Urban Health Issue in London Borough of Kensington and Chelsea - Essay Example

Analysis of Health inequalities as an Urban Health Issue in London Borough of Kensington and Chelsea Introduction According to Marmot (2010) health inequalities as experienced in London is at an increase. The Marmot review statistics established that Kensington and Chelsea registered the highest rate, claiming that in one ward a person is expected to live up to 88 years while in another within the same borough a person will live to only 72 years (Marmot, 2010). According to the World Health Organization (2009) “Health inequalities, are unfair disparities observed in health outcomes between individuals or groups of people”. The WHO Report (2009) further argues that health inequalities are associated with the social and economic gaps experienced by different people that may further compel them to indulge in specific behaviors and lifestyle choices that later place their health at risks as well as deny them the opportunity to overcome any health implications resulting from their actions. This essay examines the levels of health inequalities in London borough of Kensington and Chelsea. The essay will start by discussing the rationale behind health inequalities as an urban health issue in Kensington and Chelsea. Data from previous studies will be looked into and further discussed based on the social and economic determinants of health inequalities in London Borough of Kensington and Chelsea. Epidemiology data will be analyzed and used for comparison purposes. In the subsequent section, this essay will discuss the public health consequences and implications that are linked to, the population of London as a whole, the Boroughs of Kensington and Chelsea, on the individual and public health. The essay will further carry out an assessment on the strategies and interventions that have been put in place by the health officials as a means to fight health inequality. As part of the concluding remarks the essay will provide a summary on the main points as well as make a number of recommendations. Background and Rationale The London Borough of Kensington and Chelsea is an urban setting whose population is made up of a large number of the young people who are the working age and a slightly low number of children (Marmot, 2010). In addition to this, the borough of Kensington and Chelsea was ranked as the sixth borough with the highest population mobility rate. According to the statistics by the office of the national statistics, such a population structure influences the kind and range of services that residents in a borough can receive (Office of National Statistics, 2012). Furthermore, an increase in population mobility in any urban setting creates barriers on effective administration of public health services like screening and immunization. Marmot (2010) argues that despite the high rate of life expectancy in Kensington and Chelsea, there are still a number of cases on poor health. Poor health in this area is mostly characterized by poor living standards among people residing in areas that are mostly deprived which result to large inequalities (Marmot Review Team, 2010). Figure 1 Population Structure 2010 According to the National Equality Panel (2010) poverty and deprivation are identified as the top most factors that deny a population of enough opportunities as well as resources therefore leading to health inequalities. During the 2010 census in London, Kensington and Chelsea came 103 as the most deprived local authority in the country. The majority of wards that were deprived in this borough were mostly in the northern part of Kensington and Chelsea. Figure 2 Index of Multiple Deprivation 2010 London Boroughs of Kensington and Chelsea Townsend (1987) argues that deprivation is characterized by a number of factors within a society and one can be said to be deprived if they lack any basic needs, social amenities or any facilities that are considered as a must for a person to have. According to Dorsett (1998) urban areas tend to experience high levels of deprivation than rural areas. This is due to the different nature of socio-economic attitudes, biological factors and surroundings of an individual that may affect the outlook of a person depending on their race, ethnicity or environment (Townsend, 1987). According to Townsend (1987) these factors can contribute to urban health issues within an urban area and can be experienced by the entire population or a group of people. According to the Index of Multiple Deprivation of 2007, 21.8% (38,394) of residents in the borough of Kensington and Chelsea lived in the highest deprived areas while 0.9% (1,629) of the population lived in the least deprived areas (National Health Service Kensington and Chelsea, 2007a). Moreover, health deprivation and disability is popular in the northern areas of Kensington and Chelsea which is also characterized by the highest number of ethnic minorities. According to the Office of National Statistics (2008) London index of multiple deprivations is defined in different dimensions which include; “income, employment, education, health, access to services, housing, environment and community safety”. According to the National Health Service Kensington and Chelsea (2007a) the index of health inequality in Kensington and Chelsea displays a significant difference when it comes to life expectancy between men and women. In the most and least deprived areas, the life expectancy year gap for men was 6.9 as opposed to that of women which was 2.5 year gap in the years 2006 through to 2010 (National Health Service Kensington and Chelsea, 2007b). It is therefore evident that there is a major variation in the life expectancy between genders in the social gradient in Kensington and Chelsea. Therefore health inequalities in the borough are characterized by premature deaths with the highest numbers from half of the four wards in the northern region of the borough (Marmot Review Team, 2010). According to the Marmot review, health inequalities as experienced mostly in the northern part of Kensington and Chelsea is associated with the environment in which a person is born, grows up, live and work (Marmot Review Team, 2010). According to Marmot (2010) the accumulated implications of deprivation a person experiences throughout their life is associated with disease and ill health. Figure 3 Life expectancy gap between the most and least deprived areas in Kensington and Chelsea (2001-05 – 2006-10) Urban Context and the Determinants of Health inequalities According to a research conducted by Gibbons et al (2011) the number of people living in urban centers is increasingly becoming high and the figures are predicted to go up from 2.86 billion in 2000 to 4.98 billion by 2030. As a result, such an increase in population has shaped the context in which people live in. therefore there is need to have a clear understanding of the social, physical and political environment and how each one of them impacts the health and well being of a population. According to Galeo & Vlahov (2005) one cannot disapprove the role urban areas play in shaping the health of a population. London has shown remarkable population growth as an urban city. The Office of National Statistics (2012) argues that London is one of the most populated cities around Europe. This is because; the population of London has been increasing by 8.3% since 2001. According to the 2011 census conducted in London, the total population of London stood at 8.17 million with 3.27 million households (London Poverty Profiles, 2011). The populations accounts for 36% of people living in London but born outside the city and 3.3 million BME (Office of National Statistics, 2012). The office of National Statistics estimates the population of Kensington and Chelsea to be 169,500 people which is characterized by high numbers of immigrants moving in and out of the borough in addition to ethnic and cultural diversity. This population is also predicted to rise in the near future due to the keen focus placed on development and growth (Office of National Statistics, 2012). K&C London England White British 50% 60% 87% White Other 29% 11% 4% Black 7% 11% 5% Asian 2% 12% 2% Other/Mixed 10% 6% 2% White 79% 71% 91% BME 21% 29% 9% Figure 4 Population Ethnicity 2001 in Kensington and Chelsea Health inequalities determinants Lifestyle and health related factors According to Acheson (1998) habits such as smoking, binge drinking, lack of proper physical activity are all defined as some of the habits that a person may indulge in and eventually become part of their lifestyle. Binge drinking and smoking have been identified as two of the most life threatening activities which may lead to developing several chronic diseases and are also noted as major health inequalities determinants between socioeconomic groups (Department of Health, 2003). Nonetheless, binge drinking is also a contributing factor to crime, anti-social behavior and violence which are all associated with lifestyle risk factors. In London alone, in the years 2004 through to 2008 at least 35% of the population under 35 years old developed liver disease and died (Lord, 2008). According to the statistics collected in the city of London and its borough one out of every five men and one out of every ten women indulge in binge drinking on a daily basis (Mayor of London, 2007). Figure 5 Early death rates from preventable liver disease According to Jarvis & Wardle (1999) smoking is used as an antidepressant among individuals that come from the most deprived homes or locations. Kensington and Chelsea are identified as being among the borough in London with the highest prevalence of smoking with 50-70% smokers (Department of Health, 2011). According to Owen and Penn (1999) smoking is most popular among marginalized groups of people and as a result most pregnant women from deprived areas tend to smoke more than those from least deprived areas. According to Lord (2008) in Kensington and Chelsea, Cancer and cardiovascular disease such as heart disease and stroke are mostly attributed to unsafe alcohol intake and smoking. According to research 47% of this population has previously died of cardiovascular diseases and at least 54 of the residents in this area die of heart disease while 12 of them die of stroke (Social Exclusion Task Force, 2010). Figure 6 premature deaths in Kensington and Chelsea by cause in 2011 Socio-economic and environmental factors According to a Marmot review, the health implications associated with the current economic status in Kensington and Chelsea is that most people are likely to be living with a disability in most wards (Marmot Review Team, 2010). This is due to the fact that the highest proportion of working population is the young age and without an effective intervention most of them tend to suffer from one kind of mental disability. According to Bajekal et al (1998) levels of deprivation and poverty in terms of socio-economic and environmental factors vary from income, employment, housing, occupation and education. According to National Statistics (2003) the highest numbers of individuals suffering from mental disabilities are those from the most deprived areas in a location. In London mental health has been identified as one of the most common form of disability in the lives of many due to stress, anxiety or depression (Department of Health, 2006). According to the Social Exclusion Task Force (2010) at least 5% of premature deaths in London before the age of 75 years occur due to poor mental health while 40% of the population in London lives with a mental health disability throughout their lives. The highest rates of severe mental health issues in London include; bipolar disorder, other psychoses and schizophrenia (Marmot, 2010). According to the Marmot Review Team (2010) mental ill-health is greatly associated with other chronic diseases. For instance, a person suffering from diabetes is likely to also suffer from depression or anxiety. Individuals living in deprived areas and those who go for a long while before securing employment are most vulnerable to acquire mental diseases. This according to the Marmot Review Team (2010) is because unemployment is a major factor that contributes to low income, proper housing and healthy lifestyle which are forms of deprivation. In Kensington and Chelsea, 15-30% of patients admitted for chronic diseases, are those with severe cases of depression, anxiety and stress (Marmot, 2010). Mental health in this borough accounts for 14% of sense organ diseases, 8% of respiratory diseases and 8% of musculoskeletal disorders (National Health Service Kensington and Chelsea, 2007b). Figure 7 years of life with disability by cause 2004-2008 Public Health Consequences and Implications that impact on the general population, on individuals and on the health services. According to Pickett and Pearl (2001) the implications of the high prevalence of health inequalities is related to increased levels of deprivation and poverty. This is because most of the population living in a deprived neighborhood is at risk of being exposed to social, physical and psychological health consequences. Pickett & Pearl (2001) argue that the populations in deprived regions are heavily dependent on community resources and social amenities within their locale. Psychologically, individuals from deprived areas or abject poverty end to suffer from low self esteem, anxiety and depression. These factors may lead to unhealthy lifestyle choices and behaviors such as binge drinking and misuse of drugs (Social Exclusion Task Force, 2010). The lack of proper and adequate social amenities and basic resources creates a barrier for some of these people from deprived regions to access proper medical care and therefore leading to poor health outcomes (Wilkinson, 2002). According to the Department of health (2006) the cost of treating mental disorders such as anxiety, depression and stress, is quite high therefore placing the marginalized group at a disadvantage. People living in deprived areas evade seeking medical help due to the high costs associated with it. The socio economic and environmental factors have pushed people to occupy surroundings that place them at social and health risks. Additionally these people are also unable to afford proper housings as well as a balanced diet this raises the costs associated with treating malnutrition as well as physical and mental illnesses (Association of Public Health Observatories, 2010). According to the Marmot Review Team (2010) deprivation within the population of London continues to affect children with 21% of these children living in deprived Boroughs. Deprivation and poverty within the city of London impact the lives of children as they face social seclusion especially in school which eventually leads to absenteeism at school and in turn affects the learning outcomes of a child (Harker, 2006). Strategies and interventions for addressing this urban health problem In London Kensington and Chelsea several strategies and interventions have been introduced in order to tackle health inequalities as experienced by the population. In Kensington and Chelsea local voluntary and community development projects have been implemented in order to fight the various forms of health inequalities. These projects are aimed at fighting health inequalities especially in terms of the number of population and the economic factors that contribute to it. The voluntary and community development organizations work closely together with the general public in order to come up with preventive measures to eradicate health inequalities (National Health Service Kensington and Chelsea, 2007a). Some of the voluntary organizations in Kensington and Chelsea include; the Voluntary Organizations Forum and its sub-groups, the BME Health Forum and the Sexual Health Providers Forum (National Health Service Kensington and Chelsea, 2007b). These groups work closely together and provide networking opportunities for professionals to participate in sharing ideas and tackling the urban health issue. For instance, voluntary organizations have partnered up with the local health service departments. Such partnerships have facilitated effective service delivery to the population through financial and contractual collaborations (National Health Service Kensington and Chelsea, 2007a). According to the Marmot Review Team (2010) the local National Health Service has managed to achieve its objectives and eradicate some of the social and behavioral elements that lead to poor health outcomes, by involving the population that is greatly affected. The local voluntary and social council in Kensington and Chelsea continue to use the partnerships formed to promote effective health and wellbeing activities and reduce ill health (Marmot, 2010). This has been successful since they focus on fighting the issue of health inequalities and its wider determinants, whereby the local health departments work with people who are deprived and are at greater risks of facing negative health outcomes (National Health Service Kensington and Chelsea, 2007b). The contributions made by the participants towards the eradication of health inequalities in Kensington and Chelsea are ongoing and have triggered effective health service delivery systems in the borough. In addition to this, the voluntary sectors in Kensington and Chelsea have implements a number of services and programs that aim at supporting the local communities and those who are deprived in airing their views regarding the health and delivery services and how they impact their lives (National Health Service Kensington and Chelsea, 2007b). Another strategy that has been introduced by the city of London is the creation of employment zones in boroughs. These programs have provided job opportunities for unemployed people especially those living in deprived areas. Since the programs were implemented, at least 3830 single parent employment zone provisions have been put in place giving 1510 individuals a chance to secure jobs. According to London Development Agency (2004) by 2006 at least 2.7% of the single parents in London’s deprived areas secured employment through these programs and are currently claiming income support. This strategy has managed to tackle the issues contributing to health inequalities which are poverty, unemployment and deprivation. According to Harker (2006) a large number of the children in London come from deprived homes with parents that are unemployed. Therefore solving unemployment is an effective measure in reducing health inequalities as well as premature deaths. Conclusion This paper has looked into the various forms of health inequalities in the borough of Kensington and Chelsea. Health inequalities are experienced in a number of forms depending on the situation or environment a person is faced with. In Kensington and Chelsea wards in the northern part of the borough have been identified as the most deprived areas and those that face high risks of poor health outcomes therefore leading to health inequalities. The high population of the borough and the high numbers of that immigrants is moving in and out of the borough nave been identified as major factors that contribute to the high rates of health inequalities in the region. Poor lifestyle choices, unemployment and poor access to social amenities and local resources have also been examined as some of the factors leading to deprivation and poverty and as a result causing health inequalities. The health implications of deprivation and poverty on the health outcomes of an individual have been highlighted and discussed. Various socio-economic, environmental and behavioral issues such as; unemployment, poor housing, lack of a proper diet and low income have been linked to poor outcomes of the health of an individual and therefore leading to health inequalities in Kensington and Chelsea. Recommendations In order to achieve the set objectives and aims set by the local council of Kensington and Chelsea, it is important that the local administration and the health department work together in tackling health inequalities in the borough (Marmot,2010). This can be achieved by first building and sustaining a strong national and local leadership body in London and its boroughs. Strong leadership within Kensington and Chelsea deprived areas will play a significant role in the community as they will focus on tackling health issues in highly populated but socially secluded areas (Marmot Review Team, 2010). There is also need to implement an inclusion health agenda policy. This policy will be aimed at improving the relationship between socio-economic factors and the implications it has on the health of a population. According to the Joseph Rowntree Foundation (2010) local and national authorities need to work closely together in order to improve the living standards of people living in most deprived areas and offer them easy access to health facilities at a subsidized price. Moreover the national and local administrators need to identify the challenges that face care givers and health practitioners in reaching out to specific marginalized groups. This way the borough is able to identify the needs of these populations as well as measure the health outcomes anticipated. Therefore a sustainable joint commission between health workers, volunteers and the community should be implemented in order to stimulate innovation and effectively influence positive health outcomes. The innovative services and strategies should be cost effective and offer equal and fair health service to all. In addition to this, Kensington and Chelsea should implement health promotion and preventive measures that aspire to identify any health issues and provide alternative interventions. Social policy and public agenda programs should also be put in place in order to include people in deprived areas in any health and wellbeing strategies in Kensington and Chelsea. This step will ensure that these groups of people are not left out when it comes to the allocation of social and health resources. Implementing social and public inclusion strategies will aim at reducing the increased case of health inequalities which are mostly experienced by people from vulnerable and deprived regions (National Health Services Kensington and Chelsea, 2007a). References Acheson, D. (1998), Independent inquiry into inequalities in health, Crown. Bajekal, H., Blane, D, and Davey Smith, G. (1998). Sociology of Health Inequalities. Blackwell, Oxford. Department of Health. (2006). 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