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Unit 9 Investigating Diseases

Charlotte Acton
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Part A
Pages 1-2 Introduction
Pages 2-4 The biological basis of heart disease
Pages 4-6 Symptoms of heart disease
Pages 6-7 How heart disease can be diagnosed
Pages 7-8 The biological basis of influenza
Pages 8-9 Symptoms of influenza
Pages 9-10 How influenza can be diagnosed
Page 11 Difference in diagnosis

Part B
Pages 12-14 Factors affecting the distribution of influenza
Pages 14-16 Factors affecting the distribution of heart disease
Pages 16-18 The similarities and differences of influenza and heart disease

Part C
Pages 19-21 Diseases similar to influenza
Pages 21-22 Diseases similar to heart disease
Pages 22-25 Factors affecting the outcome of heart disease
Pages 25-26 Factors affecting the outcome of influenza
Pages 26-34 Support available for heart disease and influenza
Pages 34- 36 Work related issues

Part D
Pages 37-43 Evaluation of preventative strategies
Pages 43-45 Work related problems
Page 45 Conclusion
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Page 46 Bibliography
Page 47 Appendix
























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Introduction
For this assignment I will be investigating and comparing two different diseases, one of them being
communicable and the other non-communicable. I will have to research different aspects associated
with each disease for example their signs and symptoms, what types of work-related problems they
may cause with the individual suffering from either of the diseases, what support is available,
strategies and preventions. Once I have researched, discussed and evaluated each disease it is then
important to evaluate and conclude on the diseases and their impact on society. The way I will do
this is to comment on how successful preventions are and what work-related issues can impact and
affect them.
The non-communicable disease I have chosen is heart disease. The reason for this is because it is
one of the most common non-communicable illnesses not only in the UK, but globally and the World
Health Organisation (WHO) found CVDs are the number one cause of death globally: more people
die annually from CVDs than from any other cause. -
(http://www.who.int/mediacentre/factsheets/fs317/en/) Even though there is no cure for heart
disease scientific and technological developments have led to improved treatments which can
increase life expectancy and lead to reduce mortality rates.
The World Health Organisation (WHO) defines non-communicable disease by saying: Non-
communicable diseases (NCDs), also known as chronic diseases, are not passed from person to
person. They are of long duration and generally slow progression. What the organisation means is
that these types of diseases cannot be spread; an individual who has developed non-communicable
disease has not caught it from another person or animal. An individual can sometimes just develop a
Non-communicable disease for an unknown reason, but sometimes factors, such as the diet and
lifestyle, can contribute to a disease being developed. The WHO provides four examples of the most
common non-communicable diseases: cardiovascular diseases (like heart attacks and stroke),
cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma)
and diabetes. However, research and data collected by the WHO is worldwide, the research I am
conducting is primarily UK based, and therefore the four main non-communicable diseases may
differ.
(Source: http://www.who.int/mediacentre/factsheets/fs355/en/)
Coronary heart disease happens when fat and cholesterol in your blood builds up in your artery
walls forms a plaque or atheroma. This is known as atherosclerosis. The plaque can prevent your
heart muscle from getting the blood supply it needs. Heart disease causes around 82,000 deaths
each year in the UK making it the UKs biggest killer and currently 2.7 million people are living with
the condition. It is generally more common in those who do not exercise regularly and consume
food and drink containing high amounts of fat. Age is also a contributing factor and according to
Bupa men over 45 and women over 55 are most at risk.
(Source: http://www.bupa.co.uk/individuals/health-information/directory/c/coronary-heart-
disease)
The communicable disease I have chosen is influenza because it is one of the most common due it
being highly contagious because it can be spread by a variety of different sources, for example just
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by physically touching an individual with the disease, this is unlike most other communicable
diseases, such as HIV the only way this can be transmitted is through specific human body fluid. -
(http://aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/)
According to the government Communicable diseases are those that are transmissible from one
person, or animal, to another. The disease may be spread directly, via another species (vector) or via
the environment. Illness will arise when the infectious agent invades the host, or sometimes as a
result of toxins produced by bacteria in food. (http://www.dft.gov.uk/mca/mcga-
shs_capt_guide_chap6.pdf) Communicable diseases are typically highly infectious meaning that they
can be contracted easily if previsions are not in place. Some communicable diseases have
vaccinations in order to prevent people from developing the disease, this not only helps to reduce
the number of people with the disease but it also prevents the disease from being spread further.
The Centres for Disease Control and Prevention (CDC) lists Some examples of diseases with available
vaccines are: Mumps, Measles, Rubella, Polio, Tetanus, Diphtheria, Pertussis, Haemophilus
influenzae Type B, Rotavirus, Hepatitis A, Hepatitis B, Meningococcal disease Varicella,
Pneumococcal pneumonia and Influenza-
http://www.cdc.gov/immigrantrefugeehealth/exams/diseases-vaccines-included.html In addition,
Health promotion campaigns are used as a form of prevention as they inform the population of the
disease, providing knowledge on how to reduce the risk of catching the disease. For example, in
relation to influenza the government use promotion in order to encourage those most ask risk (older
people, pregnant women and children) to be vaccinated against influenza through their annual flu
programme.
Influenza is an infectious and common viral illness spread by coughs and sneezes. Since it is highly
infectious this means it can cause an epidemic, therefore a large amount of people become infected
at the same time. People tend to be under the impression that the common cold is similar to
influenza. However, this is not the case influenza is caused by a dissimilar group of viruses, even
though symptoms tend to be somewhat the same but those of flu tend to be more severe and last
for longer. Influenza may sometimes be called seasonal flu and this is because it is more frequent
in winter in comparison to any other time of year, nevertheless influenza can be contracted anytime
of the year. There is a vaccine available, but it is not accessible to the entire population for free on
the National Health Service (NHS), only the following groups qualify: pregnant women, children
aged two and three, children aged 2-18 with a long-term health condition, adults aged 65 or older,
people with a serious medical condition, healthcare workers or carers, people living in a residential
or nursing home if anyone wants to have the vaccination they are able to do so but they will have
to pay and it can cost up to 20.
(Source: http://www.nhs.uk/conditions/flu/Pages/Introduction.aspx)
The Biological Basis of Heart Disease
An individual suffering from heart diseases has narrow coronary arteries due to the
build-up of atheroma(A deposit or degenerative accumulation of lipid-containing
plaques on the innermost layer of the wall of an artery-
http://dictionary.reference.com/browse/atheromatain) their walls
(image 1); This condition is called atherosclerosis (image 2). If the
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atheroma ruptures a blood clot will form on the surface and this can prevent an area of the heart
muscle receiving blood and oxygen, which can lead to a heart attack. This damages the heart
muscle resulting in abnormal heart rhythms which can cause cardiac arrest this is when an
individuals heart stops beating altogether, causing death.
(Source: http://www.bupa.co.uk/individuals/health-information/directory/c/coronary-heart-
disease)
Over time the arteries will become narrower this means that not enough oxygenated blood can be
delivered to the heart and according the British Heart Foundation this can cause angina. Angina is a
pain or discomfort felt in the chest, and usually caused by coronary heart disease.-
(https://www.bhf.org.uk/heart-health/conditions/angina.aspx) Angina can be prevented from
getting worse by an individual changing their lifestyle choices, for example: stopping smoking,
controlling their blood pressure, reducing cholesterol level, being/becoming physically active,
maintain or become a healthy weight, eating a health balanced diet and only drinking alcohol in
moderation.
The effects of heart disease on an individuals body are similar to some of the symptoms they may
experience. The company Healthy Eating and Nutrition provide a list of the 12 most common effects
of heart disease on the body (appendix 1). Some examples are:
Ineffective functioning of the liver and kidney since the heart is the most vital organ in the human
body if it is not functioning properly or is under distress, theres no telling how the other organs
linked might function. They could get affected too. Studies (appendix 3) also found a similar
connection, a symptom of heart disease is heart failure and this has been associated with kidney
problems. A recent study conducted found that most patients with heart failure had some kind of
abnormal kidney function. Interestingly, individuals with kidney disease are more likely to be
diagnosed with heart disease, in comparison to others without the disease and the cause of death in
people with kidney failure is most often heart disease.
Heart disease can also have psychological effects on the body: Stress, worry and depression. The
constant feeling of stress, anxiety, worry or depression is also a possible of effect of heart disease
(appendix 1). When I interviewed (appendix 2) an individual with heart disease I found that they
sufferied with some psychological effects after they were diagnosed. One of the main reasons was
because they had to give up smoking, he said that: smoking was the hardest as it relieved stress, so
when I was feeling stress I could not do anything about it.
However, lifestyle changes are not the only causes of psychological effects on the body, another
reason could be that that they feel anxious because they are unsure of what to do once they have
the disease, the individual I interviewed had these feelings when he was diagnosed: I felt constantly
worried as I did not know what to do at first. I did not have anyone to talk to as no one I knew had
the disease and I was unsure of help was available. These feelings could lead to depression and
social isolation making heart disease harder to deal with.
Blood pressure is another effect that heart disease has on the body, but a large percentage of
individuals with heart disease do not realise they have high blood pressure this is because the only
way it can be diagnosed is for it to measured. It is important for those suffering with heart disease to
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attempt to keep their blood pressure at a normal rate, as neither high blood pressure nor low blood
pressure is a good condition. (appendix 1) The reason for this is because fluctuations are not good
for the heart. The individual I interviewed said that he tries to get his blood pressure checked
regularly, he said this was because: I attempt to get my blood pressure checked on a regular basis
as then I did not have to worry about worsening my condition, high blood pressure can weaken the
heart over time.
Symptoms of Heart Disease
There are three main symptoms of heart disease; these are angina, a heart attack and heart failure.
It is important for individuals to recognise the symptoms, so then they are able to act on them if
they ever occur. If people are not made aware then they could be fatal, it is especially important for
those of the age of 40 to look out for the symptoms because they are most at risk. Although, not
everyone who is diagnosed with heart disease has any symptoms, so says the NHS: people may not
have any symptoms before they are diagnosed. Meaning that an individual could have heart
disease without realising and this is why it is vital for those who are most at risk to have regular
health checks, the NHS provides a list of those who are most at risk of certain disease including heart
disease, the list includes:

age: older people are at an increased risk
ethnicity: some ethnic groups, for example, south Asians and African-Caribbeans, are at
an increased risk
smoking status: smokers are at increased risk
family history: if there's a history of these diseases in your family, then you're at
an increased risk
physical activity: people who are physically inactive are at an increased risk
alcohol use: if you drink above recommended limits, you are at an increased risk

(Source: (http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Symptoms.aspx)

Other than the three main symptoms there are less serious ones, such as unusual breathlessness
and palpitations (Palpitations mean that the heart is not behaving normally. It can appear to skip
beats, beat rapidly, beat irregularly, or thump in the chest- http://medical-
dictionary.thefreedictionary.com/Palpitations) however, these are not always are not always a
symptom of heart disease and therefore an individual experiencing them should visit their GP, rather
than just assuming that they have heart disease.
Angina
Angina is not as serious as the other two main symptoms and the symptoms
can be managed with medication or an alteration of lifestyle. It is generally
triggered by stressful
situations and or
physical activity. An
Angina occurs when the blood supply to the muscles of the
heart is restricted. like the image shows the arteries are
blocked due to a build-up of plaque causing abnormal blood
flow. The image also shows what a normal artery, without
angina looks like.

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attack only lasts around 10 minutes and can be subsided by resting or using a nitrate tablet or
spray. Symptoms can be uncomfortable and are similar to indigestion, however according to the
NHS severe angina attack can cause a painful feeling of heaviness or tightness, usually in the centre
of the chest, which may spread to the arms, neck, jaw, back or stomach.
(Source:http://www.nhs.uk/conditions/Angina/Pages/Introduction.aspx)
Heart Attacks
An individual will typically suffer a heart attack when their
arteries become entirely blocked (image). If medical assistance is
not provided a heart attack can be fatal and can cause damage
to the heart muscle. According to the NHS a heart attack can
occur at any time, it does not have be when a person is engaging
in physical activity. The symptoms of a heart attack can be
similar to angina or indigestion, the difference is that they tend
to be more severe, although in some cases heart attacks do not
present any symptoms this is called a silent myocardial infarction
this generally only occurs in those with diabetes. The general
symptoms of a heart attack are: sweating, light-headedness,
nausea, breathlessness, feeling of heaviness in chest, stomach
ache, heart burn and pain that affects the arms, the neck and the
jaw. If these symptoms surpass 15 minutes then it could be the
start of a heart attack.
Heart Failure
There are two types of heart failure and these are acute
heart failure which occurs suddenly and chronic heart
failure which happens gradually of a long period of time.
Heart failure could occur in individuals with heart disease
when the heart becomes too weak to pump blood
around the body (NHS) this can cause fluid to build up
in the lungs making it increasingly difficult to breathe.
(NHS) Even though heart disease is the leading cause of
heart failure it is not the only cause of it, the National Heart,
Lung and Blood institute states (appendix 4) other causes: high
blood pressure and diabetes.
There is not a cure for heart failure, but there are treatments
available to help manage the condition. It is also recommended that people with the condition
should be making positive lifestyle changes, for example becoming more active can help people
who have the condition live longer. Heart failure can cause many symptoms including:
Fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck.
Shortness of breath
Fatigue. (appendix 4)
This image shows coronary arteries that are
blocked with plaque and a blood clot both
causing a heart attack. The dead heart muscle
also caused the heart attack.
Compared to a normal heart, one that is failing
has an expanding and damaged left ventricle.
Due to the heart being weak the blood is
pumped at a reduced volume.
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Heart failure remains to be one of the most common causes of death and those with heart disease
will typically die from it.
How Heart Disease can be diagnosed
There are a large range of different diagnosis methods used for heart disease, the examples the NHS
give are as follows: electrocardiogram (ECG), X-rays, echocardiogram, blood tests, coronary
angiography, radionuclide tests , magnetic resonance imaging (MRI) scans and computerised
tomography (CT) scans (NHS)
Firstly, a GP will ask the individual what symptoms they are experiencing; this will include questions
about lifestyle factors. For example, how much physical activity a person does person and whether
or not they smoke. In some cases they may ask about medical history this is because those will heart
disease within the family have a higher risk of developing the disease themselves. There are several
tests that may be carried out, however not all of them will be conducted.
One of the first tests they will carry out is a blood pressure and blood test, this is to discover how
high an individuals cholesterol level is, it also tests the sugars and proteins in the blood. It is vital
that a doctor advises an individual to not eat around 12 hours before the test because food in the
body could impact the result.
Another test they may conduct is an electrocardiogram (ECG), this consists of small sticky patches
called electrodes being put on your arms, legs and chest. These are connected by wires to an ECG
recording machine which picks up the electrical signals that make your heart beat. This electrical
activity is recorded and printed onto paper. (appendix 5)
The individual I interviewed had to undergo an ECG as part of his diagnosis; he said that the
procedure was painless and only lasted around five minutes. - (appendix 2) This could be seen as
positive because if it was time consuming and uncomfortable people may be put off and not
undergo the procedure meaning that their health could be put at risk.
There are different types of ECGs and one of them can be called a stress or exercise test, the main
aim of this type of test according to video created by the British Heart Foundation (appendix 6) it is
to see how the heart performs when it is under stress.- (Parish Kahn- Physiologist) When the
patient is on the treadmill the electro activity of the heart and the blood pressure changes this is
monitored and every three minutes the treadmill will become steeper and faster, also at each stage
the individuals blood pressure will be measured. Unlike, a regular ECG where the individual I
interviewed was not apprehensive about the procedure the patient on the clip said that he was
nervous for this kind of test, indicating that an exercise ECG is more stressful.
An ECG may not always give an accurate picture of what is going on with an individuals heart and
this is because if a person receives a normal heart reading it does not mean that there is not a
problem with their heart and if the reading is abnormal it does not mean that there is anything
wrong. This could suggest that when diagnosing heart disease this should not be the only test
conducted.
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An x-ray is simply used to look at an individuals heart, lungs and chest wall (NHS) helping to rule
out other conditions that may be causing the symptoms a person is experiencing. These conditions
could be a lung disorder or heart failure.
A video created by the British Heart Foundation (transcript appendix 7) said that an Echocardiogram
(echo) is an ultrasound scan of the heart, which allows us to take pictures of the inside structures of
the heart (Rebecca Reynolds physiologist). According to the NHS the test can also show the
thickness and movement of each heart valve and can produce a clear picture of the heart. A video
created by the British Heart Foundation also said that during the test the individual has to remove
their top and then a transducer is passed over different areas of the chest. The patient undergoing
the test described it as stress free, no pain, no trouble at all and quite pleasant. By publishing this
clip the British Heart Foundation are providing those who may think that they have heart disease
with information and personal experiences of the diagnosis method and what they may have to
endure.
Heart disease can be diagnosed via Coronary angiography, what happens is a special dye is released
into the bloodstream. The dye makes the coronary arteries visible on x-ray pictures. This helps
doctors see blockages in the arteries. It can also help to determine how serious the blockages are,
provide information on how well the heart is functioning and the pressure level within the heart
chambers. For this procedure the individual will have to go under local anaesthetic, meaning that
they will not be unconscious as it only targets specific areas of the body. This could cause a person
more stress because they will have to experience the test, whereas if they were unconscious they
would not remember anything. Additionally, they will be in pain afterwards and could experience
various side effects, for example:
A constant or large amount of blood at the catheter insertion site that can't be stopped
with a small bandage
Unusual pain, swelling, redness, or other signs of infection at or near the catheter insertion
site
(Source: http://www.nhlbi.nih.gov/health/health-topics/topics/ca/printall-index.html)
Despite the NHS says that A coronary angiogram is relatively safe and serious complications are
rare. And the risk of a heart attack, stroke or death is only 2 in 1000.
The Biological Basis of Influenza
Influenza viruses belong to the family Orthomyxoviridae and have a single-stranded segmented
RNA genome. (appendix 8) ( image 1) There is more than one
type of influenza, the WHO divide them up into three categories,
type A, B and C. Influenza A can affect mammalian and avian
species (birds), whereas B and C just mainly affect humans. Only
types A and B can cause human disease of any concern what is
meant by this is that these two types can cause seasonal
epidemics, whereas the CDC
(http://www.cdc.gov/flu/about/viruses/types.htm) found that
Influenza type C infections cause a mild respiratory illness and are not thought to cause epidemics.
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In biological terms the way the influenza virus is transmitted
primarily by droplets or respiratory secretions of infected persons
(appendix 8) (image 2) Research conducted by the WHO (appendix 8)
has found that worldwide more children are affected than any other
age group, with between 20 30% being affected during an
epidemic, in comparison to only 5-10% of the adult population.
Typically fit and healthy individuals recover from influenza and do not
need to seek medical attention or advice, but since certain groups of individuals are more at risk
than others influenza can impact their body in a different way and this is why the NHS recommend
they become immunised to the illness. Influenza can cause Secondary bacterial pneumonia is caused
by a pathogenic infection of the lungs and it is particularly common in the elderly and individuals
with chronic diseases, resulting in a significant level of morbidity and mortality
An article suggests (appendix 9) that influenza can affect other parts of the
body, such as: the immune system, the digestive system and the respiratory
system. The immune systems fights the infection caused by influenza, the
immune system releases cytokines which are a type of chemical distress call
issued by T-cells, B-cells and natural killer cells of the immune systems in
response to influenza infection. Some of the symptoms associated with
influenza, like fever, muscle pain and headaches are in fact caused by the
release of cytokines by the immune system. This means that the symptoms
experienced when an individual is ill is their immune system responding and
therefore as the infection subsides, so do systemic symptoms.
The way in which influenza infects the respiratory system produces both upper-and lower-
respiratory symptom. The upper respiratory symptoms are sore throat, runny nose and congestion,
whereas lower-respiratory systems include cough and breathing problems. The severity of these
systems is dependent on the dose of the virus an individual is infected with. Research conducted on
experimental models of influenza infection found that the virus prompts death in the cells lining
the respiratory tract. These dead cells are shed, allowing the virus to infect the progressive cell layer,
impacting the degree of the virus.
The digestive system is affected by influenza because it is associated with a lack of appetite one of
the reasons for this is that it is thought to be a secondary effect of cytokines on the appetite
centres of the brain. there is not any other gastronomical effect on the body for those with
influenza. However, swine flu (H1N1) seems to be different as vomiting, diarrhoea or both was
reported by nearly 40 percent of people with laboratory-confirmed swine flu.
Symptoms of Influenza
All types of influenza tend to have similar symptoms, individuals may experience different symptoms
yet they both will be diagnosed with influenza. According to the NHS influenza is at its peak in the
first two to three days, normally a person will begin to feel better within five to eight days. This
does not mean that the symptoms will have completely disappeared a person will probably still
experience lingering cough and still feel very tired for a further two to three weeks.
(http://www.nhs.uk/conditions/flu/Pages/Introduction.aspx)
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The American government provides a fact sheet (appendix 10) that states the main 7 symptoms of
influenza:
A 100
o
F or higher fever or feeling feverish (not everyone with the flu has a fever)
A cough and/or sore throat
A runny or stuffy nose
Headaches and/or body aches
Chills
Fatigue
Nausea, vomiting, and/or diarrhoea (most common in children)
The NHS provides examples of other symptoms an individual may experience:
limb or joint pain
loss of appetite
difficulty sleeping (http://www.nhs.uk/Conditions/Flu/Pages/Symptoms.aspx)
Since the symptoms of a common cold and influenza are very similar some people find it hard to
determine which they have, in these cases doctors can run test in order to diagnose an individual.
However, the American government (appendix 10) recommends that an individual should look at the
symptoms they are experiencing as some of them do differ. For example, Symptoms such as fever,
body aches, tiredness, and cough are more common and intense with the flu. People with colds are
more likely to have a runny or stuffy nose. if a person thinks that they have influenza it is not always
necessary to visit a doctor as it can be treated at home. However, the NHS acclaims that certain
groups should if they think they may be suffering from it:
are 65 years of age or over
are pregnant
have a long-term medical condition, such as diabetes, heart disease, lung disease,
kidney or neurological disease
have a weakened immune system (the body's natural defence against infection and
illness) -
This is because their symptoms can be more severe and could cause further health problems and in
some cases could result in the death on an individual, so say the WHO
(http://www.who.int/mediacentre/factsheets/fs211/en/): influenza can cause severe illness or
death in people at high risk an example of a serve illness caused by influenza is secondary bacterial
pneumonia.
How Influenza can be diagnosed
Influenza can be challenging to diagnose because the symptoms it possess are similar with many
other common respiratory tract infections.
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The most common tests in order to determine whether someone has influenza is called rapid
influenza diagnostic tests these kinds of test can take up to 30 minutes but no longer, however they
not always provide an accurate diagnosis. This is more common in certain circumstances, for
example the CDC (appendix 11) say that a
false-positive diagnosis is increasingly
probable if the disease prevalence is low
this is usually when the test it taken at the
beginning or the end of an influenza season. Another reason why a false-negative result may occur is
when the prevalence of the disease is high, which is typically at the height of the influenza season.
The table above shows the percentages of success depending on the prevalence.
Not all influenza diagnostic tests are the same, the way they can differ is
in what type of influenza they are able to detect. Some are able to
identify influenza A and B viruses and tell the difference between them,
whereas other tests can only identify influenza A and B, the table shows
the different tests and what type of influenza they test for. Other tests
are waived from requirements under the Clinical Laboratory
Improvement Amendments of 1988 (CLIA) this means that they have
been enforced to have to be carried out. Different specimen types can
be used when using a rapid influenza test, the types of specimen used
could be: throat or nasal swab. The graph presents different specimens
used in a range of different tests. The accuracy of the test is dependent
of the specimen used.
Another way influenza can be diagnosed is through viral culture, this
method is critical, because only culture isolates can provide specific
information regarding circulating strains and subtypes of influenza viruses. This is important as it
allows current circulating influenza strains with vaccine strains; it provides information on what
treatment would be most appropriate when treating influenza. It can also help to identify when a
pandemic might occur, as Virus isolates also are needed to monitor the emergence of antiviral
resistance and the emergence of novel influenza A subtypes.
A method called serological testing (Routine serological testing for influenza requires paired acute
and convalescent sera) is sometimes used, however it is not recommended by the CDC and this is
because it is only used for research and public health investigation, unlike other methods which help
with clinical decision making, therefore this method would not be used as a form of diagnosis for
an individual.
Overall, there is not a vast amount of different testing for influenza because most people know if
they have influenza or not and it typically does not require treatment, the NHS suggests that If you
are otherwise fit and healthy, you do not need to see your GP when you have flu.-
http://www.nhs.uk/Conditions/Flu/Pages/Diagnosis.aspx


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Differences in Diagnosis
It seems likely that the diagnostic methods used to determine influenza or heart disease will differ
because they impact two different areas of the human body, influenza mainly the respiratory system
and heart disease the cardiovascular system.
Diagnosing influenza is a lot simpler because it is a quick and a harmless process and this is the
reason why the main method of diagnosis is called rapid influenza diagnostic test. However,
majority of the time influenza does not need to be diagnosed by a doctor as it is not life threatening
to a healthy individual. Someone suffering with influenza will usually know if they have because it is
similar to a common cold, only with heightened symptoms.
Heart disease is difficult to self-diagnose because it can be easily mistaken for other cardiovascular
related diseases, such as heart failure, congenital heart disease and a stroke. The process can be a
much lengthier and traumatic because the methods used sometimes require an individual to be
hospitalised. In addition, it can take a while for the individual to recover, unlike when diagnosing
influenza where there are no side effects. A coronary angiography is an example of an invasive
procedure as it can cause bruising and bleeding.

















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Factors Affecting the Distribution of Influenza
Influenza is generally caught via physical contact with an individual carrying the illness, but it can be
passed on from someone touching an infected object or surface, such as a door handle. The chances
of this occurring increase when a person with influenza is not cautious about spreading the illness.
To help reduce the prevalence of influenza the CDC have an intervention in place, takes 3 actions to
fight the flu (appendix 12), it consists of guidelines to which those with influenza should follow to
prevent the disease spreading. For example:
While sick, limit contact with others as much as possible to keep from infecting them.
Cover your nose and mouth with a tissue when you cough or sneeze.
Throw the tissue in the trash after you use it.
Wash your hands often with soap and water. If soap and water are not available, use
an alcohol-based hand rub.
Avoid touching your eyes, nose and mouth. Germs spread this way.
Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.
All of the above are factors that can expand the distribution of influenza, if the CDCs guidelines are
not followed correctly. Influenza can be caught anywhere, but it is mostly likely to be spread in
heavily populated areas. School is one of the most common places where influenza is distributed
because pupils and teachers are constantly exposed to a variety of germs. An article medically
reviewed by George Krucik MD recommends that schools should educate pupils on the importance
of hand hygiene as it is one of the best and most effective ways society can deal with the spread of
influenza and the spread of germs- http://www.healthline.com/health/cold-flu/preventing-flu-
school. If pupils are aware of how to reduce their risk of influenza, for example through
remembering to wash their hands, then there is a good chance of it could lower the circulation rate.
No matter how hard people try to control the spread of influenza by washing their hands or
limiting contact with the uninfected, it will not eliminate the illness and for this reason the CDC
suggests that everyone over the age of six months should be vaccinated, the WHO reaffirms this
by saying: vaccination is the most effective way to prevent infection and severe outcomes
caused by influenza viruses (http://www.who.int/influenza/vaccines/use/en/) This makes not
being vaccinated a major factor in the spread of influenza. In some countries this cannot be
helped because they do not have access to the influenza vaccine, suggesting that epidemics and
pandemics are more common. According to the WHO influenza is most common in India:
Worldwide, H1N1 2009 virus transmission remains most intense in parts of India and in parts of
the temperate southern hemisphere, particularly New Zealand and more recently in Australia-
(http://www.who.int/csr/don/2010_08_27/en/). Countries, like India do not have the same
standard and quality of healthcare as the UK. For example, evidence suggests that the vaccination
is not given out in priority of need. Within the UK the influenza vaccination is available free of
charge to high risk user groups, which are:
People of the age of 65
Pregnant women
16

Individuals with serious medical conditions
People who live in residential homes
People who care for people at risk of influenza complications
Healthcare professionals
In India, Influenza is typically prevalent between the months of June and September; researchers
suggest this is because it is monsoon season. However, despite this the vaccination is only made
available between August and September- The vaccine that is currently available in India is based
on the northern hemisphere influenza circulation and it arrives a bit
late in the monsoon (August -September) (full report appendix
12). This could mean that a large percentage of people will already
have or of had the virus when the vaccine arrives, so therefore it is
less likely that the vaccination can reduce the distribution of
influenza in countries similar to India. However, the WHO has
devised a global action pan (GAP) for influenza, this aims to increase
in seasonal vaccine use and Increase in vaccine production capacity.
By 2015 there will be enough vaccine produced in order to
vaccinate around two billion people and the long-term goal of GAP
is to produce enough vaccine to immunise the worlds population
in 6 months-
http://www.who.int/influenza_vaccines_plan/en/index.html
Within the UK only those in high risk categories are entitled to a free influenza jab (see image).
However, in 2012 BBC News report (appendix 13) discovered a decrease in those being vaccinated
against influenza. High risk groups are 11 times more likely to die from the illness and therefore it
is important that they protect themselves, but this is not the case because in 2012 only 49% of over
65s were vaccinated, compared to 55% in 2011. There is also a similar correlation for individuals
with medical conditions, as only 29% were vaccinated which is a 3% fall from the previous year.
Overall, if less people are being vaccinated against influenza it indicates that individuals will be more
likely to catch it and this can have a detrimental effect on those in high risk categories.
It could be proposed that if the vaccinations were free to all it would eliminate all risk because
people would not have to worry about that cost. Contrastingly, an article published by the Daily Mail
states that contracting influenza provides better long-term protection than a flu vaccination. Also,
the Department of Health says that it would not be best use of current resources.
(Source: http://www.dailymail.co.uk/health/article-369392/The-flu-vaccine-What-need-know.html)
Chronic stress could be a distributing factor of influenza as it has been proven that stress weakens
the immune system, leaving an individual susceptible to illnesses, such as influenza and the common
cold: Compared to people who are not under chronic stress, stressed individuals typically have
reduced responses to vaccines and more infections with viruses. In the case of flu, research studies
showed that chronic stress caused immune responses and increased rates of influenza, and also
prolonged influenza. (Study appendix 14). Alongside this discovery there has been a recent (2012)
increase in the percentage of people suffering with stress in the UK. In an article the NHS found that
admissions for stress had risen by 7% in just 12 months. If the number of those being diagnosed with
17

stress continues to rise then it could be possible that the distribution rate of influenza may also
increase.
(Source:http://www.nhs.uk/news/2012/09September/Pages/rise-in-hospital-admissions-for-
stress.aspx)
Factors affecting the distribution of Heart Disease
The chances of an individual developing heart disease can be increased by several different factors,
the main one being genetics, as a study conducted by Professor Kristina Sundquist concluded: the
results of our studies suggest that the risk of coronary heart disease is not transferred via an
unhealthy lifestyle in the family, but rather via the genes. But this does not mean that ones lifestyle
is not a factor in ones own risk of developing coronary heart disease.-
(http://www.medicalnewstoday.com/articles/233458.php) Other research reaffirms this as it
discovered, children born to parents with CHD are 40 to 60 per cent more likely to develop the
condition themselves-( http://www.telegraph.co.uk/health/healthnews/8725739/Heart-disease-
risk-inherited-through-genes-not-behaviour.html).
There is currently no test available to discover why heart disease can be heredity as it probably
results from a number of different genetic changes that individually have a subtle effect but work
collectively in a complex manner to cause disease.
(http://circ.ahajournals.org/content/128/1/e4.extract) Nevertheless, there are other methods to
learn whether an individual may have an increased risk of heart disease. The American Heart
Association recommends a pedigree (appendix 15) this is a family tree and shows who in the family
had or has heart disease or any other heart problems. This can help to calculate a percentage
chance, depending on how closely related the family members are.
Discovering this is an important way of how society deals with the disease because finding out if
heart disease runs in a persons family, raises awareness. As a result, individuals can not only
attempt to reduce their chances of the disease through a healthy lifestyle, but they can watch out
for signs and symptoms that otherwise may have been overlooked.
Smoking is another factor that can raise an individuals chances of developing heart disease and this
is because it damages the lining of the arteries which generally leads to a build-up of atheroma
narrowing the arteries. The British Heart Foundation have found that not only do smokers have an
increased risk of developing heart disease, but also those who are regularly subjected to second
hand smoke: research shows that exposure to second hand tobacco smoke is a cause of heart
disease in non-smokers (http://www.bhf.org.uk/heart-health/prevention/smoking.aspx). This
suggests that families that consist of a smoker have a greater chance of being diagnosed with the
disease, in comparison to non-smoking families. Not only are smokers more likely to get heart
disease, they also have a greater chance of dying from it, so says a 50 year report by the British
Heart Foundation (appendix 16): CHD mortality was around 60% higher in smokers (and 80% higher
in heavy smokers) compared to non-smokers. Around 20% of the adult population are smokers, so
therefore 1/5 of the population have an increased risk of heart disease, suggesting that smoking
increases the distribution of the disease.
18

Diet can massively impact a persons health and wellbeing, as both eating in excess and malnutrition
can cause health defects heart disease being one of them, according to the British Heart Foundation.
There are a variety of different diet problems that can leave an individual susceptible to heart
disease. For example, there is a strong correlation between abnormal lipid levels (A lipid is a fatty
substance that stores energy and plays a structural role in cell membranes.-
http://www.sharecare.com/health/nutrition-diet/what-does-lipid-mean) and heart disease.
Saturated fats can lead to high cholesterol and atherosclerosis, which can cause heart disease.
However, unsaturated fats that are found in foods, such as fish and nuts can help maintain a healthy
cholesterol levels as they provide the body with omega-3 and omega-6, our bodies cannot make
these acids so we have to eat them to gain their benefits. Despite this the World Heart Federation
states: if your total fat intake is greater than 37% of your total calories, then even if that fat is
unsaturated you increase your risk of cardiovascular disease. And saturated fats should only be
accounted for 10% of energy.
(Source: http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-
factors/diet/)
The British Heart Foundation suggest that consumption of foods
high in fat, is no longer one of the contributing factors of heart
disease, as in their coronary heart statistics report (appendix 16)
they comment on the types of foods being purchased in Britain:
Since the 1940s purchase of lard has dramatically reduced whilst
the amount of butter purchased has also droppedsimilarly, the
purchase of whole milk has gradually been replaced with skimmed milks, reducing total fat and
saturated fat content of the diet. However, it does not seem likely that this is the case as obesity
levels are raising and the main cause of obesity is the consumption of fatty foods. The government
provides evidence for this as they have found that the number of takeaways a family consumes has
increased from 161 in 2009 to 179 in 2012 (see table) and on average there is 23.6g of saturated fat
in the Indian meal- (http://news.bbc.co.uk/1/hi/health/7471862.stm) which exceeds the
recommended amount. If the amount of saturated fat being purchased or consumed is not
decreasing then more people are at risk of heart disease, especially those consuming large quantities
of takeaways.
A high level of fat is not the only aspect of an individuals diet that can lead to heart disease. High
levels of sodium (salt) can cause an increase in blood pressure a major risk factor for cardiovascular
disease. Reducing the amount of sodium consumed by 1g universally would reduce the number of
deaths caused by heart disease by 16%. There are also a number of foods recommended by the
World Heart Federation that can help to reduce the chances of developing heart disease:
Fruit and vegetables-contain components that can help to protect the heart from heart
disease. The World Heart Federation discovered Low fruit and vegetable intake accounts
for about 20% of cardiovascular disease worldwide
Wholegrain cereals-only whole grains which contain folic acid, vitamin B and fibre can act as
protectors from heart disease.
Fish-research has found that eating fish can reduce death from cardiovascular diseases.
19

Nuts- Eating nuts regularly is associated with decreased risk of coronary heart disease.
Soy- soy can have positive effect on lipid levels, helping to reduce cholesterol levels.
Alcohol-drinking alcohol in moderation has been proven to protect the heart.
Attempting to reduce the risk of heart disease through diet could financial problems for some
because healthy nutritional foods are expensive and in some areas hard to come by and therefore
travel costs become another contributing factor. So, it can be suggested that lower class families are
more exposed to heart disease as they cannot afford to eat the foods recommended by health
professionals.
(Source: http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-
factors/diet/)
People who are physically active are at lower risk of CHD as exercise can help to lower blood
pressure levels, strengthen the heart and cardiovascular system, improve circulation, blood flow,
lower blood lipid levels and prevent blood clots. Aerobic exercise is the best type to improve the
functioning of the heart; the American Heart association recommends that an individual should
participate in some physical activity each day in order to gain the full benefits. However, any
amount of exercise is beneficial to your health. In contrast, the WHO has found that more than
60% of the global population is not sufficiently active-
http://www.nhs.uk/news/2012/09September/Pages/rise-in-hospital-admissions-for-stress.aspx, this
could be because of recent technological advancements, leading to limited opportunities for physical
activity. For example, a large number of people choose to drive short distances instead of walking.
Even using lifts or escalators rather the stairs can lead to bad habits being formed putting people at
risk of heart disease.
The Similarities and Differences of Influenza and Heart Disease
The main difference between these two diseases that influenza is contagious as it is a communicable
disease. Whereas, heart disease is non-communicable and therefore cannot be spread, the WHO
describes non-communicable diseases, particularly cardiovascular diseases to be chronic diseases
they are of long duration and generally slow progression. -
(http://www.who.int/mediacentre/factsheets/fs355/en/) This is the opposite of influenza as it only
lasts a number of weeks.
For both heart disease and influenza there are preventatives helping to lower the chances of
individual developing the illness, but this is where they differ. If someone wants to protect
themselves from influenza there is an annual vaccination available that should completely eliminate
the risk. However, for heart disease there is currently no vaccine or medication to prevent the
disease. The risk has to be controlled through lifestyle choices, the NHS recommends:
Eat a healthy balanced diet
Be more physically active
Keep to a healthy weight
Give up smoking,
Reduce alcohol consumption
Keep blood pressure levels under control.
20

Lifestyle factors can also contribute to preventing influenza, as eating health promoting foods can
improve the functioning of the immune system. Although, there are foods that can leave the body
more susceptible to influenza, like saturated fats can increase the risk of heart disease. These foods
are called containments and the website the worlds healthiest foods
(http://www.whfoods.com/genpage.php?tname=george&dbid=128) recommends that reducing
your intake of food contaminants can be helpful in supporting your health during the cold and flu
season, as well as throughout the year. Some of the foods recommended are similar to those
recommend to reduce the risk of heart disease. For example, foods high in omega-3 can reduce
cholesterol levels and are needed to produce our immune system regulators (called
prostaglandins) which helps to prevent influenza and other similar illnesses. The symptoms of heart
disease tend to have a greater degree of severity, in comparison to influenza. For example, a heart
attack can be a symptom of heart disease, which requires hospitalisation and can lead to death.
Despite this some of the less life threatening symptoms of heart disease are similar to those of
influenza and these are: sickness, breathlessness, sweating and tiredness. But, all other symptoms
relating to each disease are completely dissimilar.
Influenza can normally be self-diagnosed and if not a doctor would be able to diagnose it fairly
quickly, the individual I interviewed (appendix 2) with heart disease had also had influenza
beforehand and he said that he was able to diagnose himself and was easy to tell he had the illness.
On the other hand, Diagnosing heart disease can be time consuming as a number of tests have to be
carried out to confirm whether it is heart disease. This can be traumatic and painful for some
individuals.

Both diseases mainly attack completely different areas of the
body; influenza generally attacks an individuals respiratory
system but does also affect other areas of the body (see
image left). Whereas, heart disease tends to affect the
cardiovascular system, mainly the coronary arteries (see
image right).
One of the main distribution factors of heart disease is it is genetic meaning
people are born with an increased. There is little evidence to suggest that influenza can be passed on
through a persons genes. However, they do share other factors of distribution, for example stress
has been has been found to increase the chances of heart disease, as well as influenza because it
exposes your body to unhealthy, persistently elevated levels of stress hormones like adrenaline and
cortisol (http://www.webmd.com/heart-disease/stress-heart-attack-risk)and can increase blood
and cholesterol levels, indicating that the increasing number of people with stress could also be
exposed to heart disease.
Exercise is a factor that can help to reduce the risk of heart disease and has been linked with
reducing the chances of influenza through improving immunity: Research is uncovering a link
between moderate, regular exercise and a strong immune systemThere are some things that seem
to protect us from catching colds and the flu. One of those things appears to be moderate,
consistent exercise.- ( http://sportsmedicine.about.com/od/injuryprevention/a/Ex_Immunity.htm)
21

This research suggests that physical inactivity could lead to a person being more susceptible to
influenza as well as heart disease.
Heart disease can be life threatening and is responsible for almost 74,000 deaths in the UK each
year, an average of 200 people each day.
(http://www.bhf.org.uk/heart%20health/facts%20and%20statistics.aspx)Influenza can also be life
threatening for those in high risk groups, according to a BBC news clip (appendix 13) which said that
at risk groups are 11% more likely to die and suffer from complications. However, normally
influenza only lasts a matter of weeks and then an individual can resume life as normal. This is not
the case for a person with heart disease once they have been diagnosed it never really goes away,
but it can be controlled via lifestyle changes.
To conclude, heart disease and influenza entirely are different illnesses only sharing a few variables.
However, it is possible to have them both at the same time, having influenza normally has low risk
but to an individual with heart disease it can cause severe complications. This is because having
heart disease* can make it harder for the body to fight influenza, heart attacks a common symptom
of heart disease are more common in an individual after having influenza or other similar illnesses.
Research has also discovered that death from the flu is more common among people with heart
disease than among people with any other chronic illness.
(Source: http://www.webmd.com/cold-and-flu/flu-guide/heart-disease-and-flu)















22

Diseases Similar to Influenza
The Common Cold
A cold is a mild viral infection of the nose, throat, sinuses and upper
airways. It can cause a blocked nose followed by a runny nose, sneezing,
a sore throat and a cough.- (http://www.nhs.uk/Conditions/Cold-
common/Pages/Introduction.aspx) Colds generally last longer in younger
children (2 weeks), whereas in adults and older children a cold usually
lasts around a week.
Since influenza and the common cold are both viral infections, it seems
likely that there are some similarities between the illnesses. Despite this,
there are only limited symptoms that are present in both the common
cold and influenza. These are: fever, chest discomfort and aches (see
table for comparisons or appendix 17). Generally, there are more symptoms present in an individual
with influenza because it impacts on the entire body, whereas a common cold is confined to the
nose and head. The reason for this is probably because they typically have different causative
organisms. The cause of influenza is the influenza virus, and the main cause of a cold is rhinoviruses,
but sometimes it can also be caused by the influenza virus (see chart 2) and this is why they share
similar symptoms.
Both the common cold and influenza do not have a specific treatment as
the human body has the ability to fight the illnesses naturally. However, if
either disease does not improve within a week, or an individual has
breathing problems and chest pain it is recommended to visit a doctor.
There are natural treatments for influenza and the common cold and again
they tend to be similar. The NHS recommends for either that an individual
should get plenty of rest, keep warm, drink plenty of fluids and eat
healthily. If an individual experiences any pain or discomfort the NHS also
suggests taking paracetomal or ibuprofen.
The NHS provides an explanation of how they can be passed on: if you sneeze or cough tiny
droplets or fluid containing the cold virus are launched into the air and can be breathed by others -
(http://www.nhs.uk/Conditions/Cold-common/Pages/Treatment.aspx) and the flu virus is
contained in the millions of tiny droplets that come out of the nose and mouth when someone who
is infected coughs of sneezes. - (http://www.nhs.uk/Conditions/Flu/Pages/Treatment.aspx) As the
diseases are distributed in the same way organisations tends to recommend the same or similar
preventatives. The company WebMD (http://www.webmd.com/cold-and-flu/11-tips-prevent-cold-
flu) provide eight tips that can help to prevent cold and influenza:
Regularly wash hands
Dont cover sneezes or coughs with hands
Dont touch your face
Dont smoke
Cut alcohol consumption
Relaxation
23

Swine Flu
Swine flu is a relatively new strain of influenza (flu) that was responsible for a flu pandemic during
2009-2010.- (http://www.nhs.uk/Conditions/Pandemic-flu/Pages/introduction.aspx) There is barely
any difference between swine flu and influenza, the only way to fully confirm which through a
laboratory test. However, few tests have been done as most swine flu cases thus far look like a bout
with seasonal flu. Swine flu could also be diagnosed by looking at an individuals symptoms, even
though both illnesses tend to display the same symptoms there are one or two differences, for
instance, the effects of swine flu are often mild in comparison to regular influenza. Despite this, a
video clip containing an interview with Doctor John Sinnott (appendix 18) found mortality rates for
swine flu and particularly higher than regular influenza, as a person with swine flu has a 1 in 200
chance of death compared to 1 in 1000 for normal influenza. The two main differences in symptoms
are vomiting and diarrhoea; even though they can occur in a person with influenza they are not
usually present, so differentiation of symptoms could be used as a partial diagnosis.
(Source: http://health.howstuffworks.com/diseases-conditions/cold-flu/swine-flu-or-seasonal-
flu1.htm)
The prevention of swine flu is identical to regular flu. The vaccination that illuminates a persons
chances of influenza also prevents against swine flu: This winter, the swine flu virus has been
included in this year's seasonal flu jab. It means that the vaccine will protect you from swine flu, as
well as other strains. (http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Prevention.aspx) this
indicates that both illnesses are very similar. Overall, it could be suggested that a large percentage of
people do not realise whether they have swine flu or influenza because it is sometimes impossible to
differentiate the signs and symptoms.
Chickenpox
Chickenpox is a mild and common childhood illness that most children catch at some point.It causes
a rash of red, itchy spots that turn into fluid-filled blisters. They then crust over to form scabs, which
eventually drop off.- (http://www.nhs.uk/conditions/Chickenpox/Pages/Introduction.aspx)
Chickenpox may not appear to be like influenza at all, but there are some similarities. For example,
they are spread in the same way: Droplets of water that are expelled from the nose and mouth of
the infected person through coughs and sneezes are inhaled by those around them. The
contaminated droplets float in the air. Like, influenza chickenpox does not usually require a test to
diagnosis it because of its distinctive symptoms, even if it is thought to be influenza it would soon
become apparent that it is chickenpox. The symptoms before the fluid-filled blisters appear are also
similar to those of influenza:
A general feeling of being unwell (malaise)
A fever (usually worse in adults than children)
Aching muscles
Loss of appetite
Sometimes there may be a feeling of nausea.
24

However, the diseases can be differentiated once the rash occurs, as this is not a symptom of
influenza.
(Source: http://www.medicalnewstoday.com/articles/239450.php)
Diseases Similar to Heart Disease
Peripheral arterial disease (PAD)
Peripheral arterial disease occurs when there is a blockage in the arteries to your limbs (usually
your legs). The similarity between this disease and heart disease is that they are both caused by
blockages in the arteries; they can be differentiated because heart disease affects the coronary
arteries, whereas PAD impacts the walls of the leg arteries. They also do not share any of the same
symptoms due to affecting different arteries in different areas of the body. PAD causes: hair loss on
legs and feet, numbness or weakness in legs and changing skin colour in legs. However, both
diseases do share another common similarity which is that sometimes an individual with either
disease does not experience any symptoms at all.
Like heart disease an individuals chances of developing PAD increases depending on their lifestyle
choices. For example, smoking, physical inactivity and an unhealthy diet can all be contributing
factors to each disease. The NHS has also discovered that an individual with PAD has a greater
chance of developing heart disease, if they make bad lifestyle choices.
(Source: http://www.nhs.uk/conditions/cardiovascular-disease/Pages/Introduction.aspx)
Although they both affect arteries the diagnosis is different. For example, in cases of heart disease
doctors will ask questions about lifestyle and then carry out internal examinations. But for PAD
doctors have to perform physical examinations, such as an ankle brachial pressure index.
Nevertheless, for all heart related diagnoses the doctor has to do the following:
Ask about your medical history and your family history
Ask questions about your lifestyle, such as whether you smoke
Listen to your heart and lungs through a stethoscope
Take your blood pressure and pulse. - (http://www.bhf.org.uk/heart-health/tests/physical-
assessment.aspx)
This is because it helps to determine what type of cardiovascular disease (if any) an individual has.
Aortic disease/Aortic Aneurysm
An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall. As blood
passes through the weakened blood vessel, the blood pressure causes it to bulge outwards like a
balloon. (http://www.nhs.uk/conditions/Repairofabdominalaneurysm/Pages/Introduction.aspx)
An aortic aneurysm has similar causes and preventions to heart disease, but this is only a prediction
because the true cause of aneurysm is unclear. Risk factors that are suspected to increase an
individuals chances are: smoking, and high blood pressure. Therefore, the same preventatives for
heart disease are recommended:
25

Quit or do not start smoking.
Avoid foods high in saturated fat.
Eating small amounts of un-saturated fat will increase levels of good cholesterol.
Regular physical activity.
Reduced alcohol intake.
Avoid foods high in sodium.
Like, heart disease an aneurysm is usually diagnosed during routine examination by a GP. However,
an aneurysm can be detected by a doctor physically touching the patient to see if they can notice a
distinctive pulsing sensation. Whereas, when initially diagnosing heart disease doctors tend to ask
questions and carry out blood tests, rather than a physical examination. For heart disease there are
multiple diagnostic tests that can be carried out, but for an aneurysm the only one used is an ultra
sound scan, determine the size of the aneurysm. For heart disease it is used in a similar way: The
test can identify the structure, thickness and movement of each heart valve and can be used to
create a detailed picture of the heart. it is an important tool for a diagnosis for both diseases as it
can define the severity and course of treatment necessary.
(Source: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Diagnosis.aspx)
Heart Attack
A heart attack is a serious medical emergency in which the supply of blood to the heart is suddenly
blocked, usually by a blood clot. Lack of blood to the heart can seriously damage the heart muscle.
(http://www.nhs.uk/conditions/Heart-attack/Pages/Introduction.aspx)
It is to be expected that a heart attack and heart disease share similarities because a heart attack is a
symptom of heart disease. Most of the signs of a heart attack have some relation to those of heart
disease: shortness of breath, palpitations and some cases no symptoms. Differing symptoms are:
feeling sick, being sick, sense of anxiety, coughing wheezing, chest pain, pain in other areas of the
body and feeling light headed.
There are a range of diagnostic methods used for both conditions because they are both heart
related. For example, an ECG records the rhythm and electrical activity of your heart. (NHS)
Because a heart attack is a serious life threatening condition an ECG is carried out within 10 minutes
of an individual being admitted to hospital, it determines whether or not an individual had a heart
attack and what type. An ECG is not as effective when diagnosing heart disease because an
abnormal reading does not always mean there is anything wrong. Similarly, a normal reading does
not always rule out heart problems. (NHS)
Factors affecting the outcome of heart disease
There is no cure for heart disease, but it can be controlled through lifestyle changes, medication and
sometimes procedures. However, there are factors that can impact the outcome of the treatment.
Time, Medication, Procedures and Transplantation
Heart disease is a degenerative condition and like most communicable diseases it is of long duration
and generally slow progression- (WHO http://www.who.int/mediacentre/factsheets/fs355/en/).
26

Meaning time is a significant factor in the outcome of treating heart disease. Even though there is no
specific cure for heart disease it can be treated and managed, depending on when it is diagnosed,
an article (appendix 9) written by Professor Avijit Lahiri, Clinical Cardiologist and Dr Anand
Jeevarethinam, Research Fellow in Cardiology reaffirms the significance of time by expressing the
importance of an early diagnosis: Early detection of Coronary Heart Disease is crucial in
preventing death from the condition. - (http://www.totalhealth.co.uk/clinical-experts/professor-
avijit-lahiri/early-diagnosis-coronary-artery-disease)
The NHS have also discovered that time is an important factor in improving the outcome of heart
disease. For example, since 2000 there has been a reduction in the mortality rates of heart disease
and the main reasons for this are, a quicker diagnosis of heart disease, access to diagnostic tests and
rapid access and choice of treatment centre for specialised cardiac care - (NHS
http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Treatment.aspx) an individual I
interviewed (appendix) with heart disease confirms that the NHS do provide a quick diagnosis
because when I asked How long did it take to be diagnosed with heart disease? They responded:
About a week, they do not like to waste time as the quicker the diagnosis the better the outcome.
If heart disease is caught in its early stages treatment can improve the functioning of the heart. But if
caught too far on not much can be done to improve the heart, this is generally when the heart is
severely damaged and medicine is not effective - (NHS http://www.nhs.uk/Conditions/Coronary-
heart-disease/Pages/Treatment.aspx ) or the heart is failing.
There are medications, treatments and procedures that can improve the outcome of heart disease.
Doctors normally prescribe medication to either reduce blood pressure or widen the arteries, the
most common prescribed are:
Antiplatelet
Statins
Beta-blockers
Nitrates
ACE (angiotensin-converting enzyme) inhibitors
Angiotensin II receptor antagonists
Calcium channel blockers
Even though these medications are supposed to improve the outcome of the disease, they can cause
serious life-restricting side effects. For example, when taking ACE inhibitors doctors have to monitor
an individuals kidneys, as around one in ten people have decline in kidney function after taking the
drug. Therefore, it is possible that taking drugs to help improve a condition can be factors that can
severe impact on the outcome of treatment.
Surgery is a last resort when trying to improve the outcome of heart disease, the two procedures
that are most commonly used are:
Coronary angioplasty
Coronary artery bypass graft
27

As with every surgical procedure there are risks. The most serious complications with a coronary
angioplasty are: damage to the heart, heart attack, stroke or death. In most cases these are rare
but, there are factors that can increase the risk of complications and therefore the outcome of
treatment, such as an individuals age, the older you are, the higher the risk. Research has
uncovered that Even operations considered fairly routine in younger patients, like appendectomies,
become high-risk for nursing home residents. This suggests that treating heart disease in elderly
patients can be more problematic due to the higher risk of death.
(Sources: http://www.nhs.uk/Conditions/Coronar-heart-disease/Pages/Treatment.aspx
http://newoldage.blogs.nytimes.com/2012/01/25/avoiding-surgery-in-the-
elderly/?_php=true&_type=blogs&_r=0)
A small percentage of patients are able to have a heart transplant (when a diseased heart is
replaced by a healthy human heart from a donor The British Heart Foundation
http://www.bhf.org.uk/heart-health/treatment/heart-transplant.aspx). This cannot really be defined
as a treatment of heart disease, more of a last resort and it does not always provide desirable
results. For example, research collated by the National Heart, Lung and Blood Institute discovered
that The 10-year survival rate is about 56 percent.
Overall, this information suggests that time is one of the most important factors because if heart
disease is diagnosed early it can be managed and the condition of the heart can be improved, as
medications and surgical procedures can cause further complications and difficulties, especially in
elderly individuals.
Lifestyle Changes and Willpower
Living with heart disease can affect an individuals life massively, as it generally requires major
lifestyle changes, for some this can require a great amount of self-restraint, whereas others are able
to adapt without hesitation. It is important that all risk factors are addressed because even one risk
factor is dangerous, having multiple risk factors is especially serious, because risk factors tend to
gang up and worsen each others effects (appendix 19) this may lead to an ineffective outcome.
The person I interviewed (appendix 2) had to make several changes causing a certain degree of
stress and worry, I asked: What life style changes did you have to make after you were diagnosed
with heart disease? he responded: I had to give up smoking, eat healthier foods which are low in
cholesterol and try to do more physical activity. In addition, I also attempted to get my blood
pressure checked regularly. I then asked: Was it hard to make the changes? he replied: Yes,
smoking was the hardest as it relieved stress, so when I was feeling stress I could not do anything
about it. I also found it difficult to do more physical activity because it was hard to find the time. in
some cases medication also has to be added to changes and a factsheet called Your Guide to Living
Well with Heart Disease (appendix 20) recommends to take medication exactly as your doctor
advises this could prove difficult for some people, due to busy lifestyles.
It is to be expected that not everyone has the willpower to change their lifestyle, even if it can
improve life expectancy because smoking and consumption of foods high in saturated fat can act as
relievers of stress. Therefore, some may feel changing their lifestyle could do more harm than good,
which is obviously not the case. If an individual does not change their lifestyle as a form of treatment
28

for heart disease there are serious repercussions, such as increased severity of angina, shortness of
breath participating in almost any kind of physical activity and an increased risk of death.
If an individual makes positive changes to their lifestyle then the outcome of having heart disease
will generally be better than those who do not commit to change. The NHS reaffirms this by saying:
If you have been diagnosed with CHD, you can reduce your risk of further episodes by making
simple lifestyle changes. The organisation then provides an example of how lifestyle changes can
improve life expectancy stopping smoking after a heart attack will quickly reduce your risk of having
a heart attack in the future to near that of a non-smoker
(Source: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Treatment.aspx)
Factors affecting the outcome of influenza
As influenza is not a long-term illness, like heart disease the factors affecting the outcome are
somewhat different.
Old Age
A persons age can affect how their body responds to influenza. The older a person becomes, the
weaker their immune system, increasing their susceptibility to illnesses and infects, like influenza.
This is why the NHS and other organisations recommend that those aged 65 and over should get the
influenza vaccination. However, the company Medline Plus have found that because older people
have slower responding immune systems flu shots or other vaccines may not work as well or have
a long lasting protection. A study conducted in 2008 reaffirms this: A growing number of
immunologists and epidemiologists say the vaccine probably does not work very well for people over
70 (http://www.doctoryourself.com/flushot.html). Despite this research, within the UK older
people are still advice to become vaccinated, as catching the illness can lead to serious
complications. For example, an elderly person is likely to have influenza for a longer period of time,
as the immune system will take longer to fight it. The longer someone has the illness the higher the
chances of pneumonia. Additionally, treatments that are recommended to other are not as effective
(rest, keep warm and drink plenty) in reducing the outcome of the illness.
(Source: http://www.nlm.nih.gov/medlineplus/ency/article/004008.htm)
Environmental and Upbringing Factors
The main course of treatment for influenza is to rest, keep warm, drink plenty of water and eat well.
These could be difficult to maintain, depending on an individuals environment. For example, low
income may prevent a prevent someone from being able to heat their home adequately, therefore
they cannot keep warm, this could affect the outcome because it is likely to take longer for the body
to fight off influenza. Additionally, not being able to keep warm can create further problems, such as
respiratory illnesses: if house temperatures fall below 16 degrees, the risk of respiratory illness
increases. Influenza complications can lead to hospitalisation and even death.
(Source: http://www.sciencemediacentre.co.nz/2008/06/18/cold-houses-and-impact-on-health/)
Nose pollution is Environmental noise that is annoying, distracting, or physically harmful
(http://www.thefreedictionary.com/noise+pollution), it could be from noisy neighbours, living by a
busy road and/or having to share room (overcrowding). This type of pollution typically has an effect
29

on the amount of rest and sleep an individual gets. Lack of sleep can have a significant impact on an
individual with illness like influenza because when the body is recovering from an illness it is not
unusual to want 10-15 hours of rest and sleep a day. When the body does not acquire enough sleep
the immune system can be disrupted, making the body less able to fight infection.
(Source: http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/lack-of-sleep-health-risks.aspx)
Education
How well society is educated on influenza can affect the outcome of
treatment. People become educated on influenza through health
promotion campaigns that warn about the harmful effects of the illness,
the importance of becoming immunised and practising good hygiene. For
example, the catch, bin it, kill it campaign (image 1) encourages people to
carry tissues and use them to catch coughs or sneezes, then to bin the
tissues and to kill the germs by washing their hands. Despite campaigns
educating society on how to prevent influenza, research conducted by the
NHS shows that Britain is the worst country when it comes to hygiene
(image 2, 3 and 4). Suggesting that more needs to be done to help educate
the public, shock tactics could be one example if people are shown the detrimental effects that
influenza can sometimes cause (death) people would probably think about hygiene and becoming
vaccinated in order to
improve their outcome.




(Source: http://www.nhs.uk/news/2012/10October/Pages/Dirty-Brits-are-
worlds-worst-flu-spreaders.aspx)



Support Available for Heart Disease and Influenza
Age UK
Older people are more likely to suffer with heart disease and will generally need more support from
services and agencies. This is because support from family and friends is not as accessible, due them
being older and not as capable. Family members may also be too busy with their own lives (work and
family) to have to time support an elderly individual suffering from heart disease. The AS Health and
Social Care book reaffirms this presumption by saying continuity and adaptation are the themes of
30

relationships in later life. Friendships remain important for companionship, but there is often a
reduction in social support and social networks as old friends die and are not replaced by new ones.
Age UK, an organisation that attempts to improve later life has devised a leaflet (appendix 20)
providing advice to those living with heart disease. It includes information on Disability Living
Allowance which can be claimed by those under the age of 65 and the Attendance Allowance which
can be accessed by those aged 65 and over.
Through providing this information Age UK are enabling individuals to access their rights, so they do
not have to suffer with difficulty managing personal care or day-to-day due to their heart
condition. The organisation encourages individuals to find out more about these and other benefits
you may be entitled to claim by calling Age UK. By reading this, individuals will feel supported and
that they are able to rely on Age UK with any issues or queries they may have.
Despite this, Age UK is the country's largest charity dedicated
to helping everyone make the most of later life and therefore it
is expected that they would have a vast amount of information
and support for heart disease. This is not the case, when
searching the website only 89 relevant links were presented
(image 1). When searching other non-communicable diseases, such as dementia there were
considerably more results (image 2). However, to overcome this they do recommend other charities
in which individuals can seek advice: The British Heart Foundation is a registered UK charity that
provides advice to people with heart conditions, including people whove had a heart attack. It has a
comprehensive website and range of publications that cover many heart conditions, healthy lifestyle
information and questions commonly asked when people are diagnosed with heart disease
(appendix 20)
Age UK also have similar support available to try
and prevent the spread of influenza. For
example, in a booklet they published called
Winter Wrapped Up (appendix 21) they
recommend that anyone over the age of 65
should have the seasonal flu vaccination because flu is not only unpleasant, it can also develop into
pneumonia, which can be serious. It also states who is actually entitled to the vaccination (image).
This is important because according to a news report (transcript appendix 13) just over 49% of over
65 year olds were vaccinated in 2012, in comparison to 55% in 2011. This data suggests that the
elderly are not being made aware of the support they are entitled to. Hopefully through the Age UK
supplying this information a higher percentage of older people will excess the support that is
provided to them.
The booklet provides other factors that can prevent influenza, such as:
Giving up smoking
Participating in physical activity
Eating well.
31

Case studies are additionally included, enabling people to relate (image). Through doing so, Age UK
is providing strong evidence to those suffering with influenza or other problems they can be relied
upon to give support and assistance. Overall, if Age UK did not provide this publication some may
not be aware of the serious complications that influenza can cause, this could lead to increased
mortality rates.
Age UK has a local support group that aims to help all older people in our local area to make the
most of life! We do this by providing a range of advice, care and practical services. Anyone is able to
access this; meaning those suffering with heart disease and influenza are able to use the support
when needed. For example, if an individual is struggling to live independently because the symptoms
of either influenza or heart disease Age UK can help: We enable older people to live independently
and exercise choice.
As I discussed earlier Age UK did not provide as much
support for heart disease compared to other non-
communicable diseases, but for influenza the support
is even less. For example, if an individual wanted to look on the website for help with the illness
there is only four links (image), significantly less than heart disease. This could be because coronary
heart disease (CHD) is the UK's biggest killer, causing around 82,000 deaths each year. About one in
five men and one in eight women die from the disease. http://www.nhs.uk/Conditions/Coronary-
) whereas, influenza is only dangerous to the elderly, heart-disease/Pages/Introduction.aspx
especially those who live in residential homes where there is more risk of contracting the virus
through contact with others. People with underlying health problems
(http://www.netdoctor.co.uk/diseases/facts/influenza.htm)

The British Heart Foundation
Another form of support for heart disease is the British Heart
Foundation which is one of the UKs top charities. They conduct
pioneering research to make a difference to peoples lives and
help millions of people every year withup to date information
about heart disease so the UK public are better informed. One of
the ways they do this is through their website (image 1) which
provides a vast array of information for heart disease suffers and
others to access. For example, it includes videos and personal
stories enabling people to provide support for others online, so
they do not feel that there are that they are alone (image 2). This
can be useful for those who are unable to join a support group
within their local community due to prior commitments, as they
are still able to feel valued and supported.
It is important that the British Heart Foundation creates information and support networks for those
with influenza because if you have a heart condition, you have a greater risk of becoming more
seriously ill from the flu than the general population (appendix 23). Like Age UK they state who is
entitled to be vaccinated against the viruses on their factsheet (appendix 23). They also give advice
32

at their help groups as I discovered from the individual I interview (appendix 2). I asked: Did you get
any support? he responded: Not from the doctors but I attend a help group run by the British
Heart Foundation and the recommended that next time I should become vaccinated against it, it is
the safest option. This evidence proposes they understand that people living with heart conditions
also develop illnesses, such as influenza and try support them best they can. However, they do not
provide anything further on influenza but this to be expected because as a charity they focus on
heart conditions.
The British Heart Foundation runs local organisations (image 3
and 4) that those with heart disease are welcome to attend.
One of the organisations provides events that help reduce the
risk of heart disease. For example, walking groups, social
activity and interaction, these kinds of events can help
individuals to adjust to life with heart disease. For instance, if
there werent group like this within the local community
individuals may not be as focused or motivated to changing
their lifestyle.
The other organisation is a monthly support group, with a
friendly and welcoming atmosphere where those suffering
with heart disease are able to communicate their problems
and interact with others in similar circumstances. Again, If this
kind of support was not locally accessible people may feel
alone and unable to cope with their illnesses.
(Source: http://www.bhf.org.uk/about-us/who-we-are.aspx)
Unlike heart disease influenza does not have any local help groups because it only It lasts from
three to five days and can be followed by fatigue for two or three weeks.
(http://www.netdoctor.co.uk/diseases/facts/influenza.htm) and it is highly contagious, so
typically dealt with on national or international level. An example of an organisation that deals with
influenza is the WHO. They produce generic statistical data on influenza, rather than personal
advice. This is because there main focus is to prevent influenza rather than providing individual
support. They do this through the Global Influenza Programme it provides Member States with
strategic guidance, technical support and coordination of activities essential to make their health
systems better prepared against seasonal, zoonotic and pandemic influenza threats to populations
and individuals. (http://www.who.int/influenza/en/)
Despite this assumption, heart disease is also dealt with on an international level, the
WHO provide help and statistics on it. Heart disease even belongs to its own
international organisation, the World Heart Federation which holds a range of events
(image) to help support individuals worldwide and raise awareness.
(Source: http://www.world-heart-federation.org/congress-and-events/calendar/)
Treat Yourself Better
33

Influenza is not categorised as a deadly disease, as there are preventatives and treatments available
to help keep it at bay and this is probably why there is not
as many organisations and support groups around to help
suffers. However, there is a campaign called Treat Yourself
Better (http://www.treatyourselfbetter.co.uk/) which has a
website (image 1) dedicated to providing advice on treating
cold and influenza symptoms. On the website they include a
section which provides expert advice (image 2) on what to
do if you have influenza. People are more likely to listen to
recommendations from doctor or GP has they have expert
knowledge and understanding; this suggests that people
can reply upon on the health promotion, Treat Yourself
Better.
This campaign aims to provide support on a national level,
like campaigns created by the British Heart Foundation or
other well-known charities. In a video for Self Care Forum
(transcript appendix 24), Rob Barracott speaks on behalf of
Pharmacy Voice (creators of Treat Your Self Better) and shares the aims, which are:
Raise awareness that antibiotics are not always the right treatment for winter and flu
symptoms.
Aims to inform the public better of the duration of the symptoms they could suffer with
during the winter months.
Its also about reminding people that they can go to their pharmacy before they go along to
their GP, as pharmacists have five years of training.
The campaign is backed by the Department of Health: the campaign is supported by a wide range of
organisations including the Department of Health, Public Health England (through European Antibiotic
Awareness Day), NICE, the community pharmacy trade associations and over-the-counter medicines
manufacturers. (http://www.selfcareforum.org/2013/11/19/earl-howe-gives-his-support-to-the-
) treat-yourself-better-without-antibiotics-campaign/
Also, RT Hon Earl How Parliamentary Under Secretary of State for Quality spoke about the
promotion: I whole heartedly support its aims I would encourage the NHS and indeed local
authorities who support the campaign very actively to get grips with it and spread the word
(appendix 24). This kind of support shows that influenza is taken seriously and supported by the
government and authority figures.
The Department of Health is also trying to improve support for
individuals with heart disease. For instance, in a recent report they
expressed several areas that needed changes (image): Consistent,
accurate and clear information should be readily available for
members of the public about how they can play their part in
preventing and managing CHD. Health professionals and others should
be actively involved in educating members of the public, and should be
34

supported in communicating information about risks and how to reduce them.
(Source:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198931/National_
Service_Framework_for_Coronary_Heart_Disease.pdf)
This data presents evidence that the Department of Health is actively promoting support and the
improvement of it for both influenza and heart disease. It is important that they have backed the
campaign, Treat Yourself Better because there is not as wide variety of support around of influenza
sufferers. People are likely to listen and access it if they are aware it is supported by credible
sources. Because heart disease already has a selection of charities supporting (the British Heart
Foundation, World Heart Federation etc.) its cause it could be suggested that it does not need
further backing from the government, like influenza. However, it is the UKs biggest killer
(http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx) so it needs the
extra support to ensure that those living with it have as much help as possible.
Local Services
Individuals can visit a doctors surgery with any health issues they may have, as they are equip to deal
with a variety of problems, therefore those with heart disease or influenza can visit there local GP.
For instance, they can carry out diagnostic tests for heart disease your doctor will ask about your
medical and family history, check your blood pressure, and do a blood test to assess your cholesterol
level (NHS). This is important because people may be unable to travel long distances to have their
symptoms checked, therefore doctors surgeries are a vital aspect of diagnosing and treating heart
disease.
Local services are also a huge support for those with influenza, as there are not many local
organisations that help those with influenza. The NHS only recommends that high risk groups should
visit their GP if they have flu like symptoms: You should see a doctor if you have flu-like symptoms
and you:
are 65 or over
are pregnant
have a long-term medical condition such as diabetes, heart disease, lung disease,
kidney disease or a neurological disease
have a weakened immune system
This is because flu can be more serious for you and your doctor may want to prescribe antiviral
medication.
It could be suggested that service users with influenza are not treated with significance, in
comparison to those with heart disease. However, according to a nurse practitioner I interviewed
(appendix 22) the surgery she works this does not happen: Yes, we offer support to anyone is
worried concerned about the symptoms they are experiencing and we will try and help in any way
we can. We also offer support in the form of leaflets. This kind of support is vital because promotes
equality and people are then aware that they able to access their local services for any type of issue
they think they have. Leaflets are also an important source of non-directive support, as it gives
35

people the opportunity to help themselves. The NHS reaffirms this by saying information is an
important part of the patient journey. It is central to the overall quality of each patients experience
of the NHS ( ). This is not http://www.nhsidentity.nhs.uk/tools-and-resources/patient-information
just relevant for influenza local services also provide a variety of leaflets in relation to heart disease
(appendix 25).
Researchers conducted a study on the most common reasons to why individuals visit there GP, at
first they thought that heart disease would be main reason, since it is Britains biggest killer:
surprisingly, researchers found that the most common condition people visit their health care
providers for isn't heart disease . In fact, the reasons were,
1. Skin disorders, including cysts, acne and dermatitis.
2. Joint disorders, including osteoarthritis.
3. Back problems.
4. Cholesterol problems.
5. Upper respiratory conditions.
6. Anxiety, bipolar disorder and depression.
7. Chronic neurologic disorders.
8. High blood pressure.
9. Headaches and migraines.
10. Diabetes. (http://www.huffingtonpost.com/2013/01/17/common-reasons-see-a-doctor-skin-
) disease_n_2497424.html
Even though heart disease and influenza were not the most common reasons, it still delivers
evidence that local services provide support for a vast variety of illnesses, no matter their severity.
As a result it seems unlikely that the help and care individuals receive for influenza or heart disease
will differ in standard.
Overall, from what I have found there is significantly more support to help heart disease suffers
locally and nationally, in comparison to influenza. For instance, the British Heart Foundation
provides national and local support, the WHO, the World Heart Federation and local services.
Whereas, support for influenza is mainly on a national or international level, the only form of local
support I discovered was from local services. This is probably because heart disease is an ongoing
issue, with life restricting symptoms (angina, heart attacks and strokes) and needs drastic lifestyle
changes which individuals may find hard to adjust to.
According to a report published by Collaborating for Health (http://www.c3health.org/wp-
content/uploads/2009/09/NCDs-briefing-paper-20111010.pdf) most non-communicable diseases
are serious. The four major chronic non-communicable diseases cardiovascular disease, type 2
diabetes, cancers and chronic lung disease between them are the cause of an enormous burden of
disability and suffering. They account for over 60% of deaths in the world .
This statistical data proposes that similar large scale support is available for
other non-communicable diseases, such as cancer. There is such a vast
amount of support for cancer; The Guardian discovered that out of
Britains top 1000s charities Cancer Research UK was 4
th
(image).
36

Breast cancer because it is the most common type of cancer in the UK: In 2011, there were 11,684
female and 78 male deats from invasive breast cancer in the UK
(http://www.cancerresearchuk.org/cancer-info/cancerstats/types/breast/)
The main charity for breast cancer is Breast Cancer Care, it is similar to
the British Heart Foundation in the respect that they both provide
national and local support for suffers. The online support also has
similarities, for example the British Heart Foundation allows people to
share their stories and Breast Cancer Care enables users to ask
questions to a nurse via email (image), as they both understand that
not everyone will be able to access local support for whatever reason.
However, not all non-communicable diseases have such a variety of support networks. For instance,
asthma (asthma is a common long-term condition that can cause a cough, wheezing, and
breathlessness - ). This is probably http://www.nhs.uk/conditions/asthma/Pages/Introduction.aspx
because it is not a life threatening condition and therefore not a major public concern. It is
important to recognise that not every disease, illness or virus gets an equal amount of support. It is
dependent on publicity and need.
Other than Age UK influenza is not particularly supported by charitable organisations, like heart
disease and breast cancer are. It relies on publically funded services and sectors, such as the
Department of Health. This is because it does not just cause people to become ill, but it can also
cause disruption in society due to it being highly infectious.
A vast majority of communicable diseases are not life threatening, such as the common cold or
chicken pox. However, there are communicable diseases that are dissimilar to influenza that can be
life restricting and threatening. For example, HIV/AIDS has be defined by the WHO as one of the
most serious to affect humanity (http://www.who.int/oral_health/action/communicable/en/)
suggesting that there is wider support offered, compared to influenza. The National Aids Trust (NAT -
http://www.nat.org.uk/default.aspx ) is just one example of a national organisation trying to prevent
HIV/AIDs and improve the lives of those living with it. NAT is more
similar to the British Heart Foundation and Breast Cancer than it is to
support related to influenza. This is because it is a leading charity with a
range of sponsors (image) and provides different types of support.
Additionally, it has as an equal severity to cancer and heart disease, as
there is no cure and has life limiting factors. This proposes that HIV/AIDS
gains a greater degree of attention and acknowledgement than influenza.
Within the local community I have expereinced further advertisment for prevention of influenza
than HIV/AIDS. For example, there are posters and leaflets distrubuted reguarly in order to
encourage people get becodme vacciated and other ways to prevent influenza, there was not any
thing on HIV/AIDS. This proposes HIV/AIDS has larger amout of national support than influenza, but
lacks support from local services, unlike influnza. Whereas, heart disease has both local and national
support.
In some respects there are similarities between communicable and non-communicable diseases. For
example, the charities or promotions they are often assiocated with are shared. The British Heart
37

Foundation and the Word Heart Federation are not entierly dedicated to supporting those with
heart disease, there are other conditions that can affect the heart (brugada syndrome and heart
valve disease). The same goes for the Treat Yourself Better campagin, it is also concered with giving
support on the common cold, as well as influenza. It would be pointless having charities for every
single illness in existence because Institutions, such as the NHS and local services can deal with a
variety of diseases simultaneously.
Work Related Issues
Both communicable and non-communicable diseases can result in work related problems. As
influenza is a communicable disease a person contaminated can pass it on to others. If an individual
with influenza went somewhere with a high percentage of uninfected people, such as school or a
workplace it could cause an epidemic episodes of disease which spread rapidly and affect large
numbers of people.- (AZ Health and Social Care)
An example of an epidemic is one that occurred after World War One (1918) which killed over
200,000 people due to lack of immunity and the primitive, crowded conditions made rapid spread
inevitable. At this time people were susceptible to illnesses like influenza because of weaker
immune systems, poor nutrition and a lack of knowledge. . It seems unlikely that an epidemic should
arise now, due to technological advancements and improved standards of living, but research
conducted by The Independent has discovered that there is no way of telling when one may occur: It could
happen next year or not for a decade. It could be mild or it could be more severe. There is no way of
knowing until it strikes.
Even though influenza rarely causes an epidemic, outbreaks of the illness are disruptive. For
example, could cause closures of companies and schools, increase in hospital admissions and may
cost companies and the government money. Nevertheless, sometimes closures can prevent further
spread of a disease, in 2009 researchers recommended to the government to close schools to curb
flu as they thought it would slow the spread of influenza and buy more time for a vaccine.
However, the government did not follow advice because from previous experience closures cause
further harm than good and can be extremely disruptive to society.
(Source: http://news.bbc.co.uk/1/hi/health/8160314.stm)
Influenza itself it not the only cause of work related issues, its preventatives can cause problems of
their own. For example, it has been found that in some circumstances the influenza vaccination has
to not been effective or an individual has experienced severe side effects. Despite this, the NHS says
the only side effects are mild fever and muscle aches. On the NHS Choices website individuals are
able to leave comments on their experiences of the influenza vaccine, I discovered multiple negative
comments, and two examples are:
Example one: I had the jab in early December and have been ill ever since. I have constant flu like
symptoms, my glands are swollen but the worst is the pain in my shoulder where i had the injection.
5 weeks after the jab andmy arm hurtsif I touch it.
Example two: I had the flu injection in October, within days I had tingling in both arms, hands and
feet, also a ringing in the ear....over the next number of weeks these symptoms got worst, I was
having very heavy night sweats and the most enormous tingling throughout my body, I would say
38

more than tingling as if my body was zigging, I have been seen by a neurologist and been diagnosed
with probably a neurological reaction to the injection.
(Source: http://www.nhs.uk/Conditions/vaccinations/Pages/flu-vaccine-side-effects.aspx)
These complaints could have negative affect on the number of people being vaccinated; therefore
increasing the percentage of influenza suffers each year. This could have a detrimental impact on
society as an increased number of people would be forced to take time of school or work, creating
disruption. The NHS has found a way to overcome the work related issue of people leaving negative
posts on their website by putting a disclaimer that says: The 17 comments posted are personal
views. Any information they give has not been checked and may not be accurate. However, this
may not prevent people from taking them literally, as personal opinions and experiences can be
easier to relate to, in comparison to statistical facts and data.
Non-communicable diseases can results in similar work related problems as communicable diseases,
but there is not the risk of the disease being spread. An individual with heart disease may sometimes
find it difficult to work or to complete daily tasks because stressful situations heighten symptoms,
such as angina. The British Heart Foundation (http://www.bhf.org.uk/heart-
health/prevention/stress.aspx) suggests that it is best for a person to avoid stressful situations at
home or work. This could mean that some people are unable to work. However, because heart
disease is considered to be a disability, according to the Disability Discrimination Act: A disability
can arise from a wide range of impairments which can be...cardiovascular diseases, including
thrombosis, stroke and heart disease. Suffers are entitled to respect within the workplace and the
provision of goods, facilities and services. Protection under the act also helps to prevent
discrimination within the workplace, for example if it was not considered to be disability employers
may be inclined to dismiss individuals with heart disease as they unable to work within a pressured
and stressful environment.
Another work related issue for heart disease is the cost and time of lifestyle changes. Healthy
nutritional food is expensive in comparison to those high in saturated fat. Therefore, someone on a
low income may find it difficult to make the change, which could result in an increased risk of a heart
attack, a stroke, heart failure or death. However, the individual I interviewed (appendix) said that
because he gave up smoking he was able to afford better quality foods. Since the majority of those
diagnosed with heart disease smoke, this is a way to overcome the barrier not being able to
purchase healthier foods. Even though physical activity does not have to cost anything, it is time
consuming and it can be hard to find the time, especially for individuals with in full time employment
and have a family. The way the individual I interview (appendix) overcame this issue was to walk to
and from work. If this is not possible walking instead of driving short distances would also be
beneficial.
The postcode lottery is another work related issue surrounding heart disease and other non-
communicable diseases. It is a situation in which someones access to health services or medical
treatment is determined by the area of the country in which they live.
(http://www.oxforddictionaries.com/definition/english/postcode-lottery) The Guardian has found
that the NHS spends more money on treating heart disease and cancer in some areas of the country
in comparison to others. For example, Middlesbrough spends 167 per head on circulatory diseases
such as heart disease, but Southwark, in south-east London, spends 76. Meaning that suffers in
39

Middlesbrough are likely to receive more efficient care, compared to Southwark, this is unfair
everyone who has heart disease should be entitled to the same quality of care and an equal chance
of successful treatment and prevention. But, has this is not the case and could be suggested that
individuals have a greater chance of survival depending on where they live.
(Source: http://www.theguardian.com/society/2008/sep/08/nhs.health)
























40

Evaluation of Preventative Strategies
To some extent both heart disease and influenza are preventable. Influenza more so than heart
disease, this is because genetic factors can play a part in developing heart disease, whereas genetics
have no effect on an individuals chances of catching influenza. However, both illnesses can be
influenced by environmental factors, such as income and upbringing. For instance, if a child
contracts influenza because their parents did take them to the doctors to become immunised they
cannot be blamed. The parents are either responsible because they ignored the recommendations
or the government as their promotion and support of influenza has been ineffective.
The most common preventative recommended for heart disease is lifestyle changes. A nurse
employed by the NHS reaffirms in this in a video clip (transcript appendix 26) she said at a cardiac
risk assessment a care practitioner would lay out the patients options, some of those options are
medication but many of them are lifestyle. She additionally said that patients do not have to take
any of the options recommended. This provides evidence that preventing and treating heart disease
is mostly down to the individual.
Amongst all organisations the lifestyle changes are very similar. For instance, those proposed by the
British Heart Foundation and the NHS are:
Eat healthily A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and
vegetables (five portions a day) and whole grain (NHS)
Be active physical activity can help to lower cholesterol and maintain a healthy blood
pressure level.
Get the right support this could be informal support (family and friends) or attending
support groups.
Give up smoking Smoking is a major risk factor for developing atherosclerosis (furring of
the arteries). (NHS) Therefore, giving up smoking will reduce the chances of heart disease.
Reduce alcohol consumption the NHS recommends avoiding binge drinking. If an individual
if going to drink they should only drink the recommended daily amount, for men is three to
four units a day and two to three units for women
Unlike, the British Heart Foundation the NHS actually explains and goes into detail about how to
make each change. This gives the public understanding of what to actually do, rather than just
knowing. It could be suggested that the NHS has better more effective resources because it is a
government funded organisation, whereas the British Heart Foundation relies upon donations.
Contrastingly, in the comments section of the NHS website users have expressed that they do not
think that the advice they are providing is correct.
Example one: Your advice is wrong. You have not mentioned that sugar and not fat is the main
culprit in relation to Heart disease Shameful, considering my taxes are probably contributing to
the maintenance of the site.
Example two: I find it discussing that our NHS is giving out such terrible advice for preventing heart
attacks. You mentioned the old saturated fat thing. Which we all know is based on a faulty study (the
Ancel Keys 7 countries study.) There has never been a conclusive study that had proved a solid link
between saturated fat and heart disease. However there are mountains of evidence that sugar does!
41

And you haven't mentioned that people should cut down on sugar intake once I would recommend
anyone reading this page to do some research on the effects of sugar on VLDL (bad cholesterol.)
These comments suggest that in fact providing detailed information causes confusion amongst
individuals, rather than act as a successful prevention strategy. However, just because some did not
find it effective does not mean everyone will. Additionally, it is important to remember they are only
guidelines. People do not have to change their lifestyle if they do not want to, as there is no one
continuously telling them to. For example, the heart disease sufferer I interviewed (appendix 2)
found it hard because of this reason.
This is not always why people struggle or cannot change their lifestyle; there are many factors that
have an influence. For instance, getting the right support can be difficult. Individuals with limited
social networks, such as the elderly may not have the support of family and friends because in later
adulthood there is often a reduction in social support as old friends die and are not replaced by
new ones (AS Health and Social Care book). If an individual does not feel supported by people
close to them it could have an effect on them implementing other preventatives. An article
published by the Health Promotion Board (http://www.hpb.gov.sg/HOPPortal/health-article/8200)
reaffirms this by saying human beings do no thrive alone. We need our family and friends as pillars
of support, especially in difficult times. Having a strong network of supportive family and friends
helps enhance our mental well-being. Meaning that people without a strong network of support
friends and family will be less motivated to change.
However, there are support groups created by services (British Heart Foundation) where people can
go to access support and learn how to change and improve their lifestyle. The heart disease sufferer
I interviewed (appendix 2) said he would not have been able to make the changes if it was not for
attending a support group. It could be suggested that support groups could act has a form of
prevention because if people are well educated on how to lower their risk of heart disease then they
are likely to follow the advice. The British Heart Foundation even has local groups that anyone can
attend: all those at risk of heart disease. This programme of events includes walking groups, social
activity and interaction with all the carers and families of our membership.
(https://www.bhf.org.uk/about-us/where-we-are/the-bhf-
map.aspx?m=advanced&q=&p=1&od=0&lctn=hx3%207et&rds=5&lng=-1.83399&lat=53.74157)
Nevertheless, people may not be able to attend support due to external factors (involuntary actions
of compulsion that cannot be controlled), such as low income and
transport issues. For example, those without a car may find it
difficult to attend because of being tied to the public transit
system or having to rely on someone else for a ride
(http://www.succeedsocially.com/lifestyle). However, this has
not seemed to have had a huge effect on the prevention of heart
disease, as mortality rates are still declining (image/ appendix
16).
To reduce heart disease the National Heart Lung and Blood
institute recommend in a hand-out they created (appendix 27) that people should do around 30
minutes of moderate activity on most, preferably all, days of the week to reduce their chances of
heart disease. They even provide a various examples of the best types of exercise (image/appendix
42

27). However, preventions like this do not seem to be successful because
the Coronary Heart Disease Statistics study (appendix
16) discovered that only 42% of men 31% of women
get the recommended daily amount of exercise (table).
I think in order for preventions like this to be successful
the public need to be physically told, as well services
creating publications. The heart disease suffer I interviewed (appendix 2)agrees
with this statement, he said: If I had actually been told at school about
developing diseases like heart diseases I may not be where I am now. Yes,
they tell you that smoking, eating saturated and not exercising are bad you,
but why is this? I think children should learn, in detail about chronic diseases.
A way this could be done is through shock tactics; this method has already
been used in relation to smoking (image) and been successful. Therefore, it
could be proposed that I could work in relation to heart disease.
The NHS also makes recommendations on how to prevent influenza:
Good hygiene
Get the influenza vaccination
Antiviral medications
As I discussed in Part B good hygiene is an important factor in preventing influenza and children
should be taught how to practice it because if they are taught at an early age then they are likely to
remember to actually do it. However, there is the issue of how many people practice good hygiene,
it is not mandatory therefore people are likely to forget. For instance, in Part C I discovered that only
53% of the British population frequently washed their hands, which is significantly lower than any
other country that took part in the study. This data proposes good hygiene cannot be relied upon as
an effective method of prevention. In my opinion, the only way to overcome this would be run
workshops in schools and local services to help educate people on how being hygienic can help to
prevent influenza. However, it is hard to change the it will not happen to me attitude, just because
people are aware of the risk does not mean they will change.
Influenza is not categorised as a serious illness and as a result there is not any voluntary
organisations to encourage prevention. Instead, the government are supporting health promotion,
such as the Treat Yourself Better campaign I discussed in Part C. In some ways this may have a
negative effect on prevention because if people are seeing that influenza does not receive significant
acknowledgement then they may not prevent themselves. This could lead to an increase in influenza
rates in the UK. Causing detrimental problems, for instance a Walgreens study from September
2011, influenza was responsible for 100 million lost workdays during the 2010-2011 flu season
Some estimates say that 10 percent to 12 percent of all employee absences are due to employees
contracting the flu virus -
(https://www.shrm.org/hrdisciplines/safetysecurity/articles/pages/economic-effect-influenza-
businesses.aspx). If this were to increase because of lack of prevention, it could cause massive
disruption for businesses and local authorities.
43

However, Influenza receives recognition from the government, as the Department of Health
supports different health promotions in relation to influenza, such as the Treat Yourself Campaign I
discussed in Part C. Since the government has the authority to govern a country or state
(http://www.oxforddictionaries.com/definition/english/government) it means that people that are
likely to listen them because they have a significant influence on society. This provides evidence that
influenza and its prevention is taken seriously, just not on the same level as heart disease.
The government have even created programmes themselves in relation to influenza, this gives
further evidence that government are taking the illness seriously. The main example is the annual
influenza programme which is a coordinated and evidence-based approach to planning for the
demands of flu across England. Since the influenza vaccination is one of the main sources of
prevention this programme is extremely important. If it was not in place the influenza vaccination
would not be available each year. The intervention also aims to provide information for health care
practitioners on how administer the vaccination. This is another important aspect because if health
providers are unaware of how to do it then the whole prevention strategy is compromised because
the vaccination will fail to prevent influenza.
The government sometimes provide information through publishing leaflets and documentation
(appendix 25), which are distributed in public and local services. This can act as a form of prevention
because they are a constant reminder to people that they need to protect themselves from
influenza. In some circumstances leaflets are a success, they can grab an individuals attention easily.
Many people would rather not waste time reading lengthy advertisements Luckily leaflets have
space constraints. However, this can cause them to lack detail and leave important information out.
Overall, leaflets can be an effective method of prevention because they can fit in just about in any
place, inside newspapers and magazines, in womens purses and wallets, and of course in pockets.
People can quickly glance at a leaflet and skim through it, which will hopefully immediately grab
their attention. I do not think that they can work alone because they lack detail, but alongside other
preventative campaigns and promotion it is likely that they will work.
(Source: http://radfordpress.co.uk/leaflet-printing-services/leaflet-printing-services/)
The government also have strategies in place in relation to heart disease. They launched a strategy
on March 5
th
2013 to help promote awareness and
prevention of heart disease (image); it provided advice
to local authority and NHS commissioners and providers
about actions to improve cardiovascular disease
outcomes. One of the actions it sets out to improve is
the promotion of healthy lifestyle choices and the
benefits. If the public experience the Department of
Health heavily promoting lifestyle changes then it is likely to encourage people to change.
Many assume that heart disease and influenza do not have any of the same preventions but
contrastingly a recent study (March 2014) has found that exercise can prevent influenza as well as
heart disease: Dr Alma Adler said: We already know that people who do regular activity have a
lower risk of many chronic diseases, such as heart disease and diabetes, but our research now
suggests that there may also be a link between exercise and flu
(http://www.express.co.uk/news/health/465247/Two-and-a-half-hours-of-vigorous-exercise-a-
44

week-can-ward-off-flu) These findings suggest that the government could create a joint strategy that
would educate the population on how physical activity can prevent both influenza and heart disease.
This could be effective because if people are aware that exercise can in fact help to prevent more
the one illness they may be more likely to listen to the advice. Nevertheless, it might cause confusion
because heart disease and influenza are viewed as completely different diseases. For example, I
asked a heart disease sufferer (appendix 2): Do you think heart disease and influenza are similar in
anyway? he responded: No, influenza is a short term virus, whereas, heart disease is a serious
disease with significant symptoms.
Preventions are not always effective, one of the reasons for this because of attitudes and behaviour.
For instance, individuals may have a negative approach to health. In general terms this is when
health is defined in terms of absence of illness. The logic of this approach is that a person can be
considered healthy when they are not ill or have any signs or symptoms that suggest they have
disease (AS Health and Social Care book). In relation to heart disease a person would not think
about how to prevent themselves because they do not have it. Therefore, they may not be conscious
about what they eat, how much they exercise and their alcohol consumption. Only when it is too
late would they do something. In relation to influenza an individual with a negative approach to
health would not consider vaccinating against influenza, as they tend to have adopted the it will not
happen to me thought process. Within the UK it is thought that a large percentage of people adopt
this approach. An article published by The Telegraph
(http://www.telegraph.co.uk/earth/environment/9338023/British-population-is-getting-too-fat-for-
the-planet.html) reiterates this assumption as it discovered that the UK was the 18
th
fattest country
in the world despite being so small. This proves that preventions are not always successful because
people do not take them seriously or do not have the willpower to change, like I discussed in Part C.
The media can influence whether prevention is effective or not. For example, one of the lifestyle
changes to help prevent heart disease is to reduce alcohol consumption. Within the media alcohol is
highly advertised and encouraged. The joseph Rowntree Foundation (JRF) reaffirms this with a study
they conducted on the relationship between the media and alcohol consumption. It uncovered that
young people are subject to a variety of media representations of alcohol which, along with other
factors, may influence their drinking behaviour and attitudes to alcohol
(http://www.jrf.org.uk/publications/young-people-alcohol-and-media).This
research could suggest that the media can negatively impact the prevention
of diseases, as the public are sometimes encourages individuals to do the
opposite of what organisations, like the NHS recommend. A way in which
this could be overcome is for the government or organisations to increase
their media coverage of diseases. The British Heart Foundation have already
attempted to this through posting preventative videos on YouTube (image
http://www.youtube.com/user/BritishHeartFound/featured). However, these would be more widely
successful if they on published on television or in newspapers because they have a higher
viewer/reader rate. For instance, British viewers watched a record of more than four hours of TV a
day in the first three months of 2010 and a record 48 ads a day as a result.
(http://www.theguardian.com/media/2010/may/04/thinkbox-television-viewing)
Money hugely impacts the success of preventions. The influenza vaccine is only available on the NHS
to high risk groups, those not be considered a risk have to pay. Money can act as deterrent because
45

some people would rather chance the possibility of influenza, than pay. Even though the vaccine
only costs around 20 if families with a low income all want to be protected against the illness it
quickly becomes expensive and therefore they cannot afford to prevent themselves. A way to
overcome this would be to provide free immunisation to all, the no one would have to worry about
the cost. However, this is not an effective solution. As data I collected in Part B uncovered that
contracting influenza provides better long-term protection than a flu vaccination and the
Department of Health said it would not be best use of current resources.
Reducing the risk of heart disease can also be expensive because of the lifestyle changes
people have to entail. For example, healthy foods are considerably more expensive,
which could make it difficult for individuals on low income to prevent themselves from
heart disease. However, there are a variety of ways to overcome this barrier to
prevention. The Change 4 Life provide information on how to save money and still be
healthy: there are plenty of things you can do to eat more healthily, and the good news
is, making healthier meals neednt cost a lot of money. One of their recommendations is
plan shopping trips to get the best deal and use coupons. Although, this might be harder
for those on a low income prevent themselves from diseases, if an individual is
motivated enough to change there is always an alternative.
(Source: http://www.nhs.uk/Change4Life/Pages/healthy-food-shopping-tips.aspx)
In order to for an individual to change their lifestyle they need have a great amount of willpower and
patience, especially their lifestyle was bad beforehand. For example, the individual I interviewed
(appendix 2) said he found it challenging at first, but still managed to do it. However, some people
may be unable to do this. If a person is not supported by family and friends they may find it easier to
revert back to their old habits, therefore becoming increasingly susceptible to heart disease.
In some ways an individuals willpower could also come into play when preventing influenza because
they may have a phobia of needles. Needle phobia is quite common affecting up to 10 percent of
the population and it may even be inherited.
(http://abcnews.go.com/Health/PainManagement/story?id=4072974)Therefore, it could be
suggested that most effective flu prevention (vaccine) is not effective because of growing fear of
needles. However, there are other ways to prevent influenza that do not require needles. For
instance, antiviral medication such as Relenza and Tamiflu can be used as preventatives in some
circumstances, which are:
there is a lot of flu around
you have a medical condition that puts you at risk of flu, such as diabetes, heart
disease, lung disease, kidney disease or a neurological disease
you are aged 65 or over
you have been in contact with someone with a flu-like illness and can start antiviral
treatment within 48 hours
you have not been effectively protected by vaccination
(http://www.nhs.uk/Conditions/Flu/Pages/Prevention.aspx)
46

The CDC does not promote the use antiviral medications as a form of prevention because it can
lead to drug-resistant strains of the virus (http://www.webmd.com/cold-and-flu/flu-guide/flu-
medications).They should only because used when someone is at significant risk. Therefore, they
cannot be used as a successful alternative to the influenza vaccination.
Not all strategies for prevention fail because of individuals it is sometimes as a result of
organisation or the technique itself. One example I used in Part C was when the influenza
vaccination did not work and some individuals got influenza anyway. An example similar to this in
relation to heart disease I found when I interviewed a heart disease sufferer (appendix 2). I asked:
Before you were diagnosed did the doctor recommend changing your lifestyle as a form of
prevention? response: no not really, this provides evidence that in some cases it is not always
the fault of the individual, the doctor should have told them that they were at risk. Nevertheless,
this is only the experience of one person and in most cases doctors and organisations do their
upmost to help prevent diseases.
Work Related Problems
There can be a number of work related issues when diagnosing and treating heart disease. For
example, the diagnosis can be time consuming in comparison to other diseases. This could cause
disruption to an individuals normal routine. They may need to take time off to go to appointments
and procedures or because condition has worsened. These issues can be overcome because
employers have to make allowances for people with illnesses, like heart disease because it is
unlawful for an employer to dismiss on the grounds of chronic illness under the Equality Act 2010
employers must make reasonable changes to workspace and working conditions
(http://www.nhs.uk/Planners/Yourhealth/Pages/Gettingsupportatwork.aspx). This piece of
legislation is likely to prevent an individual from losing their job.
Nevertheless, as heart disease a lifelong illness it can impact an individuals ability live normally. I
discussed in part C a person could become distressed because balancing work with a long term
illness can be difficult, it could even lead to depression. The individual with heart disease I
interviewed (appendix 2) describing juggling the two as very stressful.
To overcome this, the NHS suggest for a person to ask their employer if they can:
Change job or work load
Move to less demanding job
Train in another job
Work from home.
The British Heart foundation offers similar advice. It is important for an individual to ask themselves
if they are ready to return to work, otherwise they could put too much pressure on themselves. They
should also ask their GP if they think they are ready to return to work: Your GP or heart specialist
will help you decide when you are fit enough to return to work. They will also help you to decide
whether you can return to full-time work straight away or if it would be advisable to work part-time
to begin with (http://www.bhf.org.uk/heart-health/living-with-heart-disease/returning-to-
work.aspx). If an individual returned to work too quickly after being diagnosed with heart disease it
would a negative impact on them personally and their quality of work.
47

Since heart disease is the UK's biggest killer, causing around 82,000 deaths each year (NHS). It is
likely to have an impact on employment as whole, not just on an individual level. For example, if a
large proportion of employees have time off because of the disease it is going to have a negative
effect on the success of a business. This is the same for any disease; statistics show that 52% of
people with long-term illnesses of disability were in full time employment meaning that a
considerable amount of people need special consideration by their employer. It could be proposed
that this would cost a company a higher amount of money, in comparison to if were only employing
healthy individuals.
(Source: http://bjp.rcpsych.org/content/182/6/467.full)
Short term illnesses, such as influenza do not seem to contribute to as many work related issues
because treatment and prevention is fairly simple. However, influenza (as discussed in part C) is
highly disruptive and can never be avoided as not everyone chooses to become vaccinated,
therefore it can cause mass disruption for companies. A way they could overcome this is to pay for
all employees to become vaccinated against influenza. An example of this happening is by an
America medical company called Johns Hopkins which has policies in place that requires all
all individuals, employees, faculty, staff, residents and fellows, temporary workers, trainees,
volunteers, students, vendors and voluntary medical staff, regardless of employer, who provide
services to patients or work in patient care or clinical care areas, including acute and chronic care
hospitals, outpatient facilities and clinics
(http://www.hopkinsmedicine.org/mandatory_flu_vaccination/faq.html). They do this in order to
protect the patients they are treating and to reduce illness rates amongst staff. Despite this,
compulsory influenza vaccination across the UK or even globally would not solve the issue of
influenza. Firstly, because it will cost the government a large amount of money to pay for entire
population to be vaccinated and therefore could cause economic issues. Another reasons is because
it is against human rights which are fundamental rights, especially those believed to belong to an
individual and in whose exercise a government may not interfere as the rights to speak, associate,
work, etc. (http://dictionary.reference.com/browse/human+rights) and they should not be
breached, as people will feel like they do not have a voice in other decisions made by the
government.
Employment can have a huge impact on the prevention of a disease. A prime example of this is
working for a fast food chain. If an individual is constantly surrounded by people purchasing
unhealthy foods high in saturated fat they are likely to eat it themselves, therefore increasing their
chances of illnesses, like heart disease. In some respects this could act as a deterrent to employees
in those types of environments because they are aware of what goes into the food, so understand
how unhealthy it is.
There are also certain environments that increase the chances of influenza. For example, if an
individual works in school they are constantly susceptible to germs and bacteria. Even if they try to
prevent themselves through practicing good hygiene it is unlikely to be successful because not
everyone does the same. In these circumstances the only way to completely ensure that they are
protected from influenza is to have the vaccination. The CDC recommends that if an individual works
in an environment where influenza can spread quickly to:
Stay at home if you are ill
48

Cover your nose and mouth
Wash your hands regularly
Avoid touching your eyes, nose and mouth
Clean and disinfect surfaces
(Source: http://www.cdc.gov/flu/school/)
Conclusion
Overall, both influenza and heart disease can pose serious and detrimental risks to individuals. It
cannot be said that one is more serious than another because people react differently to illnesses.
For example, influenza and heart disease can kill, especially those in
high risk categories. Nevertheless, people still tend to think that heart
disease is much worse, as found from a small scale study (appendix 28) I
conducted. Over half (57%) thought that heart disease was considerably
worse, all participants provided reasons to why;
Example one: Because influenza is rare now. Well rarer than
heart disease.
Example two: it is unknown of until you suffer problems. It is
still a big problem in Britain, whereas influenza is almost irradiated.
This data provides evidence that some individuals are ignorant to how serious influenza actually can
be. Just because it is not a life long illness does not mean it cannot cause serious problems nationally
and individually.
The diseases do not just have an effect on individual level; they can affect society as a whole. For
instance, since heart disease is one of Britains biggest killers it could be suggested that the NHS
spends a large proportion of funding on the disease, negatively affecting other areas. I discovered
that there has been a reduction of high risk categories getting vaccinated against influenza (appendix
13). If an individual in one of the categories contracted influenza it could lead to serious health
problems, such as pneumonia or a bacterial chest infection which would have to be treated in
hospital, unnecessarily costing the NHS money.
Today there is a greater scientific understanding of both illnesses and as a result treatment and
prevention techniques are a greater success resulting in a decrease in
mortality rates. For example, in 1996 37% of deaths were a result of
heart disease, but in 2009 only 20% of deaths were from heart disease
(graph 2). There is not definite statistics in relation to mortality and
influenza; this is because they may be recorded as resulting from
pneumonia or another secondary condition on the death certificate.
However, it can be assumed that death rates have reduced because
pandemics like I discussed in Part C do not occur in Britain today.
(Source:
vhttp://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733821514#mor)

57%
43%
What do you think is
worse heart disease or
influenza?
Heart Disease Influenza
49















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50

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51

Part C
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http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Prevention.aspx)
http://www.nhs.uk/conditions/Chickenpox/Pages/Introduction.aspx
http://www.medicalnewstoday.com/articles/239450.php
http://www.bhf.org.uk/heart-health/tests/physical-assessment.aspx
http://www.nhs.uk/conditions/cardiovascular-disease/Pages/Introduction.aspx
http://www.nhs.uk/conditions/Repairofabdominalaneurysm/Pages/Introduction.aspx
(http://www.nhs.uk/conditions/Heart-attack/Pages/Introduction.aspx
http://www.who.int/mediacentre/factsheets/fs355/en/
http://www.totalhealth.co.uk/clinical-experts/professor-avijit-lahiri/early-diagnosis-coronary-artery-
disease
http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Treatment.aspx)
http://newoldage.blogs.nytimes.com/2012/01/25/avoiding-surgery-in-the-
elderly/?_php=true&_type=blogs&_r=0
http://www.bhf.org.uk/heart-health/treatment/heart-transplant.aspx
https://www.nhlbi.nih.gov/educational/hearttruth/downloads/html/factsheet-heartdesease.htm
http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Treatment.aspx
http://www.doctoryourself.com/flushot.html
http://www.nlm.nih.gov/medlineplus/ency/article/004008.htm
http://www.sciencemediacentre.co.nz/2008/06/18/cold-houses-and-impact-on-health/
http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/lack-of-sleep-health-risks.aspx
http://www.nhs.uk/news/2012/10October/Pages/Dirty-Brits-are-worlds-worst-flu-spreaders.aspx
http://www.bhf.org.uk/about-us/who-we-are.aspx
http://www.cancerresearchuk.org/cancer-info/cancerstats/types/breast/
http://www.who.int/oral_health/action/communicable/en/
52

http://www.nat.org.uk/default.aspx
http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx
http://www.netdoctor.co.uk/diseases/facts/influenza.htm
http://www.who.int/influenza/en/
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198931/National_
Service_Framework_for_Coronary_Heart_Disease.pdf
http://www.nhsidentity.nhs.uk/tools-and-resources/patient-information
http://www.huffingtonpost.com/2013/01/17/common-reasons-see-a-doctor-skin-
disease_n_2497424.html
http://www.nhs.uk/conditions/asthma/Pages/Introduction.aspx

Part D
http://www.hpb.gov.sg/HOPPortal/health-article/8200
https://www.bhf.org.uk/about-us/where-we-are/the-bhf-
map.aspx?m=advanced&q=&p=1&od=0&lctn=hx3%207et&rds=5&lng=-1.83399&lat=53.74157
http://www.succeedsocially.com/lifestyle
https://www.shrm.org/hrdisciplines/safetysecurity/articles/pages/economic-effect-influenza-
businesses.aspx
http://www.oxforddictionaries.com/definition/english/government
http://www.telegraph.co.uk/earth/environment/9338023/British-population-is-getting-too-fat-for-
the-planet.html
http://www.youtube.com/user/BritishHeartFound/featured
http://www.nhs.uk/Change4Life/Pages/healthy-food-shopping-tips.aspx
http://www.nhs.uk/Conditions/Flu/Pages/Prevention.aspx
http://www.webmd.com/cold-and-flu/flu-guide/flu-medications
http://www.nhs.uk/Planners/Yourhealth/Pages/Gettingsupportatwork.aspx
http://www.bhf.org.uk/heart-health/living-with-heart-disease/returning-to-work.aspx
http://bjp.rcpsych.org/content/182/6/467.full
http://dictionary.reference.com/browse/human+rights
http://www.hopkinsmedicine.org/mandatory_flu_vaccination/faq.html
http://www.cdc.gov/flu/school/
vhttp://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733821514#mor
53


Books used throughout
Collins AS Health and Social Care Mark Walsh, Paul Stephens and Richard Chaloner
Collins A2 Health and Social Care Mark Walsh, Paul Stephens, Mariyn Billingham, Mary Crittenden,
Alison Thomson and Douglas Thomson
AZ Health and Social Care Judy Richards and Sue Ford
AQA A2 Sociology Rob Webb, Hal Westergaard, Keith Trobe and Liz Steel