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The Role of Public Health in Health and Social Care
Cynthia Shokoya

The Role of Different Agencies in the Monitoring and Control of Diseases in the Community.

Public health has involved several agencies to ensure that measures are taken for disease prevention, promotion of the health of the communities and extend life expectancy among populations. These agencies are found at the community, national, and international levels. This report opines that the government has developed policies and legislations to prevent both infectious and non-infectious diseases.

Health Protection Units (HPUs) are the major communicable disease control organizations at the local level. HPUs get support from the Health Protection Agency, (HPA) that is part of the Public Health England. HPUs provide specialist advice on disease control and prevention to bodies such as local authorities and schools (Holman, Forouhi, Goyder, & Wild, 2011). HPUs also teach and train the local healthcare providers on disease prevention. The local authorities play important roles in local disease prevention. Local authorities have a direct control over the social determinants of health such as places of work, housing facilities, and living conditions (Guest, Ricciardi, Kawachi, & Lang, 2013). Local authorities also have a role in commissioning healthcare services such as immunization to ensure a safer community. The local authorities identify the community levels of health based on the WHO stipulation of the determinants of health such as quality of housing and availability of clean water. These include the socio-economic environment of the locals, physical environment, and personal attributes of the residents. Good health is attributed to high income, social status, high education level, good housing facilities, safer air and cleaner water. Access to healthcare facilities and community-based support systems contributes to the health of populations. Through the leadership of the Director of Public Health, local authorities work together with the clinical commissioning groups to ensure the health needs of the local populations are met to prevent the gradual spread of infectious disease (Public Health England, 2014). The Public Health England, through the guidance of the HPA, takes public health role at the national level. It supports and advice the local HPUs, emergency services, and local authorities. HPA also develops strategies to reduce the dangers to health from infections, radiation and chemical hazards (Tulchinsky & Varavikova, 2014). Public Health England uses a number of tools in the community assessment of the level of health. Public Health England collects primary data by conducting health surveys in the community, observations, and interviews. General practitioners are also useful resource persons in informing Public Health England on the state of health in the community based on their patient records. The Foundation Trusts report to the Monitor cases of hospital-acquired infections and the factors limiting infection control at the hospital level (Public Health England, 2014). The government protects the public through the development of policies to regulate health behaviors of the public. The government, through the advice of the Public Health England, developed screening at the ports to ensure immigrants and travelers do not pose local communities at risk of infections.

The WHO and voluntary organization also play key roles in control and prevention of diseases among communities. The WHO has developed programs that aim at reduce contraction of infectious diseases in communities. The Chronic Disease Prevention and Control Program strengthen prevention and control of chronic noninfectious diseases by addressing predisposing factors. The program also aims at reducing premature mortality and morbidity. Voluntary organizations also promote health at the community level. According to the f word website, Eaves is a charitable organization based in London that provides vulnerable women with high-quality housing and support and this shows success of voluntary organization in preventing and controlling diseases. The WHO considers quality of housing facilities as one of the determinants of health and promoting high-quality housing prevents infectious diseases such as tuberculosis.

Internationally, the European Union developed the core competencies necessary for infection control and hygiene in healthcare facilities. The European Center for Disease Prevention and Control (ECDC), was developed by the European Union for surveillance and report on infectious diseases such as Tuberculosis, Influenza, Ebola, vector-borne diseases, and sexually transmitted diseases (Zarb, Coignard, Griskeviciene, Muller, Vankerckhoven, Weist, & Suetens, 2012). The ECDC also publishes scientific and research finding reports on control and prevention of emerging communicable diseases. Voluntary organizations also contribute to health education and promotion programs to ensure control and prevention of diseases. Diseases such as tuberculosis have been under control through vaccination programs organized by voluntary organizations such as Action for Sick Children (Public Health England, 2014). These organizations monitor the levels of health in the community using various ways. The Public Health England has developed local community health surveillance systems enforce regulations to protect health. The ECDC also diagnose and evaluate community health hazards and problems. The Public Health England also evaluates the effectiveness and accessibility to quality care in the community.

Epidemiology of Tuberculosis and Diabetes mellitus Tuberculosis.

Tuberculosis

Tuberculosis is one of the infectious diseases that have attracted the attention of most epidemiologists in the United Kingdom. A 2013 report asserted that there were 7, 892 cases of tuberculosis in the UK. The incidence rate was 12.3 cases per 100, 000 populations (Orcau, Caylà, & Martínez, 2011). Despite the persistently high rate of tuberculosis infection over the past decade in the UK, there was a 10.4% decline in 2013. The following graphs show rates and case reports of tuberculosis by country in the United Kingdom from 2004-2013 (Public Health England, 2014).

According to the Public Health England Tuberculosis in the UK report for 2014, the incidence rates of TB in England were mapped as below

According to the ECDC report, the vulnerable groups to tuberculosis include prisoners, HIV-seropositive patients and people with low socioeconomic status living in congested areas, and alcoholics. The ECDC also stresses the importance of screening immigrants from countries with high TB incidences due to their vulnerability (Public Health England, 2014). The Public Health England (2015) further asserts that the current prevalence of TB is 12.0 per 100, 000 based on the 6, 520 clinical cases in 2014.

Tuberculosis should be monitored through targeted screening especially among immigrants from high-risk countries. The UK government should also avail healthcare facilities that can be used for early diagnosis of tuberculosis during surveillance of populations of immigrants (Public Health England, 2014). The cross-border movements should also be monitored to ensure the risks and origin of TB risks is identified. Case detection and relevant referrals are important among homeless persons in major urban areas. The government should also improve housing and social facilities for use, especially during treatment.

Support groups also help patients to adhere to treatment programs and reduce the development of drug-resistant tuberculosis strains (Ivany & Boulton, 2014). Awareness programs can also be imitated to ensure everyone has a basic understanding of tuberculosis transmission process. The Public Health (Control of Disease) Act of 1984 is in place to promote prevention of infectious diseases in the aspects of social and economic life of citizens. For Example, as person suffering from a notifiable disease should not get involved in trade. TB infection has also been controlled by immunization of the vulnerable groups. Particularly, BCG vaccine has been used to immunize children and healthcare professionals at risk of contracting tuberculosis. Public Health England aims to use a vaccination that targets people who have been exposed and children so that the number of those infected with TB reduces. This reduction would lead to low prevalence of TB that further reduces the chances of the healthy population of contracting TB. These campaigns would include education programs to increase TB awareness countrywide. The BCG vaccine is also used to immunize children and healthcare workers to prevent contraction of TB in later life and during care respectively (Ivany & Boulton, 2014). Laws have been enacted to control TB spread especially from animals to human. The UK laws also provide for essential screening for all immigrants from high-risk countries.

Diabetes mellitus.

Approximately 3.8million people have diabetes in the UK (global diabetes community, 2015). There is a lot of government expenditure used in the prescription of diabetes drugs with NHS spending 10 percent of primary care budget on managing diabetes. According to the global diabetes community, the average prevalence rate of diabetes in the UK is 6.2% with geographical variations as shown in the table below.

The YHPHO mapped the incidence rates of diabetes in Britain as shown below;

The incidence of diabetes is increasing with an estimate of 5million people infected by 2025 (Holman, Forouhi, Goyder, & Wild, 2011). Obesity predisposes people to ionsulin resistance that is the basis for Diabetes Mellitus type 2. Areas with high obesity will have more people with diabetes. The vulnerable groups to diabetes include obese persons, those who lack physical activity, people in Africa, Polynesia, South Asia, and American-Indian origins. The disease does not spread from one person to another (Taylor, Cottrell, Chatterton, Hill, Hughes, Wohlgemuth, & Holt, 2013) However, it causes lack of physical activity and obesity that leads to insulin resistance in the body. Diabetes education has been helpful to create awareness on diabetes and improve self-management. Early detection of overweight helps the government to conduct a directed intervention in preventing diabetes(Dyson, Kelly, Deakin,  Duncan, Frost, Harrison, & Worth, 2011). The NHS has a role to develop and monitor strategies to reduce the risk of developing Diabetes Mellitus type 2. The law also provides for coverage for diabetes training and supply of equipment.

Diabetes is most prevalent in Wales with a rate of 6.7%. The strategies include a call to reduce obesity in the whole population, raising the levels of awareness about diabetes, and identifying and tackling the personal risk factors. 62% of adults were overweight in Britain in 2012 according to the Public Health Report while 90% of obese people have type 2 diabetes. Exercise to reduce weight has been shown to reduce prevalence rate of diabetes and people with healthy weights have a prevalence rate of diabetes lower than 1.5%. NHS also provide structured education to help people adopt healthy diets and lifestyle but unfortunatly this has not been succesfull as people are still obese.  According to Davies (2011), many interventions to modify health behaviors have failed because the underlying attitudes are often overlooked. Therefore, NHS should consider changing the attitudes of people towards obesity to prevent future failures in the patient education programs.

Conclusion

In summary, public health sector works towards preventing both infectious and non-infectious diseases in the United Kingdom. The government should improve screening of employees at risk of infectious diseases. For instance, vaccination of healthcare professionals and surveyors working in overcrowded places at risk of contracting TB. The Public Health England should also expand its campaign grounds including the media and schools to ensure everyone get educated on the impact of diabetes on health. A special authority should also be bestowed upon the port authorities to screen both immigrants and emigrants to assess the risk of infectious diseases and their patterns. The work is coherent with the principles of ECDC and public health. The disease prevention strategies are very effective in improving public health in England. According to Public Health England (2015), the effectiveness of the 2014 to 2015 flu vacciine was 35% and 100% against influenza A and B respectively. According to the oxford vaccine group (October 2015), BCG vaccine is 70-80% effective against severe forms of TB and the vaccine contributed to a decrease in the prevalence of TB to a very low level by 2005. Therefore, the use of BCG vaccine, coupled with the ongoing TB screening of immigrants as mentioned earlier, could be the reason behind the drop in TB prevalence from the 2013 peak of 13.0 per 100, 000.