Public health as agreed by the faculty for public health (2010) is “ The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society. ” A health needs assessment HNA, is a public health tool which underpins a large proportion of government policy. It offers ideal opportunities to engage with an identified population, and accumulate evidence from them and about them. This provides an evidence base from which resources can be prioritised and delivered.Through partnership working with key stakeholders, increasing the capacity to promote and protect the health needs of a population, and reducing the level of unmet need and health inequalities.
(Cavanagh and Chadwick 2005) An HNA is designed to lead to the implementation of a public health strategy. (Cavanagh and Chadwick, 2005) The assessment is supported by local and national government priorities which encourage local authorities, groups and individuals to establish which services are required to meet these needs, therefore implementing strategies that are needed by communities to prevent ill-health.Through Healthy Lives Healthy People (2010) the government promotes the move of power to local government and communities, enabling them to tackle local problems and increase their health and well-being. Epidemiology is the study of health and disease in populations (Saracci 2010). It enables a strategic insight into the prevalence and indecencies of particular conditions or needs, and promotes the understanding of why they concentrate in particular populations. (PCT Network 2008).
‘Need’ implies the capacity to benefit from an intervention. Asadi-Lari et al. (2003) acknowledged that this capacity to benefit can be influenced by several factors including epidemiological aspects such as incidence and prevalence of disease and the effectiveness of interventions. An HNA is an initial step in planning a health promotion intervention. Historically, the promotion of population health has been dominated by focusing on why individuals and communities become ill.This is known as a pathogenic approach. However, this approach has been shown to be inadequate in promoting health and well-being amongst individuals and communities, as they have a tendency to ignore psychosocial factors as well as abilities and resources for health and well-being. More often than not, pathogenic approaches are usually professionally-led, and encourage dependency on health services; they are inclined to dis-empower individuals and communities.
(Naidoo and Wills 2010) Antonovsky (1996) promotes the Salutogenic approach to health, which offers the opportunity to discover why individuals and communities remain healthy despite being faced with challenging circumstances. Antonovsky identifies this as a sense of coherence which is the capacity to understand, manage and make sense of change. The concept of need has many dimensions, as individuals and populations have varying perceptions of what need is.There are four main types of health and social need, as identified by Bradshaw’s Concept of Social Need (1972) cited by Naidoo and Wills. (2010) An HNA must involve a balance of Bradshaw’s identifies health and social needs when selecting priorities. (Canvanagh and Chadwick 2005) Normative needs, which are professionally identified with professionally defined intervention. Felt needs are identified by individuals as a variation from what is normal health.
Expressed needs are felt needs which the individual has requested support for.Comparative needs are compared to similar population groups or individuals. Public Health Observatories provide information on a population’s health. Their purpose is to produce a format from which practitioners, commissioners, policy makers and the wider community can gain insight into the health needs, and access meaningful health intelligence (2012). Indicators are measures that reflect the state of a population in terms of health, socio-economic statuses.
They might also reflect the process and outcome of existing services.(PHO 2012) Information published from Child and Maternal Health Observatory (2012) and the joint strategic needs assessment (2012) has identified that there are a lower then average percentage of children in the local area, profiled in carrying out the health needs assessment are not achieving a good level of development at age five. This is measured by Foundation Year teachers during the child’s foundation year at school, and focuses on the child’s emotional, social and communication abilities.(DE 2011) There is evidence that supports confirms that the areas of personal, social and emotional development, communication and language, and physical development are the essential foundations for healthy development. (Tickell 2011) The extent to which children are ready to start school and are able to learn can have a long-term impact on their success in education and employment (Washbrook and Waldfogel 2011). Children who are assessed in the foundation years at school as being in the bottom range of achieving good level development tend to stay there.
(Field 2011) It is widely understood that a child’s level of development at aged five can affect their ability to make informed healthy choices about how they lead their lives (Chimat 2011). World Health Organisation, WHO (2007) recognises that the many challenges we face in adult society, for instance mental health problems, criminality and competency in literacy and numeracy to name a few, stems from early childhood. National statistics on Early Years Foundation Stage, are produced by the Department for Education, alongside other data relevant to health needs and published on the Public Health Observatory.(PHO 2012) In terms of accuracy, the Public Health Observatory acknowledges that data submitted by local authorities is done so on a voluntary basis, for 2011 / 2012 the data collected from local authorities was submitted for 57% of children.
Ten local authorities provided complete data, and one hundred-and-twenty-nine provided partial data. Thirteen local authorities did not provide any data. (PHO 2012)The information gathered from the observatory which contributed towards this HNA, provided the following data.The percentage of children achieving a good level of development at age five within the geographic area is low at 47. 3%, compared to the local authority chosen for this HNA which averages at 49%.
It is also low compared to the national average of 55%. England’s worst is recorded 11. 2%. (PHO 2012) It has been identified that in comparison to other local authorities across the county, levels of development achievement at age five with the identified local authorities have been decreasing since 2008. (CYPT 2011).Bronfenbrenner (1979) developed an Ecological Theory of Child Development which looks at the complexities of relationships and the surrounding environment, and how they impact upon the child’s development, which focuses on four component systems. The Microsystem, which is defined by the immediate relationships and attachments directly experienced by the child.
The Mesosystem, which reflects the link between interactions of the family and the child. The Exososystem, which is external sources not directly related to the child. The Macrosysterm is the fourth component of Bronfenbrenner’s (1979) Ecological Theory of Child Development.
This focuses on cultural, political and legal aspects of society. This model reflects the work of a specialist community public health nurse working across and through-out the systems of this ecological theory leading the Healthy child programme, collaborating with key stake holders (Bryans 2009) Within the Microsystem, (Bronfenbrenner 1979) the presence or lack of secure attachment and attuned parenting effects how the child’s brain develops in the first two years of life, and is influenced by the emotional and physical environment including level of learning opportunities as well as by genetic factors.(DH 2009) These impact upon the child’s sense of coherence as described by Antonovsky’s Salutogenic model. (1996) The Healthy Child Programme, (HCP) (DH 2009), produced by the Department of Health to guide primary care trusts (PCTs), local authorities and providers of services. This programme is led by Health Visitors focusing on pregnancy and the first five years of life. (DH 2009) The healthy child programme focuses on a universal service, providing families with routine health and development reviews, with additional advice about health, well-being and parenting, whilst maintaining a wider public health view.
The health visitor role supports the Mesosystem link with the Exosystem (Bronfenbrenner 1979) by collaborating with key stakeholders to support and encourage the engagement between families, Local children’s centres, libraries and the ‘bookstart’ programme Bryans et al. (2009) Funding for libraries and book start has been reduced over recent years, (Bailey 2011) which may have unintentionally contributed inequalities which are presented as the low level percentage of children achieving good development at aged 5 within the profiled area for the health needs assessment.(PHO 2012) The Tickell Early Years Report: Foundations for Life, Health and Learning (2011) highlights the interaction between the Microsystem, Mesosystem and Exosystem (Bronfenbenner 1979) as it identifies good quality early years provision as being the next largest impact on a child’s development, following secure and attuned parenting influences. Tickell (2011) recommends that personal, social and emotional development, communication and language are acknowledged as key areas of development in the early year’s services.Health visitors mediate between parents and community resources to facilitate, build and strengthen collaborative working with key stakeholders.
(DH 2011) Bronfenbrenner’s (1979) Macrosystem does not seem to directly influence the child; however this component interacts with the Mesosystem and Mircosystems as it relates to the social-political factors. (Bryans 2009) Social and economic conditions impact upon the sense of coherence, which can determine an individual’s ability to facilitate health and well-being.(Ananovsky 1996) These are known as the wider determinants of health that cause health inequalities.
The stress caused by poverty is shown to increase the risk of parents being less able to provide conscientious and sensitive parenting. (Waldorf and Washbrook 2011) By 3 years old a child in a family living in poverty is likely to be eight months behind in language, and nine months behind in school readiness, compared to families not in poverty.(Bailey 2011) Indicators show that 42. 1% of children living in the identified ward live in poverty, which is higher than the average for the wider local area where 29. 6% are affected, and significantly higher than the County, which gave a total of 18. 1%.
(PHO 2012) The Child Poverty Act (2010) established a plan to alleviate child poverty by 2020, setting out to reduce the disadvantage of the social and economical determinants.Evidence indicates that factor within the Mesosystem and Exosystem (Bronfenbrenner 1979), for instance attuned parenting aligned with positive engagement with community facilities such as children’s centres and libraries can reduce unmet need and health inequalities, modifying the levels of children achieving a good level of development at aged five, even though significant confounding factors which make up the Macrosystem are taken into account. This is also supported by Washbrook and Waldfogel (2011) who note that high quality early years services can protect children from less than ideal home environments.The government has allocated funding to facilitate free early years education to the most disadvantaged two-year olds (DE 2012) The Strategic Review of Health Inequalities in England Post-2010 (The Marmot Review) (2010) Promoting development of children in the first years of life by giving them the best start is the number one recommendation of the UK report, (The Marmot Review 2010) and also features substantially in the WHO Commission report (CSDH 2009) These reports promote broadening interventions to include integrated programs of social, emotional, language, behavioural and cognitive development to the age of five.(Lynch et al. 2010) The child health strategy Healthy Lives, Brighter Futures, (2009) produced collaboratively by the Departments of Health and Education, is identified by the WHO, (2009) Commission for the Social Determinants of Health and Marmot reviews as a clear and integrated policy response. These policy proposals for reducing inequalities in child development are significant to increasing support to families through parenting programs and Children’s centres. (Lynch et al.
2010).Using Bronfenbrenners ecological development theory (1979) as a framework to guide health visiting intervention to improve levels of child development within the context of the interrelated determinants of health enabling a move away from the pathogenic approach to health promotion. (Naidoo and Wills 2010) Bronfenbrenners (1979) theory facilitates a ‘person in context’ approach, focusing on the wider aspects of what keeps people health as described by Antonovsky (1996) Salutogenic approach and the individuals sense of coherence. Reference list. Antonovsky,A.
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