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The aim of the assignment is to demonstrate the role of the Advanced Nurse Practitioner (ANP) when assessing and analysing the health needs of a specific population. The author will focus on one specific disease, Chronic Obstructive Pulmonary Disease (COPD) in relation to South Asian men living in both the United Kingdom (UK) and in South Asia. In view of the large demographics of South Asia the author will specifically focus on Indian, Pakistan and Bangladeshi groups also making a comparison with the population residing in Ireland.The author will provide a critical and analytical discussion of the key findings in relation to the defined population demonstrating how the ANP role can take these findings forward to inform current practice and initiate the development and planning of a new service to meet specific health needs.

Firstly, an overview will be provided on the financial burden COPD is currently having on the National Health Service (NHS). This will be followed by a critical discussion of COPD, detrimental factors and the impact on the South Asian population.COPD is a growing concern worldwide and in the United Kingdom (UK) (Fletcher et al, 2010). COPD is a slow developing lung disease involving the airways, leading to gradual loss of lung function (NICE, 2010). COPD is the leading cause of mortality worldwide (Calverley and Walker, 2003) and projected to be the UK fifth leading cause of death and the second highest cause of emergency admission to hospital (Department of Health, 2005). There are an estimated 4. 8% of COPD cases in the UK, although only an estimated 1.

5% of the population are correctly diagnosed (Stang et al, 2009).It’s estimated that 30,000 people a year die from COPD and 1. 4% of the population consult their General Practitioner (GP) each year (Murray and Lopez, 2008). Cost varies to treat COPD dependent on the severity of the disease; mild COPD costs ? 149 whereby treating severe COPD can cost up to ten times as much at ? 1037 (British Lung Foundation, 2009). The prevalence of COPD is set to continue rising at alarming rates (British Lung Foundation, 2009). This is predominately due to the lack of awareness of the disease (British Lung Foundation, 2007).A survey by the British Lung Foundation (2007) concluded that 89% of people in the UK and 85% of smokers had never heard of COPD.

An audit of 80,000 COPD admissions showed that 70% of patients had not previously admitted with the condition (Luis, Soljak and Meade, 2007). The current unawareness of the condition is leading to inappropriate hospital admissions and contributing to the significant strain on the NHS with a financial estimate costing ? 500 million per year (British Thoracic Society, 2006). COPD usually develops in life-time smokers.It is estimated 50% of smokers develop COPD although non-smokers can also be affected by COPD (Murray and Lopez, 2008). Noxious gases, pollution, passive smoking, chronic respiratory infections and genetic susceptibility are other potential risk factors for developing COPD (Murray and Lopez, 2008). Risk Factors that Contribute to the Prevalence of COPD (Murray and Lopez, 2008) The prevalence of COPD within the author’s local ward is 0. 67%, which is below the national average of 1.

5% (The National Service Health information Centre, 2008).It is estimated that these figures are grossly under estimated (The National Service Health information Centre, 2008). The prevalence of COPD in both South Asia and Ireland is significantly higher with figures estimated at 6. 2% in South Asia and 7. 2% in Ireland (Murtagh et al, 2008 and Chan-Yeung et al, 2004). However, all this data is thought to be unreliable, due to differences in disease occurrence, differences in defining COPD, cultural bias, and whether spirometry was used to confirm the diagnosis (World Health Organisation, 2011).Due to the under-diagnosis and misdiagnosis of COPD within the author’s area a predictive modelling tool using smoking status, gender, ethnic group, age and deprivation has been developed by the West Midlands Public Health Observatory (2009) to ascertain current and future estimates of COPD prevalence.

This tool has been developed so the trust can plan for future health needs of the local area (West Midlands Public Health Observatory, 2009). Using the predictive tool it is estimated within the author’s local area that 5. 89% of South Asian groups have COPD compared to their White British counter parts at 4. 5% (West Midlands Public Health Observatory, 2009). There is currently a large proportion of South Asians residing in the area, which may contribute to the higher rates of COPD in this particular ethnic group. South Asians Residing in Author’s Local Ward (Office for National Statistics, 2004) Ethnic minorities make up 8% of the total population in the UK compared to only 2% in Ireland (Office for National Statistics, 2004). Within the author’s local ward South Asian groups are significantly higher at 20% compared to national average 5.

5% (Office for National Statistics, 2004).Using the predictive tool it is suggested that COPD rates within the author’s ward are estimated to steadily rise between all ethnic groups by 2020 (West Midlands Public Health Observatory, 2009). This is believed to be due to an increase in births, migration and a decrease in deaths within the area (Birmingham City Council, 2005) Environmental factors such as smoking are a significant factor in the prevalence of COPD. In the UK, smoking rates are significantly higher in South Asian and Irish groups compared to the national average of 24% (Department of Health 2007). National Smoking Rates Department of Health, 2007) A key element of the ANP role is to be able to assess the needs of their specific population (American Association Colleges of Nursing, 2005). The author analysed population trends within her defined population, South Asian men as a starting point when looking at the relationship between COPD and smoking rates. This gives the author information to inform current clinical practice and plan service to tailor services to meet the needs of that specific population (Hamric, Spross and Hanson, 2009).

The author then went to analyse why smoking rates were high within this population.It’s estimated that 50% of the male South Asian population smoke (Office for National Statistics, 2004). Smoking in South Asian men is linked to social acceptance, social bonding, and tradition. Smoking is associated to be ‘Macho’ and fashionable, which is promoted by Indian films and media (Shihadeha et al, 2004). South Asian groups tend to smoke bidi or hookah (Shihadeh et al, 2004). In an hour-long smoking session of hookah, users consume about 100 to 200 times the smoke of a single cigarette (Shihadeh et al, 2004). Only 10% of South Asians associate smoking with any form of lung disease (Shihadeh et al, 2004).

The belief within Asian culture is that hookah smoking is safer than cigarette smoking due to tobacco being filtered by passing through water (Shihadeh et al, 2004). Hookah contains similar properties of that of a cigarette. Research has identified that there are in fact greater amounts of tar and heavy metals in Hookah than cigarette smoke (Shihadeh et al, 2004). Stress is also thought to influence smoking in South Asian groups. South Asian men tend to lead stressful lives due to them being separated from family and employed in poorly paid work (Chang-Yeung et al, 2004).South Asian men working in the catering industry suffer particularly severe stress as a result of unsocial and long working hours (Chang-Yeung et al, 2004). Age also influences smoking.

Smoking is cultural accepted especially in the older generation. However, this generation in particularly lacks knowledge of the health effects of smoking and have a more fatalistic approach to life (Chang-Yeung et al, 2004). The younger generations are more likely to smoke because of influence of peer pressure, image, and rebellion, which are similar characteristics to their White British counter parts (Chang-Yeung et al, 2004).A large proportion of South Asians are Muslims (Chang-Yeung et al, 2004). The Koran does forbid intoxicants that harm health but does not expressly forbid tobacco. However it is religiously unacceptable to smoke in a mosque (Chang-Yeung et al, 2004). A key competency with the ANP and author’s role is to promote health and reduce health risks through teaching and coaching with the long-term aim of preventing disease (RCN, 2008).

The RCN (2008, p16) state that an “ANP should be able to identify any obstructive behaviours and put strategies in place to try and achieve better outcomes for patients”.The author’s objectives are to reduce tobacco smoking, raise awareness of health conditions related to smoking amongst South Asians men. Appropriate targeting and involvement of South Asian men taking into consideration culture and tradition is essential for health promotion to be successful (Chang-Yeung et al, 2004). To address these smoking rates the author plans to work with Muslim religious leaders to educate them on the health risk associated with smoking and to gain support that tobacco smoking is religiously unacceptable.With religious leaders backing the author then plans to hopefully obtain agreement for a national policy to be disseminated. To disseminate a policy nationally the authors plans to use her ANP professional credentials and expertise. The author plans to provide evidence based literature with regards to the link between COPD and smoking.

The author plans to build reliance’s with community leaders, ANP’s and the public health department to gain support in developing a national policy highlighting the risk factors of smoking in the South Asian community.Developing a coalition with the multidisciplinary team and gaining public support will influence the development of a policy and strengthen its credibility (Hamric, Spross and Hanson, 2009). The author also plans to raise awareness of smoking cessation aids by approaching South Asian radio, TV and press. Advertising through the media is a powerful way of the ANP addressing public health issue within a specific community (Hamric, Spross and Hanson, 2009). There is evidence that passive smoking can also reduce lung function and gas diffusion which can have an impact on COPD (Chapman et al, 2006).The government in both the UK and Ireland have since highlighted that passive smoking is a public health issue and have since barred smoking in the workplace and public areas (Chapman et al, 2006). In the UK, cigarette sales fell by 11% following the first month of the smoking ban.

However the number of smokers among the Irish population has risen significantly since the introduction of the smoking ban to 29% from 27% according to the Department of Health (2007). Current smoking rates are higher than that of the UK average which may explain the higher prevalence rates of COPD in Ireland.It’s is suggested the rise in smoking rates following the ban are that non-smokers are trying cigarette so they don’t feel left out when accompanying their smoking friends outside public places, such as, public houses (Pride and Soriano,2008). The public have also adapted to the ban by smoking and ‘partying’ at home (Robinson, 2008). It’s encouraging to know that South Asia has followed both UK and Irish tobacco laws. A bill was passed in 2005 banning on all forms of tobacco advertisements, making the majority of public places smoke-free and highlighting warnings signs on tobacco products (Robinson, 2008).The smoking ban was originally implemented to have positive outcome on reducing smoking rates.

However, the effects of the smoking ban are both controversial and embarrassing for the government with smoking rates increasing in Ireland since the implementation of the smoking ban (Robinson, 2008). The author recognises various environmental factors affecting people can contribute to the likelihood in developing COPD. The author plan to promote health promotion and educate patients around all risk factors associated with COPD.This strategy along with the smoking ban demonstrates the ANP competency by providing health protection interventions to promote healthy environments for individuals, families and communities (RCN, 2008). Social-economic status is also a detrimental factor in the prevalence of COPD (Collins et al, 2010). Nearly 50% of patients with a diagnosis of COPD live in deprivation (Renwick and Connolly, 1996). The more deprived the area, such as low income and high rates of unemployment the higher prevalence of COPD (Renwick and Connolly, 1996).

Deprivation will not directly increase the risk of developing COPD but will be a factor that indirectly increases risk through environmental factors like damp housing, higher occupational exposure to sources of dust/asbestos and fewer resources to seek and receive appropriate medical care (Dewar and Curry, 2006). Within the author’s ward 82% of the population are within the 5% most deprived area and is amongst the 20% most deprived areas in the UK. Figures in Ireland are marginally lower with 20% of the population living in poverty.However, figures are double in South Asia suggesting 40% of the population lives in poverty surviving on less than 76 pence per day. The number of South Asians living in poverty is occupied by low income (Chang-Yeung et al, 2004). High levels of poverty can have a serious impact on people’s access to appropriate healthcare (Robinson, 2008). ANP’s are central to improving patient access to services by providing clinics in accessible places where historically care would not of been provided, such as in a mosque, refugee or shopping centre (Hamric, Spross and Hanson, 2009).

A report by the Agency Healthcare Research and Quality (2005) concluded that 85% of people living deprivation received lower quality in care in comparison to people receiving higher incomes. This may be due to people living in areas of high levels of poverty and deprivation is strongly associated to crime and violence (Collins et al, 2008). This can lead to difficulties recruiting staff into these areas contributing to staff retention due to the added risk factors associated to crime and violence (Collins et al, 2008).South Asians groups living in the UK have similar educational backgrounds to their White British counter parts (Tanner, 2000). However, degrees achieved in South Asia are often not accepted in the UK (Tanner, 2000). For this reason, there are higher instances in this group forced into lower paid jobs, such as, taxi driving and hotelier, which will contributes of deprivation which is known to increase the incidence of COPD (Tanner, 2000). Poor housing, damp and inadequate ventilation can contribute to the prevalence and mortality of COPD (Chapman et al, 2006).

Nationally overcrowding is a concern in-particular within Bangladeshi households with 44% living in overcrowded conditions compared to only 6% of their White British counter parts (Office for National Statistics, 2004b). The rise in property price, limited affordable housing contribute to low income and high levels of over-crowding (Office for National Statistics, 2004b). South Asians have higher average household sizes than the national average, which again make them more liable to overcrowded conditions (Ahmed, 2001).Overcrowding may also be related to poor accessibility to adequate housing in different parts of the country (Office for National Statistics, 2004b). Ethnic Minorities Percentage Who Own Their Own Homes (Office for National Statistics, 2004b) The author’s local ward is densely populated with a population of approximately 26,000 people. The population density is 364 people per Square Kilometer (km2) compared to an Irish population density of just 63 people per km2 (Gallego, 2008). South Asia on average consists of 571 people per km2 (Gallego, 2008).

However within these figures Bangladeshi have the highest population density at 1,127 people per km2 (Gallego, 2008). This is due to high fertility rates and young population 40% of the population is under the age of 24 years old ( Koenig et al, 1997). Traditionally, marriage is promoted relatively young; contraceptive prevalence is low, leading to childbearing starting early among Bangladeshi women (Koenig et al, 1999). Highly densely populated areas have an impact on the incidence of COPD due to higher levels of air population (Gallego, 2008).Air pollution can have a detrimental effect on lung function and exacerbations of COPD (Chapman et al, 2006). Air pollution levels are higher in densely populated areas because that is where most sources of pollution are found and are generated from human activity (Ayres and Harrison, 2005). The World Health Organisation (2005) estimates that air pollution causes 1-2 % of COPD cases annually.

Air pollution is exacerbated in South Asia due to its heavy reliance on coal for power generation ((Ayres and Harrison, 2005). Vehicle emissions are responsible for 70% of the country’s air pollution (Anderson, 2010).Indoor air pollution is one of the most important causes of COPD in South Asia (World Health Organisation, 2005). Over 700 million people in South Asia suffer from high levels of indoor air pollution in-particular affecting women and young children as 75% of homes use burn biomass fuels use inefficient wood stoves in poorly ventilated area ( World Health Organisation, 2005). Evidence shows that people living in deprivation have less healthy diets, such as, less fruit and vegetable intakes and consumption of more processed foods which are higher in saturated fats and salt rather that fresh food (REF).Generally South Asians tend to eat fewer fruit and vegetables, which contain lower antioxidants (Department of Health, 2007). This may be because they traditionally adapted their diet before migration to the UK due to financial constraints and high levels of deprivation within their original country (Collins et al, 2008).

A diet rich in antioxidants may be a risk factor in lung injury leading to COPD (Rahman and Kilty, 2006). Although not intentional a diet low in antioxidants may be beneficial in COPD, however, the overall risk factors of a diet consisting of little fruit certainly outweigh this theory (Collins et al, 2008).Research highlights a diet rich in omega-3 inhibits arachidonic acid production protecting against bronchoconstriction, which can lead to COPD (Chapman et al, 2006). However, foods such as fish which contain high levels of omega-3 can become costly for people who are on a low income (Collins et al, 2008). Research suggests that genetics may also determine the likely hood and progression of developing COPD (Britton and Hopkin, 1999). It is estimated that about 1% of all COPD patients actually have anti-protease antitrypsin (A1AT) deficiency. Patients who have A1AT deficiency i have a high risk in developing COPD.

A1AT deficiency is more common in White than in South Asian groups (Britton and Hopkin, 1999). People with low levels of A1AT are further characterised by their phenotype (Britton and Hopkin, 1999). The normal phenotype is MM, which means one normal gene from each parent. There are many phenotypes which categorise a level of risk of developing COPD with ZZ indicating a high risk of contracting COPD. The ZZ phenotype does not occur in black and is very rare in Asian groups (Britton and Hopkin, 1999). This genetic difference indicates that the risk of developing COPD is more probable in White than Asian groups (Britton and Hopkin, 1999).However, further research is required in genetics to confirm this theory (Britton and Hopkin, 1999).

Diagnosing COPD in both the UK and Ireland are robust using standards, such as National Institute of Clinical Excellence (2010) and Global Initiative for Chronic Obstructive Lung Disease (2006) which suggests spiromery as ‘gold’ standard when diagnosing COPD. Both standards give clear evidence based recommendations in the management of COPD (National Institute of Clinical Excellence, 2010 and Global Initiative for Chronic Obstructive Lung Disease, 2006).In South Asia COPD is predominately diagnosed by a medical practitioner on symptoms alone. Diagnosis is not always consistent nor evidence based. The use of spirometry is not commonly used due to financial constraints (Raherison and Girode, 2009). This leads to under diagnosis due to these financial constraints in a country where there are high levels of deprivation (Raherison and Girode, 2009). Purchasing healthcare in South Asia can be extremely costly due to a private healthcare system (Raherison and Girode, 2009).

This can leaves people unable to seek medical help, and unable to purchase the appropriate medical treatment.However, evidence also highlights that COPD is also under diagnosed in developed countries, such as the UK and Ireland (World Health Organisation, 2011). This is due to under-diagnosing, mis-diagnosing and lack of public awareness of the disease worldwide (World Health Organisation, 2011). In view of the UK’s financial deficit the government have published a document, The White Paper Equity and Excellence: Liberating the NHS (Department of Health, 2010a). The paper plans is to reform the NHS (Department of Health, 2010a). The policy aims to make GPs responsible for commissioning health services through consortiums.GP consortiums plan to work closely with secondary care, community and other health and care professionals to design services that are tailored to patient needs (Department of Health, 2010a).

These consortiums will have to make savings of ? 50 million over the next four years (Department of Health, 2010b). That equates to ? 1m for each month for the next 48 months (Department of Health, 2010b). For this to be achieved requires a significant reduction in costly hospital admissions (Department of Health, 2010b). It is estimated that commissioners could save more than ? 00 million over the next decade by improving COPD care (Calkin, 2010) The disease is costly accounting for one in eight emergency admissions in the UK and the second highest number of bed days. Data suggests that consortiums could save an average ? 5. 3 million each by 2020 if they implement programs to educate patients and help them manage their condition without the need for hospital admissions (Department of Health, 2010b). This could reduce the number of COPD hospital spells by an average of 33% by 2014 (Department of Health, 2010b).

In the author’s local area between 2006-2007 there were 470 hospital admissions for COPD accounting for 3,592 hospital bed days average cost with each admission averaging a single hospital stay at ? 2,426 (The National Health Service Information Centre, 2009). This equates to a substantial amount of money due to hospital admissions that could have been avoided with earlier diagnosis and better management of the condition within Primary Care (The National Health Service Information Centre, 2009). A population assessment can be beneficial within the ANP role when evaluating and improving on existing services, (RCN, 2008).The author is currently working within an ANP role. The author plans to enhance existing community COPD screening provision by implementing a clinic to identify South Asian patients at risk of developing COPD. The author plans to setup various prevention and early diagnosis screening clinic throughout her ward, targeting South Asian men. The author plan to target this at risk group by firstly examining GP’s Quality Outcome Framework registers.

This ANP led service will promote early diagnosis and improve the long-term management for these patients and reduce the financial burden long-term.The service would provide health promotion and education, early spirometry screening informing patient of their lung age and smoking cessation support. Early spirometry screening telling smokers their lung age significantly improves the likelihood of them quitting smoking (Parkes et al, 2008). Currently within the authors trust services focus on managing late onset COPD which is both timely and expensive. Clinics led by ANP’s are rapidly growing due to being easily accessible, conveniently situated and value for money (Hamric, Spross and Hanson, 2009).ANP led clinics are substantially lower in cost than employing a doctor (Hamric, Spross and Hanson, 2009). However, some doctors do have concerns with ANP led clinics and the quality of care they may be provided in comparison to a doctor (Hamric, Spross and Hanson, 2009).

However, with consortiums facing substantial cuts in budget’s it is speculated that the role of the ANP will be embraced by GP’s throughout the country with regards to meeting the needs of their population and the delivery of quality cost effective treatment (Department of Health, 2010b).The authors proposed service would meet several of the priorities set out by the White paper to improve COPD services, reduce costs and improve outcome for patients. On the basis of the needs of the author’s local area this would address the number of hospital admission, reduced bed days with the overall aim of reducing cost and improving outcome for patients. This highlights the author is demonstrating skills defined by an ANP, such as, planning, developing and implementing programmes of care to promote health and well-being and address the needs of her population (Hamric, Spross and Hanson, 2009).In conclusion, research consistently shows that there is a lack of awareness of the serious health risk associated with smoking in-particular among south Asian groups. Unfortunately there is further evidence needed in the prevalence of COPD especially in South Asian groups. The current under reporting of QOF data prevalence means that it may be difficult to plan for and deliver future health needs.

Under reporting can lead to a failure in identifying the disease. Identifying the disease earlier can lead to most cost effective treatment (Department of Health, 2010b).

ISS4304 Contemporary Social Problems

Read the book chapter titled Predatory Lending, Wealth Inequality, and the Great Recession of 2008 from this week’s module.
For this week’s discussion, reflect on some of your takeaways from the chapter. In your initial post, discuss your reflections on the article, as well as the ways that the social problem(s) from the reading can be analyzed at the intersections of economics and political science, or economics and sociology. This initial post should be 2-3 full paragraphs in length.