The Health Needs Assessment

This assignment is a quasi-report on a health need assessment (HNA) which is being prepared, as part of this module summative assessment, in order to gather information on the basis of designing and implementing a programme, on a limited scale, of health and health care acceptable, accessible and identified in Southwark based on evidence of cost-effectiveness and is beneficial to the needs of this practice area. The aim of the report is to demonstrate a critical understanding of HNA and HNA policy at the community level. The use of local and national data in identifying health met and unmet needs by demonstrating an understanding the handling and interpreting local and national data. Using policies context of increasing exclusive breastfeed and using the right evidenced based intervention by emphasising on the advantages of increasing exclusive breastfeeding to infants up to six months old. The intervention of increasing exclusive breastfeeding is through the introduction of fathers’ as an initiative will be discussed in depth.

In order to succinctly focus the critical analysis of the assignment the Hooper & Longworth (1998) five steps theory of HNA will be used.

Step 1) Getting started

Step 2) Identifying the Health Priorities for the Population

Step 3) Assessing the Health Priority

Step 4) Planning for Health

Step 5) Evaluation

As stated above this is a limited assignment therefore not all the steps will be used.

Health Needs Assessment (HNA)

Definition

Health Development Agency (HDA) (2004) define HNA as a way of identifying the health needs and inequalities being experienced by a specific population groups in Southwark and identifying their priorities for professional and service development to improve the health of that target population or individuals to reduce health inequalities. The HNA assist the HVs in identifying the wider determinant of health of the population and appropriate intervention put in place to meet that needs.

Needs or who will be benefiting from the intended intervention must be identified and it must be cost-effective. Bradshaw (1994) identified four different needs which is termed the Taxonomy of Needs – it is Felt needs what the individuals want, expressed needs what is demanded, normative which consists of both the met and unmet needs, and … In this report the normative needs will underpin the HNA as both the met and unmet needs are going to be identify.

Marmot (2003) suggests it is important for people to be in control of their lives and exercise autonomy instead of them being told what they have to do; this is a way of tackling health inequalities (DH 2003). It is Government national priority as resources were allocated to it. HV should make time to find their priorities and preferences and working with their community to achieve their goals. This is a way to achieve health equality and built social capital.

Social capital is the way that HV could work with mothers and fathers in improving community relationships and trust which has a direct and positive effect on increasing breastfeeding continuation up to six months.

Research indicates that peer education by lay people is sometimes more important than getting information by experts who are coming from a level of power.

HMSO (2012) Healthy Lives Healthy People White Paper is an overarching document responding to Marmot Review Fair Society Healthy Live (Marmot 2010) is providing a framework in tackling the wider social determinant of health and health inequalities. It aims to build people’s self-esteem, confidence and resilience right from conception and into older age with stronger support for early years. It is underpin by the White Paper Liberating the NHS (DH 2010) providing the framework in commissioning services that has an impact on the health of the most needy in the community thereby helping in reducing health inequalities.

Demography of Southwark

Health inequality is defined as providing equal health to all across the different boundaries (reference). Southwark in a central London borough and is ranked 12th as the most deprived London Borough and 41st most deprived in England according to the Index of Multiple Deprivation in 2010 (reference). Pocket of extreme deprivation are concentrated in the centre of the borough. Data from the Charity Shelter UK (2012) reveal that Southwark are among the most vulnerable London Boroughs with 1 in 46 households are at risk of losing their homes. According to the 2010 census (NAO 2012) it has a diverse multicultural, multilingual and multi-ethnic population and 51% of the Southwark population is from the British minority ethnic (BME) group.

This is a challenge

In Southwark 4.1% compared to 3.1% in London of the households are homelessness and one is four households are overcrowded living in overcrowding homes (Shelter 2005) putting extra pressure and stress on families relations. However, the coalition government has recognised the overburden on the housing stock and in the process of funding new home building across England (). This will not relieve the housing situation in the sort term.

children living in poverty 16’986 (32.3%) (21.9% England and 29.7% London average)

First time entrant to young justice 402 (0.7% or 4.8%) (Eng. 57’291; London 8’349)

16-18 NEET 330 (4.37%) (4.50% London & 6.13% England)

homelessness 510 (4.11%) (London 3.14%; England 2.03%)

4’136 (90.56%) babies initiated breastfeeding after birth compared with 74.08% in England and 87.06% in London.

3’446 (75.69%) breastfeed until six to eight weeks compare with England 47.02%; London 67.32%.

Smoking status at time of delivery 202 (4.38) compare with England 13.19%; London 6.02%

Under 18 years old conception 679 (61.5%) compare with 38.1% and 40.9%

Infant mortality 79 (5.3%) England 4.6% and London 4.5%

compared to England, 49 percent of the population is white British descent. The largest minority ethnic groups are Black African and Black Caribbean. Southwark has a young population. Overall the health profile of Southwark population is poor. Deprivation, crime, teenage pregnancy, and children living in poverty rates are higher than England average (Reference).

Rationale

The rationale is to identify the role of fathers in motivating and promoting their partners to breastfeed their babies as part of public health initiative thereby reducing health inequalities for both mother and infant. Furthermore, it will explore the health benefit of breastfeeding and the potential health risks factors to babies and mothers if exclusive breastfeeding is discontinued after six to eight weeks postpartum. Evidence has shown that exclusive breastfeeding infants until they are six months old greatly reduce childhood obesity and prevent them from acquiring other health problems when they are adults.

Reducing smoking and increasing life expectancy are among Southwark health priorities together with the reduction of children obesity (Reference). In order to reduce childhood obesity research has shown that mothers should be highly encouraged to exclusively breastfeed their babies up to six months () and fathers are well-placed to encourage mothers whilst breastfeeding (). This underlines the reason

Breastfeeding is among one of the Southwark health priorities as it an important factor in the reduction of child obesity.

Such as reducing smoking and increasing life expectancy most importantly is the reduction of child obesity. Research has shown that breastfeeding up to six months is an important intervention to reduce children obesity.

The rationale

Data

In 2010 there were 5131 live births, the highest birth rate in London, out of which 226 were young mothers under the age of 18 years old (National Office of Statistics (NAO) (2011) and Department of Health (2012)

Links – bf rates and health inequality

The breastfeeding initiation rate was 73.9percent in 2012/13 Quarter 2, which is just less than the annual percentage for 2011/12 (74.1percent) and slightly higher than 2010/11 (73.7percent). The prevalence of breastfeeding at six to eight weeks

92% of mothers in Southwark initiate breastfeeding postpartum until 6-8 weeks. 1 in 4 mothers breastfed their babies 6 months, the remainder either revert to mixed feeding or exclusively formulae-feeding. decrease by 66% thereby coming down to a ration of 1 in 4 babies are breastfed by 6 months and over (Bolling et al 2007; NICE 2008).

Initiation and duration rates of any breastfeeding rates are lowest among families from lower socio-economic groups, adding inequalities in health and continuing to the perpetration of the cycle of deprivation.

BF rates are low in the UK for several generations, and professionals, childbearing women, families and the public at large have all been exposed to formula feeding as the norm.

This is one of the reasons that mothers are encouraged by the midwives and HVs to continuously breastfeed their babies until six months and up to two years. It seems that most mothers discontinue breastfeeding their babies after six to eight weeks reverting to formula feeding which is classified as health inequalities. The intervention by fathers is important motivators in supporting mothers to increase breastfeeding rates up to six months thereby prevent health inequalities.

The 2012 data in England, London and Southwark on initiation and continuation of mothers’ breastfeeding from two hours to six to eight weeks postpartum identified a slight increase from 76% in (year) to over 90% in 2013. The discontinuation of breastfeeding after six to eight weeks is as a result of either mothers are returning to work, feeling pain at breastfeeding or lack of family support. Fathers’ involvement by midwives and Health Visitors (HVs) from antenatal is an important intervention in supporting their partners to breastfed their babies until six months postpartum.

The drive placed on mothers by midwives and Health Visitors (HVs) to continuously breastfeed are underpinned by International, National and local policies

The determination placed on mothers by the Government and Health Visitors (HVs) to exclusively and continuously breastfeed their babies until six months postpartum is an important and effective measure that can protect their health and that of their babies with specific contributions and motivations from babies’ biological fathers. Healthy Child Programme (HCP) (2009) recommends that fathers are involved However, the HCP has conflicting information from the UK government which flexibly recommends formula or mixed feeding could be introduced after four months (17 weeks) however with the caveat it should be delayed until six months. This is giving conflicting information to both the mothers and Health Visitors (HVs) who tends to follow the UNICEF BFI UK guidelines.

Risk Factors

Ip and colleagues (2010) conducted a systematic review of the evidence on the effects of breastfeeding on short- and long-tem infant and maternal health and suggested that breastfeeding reduces the risk of diarrhoea and chest infection; atopic dermatitis and asthma; obesity and type I and type II diabetes (Sherburns-Hawkins et al. 2008); childhood leukemia; sudden infant death syndrome (SIDS) and necrotising enterocolitis. According to

Breastfeeding also confers benefits on the mother by regulating fertility (WHO 2010)

Employment, housing and income are primary determinants of health and health inequalities4. They affect individuals, families and society both directly or indirectly through wider social and economic factors, e.g. child poverty, educational attainment of children, social isolation, etc. London is arguably disproportionately affected by employment, housing and income as determinants of health due to demographics, higher living costs and the nature of its housing and employment markets

Reference Lists

Custworth L. & Bradshaw J. (2007) A comparison of policies to enhance child well-being. Special Policy Research Unit, University of York.

Hooper, J. and Longworth, P. (1998) Health Needs Assessment in Primary Health Care. Huddersfield: Calderdale and Kirklees Health Authority. Downloaded on the 23rd November 2012 www.geocities.com/HotSprings/4202/ hnawrk.html

Shelter UK (2005) Full house? How overcrowded housing affects families. Downloaded on the 24th December 2012 http://england.shelter.org.uk/__data/assets/pdf_file/0016/66400/Full_house_reportL.pdf

Stevens A. & Gilliam S. (1998) Needs assessment from theory to practice. British Medical Journal 316, 440-444.

Tate A., Lloyd T., Sankey S., Carlyon T., Marshall G., Jefferys P., Williamson K and Chung S. (2012) The housing report 2012: The coalition midterm review. Shelter, London.

DH (2007) Implementation plans for reducing health inequalities in infant mortality: a good practice. The Stationery Office, London.

DH (2003) Infant feeding recommendation. The Stationery Office, London.

www.chimat.org.uk.

www.ic.nhs.uk/pubs/ifs2005

www.london.nhs.uk/publications/tools-and-resources/pct-perfromance-quick-guides