Morbidity (Asthma In NZ)
This essay outlines the social and cultural factors that may have influenced the increasing rate of asthma morbidity within New Zealand. The issues that will be discussed at length include the latest facts and statistics of asthmatics provided by the New Zealand Asthma & Respiratory Foundation, the characteristics and symptoms of asthma and the socio economic problems that are often associated with the disease.
Asthma, disorder of the respiratory system in which the passages that enable air to pass into and out of the lungs periodically narrow, causing coughing, wheezing, and shortness of breath. This narrowing is typically temporary and reversible, but in severe attacks, asthma may result in death. Asthma most commonly refers to bronchial asthma, an inflammation of the airways (Marieb, 2001).
To understand asthma, it is important to have a basic understanding of how we breathe and the anatomy of the lungs. We breathe in air through the nose and mouth and the mucosal lining of these areas are warm and moist. This means the air we breathe in is warmed and moistened before it reaches the lungs. Additionally, mucous traps all foreign particles so as to prevent them from entering the lungs, which could cause infection. (Marieb, 2001).
In New Zealand, The Asthma & Respiratory Foundation (1999) has stated that the morbidity of asthma has increased predominately amongst children and young adult sectors of the population, although the reasons for this still remain unexplained. An international study spanning 56 countries revealed that New Zealand has the second highest rate of asthma in the world, particularly among fourteen year olds at a rate of 30.2 percent, second only to the United Kingdom at a rate of 32.2 percent. Australia follows having the third highest rate of 29.4 percent (Asthma & Respiratory Foundation, 1999).
The International Study of Asthma and Allergies in Children showed a tendency for a higher incidence of asthma in more economically developed western countries as opposed to poorer, under developed countries. Studies are currently being conducted to understand and identify reasons for this. Economic conditions, our diets, immunisation programmes, climate conditions, community health care standards and rates of Tuberculosis and other respiratory infections are being investigated and compared to other countries with lower morbidity statistics (Asthma & Respiratory Foundation).
The burden of asthma in New Zealand outlines the extent and impact of asthma, and presents compelling evidence that the condition needs to be taken more seriously. Asthma affects approximately one in six New Zealanders usually beginning in childhood (Asthma & Respiratory Foundation, 1999). It is a concern that although it is part of a world wide trend, the prevalence of childhood asthma in New Zealand has increased over the past 20 to 30 years. An estimated 44 percent of New Zealand children experience asthma symptoms at sometime before they reach the age of fifteen. Reasons for this still remain unclear. Fortunately however, few New Zealand children die from asthma, statistically every year one to four children die from asthma. It is said that improved medication and clinical management has played a major role in the prevention of deaths (Asthma & Respiratory Foundation, 1999).
Statistics supplied by the New Zealand Asthma & Respiratory Foundation (1999) state that in our country around 450,000 people in 1993 were diagnosed with asthma. Of these, 170,000 were children aged 0 to fourteen. The rate of increase is estimated to be 50 percent every ten to fifteen years.
Asthma costs New Zealand an estimated $825 million per year in total. This accounts for the 450,000 New Zealanders who have been diagnosed with asthma, the direct costs of health services, and the indirect costs due to lost productivity within the work force. It’s estimated that an enormous 990,000 days are lost due to asthma each year. In 1997, 10,539 people in total were hospitalised due to asthma. Statistics show that children have over three times the hospitalisation rate of adults. (Asthma & Respiratory Foundation, 1999).
The average cost of an asthma admission in 1991 was $1,594. Every year, there are around 6000 hospital admissions for asthma among children alone. Using these figures the cost to New Zealand of hospitalisation for childhood asthma is at least $9.5 million each year. Up to 75 percent of children with asthma continue to suffer from the disorder through puberty and adulthood (Asthma & Respiratory Foundation, 1999).
Although asthma is very common in New Zealand and a wide range of New Zealanders are affected by it, Fergusson (1997) comments that patients admitted to hospital with acute asthma are often severely economically disadvantaged. Thirty three percent of patients receive a social welfare benefit as their only means of support, forty percent postpone going to the doctor because of the expense. A further twenty six percent have difficulty managing an asthma attack due to concerns they have about taking time off work (Fergusson,1997).
Those economically disadvantaged are more likely to seek a health professional at the beginning of a week. There is no clinical reason for the day of the week itself being responsible for triggering an asthma attack however, it is argued that patients tend to wait the duration of the weekend simply because the cost of after hours healthcare is too costly (Fergusson, 1997), With a community services card, visiting a healthcare professional equates to forty dollars during the weekend, on the other hand, with out a community services card, the total cost amounts to fifty-five dollars taking into account that these figures do not include prescriptions (Primecare, 2002).Therefore its suggested that they tend to seek help during normal consulting hours where the expense is less. It is also assumed that the delay in seeking medical attention during weekends could be due to the patient preferring to wait till his or her own general practitioner is available (Kljakovic & Salmond, 1996).
The latest findings from a survey done on lower socio-economic people by Crampton, Salmond, Blakely & Chapman (2000) found that this portion of society had poorer health than their wealthier counterparts. Their findings also point out that it is not just the level of poverty that affects a person’s health, but also the available resources in society. No matter how rich or prosperous a population or country may be, a social gradient of health will always be obvious, as those economically lower down the scale are more likely to have health of inferior quality than those above them.
A health survey conducted in 1996/1997 showed that the rate of asthma in New Zealanders was only slightly higher in Maori than non-Maori, particularly for Maori men (16.4 percent compared to non-Maori men 13.3 percent). Of Maori women surveyed, 20 percent has asthma compared to 18.7 percent of non-Maori women. This was an improvement for statistics gathered in 1994 that showed Maori were almost 50 percent more likely to develop asthma than non-Maori. In 1997, the rate of hospitalisation for Maori was twice as high as the rate of non-maori. Those of pacific decent however, had relatively low rates of asthma in the 1996/1997 health survey (Asthma & Respiratory Foundation, 1999).
Despite worldwide research, The New Zealand Asthma & Respiratory Foundation (1999) say there is as yet no definitive answer why some people suffer from asthma and others don’t, though links have been made to diet and overexposure to dust mites and other allergens. Approximately 70-80% of asthma in New Zealand is associated with allergy. Sometimes more than one part of the body can be affected, which is why people with asthma often also suffer from hay-fever and eczema (Allergy Centre, 2002).
The most common causes of asthma attacks are extremely small and lightweight particles transported through the air and inhaled into the lungs. When they enter the airways, these particles, known as environmental triggers, cause an inflammatory response in the airway walls, resulting in an asthma attack (DuBuske, 1999).
In many people, an asthma attack may be brought on by exposure to allergens, substances that can trigger allergic reactions in susceptible people. Pollen grains, cigarette smoking, house dust, and dust mites are some of the most common and pervasive allergens (DuBuske, 1999). The dust mite is a microscopic insect that lives in human homes, where it feeds on the dust produced by human and animal skin. Dust mites are not harmful in themselves, but their droppings, which contain left-over digestive enzymes, are a significant cause of asthma and other allergic diseases (Lowhagen, 1999).
According to the Asthma & Respiratory Foundation (1999) statistics, one third of ten to fourteen year olds report some form of exposure to tobacco smoke at home. They also state that children exposed to tobacco smoke are 50 percent more likely to suffer from asthma than children not exposed and have estimated, that if no adult smoked when near children, 15,000 fewer New Zealand children would suffer from asthma. Laugesen (1996) makes the point that this cycle is likely to continue as children whose parents smoke are also more likely to take up cigarette smoking.
Asthma also occurs in people who do not have allergies. In these people, chemical irritants trigger an inflammatory response that is initiated in a different way than in allergen triggered asthma. For example, some people are sensitive to certain common chemical irritants, such as perfume, hairspray, cosmetics, and household cleaners. Other chemical irritants include industrial chemicals and plastics, as well as many forms of air pollution, such as exposure to high levels of ozone, car exhaust, wood smoke, and sulphur dioxide. Current research seeks to determine whether indoor pollutants also contribute to the development of asthma (Lowhagen, 1999).
Research also suggests that genetic factors may increase the risk of developing the disorder. Children with a family history of asthma are more likely to develop asthma than other children. Despite this apparent genetic link, many people without a family history of asthma are still eligible to develop the disorder, scientists continue to investigate additional causes (Valacer, 2000).
A recent paper presented by the Wellington Asthma Research Group showed that antibiotic use, especially in the first year of life, is associated with a fourfold increase in the likelihood of asthma (Asthma & Respiratory Foundation, 1999). Many Parents become concerned when they learn their child needs asthma medicines, particularly when they are required several times each day. They worry that the medicine will harm their child and that they may become addicted to them or that the medicines loose the effectiveness through repeated use (Sears, 1989).
Fergusson (1997) states that asthma educators need to acknowledge the influence of social, economic and psychological factors on education initiatives. Its argued that these factors need to be recognised and incorporated into educational programmes for a reduction in morbidity to occur. This approach would enable a patient to understand their specific patterns and early warning signs and implement improved self-management actions to reduce the severity of future attacks. It is vital that treatment programmes are targeted to meet the specific needs of the patient, allowing them to have a role in decision making about such treatment (Stodart, 1995). It is also vital that treatment programmes are targeted to meet specific needs of the patient, which could mean allowing them to have a role in decision making concerning treatments.
Dickson (1992) concurs that to establish good asthma control, it is important that a child receives regular check-ups by a health professional. It is also important that the family is taught how to monitor symptoms and know at which point to take action. The aim of asthma management is to enable normal participation in activities such as exercise, minimising school absences as 550,000 school days are lost per year due to asthma (Asthma & Respiratory Foundation, 1999), eliminating symptoms such as a night cough, and by encouraging normal healthy growth and development (Dickinson, 1992).
Educating a person with asthma means assessing them and finding out what they need at the present time, rather than just passing on a lot of information, which the patient may or may not be ready to hear. Working with the person with asthma could, among other things, involve counselling or helping them to gain access to other services (Stodart, 1995).
Stodart (1995) reflects that asthma education is not just physical care. One of the problems an educator can have working with people with asthma, is seeing the difficult social situations some are in and the problems they have in getting the help they need, such as prescriptions and doctors visits. A person may have numerous problems of which asthma is just one. An educator’s main role is to teach preventative strategies. However where appropriate, other social service agencies should be suggested for assistance with any other problems the client might have that may be impacting on their illness.
In conclusion, many psychosocial factors influence increased morbidity in New Zealand. There is a need for an integrated approach to asthma management, and for increased co-ordination between secondary care and primary care services. We know that good medical advice, appropriate medication and education used within the framework of a written asthma self-management plan can significantly reduce morbidity from asthma among adults and children within New Zealand. Adequate funding needs to be available to ensure that people with asthma can access this regardless of their financial situation. Educators must also ensure that both social and cultural issues are taken into account when assessing the needs of children and adults with asthma. Only then, can we hope to achieve the positive results of an improvement within New Zealand amongst asthma sufferers.
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