Public Health Issue Homework Questions and Answers

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Learning Outcomes

LO1: Evaluate social perspectives relevant to health.

LO2: Identify the social, political and economic drivers of health/social policy.

LO3: Appraise methods to plan, advocate and evaluate health policy that will improve population health and well-being and reduce health inequalities.

Submit on Canvas before 2pm on the 8th January 2024 (No hard copies to be submitted).

You are working in the Public Health field and have been asked to advise on policy in the context of how social determinants of health are being addressed.

Using a case study approach, you are required to use an appropriate public health or social policy provided to discuss one case study scenario. You are required to clearly indicate how the policy relates to the social determinants of health.

1. Critically examine how the policy problem has been constructed and consider the social perspectives that have influenced the policy.
2. Using an appropriate policy analysis framework, provide a critical analysis of the policy.
3. Propose alternatives to how the problem is being addressed, discussing the alternative views.
4. Discuss the strategies you would employ from your findings of the policy analysis in order to influence policy makers.

Case Study 1

Knife Crime

The Johnson crew historically terrorised parts of inner-city Birmingham acting as judge, jury and on more than one occasion as executioner. Born out of the poverty and decay in inner-city Birmingham, the Johnson Crew emerged from the ashes of the Handsworth riots in 1985.

Formed in the late 80s to combat white supremacists, the Johnson Crew quickly morphed into a criminal enterprise when the far-right threat disappeared.

They initially concentrated their efforts on overcoming the Jamaican-born so-called “Yardies” who would bully and threaten the local “homeboys” who they considered soft targets.

By the mid-1990s the Johnson Crew had over-run the local Yardies by employing the same brutal and ruthless violence of their adversaries. At this juncture, this behaviour mainly consisted of aggressive and violent knife crimes which often resulted in fatal stabbings.

“Big Chris” Johnson is of dual heritage and 66 years of age. He is a founding member and high-ranking affiliate of the notorious Johnson crew. He has three sons; Christopher; known as “Little Kitty” aged 44 years, Mikado aged 42 years and Zephton aged 35 years. He also has one daughter called Elise who is 22 years old. Elise is physically disabled and a wheelchair user.

“Little Kitty”, Mikado and Zephton are all established Johnson gang members and have been arrested and imprisoned multiple times for gang related offences, including aggravated assault and grievous bodily harm with intent involving violent knife crimes.

“Little Kitty” has twin sons named Robert and Renford aged 24 years, Mikado has one son called Nimrod aged 19 years and Zephton has two daughters called L’Shay aged 12 years and Pebbles aged 7 years. Zephton also has a dog; an XL American Bully called ghost.  Robert and Renford are known to the police and have established gang affiliations within the Johnson crew. They too have also been arrested and imprisoned numerous times in relation to gang related stabbings and violent knife crimes in the current context of “county lines”.

Case study 2

Tackling Domestic Violence and Abuse Plan

Pauline is 65 years old and white British. She is the long-term partner of “Big Chris” Johnson and the mother of “Little Kitty”, Mikado, Zephton and Elise.

Pauline has experienced years of ongoing sexual and physical abuse during her 46-year relationship with “Big Chris”. Initially, “Big Chris” was very insecure about Paulines previous relationships and became jealous of anyone he thought might be ‘a threat’. At the beginning of the relationship, it seemed almost charming – like he wanted to be number one in her world… but over time he became more and more frightening and controlling.

Whenever Pauline went out, “Big Chris” would want to know why, where she had been and exactly who had been there. If Pauline came home later than she said, he would accuse her of having an affair. If he’d been drinking, he would call Pauline a ‘f**king whore’, ‘a slag’ and other derogatory names. He would shout, swear and be physically abusive – this behaviour happened multiple times a week in front of the children.

After Pauline gave birth to “Little Kitty”, she told “Big Chris” that she I did not feel comfortable having sex as she was in a lot of pain. But he forced her to sleep with him on a daily basis when he arrived home from gang related incidents; often violent, drunk and demanding.

Pauline had no money as “Big Chris” controlled all the finances. He told her if she wanted to buy anything, she would have to be “nice to him” and have sex in return. She felt worthless and very frightened. Pauline always gave in to “Big Chris’s demands to protect her three sons and her daughter.

To make matters worse, “Big Chris” still attends all Paulines medical appointments so that she does not have a chance to disclose anything. The only time she historically spent out of the house was a short walk to take her children to school and to take Elise to various medical appointments. At family and social gatherings “Big Chris” acts the part of a devoted partner, father and grandfather.

Pauline tried to leave with “Little Kitty”, Mikado, Zephton and Elise multiple times over the years when the children were young. “Big Chris” always managed to find Pauline and would force her to return to the family home with the four children. Pauline has resigned herself to her current situation as she feels she is too old and exhausted to even try and leave “Big Chris” and to start again somewhere new. Pauline also worries about leaving her younger grandchildren Nimrod, L’Shay and Pebbles. (Nimrod disproves of his family’s lifestyle, is not involved in any criminal activities and is living in student accommodation as he is enrolled on a university nursing degree).

Case Study 3

Tackling Violence against Women and Girls Policy

“Little Kitty” and his twin sons Robert and Renford run County Lines from within the Lozells, Aston and Newtown in Birmingham.

County lines is a form of criminal exploitation. It is when adults (criminals) befriend children, either online of offline, and then manipulate them into drug dealing and or sex work. The ‘lines’ refer to mobile phones that are used to control a young person who is delivering drugs or selling sex, often to towns outside their home county. This is achieved through coercion, intimidation, debt bondage (creating a debt the child has to pay back), violence and/or grooming.

Young people aged 14 – 17 are most likely to be targeted by criminal groups, but there is evidence to suggest that seven-year-old children are being groomed into working within county lines.

Primary school children are seen as easy targets as they are less likely to get caught. The grooming may start with them being asked to ‘keep watch’, but it soon escalates to them being forced to stash weapons, burner phones or become drug couriers or sex workers.

Peer grooming is common and can take place in schools, social media and contexts where children meet. Social media is used in multiple ways, to glamorise/normalise drug selling/gang involvement and criminality, but also used to sell and advertise the drugs.

Lauren is 13 years old and is a looked after child within the care system.  She was recruited by Robert and Renford initially through social media. She was groomed into what she believed to be a romantic relationship with Renford. This very quickly lead into exploitation where she was forced into sexual activity with other gang members in “trap houses” across Birmingham. Lauren is devoted to Renford even though he has been violent to her on numerous occasions. She believes that she is his ‘special’ or number one girl and will cooperate with any of his requests through both fear and loyalty.

Gangs often use threats, coercion and violence to force children to do what they want. Punishments are common for children involved within county lines. This is usually for mistakes deemed to have been made. The gang will respond with often physical or financial punishments for the child. The punishments can be extremely violent such as stabbings, and acid attacks. The financial punishments often mean any mistakes made that lose money for the gang have to be repaid with an extortionate amount of money added on top as interest. Often this will just keep getting added to. Gangs may also trick children into getting into their debt, for example, by giving them a mobile phone or drugs only to later demand repayment for the cost. The child will then be in ‘debt bondage’ to the gang as described above.

Case Study 4

COVID-19 mental health and well-being recovery action plan (2021)

Mental Health Policy in the UK

Leanne aged 30 years is Zephton’s partner and mother to their two daughters, L’Shea and Pebbles.

Pre and post the Covid 19 Pandemic in 2020, Leanne experienced severe and debilitating depression and anxiety. This was partly due to fear of contracting Covid 19, social isolation and living in very close proximity to Zephton (who is both violent and often unstable) for long periods of time. Leanne is also frightened of Zephton’s XL Bully dog Ghost who is aggressive and unpredictable.

Leanne worries about many things in life and her most common thought is “what if”? She often imagines the worst happening and has disclosed to her GP that when she worries, she often feels sick, has headaches, feels butterflies in her stomach and is aware of her heart pounding. Leanne often gets hot and sweaty and has stated that her anxiety makes it difficult to deal with Zephton’s aggressive behaviour, look after her children and Zephton’s dog Ghost. She is very distressed by her constant worrying and feelings of anxiety and regards it as a sign of weakness. Leanne has also disclosed that she is very lonely, has difficulty coping with everyday life and feels sad most of the time.  She also finds it difficult to sleep due to Zephton’s aggressive behaviour and his nocturnal gang related activities. 

Case Study 5

Tackling Obesity: Empowering Adults and Children
to Live Healthier Lives’

Zephton and Leanne’s daughter Pebbles is 7 years old and currently weighs 9:5 stone. She has been diagnosed as being obese.

Zephton spoils Pebbles and often takes her out in his car late at night with his dog Ghost on gang related business. He continually buys Pebbles fast food, fizzy drinks and sweets. He likes to brag that she can eat as much as him. Pebbles is not interested in sport and likes to play games on her i-Pad.

The school nurse at Pebbles’ school has arranged several meetings with Leanne in relation to Pebbles weight. These meeting were not successful as Leanne did not appear to be receptive to the school nurse’s concerns. In addition, she did not appear to understand the advice that was offered in relation to nutrition and healthy eating. The school nurse repeatedly raised concerns about Pebbles escalating weight to the pastoral and safeguarding lead in school, who then made a referral to the local authority.

The local authority children and family safeguarding team have become involved and have informed Leanne that Pebbles could potentially be removed from the family home due to safeguarding issues and child neglect in relation to her weight. This has caused considerable tension within the family home.  Zephton has been aggressive and verbally threated social workers from the local authority.  He has also refused entry to the home to social services, nutritionists and the community nurse. Zephton has also threatened professionals with Ghost on several occasions. The Police and the RSPCA have been informed and have told Zephton that Ghost must wear a muzzle in public and may be removed from the family home in relation to concerns about the breed.

Case Study 6

National Disability Strategy, Part 1: Practical steps now to improve disabled people’s everyday lives.

Elise has recently graduated from Manchester University with a first-class honour’s degree in business computing. She is very independent and has informed her parents “Big Chris” and Pauline that she is looking for employment in Manchester and has already had two job offers.  She is in the process of looking for accessible accommodation with her boyfriend Rajinder.

Elise has also made it very clear that she does not approve of her family’s lifestyle and is not prepared to live in the family home as it does not meet her needs physically or emotionally. Elise has repeatedly stated that she wants a fresh start away from the family’s criminal lifestyle and is trying to persuade her mother Pauline to go with her to Manchester.

“Big Chris” is totally against Elise moving out of the family home as he feels that she would not be able to cope on her own and views her as “his little girl”. “Big Chris” does not like Rajinder as he is in the police. Pauline and Elise have not discussed the possibility of Pauline moving to Manchester with “Big Chris”. 

Case Study 7

Improving Outcomes: A strategy for Cancer 2011

Mikado was diagnosed with testicular cancer in 2020.

He had noticed a change in the way one testicle felt for over two years. His partner Jada encouraged him to get it checked a few times, but the doctors reassured him it was nothing to worry about. Then, in early 2020, a very small lump appeared which the GP thought may be an infection. They continued to monitor it with ultrasounds because it wasn’t possible to take a safe biopsy. However, it continued to grow larger, and they suspected cancer, so they did an orchiectomy to remove the testicle that confirmed diagnosis.

Both Jada and Mikado were shocked that he had testicular cancer, probably because it had taken a long time to get diagnosed. He had many scans and checks so in a way it was a relief knowing that he wasn’t a hypochondriac and something was now going to be done. He was reassured that it had been found at an early stage so was highly curable. Once he was finally diagnosed everything moved quickly so that there was not much time to think. He was admitted to hospital for the operation the day after the formal diagnosis.

Mikado states ‘It was hard to talk to my family about my diagnosis and I have not told my son as I don’t want to distract him from his studies. My dad was in complete denial and just kept saying “it’s a mistake, we don’t get things like this” My mum Pauline and my partner Jada were really supportive and came with me to the hospital.  Other people who I thought were close friends made no contact with me during or after treatment. That made me feel very isolated.

Mikado had an orchiectomy to remove the cancerous testicle. There was no indication the cancer had travelled anywhere else, so he went on a six-weekly surveillance program of blood tests and scans.

Just over a year later, in 2022, the scan showed that some cells had been growing in the lymph nodes so he would need chemotherapy. He had three sessions of higher dose carboplatin. This was part of a trial, so it was different from standard treatment, but the doctors reassured him it had shown good results and had fewer long-term side effects.

The operation was painful, but he was back at “work” after a few weeks. The first couple of weeks after each chemotherapy session felt like he had been in a boxing ring: battered, bruised, and in a daze. He was exhausted but didn’t feel like sleeping. He lost his appetite, and everything tasted horrible and metallic. Mikado recalls “I remember it being very disruptive because I was in the hospital on Christmas Eve and New Year’s Eve. A lot of the time I felt really bored but couldn’t really focus well enough to do much”.

Mikado went back on the surveillance program, so he had more scans and blood tests. Two years down the line he now only has them every six months. Mikado has stated “I was well supported by my mum and my partner, but my dad tried to push me. It took me about nine months to get back to where I was pre-chemo”.