Introduction
At best, London may be described as a city that is extremely mobile. In addition, the population is highly diverse, and not to mention the rampant health inequalities that plagues this city. Apparently, Londoners appear less satisfied, with respect to the provision of health services, when they are compared with the rest of the population of England, in other urban areas (Bardsley et al, 1999). What this appears to suggest is that the need of the Londoners are not being met, health-wise. When there exist inequalities in the provision of health care, what this means is that individuals do not have an equal chance to these services. In addition it also means that all too often, individuals who are in a dire need for health care ends up not getting it simply because they may not to afford it.
According to available evidence, breast screening helps to dramatically reduce the ensuing deaths as a result of breast cancer. This is because as a result of screening, detection may be made while the cancer is still at the early stages, and for that reason then, it may be possible to offer easier treatment. Furthermore, recovery rates have also been shown to be higher, when breast cancer is detected early. Statistics indicates that breast screening uptake in London happens to be the lowest in the whole of England (Barer, 2003). For example, in 2005, out of a possible 100 women that have been invited to attend a screening appointment, only 62 percent of these attended this appointment. The age of this population was between 50 and 70 years. This is in comparison with the national average that year, which stood at 75 percent (Barer et al, 2003).
Furthermore, it has also been shown that in the inner boroughs of London, screening appears to be extremely poor. Of particular importance here is the fact that the uptake of invitation to breast screening may be especially low in certain groups. The include those people that are residing in communities that have been deprived, such as those that have a reduced access to health care, in comparison to the groups of affluent Londoners (Royal borough of Kingston, 2004). Again, the inner boroughs bear the brunt here. Another vulnerable group is individuals that have recently moved, seeing that this group is less likely to have enlisted the services of a GP within their new locality. Then there are the ethnic communities who are a minority on London, such as the Asians and the blacks.
Statistics shows that these groups have a lesser likelihood of being aware of the need to take breast screening programmes. Furthermore, they are also les likely to gain access to NHS services, chiefly as a result of language barriers. The reduced uptake for breast cancer screening that has been witnessed in London could as well bear a connection to the manner in which this service gets delivered (Royal borough of Kingston, 2004).
Those women that gain eligibility to breast screening programmes are usually given a letter of invitation to the screening programme. This letter often comes from the screening service providers within a locality. Nevertheless, the locations, as well as the times of appointment that these women could be offered could prove to be a hindrance to their attending since such women could be committed to other activities, not to mention the difficulties they might have to face while travelling. Additionally, it is also possible those individuals that have difficulties speaking in English could also have problems understanding information on breast cancer.
Given that the role of a GP is usually to supply the screening services with patients that are eligible, it then follows that patients fails to gets an encouragement from their GPs on the need to attend such screening appointments (Bardsley et al, 1999). In light of these developments, it is therefore important that an evaluation of breast cancer amongst women in London be carried out, in order to explore strategies and policy formulations that could be implemented, with a view to enhancing the service provision of this health issue.
This research paper is concerned with the assessment of breast cancer amongst women in Kingston borough, London. Above all, this research assessment is also important with regard to helping shed light on the burden of disease that is breast cancer in London and specifically, in the Kingston borough. Besides, this research study is also an opportunity for the review of the works of others in the same area. For purposes of examining the areas of the study that could have been overlooked thus calling for a further exploration. The remainder of this essay shall attempt to explore the key features of heath and health care, within the context of London. In light of this, both the strengths as well as the weaknesses that the authorities in the city of London may be characterised by shall be assessed.
Further, the health strategy principles in London shall be discussed, such as how the health care inequalities could be addressed, and also how the health care providers may liaise with the local communities, in action to forging partnership with other stakeholders fro purposes of improving health care in the city. Further this research paper shall explore the issue of breast cancer amongst women in Kingston borough, London. The occurrence of this health care issue shall; be addressed, within this borough, as well as how the issue of health care is addressed in the borough. Finally, this research paper shall give out recommendations on how to improve the conditions of this population that could be victims of breast cancer. In this regard, both strategic as well as immediate practical steps that may be taken by the authorities shall be given
The London context
London is characterized by a huge capacity and expertise in terms of voluntary organisations and community groups. More than 60,000 community and voluntary groups have been accounted for in London (Bardsley et al, 1999). These groups often played a significant role in terms of facilitating in service delivery. This is in addition to the provision of campaigning and advocacy roles that are of importance. In light of this, these groups could be used for purposes of highlighting the plight of breast cancer amongst women in London, as well as the various boroughs in it.
Furthermore, these groups could also ensures that the vulnerable groups are provided with the right information to access healthcare, as well as joining hands with the initiative by the mayor of London to reduce inequalities amongst the various Londoners. There are also a number of key strategic partners in London who have both the experience and achievements of health care issues, and these could not only coordinate health care provision actions, but also offer advice to individuals on the same (Barer et al, 2003).
Nonetheless, there are also a number of weaknesses that London may be faced with, in terms of the issue of breast cancer amongst women. To start with, the national breast cancer programme in the UK often targets mostly women above the age of 50 years for screening. However, there have been changes with regard to lifestyle of the Londoners, and this has seen women as young as 30 years getting diagnosed with breast cancer. In addition, the changes in the lifestyles have meant that more Londoner women are getting their babies later in life, thanks to improved living stands. This then increased the chance of breast cancer occurring. Then there is the issue of an escalation in the population, meaning that the authorities in the breast cancer facilities in the city of London may not in the long-term be adequate to cater for the rapid rise in the populace (Bardsley et al, 1999).
Furthermore, the number of GPs for every one Londoner is not evenly distributed in the various boroughs, with the result that some of the GPs ends up being overwhelmed by the number of patients that they have to attend to (Boyle, 1997). For this reason, a proper diagnoses and consequently, treatment regimen may not be arrived at, resulting in an increased in the disease burden.
If at all a lasting intervention into the issue of health care inequalities within London is to be resolved there is a need to involve all the various stakeholders involved. In this case, it would really be beneficial if at all the various communities that are afflicted by the health care issues may be involved in the interventions and implementation programs (Boyle & Hamblin, 1997). The reason for this is so that members of the community may become active participants of their own wellbeing. This way, they shall be taking charged of their lives.
Often, health care intervention involves the implementation of policies and programmes, and this is a form of change (Boyle, 1997). It would then be expected that a form of resistance may be present. To minimise such a resistance, the involvement of the community is required. Given that the population in London is rising due to massive migrations, it may be expected that the government shall in the long-term be overwhelmed by this burgeoning population, thus calling for a partnership between the government and other stakeholders in he healthcare sector to address the issue of providing health care, along with the endeavours to contain inequalities in healthcare.
The London Health Strategy Principles
The mayor of London has highlighted a number of principles that shall be used for purposes of addressing the issues of health inequalities in the city of London. In addition, such principles are also aimed at establishing a framework for evaluation and monitoring of health inequalities in London in the years to come (King’s Fund London Commission, 1997). The implementation of these principles shall not only used in the establishment of the ideal strategies, but also for purposes of giving priority to the desired action (Fitzpatrick et al 2001). In line with this therefore, the mayor of London is committed to the promotion of both physical and mental well-being of individuals in London, for their entire lives.
Further, the mayor has identified a need for the establishment of a universal health promotion approach, in addition to policies implementation, whose focus is on disadvantaged groups, with regard to health issues. Another principle is the promotion of a social health model (London Health Commission, 2004). In this case, greater emphasis shall be on inequalities reduction, and which hinders individual well-being. It has also been deemed necessary to realize that health care provision in the future should place more emphasis on strategic actions that are long-term, as well as the initiatives that are short-term. Moreover, the NHS, the government, national and local authorities, local and regional programmes, are at a position to impact in an enormous way on the inequalities of health care in London.
One of the greatest influences of health and wellness is income. When individuals have access to a good income, then they are in a position to gain access to not only living standards that are decent, but also the enjoyment of a healthy lifestyle. A Survey on family resources that was carried out in 2005/06 in Britain established that the city of London has exceedingly large number of individuals both in the lowest and highest income groups. With such a disparity in terms of income, it would be expected that inequalities would also be evident in the health care sector as well (London Health Commission, 2008).
According to the UK government, health inequalities may be defined as “inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants” (London Health Commission, 2004). In other words, heath inequalities are those differences that impacts on the health of an individual. There could also be a difference with respect to their life expectancy. Health inequalities are often an occurrence between areas that are quite diverse, such as either the affluent or deprived areas. It could also be on the basis of ethnicity, income, or even disabilities. As a significant measure of the health of an individual, life expectancy is also a demonstration of how the health of an individual could vary between boroughs, or regions.
Although life expectancy has been on an upward trend in the UK and by extension, London, nevertheless there are several parts of the city that have failed to experience such an improvement (Mayor of London, 2002). For example, the life expectancy of a girl born in Kingston has been estimated to be 86.2 years. However, considering that breasts cancer is on the rise in the UK, and that London has one of the lowest screening rates in the country, such a life expectancy could be drastically reduced. Other features of health inequality that are worth of exploration include employment, access to income, as well as life chances. There is a relation between on the one hand, the level of social class that a person occupies and on the other hand, their life expectancy (King’s Fund London Commission, 1997). Even then, there are also vulnerable groups that are more prone to worse forms of health care than the average individual.
Economic, social and environmental factors have an influence on the lives of individuals (Boyle 1997). As such, the “upstream factors” have also been shown to affect such health inequalities as employment, education and housing. In addition, these determinants will also have a role to play in the ability of individual to access health care, and also their lifestyles. The two are otherwise referred to as “down stream causes of health inequalities” (London Health Commission, 2008).
When people are able to access effective social and health care, along with other forms of public services, there is likelihood that the incidences of illness amongst a population could also be reduced. Furthermore, recovery rates could also be higher, at a time when the populace gets sick. This notwithstanding, there is a remarkable geographical variation in London, meaning that there are those Londoners who are better able to access preventative and treatment services, relative to others.
There is also a rich diversity of race and ethnicity in London (NHS Executive London Regional Office, 2000) and this again pose a vital challenge to breast cancer health services, in Kingston borough. The pathway to diagnosis, treatment and care for breast cancer is riddled with large inequalities. For this reason, it means that there are those Londoners that are more vulnerable to health care inequalities than other. For example, language could be a barrier to the black Londoners, as opposed to the whites. In addition, there is also the issue of cultural relevance, as regards the issue of early intervention to breast cancer.
There is also the issue of psychological support for the patients in this case the immigrants of Asian or African origins are less likely to get such support, especially from their families and friends, seeing that these may not be there, in the first place, the same case applies to asylum seekers and refugees (Fitzpatrick et al 2001). These are the vulnerable communities in Kingston borough, whose likelihood of encountering poor access to heath care are quite high. There are a number of key partners who have thus far been identified for their role in the development and securing of the health strategy fro London (Mayor of London, 2002). They include the executive regional office for NHS in London, the local authority for London, King’s fund, the health project of Londoners, London’s social care region London government association, and the London metropolitan police service, to name but a few.
The engagement process among the various stakeholders, appear to be taking shape, with the effect that a majority of the groups in London are holding meetings with members to the aforementioned groups to chart a common path into the future. Most of the activities for the promotion of health, as well as the reduction of inequalities within London are being carried out at the local level (London Health Commission, 2008). There are also plans to lay out criteria to facilitate the identification of issues that needs to be address in terms of a London health care strategy. It is anticipated that such issues, besides helping in the shaping of good practice, shall also augment the existence of partnerships for addressing common issues, at the local level. Some of the benefits that are anticipated include that of improved health care and health, for the residents of London.
A health service issue for a population
In the UK, breast cancer happens to be the most prevalent form of cancer amongst the women (Imaginis Corporation 2006). One in every three cases of cancer that affects women in the U.K happens to be breast cancer. Furthermore, it has also been estimated that in their lifetime, one out of every nine British women shall be diagnosed as having breast cancer. In 2004, 3, 841 people in London were diagnosed as having developed cancer of the breast (London Health Commission 2004). In the same years still, 1,236 Londoners succumbed to breast cancer. Breast cancer incidences have been shown to differ in terms of demographics. In this case, there exists a very strong association between on the one hand, breast cancer and on the other hand, age. Approximately 80 percent of breast cancer amongst women occurs in those who are above the age of 50 years (Kingston NHS primary care trust, 2007).
Although the likelihood of a woman being diagnosed as having breast cancer is higher in comparison to that of a man, nevertheless there is also a smaller number of males who are often diagnosed as having breast cancer, on an annual basis. This figures averages at about 300 men, on an annual basis. Breast cancer incidences appear to be higher amongst individual residing in affluent areas (Royal borough of Kingston 2004). In this case, there ahs been an association between the disease, and the factors of lifestyle one of the lifestyle factors has to do with the fact that on average, an exceedingly large number of affluent women opts to get children when they are mush older, and this then predisposes them to being diagnosed with breast cancer.
The Kingston council has been actively involved in several initiatives that are aimed at creating awareness about breast cancer within the Borough. For example, the council facilitates talks on breast awareness within local communities, in which they target the women. In addition, the council also takes part in the posters displayed at various pharmacies during the October breast awareness campaign. Furthermore, the council is also involved in the encouragement of GPs and practicing nurses so that they remind their patients of how important it is to take part in a breast screening programme (Royal borough of Kingston 2004).
According to a recent study, Kingston has been identified ads a hot spot in London for three forms of cancer; breast, skin, and prostrate. In comparison to the other boroughs within London, Kingston is amongst those characterized by higher rates of occurrence for all the aforementioned forms of cancer. This is according to a report that was released by the Cancer Registry in Thames. What this report appear to reveal is that there exists diverse levels with regard to the levels of cancer that characterizes the various areas. In light with this, higher breast cancer rates have been noted to be in Kingston, followed by Richmond, and Twickenham (Kingston NHS primary care trust, 2007). The Corydon chief of public health, Dr. Tim Crayford is quoted as having said that “The differences in society and affluence are reflected very clearly in diseases such as cancer” (Kingston NHS primary care trust, 2007).
About 200 new patients get to be diagnosed with breast cancer on an annual basis, at both the Queen Mary and Kingston hospitals (Royal borough of Kingston, 2004). It has been projected that the number of older people in Kingston borough are rising at a rate of 0.5 percent every year. Seeing that breast cancer risk increases with age as well, it is important that the health care services here are enhanced to keep pace with this development. In addition, there has also been a decline in terms of government grants and rates that the local authorities give to the Kingston borough. The idea behind this is that this borough is seen as being constituted of low need levels, coupled with high property value. The implication then is that the people living within the borough are quite affluent.
On the other hand, the isolated groups are the one who suffer, such as the minority races, the unemployed, and immigrants, to name but a few. These are often not in a position to afford healthcare care services, as the rest of the population. There has also been witnessed a rise in the intensity with respect to the complex needs for individuals supported at residential care facilities, or even at home. Furthermore, the cost of care in Kingston is 18 percent higher, in comparison with other London boroughs (Kingston NHS primary care trust, 2007). The implication here is that access to affordable medical care is becoming dear by the day. Breast cancer is a health issue that requires a lot of care and management following diagnosis and treatment. With such a rapid rise in the cost of caring for patients, it means that breast cancer victims in Kingston may in future have to make do with less care than is necessary.
Nevertheless, this is not the only issue that the health care providers in the borough have to contend with. Diversity is yet another issue worth of consideration. The White British are the predominant race in Kingston, making up 72 percent of the population, while the Irish British constitute 1.9 percent. On the other hand, the other white raced combined make up 7.3 percent of the population. For the non-white, the Indians are the biggest population, at 4.4 percent, while black Africans constitutes a partly 1.4 percent of the population (Kingston NHS primary care trust, 2007). With such diversity in terms or race, there could be a deviation in terms of how these various races approach health care services (London Health Commission, 2004). In addition, the health care providers may also be faced with a challenge in terms of both diagnosis and treatment. For example, the prevalence rate of breast cancer amongst the white women is different from say, that of the African women.
Also, there could also be a difference in terms of how the various races respond to medications, and this is a further challenge. In addition to the implementation of the health care strategy in the whole of London, there is also a need to have a health care strategy at the local level, preferable unique for each and very borough in London. This is because the health care determinants across the local levels differ, and as such, there should also be a variation in terms of the criteria adopted (London Health Commission, 2004). For example, the inhabitants of Kingston borough are believed to be well off financially compared to a majority of the other boroughs in London.
On the other hand, there are several pockets of this borough that are below the average economic and social status (Kingston NHS primary care trust, 2007). If at all the health care strategies and policies are uniformly taken across the borough, the residents in these pockets shall suffer. In this regards, the input of the government, the local authority, the private partners and the local residents is needed, so that they may develop strategies for health care and inequality reduction that shall be to the benefit of the majority.
Conclusion
Most of the policies in social care and health to a certain extent influence the health status of a populace. It is with such a mindset then that a far-reaching mapping initiative was carried out with a view to classifying the principle elements of strategic actions that renders the greatest opportunity for facing inequalities in health within London. These same elements shall also impact on specific health issues, such as the prevalence of breast cancer. Kingston borough in London has been noted to have a high rate of breast cancer in London, more than any other borough (Kingston NHS primary care trust, 2007). Seeing that breast cancer is a health care issue of grave concern, there is a need to ensure that both long-term and short-term strategies are put in place, so that this situation may be contained. One of the most immediate practical steps that may be implemented in this borough with a view to containing the breast cancer incidences is a creation of awareness about breast cancer. In this case, a number of stakeholders in the health sectors will need to forge an alliance (For example, the GPs, nurses, the local authorities, community leaders, as well as the government).
It is also important to involve the local communities, especially various residence groups, as these are quite effective in information dissemination (London Health Commission, 2008). However, there is a need to come up with a long-term strategy to address the issue of health care in Kingston borough. This may be possible through legislation of heath care policies to address specific matters of health. For example, in the case of breast cancer, a long-term strategy would involve lobbying to have the policy makers pass a law that allows more centres to undertake breast cancer screening, in addition to health care awareness and education. This way, it will be easier to identify opportunities and gaps within the existing activities that bear a correlation with inequalities in health, not to mention those communities that may be victims of such an inequality in health care service provision. Ultimately, a legislation of health care policies is what may even out diversity differences within a population.
Bibliography
- Bardsley, M, Jones, I. R, Kemp, V, Aspinall, P, Dodhia, H, & Bevan P. (1999). The Health of Londoners: a public health report for London Health of Londoners Project
- Barer R, Davies H and Fitzpatrick J (2003) Health in London. London: LHC.
- Boyle S, H. R, 1997, The Health Economy of London: A Report to the King’s Fund London Commission. London: King’s Fund.
- Fitzpatrick J et al (2001) Mapping Health Inequalities Across London. London Health Observatory
- Imaginis Corporation.” Breast cancer: statistics on incidence, survival, and screening”. Imaginis Corporation, 2006.
- London Health Commission (2004) Health in London: focus on health of London’s Black and minority ethnic communities. London: Greater London Authority
- London Health Commission (2008) Mayor’s Health Inequalities Strategy.
- King’s Fund London Commission (1997) Transforming Health in London. London: King’s Fund.
- Kingston NHS primary care trust (2007). Cancer inequalities in Kingston.
- Mayor of London. (2002). London Divided: income inequality and poverty in the capital
- London: Greater London Assembly NHS Executive London Regional Office (2000) The London Health Strategy.
- Royal borough of Kingston. (2004). A Community Plan for The Royal Borough of Kingston upon Thames 2004-2009