School: School of Nursing and Midwifery (Cambridge)

Course: BSc (Hons) Nursing (Mental Health)

Module title: Exploring and Promoting Health and Wellbeing

(Cambridge and Chelmsford)

Module code: 7209

Word Count: 3018 words

SID number: 2200417

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Table of Content

1. Introduction.........................................................................................................................3

2a. Locality.................................................................................................................................4

2b. Health and Social Care Data................................................................................................5

3. Determinants, Inequalities and Barriers to Health.................................................................6

4a. Review of Current Service Provision...................................................................................6

4b. Role of the Nurse in Health Promotion and Screening........................................................6

5. Conclusion..............................................................................................................................7

6. Recommendation....................................................................................................................8

7. References..............................................................................................................................9

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 1. Introduction

The purpose of the research is to analyze data from several sources to determine the best

course of action for addressing a growing public health risk in a certain area. Health factors

that contribute to Public Health and their impact on care in a certain area will also be taken

into account. The Joint Strategic Needs Assessment (JSNA), which will be discussed in this

report, is a county-specific document that forecasts future health care demands and lays the

groundwork for the local government to take action in response. The report's major focus will

be the rate of adult smoking and its public health consequences in Bedford, England. The

dangers of smoking, including the increased risk of disease that comes with excessive

smoking which poses a risk to public health not just in this location but also in every other

location. After determining the scope of the smoking problem in Bedford and the possible

causes of it, we can take action to reduce it. This report will take a look at the services on

offer, talk about how these factors might enhance population health, make recommendations

for the future, and review the role of the nurse in health promotion and screening.

2a. Locality

The locality chosen for this report is Bedford as it is where I live. Bedford is a market town

and unparished district in Bedfordshire England. Bedford is the second largest municipality

in Bedforshire. It has a population of 185,761 which comprises of 57 ethnic groups well

represented as per 2021 statistics (Office for National Statistics, 2022). Bedford's population

increased by an estimated 11,074 between mid-2020 and mid-2021 as the age of the

population is also increasing. JSNA reported 17.5% of adults in Central Bedfordshire are

smokers, 85 percent of these deaths that occur are attributed to the effects of smoking (Office

for National Statistics, 2022).

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Figure1: Map of Local authority districts in Bedford

Bedford Borough Council (2020). Available at: https://bedford.oc2.uk/document/1.

2b. Health and Social Care Data

Figure 2: Smoking Prevalence

Source: Tobacco Profiles - Smoking Prevalence Annual Population Survey (APS)

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Current rate of smoking among adults in Bedford Borough is 17.2%, a rise of 3.7% over the

last year. The 0.6% increase in smoking prevalence compared to the East of England average

and the 0.3% increase compared to the England average are both very small increases.

Lower-income and disadvantaged people in England, including the Bedford Borough, have a

greater smoking prevalence (Public Health England, 2019). When taking into account both

net income and the cost of smoking, 3,002 (or 27%) of all families are at or below the poverty

level. If these people in Bedford Borough gave up smoking, 658 families be rescued from

their plights of poverty.

Figure 3: Cost of smoking in Bedford

Source: file:///C:/Users/cara.umney/Desktop/JSNA/2015%2016/ash.org.uk/localtoolkit/

docs/Reckoner.xls

The estimated 18,021 smokers in Bedford Borough cost the local economy £31.9 million

annually. The Integrated Household Survey (IHS) was used to calculate prevalence rates;

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however, if the Annual Population Survey (APS) had been used, the picture would seem

different and the numbers would be higher. An estimated £4.3 million is spent annually on

direct treatment of smoking-related sickness in Bedford Borough, with an additional

£261,664 spent on addressing the effects of passive smoking on non-smokers (PHE – Public

Health England, 2018).

It is estimated that in Bedford Borough alone, £2.3 million is spent annually (Public Health

England, 2019.)on treatment for current and former smokers who develop smoking-related

ailments in old age . This translates to a cost of £1.3 million for the local government and

£997.3 thousand for those who choose to pay for their own treatment out of pocket. Each year

in the United States, there might be as many as 5,000 miscarriages, 300 perinatal deaths, and

around 2,200 preterm births United Kingdom due to smoking during pregnancy (PHE –

Public Health England, 2018). A total of roughly 70,000 babies are delivered to mothers who

were smoking throughout labour and delivery in England each year (PHE 2015/16).

Significant demographic variations and characteristics linked to inequality and deprivation

are associated with smoking at the time of delivery. More than three times as many moms

under the age of 30 smoke during pregnancy than do mothers beyond the age of 30 (Public

Health England, 2019). Children of smokers are more likely to take up the habit themselves, a

cycle that contributes to generational health disparities.

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Figure 4: Smoking at time of delivery

Source: NHS digital (HSCIC) - Statistics on Women's Smoking Status at Time of Delivery

England

The Bedfordshire Clinical Commissioning Group provides the basis for the local data sets;

Consequently, it is shown as information from Bedfordshire. Bedfordshire's 10.3% smoking

rate at birth is lower than the regional and national rates of 11.2% and 10.6%, respectively

(Public Health England, 2019). The Stop Smoking Service at Bedford Hospital Trust has

strong ties to both the Maternity Department and the community services provided by SEPT.

The majority, 53%, of community midwifery teams have received training to refer patients to

the Stop Smoking Service, take carbon monoxide readings, and provide brief interventions to

help smokers quit (PHE – Public Health England, 2018).

3. Determinants, Inequalities and Barriers to Health

According to Statistics on Smoking, (2014), health disparities are preventable and unjust

discrepancies in a person's health state. People who share characteristics such as

socioeconomic class, race, or gender are more likely to have these experiences. There are

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repercussions for society as a whole when unequal conditions result in early deaths and fewer

years spent in good health substantial financial and ethical implications for our society

(Public Health England, 2019). The social determinants of health include socioeconomic

variables including social class, living circumstances, and income that interact to have an

effect on an individual's overall health. Genetics, lifestyle, environment, and health care are

the four key factors that comprise the four layers of the primary factors in developing health.

Figure 5: Determinants of health

Source: Adapted from Dahlgren & Whitehead, 1991

According to the findings of the Marmot Review of health disparities in Bedford in "Fair

Society, Healthy Lives" (Marmot, 2010), those who live in the poorest regions of Bedford

will pass away on average seven years sooner than those who reside in the wealthiest areas;

they will have worse quality of life for a longer period of time. This is the relation between

socioeconomic status and health. There is more to it than just a straightforward correlation

between money and longevity. When seen on a global scale, the curve levels off with a

GDP/capita of $10,000; what is more important is how countries work toward improving the

health and welfare of their inhabitants (Marmot, 2010). The Marmot study made

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recommendations about six primary areas that would have the most impact on reducing

health disparities. Among them were ensuring that all children had the greatest possible start

in life, expanding people's access to stable employment, protecting people's standard of

living, and enhancing educational possibilities. When determining the health requirements of

a community, it is essential to take each of these aspects into consideration. Social, economic,

and environmental factors all contribute to people's overall health (Public Health England,

2019).

Environmental, social, economic, and genetic variables all have a role in determining an

individual's overall health. Due to systematic changes in these characteristics throughout

bedford community, health disparities may emerge, adversely impacting the health of more

disadvantaged people (Statistics on Smoking, 2014). Those with less education are less likely

to be employed with a decent salary, and hence more likely to smoke (Office of National

Statistics, 2022). The proportion of current smokers in the UK is lowest among individuals

with a university degree (7.3%), compared to those with no university degree (29.1%) (Office

for National Statistics, 2022). Low income is associated with increased smoking prevalence

compared to higher income levels (Office for National Statistics, 2020). Smoking prevalence

is highest among those with routine and manual jobs (23.4%), followed by those with

intermediate jobs (12.4%), and then those with management and professional jobs (9.3%) in

the United Kingdom (Office for National Statistics, 2022).

Disparities in health care access and quality are known as health inequalities, and they are

both unjust and avoidable (Public Health England, 2019). They result from factors such as

where one is born, the kind of job one does and age all of which have an effect on one's

health and longevity (Public Health England, 2019). Smoking is a major contributor to health

disparities since it shortens people's lives and makes it more difficult for them to live

independently from the effects of impairment. According to the Office of National Statistics

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(2022), in 2016, smoker rates were four times higher in the most disadvantaged parts of

England compared to poor areas. In 2016, almost 6.3 million people in England smoked, with

the highest rates in the poorest communities (Office for National Statistics, 2022). One in six

(16%) people in the United Kingdom resided in the 10% most disadvantaged regions,

whereas one in twenty (5.2% of the population) have access to the least disadvantaged

neighborhoods (Office of National Statistics, 2022). In England's most and least

disadvantaged regions, male and female birth life expectancies were 9.4 and 7.6 years

shorter, respectively, in 2017-2019 (Office for National Statistics, 2022). Those in the most

economically disadvantaged locations have more severe health disparities in terms of access

to care and health outcomes (Nursing In Practice, 2021).

High-poverty neighbourhoods in Bedford are associated with a higher risk of acquiring

chronic respiratory ailments, cardiovascular diseases, and arthritis compared to less

impoverished neighbourhoods. This might be due to a lack of encouragement and

information about healthy living and bad habits, which could lead to an increase in risky

lifestyle choices like smoking and being overweight. People in low-income areas are a prime

market for tobacco companies because they are more likely to use smoking as a coping

mechanism for the stresses of daily life (Inequality, 2021), tobacco contributed to the poverty

of 447 thousand families in the United Kingdom.

4a. Review of Current Service Provision

The Clinical Commissioning Group (CCG), which is the governing authority for healthcare

in the county, has representatives from each of Bedfordshire's 53 general practitioner (GP)

practises (Office for National Statistics, 2022). The 53 general practitioner (GP) practises in

Bedfordshire, consist of members of the consortium (Public Health England, 2019).

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About 450,000 people in Bedfordshire Borough and Central Bedfordshire depend on them to

plan, administer, and purchase healthcare services paid for by the NHS (Public Health

England, 2019). These people may be found in Bedfordshire Borough as well as Central

Bedfordshire. Because they are the individuals with whom you interact anytime you interact

with the National Health Service (Office for National Statistics, 2022). It is logical for

general practitioners, nurses, hospital physicians, and other clinicians to run the British

Clinical Commissioning Group (BCCG) (Office for National Statistics, 2022). In addition,

the British Clinical Commissioning Group (often abbreviated as BCCG) is the name of this

organisation. Healthcare in the Private Sector in the United Kingdom in the Year 2020

(Office for National Statistics, 2022). Additionally, Private medical facilities and services,

which are offered to individuals in addition to companies, may be found in Bedford, which is

home to a sizeable number of these establishments and services (Office for National

Statistics, 2022).

These conveniences and services include not one but two hospitals in addition to a significant

number of medical facilities located all throughout the surrounding region (Public Health

England, 2019). Nicotine replacement therapy, which is often referred to more widely as

NRT, bupropion, and varenicline are the three primary pharmaceuticals that are supplied by

the National Health Service (NHS) to patients who are attempting to quit smoking. Patients

may get these prescriptions free of charge including testing and screening(Office for

National Statistics, 2022). In addition, general practitioner (GP) practises provide

consultations with a practises nurse or a healthcare assistant who has been trained as an

expert in the field of quitting the habit of smoking and may give advice on how to do so

successfully (Office for National Statistics, 2022). The customer will have the chance to

discuss their choices with a skilled professional who is able to offer them with correct

information as well as assistance to assist them in quiting smoking during these visits (Office

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for National Statistics, 2022). During these appointments, the individual will have the

opportunity to get advices and lessons that may help them change their mind and maybe quit

smoking.

4b. Role of the Nurse in Health Promotion and Screening

In relation to NMC code, nurses are required to "give careful consideration to enhancing

people's sense of well-being, preventing disease, and adapting to their ever-evolving health

care requirements at every stage of life." (NMC, 2018). This requirement applies to all

periods of a person's life. As a result of the fact that nurses are involved in almost every

aspect and location of patient care, they have a particularly advantageous position from which

to make contributions to public health. In the United Kingdom, nursing is consistently ranked

as the "most trusted profession."

Additionally, compared to other medical professions, nurses spend a greater amount of time

directly with patients (Nursing In Practice, 2021). All Our Health is a resource that is geared

at helping those who work in the medical field understand how they may more successfully

offer health promotion that is based on research. It offers material that is organized according

to topics, as well as learning opportunities online and suggestions for how to conduct 'short

discussions' with patients. This strategy is known as "Making Every Contact Count" (Health

Education England, 2023). It is recommended that nurses address smoking, exercise, and

alcohol use with patients who have cardiovascular disease and ask them whether or not they

have had their blood pressure and cholesterol tested. The use of these tools may provide

nurses with an increased level of self-assurance when it comes to having these talks;

nevertheless, this is yet another responsibility that nurses need to make time for, and they

may be required to engage in independent online learning (Kemppainen et al., 2013, p. 490-

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501). It's possible that some nurses are in managerial or strategic positions. If so, they may

make a significant contribution to health promotion by examining broader concerns within

the service they work in and assisting in the distribution of resources to the appropriate

individuals.

Many of the treatments for cardiovascular diseases are administered by nurses, such as

rehabilitation, addiction specialists, and general practitioner nurses who do NHS Health

Checks. There are obstacles, such as patients not adhering to treatment or just lacking the

motivation to alter their behavior. According to the findings of several studies, members of

the general public are more inclined to follow the recommendations of someone who models

good behavior in their own life. There is a lack of information on patient views and

insufficient evidence to imply that nurses' own weight or alcohol usage affected their health

promotion practice (Mendes 2022, p.525-526). The empowerment concept is a good

illustration of this. Individuals recognize their own issues and then get the confidence to take

action based on those worries. Sometimes individuals will not be ready to make a change,

and a nurse's job would be to let them know that the door is open in the future even if they are

not ready to make the change now. It is impossible for nurses to become specialists; thus, one

of their most essential responsibilities is to recognize when they need more guidance and

direct patients to other services.

5. Conclusion

In conclusion, there is a rising public health concern about smoking as a result of educational,

economic, and social inequalities that have a plurality of bad knock-on consequences on

people's health and life expectancy in Bedford. These disparities are caused by the fact that

smoking has a multiplicity of negative knock-on impacts on people's health and life

expectancy.

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The greater rate of smoking in Bedford also indicates a growing problem in terms of public

health. Smokers have access to a variety of services, including as the Stop Smoking Service,

the National Health Service (NHS), and vape shops. However, if national lung cancer

screening activities are carried out in a safe manner, they may assist in the early detection of

the illness and make it possible to begin treatment at an earlier stage. Nurses play an

important role in ensuring that patients obtain the support they need by providing them with

guidance and sending them in the direction of appropriate resources.

It is possible to make recommendations within the scope of nursing practice that, if

implemented, would improve the standard of care given to patients as a whole. These

suggestions might include ensuring that interprofessional cooperation is finished and

competent, as well as ensuring that nurses do not discriminate against patients based on the

patients' social status or habits. In addition, these recommendations could include ensuring

that patients are not subjected to discrimination based on the nurses' own personal beliefs. It

is feasible to increase access to healthcare for all individuals by improving access to local

services and expanding access to public transportation. It is possible that nurses may play a

big role in persuading people to give up smoking if they treated smokers with more love and

acceptance and abided by the regulations that were set at the local or national level.

6. Recommendation

The practice nurse has to be able to assess patients' and families' needs by educating them and

providing support for inpatients in acute care and mental health settings who are attempting

to temporarily abstain from smoking with the ultimate goal of quitting smoking permanently.

To help present smokers, it is necessary to reduce both the supply of and the demand for

illicit tobacco in kicking the habit and discourage younger generations from starting to

indulge in it. Programs that decrease both supply and demand have a significant influence on

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encouraging smokers to give up the habit, and effective marketing may increase the number

of people who use cessation services.

Creating a marketing strategy that is more focused on the consumer and uses a variety of

different media to target important groups with information, support, and encouragement to

quit smoking. In particular, make advantage of the help that is provided by the Central

Bedfordshire Stop Smoking Service.

Developing a website for Smokefree Bedfordshire and including online support programs for

users of the service are two of the goals of this project. Implementing electronic booking

tools will also help to expedite administrative processes and improve the overall experience

for Smokefree Bedfordshire's clients.

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7. References

Cornes, M., Nagendran, T. and Manthorpe, J., 2008. Care and support needs in rural areas: a

review of joint strategic needs assessments in England. London: Social Care

Workforce Research Unit, Kings College London.

Crosse, A., 2018. Orthodontic needs assessment for Northamptonshire, Bedford Borough,

Central Bedfordshire, Luton, Milton Keynes and Hertfordshire 2018. Public Health

England.

Health Education England (2023). Available at: https://www.hee.nhs.uk/.

Hopkinson, N.S., 2020. The path to a smoke-free England by 2030. Bmj, 368.

Kemppainen, V., Tossavainen, K. and Turunen, H., 2013. Nurses' roles in health promotion

practice: an integrative review. Health promotion international, 28(4), pp.490-501.

Marmot Review report – ’Fair Society, Healthy Lives (2010). Available at:

https://www.local.gov.uk/marmot-review-report-fair-society-healthy-

lives#:~:text=The%20Marmot%20Review%20into%20health,can%20lead%20to

%20health%20inequalities.

Mendes, A., 2022. Nurses’ role in smoking cessation interventions. British Journal of

Community Nursing, 27(11), pp.525-526.

Nursing In Practice (2021) Nursing News, Articles & Learning | Nursing In Practice.

Available at: https://www.nursinginpractice.com/.

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Office for National Statistics (2022) “How the population changed in Bedford: Census 2021,”

www.ons.gov.uk

https://www.ons.gov.uk/visualisations/censuspopulationchange/E06000055/.

PHE – Public Health England, Tobacco Control Support Pack 2017-2018

Public Health England, 2019. Local authority health profiles.

Scanlon, D.C.A.B., Marie Horton and Sophie (2019) “Adult smoking habits in the UK -

Office for National Statistics,” www.ons.gov.uk [Preprint]. Available at:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/

healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018.

Statistics on Smoking: England 2014. Health and Social Care information Centre 2015.

The Nursing and Midwifery Council NMC (2018). Professional standards of practice and

behavior for nurses, midwives and nursing associates. Available at:

https://www.nmc.org.uk/standards/code/.

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