Introducing public health
Introducing public health

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Introducing public health

1 Public health on the ground

You start by exploring a group of public health-related projects in Coventry, England.

Activity 1 Health initiatives in Coventry, England

1 hour

Watch the case study, Health initiatives in Coventry, England. Give yourself time to watch carefully as this is a large multidisciplinary project to promote public health in a complex city environment. You may need to look at the video more than once to complete the tasks below.

  1. Make a list of all the factors mentioned by people in Coventry that might influence health and ill-health.
  2. Make a list of the range of people involved in the Coventry initiatives and note down what their roles are.
Download this video clip.
Skip transcript: Health initiatives in Coventry, England

Transcript: Health initiatives in Coventry, England

Coventry is a large city, with diverse communities.

Shashi Carter, Health Development Officer, Coventry City Council:
Communities actually want to improve their health. They want to improve their status but don’t know how to go about it.
Mohammed Sheikh, GP Practice Manager:
There are cultural issues, language barriers are coming in the way so they are not accessing the services and we want to sort of bridge the gap between the surgery and the patients.

 

Many factors influence health demands and the uptake of health provision.

 

Veena Singh, Women's Health Development Officer, Coventry City Council:
Within Foleshill you’ve got poverty. We’ve got one of the highest numbers of diabetes cases here as well, high blood pressure, cholesterol problems.

 

Health promotion agencies put the needs of disadvantaged and hard-to-reach communities high on their agenda.

 

Lorraine Galatowicz, Sex Workers Into Sexual Health (SWISH):
We’re there to uphold the law as much as the police and the women know that what they’re doing is illegal. We’re just trying to help. We’re not condoning it but we’re trying to help them do it safely.

 

In Foleshill, Veena Singh is working with a local GP practice to improve women's health and wellbeing.

 

Veena Singh:
Okay, the reason that we’ve set this group up here on a Tuesday is trying to get women like yourself and other women that are frightened to have the smear test and go over those barriers and anxieties and fears that they’re having. Why is it they don’t want to have the smear test?
Mohammed Sheikh, Practice Manager:
The value of having a project like Veena’s at the practice is basically to make the patients aware of the services that are in the practice, which we’re offering.
Woman patient:
Hello.
Nurse:
Come on in.
Woman patient:
Thank you.
Nurse:
Are you going to sit down?
Mohammed Sheikh:
In my experience I found that there are many issues that, cultural issues and religious issues, that stops women accessing the services.
Nurse:
OK, by looking at the screen your smear is due. Are you happy to go through and have a talk about the smear?
Woman patient:
Yes.
Nurse:
OK I’ll go upstairs. I’ll go and call Veena and then she’ll come down and take you back upstairs to the session. Is that OK?
Woman patient:
OK.
Veena Singh.
So you’re happy and you’ve booked your appointment with the nurse now so that’s all finalised.
Woman patient:
Yeah.
Veena Singh:
And you’re not worried about anything?
Woman patient:
Just I like to know more information about the diet.

 

Many of the practice's female patients prefer to talk to Veena about sensitive health issues.

 

Veena Singh:
You want some information about the diet and healthy eating.
Veena Singh:
Most of the problems that I had in my groups were which they wouldn’t really discuss with their own GP, or weren’t confident about discussing and I’ve always said to them, look I’m not a GP and my background isn’t nursing, I’m not an expert in that area but I can refer you on, so most of my work is involved round referring the patient on to whatever agency is needed. It could be domestic violence for example and again, it could be again to do with health.
Veena Singh:
Have I answered all your questions?
Woman patient:
Yeah. Thank you for your help.
Veena Singh:
That’s all right. Thank you for coming.

Her work is based very much within the local community.

 

Rehana Afzal:
Hello Veena.
Veena Singh:
Hello. How are you?
Rehana Afzal:
Yeah I’m fine thank you. Are you okay?
Veena Singh:
I’m fine thank you. Lovely day today.
Rehana Afzal:
Beautiful.
Veena Singh:
It is.
Rehana Afzal:
Since I’ve had my coil fitted and after a few days I was having night-time like a labour pain and I found a private doctor…
Mohammed Sheikh:
The other value to the purpose of having a project is we have health development officers who work locally or who can go and do home visits in the comfort of the patient’s home, at their own time and speak to them in a very confidential way, with expertise and try to help the women in whatever problems they have.

Coventry's Health Development Unit also do outreach work at the Jesus Centre.

People who come to the morning drop-in are among the most disadvantaged in Coventry.

 

Woman eating:
I won’t be coming down here any more if I don’t get any…
Piers Young:
I mean a place like Cyrenians is charitable.
Man eating:
She had nine days left on her license didn’t she?

They might be homeless or unemployed, asylum-seekers or refugees, and may also have drug and alcohol problems.

Shashi Carter, Health Development Officer, Coventry City Council:
Right, if you step on that machine making sure your heels are on the silver and then stand up and keep still.
Shashi Carter:
We actually go out and work with pockets of people and develop right from the start and see it through and give them the confidence, give them the ability to take control, to empower them.
Deina Johnson:
It sort of dawned on me it’s up to me.
Shashi Carter:
I agree but you still need the support from somebody else.
Shashi Carter:
People are curious but they just don’t know how to go about it and to actually work in a community, in a setting that they are comfortable, with we can provide a lot, lot more information and give them the choice to take control of their own life.
Deina Johnson:
I wasn’t even eating loads. I was just eating regular and I just, my body just went to eleven and a half and that was it.
Shashi Carter:
Smoking, smoking does keep the weight down and it is looking at if you want to give up smoking then we can support you on that. All right?
Shashi Carter:
I could go out and say, well okay, these are the issues at the moment, say for instance reducing smoking. Yes we need to cut down on people smoking. However that might not be the priority for the people I’m working with. Their priority might be they need to keep a roof over their head. Their priority might be that they need to feed their children or find pair of shoes or something.
Deina Johnson:
I went to Court before Christmas and I nearly lost where I was living and the judge said to me ‘I don’t want to see you back here any more.’
Shashi Carter:
I need to know what people want. We can’t give it to them all the time. We can’t give hundred per cent, but it’s nice to say that they have these problems and how I can incorporate or how I can work with them to alleviate even a small amount of that problem.

In Coventry, outreach work also extends into schools.

 

Najeeba Durrani:
So fallopian tubes. How do you think it’s going to work, the pill? Anybody? The contraceptive pill.

 

These 15 year-olds are using a health promotion package called ‘Contraception: the board game’.

 

Johnny:
It kills the egg where they’re released.
Najeeba Durrani:
Yeah, and where are the eggs released from?
Johnny:
Number A.
Najeeba Durrani:
Yeah.
Paris:
Number A.
Najeeba Durrani:
OK.
Najeeba Durrani, Young People's Worker, Coventry PCT:
I think it’s very good. It’s very effective and it gets the young people to think as well, maybe which they haven’t thought of areas before, and I think it’s an excellent tool to use.
Amy:
Your friend thinks she is pregnant. You tell her to keep quiet about it until it starts to show.
Najeeba Durrani:
What would you tell your friend to do?
Najeeba Durrani:
The good sexual health message that I’m trying to get across is about having a happy, stable, emotional, safe, sexual relationship. It’s also about promoting safe sex, raising awareness about STIs, HIV and Aids and unwanted pregnancies.

 

Najeeba doesn't always work with such mixed groups.

 

Najeeba Durrani:
In this job I do do sexual health workshops for young Asian girls and I’ve had a positive feedback ’cos I have a good rapport with them and they do, I think they do identify more with me, and they have said that we do find it easy to discuss a lot of things with you which we couldn’t with a white worker, because I think I understand the culture. I understand the religion. I understand the barriers that are there and I understand the family pressures that go along with it.
Najeeba Durrani:
Would any of you talk to your parents about sexual health, about contraceptive advice?
Amy:
No, she’d kill me.

 

It helps if parents can be involved as well.

 

Najeeba Durrani:
She’d kill you.
Amy:
If she’d found out I’d had sex yeah.
Najeeba Durrani:
I mean…
Amy:
No, if I did.
Najeeba Durrani:
What I would like to see happen as well is maybe not during school time, after school where you have workshops for the parents and young people. They get together and they engage and participate in activities and ideas. So it’s not only a learning tool for young people, it’s also a learning tool for parents as well so that you’re opening up channels of communication.

 

In Coventry, sexual health promotion extends to sex workers, a community that's much harder to reach.

 

Lorraine:
So where are you stopping at the moment then?
‘Diane’:
I’m here, there and everywhere as per usual. I’m still waiting to try and get somewhere but it annoys me where I am because obviously I have to work more to get more drugs and stuff to feed the people’s habits where I’m staying.
Lorraine Galatowicz, Sex Workers Into Sexual Health (SWISH):
Predominantly my job involves working with female sex workers, that’s both workers on the street and indoor, as part of a team of four in SWISH. That can involve anything from attending court. If a client’s been arrested for loiter then we have a court diversion scheme which effectively means that SWISH can go over and represent the woman and hopefully she won’t be fined. She will be bailed to make contact with the project.
Lorraine Galatowicz:
Do you need some needles?
‘Diane’:
Yeah please.
Lorraine Galatowicz:
Are you still on one mils?
‘Diane’:
One mils, yeah, one mils.
Lorraine Galatowicz:
We also provide sexual health services to the indoor workers and the women on the street and that’s anything from condoms. We do needle exchange. We can also chlamydia test.
Lorraine Galatowicz:
Do you want some condoms as well?
‘Diane’:
Yes please.
Lorraine Galatowicz:
How many packets do you want?
‘Diane’:
Two please.
Lorraine Galatowicz:
Two, OK.
Lorraine Galatowicz:
We do what’s known as targeted outreach which is around Coventry there’s lots of areas that particularly street-working women will access, like the Anchor Health Centre, Coundon Road Hostel is another one. The refugee centre, we’re going to look to start doing some outreach work in there. Pretty much any service that the woman might use it makes sense for us to take the service to them rather than them try to find us.
End transcript: Health initiatives in Coventry, England
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Comment

How did you get on?

The health influences that I listed included: diet, smoking, sexual activity, domestic violence and poverty. They also included some more indirect barriers to health, such as lack of confidence, cultural and language barriers and lack of adequate access to services. In addition, there was mention of some existing health conditions, such as diabetes, high blood pressure and high cholesterol, which might be made worse by some of the factors already mentioned. For example, existing high blood pressure is likely to be exacerbated by heavy smoking or by the stress linked to inadequate service provision or barriers to access.

Did the range of people involved in the Coventry initiatives surprise you? Health, local council, voluntary bodies and volunteers all played a part. This indicates that promoting public health is complex and not confined to the health sector. Communities and lay people can be active co-workers – not just ‘patients’ or ‘clients’ to whom things are done. Indeed, as the study highlighted, communities may have different priorities to those of professionals.

Keep any notes you make for later reference.

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