Shn4023 Social Influences On Health And Wellbeing Portfolio Case Study

1.1 Introduction - Infrastructure of communities

An economy's infrastructure includes all of the facilities, services, and activities that are necessary to provide a range of services (Geeksforgeeks, 2023). Essentially, it is the structural underpinning that makes a country's social and economic development possible.

Infrastructure refers to the fundamental services and systems required for a nation or organisation to function well. Along with essential services like law enforcement, emergency response, healthcare, and education, this also includes physical infrastructure like roads, trains, utilities, sewage systems, water supplies, telecommunications infrastructure, and air traffic control towers (Marketbusinessnews, 2022b).

Infrastructure of Hospitals

Hospitals in London have some of the worst hospital buildings in Britain mixed in with some of the most cutting edge staff and amenities in the world (Jain et al., 2021). Many hospital buildings are in poor shape, with some even dealing with basic maintenance like keeping out the weather, despite possessing top-notch medical staff and resources.

There have been substantial plans and commitments for renovation and reconstruction to solve these problems. As an example, the Department for Health and Social Care and NHS England have begun the clearance process for the reconstruction of St Mary's Hospital in Paddington after receiving a strategic outline case submitted by the Imperial College Healthcare NHS Trust. As part of a £3.7 billion deal, the UK government has also pledged to constructing 40 new hospitals by 2030 (Department of Health and Social Care, 2020). This commitment was a key feature of the government's 2019 election agenda.

Specialised Units and Medical Services

In the healthcare industry, specialised departments and medical services are places with a focus on treating particular medical disorders (Mohanty, Kabi and Mohanty, 2019). These consist of sections such as Oncology Units, Cardiac Care Units, Neonatal Intensive Care Units, and Intensive Care Units (ICU). They provide cutting-edge medical treatments such as palliative care, diagnostic imaging, surgical specialisations, and rehabilitation. To improve patient care, these facilities frequently use interdisciplinary teams and state-of-the-art technology.

2. Infrastructure of Housing

A network of specialised divisions in London provides emergency and urgent care, guaranteeing prompt medical response for a range of health requirements (Kruk et al., 2019). This comprises General Practitioner (GP) services for urgent treatment, Accident and Emergency (A&E) Departments for life-threatening situations, and Urgent treatment Centres (UCCs) for non-life-threatening but urgent problems. London also provides specialist emergency services, such as the London Air Ambulance, and units for particular situations like heart attacks and strokes (Lyng et al., 2021). For less urgent problems, walk-in clinics and Minor Injury Units are available, while the NHS 111 service offers telephone medical advice. There are specialised care facilities and helplines specifically for mental health emergencies.

3. Infrasctrure of Schools

Especially in light of programmes like the Growing Places Fund, London's school infrastructure is an essential part of the city's urban development. This fund, which is a portion of the Mayor of London's wider £110 million investment, aims to enhance infrastructure and regenerate high-potential neighbourhoods to promote growth. Modernization is being done in London schools to improve the learning environment (Kumar, 2020). This includes making necessary facility updates that support contemporary educational standards, as well as remodelling ageing buildings and enhancing the classroom environment.

Most of the money is probably going to go towards implementing cutting-edge technology in classrooms. In an effort to keep up with the latest developments in digital learning, high-speed internet access, state-of-the-art computer labs, and interactive learning tools are all provided. Expanding current schools and building new ones are two ways that school infrastructure development in London responds to the city's growing population (Boys and Jeffery, 2023). In especially in places that are developing quickly, this expansion is essential to meet the growing number of students.

4. Infrasctrure of Sport

London's strong and vibrant sports infrastructure reflects the city's dedication to encouraging physical activity and community involvement (Lee, 2022). The Mayor's Sports Legacy Plan is a crucial component of this infrastructure, with the goal of boosting sports participation overall and among previously underrepresented groups in particular. We encourage development plans that improve sports and recreation facilities, with a focus on multipurpose public spaces and sports lighting to boost opportunities for participation. Sports facilities are receiving more attention now that they are acknowledged as essential components of social infrastructure during the 2012 Olympic and Paralympic Games (Brown and Pappous, 2020). Future sports provision will require strategic planning as London has a deficiency of indoor community facilities such as sports halls and artificial grass pitches.

1.2 Demographics of communities

Age

Figure 1: Population of London in 2020, by age group

(Source: Statista, 2021)

London's broad and dynamic community demographics are reflective of the city's status as a global hub (Van et al., 2021). London's overall population as of 2021 was estimated to be 8.8 million, up 6.7% from 2011 a rate marginally greater than the 5.9% growth experienced by the rest of England. With a 10% increase, East London showed especially robust growth. The population of North, South, and West London increased by 5.6%, 6.5%, and 7.5%, respectively, while Central London's population increased by a more moderate 0.3%. The age group of 30 to 34 represented the biggest proportion of the population in London, United Kingdom, in 2020 nearly 822,000 people (Statista, 2021). The age groups that were most populous were those between 25 and 44, and following the peak of 30 to 34 years old, the size of each elder age cohort gradually decreased.

1.3 Support networks available to communities

Access to Community Resources

All Londoners will have resources at their disposal by 2025, allowing them to volunteer, receive assistance, and create strong community networks (london.gov.uk, 2019). This purpose is to ensure that communities, especially the most disadvantaged ones, are empowered, have more control and choice over the services they receive, and have the appropriate assistance and resources.

Fostering Community Engagement and Learning

Londoners get together through events like the Festival of Ideas and the Festival of Learning to exchange best practises in cooperation, equity, leadership, and procedures as well as to discuss ideas for thriving communities. In addition, the Propel collaboration seeks to create cooperative strategies to address London's major difficulties with an expected expenditure of £100 million over the next ten years.

Mental Health Crisis Care Agreement

This agreement aims to give all Londoners experiencing a mental health crisis equitable access to prompt and appropriate help (England.nhs.uk, 2019). It involves health organisations, London Councils, the Metropolitan Police, and the London Mayor's office. The strategy was created with participation from a variety of community groups, including minority ethnic communities and specialists with expertise, to guarantee that care is available, safe, and harm-free at the appropriate time and location.

2.2 Inequalities in communities

The unfair and preventable variations in health status that exist within and between various groups of people are referred to as health inequalities in communities. The complicated interactions of multiple factors, such as socioeconomic status, environment, education, lifestyle decisions, and access to healthcare, lead to these differences (Braveman and Gottlieb, 2014). For instance, people with lower socioeconomic status frequently have worse health outcomes than people with higher socioeconomic status.

Inequalities in life expectancy

There are significant disparities in life expectancy in London between various boroughs and socioeconomic categories (Ingleby et al., 2021). The difference in life expectancy between men living in different places is glaringly obvious: a man in the rich area of Kensington and Chelsea will live an average of 90 years, while a man in the impoverished area of Barking and Dagenham will live an average of only 73 years. This disparity is a reflection of larger health disparities associated with socioeconomic status and living circumstances.

Figure 2: Provisional life expectancy in England, 2015 to 2020, by sex

(Source: Ukhsa.blog.gov.uk, 2021 )

In recent years, there has been a decrease in the life expectancy in London's poorest regions. For example, a man's life expectancy in the most impoverished region of London dropped from 77.3 years in 2014–16 to 75.9 years in 2020–21 (ukhsa.blog.gov.uk, 2021). The difficulties encountered in such communities, such as decreased government funding and the ensuing cuts in local services, are best illustrated by Barking and Dagenham, one of the most impoverished regions in the nation with nearly half of its children living in poverty.

Inequalities in long-term health conditions

Long-term health condition disparities in London are a symptom of larger health disparities influenced by a range of demographic and socioeconomic factors (Hayanga, Stafford and Bécares, 2023). Disparities in income, location, sexual orientation, ethnicity, and social exclusion such as homelessness or refugee status all influence these disparities. Individuals who are burdened with numerous disadvantages frequently feel the compounding consequences of these disparities.

The discrepancies between the various groups' experiences with health outcomes clearly show these disparities (Wasserman et al., 2019). People's life expectancies, for example, differ greatly depending on where they reside. Those who live in the most impoverished areas, for example, will live over ten years less than those who live in the least impoverished places. When taking into account healthy life expectancy, which gauges the amount of time spent in excellent health, this disparity grows. People can anticipate living eighteen fewer healthy years in the most deprived areas than in the least poor areas.

The wider determinants of health

Income

With substantial effects on the wellbeing of its citizens, income is a major broader factor of health in London. After housing prices are taken into consideration, over half of Londoners are either "financially struggling" or "just about managing," with over a quarter (27%) living in poverty as of 2021. In London, there is a notably sharp income gap, with the richest 10% of earners earning roughly ten times as much as the lowest 10%.

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Housing

The location, cost, and standard of housing in London all have a big influence on health (Swope and Hernández, 2019). Overcrowding, moisture, and insufficient heating are examples of poor housing conditions that can cause chronic illnesses, mental health disorders, and respiratory ailments. Exorbitant housing costs can also put a strain on finances and restrict access to other necessities like wholesome food and medical care.

Transport

Access to opportunities and services, levels of physical activity, and the quality of the air are all impacted by London's transport system on health. Air pollution aggravates respiratory and cardiovascular conditions, and it is a result of heavy traffic and an over-reliance on automobiles (Balali-Mood, Ghorani-Azam and Riahi-Zanjani, 2016). On the other hand, having access to safe cycling and pedestrian infrastructure as well as public transport can promote physical activity and lower health risks.

Education

In London, health outcomes are closely correlated with educational attainment. Better health literacy, healthier lives, and easier access to resources and well-paying jobs are all frequently associated with higher education levels. Health disparities can be caused by educational disparities, as lower educational attainment is frequently linked to worse health outcomes.

Work

In London, employment and working conditions have a significant role in determining health. Physical and mental health are directly impacted by factors such as job security, income, stress at work, and workplace safety. While safe, secure, and meaningful work can improve well-being and health, unemployment or precarious employment can cause financial difficulty and stress, which can have a detrimental influence on health.

The impact of Covid-19 on health inequalities

The Covid-19 pandemic has had a significant effect on health disparities, exposing and intensifying inequities across different demographic and socioeconomic populations (Ala et al., 2021). The impact of the epidemic has been uneven among individuals and groups, with marginalised populations experiencing a disproportionate burden. Socioeconomic factors, including income, healthcare accessibility, and living conditions, exert a substantial influence on the degree of exposure to the virus and its associated ramifications. Individuals belonging to lower socioeconomic strata frequently encounter restricted availability of healthcare resources hence rendering them more vulnerable to adverse consequences upon contracting the virus. The current imbalance is further amplified by the high occurrence of pre-existing health issues among economically disadvantaged communities, hence increasing the likelihood of experiencing severe illness or mortality.The global health crisis has additionally emphasised the significance of profession as a determining factor of susceptibility (Kruk et al., 2019b). Frontline workers, frequently hailing from socioeconomically disadvantaged families, encounter heightened susceptibility to the virus as a result of the inherent characteristics of their occupations. The increased risk is exacerbated by probable difficulties in obtaining protective equipment and sufficient healthcare services that exacerbating health disparities.

Figure 3: COVID-19 Mortality rates

(source: health.org.uk, 2019)

The total count of COVID-19 fatalities has exhibited a decline; nonetheless, a notable disparity in the mortality risk associated with COVID-19 persists between those residing in the most and least socioeconomically disadvantaged regions. Since July 2021, there has been a steady elevation in both age-standardised mortality rates and the absolute number of COVID-19 deaths within the most socioeconomically disadvantaged regions (health.org.uk, 2019). The age-standardised mortality rates for COVID-19 have exhibited a consistent pattern of being approximately three to four times higher in the most socioeconomically disadvantaged regions compared to the least disadvantaged regions within a given month. During the period spanning from July to December 2021, it was seen that the number of COVID-19-related fatalities in the most socioeconomically disadvantaged regions of England amounted to 2,300, which surpassed the corresponding figure of 900 recorded in the least socioeconomically disadvantaged areas by a factor of 2.5 times.

Effect of social factor on people's health and well-being in case of Extended case study

The influence of deprivation on Sanku’s health and wellbeing

Income deprivation and Mental Health

The case study of Sanku serves as a compelling example that highlights the complex interplay between social determinants, specifically the experience of income deprivation, and its significant influence on his overall health and well-being. Sanku's socioeconomic situation as a low-income individual is situated within a broader environment of pronounced deprivation within his residential area. This setting is marked by elevated levels of unemployment, crime poverty and a dearth of educational resources and possibilities. The socio-economic context significantly influences Sanku's mental well-being, leading to the development of chronic stress and a sense of being inundated. The relationship between income deprivation and mental health is complex, and Sanku's financial difficulties serve to intensify his personal troubles. Sanku, as the primary earner in a low-income household faces the challenge of managing debt and frequently relies on working additional hours to meet household financial obligations. The confluence of financial instability and the role of primary carer for his wife Salima that contends with persistent mental health disorders, engenders a multifaceted array of difficulties that impact Sanku's psychological welfare.

Furthermore, the presence of limited resources within Sanku's community, as seen by restricted availability of green spaces, a higher prevalence of fast food options compared to fresh produce and a lack of recreational amenities, has an impact on his health-related behaviours. The environment has a significant role in shaping a lifestyle characterised by suboptimal food patterns, restricted engagement in physical activities, and the difficulty of achieving and sustaining a healthy body weight. The convergence of poverty and harmful behaviours becomes apparent in Sanku's endeavour to effectively control his Type 2 diabetes, which is manifested by an elevated body mass index (BMI), inadequate dietary choices, and challenges in comprehending his medication regimen.

A comprehensive and individual-focused approach is essential for examining the impact of hardship on Sanku's health and well-being. Interventions must to incorporate in addition to the medical dimensions as well as effectively address the social determinants of health (Kolak et al., 2020). The implementation of social prescribing, which involves connecting individuals like Sanku to community-based resources support groups and financial counselling can play a crucial role in addressing the complex array of issues that he encounters (Kolak et al., 2020).

Poverty and unhealthy behavior

Moreover, the presence of poverty within Sanku's neighbourhood exacerbates the prevalence of harmful behaviours that intensifying the obstacles to his general well-being. Sanku's nutritional choices are influenced by the limited availability of fresh and healthful food options, as well as the abundance of takeout in the nearby high street. The presence of a scarcity of green areas and recreational amenities within the surroundings poses a significant barrier to engaging in physical activity. The aforementioned issues all lead to Sanku's challenges in effectively controlling his Type 2 diabetes. The individual's suboptimal dietary choices, along with a limited comprehension of his prescribed pharmaceutical regimen, demonstrate the convergence of socioeconomic disadvantage and detrimental habits, hence intensifying his state of health. A comprehensive strategy is needed to address the impact of deprivation on Sanku's health and wellbeing. Interventions must to take into account the social determinants of health in addition to conventional medical care. Initiatives known as "social prescribing," which link people like Sanku to financial counselling, support groups, and community services, can lessen the stress that comes with not having enough money (Reinhardt, Vidovic and Hammerton, 2021). Furthermore, community-based initiatives that work to provide accessibility to reasonably priced, wholesome food, encourage physical exercise, and establish nurturing surroundings might help lessen the negative effects of poverty on unhealthy lifestyle choices (Reinhardt, Vidovic and Hammerton, 2021).

The influence of social class on the person’s health and wellbeing

Social class and lifestyle behaviour

An individual's social class has a significant impact on their health and well-being, influencing many facets of their lifestyle choices and medical consequences (Hu et al., 2020). It is a factor that represents health habits, work-related variables, accessibility to healthcare, and availability to necessary resources. Higher socioeconomic class people typically have more access to wholesome food, stable jobs, and private healthcare, which promotes healthier lifestyles and better health results (Hu et al., 2020). On the other hand, those from poorer socioeconomic backgrounds could experience financial strain, unstable employment, restricted access to healthcare, and involvement in risky health practises (Matin et al., 2021). This discrepancy emphasises how critical it is to identify and solve health disparities associated with social class through focused interventions and just policies that advance everyone's well-being, regardless of socioeconomic status.

Social class and Healthcare access

As Sanku comes from a low-income family and lives in a highly impoverished location, his socioeconomic status greatly influences the healthcare that he receives. It is commonly known that socioeconomic position affects health outcomes, and those from lower socioeconomic groups frequently face obstacles while trying to get access to high-quality medical care. Sanku's social class is characterised in large part by financial constraints, which may limit his capacity to buy private healthcare options and force him to rely on the public healthcare system. According to the case study, Sanku has been identified as having high blood pressure that Type 2 diabetes and perhaps chronic obstructive pulmonary disease. But he says he doesn't know enough about his nutrition, enough to take his medications, or the best way to keep an eye on his diseases. Therefore, he finds it hard to manage his health. His socioeconomic class has an impact on his lack of awareness of and involvement with his healthcare needs, as conflicting priorities and financial hardships can prevent proactive healthcare-seeking behaviour.

Sociological Theory and its applications to Health and Wellbeing

A thorough foundation for comprehending the complex relationship between social circumstances and personal health and well-being is provided by sociological theory (Vyalykh et al., 2021). That may investigate how cultural norms, institutional practises, and socioeconomic position influence health outcomes by putting these theories to use (Vyalykh et al., 2021). Important sociological methods include looking at social determinants of health, which show how factors like education and poverty affect health, and using intersectionality to analyse health disparities since it takes into account the compounding impacts of overlapping social identities. While conflict theory and structural functionalism examine how societal conflicts and healthcare institutions contribute to the persistence of health inequities, symbolic interactionism and other theories examine how society perceptions affect health behaviours. Gender-related aspects of health are clarified by feminist viewpoints, while the effects of socio-political and economic systems on health disparities are examined by critical theories such as Marxism and critical race theory (Vyalykh et al., 2021).

Theory and its significance on Health and Wellbeing

When it comes to health and wellbeing, feminist theory is primarily concerned with figuring out how gender-based disparities affect health outcomes (Doherty, 2019). It highlights how differences in healthcare access and treatment for women and other marginalised genders can result from cultural norms and systems, which are frequently patriarchal in nature (Doherty, 2019). In addition, feminist theory critically investigates matters pertaining to sexual and reproductive health as well as the demands of women's mental and physical health, which are frequently disregarded. It promotes a more fair and inclusive healthcare system that deals with these problems and health issues unique to gender.

Feminist theory can assist explain how a middle-aged woman's health experiences may be influenced by gender biases in healthcare when applied to a specific individual (Riach and Jack, 2021). Her physical and emotional health may be negatively impacted by not being able to get reproductive health services, having trouble getting her symptoms addressed seriously, or carrying the weight of social expectations about providing care.

Economic Stress

Economic stress may be experienced by the woman as a result of things like the gender pay gap and few job opportunities. She might experience financial instability if she belongs to a lower socioeconomic group, which would make it difficult for her to pay for essential services like food, medicine, and other resources for her health and wellbeing.

Structural Inequality

Her life may be impacted by structural gender inequality if she has limited access to job and educational options. This may lead to differences in resources and income, which could have an impact on her ability to get high-quality medical care and the state of her health in general.

Healthcare Access and Power Dynamics

Her experiences in hospital settings could be influenced by power dynamics. Her health issues might not always be addressed seriously, and she might run into prejudices based on her gender. Frustration and possible health inequities might result from a lack of autonomy in healthcare decisions.

Family Dynamics and Mental Health

When conflict theory is applied to family dynamics and its effects on mental health, it becomes clear that complex power relationships, disagreements over how to allocate resources, and role expectations can pose serious problems for the people who live in families (Fama and Jensen, 2019). Feelings of helplessness and tension can result from power disparities in these kinds of situations, which are frequently related to elements like gender and socioeconomic status (Fama and Jensen, 2019). Conflicts over the distribution of resources and role expectations can also lead to stress, annoyance, and a feeling of being stuck, all of which can exacerbate mental health problems. Extended interpersonal disputes and insufficient resources in families can intensify tension and anxiety (Fama and Jensen, 2019). It is critical to identify and resolve these power disparities and conflicts in order to create a loving family atmosphere that supports each member's mental health.

Community and supporting networks

When conflict theory is applied to community and support network dynamics, it becomes clear how complex power dynamics, disagreements over resource distribution, and societal injustices can impact people's well-being in these settings (Özkaynak et al., 2023). Certain community members may become marginalised and disempowered as a result of power disparities and disagreements over decision-making and resource allocation, which can cause stress and exclusion (Özkaynak et al., 2023). Vulnerable populations may experience increased mental and emotional suffering as a result of social exclusion and inequality brought on by discrimination and exclusionary practises (Carter, 2021). Although activism and social movements have the potential to overthrow established power systems, they can also cause conflict and division in local communities (Carter, 2021). It is crucial to identify and resolve these conflicts in order to create more inclusive and equitable community settings where everyone's well-being is given first priority (Carter, 2021).

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