they do not have control over how to organise their jobs and use their skills to accomplish the tasks. The men are subject to a routine environment that does not allow them to make decisions on their work. This may increase the stress levels of the men and increase their risk for cardiovascular diseases (Lang et al. 2011). The other factors related to the work environment include the unfavourable working environments that the men could be exposed to. There is a causal relationship between unfavourable working environments and chances of cardiovascular diseases (Lang et al. 2011). This means that the increased exposure to unfavourable conditions increases the chance of contracting cardiovascular diseases. This is especially true for middle and low cadre employees that characterises the men living in Haringey (Lang et al. 2011). The other work related factor is health behaviours. For example, due to work stress, the men may develop poor eating habits and may engage in reduced physical activity. These habits will increase the risk of cardiovascular diseases in these men (Lang et al. 2011).
The third risk factor is unemployment and job instability. Haringey is among seven local authorities that have the highest rates of unemployment in England (The King’s Fund, 2012). An unstable condition has negative effects on the cardiovascular system of the men in Haringey. The impacts can also be seen in other men who are in unstable employment like seasoned work and internships, fixed term contracts and involuntary part time works. The relatively low education levels of men in Haringey expose them to such situations where they have to contend with job instability. This increases the risk of cardiovascular diseases because these men have to provide for their families. Job related stress may just be secondary because this stressor may expose the men to other lifestyles like alcohol consumption and smoking which increase the risk of cardiovascular diseases. (Lang et al, 2011) proposes that organisations should look at individual risk factors of stress so as to design measures that can help alleviate stress from their organisations.
The fourth determinant that affects men in Haringey is social isolation. Social isolation may increase the risk of myocardial infarction. There are different mechanisms that are involved in the issue of social isolation. Some of the mechanisms include instrumental support like financial help, emotional and psychological support and the encouragement from social networks to visit a health care facility. However, due to the deprivation, medical facilities are not available close to the people. The few that are available cannot adequately take care of the needs of the community.
The other factor is discrimination and ethnicity. Many immigrants in London belong to the social disadvantaged groups. For example, the data on Haringey has shown that a big proportion of Haringey’s residents comprises of immigrants. The issue in this case is whether discrimination based on social groups has an effect on the health of the disadvantaged groups. This was confirmed in a 1999 health survey for England that determined that the highest prevalence of stroke existed among Indians aged over 55 years (Primatesta & Brookes, 2001). The same case applies for cardiovascular diseases in Haringey where the highest prevalence is in this group of the South Asian people (Haringey Council, 2015). In addition, there are studies that have confirmed that stress from discrimination and racism may increase the health risk factors (Vlahov et al. 2007).
In summary, it is important to note that these determinants or risk factors do not act alone. Rather, they act with traditional risk factors like consumption of alcohol, smoking and obesity. The meaning of this is that each risk factor acts just in the background but increases the risk of smoking or alcohol consumption which then increases the risk of cardiovascular diseases.
The healthcare system has also in a way acted to increase the risk for cardiovascular diseases among men in Haringey (Steptoe & Marmot, 2002). This is based on the fact that the healthcare professionals may not be adequately trained to consider all the emotional and psychological issues of the patient while handling cardiovascular diseases in the patients. The result of this is that there is an underestimation of the actual problem especially among the low income people who may find trouble expressing themselves to the professionals.
The public health consequences and implications of cardiovascular diseases
Cardiovascular diseases have negative effects on the health of individuals. This is because the disease may lead to stroke, heart attack and in adverse conditions, it may lead to death. For example, according to data presented by Haringey Council (2015), in 2011, the mortality rate from cardiovascular disease is 206.7 per 100,000 people in males. Apart from death, the other effects of cardiovascular disease to an individual are that the disease may cause weakness, fatigue, chest pain and a relative shortness of breath.
For the populations, cardiovascular diseases increase the stress levels for the members of the society. This may also affect the psychological soundness of the society. This reduces the overall health and wellbeing of the society by reducing the number of happy people within the populations. Furthermore, cardiovascular disease reduces the life expectancy of people in Haringey (Lang et al. 2011). The reduced life expectancy will have an effect on the family structure within Haringey and the entire London. This means that there is a proportion of the population that will not see their children or grandchildren grow and they will not impact on the lives of these young children. This may have an effect on the crime rates bearing in mind that the problem mainly affects men in deprived regions (Jeemon & Reddy, 2010). Apart from crime levels, the children may experience some form of isolation especially bearing in mind that the traditional family structure is still respected in most regions in London and Haringey.
Cardiovascular diseases also have an effect on the public health system. This is because the increased prevalence of cardiovascular diseases increases the burden to the public health system. According to the Cebr study conducted in 2014, cardiovascular diseases cost the health care system approximately £10 billion pounds (Cebr, 2014).
Strategies and interventions for addressing the problem of cardiovascular diseases in Haringey
The National Health Service (NHS) has devised a programme to help in early diagnosis of cardiovascular disease in Haringey. In this programme, every person between the age of 40 and 74 who has not already been diagnosed of the condition or who are exposed to certain risk factors is invited for diagnosis at least once every five years (Haringey Council, 2015). Apart from accessing the risk factors, the NHS programme provides support and advice to these people on the lifestyle and behavioural options that they can take to help them reduce the risk factors for cardiovascular diseases. The programme has mainly targeted on the people of east Haringey because they have the highest prevalence of cardiovascular disease in Haringey (Haringey Council, 2015).
The Haringey Community Sport and Physical Activity Network is working with the local council and other authorities like the NHS to develop programmes and strategies that can help increase the number of Haringey residents who engage in quality physical activities. Physical activities have benefits in that they reduce the prevalence of obesity and cardiovascular diseases. In addition, through engagement of the populations, the amount of depression among the members of the population reduces (Haringey Council, 2015). This programme is mainly focused at persons with the long term condition and who are not physically active. However, there remains a challenge that Haringey does not have enough space to fully support this initiative. This will create a problem of access to recreational facilities and if not handled well, may create another inequality in health and well being (Rose, 1992). Some of the proposed physical activity programmes include three leisure centres that are owned by the Haringey Council and leisure provided by community partners and other voluntary organisations. The physical activity programmes are geared towards helping the population manage weight (Haringey Council, 2015).
The NHS and the local council have involved the support and participation of the local community. For example, there are members of the community who are trained on how to promote positive lifestyle choices among members of the population. These people are then expected to train the other members of the community (Haringey Council, 2015). Some of the positive lifestyle changes proposed includes cessation of smoking and substance abuse. More staff is trained on how to offer interventions and therapies to members of the population who are most affected by some of the risk factors. The training focuses on motivational interviewing and cognitive behavioural therapy (CBT) to help the community focus on positive lifestyle choices (Haringey Council, 2015).
Recommendations and conclusions
As a recommendation, it is important that Haringey authorities work in collaboration with the NHS and other related agencies to reduce the inequalities in cardiovascular disease prevalence and mortality. This should follow a population based approach instead of just focusing on the individual-level interventions on the risk factors (Capewell & Graham, 2010). By focusing on the whole population, it will be easy to identify the causes of the disease and work on ways of reducing the underlying risk factors (Rose, 1992). This means that more policies on environmental planning, pollution and work related laws among other should be propose and implemented. Other policies that can be implemented and have been effective in some countries include the policies on smoke-free public places (Karppanen & Mervaala, 2006).
As has been mentioned, inequalities in risk factors may increase when the effects are mediated through individual based approaches. For example, when the interventions focus on improving health awareness, education of the population and behaviour change programmes among other individual based interventions (Capewell & Graham, 2010). This is because there is a proportion of the population that may not be able to access some of these services (White, Adams & Heywood, 2009). Such interventions that require individuals to mobilise their resources will always favour those with more resources thereby increasing the social inequalities (McLaren, McIntyre & Kirkpatrick, 2010).
In conclusion, this paper has discussed a public health issue in London’s borough of Haringey. This is a borough that has one of the highest deprivation rates in London. Death from cardiovascular diseases among men in Haringey has been discussed in the paper. This topic was chosen because of the high prevalence rates of mortality from cardiovascular diseases among men in Haringey. The mortality rate from cardiovascular disease is 206.7 per 100,000 people in males. This figure is higher than the value for entire London which is 191.4 and 195.2 per 100,000 people in England (Haringey Council, 2015). The paper has therefore identified different risk factors for cardiovascular disease in Haringey.
Some of the risk factors include the urban environment, work, unemployment and job instability, social isolation, ethnicity and the health care system (Lang et al. 2011). It is important to note that these determinants lead to other behaviours like smoking and alcohol consumption and these are the factors that increase the risk for cardiovascular diseases.
Cardiovascular disease in Haringey has effects on individuals, the community and the entire health care system. To individuals, this disease leads to weakness, fatigue and difficulty in breathing among other effects. To the community or population, cardiovascular disease reduces the life expectancy thereby reducing the number of years that the men can have to provide care for their families (Lang et al. 2011). This may create some social problems like increase in crime rates especially bearing in mind that the Haringey population is mainly composed of deprived populations. To the health care system, cardiovascular diseases increase the burden to this system (Cebr, 2014).
There are different interventions that can be used to help reduce the prevalence of cardiovascular diseases in London and Haringey. Some of the interventions that are being done include lifestyle and behavioural changes, improvement in physical activities and promoting positive lifestyle choices (Haringey Council, 2015). However, these programmes have not been very effective because there is a proportion of the population that does not have access to some of these services. It is therefore important that the interventions focus on the entire populations instead of focusing on individuals. The paper has achieved the objectives as all the questions have been comprehensively answered.
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