Social Political & Environmental Issues in International Healthcare

This article discusses the impact of social, political, and environmental issues on COPD diagnosis, prevalence, and management in international healthcare. It covers the key risk factors, diagnosis, and management of COPD, as well as the impact of international, economic, environmental, and political issues on COPD in the UK. The article also compares the prevalence and management of COPD in the UK and China and discusses the strengths and limitations of global strategies in addressing the global burden of COPD.

Social, Political & Environmental
Issues in International Healthcare

Table of Content
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Task 1...............................................................................................................................................1
The key risk factors for COPD and key features of it, in terms of aetiology, diagnosis and
disease management.....................................................................................................................1
Task 2...............................................................................................................................................3
Impact of international, economic, environmental and political issues on diagnosis, prevalence
and management of COPD in UK...............................................................................................3
Aetiology and assessment of prevalence of COPD in UK (Developed Country) and China
(Developing Country), comparison of differences between both the countries..........................4
Strengths and limitations of Global strategies in addressing the global burden of COPD..........5
Task 3...............................................................................................................................................6
Reflection.....................................................................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
COPD is a chronic respiratory disease referred as, chronic obstructive pulmonary disease
which affects the airflow from lungs and produce symptoms like breathing difficulties. COPD
has been the reason of decrease health quality and mortalities in developing countries, developed
countries and underdeveloped countries (Iheanacho and et. al., 2020). The project aims for
social, political and environmental issues within the international healthcare in reference to
COPD including the general information about COPD and its stages of disease progression.
Further, it includes impact of international, economical, environmental and political issues in
COPD management within UK. In addition to that, here is a discussion over COPD prevalence
and management aspects in regard to a developed country (UK) and in a developing country
(China). It further explains strength and limitations of WHO in addressing global burden of
COPD along with the reflective account of learning and understanding.
MAIN BODY
Task 1
The key risk factors for COPD and key features of it, in terms of aetiology, diagnosis and disease
management
The COPD stands for Chronic obstructive pulmonary disease. The chronic obstructive
pulmonary diseases is a chronic lung disease in which the flow of air in the lungs is blocked or
abruptly disturbed due to chronic inflammation in the lung. The symptoms of chronic obstructive
pulmonary disease includes, breathing issues, cough along with mucus production etc.
The risk factor is a condition which increases the chances of acquiring disease. Some of
the risk factor are: smoking, environment, alpha-1 deficiency as well as working with chemicals,
dust and fumes. Smoking is the most common and important risk factor for chronic obstructive
pulmonary disease. Nearly all chronic obstructive pulmonary diseases are caused by cigarette
smoking. The exotic form of tobacco smoking can be more harmful or increase the chances of
COPD. The regularly exposed to second hand smoke may also increase the chance of chronic
obstructive pulmonary disease (Huang and et. al., 2019). The regular exposure of harmful gases
such as burning wood, crop or charcoal, dust, chemicals and some fuels can also increase the risk
of COPD. The cases of COPD is more common in male than female. This happens due to the
rate of smoking in men is higher than in female. The death rate is increasing in women due to
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COPD. The rate of COPD cases is increases in an individual who have history of lung infection.
Chronic obstructive pulmonary disease is mainly occur due to long term exposer of irritant
substance which can damage the lungs or the airways, other co morbidities can also significantly
contribute in COPD progression as well as it prevalences. These may include asthma, hypoxia.
COPD can also develop into other health related disease which further are responsible for
mortalities due to COPD.
The COPD diagnosis is first achieved by asking the symptoms of patients, examining the
chest and examining the heart beat using stethoscope, with blood test and spirometry test. The
spirometry is a test which show that the lungs is working properly or not. The spirometer include
two measurement test, in first measurement the test include volume of air breath out in a second
where as the second measurement include the total volume air breath out. This procedure is done
for some times in order to get some consistent results. The blood test is diagnosed in order to
find out the similar condition or symptoms to chronic obstructive pulmonary disease like
decrease concentration of iron amount than the optimum level refer to anaemia or increase
concentration of red blood cells in the body is termed as polycythaemia. The blood test also find
the antitrypsin concentration in the body. As deficiency of antitrypsin can increase the risk of
chronic obstructive pulmonary disease. Some other diagnosis test includes electrocardiogram,
echocardiogram or CT scan (Sutradhar and et. al., 2019).
The cure for chronic obstructive pulmonary disease is not available. The treatment can
only can help in reducing the symptoms, decreasing the progression of disease and in boosting
the activeness. The treatment of COPD include lifestyle changes, medication, oxygen therapy,
pulmonary rehabilitation. Quitting or reducing the regular smoking, is the most common or
important to introduce in living lifestyle in the treatment of COPD. Also avoiding the second-
hand smoking habit in COPD treatment. Introduce regular exercise or healthy diet in the COPD
treatment. Some medicine are prescribed in COPD treatment such as bronchodilators including
salbutamol, terbutabline, bambutorol etc. as the bronchodilator relaxes the muscles around the
airways. This help the lungs to open the airways which make breathing easier. In severe
condition, the steroids were prescribed in order to reduce the chronic lungs inflammation.
Health is a state in which an individual is completely well being as from physical, mental
or from social. It is achieved through fundamental interaction between the people or the
environment (Fazleen and Wilkinson, 2020). There are two most important factors in health
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maintenance which are also important in treatment of COPD such as lifestyle and living
condition. The life style habits or health activity like healthy diet, exercise, substance use such as
(tobacco, smoking) and sexual behaviour. For maintaining good health these thing need to be
maintained like avoid the use of substance use. As avoiding the substance use can reduce the
chance of COPD. The living condition can also need to improve in order to maintain health. The
living condition includes the environment or the impact of society. Living condition is need to be
improve as bad environment or surrounding can increase the case of COPD. Away from dust,
pollution can reduce the chances of COPD.
Task 2
Impact of international, economic, environmental and political issues on diagnosis, prevalence
and management of COPD in UK
International, economic, environmental and political issues are gradually being important
in addressing the diagnosis, prevalence and management of COPD in UK. COPD is effecting the
developed countries, underdeveloped countries and developing countries throughout the world,
but its prevalence is observed to be effecting most in UK. The economical aspects of responses
by patients in a survey within UK showed that COPD is creating a huge burden over healthcare
system and society with estimated annual direct cost at 819.42 per patient and the estimated
annual indirect cost at 819.66 per patient. This results into 1639.06 pound per patient cost which
is making difficult for patients and their families to get proper diagnosis and management of the
disease (The burden of COPD in UK: results from the confronting COPD survey, 2003). The
COPD costed NHS to nearly ten times more in treating the patients, this economical burden is
hindering the country in management of COPD and stopping its prevalence (COPD
Commissioning Toolkit, 2012). Internationally, world wide organisation like WHO guide each
country including UK in diagnosis, control, prevalence and management of COPD. They provide
continuos data of patients with COPD in UK along with its criteria for management and stopping
its prevalence. The organisations help the countries like UK who are facing difficulty in
managing the COPD. They have succeeded at some extent but still COPD is effective and
causing mortalities internationally in every country up to an extent. Effect of environment on
COPD diagnosis and management was mostly observed due to urbanity and environmental
pollution. The residents of UK who are living in more green areas shows less risk of COPD,
whereas the residents of urban areas showed high risk for COPD due to polluted environment,
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high vehicles and less people contribution in environmental protection. The planning and
designing potential urban value will reduce the environmental risk for management and
prevention of COPD. The political factors that may contribute in diagnosis, prevalence and
management of COPD are associated with economical aspects such as the demand of ban over
smoking and tobacco to mange COPD is linked with economical aspects as these products share
a good economical contribution for country (Iheanacho and et. al., 2020). Additionally, powers
regarding guidelines of management of environmental, intentional and economical factors are
lied on political factors and up to local authorities. These factors have both the aspects of impact
over COPD diagnosis, control and management, they effect the disease management in either
positive or negative way or both.
Aetiology and assessment of prevalence of COPD in UK (Developed Country) and China
(Developing Country), comparison of differences between both the countries
COPD is a cause of morbidity and mortality within UK, but aetiology of prevalences in
UK vary considerably. Smoking is emerged as the primary cause of COPD prevalence in UK,
the probability of COPD increases with smoking and duration of its exposure. An approach used
for assessing the prevalences of COPD among ex or current smokers in UK showed 4.56%.
whereas, it was 2.57% in total population of UK (L. Rayner and et. al., 2017). other responsible
aetiologies for COPD prevalences in UK was measured to be environment, life style,
professional environment etc. up to a less extent. COPD in china is becoming a reason for public
health concern as this ranks first among the disability causes. A rate of prevalence shows that
COPD in China have prevalence rate of 8.2% and mortality rate of 1.6%. The aetiological causes
for COPD prevalence in China is smoking, lack of physicians awareness, genetic susceptibility
and biomass fuel. A data for assessment shows that only 20% of the primary care physicians are
knowledgeable about COPD recommendations (Gao J and Prasad N, 2013).
Diagnosis of COPD includes Lung (pulmonary) functioning test, chest X-ray, CT scan,
laboratory tests and Arterial blood gas analysis. COPD diagnosis measure in UK include Chest
X-ray and blood test. For a majority of people, COPD diagnosis can only be confirmed with
spirometry. Whereas, in China the COPD diagnosis methods include blood oxygen test, CT scan.
Management methods of COPD in UK involve pharmacologic therapy to reduce symptoms and
severity of symptom progression. Other includes maintaining good health with balanced diet and
physical exercise (Doiron and et. al., 2019). Additionally, it includes treatment with
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medicaments and stopping smoking. In china, the management methods include oral
pharmacological treatment with theophylline and bronchodilators along with healthy lifestyle
habits.
UK have adopted approaches for COPD management, which includes Multidisciplinary
supportive approach for care, psychological support to patients including frightening
breathlessness, activation of community, self-management plan, signposting etc. In addition to
this, UK adopted methods for management of co-morbidities and smoking cessation. UK, for
managing COPD is using early detection methods and accurate diagnosis (Quan and et. al.,
2021). The NICE guidelines provide guidance for COPD management and diagnosis in UK. In
China, GOLD (Global Initiative for Chronic Obstructive Lung Disease) guideline provide COPD
management and prevention methods. The physicians were forced to use spirometry for COPD
diagnosis. Additionally, China have significantly forced over patient self management for COPD
and healthy lifestyle habits.
Strengths and limitations of Global strategies in addressing the global burden of COPD
Global strategies aim for managing the prevalence of diseases across the world by
providing effective support to the counties who are facing difficulties in managing the disease.
World Health Organisation (WHO) is a UN agency which connect the nations and promote
health. It aims for keeping the world safe and to attain vulnerable people and every person of
every place for attaining the highest health level. COPD is inclosed within the WHO Global
Action Plan for its prevention and control. COPD is also included in United Nations 2030
Agenda for sustainable development. WHO has take initiatives in order to extent the diagnosis
and treatment of COPD by several ways.
Strengths of WHO in addressing the global burden of COPD:
PEN (WHO Package of Essential Non communicable Disease Interventions) was
developed with perspective to improve NCD management in primary healthcare. PEN included
rules for assessment, management and diagnosis of chronic respiratory disease like COPD.
Reduce tobacco and smoke exposure as primary prevention of COPD was the motive for
which The Framework Convention on Tobacco Control is an enabled process. Futher, WHO
Clean Household Energy Solutions Toolkit (CHEST) was developed to promote clean and safe
environment. The Global Alliance against Chronic Respiratory Diseases (GARD) work in
contribution to WHO for prevention and control of chronic respiratory diseases. WHO is
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supported by many countries in terms of fulfilling the criteria, adhering the guidelines and asking
the people to follow WHO protocols for disease management (ur Rehman and et. al., 2020).
Government, funding agencies and private sectors are working in collaboration with WHO and
supporting the countries who are requiring it the most for COPD management. With these
initiatives overall COPD death rates reduced in 2019 internationally.
Limitations of WHO in addressing the global burden of COPD:
After conducting several national programmes and taking initiatives regarding COPD
management, COPD is still the leading cause of death internationally. WHO was succeeded to
manage COPD up to some extent In developed countries but about 90% of death due to COPD
occurred in those who were under the age of 70 years in low and middle income counties
including the developing countries too. The low and middle income countries have less resources
in order to fulfil the needs of patients (Hassali and et. al., 2020). Cessation support, proper
diagnosis including treatment is required to slow down the progression of COPD symptoms and
to reduce flare ups, which is not available in under developed and developing countries. Beside
that, WHO was not able to promote health consciousness among people regarding the use of
tobacco and smoke. Indoor air pollution and fumes, chemicals etc. also contribute in limitation of
WHO to work globally.
Task 3
Reflection
Reflection shows the learning and understanding of a responsible global citizen on issue
of effectiveness of COPD interventions globally using Gibbs reflective model. Gibbs reflective
model gives structure to learning. This model gives a framework for examination of experiences
along with allowance to learn and plan.
Description: Me as a responsible global citizen have experienced the effectiveness of COPD
interventions globally. The Global strategies like WHO, which developed strategies and
organised national programmes in order to control the prevalence of COPD globally have seen to
be effective up to an extent but on the same hand it showed limitations due to multiple factors. I
measured the effectiveness of interventions in developed countries like UK and in in-developing
countries like China to measure the difference of disease aetiology, prevalence and approaches
for intervention and treatment.
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Feelings: I felt that the aetiology of COPD, COPD progression rate and COPD effectiveness was
different in both the countries as their internal aspects have shown to produce the effect over
disease prevalence. Before examining the effectiveness of COPD globally I was expecting that
the disease may have produced similar effects over all the countries due to similar causes but the
results were quiet different.
Evaluation: The positive things about the effectiveness of intervention were that global
strategies were producing effective outcome in regards to COPD management. The positive
outcomes encouraged other countries to take effective measures and follow the guidelines of
global healthcare organisation like WHO. The negative aspect included the limitations of WHO
in world wide COPD prevalences management that is the effective contribution of all the
countries was missing.
Analysis: The effectiveness of global interventions were impacted both ways, positively and
negatively in management of COPD across the world. The positive impacts with global
interventions were shown due to support of developed countries in adhering with the guidelines
and giving equal hand for COPD management programmes. The negative impacts here shows
the limitation in reaching the effectiveness, which occurred due to lack of support from all the
countries.
Conclusion: From the understanding of effectiveness of interventions globally I have learnt that
for being effective to reach the aim and beyond of it, the support from all the countries is
required. The lack of support or insufficient support from countries showed the healthy outcome
in COPD patients and reduced mortalities up to an extent which could have been increased.
Action Plan: To increase the effectiveness of intervention of COPD globally, I would like to
design interventions differently by creating a segment of countries according to their aetiology of
COPD and providing interventions different for each segment. As different country face different
issues in dealing with disease so there should be a hand of control on every responsible issues.
CONCLUSION
The above project concludes that COPD is among the most prevalent non communicable
diseases which have effected every country globally weather its a developed one or
underdeveloped one. The global strategies, such as WHO have been trying with building and
designing strategies in order to decrease mortalities due to COPD globally but is facing several
strengths and limitations. Developed countries like UK have impact of international, economical,
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environmental and political issues in COPD diagnosis, prevalence and management. The in
developing countries like China have different issues in regards to prevalences of COPD when
compared with developed countries like UK. These issues are required to be addressed by
respective countries for COPD management and its prevalence with the directions of global
strategies like WHO.
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REFERENCES
Books and Journals:
Alqahtani, J.S. and et. al., 2020. Prevalence, severity and mortality associated with COPD and
smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PloS
one, 15(5), p.e0233147.
Caminha, G.P. and et. al., 2018. Rhinosinusitis symptoms, smoking and COPD: Prevalence and
associations. Clinical Otolaryngology, 43(6), pp.1560-1565.
Doiron, D. and et. al., 2019. Air pollution, lung function and COPD: results from the population-
based UK Biobank study. European Respiratory Journal, 54(1).
Fazleen, A. and Wilkinson, T., 2020. Early COPD: current evidence for diagnosis and
management. Therapeutic advances in respiratory disease, 14, p.1753466620942128.
Gao J and Prasad N, 2013. Chronic obstructive pulmonary disease in china: the potential role of
indacaterol. J Thorac Dis, 5(4), p. 548-558.
Giokas, K., Makris, I., Iliopoulou, D. and Koutsouris, D., AUTONOMY, MOTIVATION &
INDIVIDUAL SELF-MANAGEMENT FOR COPD PATIENTS, THE AMICA
PROJECT–THE GREEK EXPERIENCE. INFORMATION COMMUNICATION
TECHNOLOGIES IN HEALTH, p.178.
Hassali, M.A.A. and et. al., 2020. The economic burden of chronic obstructive pulmonary
disease (COPD) in Europe: results from a systematic review of the literature. The
European Journal of Health Economics, 21(2), pp.181-194.
Huang, X. and et. al., 2019. The etiologic origins for chronic obstructive pulmonary
disease. International Journal of Chronic Obstructive Pulmonary Disease, 14, p.1139.
Iheanacho, I. and et. al., 2020. Economic burden of chronic obstructive pulmonary disease
(COPD): a systematic literature review. International journal of chronic obstructive
pulmonary disease, 15, p.439.
Iheanacho, I. and et. al., 2020. Economic burden of chronic obstructive pulmonary disease
(COPD): a systematic literature review. International journal of chronic obstructive
pulmonary disease, 15, p.439.
Quan, Z. and et. al., 2021. Current status and preventive strategies of chronic obstructive
pulmonary disease in China: a literature review. Journal of Thoracic Disease, 13(6),
p.3865.
Rayner and et. al., 2017. The prevalence of COPD in England: An ontological approach to case
detection in primary care.
Respiratory Medicine,
132,
p.217-225.
Sutradhar, I. and et. al., 2019. Prevalence and risk factors of chronic obstructive pulmonary
disease in Bangladesh: a systematic review. Cureus, 11(1).
ur Rehman, A. and et. al., 2020. The economic burden of chronic obstructive pulmonary disease
(COPD) in the USA, Europe, and Asia: results from a systematic review of the
literature. Expert review of pharmacoeconomics & outcomes research, 20(6), pp.661-
672.
Online:
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COPD Commissioning Toolkit, 2012 [Online] Available through:
<https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/
file/212876/chronic-obstructive-pulmonary-disease-COPD-commissioning-toolkit.pdf>
The burden of COPD in UK: results from the confronting COPD survey, 2003 [Online]
Available through: <https://pubmed.ncbi.nlm.nih.gov/12647945/>
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