WHAT ARE THE PREVENTABLE CAUSES OF ILL HEALTH ON YOUR PATCH? CAN YOU IDENTIFY ANY OTHER HEALTH NEEDS?

Although respondents identified fifty-three preventable causes of ill health, seven of these were mentioned particular frequently. These were depression, poor nutrition, unemployment, smoking, housing, stress and poverty. Following these came the needs of the elderly especially poor nutrition and tension. Isolation and marriage breakup were noted; accidents and environmental hazards, e.g. fumes from the corporation tip, were also included. Several answers had a similar theme of poor education, lack of motivation, unrealistic expectations of children, odd health priorities, people expecting to be unhealthy, not recognising early signs of illness in children and living at times of day not compatible with child rearing, in the respondents view. For instance.

"Poverty, unemployment, low expectations of health. Its part of the culture. Children poorly nourished. Expect children to be under the weather most of the time. There are very few children here that I could say were, well, bursting with health .... Children constantly attending the doctors." M.I. "For the elderly loneliness, a lot of people living close who really, there are facilities available for them to mix but I think when you’ve lost your spouse you lose motivation." E.Q.

"I don’t know if its any higher in this area but just stress and unemployment. The stress of coping and being isolated." N.G.

"Unemployment. Round this half of the city it is the exception rather than the rule when people are working. I think stress, unhappiness, marriage breakup is a definite cause of ill health. Causes lack of motivation to take your kids anywhere, their priorities are often very strange and they don’t use the health service properly. Don’t contact the doctor as early as they should do. Either that or they pester the doctor for nothing or call the night service because they haven’t got the bus fare down to the doctors or they find it easier than to drag the children there. Even when the kids have seen the doctor they don’t get the prescription for several days. No idea that its free .... They get in this terrible cycle of depression and its very hard to get out of it. With the young mums depression is almost endemic round here .... We have a certain section of the population who are virtually unemployable now, if they do have a job the stress on the family is almost too much and they give it up almost immediately." K.I.

"A lot of problems related to bad housing. Diet is a problem. Very difficult to get through to some families that you want the children to put on weight but you don’t want them to put too much weight on .... Problems in the winter with coughs and colds, lots of chest problems linked with children being overweight or combined with bad damp housing. Also lots of parents smoking, drink problems." I.T.

Another series of responses described particular illnesses and conditions, for example, asthma, pre-menstrual tension, hypertension, ulcers, gastric and duodenal, squints, breast disease, dental decay, cervical cancer, anaemia, carcinoma of the lung and sexually transmitted diseases. One respondent wondered whether the pattern of congenital heart defects she was seeing locally had an environmental cause. Immunization was considered very important for the prevention of illness. Among ethnic minority groups failures in communication were seen as a cause of ill health. Other causes were unemployment itself, non-accidental injury, alienation from the National Health Service appointments system, the effects of preservatives in food, behavioural problems, lead in petrol, and an over-zealous commitment to a poor vegetarian diet. Examples include;

"Better cervical cytology screening particularly for younger women. Politically its not always easy for them to have routine smears. I don’t think every five years is frequent enough anyway. The fibre thing has got through to everybody but we’ve been talking to mums for years about not having extra sugar and I think thats having some influence .... I seem to spend a lot of time helping people find their way through the system. We have a good uptake of immunisation in our practice. I’ve asked for the figures but not got them .... One (surgery) takes in from most deprived areas and the (G.P.s) are not always sensitive to how difficult those people find using services." S.T. "Mainly the children, measles, chickenpox - difficult to contain once it starts. If measles (vaccine) uptake was better it would prevent a few measles, and whooping cough - the uptake is not bad but it could be better." M.P.

"Diet specially the 60 plus group. We do a ten week relaxation course, change in their way of living, change in diet - you see the person change over the year, social conditions, e.g. homeless families rehoused but in a depressed area. Shows in psychological problems in children. Change, for example employment to unemployment you see a fall in their health." N.Y.

14. HOW DO YOU KNOW THESE ARE THE HEALTH NEEDS ON YOUR PATCH?