theExample Assignment 4NH026

Please note my example is not a complete assignment and is not intended to flow (i.e.,
each step is not linked to the same need and target population throughout). However,
yours will need to in your final submission. Please click on the annotations / comments to
see an explanation of each part of the assignment

Example of Main Introduction

This assignment is based upon the health needs assessment undertaken on the population of
Cornwall. A summary of the local geographical prolife is presented; from this a target population of
children has been identified and justified. The prioritised need of poverty has been identified and
justified in accordance with national and local priorities and strength of evidence. Local drivers have
been used to identify an appropriate health promotion initiative to address the impact of children’s
poverty in Cornwall. Finally, health promotion theory has been applied to the local initiative to
identify health promotion approaches and level.

Example of STEP ONE

Introduction to geographical profile summary

This is a summary of a geographical profile of Cornwall. The characteristics of the population will be
presented to include population number, age, gender and ethnicity distribution. It will examine the
factors impacting upon health including deprivation and poverty. Finally, the health status of the
population will be explored focussing upon mortality rates, lifestyle choice and mental ill health.

Population Characteristics

Cornwall’s estimated population is 565,968 (Office of National Statistics, 2018). This figure has risen
by 10% over the last decade (Court, 2017). Cornwall has an older population than the national
average with 24.3% aged 65 years, compared with 17.9% in England (Public Health England PHE,
2018a). The percentage of the population under 18 is 19.1%; which is lower than the national
average of 21.3% (PHE, 2018a). Cornwall is therefore a predominantly older population. There are
15, 884 more females in Cornwall than males; with the largest number of females aged between
years 50-54 (PHE, 2018b). Cornish people were granted ethnic majority status in 2014 (Ministry of
Housing, Communities and local Government, 2014); and in 2018 92.18% recognised themselves as
Cornish (PHE, 2018c). Only 1.8% of Cornwall's population recognise themselves as from a Black or
ethnic minority (PHE, 2018c) making Cornwall a predominantly white population.

Factors Impacting upon Health

Cornwall’s Index of Multiple Deprivation Index (IMD) ranking is currently 83 out of 317 (Ministries of
Housing, Communities and Local Government, 2019). This is an improvement from 2015 when
Cornwall IMD ranking was 68 out of 326 (Ministries of Housing, Communities and Local Government,
2015). Compared with 2015, 24% of Cornwall’s 326 neighbourhoods are relatively less deprived; 8%
are relatively more deprived and 68% have not changed (Cornwall Council, 2019). Camborne and
Penzance are the two most deprived towns; and the primary types of deprivation in Cornwall’s
worse affected neighbourhoods relates to income, employment, education, skills and training and
health and disability (Ministries of Housing, Communities and Local Government, 2019). Research
shows deprivation increases the risk of poor general and mental health (Stafford and Marmot,
2003). Currently, in England, people living in the least deprived areas of the country live around 20
years longer in good health than people in the most deprived areas (PHE, 2017). Deprivation is the
consequence of a lack of income and other resources, which cumulatively can be seen as living in
poverty (Mack, 2016). Child poverty as an issue is growing in Cornwall (Pearson, 2018), although only
16.2% of children under 16 years are living in low-income families, which is 0.6% lower than the
national average (PHE, 2016). Child poverty in some areas of Cornwall is double the National
average (Pearson, 2018). The Marmot Review (Marmot, 2010) suggests child poverty leads to
premature death and poor health outcomes in adulthood so reducing child poverty will improve
health outcomes and increase life expectancy and break the intergenerational cycle of poverty
(Cheng, Johnson and Goodman, 2016). Closing this gap and reducing health inequalities is one the
biggest challenges faced in public health (PHE, 2017).

Health Status of the Population

Life expectancy of men and women living in Cornwall respectively is 79.8 years and 83.3 years (PHE,
2017). Both of these are above the national average of 78.7 years and 82.75 years respectively (PHE,
2017). The highest cause of death in those under 75 years is cardiovascular disease (CVD) which
affects 66.7 per 100, 000 people. This is better than the national average of 71.7 people per 100,
000. (PHE, 2018d). The majority of factors influencing CVD risk can be attributed to an individual's
lifestyle choices (Chiesa et al 2016). PHE (2017b) explains there are a number of different
physiological and behavioural risk factors for CVD, including smoking, high cholesterol, high blood
pressure, poor diet, harmful drinking and physical inactivity. The optimal dietary pattern to reduce
CVD is one promoting whole grains, fruits and vegetables, legumes, nuts, fish, poultry, and moderate
dairy and heart-healthy vegetable oil intake; this pattern will likely reduce the CVD risk by about a
third (Anand, 2015). Although PHE (2015) estimates 57.3% of people in Cornwall at age 15 years eat
five fruit and vegetables a day which is average the national average of 52.4%. Considering physical
activity as a risk factor PHE (2018e) note 21.1% of adults in Cornwall are inactive but 46.8 % of
people walk at least 5 times per day however, this is lower than the national average of 50.6%. In
relation to the risks associated with smoking; the number of adults who smoke in Cornwall 13.8%
better than the national average of 14.4% (PHE, 2018e). This risk has reduced as the percentage of
smokers in Cornwall has reduced over the last 10 years (Cornwall Council, 2019).

Mental ill health is an area of concern for people living in Cornwall. The suicide rate for males living
in Cornwall is 21.9 per 100, 000 compared to only 14.9 per 100, 000 in England (PHE, 2018f) 7.1% of
females commit suicide which is also above the national average (PHE, 2018g). It estimated those
suffering from common mental health disorders aged 65 years and older is 11.4 per 100, 000
marginally higher than the national average of 10.2 per 100, 000 (PHE, 2018h). Poor mental health
impacts on individuals and their families, through lost income, lower educational attainment, quality
of life and a much shorter life span (WHO, 2013; Kang et al, 2015). Poor mental health in childhood
and adolescence is further associated with a broad range of poor health outcomes in adulthood,
including higher rates of adult mental illness, as well as lower levels of employment, low earnings,
marital problems and criminal activity (Royal College of Psychiatrists, 2010). Although Dementia is a
neurological disorder there is an interface between dementia and mental ill-health (Regan, 2016).
People with dementia of any type have a high incidence of major depression (Kitching, 2015).
Despite Cornwall’s older population, the rates of dementia are better than the national average with
an incidence of only 3.23% of the population compared to 4.33%.

In summary Cornwall is predominantly an older white British population with little ethnic minority
representation. The increasing rate of deprivation and child poverty is impacting upon the health of
this population. A reduction in inequities is also necessary in relation to CVD which results in the
highest death rate in under 75 years (PHE, 2018d). Inequalities exist in relation to mental ill health
especially the rate of suicide in men, which is higher than the national average (PHE, 2018f).
Step 2:

The target population chosen to focus upon in this assignment is children in Cornwall. The
drive for improved child health is set in law as the Child Care Act (2006) identifies key areas
of child wellbeing which reflects central government’s commitment to giving every child a
strong start in life. A focus upon child health is driven nationally by NHS England vision in
Healthy Children: A Forward View for Child Health Information (NHS England, 2016).
Providing a good start in life and enabling children to achieve their full potential and to be
physically and emotionally healthy provides the cornerstone for a healthy, productive
adulthood (PHE, 2014). A child’s development between 5 and 12 years has an impact upon
adolescent health outcomes, as Black et al (2021) discovered in their systematic review.
Therefore, making this life stage an important focus for health promotion.

There are several local policies and plans driving the need to focus upon children's health.
Healthwatch Cornwall (2022) highlight their continued plans to focus on engagement
around children and their health inequalities issues. Cornwall’s latest Public Health report
also focusses upon the importance of child health and the importance of reducing
inequalities which exist in Cornwall (Pearson, 2018). In addition, Cornwall’s health and
wellbeing strategy 2020- 2030 (Cornwall Council, 2019) proposes to focus upon a healthy
start for children to enable them to reach for full potential . Early intervention for children is
seen as a way of reducing health inequalities which exist (Marmot, 2010). The drive to
create a culture of early intervention, was recommended in the first Allen report (Allen,
2011). An increasing variety of early intervention programmes have been shown to improve
life outcomes for those affected by childhood adversity, while also saving long-term costs
for the Government (House of Commons Science and Technology Committee, 2018). This
idea of intervening early in life to prevent ill-health in later life is also supported by the life-
course approach to public health (Jacob et al 2017). Cornwall’s One Vision Partnership Plan
also aims to address many of the poor outcomes associated with adversity (Cornwall Council
2017) so focussing upon children as a target population aligns with local, national prioritises
and research findings
Step 3

An Example of a justification of One Need (you need to justify Three Needs)

A key need in school aged pupils in Cornwall is social, emotional, and mental health needs which
affects 2.63% this population, which is significantly higher than the national average of 2.1.9% (PHE,
2018a). Further to this 297.8 per 100, 000 pupils aged 10-14 years are admitted to hospital each year
following self-harm (PHE, 2018b) an issue continuing to rise and one which is significantly worse
than the national average of 210.4 per 100,000. Nationally there is a drive to ensure equality
between physical and mental health (Mental Health Taskforce, 2016). This drive to improve
children’s mental health has continued over the past four years. The NHS Long-Term Plan (NHS
England, 2019) reaffirmed the Government’s promise to deliver the Five Year Forward View for
Mental Health statements and set out further commitment to improve the provision of, and access
to, mental health services for children. The HM Government (2021) published the Covid-19 Mental
Health and Wellbeing Recovery Action Plan which proposes a renewed commitment to improve
children’s mental health using a collaborative approach between national, local, and voluntary
organisations. In May 2021, the Government (Department of Education, 2021) announced more
than £17 million to improve mental health and wellbeing support in schools and colleges. The impact
of mental ill health in children includes poor educational achievement, and a greater risk of suicide
and substance misuse, antisocial behaviour, offending and early pregnancy (Royal College of
Psychiatrists, 2010). The long-term impact of poor mental health on the child and their family is loss
of income, lower educational attainment, poor quality of life and shorter life expectancy (HM
Government, 2015). The financial cost of poor mental health is unsustainable (Mental Health
Taskforce, 2016); with an estimated £41.8 billion spent per annum in England on the adverse effects
and approximately £77 billion a year lost due to welfare benefits and loss of work productivity
(National Mental Health Development Unit, 2016). Focussing upon mental ill-health in Cornwall is
driven locally by their Health and Wellbeing Strategy 2020-2030 which aims to enable the population
to pay as much attention to their emotional and mental wellbeing as their physical health (Cornwall
Council, 21019). Cornwall’s JSNA for Children and Young Peoples Mental Health (2019) recognises
early access to mental health interventions is greatly needed to support the mental well-being of
more vulnerable children. This national and local evidence supports the need to focus upon the
emotional and mental health of school aged children in Cornwall.
Step 4 of the assignment.

The prioritised health need of teenagers in Cornwall is emotional wellbeing. There is overwhelming
evidence to prioritise emotional health of this target population. Firstly, no other illness has the
collective incidence, persistent and breadth of impact shown by emotional and mental ill health
(Friedli & Parsonage (2007). Emotional health remains a key national priority (NHS England, 2016;
2017; 2019). Public health England (2019) also identifies mental health as a priority believing it is
an area they can make the most impact. Emotional and mental health is also a local priority as the
Strategic Plan of Cornwall Partnership NHS Foundation Trust (2018) aims to improve mental health
and wellbeing of the population by working together to create life opportunities. Cornwall’s Clinical
Commissioning Group (Kernow, 2017) propose to improve prevention, health promotion and early
help, to children and young people with regard to emotional and mental wellbeing. The emotional
and mental health of teenagers is set to impact upon the proposed increase in prevalence of all
mental health disorders among adults by 2035 as discussed by Cornwall’s current Mental Health
Strategy (Kernow, 2019). There is a growing body of evidence demonstrating cost effectiveness of
investing in the promotion and prevention of mental ill health; and early intervention strategies
(Royal College of Psychiatrists, 2010). Adding to this body of evidence to justify the need to
prioritise emotional health of teenagers in Cornwall is the views of the teenagers themselves.
Cornwall Council (2017) found only 29% of young people were satisfied with the services and
support offered by their local council, highlighting the need for additional support.

Strong local (Cornwall Partnership NHS Foundation Trust, 2018; NHS Kernow CCG, 2017; NHS
Kernow CCG, 2019) and national evidence (NHS England, 2016; 2017; 2019) supports the need to
prioritise mental health in Cornwall. NHS Kernow CCG, (2020) place a clear focus upon suicide
prevention in their mental health strategy to reduce the number of deaths by suicide which is
significantly higher than the national average (PHE, 2018). This local strategy identifies Zero Suicide
Collaborative (Brodsky, Spruch - Feiner and Stanley, 2018) as an evidence-based framework to
support suicide prevention initiatives. A specific initiative proposed by Cornwall Council (2019) is
free mental health and prevention training for anyone living in the county. Suicide First Aid is an
evidence-based training course (Zilnyk, 2010) designed to provide knowledge, skills and most
importantly the confidence to intervene with people at risk of suicide. The NMC (2018) establish the
importance of evidence-based practice.
Suicide First Aid is a primary level of health promotion as it seeks prevent suicide in those members
of community at risk (Boyce et al 2010). It adopts a combination of health promotion approaches;
health education; empowerment and behaviour change as discussed by Naidoo and Wills (2016).
Practitioners who have undertaken the programme will be equipped to provide educational material
tailored to the individual as Kreuter et al (2000) have found tailored educational material to be more
effective. Increased practitioner knowledge has been linked into empowerment (Woodall, 2010);
increasing the confidence and ability of practitioners to support those at risk of suidicide.
Empowerment is a good way to foster behaviour change (Guarneri, Brocca & Piras, 2015) and this
change in practitioner behaviour will lead to positive changes in clinical practice thus preventing
suicide in those adults living in Cornwall.

Example Conclusion

This assignment has explored how the prioritised health need of mental impacts upon the adults
living in Cornwall. This need was prioritised using national and local drivers and research findings to
create a strong body of evidence to justify this choice. Free mental health training for the public and
health practitioners is a local initiative in Cornwall set at primary level of health promotion to
prevent suicide. Health education, behaviour change, and empowerment health promotion theory is
applied to the initiative to explain how practitioners and others will help to prevent suicide in the
adult population of Cornwall.