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The report investigates and analyses the demographic data of the UK population and discovers that about 30% of UK residents live below the minimum standard of income, which could impact the health and well-being of such individuals. It shows that cancer is a significant public health issue, as cancer has an incidence rate of 375,000 cases and a mortality rate of 167,000 deaths yearly in the UK. The report attributed the cancer outcomes to the percentage of people living below the minimum standard of income, which could have resulted in poor lifestyle and poor engagement in physical activities based on the theory of Dahlgren and Whitehead's framework on social determinants of health and well-being. Also, it discusses the cancer issue in the country based on the impact, changeability, acceptability and resource feasibility. In addition, it identifies available policies and strategies for addressing cancer issues, including national cancer strategies in the four countries (England, Wales, Scotland and Northern Ireland), NHS Long-Term Plan (2019) and other intervention strategies developed by researchers. Furthermore, the report identifies the ABACus Health check campaign as an effective intervention that could ensure the achievement of modifiable lifestyle changes, as the intervention is underpinned by the theory of behaviour change wheel and considered socio-economic inequalities to help improve cancer outcomes in the UK population, especially for those living below the minimum standard of income. Also, the ABACus Health Check media campaign was developed to increase the level of awareness of different types of cancer and lower the onset of symptom presentation among adults residing in socio-economic deprived areas in the United Kingdom. Moreover, the report shows how the ABACus Health check campaign is more appropriate than the "Know 4 Sure" cancer campaign and “Be Clear on Cancer” campaign. It also related public health intervention to nursing practice. Finally, the report recommended that a more appropriate randomised controlled trial of the ABACus campaign should be evaluated in other regions of the United Kingdom to provide further proof of the effectiveness of the intervention in addressing cancer issues in the whole population.
This report on the analysis of public health campaigns is an assessment of contemporary public health issues. In this report, epidemiological and demographic data of the United Kingdom population will be analysed to determine the population's health needs. Also, the report will identify a particular public health issue and then identify the available policies and strategies that would be appropriate to address the identified public health issue. In addition, this report will show how theoretical components are related to nursing practice.
The selected population chosen for the current report is the United Kingdom. According to the WorldometerInfo (2022) report, the United Kingdom is over 68 million, with a population density of 281 per Km2. An estimation by the IndexMundi (2022) on UK demographics profile showed that the White ethnic group has about 87%, Black African, the Caribbean and the British 3%, Asian and Asian British 4.2%, of the UK population in 2020. The population increase rate between 1980 and 2014 was 14.3% and was estimated to be 048% in 2021 (see table 1 below for other demographic data) (Richard et al., 2015; IndexMundi, 2022). The notable non-communicable diseases in the United Kingdom are cardiovascular diseases (Ischaemic heart disease, hypertension, stroke, among others), respiratory diseases (chronic obstructive pulmonary disease and others), cancer (lung, pancreatic and colon cancers) and dementia (Gov.UK, 2022). In terms of morbidity, reports have shown that body pain (back and neck), skin diseases, migraine, and impairments (auditory and visual impairment) are the most common diseases that increase morbidity rates (Public Health England, 2020). Concerning communicable diseases, the COVID-19 pandemic is the notable cause of morbidity and mortality in the United Kingdom (WHO, 2022). In addition, Public Health England (2018) showed that about 30% of UK residents are living below the minimum income standard, which could impact such individuals' health and well-being. So social factors could determine the health of individuals. As shown by Islam (2019) and Graham and White (2016), social determinants of health involve conditions individuals are given birth to, grow up, live, work and age, that are structured by political, social and economic forces that affects their overall health and well-being. Such social factors could be responsible for the communicable and non-communicable burdens in the nation. Concerning Dahlgren and Whitehead's framework on social determinants of health and well-being, it was evident that the global ecosystem, natural environment, built environments, local economy, community, lifestyle, and individuals' age, sex, and hereditary factors affect the health outcomes of the UK population (Graham and White, 2016). For example, old age is associated with long-term non-communicable diseases and body pain; living below the minimum income standard may result in a poor lifestyle and poor engagement in activities that result in developing cardiovascular health problems, cancer, respiratory issues, and mental health impairment and their comorbidities.
S/N
Socio-demographics variables
Estimations
1
Life expectancy at birth
81.2 years (79.3 years (male) and 83.1 years for females)
2
Median age
40.6 years
3
Morbidity rate
11.77 births per 1000 population
4
Mortality rate
9.41 births per 1000 population
5
Maternal mortality rate
Seven deaths per 100,000 live births
6
Infant mortality rate
4.27 deaths per 1,000 live births
7
Urbanisation
84.2% of the total population
8
Population living below per capita income
0.3 of the UK population or 30% of the UK population
9
Gross National Income per capita ($)
$ 45,170
10
Total fertility rate
1.86 children per woman
11
Contraceptive prevalence rate
76.1% (among women aged between 16 to 49)
Cancer has been reported to be a significant matter for the public, resulting in about 9.6 million deaths worldwide (WHO, 2022). In the United Kingdom, cancer has an incidence rate of 375,000 cases and a mortality rate of 167,000 deaths yearly (Cancer Research UK, 2021). Males have a higher incidence (192,000) and mortality (89 200) rate of cancer than females (incidence-182, 000, mortality-78,000) in the UK (Cancer Research UK, 2021). A cancer treatment centre in South-East London, England (Guy's Cancer Centre) has been reported to treat 8800 cancer patients yearly and diagnoses about 4500 new cancer cases annually (Russel et al., 2022). The associated risk factors of cancers are age (higher incident rate among older people between 85 to 89 years), genetics, smoking and other exposure risk factors (Cancer Research UK, 2021). In addition, Brown et al. (2018) study reported that tobacco smoking is the major risk factor for the development of all cancers, which is in agreement with the report by Cancer Research UK (2021) that showed that smoking accounts for 15% of different cancer types in the UK population. Similarly, research has shown that in every two people born after 1960, one will undoubtedly be diagnosed with cancer in their life in the United Kingdom. So, cancer poses a significant public health impact on the UK population.
The public health issue of cancer can be changed and effectively addressed in the population of the United Kingdom by tackling the associated risk factors (to prevent the increasing incidence of the disease) and improving the management and treatment of cancer patients to reduce the mortality impact of the disease. Brown et al. (2018) show that changing the population-level exposure to modifiable risk factors is a significant way of achieving change in cancer incidence. The lifestyle modifiable risk factors must be changed through smoking cessation, engaging in physical activities and healthy lifestyle promotional activities, such as eating healthy foods (Cancer Research UK, 2021, WHO, 2022). Brown et al. (2018) added that an adequate understanding of these factors and establishing interventions and policies based on these factors would help achieve adequate and sustainable health outcomes for cancer in the UK. Another study by Watt et al. (2022) reported that cancer outcomes in the UK could effectively change by considering social determinants, such as lifestyle modification factors, a change in patient pathways and care delivery services. The changing pattern of cancer outcomes reported by Watt et al. (2022) regarding the change in social determinants of patient pathways and care delivery services could be achieved by ensuring evidence-based practice, nursing and midwives' code of practice (using NICE guidelines), holistic care and person-centred care (NMC, 2018, Brown, 2018, WHO, 2022).
Several research studies have identified that smoking and physical activity are significant modifiable factors contributing to cancer development. The Cancer Research UK (2021) on cancer statistics showed that smoking is the leading cause of more than 7 out of 10 lung cancer cases in the UK, as smoking is a common behaviour of several people in the UK. Brown et al. (2018) show that tobacco smoking and obesity (resulting from non-engagement in physical activities) were the associated risk factors for developing cancer. Another retrospective study by Jacob et al. (2018) showed that smoking increases the overall risk of the development of cancer in primary care practices in the UK. Therefore, there is high acceptability that a behaviour change involving smoking cessation and engaging in physical activities could help improve the health need of cancer and address cancer issues in the UK population. Also, incorporating modifiable risk factors of cancer in developing interventions and policies could help improve cancer outcomes in the UK population.
Resource feasibility involves the availability of adequate health resources to help address cancer issues in the UK. Studies have identified the influential role of the UK health systems in developing evidence-based practices for caring for cancer patients, cancer intervention programs and the effort of private and public health facilities to improve the cancer issues in the nation (Exarchakou et al., 2018; Russel et al., 2022; Wait et al., 2017). However, Wait et al. (2017) identified three aspects that need to improve to ensure adequate care for cancer patients, i. a more elaborate view across cancer pathways ii. investing in the appropriate data, and iii. utilising the data to improve the system. Therefore, improving the UK health system, especially the healthcare delivery and health resource aspects, is necessary to address cancer issues in the UK population effectively.
About 50% of cancer deaths could have been prevented worldwide by modifying or changing the risk factors associated with cancer development and implementing evidence-based strategies (WHO, 2022). So, the World Health Organization encouraged the development of national cancer plans or strategies to help combat cancer issues in different countries (WHO, 2022). In the UK, the four different nations have published different cancer plans, such as publications on achieving better cancer outcomes for England in 2015 to 2020 (published in 2015), Response to a new Cancer Strategy for Scotland published by Cancer Research UK, the NHS Long Term Plan (published in 2019) and several others. Also, Wales and Northern Ireland have their cancer plans and strategies to improve cancer issues and reduce the disease burden in the UK. In addition, established cancer institutes and Cancer Research UK work with the government to ensure that cancer issues are addressed in the UK (Cancer Research UK, 2021). Also, Moriarty et al. (2021) showed that cancer prevention plans and guidelines are built on evidence-based policies and strategies for cancer in the UK. However, the study by Exarchakou (2018) showed little evidence of a direct impact of national cancer strategies on cancer survival. In addition, Wait et al. (2017) showed that sustainable and long-term achievement in addressing cancer issues is very complex and requires the role of all stakeholders. Therefore, the UK nations have developed and keep publishing updated national cancer strategies, has several cancer institutes and Cancer Research UK, which collaborates with the government to effectively address cancer issues in the nation. However, it requires the collaborative effort of all the relevant stakeholders to ensure efficient and effective improvement regarding cancer issues in the UK.
The intervention identified to change cancer health outcomes in the UK population is the Awareness and Beliefs About Cancer trial (ABACUS) health check. The ABACus Health Check media campaign was developed to increase awareness of different types of cancer and lower the onset of symptom presentation among adults residing in deprived areas of socio-economic areas in the United Kingdom (Moriarty et al., 2021). As shown in the demographic data above, it was reported that about 30% of people resident in the UK are living below the minimum standard of income, and this could impact the health and well-being of such individuals, which translates to over 20 million people (Public Health England, 2018). Such people live in the most deprived areas of the UK, in areas like Yorkshire and South Wales (Moriarty et al., 2021; Smits et al., 2016). The intervention programme was based on reducing the onset of the cancer among individuals and incorporates symptoms of cancer detection, screening and prevention recommendations to achieve behavioural change and improve cancer outcomes (Moriarty et al., 2021). Also, the economic aspect of the ABACus intervention as being a low-cost intervention strategy will allow both men and women, low-income and high-income earners, to partake in the media intervention program (Moriarty et al., 2021). Therefore, the ABACUS intervention is relevant for the UK population to achieve excellent health outcomes concerning cancer in the nation.
The ABACus health check campaign developed by Moriarty et al. (2021) is underpinned by the behaviour change wheel theory by Michie et al. (2014). The theoretical framework of Michie et al. (2014) behaviour change wheel has three major components (which include sources of behaviour (green colour), intervention functions (red colour) and policy categories (grey colour)), as shown in figure 2 below. The ABACus intervention is based on the behaviour change wheel theory since the intervention is aimed at creating awareness of the different ranges of cancer through education. Also, it identified barriers and facilitators to help socio-economic deprived people of the UK through motivation, capability and providing opportunities to achieve behavioural change among the population as it is cost-effective. Similarly, Smits et al. (2016) showed that motivating socio-economic disadvantaged individuals is essential to ensuring behaviour change through education to help them engage in preventive and protective health behaviour. In addition, the ABACus considered policy categories of the behaviour change wheel as it utilises trained lay advisors to deliver face-to-face behavioural support. The above theory adopted in designing the ABACus Health campaign showed that nursing practise should be based on holistic care to meet patients' health needs and ensure behavioural change (NMC, 2018).
The ABACus intervention was also developed based on published research studies. Wakefield et al. (2010) study showed that mass media could be utilised as a great tool in achieving change in health behaviour. Based on the above study, the ABACus was developed as a mass media-based intervention to achieve such behavioural changes concerning cancer for the UK population, including socially deprived individuals. According to Valle et al. (2015), primary prevention is an essential approach to tackling cancer issues, including awareness campaigns that enable individuals to learn about different types of cancer and how to prevent them, especially when the intervention is cost-effective and not determined by socio-economic status. The ABACus intervention corresponds with the study by Valle et al. (2015) as a primary prevention approach, since the intervention is cost-effective, easily accessible and developed explicitly for the socio-economic disadvantaged population of the United Kingdom. Other research studies have identified barriers affecting cancer outcomes in the UK, which include poor awareness of cancer symptoms, socio-economic inequalities of cancer and delays in providing health care for cancer patients as well as late diagnosis of cancer (Hiom, 2015; McCutchan et al., 2015; Nnaji et al., 2022; Quaife et al., 2015; Wakefield et al., 2010). Hence, the reason for developing and designing the ABACus intervention will address the above-identified barriers reported by the articles mentioned above. In addition, Moriarty et al. (2021) showed that ABACus could improve and promote health-seeking behaviour regarding cancer among socio-economic-deprived individuals in the UK and other countries.
Before the ABACus Health Check campaign was developed, other health campaigns in the United Kingdom concerning cancer issues existed. One of them is the "Know 4 Sure" cancer symptoms campaign that commenced from January to March 2013 in certain areas in England (Cancer Research UK, 2014). The campaign focused on cancer symptoms and encourage individuals who presented with the symptoms to visit medical doctors. Compared with the ABACus Health check campaign, the two campaigns encouraged awareness of cancer symptoms. However, the ABACus Health check campaign had a more comprehensive approach than the "Know 4 Sure" campaign, as it included socio-economic disapproved individuals and involved trained lay workers that engaged in face-to-face conversations with the concerned individuals (Moriarty et al., 2021). Another cancer campaign in the UK is the "Be Clear on Cancer" campaign that aims to increase awareness and encourage early diagnoses of lung cancer, which was initiated in 2010 (Cancer Research UK, 2015). The Be Clear on Cancer campaign is related to the ABACus Health check campaign, as the two campaigns are aimed at promoting cancer awareness and encouraging early diagnoses. In contrast, the ABACus awareness campaign is not limited to lung cancer; it focuses more on education (interactive sessions), motivating, creating opportunities and ensuring the capability to enhance behavioural change (the behaviour change wheel), unlike the Be Clear on Cancer campaign.
This report has analysed the demographic data of the UK population and identified cancer as a public health issue in the nation, which was discussed based on the impact, changeability, acceptability and resource feasibility. Also, the report identified available policies and strategies for addressing cancer issues, including national cancer strategies in the four countries, NHS Long-Term Plan (2019) and other intervention strategies developed by researchers. In addition, this report identified the ABACus Health check campaign as an effective intervention that could ensure the achievement of modifiable lifestyle changes, as the intervention is underpinned by the theory of behaviour change wheel and considered socio-economic inequalities to help improve cancer outcomes in the UK population. It also related public health intervention to nursing practice. Finally, the report compared and contrasted the ABACus Health check campaign with the "Know 4 Sure" cancer campaign and "Be Clear on Cancer" campaign. The remarkable difference in comparing and contrasting the public health campaigns is that: i. the ABACus awareness campaign is not limited to lung cancer, and its focus is more on education (interactive sessions), motivating, creating opportunities and ensuring the capability to enhance behavioural change (the behaviour change wheel theory) ii. it included socio-economic disapproved individuals, and iii. involves trained lay workers that engage in face-to-face conversation with the concerned individuals. Therefore, the ABACus Health check campaign could prove to be an effective intervention that will help address cancer issues in the UK, as it is developed from the theory of behaviour change wheel and supported by the public health published articles. It is recommended that a more appropriate randomised controlled trial of the ABACus campaign should be evaluated in other regions of the United Kingdom to provide further proof of the effectiveness of the intervention in addressing cancer issues in the whole population.
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