Population Health and Co-Production

This assignment delves into the concept of population-centered healthcare within communities. It examines the role of co-production in healthcare service planning and delivery, drawing insights from academic research and real-world examples like the Ebola outbreak. The document also includes statistical representations of diseases, highlighting the importance of data analysis in public health.

The Role of Public Health in
Health and Social Care

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
TASK 1............................................................................................................................................1
1.1 Roles of World Health Organisation, Department of Health and communities...................1
1.2 Epidemiology of one infectious and one non-infectious disease..........................................3
Research on mode of transmission and preventive strategies.....................................................4
1.3 Effectiveness of different approaches and strategies for controlling infectious diseases.....4
TASK 2............................................................................................................................................5
2.1 Current priorities and approaches to the provision of services for people with disease or
illness...........................................................................................................................................5
2.2 Relationship between prevalence of disease and service requirements for supporting health
and social care individuals..........................................................................................................6
2.3 Impact of current lifestyle choices on future needs of health-care services..........................7
TASK 3............................................................................................................................................8
3.1 The health and well-being priorities for individuals in a particular health or social care
setting..........................................................................................................................................8
3.2 Effectiveness of strategies, systems and policies in a health and social care setting............9
3.3 Changes that could be made to improve the health and well-being of individuals in a
health or social care setting.......................................................................................................10
3.4 Activity that has been implemented to encourage behaviour change for maximising health
for individuals in a health or social care setting........................................................................11
CONCLUSION..............................................................................................................................12
REFERENCES..............................................................................................................................13

Illustration Index
Illustration 1: Statistical representation of Ebola disease................................................................5
Illustration 2: Disability Adjusted Life year....................................................................................8

INTRODUCTION
Public health concerns in helping people to stay healthy, and protecting them from threats
to their health. According to Stephen Gillam 2012, public health is defined as ‘the science and art
of preventing disease, prolonging life and promoting health through the organized efforts of
society’. The government wants everyone to be able to make healthier choices, regardless of
their circumstances, and to minimize the risk and impact of illness (Popescu, 2014)
Health and social care is one of the largest industries that are responsible for providing
health care services to the users. For an instance, NHS which is a type of public health
organization provide one of the best health services across world. The treatment given in this
hospital is free of cost .The services and treatments that are given in NHS hospitals can as
follows-:
 Accident and emergency services
 Treatment for infectious disease including sexually transmitted infectious (STIs).
The London bridge hospital at UK is one of the world-class private hospital. Various
facilities and care is given to patients at this health care organization.
Many private and public-sector organisations are involved in making services available to
the people. Elements such as nutritious diet, sociology, biology, ethics and government laws are
also part of it. In order to provide patients and their families a well-maintained environment these
elements are important. The elements such as nutrition diet will be given people at these
organization so that they can recover rapidly. The government laws need to be followed at these
organization in order to protect the rights of employees and patients. Adoption of these laws will
make sure that equal rights and opportunities are given to all. The use of ethics will help the
individuals to make correct decisions regarding what is wrong and what is right. In the world
there are various agencies involved in providing care and support to the individuals (Stewart and
Wild, 2017).United States Agency for International Development is one of the global agencies
that is involved in the global health efforts. Another example is The Centers for Disease Control
and Prevention (CDC) which is part of the U.S. Department of Health and Human Services. The
organization is responsible for implementing public health initiatives in the U.S., and also
investing in its resources to advance global health initiatives. Several factors are also there that
affects wellbeing of the people which required special attention.
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This essay considers different approaches and strategies used to control, monitor and
measure the incidence of disease in communities. Furthermore, it discusses the implications of
illness and disease in communities for the provision of health and social care services.
Additionally, it accesses and evaluates the factors influencing health and well-being of individual
living in the community.
The roles of World Health Organisation and Department of health will be studied in the
report. Impacts of lifestyle which is being chosen by the people today would have on the future
needs will also be covered.
TASK 1
1.1 Roles of World Health Organisation, Department of Health and communities
Public health activities are executed at different levels from global to national to local.
The organisations and agencies committed to public health at these different levels share many of
the same functions including disease control, policy development, and provision of access to
health care. To better understand how all these agencies works to provide public health services,
this section of the essay will look at public health organisations.
On a global level, the World Health Organisation has set up certain standards to promote and
monitor health care services for the population that are residing in UK so that they could be
protected from several diseases. Various strategies and plans that are made by WHO expands
from government to non-governmental services, NGO’s and private health and social care
services It is also associated with prevention of diseases along with promotion of fundamentals
of healthy life among people. Several standards have been identified which ensures a healthy
environment (Stanhope and Lancaster, 2015). Assessment of the population is also done by
WHO so that people at risk could be identified. It is done to reduce the impact of disease on
people and encourage healthy lifestyle among population of UK. For inspection of health-related
problems, various policies have been also formulated. Improving health together policy can used
in order to improve the health of population across world and prevent them from various health
problems. There are various agencies that are involved into these practices along with WHO
such as Department of Health or Public Health England and Local Authorities, European Union.
At international level, role of WHO could be summarized as:
 They provide leadership on critical health matters such as Ebola, Cancer, HIV,
obesity, tuberculosis
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 Provide research to find solutions and stop dissemination of certain diseases
 They monitor and assess the health situation in different countries
 They engage themselves into partnerships whenever required along with providing
leaderships on health-related matters.
 Valuable knowledge is disseminated by WHO.
 Health care standards are also set by them and they also monitor them after
implementing these standards.
 Technical support is provided along with bringing changes in the working practices.
Apart from WHO, the Europe Union (EU) works to protect and improve the health of all
Europeans throughout their lives. EU health policy complements national policies to ensure that
everyone living in the EU has access to quality healthcare. While the organisation and delivery
of healthcare is the responsibility of individual countries, the EU brings added value in helping
countries achieve common objectives. EU health policy generates economies of scale by pooling
resources, and helps countries to tackle the common challenges, including health threats such as
pandemics, the risk factors associated with chronic diseases or the impact of increased life
expectancy on healthcare systems (Europa).
On a national level, in the United Kingdom, there is an executive agency named as Public
Health England which is a part of Department of Health. It came into existence on 1st April in the
year 2013. It came into force because National Health Service was reorganized (Brownson,
2017). It was engaged into improving people’s health with the objective of reducing inequalities
in health matters. Support is also provided by them to the local communities and government
encouraging them to present advertisements for the benefits of good health. The DH is
responsible to provide an emergency response to situations that may arise.
On the other hand, Department of Health is also involved in providing health services to
the individuals so that their life expectancy could be increased and a better life could be led by
them. Funding is also provided by them so that people in need could get benefited. A good
example of this is the professional development of health care workers in partnership with the
Student finance scheme.
Clinical commission groups were formed as a result of the Health and social care act
2012. They are statutory bodies of NHS that is engaged in providing health care services to the
people of local community.
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On a local level, local authorities commission care and support services and have the
responsibility to protect and improve health and well-being. Leading joint strategic needs
assessment (JSNA) to ensure commissioning strategies. The current strategy of JSNA is to look
at the health of the population and provide them with health care needs .The client approach is
being used by JSNA to understand the health and well-being needs of distinct population. They
use their knowledge of their communities to tackle challenges such as smoking, alcohol and drug
misuse and obesity. Working together with health and care providers, community groups and
other agencies, they prevent ill health by encouraging people to live healthier lives (gov.uk).
The Care Quality Commission (CQC) inspects and regulates different care services in
different ways, measuring whether services meet national standards of quality and safety,
ensuring that people are treated with dignity and respect (cqc.uk).
1.2 Epidemiology of one infectious and one non-infectious disease
This part of the discussion explains the use of statistical data, the epidemiology of Ebola and
Breast cancer.
Epidemiology could be defined as the study of health-related issues which may include both
infectious and non-infectious diseases along with implementing control measures so that it could
be prevented among individuals (Giddens and Carr, 2016).
WHO is engaged into collecting and gathering all the statistical data of global world so
that observations could be carried out to identify the pattern or diseases and accordingly
preventive measures could be taken up. They also identify preventive measures so that epidemics
could be prevented by taking nutritive diet and immunization. Health issues are also identified by
them and programmes are designed accordingly so that people could be provided with health
care facilities.
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The data that were gathered by WHO related to the disease such as Ebola. This graph shows
Total suspected, probable, and confirmed cases and deaths of Ebola virus disease.
5
Illustration 1: Statistical representation of Ebola disease
(Source: Statistical representation of Ebola Disease)

EDV is an abbreviation for Ebola virus disease which is also called as Ebola haemorrhagic fever
that causes illness among people. It is generally found in various countries but the most
popular among them are African countries (Stanhope and Lancaster, 2015). It was first
identified in the year 1976. After that, outbreaks began to appear all over the area. Ebola
is an infectious disease that gets spread by physical contact. For example, if there is a cut
on the skin, or wounds are uncovered, then it gets easily made into other's body.
Individuals suffering from this disease are consequently advised to remain isolated
because the virus gets easily spread among others. To date, there have been more than
15,000 cases of Ebola in Guinea, Sierra Leone and Liberia. Out of these, there have been
5,400 deaths. There have been 8,142 laboratory cases, which brings the mortality rate up
to 60.79%. In comparison, the Spanish Flu (the 1918 Flu Pandemic) caused
approximately 50 million deaths, but infected far more people such that only 2.5% of
infected people died. This is the deadliest outbreak of the virus since its discovery in
1976. 70% of patients are need to be isolated for the outbreak to decrease at nearly the
same rate of increase. Due to Ebola epidemic it is estimated that about 7,000 children
have been orphaned. About 4,461 beds are in Ebola treatment centres as being said by
WHO.
Breast Cancer is another disease which is non-infectious but have affected so many
individuals .It is most commonly observed in women but can also affect men (Hoeve, Jansen and
Roodbol, 2014). It also occurs with the growing age and is most commonly observed in females
who are above 50 years age. From the statistics, it has been said that out of 8 women one woman
will face breast cancer in their life. Every year in the UK, 11,400 people die because of breast
cancer. The chances of it to be faced by men are much lower compared to the women. The
survival breast cancer rate is 78%. Prevention cases are 27%. According to the statistics, 390
cases are observed in men when compared to women where number of cases are 55,000. The
progress will slide backwards the longer the Ebola epidemic goes on (Voorberg, Bekkers and
Tummers, 2015).
1.3 Effectiveness of different approaches and strategies for controlling infectious diseases
This section of the essay evaluates the effectiveness of different approaches and strategies
to control the incidence of disease in communities.
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It has been observed by studying various reports that there is significant growth in the
number of HIV/AIDS people. Viruses of it has been spread with high speed over the last few
years (Cotlear and et.al., 2015). It has been seen that there were estimated 40 million people who
are suffering from it in the year 2015. NHS and WHO have planned various strategies to help
how people could be prevented from getting affected. For this, HIV screening tests have been
provided so that infection could be minimized from getting acute in the body. WHO has
executed HIV/AIDS programmes which have been combined by both government and
nongovernment sectors? Some of the strategies that could be implemented are listed below:
 Voluntarily taking tests so that presence of any kind of HIV viruses could be identified
 To take control measures in sexually transmitted infections (STIs)
 Antiretroviral treatment provision
 Care that could be taken at home
 Free Testing
 Health Education
Prevention programmes breast cancer, diabeted etc.
are conducted with the aim of controlling risks and taking preventive measures (Osborne,
Radnor and Nasi, 2013). Education is the best way to make people aware about anything.
Schools, colleges and offices could be offered educational sessions so that people could be told
about the causes, symptoms, preventive measures to be taken and precautions that should be
adopted so that infections could be controlled.
TASK 2
2.1 Current priorities and approaches to the provision of services for people with disease or
illness
“According to WHO, Burden of disease is the analyses of mortality and loss of
health due to disease “(WHO).
DALY – is a way of measuring the overall life.
DALY = YLL + YLD
Where: YLL = years of life lost due to premature mortality. YLD = years lived with
disability.
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Some of the approaches and priorities in providing health-related services are discussed
below:
Disease prevention: Disease preventive measures basically focuses on how to keep people
healthy so that they do not get infected by diseases (Vaidya, 2013). Measures that could be taken
up in context of HIV/AIDS are:
 People should be taught about the ways by which viruses spread among individuals and
what control measures should be adopted so that it could be taken care that others do not
affected (Voorberg, Bekkers and Tummers, 2015).
 Wounds should always be covered on people suffering from it so that if they have some
cuts on their skin would not affect others by mixing into blood.
As we know, no vaccination is available which could be utilized for HIV infection.
Treatments: these are provided with the aim of curing individual who has been suffering from
infectious and non-infectious diseases. It involves medications, treatment courses etc. that are
given to the people for their well-being. Therapies are also provided to recover from injuries.
Palliative care: It could be defined as care that is being provided to the individuals who are
suffering from diseases which is very serious or terminal (McCarthy, Johnson and Audet, 2013).
This is basically emphasized on providing relief to the individuals from the illness. The objective
8
Illustration 2: Disability Adjusted Life year
Source: Evaluating firefly's impact, 2016

of the palliative care is to enhance quality of life of the person who is suffering along with their
family members.
Remedial care: it is a non-residential centre that provides health care services for the people
who have physical incapacity. It can include alternative therapies, such as osteopathy,
homeopathy, etc.
Pregnant women tend to take medicines of HIV in order to prevent its transmission in the
child. During some circumstances, a caesarean section delivery is preferred by the doctor in
order to reduce the risk of transmission of the disease to the minimum.
There are various negative beliefs that have been opted by the people in case on people
suffering from HIV positive and AIDS. It destroys the social life of a person. Moreover, the
person have to sometimes indulge in the treatment of depression and anxiety as well due to
unacceptable of family members and inadequate awareness about the disease.
2.2 Relationship between prevalence of disease and service requirements for supporting health
and social care individuals
In order to provide health and social care services to the individuals, there are few
requirements which are needed to be fulfilled so that individuals could be treated in a much
effective way. There is relationship between all the types of diseases which are discussed below:
 Planning: To implement any preventive measures, it is important to analyse what are the
major factors that have caused the infections (Popescu, 2014). Therefore, when the
causes are identified then it becomes easy to implement measures effectively without
consuming time. After knowing all the root causes, implementation plan should be
prepared. g time. After knowing all the root causes, implementation plan should be
prepared. It will help in assessing the prevalence of breast cancer in women and its causes
as well. The plan will be prepared by the healthcare board as it will help in analysing that
whether the services provided by the healthcare centres is adequate enough for the
patients or not. It is important to as it will help in providing better services to the patients.
 Facilities: there is direct dependency between the requirements and the processes that has
been carried out in context of specific diseases. Facilities are accordingly provided on the
basis and acuteness of the disease. For example, if a region has high number of
individuals affected by HIV infection, there would be required to adopt resources that
could facilitate people to get preserved (Voorberg, Bekkers and Tummers, 2015 ).More
9

facilities that technological upgraded health centre will be able to diagnosis the cancer at
initial staege only which will reduce the death prevalence through breast cancer.
 Expertise: People who are expertise in this sector should provide information to the
population about the importance of healthy life style and how diseases like HIV, breast
cancer affects peoples along with preventive measures that should be adopted.
 Funding: With the prevalence of diseases, there is always requirement of funding so that
necessary steps could be taken up in context of specific disease (Enthoven, 2014). All the
essential areas should be analysed and finances required should be allocated accordingly.
It can be received from the government and from the private funding technique as well.
For instance, the government of UK have invested in various medical colleges in order to
develop quality doctors and provide better services to the health centres.
2.3 Impact of current lifestyle choices on future needs of health-care services
It has been seen that what you perceive today would have impact on the future as well.
Currently people are engaged more into bad habits such as smoking and drinking whose impacts
would be visible at later stage making health conditions poorer.
 Smoking: this is one of the most dangerous issues that has long lasting impacts on the
body. The number of people involved into such practices have increased and the effects
on the health are carried along in the future as well (Fung, 2015) It is the key of various
other diseases which can lead to hazardous health symptoms. It can also lead to lung
cancer. It has been seen that one out of 10 people suffer from cancer due to smoking.
They will be requiring more healthcare services in the near future due to increase in
prevalence of smoking among people.
 Diet: Change in diet patterns also causes damages to the stomach and intestine such as
gastritis, etc. There is another issue observed in the people that obese whose percentage
observed is 46% and the reason behind this is poor eating habits involving denial of
nutritious food and consumption of fast food. People are getting involved in poor eating
habits which has led to prevalence of various stomach and immunity related diseases. It
will increase the need of physicians in order to assess the disease and treat the patients
 Exercises: to remain healthy and fit, it is always suggested doing exercises regularly such
as swimming, walking, running, etc. These habits make people to develop immunity and
fight against diseases. People who are not engaged into physical activities are more prone
10

to diseases. Obesity is the core reason to various diseases such as, cholesterol problem,
hear related and pre diabetic state. It has led to people seeking for medical health
 Relaxation: While within organisations, it has been observed that people suffer from
various health related issues such as stress, pain in joints, headaches etc. (Van Eijk and
Steen, 2014) these are all because of lack of relaxation and social life. If such issues
continue, then there are chances that all the problems will affect in the future as well.
 Alcohol: Consumption of alcohol causes serious damages to liver and stomach. Despite
of various government policies it is very difficult to control people for consuming it. It
also leads to liver failure and cancer to the mouth, throat, Esophagus etc. It will require
advanced technology at the health centres as more people will seek help from the medical
advisor.
Therefore, health-care organisations could prepare various programs to generate awareness
among the people about the good health and what factors should be taken into consideration in
leading daily life.
TASK 3
3.1 The health and well-being priorities for individuals in a particular health or social care setting
It is vital that effective health care services should be provided to the individuals so that they
can live a standard and longer quality life. Further, the government always makes efforts for
providing better and effective medical care to the individuals. In this section people living in
Haringey Borough of London is studied. The health and wellbeing priorities of individuals living
in that borough comprise of prevention and identification of diseases. Early and fast help for
individuals who require support and identification of medical issues and its fast process helps for
better treatment per example in cases of STIs (Martin, 2010).
In addition to that health priorities of individuals include earlier detection of diseases so that
timely treatment could be provided to them. In addition to that integrated support is required for
individuals who are at risk so that effective and integrated care should be provided to people.
One more priority need is quality services and patient experiences so that people in the Borough
should receive better medical care and treatment (Earp, 2008).
Therefore, exists the need for ensuring better and effective care for vulnerable children and
reducing hospital admissions. One more health priority is to provide better and effective
integrated care for the elderly populations so that appropriate medical treatment should be
11

received by them. Priorities of individuals comprise of social and emotional needs and it is
critical that all the requirement of individuals should be met so that safety and mobility needs
should be maintained (Bruno, 2010). In addition to that diet, hygiene and intellectual needs are
also at priority of individuals in Hackney.
3.2 Effectiveness of strategies, systems and policies in a health and social care setting
Health care settings in the Haringey Borough makes best possible efforts for providing better
and effective care to the individuals that are living there. NHS is providing medical care to
people and it is supporting suitable medical facilities to individuals. Policies are there for
monitoring and improving the provision of care in that borough it has helped addressing and
meeting the needs of the people who lives in Hackney. In addition to that provisions of services
are effective (Atwal and Jones, 2009).
Care quality commission work for regulating the health and social care services that is
provided in the borough and therefore it ensures a better care is offered to the individuals
(Renaud and Goucher, 2012). Guidelines have been given for care providers, public and other
individuals. Health policies and strategies are supported for meeting the health care requirement
so that better and effective health care services should be given to individuals living in Hackney.
Public health department of the borough has developed strategies for providing protection to the
community people for infectious diseases.
Immunisation and vaccination programs have been initiated by the government so that
protection could be provided against the childhood diseases and it has helped for giving better
and effective care to the individuals. A routine immunisation protocol have been issued by the
UK government that is required to be followed by the medical health centres. There are various
vaccination issued to prevent the diseases such as, Rotavirus, measles, Meningococcal etc. These
are made available at all the health centres so that people can reach to it easily. Several
immunisation campaigns are also organized by the government to reduce the impact of disease to
the minimum (Immunisation, 2017). Cancer screening programs have been organized so that
detection of cancer could be done and based on that care should be provided to individuals of the
community at an early stage (Petch, 2012). People are also made aware about certain cancers in
order to make early detection. One of such programmes is NHS breast screening programme in
order to accelerate safety and and awareness among women.Moreover, systems adopted by
12

Hackney have been supported for ensuring better and effective medical care to the individuals
living in that borough.
3.3 Changes that could be made to improve the health and well-being of individuals in a health
or social care setting.
As per UK's population there are more than 65M people. There are 8 commissioning which
can be made under the healthcare and well-being of individuals (Popescu, 2014). These are
mentioned below:
 Identify the long-term demands and conditions of population: This can be completed
through the support of social-care partners. Further, understanding about the diseases
prevalence, mortality rates, demographics, deprivation, socio-economics and services to
the people. Support from the local authorities can be engaged. Systematic and specific
risk identification tools can be used to evaluate the risks to population. Take feedback
from the patients about their health. Identify services which are ineffective or insufficient.
 Review the current Health-services areas: In this, services which are available and those
who are most in need are required to be identified and assessed. This can be done through
assessing the practices within the area (Renaud and Goucher, 2012). In the current
services provided, identifying the gaps and fulfilling them. Further, providing education
and information to the people about different diseases. Including all the health-services
such as NHS, private sector and third parties. Offering new and affordable health budget.
 Decide priorities: Through the assessment process priorities of individuals can be
identified. Moreover, identifying the areas in other sectors about health-services. Using
analysis, analytical data and reports, health-care and well-being services can be
improved.
 Design Services: Services are required to be designed as to provide support to people.
The care provided to the individuals should be under the budgets. Services should be
more flexible and personalized in nature. Further, providing generic specific care and
training. Systematic sharing of information through an effective information-system.
Development of new models and patient’s representatives.
 Configure structure of supply: This is required to ensure that services can be accessible to
people easily and early. Innovation is required in the supply system (Stanhope and
13

Lancaster, 2015). Further, identifying the needs and demands of people regarding
services and fulfilling them.
 Ensuring appropriate access and manage demands: Promote more personalized services
as well as ensure the clinical cost effectiveness. Develop new communication areas so
services can be easily delivered.
 Make decision related to this: The services provided must be fully utilized by the patients
and families in the best possible way. Managing the needs and providing more
knowledge about the services.
 At last managing quality performance outcomes: Identify the needs of people at local and
national level and set new measures (Stewart and Wild, 2017). Analyse, assess and
prepare meaningful data which can help to make changes in future.
3.4 Activity that has been implemented to encourage behaviour change for maximising health for
individuals in a health or social care setting.
As public health is influenced by many factors other than the healthcare received,
opportunities exist to integrate public health priorities into some of the key wider determinants of
health such as education, housing and transport.
There are various activities which can be implemented to improve health services. One
activity was Community Health Improvement Process (CHIP). The committee can easily access
the requirements and can provide better instant health-care services (Van Eijk and Steen, 2014).
Moreover, they can help in accessing, establishing, determining, improving, maintaining and
monitoring the health care services. They better understand where the responsibilities are lacking
and can help to improve it. After implementation of this, problems can be easily identified and
prioritised. It has helped in managing and improving the health services.
Further, details related to the smoking cessation programmes are mentioned below:
Change 4 Life: It is the public health program that started in the year 2009, in UK. It is
organized by the Department of Health. It is based on the 6 healthy behaviours which people
must adopt in order to stay healthy. These are: Eat 5-time fruits and vegetables in a day, use only
6g of salts, reduce the consumption of fat food, get information about the sugar in the food, use
less alcohol consumption, lead an active lifestyle into simple ways (Brownson, 2017).
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Healthy Eating: Under the healthy eating there are various things included such as balanced diet,
which included fruits, vegetables, starchy foods, wholegrain, dairy products, sources of protein
and small portion of fatty foods. Further, in a day there 5 times when fruits and vegetables must
be consumed. Besides this, person should be aware about the level of alcohol, salt and fats
consumption (Brownson, 2017).
Physical Activities: There are various activities that are included in it which helps to develop
mentally, physically and physiologically. It includes playing outdoor, running, gymnastics,
walking, martial arts, weight training, aerobics, dance and many more exercises that help to body
development and improving the physical health (Brownson, 2017).
Routine Screenings: Screenings is the way by which person can know about the risk they may
be having in their health issues. In UK, there are various screenings tests which can help to cure
the diseases caused by smoking (Brownson, 2017). There are various advantages of it which
people can have after diagnosis of their diseases. Moreover, they can easily check their Cancer
level and its type.
CONCLUSION
From the above report, it can be concluded that it is very essential for individuals to take
care of their health and understanding should be developed about the impacts of bad habits and
current lifestyles on the future. There are infectious and non-infectious diseases for which
various institutions such as World Health Organisation, Department of Health, NHS are engaged
in making various strategies to deal with these diseases. Various regulations and standards have
been set by these organisations so that a healthy environment could be enhanced.
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