Health Policy And The Social Determinants

wellness Policy And The Social De shapeinantsINEQUALITIES IN moral HEALTHIntroduction and explanations kind wellness is described by the piece wellness Organization (WHO) asa postulate of well-being in which the individual realizes his or her own abilities, corpo symmetryn cope with the radiation diagram stresses of life, hindquarters work productively and fruitfully, and is able to make a contri saveion to his or her comm unit of measurementy (WHO 2001a, p.1).According to NHS website ever soy year in the UK, much(prenominal) than 250,000 raft atomic number 18 admitted to psychiatric hospitals and oer 4,000 volume commit suicide(http//www.nhs.uk/conditions/ kind-wellness/Pages/Introduction.aspx , accessed 20-4-2010)genial wellness variation is a considerable standing job that has been tackled for decades by epidemiologists, sociologists and wellness professionals.And be beget this problem has dickens strong melt downer and wellness spirit there is no unified a pproach to identification and resolution.From Sociologists viewpoint in equivalence with amiable wellness is a problem that has two master(prenominal) explanations passel be vile because they withstand manpowert on the wholey sickness that makes them unable to keep back work probably ( amicable selection), or they become intellectually ill chthonian the stress of being poor ( genial causation). However, in modern psychiatry early(a) factors ar believed to involve in the etiology such(prenominal)(prenominal)(prenominal) as transmissible factors, diet, and hormonal disturbance which interact with in the flesh(predicate)ity ails or emotional state to produce affable illness.The problem of inequality is non yet virtually serious genial illness but we can expand the definition of intellectual health inequality to include everyday feelings which is considered by unite Kingdom Department of Health to be public health forefingerHow population feel is not an elusive or abstract concept, but a of import public health indicator as significant as order of smoking, obesity and sensible activity (Mental Well-being extend to Assessment ,2009)The table below gives examples of those factors that promote or cast down opportunities for thoroughly psychical health (DOH 2001)MENTAL HEALTH antifertility FACTORSINTERNAL PROTECTIVE FACTORSEXTERNAL PROTECTIVE FACTORSEMOTIONAL RESILIENCE sensible health egotism esteem/positive sense of selfability to manage fightingability to learnCITIZENSHIPa positive en keep downer of early stick topositive stimulate of attachmentability to make, maintain and break coitionships conversation skillsfeeling of acceptanceEMOTIONAL RESILIENCEbasic pick ups met food, warmth, protective coverCITIZENSHIPsocietal or community validation yieldive social meshingpositive fiber models physical exerciseHEALTHY STRUCTURESpositive educational get under ones skins steady-going and secure purlieu in which to live defendiv e political baselive within time of peace (absence of conflict)MENTAL HEALTH DEMOTING/ photograph FACTORSINTERNAL VULNERABLE FACTORSEXTERNAL VULNERABLE FACTORSEMOTIONAL RESILIENCE innate illness, infirmity or disabilitylack of self esteem and social statusfeeling of helpless(prenominal)nessproblems with sexuality or sexual preferenceCITIZENSHIPpoor quality of relationshipsfeeling of isolationfeeling of institutionalisationexperience of dissonance, conflict, or alienationEMOTIONAL RESILIENCEneeds not being met hunger, cold, homelessness/poor lodgement conditions etc.experience separation and lossexperience of convolute or violencesubstance misusefamily history of psychiatric disorderCITIZENSHIP pagan conflict experience of alienation variation the negative experience of being mugtisedlack of autonomythe negative experience of peer wedge un exerciseHEALTHY STRUCTURESvalue systemseffects of povertynegative physical environmentTable 1 factors that promote or reduce opportunit ies for good cordial healthWhat is the evidence on mental health inequalities?Socio- sparing statusCommunity-based epidemiological studies across countries and over time have consistently identified an opposite word relationship between Socio-economic status and prevalence place of schizophrenia .The ratio between the current prevalence (defined as period prevalence up to one-year prevalence) of the disorder among low-SES and high-SES tidy sum was 3.4, whereas the ratio for lifetime prevalence was 2.4 (Saraceno et al,2005), and in Britain, twice as many suicides occur among plenty from the around turn away SES (Blamey A et al ,2002).There atomic number 18 phoebe bird hypotheses to explain this relation (Hudson 2005)Hypothesis 1 Economic stress. The contrary SES-mental illness correlational statistics is a specic outcome of stressful economic conditions, such as poverty, unemployment, and housing unaffordability.Hypothesis 2 Family fragmentation. The inverse SES-mental il lness correlation is a usance of the fragmentation of family structure and lack of family supports.Hypothesis 3 Geographic drift. The inverse SES-mental illness correlation results from the movement of individuals from high to cast down SES communities subsequent to their sign hospitalization.Hypothesis 4 Socioeconomic drift. The inverse SES-mental illness correlation results from declining employment subsequent to initial hospitalization.Hypothesis 5 Intergenerational drift. The inverse SES-mental illness correlation is a function of declines in community SES levels of hospitalized adoles centimeimes between their rst hospitalization and their most juvenile hospitalization after turning 18AgeIn elderlyNational Institute for Mental Health in England (NIMHE) has opus the following point regarding mental health problems in elderly 3million old tidy sum in the UK experience symptoms of mental health problemsthe annual economic burden of late onset dementia is 4.3 billion which is greater than that for stroke, crab louse and heart disease combineddementia affects 5% of those aged over 65 and 20% over 8010-15% of all aged(a) the great unwashed meet the clinical criteria for a diagnosis of impressionthese numbers are set to increase by a third over the bordering 15 geezerhood(NIMHE, 2009).Mental health problems in elderly very much go unrecognised. Even where they are acknowledged, they are often inadequately or in divertly managed (DH 2005c).The UK inquiry into mental health and well-being in after life (2006) identified five factors that influence the mental health of aged people discrimination (for example, by age or culture) participation in meaningful activity relationships physical health (including physical capability to take in charge everyday tasks) and poverty.in children WHO states, that the development of a child and adolescent mental health form _or_ system of government requires an ascertaining of well-being and the prevalence of ment al health problems among children and adolescents(child and adolescent mental health policy, 2006)However, there is an evidence that levels of distraint and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases that require interventions are around 3-6 per cent of people under 16 years of age (Bird et al.1988 Costello et al. 1988).Emotionally fed up(p) children are exposed to ill-treat or neglect in their family of origin, with estimates up to 65 per cent (Zeigler-Dendy,1989).GenderWomen and Mental HealthMental health problems are more(prenominal) common among women than men with higher incidence rates of depressive disorder than men (Palmer, 2003).There are many factors to explain this, offset printing Socio-economic factors such as poverty and poor housing conditions cause greater stress and fear of future amongst women. lack of confidence and self-esteem neatthorn be the results of educational factors such negative s chool experiences , Living in unsafe neighbourhoods cause stress and anxiety amongst women , dependency on prescription medicine drugs (for depressive and sleeping disorders) often leads to anxiety.Men and Mental HealthMen tend to be more vulnerable to mental health problems and suicide than ever before due for a number of reasons includingMen in superior general are less likely to talk about their problems or feelings or to admit that they have depression.Men are less likely to judge help for mental and emotional health problems.Unemployment has a greater regard on men in general.Some mental disorders are more serious in men for example suicide is the leading cause of death among puppylike men. The rate for young men aged 10-24 years is higher among those from deprived communities compared with those from affluent communities. Men also experience primitively onset of schizophrenia with poorer clinical outcomes (Piccinelli, 1997)Risk groups for mental illness in men include (D HSSPS,2004)Older men they are less unforced to use health service because of the perception that these serve are for cured women.Divorced men because they have less support uncommitted from family , and operate designed to meet the needs of this group is specially.Male victims of domestic abuse -especially boys in cracker-barrel areas.Gay and bisexual men few operate are available to help men deal with problems such as homophobic bullying and harassment.Male survivors of sexual abuse lack of co-ordinated support for adult survivors of abuseFathers despite examples of good fare, men have comparatively less access to support services than women, to enable them to cope with the stresses of parenthood. divest men lack of appropriate services specifically targeted at men who have experienced bereavement.Men in rural areas particularly disjointed in terms of service access.Young offenders inadequate psychological services in juvenile justice centres despite the high propo rtion of young people entering the juvenile system with a range of mental health problems.Ethnic groupA canvas by steering for Health get by Audit and Inspection,( Count me in, 2009) noted that Rates of admission were lower than the study average among the White British, Indian and Chinese groups, and were average for the Pakistani and Bangladeshi groups. They were higher than average among separate nonage heathen groups particularly in the Black Caribbean, Black African, different Black, White/Black Caribbean coalesce and White/Black African Mixed groups with rates over leash times higher than average, and nine times higher in the Other Black group.Employment Status and Mental HealthHaving a line of business helps to maintain give out mental health than not having one, but this is not always true as many factors involveFor example, blood lines which are unsatisfactory or insecure can be as harmful to health as unemployment (Wilkinson et al , 2003). Anxiety about job security, lack of job control, perceived effort-reward imbalance, negative relationships in the piece of work, including bullying and harassment can have negative mental health consequences.According to OSC Health Inequalities Review (2006) people with a common mental disorder are five times more likely to be unemployed, and if they have work they are more likely to be excluded, people with an identified mental health problem are twice as likely to be on income support and four to five times more likely to be getting invalidity benefits. A someone with a diagnosis of a psycho illness leaves him with only a one in four knock of being in employment.Geographic variationStudies result on geographical variation of mental illness are inconsistent , for example Hollie has reason out that In mental health problems there is substantial variation at the household level but with no evidence of postcode unit variation and no association with residential environmental quality or geographic al accessibility. It is believed that in common mental disorder the psychosocial environment is more cardinal than the physical environment (Hollie et al, 2007)On the other hand, a new-made Swedish study of 4.4 million adults found that the incidence rates of psychosis and depression rose with increasing levels of urbanisation (Sundquist K.et al.,2004).Another study by violet Commission on Environmental Pollution shows that people from densely live areas had a 68-77% and 12-20% higher lay on the line of developing any psychotic illness and depression respectively when compared to a control group in rural areas. Within urban areas the rates for psychoses map closely those for deprivation and the sizing of a city also matters in London schizophrenia rates are about twice those in Bristol or Nottingham (Royal Commission on Environmental Pollution, 2007a, 2007b). hindrance and Mental HealthDefinition According to Disability Discrimination Act (1995) (DDA)A person has a disability i f he has a physical or mental impairment which has substantial and semipermanent adverse affect on his ability to carry out normal day to day activitiesIn the light of this definition we can heighten on mental health inequality of three groups of people multitude suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems. People with two mental health problems and physical disabilities. People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience.Disabled people are more likely to experience stress and emotional instability than those who are not disabled.a describe by the Equality Commission for Northern Ireland (2003) has found that whilst 34% of those who were not disabled had experienced quite a lot or a great deal of stress in the work 12 months preceding to the raft, the percentage rose to 52% for disabled peop le. Experiences of depression within the last 12 months were higher among women who were disabled (44%) than men (34%).ConclusionInequality in mental health is as important as any other form of health inequality, however the inter do between social and personal level in mental illness makes it more difficult to predict different kinds of mental health Inequalities associated with it.Question 2 word count (2000)Tackling inequalities in mental healthIntroductionMental illness, among other disorders, is astray considered as a significant determinant of both health and social outcomes and many studies have spotted mental health disorders as both consequence and cause of inequalities and social exclusion.Mental health diseases have two distinct characteristics as a public health problem scratch line very high rates of prevalence secondly onset is usually at a much younger age than for other health problem , Mental health diseases effects all areas of peoples lives personal relatio nships, employment, income and educational consummation. (Friedli and Parsonage , 2007 McDaid , 2007)Who is at try for mental health problems?Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality forwardingal programs.A review of recent evidences on mental health inequalities can help to define the bountiful groups at risk People lifespan in institutional settings such as heraldic bearing homes or those in secure care or subject to detention. People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless. People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse.children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommo dated children, People from groups who experience discrimination.Key policiesThese policies can be long term policies focusing on deep change over long period or diddle term seeking fast results such as health promotional material. big term aimsInequalities in mental health are not only about equality of access, but also about quality of access.In the year 2009 Mental Health Foundation has published a level on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities ,2009)This theme mentioned four priorities for action1-Social, cultural and economic conditions that support family lifeThis can be done by reduce child poverty , parenting skills formulation and high quality preschool education , increasing access to safe places for children to play, especially outdoors, inter-agency partnerships to reduce violence and sexual abuse.2- Education that helps children both economically and emotionally byschools health promoting programs, involving teache rs, pupils, parents and supporting parents to break the home learning environment (HLE)support social, sports and creative achievements, as well as academic performance3- Reduce unemployment and poverty levels and promote and protect mental health bySupporting efforts to improve pay, work conditions and job security.Facilitate early referral to workplace based support for employees with psychiatric symptoms or personal crises to prevent employment breakdown.4- Tackle economic and social problems, which cause the psychological harm. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too.However, these strategies take long time to be effective, that means the need for more rapid actions or short term aims.Short term aims Mental health promotionTo build an effective outline to promotion for health equality the following points should be achieved Comprehensive Mental Health promotion is not only the responsibility of hea lth services simply other sectors of society should join that effort. ground on evidence Based on the needs of the local communities, and with the agreement of these communities. Subject to evaluation The strategy should be subject to critical evaluation and can be changed when necessary.A good example of such strategy is the Mental health national evidence based standards which have been issued by The National Service modelling for Mental Health (DOH 1999). The purpose of these standards is to deal with mental health discrimination and social exclusion associated with mental health problems. And that can be achieved by promotionpromote mental health for the whole society, working with individuals and communities check mark discrimination against individuals and groups with mental health problems, and take steps towards better promotion for their social inclusion.Tackling inequalities for special risk groupsThe Suicide prevention strategy whizz of the best example is the strategy based on work by (DOH 2002) and The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals1. To reduce the risk in key high-risk group.2. To promote mental well-being in the wider population.3. To reduce the availability and lethality of suicide methods.4. To improve the reporting of suicide mien in the media.5. To promote research on suicide and suicide prevention.6. To improve monitoring of progress towards the target for reducing suicide.Women and Mental Health PreventingThe results of UK-based look back (Williams, 2002) shows that mental health services for womenDo not meet womens mental health needs. stick out replicate inequalities.Can be unsafe for women.Can be insensitive to the effects of gender and other social inequalities, such as race, class and ageHowever, in their reception to a survey conducted in England and Wales, women said that they wanted services that Keep them feel safe. advertise empowerment, choice and self-determination. Place importance on the underlying causes and context of their distress in addition to their symptoms. Addressee important issues relating to their contributions as mothers, the need for safe appointment and access to education, training and work opportunities. Value their strengths, abilities and potential for recovery.(DH, 2002a)These points are important to build a need-based action plan for better equality in health services.Men and Mental Health PreventingThe Equal Minds conference shop which had special focus on men and mental health listed five service design features targeted at mens mental health and well-being (equal minds, 2005) availableness and flexibility of services regarding time, location. For example, Select places familiar for men, Men Only sessions hotfoot by male staff, make use of some activities, such as sport and physical activity programmes. Holistic app roach, works on the person as a whole, not just on mental health. archean intervention to prevent anxieties and concerns build up, especially in stress and raise management. Trust and confidence are important to solve problems of identity and role that can underlay mens anxieties and self-perceptions or lack of self-esteem.Ethnicity and Mental Health PreventingThe main problem in this field was the barriers to access services. Barriers include Language. Stereotyping. Lack of cognisance or understandings of mental illness.The report Inside Outside (Sashidharan, 2003) which addresses mental health services for people from black and minority cultural communities in England and Wales. draw out that patients from all minority ethnic groups are more likely than white majority patients To follow aversive pathways into specialist mental health care. To be admitted compulsorily (there are differences also between ethnic groups at all ages). To be misdiagnosed. To be prescribed drugs and Electroconvulsive therapy (ECT), more than talking therapies. To have higher readmission rates and stay for longer periods in hospital. To be admitted to secure care/forensic environments. Their social care and psychological needs are less likely to be addressee within the care planning process. To have worse outcomes.A strategic approach in Ethnicity and Mental HealthIn England and Wales a framework have been developed for action for delivering race equality in mental health (DH, 2003b)The framework focuses on three building blocks which are essential to improved outcomes and experiences of people from black and minority ethnic communities Information of better quality and more intelligently used. Services which are more appropriate and responsive. Increased community engagementIn other words any approach should take in consider both quality of health services and the socio-economic disadvantages experienced by people from ethnic communities.Some suggested steps for this approac h may includeProviding interpretation and transformation services beside mental health service to insure highest possible quality.Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in expression of mental distress.Developing estimate and diagnostic tools that can better assess patients from different backgrounds and ethnicities.Ensuring that services understand and respect spiritual requirements for different cultures.Ensuring access equality to culturally appropriate services including, counseling, psychotherapy and advocacy.Addressing common problem for people from black and minority communities, such as housing, employment, welfare benefits, and child-care.Disability and Mental Healthpeople with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special interest regarding mental health services , they a re liable for what Rogers and Pilgrim (2003) described inequalities created by service provision.Mental health services for disable people should be customized to their needs, some recommendations for such services may includePromotion for mental health, well-being and living with disability.Early intervention for people who show symptoms for possible mental illness. personalized care based on individuals needs and wishesStigma work for better social inclusion and tackling stigma and discrimination associated with some disabilities.Elderly and mental healthIn order to achieve better equality for this group, policy makers should insure better access to mental health services on the first place.In the year 2005 the Department of Health published a report titled Securing Better Mental Health for Older Adults to put in a new programme to bring together mental health and older peoples policy in order to improve services for older people with mental health problems.The National Directors for older people and mental health promoted the dual principles of Delivering non-discriminatory mental health and care services available on the basis of need, not age and Holistic, person-centred older peoples health and care services which address mental as well as physical health needsHere, it is essential to emphasis the importance of specialist mental health service for older adults.Sexual Orientation and Mental HealthIn this group health promotion plays a great role to address the mental problems associated with sexual orientation.PACE organization has drawn up a set of practice guidelines for working with lesbian, gay and bisexual people in mental health services (PACE guideline.2006).The guidelines suggest promoting services and resources specifically for LGB people, including services such counselling and advocacy provided by LGB organisations.In response to these guidelines and studies about LGB such as (McNair et al, 2001). Mental health services for LGB people shouldRe flect upon the homophobia and heterosexism that LGBT people may experience within mental health services.Enhance awareness of LGBT people problems, and the forms of discrimination and social exclusion they may face.Consider the nature of a culturally competent for LGBT peoplePreventing in Mental Health Problemspeople with mental health problem are in need for resilience factors that enable them to recover from mental distress and to fight the effects of discrimination and stigma, we can name some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially comprehensive accepting communities (Dunn, 1999).Examples for these services can be found in report on Mental Health and Social Exclusion which has been published by Social Exclusion Unit. The report included a 27-point Action intention aimed at tackling stigma and discrimination, focusing on the role of health and social care in addressing problems of social exclusion, unemployment, and supporting families and community participation done ensuring access to goods and services such as housing, financial advice and transport (SEU,2004).beyond this report, it is important that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will go on more holistic approach that aim prevention on the long run.ConclusionIt is essential to put the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not impetuous practice for reducing inequalities in mental health within elementary care, and the primary care organization studied is not conducive to addressing inequalities in mental health. (Craig, 2009).For that reason, it is the responsibility of government, health services and health professionals to put thes e strategies and plans into action to insure a better and healthier society.