The purpose of this assignment is to complete a health needs assessment within a defined community. It will seek to explore socio-economic factors and health issues to find what conditions are most prevalent within the ward and how they impact on the community. The assessment process will be guided by a framework which will explore all aspects of the community.

Health inequalities have existed in society for at least thirty years that we know of. The first report on health inequalities was the commissioned Black Report by the then Labour government. This was then brushed aside when the conservatives came into power in 1979 (Acheson 1998). Both the Black report (1980) and Acheson's reports (1998) where commissioned to look at health trends and trends in inequalities faced by the population of the time, and to see how government and social policy could work best to tackle and improve these outcomes.

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The Acheson report looks at general health trends, socio-economic position, mortality, morbidity, income, education, employment, housing, homelessness, public safety, transport, health related behaviours and ethnicity (Acheson 1998). All of these issues will be explored as part of the process within this health needs assessment of the ward being discussed to build up a health profile of the community.

What is health?

' [Health is] the extent to which an individual or group is able on the one hand, to realise aspirations and satisfy needs and on the other hand to change or cope with the environment. Health is therefore seen as a resource for everyday life, not the object of living: it is a positive concept emphasising social and personal resources as well as physical capabilities...' (WHO 1984)

National Institute of Clinical excellence (Nice 2005) define a health needs assessment as

'..a systematic method for reviewing health issues facing a population, leading to agreed priories and resource allocation that will improve health and reduce health inequalities'

The framework used to complete this health needs assessment is based on guidance published by NICE (2005) which details a five step process. Step one defines who the population is, step two identifies health priorities which then builds a profile about the population group to target and benefit, step three looks at identifying conditions impacting on the community and identifies any gap in service provision which would lead to a proposed change ready for steps four and five, the development and implementation of and action plan and then evaluating its effectiveness (NICE 2005). Due to word constraint, only steps one, two and three will be explored.

For purpose of this assessment only information and data within the public domain has been used to maintain confidentiality (Nursing and Midwifery Council NMC 2008).

Evidence based research plays an enormous part in the way nurses practice and carry out tasks. It is ever changing so all research gathered and looked at has to be up to date and accurate. Gray, (2001) suggests that research is a process of enquiry that produces knowledge and can help us to understand and promote health care, through intervention, treatments and therapies. So by undertaking a health needs assessment on the population not only looks at prevalence of disease but can point out a gap in service provision and point out a way of meeting this need.

A health needs assessment rather than a focus needs assessment has been chosen for the purpose of this assignment. The reason for the choice of assessment come from the author being new to the practice area and new to the district with no knowledge of the community's issues and problems regarding health and social care.

Step one

Social Structure and Social Activity

The community is a small town in the North of England with a geographical area approx 9 square miles. In 1981 the ward was ranked 232 out of 678, by 1991 it had slipped to 176 putting it within the worst 25% of places to live in the north east. It has been difficult to find up to date data on where the ward ranks at present despite searching census and quality and outcomes framework (QOF) data bases.

The last census in 2001 shows the population in the ward at that time to be 11,222 people, with an approximate gender split between male and females (ONS 2001).

The wards community facilities include two nurseries, three primary schools and one senior school (Local Authority 2008), there are many local bakeries, one green grocer and two butchers but the community only has one small supermarket. The nearest large supermarket is roughly six miles away (AA route finder 2008). What is noticeable about the community's amenities is the large amount of fast food and takeaway businesses.

Since the closure of the mines in the 1980's there has been no industry within the town and the majority of those working of seeking to find jobs need to travel to the nearest city. When the mines closed many hundreds of people lost their jobs and were unable to find suitable or regular jobs due to poor education and the lack of qualifications to work in business. Unemployment within the community is higher than the nation average with most people having no qualifications to seek out permanent long term employment (ONS 2001).

There is one newly built community centre which houses a library, the local housing office, a caf�, gym and nursery. The Primary Care Trust (PCT) also use the facilities to provide communities services. Facilities can also be booked for individuals to use.

The ward itself is classifies as being in the most deprived 20% of the country (STPCT2006/07).

Age

The average age of the ward population is 45-54 years of age compared to the local and national average which is 35-44 years of age (ONS 2004).

The population of those aged 0-4 is 6.75% and the population of 0-14 is 22% in comparison to the nation average, this is 3.2% higher, a significant factor when looking at the health needs and future health needs of the population.

The proportion of those age 65 and over are 21.7%, 6.6% higher than the nation average which is 15.51%. With the population of those aged 65 and over being higher than the national average, this would suggest that health provision for those within this age group is well provided for and that the town is good place to retire to.

National target of life expectancy for the area is around 78-79 years of age (DH 2007) but as the figure show, this town has a significantly higher proportion of those aged over 65 in age and a slightly higher (0.8%) population of those over 80 years of age. (ONS 2004).

On the other hand due to the long liverty of the population, limiting long term illnesses maybe significantly higher. Hip fractures in those over 65 is shown to be significantly higher in the district than England (NEPHO 2008).

Ethnicity

The ethnic* population makes up just 2.3% of the population, an average of just over 2 in 100 people. The district also shows the ethnic population to be 4.79% compared with the national average 21.60% which equates to 1 in 5 people (ONS 2001). This shows a major difference in culture and provision of services which may need to be provided.

*For the purpose of this assignment ethnicity is anyone born outside of Great Britain and Ireland.

Health Care

The community serviced by one health centre which houses 7 general practitioners, 4 Health visitors and a nursery nurse. Midwifery service and district nursing service also share the same site. There are two Pharmacies in the ward, owned by the same company (no scope for choice), one dentist and one optician (Local NHS 2008).

The location of the health centre posses issues as to were it is situated (way back off the main street on an incline). Access up to the health centre is poor. The bus stop in the town centre and a main road has to be crossed before a long walk up to the health centre.

Children in the ward have higher than average tooth decay (NEPHO 2008). The district as a whole has the worst dental health care for children within north east. Is this lack of education or only having one dentist to services a population of almost 12000 people?

Data for the district shows Children are significantly more obese than in England, Child poverty is significantly higher, Obesity is higher in adults being significantly higher than the nation average for the ward (STPCT 2006/7) and Deprivation is higher. QOF data for the ward also shows that CHD, asthma, cancer, diabetes mellitus, blood pressure, Left ventricular dysfunction, mental health, cardio Vascular Accidents (CVA) and thyroid are all higher than the district average and the UK average (QOF 2005/06). The ward is among 10% of wards in England with the lowest percentages of adults eating five or more potions of fruit and vegetables a day (STPCT 2006.07).

What data does show about the area is how good an uptake of the immunisation programme there is within the trust of primary vaccinations, boosters and MMR vaccinations. It is almost 11% higher than the national average uptake (STPCT 2006/07)

General health

Within the ward there are 1693 people who report themselves to be in not so good health (15.09%), within England this figure is 9.06% a difference of 6.03% almost a third higher.

The percentage of those with limiting long tern illnesses is 29.01%, 11.08% higher than in national average. The district is also 6.12% above the national average.

The biggest mortality rates for the area are Cancers, CVA and Coronary heart disease (CHD) (NEPHO 2008, STPCT 2006/07). The north east over the last 25 years has always had a higher than average mortality rate, dating back to the 1981 census (Philimore et al 1994). In the period of 1981-1991 the north east had the highest mortality rates per ward than all of England and Wales (Philimore et al 1994).

In 2003-2005 deaths by lung cancer in the district was 5% higher than anywhere else in England and of all deaths by cancer, Lung cancer accounts for more than 60% of all respiratory diseases in woman. The figure for men is on average 10% lower accounting for an average 50% of all respiratory diseases in men (STPCT 2006/07).

Chronic obstructive pulmonary disease (COPD) prevalence is highest in the district by 0.4%, as well as being 1.37% higher than the national average (STPCT 2006/07). Asthma is another area the district's prevalence is higher (0.33) although a sister district does have a higher prevalence of 0.56% (STPCT 2006/07). As with the other respiratory problems it appears the north east far out weights the rest of England for prevalence of these diseases. Is there a gap in service provision here or could more be done locally to resolve these issues.

The ward has a significantly lower rate of low birth weight babies (STPCT 2006/07) this is a common occurrence throughout the north east. Smoking whilst pregnant is known to increase the chances of having a lower birth weight baby (NICE 2008)

The prevalence of smoking ranks it among the worst 20% of wards in England with the highest proportion of smokers, with 23% of the districts women smoking throughout their pregnancy (STPCT 2006/07). The number of girls aged 10-15 years old in the district who smoke is 3% higher than the national average, yet the number of boys aged 10-15 years old who smoke is 1% lower than the national average (STPCT 2006/07).

Binge drinking was also ranked within the worst 20% of wards in England with the highest proportion of individuals who binge drink weekly.

Mental health

Prevalence of depression in the ward was ranked among the best 10.5-21% of wards (STPCT 2006/07). People of the district received more incapacity benefit for mental health/behaviour disorders than in any other district within England (STPCT 2006/07. It is estimated that 1 in 10 children between the ages of 5 and 16 has a recognisable mental disorder, with boys being more prone to mental illness. It is also thought that children from single parent households are more prone to mental disorders (ONS 2004).

It was difficult to find accurate ward data when completing this part of the health needs assessment. By going on data for the district as a whole may not necessarily mean it's a common theme in this ward. Had data from GP's been in the public domain a more complete and accurate picture may have been given

Housing

From observed practice most people live in two bedroomed converted properties which were originally single story houses which have then been built upwards and extended out the back of the house. There are

4800 house holds in the ward with 41% of the population live in rented or council property 10.25% higher than the national average. Due to the type of properties on offer in the ward there is a lot of social movement in and out of the local towns surrounding the ward. Housing isn't offered on a point system from the council but on a swap for swap basis (Local Authority 2008).

Transport

The number of households with access to a car or a van is 34.7 percent. This is lower than the national average by 6.64%. The figure do however show that the percentage is higher than within the district and the north east by an average of 15.7%. Data from the 1991 census (Phillimore et al 1994) and 2001 census (ONS 2008) shows that they has been a 13.9% increase in car or van ownership. If up to data had been available it would have been interesting to see how different again this was after eight years.