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Your assignment should:

1. Identify and justify the chosen group and the health issue

2. Explore the topic from a social and cultural perspective including relevant theory and a definition of culture

3. Include strategies or reports on local and national policy concerning your topic

4. Discuss what is happening locally regarding your chosen topic and identify local initiatives that relate to your topic area 

Justification of chosen health issue

Health of pregnant women is very important for healthy future generations. In this report, I have chosen the health issue of smoking among pregnant women. The justification for choosing this particular health issue in the chosen group is given in the beginning of the report. Social and cultural determinants influence the habit or behaviour of smoking among individuals including pregnant women. Many such social and cultural factors are discussed in the report. It is very important for the state to intervene for assuring good health of its citizens. Thus the report also discusses various national policies concerning smoking. At last the report discusses various anti-smoking campaigns happening at local level. 

In the year 2009, 21% of adult population in England, reported the habit of cigarette smoking. Prevalence is almost similar between men and women; with 22% of male population and 20% of female population reporting cigarette smoking (NHS 2011). In 2009, on an average 13 cigarettes were smoked daily by a smoker; which include, on an average 14 cigarettes by man and 12 cigarettes by woman (ibid).

In 2010 it was estimated that, £18 billion were spent on tobacco in the country. The lost economic opportunities due to Smoking are severe as majority of smoking-related deaths occur during the prime productive years (ages 30 – 69) of population (Shahab et al. 2016). The money spent on negative externalities of smoking products is much more than the revenue earned by taxes on tobacco products (ibid).

In 2010, there were about 1.5 million hospital admissions in UK, in adults aged 35+, from a disease related to smoking, and this number is constantly rising since 1996/97, when such admissions were 1.1 million (NHS 2011). About 5% of all hospital admissions in the age group of 35+ could be directly attributed to smoking (ibid).

In England the prevalence of smoking in pregnant women was 12 percent in 2014 (Health and Social Care Information Centre, 2014). This is a matter of grave concern because smoking during pregnancy has fatal effects on the developing foetus and is harmful for the health of both, mother and the baby (Flenady et al. 2011). The products of cigarette combustion lead to hypoxia, and vasoconstriction of utero-placental vessels, which hampers growth of foetus. Maternal smoking also leads to increased risk of preterm delivery, Still-birth and Perinatal mortality (ibid).

Recent epidemiological studies and meta-analysis have also shown that maternal smoking increased the risk of SIDS – Sudden Infant Death Syndrome (Vennemann et al. 2012). Prenatal tobacco exposure makes it difficult for infants to recover from hypoxia especially preterm infants. Tobacco exposure also impairs arousal patterns and these changes lead to increased risk of SIDS (ibid). The 7000 different compounds of tobacco/ tobacco smoke also have deleterious effects on development of foetus and cause major birth defects. The studies have shown a causal relationship between maternal smoking and occurrence of cleft lip and/or cleft palate in new-borns (Hackshaw et al 2011).

Pregnant Women

Moreover the evidence has shown that in UK, 2/3rd of all deaths of smoker women in their 50s, 60s, and 70s was attributed to their smoking habit; and also smoker women on an average lose at least 10 years of lifespan (Pirie et al. 2013).

The World Health Organisation (WHO) has described the Social Determinants of Health (SDH), as the situations/circumstances in which populations were born, spent their childhood, grew, lived, married, worked and grew old, and the health systems were put in place to dealt with disease and illness. These situations or conditions in which people have spent their lives were, in turn moulded by governmental, social, cultural and pecuniary forces, and were characterised by the inequitable distribution of resources, authority, income, possessions and services; inequitable access to education and healthcare; and conditions of work and leisure settings i.e. home, groups, settlements or cities (WHO 2008). 

Smoking is generally considered as a matter of personal choice and thus seen in context of individual responsibility rather than a broad social context. There is a victim-blaming approach in case of tobacco induced diseases. It is considered that smokers have brought these diseases on themselves and it is only their own fault but no one else’s. The common view is that, it is upto the Smokers to change their behaviour and quit to avoid adverse effects of Smoking. Such a belief fails to view Smoking habit as a response to social circumstances. It is very important to research beyond ‘individual-level’ risk factors to structural level or population level determinants. Health states or conditions do not exist in isolation apart from other people. People together form societies and any study of the traits of people is also a study of the expressions of the form, the structure and the developments of social forces.

The material, cultural, social and political world around us plays a very important role in susceptibility or resistance to diseases or risk factors. The focus here is on social and cultural phenomenon rather than only on clinical manifestations of smoking. Health behaviours including Smoking behaviour are not haphazardly dispersed in the population. Rather they are socially and economically patterned and often clustered with other behaviours. There are circumstances that place individuals “at risk of risks”. Smoking behaviour is not solely a matter of “individual choice”. Rather, environment place constraints on individual choice and incentivize particular choices with promises of social, psychological, financial or physical rewards. If our interventions address only smoking cessation by focusing on individual behaviour, then even if we are completely successful in this intervention, new individuals will continue to add to the smokers’ population because we have not done anything to influence those social and cultural forces in the community/ populations that altered the individual behaviour at the first place and instigated them to smoke.

Justification of chosen group

The disease outcomes and risk behaviours across populations are associated with almost similar circumstances which are socially, culturally and economically patterned and often clustered. The Smoking behaviour is complex like other behaviours and has its interactions with social and physical environments of people. Such interactions about health behaviours were documented as early as the 1800s. Holman and colleagues have mentioned that, Villerme observed that social aspects, such as the standards of living and duration of work, controlled the behaviours of people in different trade, such that different vocations were associated with certain behavioural tendencies and even levels of sanitisation [Holman 2017]. The Smoking habit has also been seen to get influenced by material and cultural disadvantage and deprivation.

Bambra in 2009 and 2011 has also shown that working conditions, work and worklessness are major determinants of risky behaviours such as smoking (Bambra & Eikemo 2009, Bambra 2011). The welfare policies of the government, economic growth, distributive justice, labour laws, trade laws, social security, unemployment etc. influence the health and well-being of individuals and determine their risk behaviours including smoking (ibid).

The factors that lead to smoking habit among individuals have a life-course approach beginning in childhood and that accumulate throughout life leading to risky behaviours (Braveman & Barclay 2009; Osler et al. 2008). Childhood social circumstances and health disparities in childhood determine health behaviours such as smoking in mid-life (ibid).

Social ties, social relationships, social connectedness or a feeling of isolation, desertion, and loneliness also determine smoking among individuals (Huijts 2011). Social and cultural resources and support act as buffer and play a protective role against risk behaviours whereas alienation and anomie leads to altered cognition and increased susceptibility to smoking. Social participation and engagement in a productive social context provide opportunities for networking, companionship, friendship and thus provide individuals with stable and coherent sense of identity and thus protect against risky behaviours (ibid).

Socio-economic status of a section of society also determines smoking prevalence among them (Murray 2017, Stringhini et al 2011). The research has shown that poverty, inequity, low socio-economic status, struggle to earn daily bread influence or rather instigate the habit of smoking among individuals (Marmot 2010).

Culture defines all social systems that emphasize the practices, norms, dialogues, way of living and factual expressions, which, over time, determines the stabilities as well as incoherence of social lives (James et al. 2015).

The tobacco was introduced in England in 16th century when Columbus discovered America and Portuguese traders brought tobacco cultivation here. Initially it was popular among bonded labourers and slaves. There was wide criticism also as the ill effects of tobacco were known at that time. King James in 1604 wrote on smoking, Smoking is a custom hateful to the eye, odious to the nose, injurious to the brain, perilous to the lungs, and in the black, reeking fume thereof nearest resembling the awful stygian smoke of the pit that is infinite. King James also wrote on passive smoking, “The wife must either take up smoking or resolve to live in a perpetual stinking torment”.

Social Determinants of Health

The cigarette industry catalysed with the invention of Bonsack machine by James Bonsack. After that cigarettes became increasingly popular in England. Cigarette industry started targeting youth and women. They targeted women by projecting cigarettes as slim, modern, fashionable, independent, attractive and symbolising a sense of freedom and glamour with them. Increasing cigarette advertisements on print and media played an important role in attracting customers.

In the beginning of 21st century, to address the global burden of smoking, World Health Organisation came up with Framework Convention on Tobacco Control i.e. WHO FCTC. The World Health Organization adapted the Framework Convention on Tobacco Control (WHO FCTC) in World Health Assembly (WHA) in 2003.  It is in force since 2005. The key objective of the WHO FCTC is to safeguard present and forthcoming cohorts from the adverse health, social, cultural, ecological and monetary penalties of smoking and exposure to second hand smoke.  Currently the WHO FCTC is ratified by 180 Parties as on March 2017. The WHO FCTC currently covers about 90% of the world's population. The WHO FCTC is an international officially binding treaty which compels Parties to the Convention including UK to develop and implement a series of evidence-based smoking control measures to reduce the demand and supply of tobacco.

The Great Britain is a signatory to WHO FCTC (World Health Organisation Framework Convention on Tobacco Control) since 2003 and endorsed it in 2004. After signing WHO FCTC, lots of national policies were formulated to control smoking, which are described in next section. The culture of society then started resisting or rather abhorring the practice of cigarette smoking which was once culturally accepted. The habit is now no more culturally accepted. Thus at different points of time, culture shaped the practices and discourse regarding the habit of smoking.

The following are national policies concerning smoking in Great Britain.

  • There is a ban on Tobacco advertising, Promotion and sponsorship in UK. Point of sale advertising is also banned since 2012.
  • The tax rates on cigarettes are high and constantly increasing in each financial year. There are regulations regarding counterfeit cigarettes and smuggling of cigarettes.
  • Smoking is ban in all indoor workplaces and public places since 2007. This has been done to protect the non-smokers from the exposure of second-hand-smoke.
  • Sale of tobacco products to minors (under 18 years) is also prohibited under Children and Young Persons Act 1933.
  • Plain packaging of cigarette packs has also come into force since 20 May 2016.
  • There is a proposal to ban e-cigarettes also. 

Lots of anti-smoking campaigns happen at local levels. In the year 2009 some innovative anti- smoking public campaigns were launched in UK (United Kingdom), and each one was on distinguished type of media. All the four anti- smoking advertisements were non- profit public campaigns, which were supported by Department of Health in UK. One advert was ‘invisible-killer’ advertised via television. Another commercial which was supported by press as well as by Television talks about effects of smoking on people’s sex life. The third advertisement says “get unhooked”. This advertisement has two choices of media; one is on television; and the second outdoor hook billboards. The fourth advert has just one choice of media- outdoor posters. These poster firmly say that at present times, there are so many other things to do instead of smoking.

Social Determinants of Smoking

Conclusion

Smoking among pregnant women is very harmful for developing foetus and thus have adverse pregnancy outcomes. The pregnant women themselves should not be blamed for the habit as it has many social and cultural determinants. The poverty, working conditions, social conditions, culture, lifestyles, norms of the society etc. play a very important role in determining the smoking behaviour among individuals. In UK, the government has formulated many national policies to control this problem. Anti-smoking campaigns are also very active at local and national media.

References

Bambra, C 2011, ‘Work, Worklessness and the Political Economy of Health’, Oxford: Oxford University Press.

Bambra, C, & Eikemo, T A 2009, ‘Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries’, Journal of Epidemiol Community Health, Vol 63, pp. 92–98.

Braveman, P, & Barclay, C 2009, ‘Health disparities beginning in childhood: a life-course perspective’, Pediatrics, Vol 124, pp. S163–S175.

Flenady, V, Koopmans, L, Middleton, P, Frøen, J F, Smith, G C, & Gibbons, K et. al. 2011, ‘Major risk factors for still-birth in high-income countries: a systematic review and meta-analysis’, Lancet, Vol 377, pp. 1331-40.

Hackshaw, A, Rodeck, C, Boniface, S 2011, ‘Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls’, Hum Reprod Update, Vol 17, Suppl 5, pp. 589-604. doi: 10.1093/humupd/dmr022.

Health and Social Care Information Centre, 2014, ‘Statistics on Women's Smoking Status at Time of Delivery: England, Quarter 4—April 2013 to March 2014’. Health and Social Care Information Centre.

Holman, D., Lynch, R. and Reeves, A., 2017. How do health behaviour interventions take account of social context? A literature trend and co-citation analysis. Health:, p.1363459317695630.

Huijts, T 2011, ‘Social Ties and Health in Europe. Individual Associations, Cross-national Variations, and Contextual Explanations’, Nijmegen: Radboud University Nijmegen/ICS.

James, P, Magee, L, Scerri, A, Steger, Manfred B 2015, ‘Urban Sustainability in Theory and Practice: Circles of Sustainability’, London: Routledge, pp. 53.

Marmot, M 2010, ‘Fair society, healthy lives: the Marmot Review : strategic review of health inequalities in England post-2010’, The Marmot Review.

Murray, M.P., 2017. The pre-history of health psychology in the UK: From natural science and psychoanalysis to social science, social cognition and beyond. Journal of Health Psychology.

Osler, M, Godtfredsen, N, Prescott, E 2008, ‘Childhood social circumstances and health behavior in midlife: the Metropolit 1953 Danish male birth cohort’, Int J Epidemiol, Vol 37, pp. 1367–74.

Pirie, K, Peto, R, Reeves, G K, Green, J, Beral, V 2013, ‘The 21st century hazards of smoking and bene?ts of stopping: a prospective study of one million women in the UK’, Lancet, Vol 381, pp. 133-141.

Shahab, L., Dobbie, F., Hiscock, R., McNeill, A. and Bauld, L., 2016. Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services: findings from the ELONS study. Nicotine & Tobacco Research, p.ntw258.

Stringhini, S., Dugravot, A., Shipley, M., Goldberg, M., Zins, M., Kivimäki, M., Marmot, M., Sabia, S. and Singh-Manoux, A., 2011. Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. Plos med, 8(2), p.e1000419.

The NHS information centre for health and social care, 2011, ‘Statistics on smoking: England’. Available from: <https://www.ic.nhs.uk/pubs/smoking11> [7 April 2017].

Vennemann MM, Hense HW, Bajanowski T, Blair PS, Complojer C, Moon RY, Kiechl – Kohlendorfer U 2012, ‘Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate?’ Journal of Pediatrics, Vol 160, suppl 1, pp. 44-48.

World Health Organisation (WHO) 2008, ‘Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health’, Final Report of the Commission on Social Determinants of Health, World Health Organisation, Geneva, Switzerland. Available from, <https://whqlibdoc.who.int/publications/2008/9789241563703-eng.pdf> [27 March 2017]. 

Bambra, C 2011, ‘Work, Worklessness and the Political Economy of Health’, Oxford: Oxford University Press.

Bambra, C, & Eikemo, T A 2009, ‘Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries’, Journal of Epidemiol Community Health, Vol 63, pp. 92–98.

Braveman, P, & Barclay, C 2009, ‘Health disparities beginning in childhood: a life-course perspective’, Pediatrics, Vol 124, pp. S163–S175.

Flenady, V, Koopmans, L, Middleton, P, Frøen, J F, Smith, G C, & Gibbons, K et. al. 2011, ‘Major risk factors for still-birth in high-income countries: a systematic review and meta-analysis’, Lancet, Vol 377, pp. 1331-40.

Hackshaw, A, Rodeck, C, Boniface, S 2011, ‘Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls’, Hum Reprod Update, Vol 17, Suppl 5, pp. 589-604. doi: 10.1093/humupd/dmr022.

Health and Social Care Information Centre, 2014, ‘Statistics on Women's Smoking Status at Time of Delivery: England, Quarter 4—April 2013 to March 2014’. Health and Social Care Information Centre.

Holman, D., Lynch, R. and Reeves, A., 2017. How do health behaviour interventions take account of social context? A literature trend and co-citation analysis. Health:, p.1363459317695630.

Huijts, T 2011, ‘Social Ties and Health in Europe. Individual Associations, Cross-national Variations, and Contextual Explanations’, Nijmegen: Radboud University Nijmegen/ICS.

James, P, Magee, L, Scerri, A, Steger, Manfred B 2015, ‘Urban Sustainability in Theory and Practice: Circles of Sustainability’, London: Routledge, pp. 53.

Marmot, M 2010, ‘Fair society, healthy lives: the Marmot Review : strategic review of health inequalities in England post-2010’, The Marmot Review.

Murray, M.P., 2017. The pre-history of health psychology in the UK: From natural science and psychoanalysis to social science, social cognition and beyond. Journal of Health Psychology.

Osler, M, Godtfredsen, N, Prescott, E 2008, ‘Childhood social circumstances and health behavior in midlife: the Metropolit 1953 Danish male birth cohort’, Int J Epidemiol, Vol 37, pp. 1367–74.

Pirie, K, Peto, R, Reeves, G K, Green, J, Beral, V 2013, ‘The 21st century hazards of smoking and bene?ts of stopping: a prospective study of one million women in the UK’, Lancet, Vol 381, pp. 133-141.

Shahab, L., Dobbie, F., Hiscock, R., McNeill, A. and Bauld, L., 2016. Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services: findings from the ELONS study. Nicotine & Tobacco Research, p.ntw258.

Stringhini, S., Dugravot, A., Shipley, M., Goldberg, M., Zins, M., Kivimäki, M., Marmot, M., Sabia, S. and Singh-Manoux, A., 2011. Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. Plos med, 8(2), p.e1000419.

The NHS information centre for health and social care, 2011, ‘Statistics on smoking: England’. Available from: <https://www.ic.nhs.uk/pubs/smoking11> [7 April 2017].

Vennemann MM, Hense HW, Bajanowski T, Blair PS, Complojer C, Moon RY, Kiechl – Kohlendorfer U 2012, ‘Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate?’ Journal of Pediatrics, Vol 160, suppl 1, pp. 44-48.

World Health Organisation (WHO) 2008, ‘Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health’, Final Report of the Commission on Social Determinants of Health, World Health Organisation, Geneva, Switzerland. Available from, <https://whqlibdoc.who.int/publications/2008/9789241563703-eng.pdf> [27 March 2017].

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