Healthy Hearts
Type of work
Group project cooperated with NHS Scotland in Glasgow
Duration
7 months, Nov 2021 to May 2022
Tools
Miro, Illustrator, Adobe Premiere Pro, PowerPoint
My Role
Service designer, User researcher
Background
Cardiovascular disease or CVD is a general term for conditions that affect the heart and blood vessels. It is the leading global cause of death - three-quarters of these deaths take place in countries of low and middle socio-economic status. In England alone, people living in areas of ‘deprivation are four times more likely to die prematurely. At the beginning of the 20th century, Glasgow had one of the highest population densities in the world, with some areas being considered the worst slums in Britain. Even today, Glasgow deals with high levels of socio-economic deprivation (homelessness and housing instability, economic and employment insecurities), along with high rates of smoking, drug, and alcohol use. Glaswegians have a 30% higher risk of dying before they are 65. This excessively high mortality rate in Glasgow has been coined, “The Glasgow Effect”.
Why is Glasgow at risk? Inequality/Risk Factors
What does the Glasgow Effect have to do with cardiovascular disease? Well, CVD risk factors are the same de’terminants of health that contribute to the Glasgow Effect. Primary risk factors of CVD are poor diet, lack of physical activity and o’beesity, smoking, alcohol use, poor air quality, and high blood pressure.
Primary discussion with experts
To further explore the relationship between Glasgow and CVD, we met with Dr Paul Welsh, a cardiovascular and medical sciences professor at the University of Glasgow. Paul’s audio about living, not dying, of CVD.
We learned the impacts covid has had on children’s lifestyles; the relationship between Brexit and GP shortages; developments in at-home testing methods; public health campaigns targeted at heart health; and how poor communities struggle to access appropriate health care.
As a result of this interview and our desk research, we concluded that because people of low socio-economic status already face enough barriers, our solution should not place the ‘onus on the individual. Instead, the problem is a systemic issue that requires a preventative approach. According to the Scottish Index of multiple deprivations, a BBC article published in 2020 names Carntyne West and Haghill as two of the most deprived neighbourhoods in Glasgow. This directed us to focus on the east end of Glasgow. From here, we developed a challenge statement for the project: Our intervention is early detection as a form of prevention.
Our visit to the east end
We went to the east end to interview residents and gather supplementary data through engagement tools. The residents we spoke with have lived in the area for many years and have a good relationship with their GP, but they disagree with how seldom the NHS ‘recommends check-ups.
At a child care centre, staff noted how children of low-income families generally bring pre-packed food instead of homemade meals. These families may not have access to or an understanding of healthy food.
Why primary school kids？
Our visit to the east end exposed gaps in the current health and education systems. Patients have a strong relationship with their doctors but do not see them enough, and school children are exposed to risk factors their care providers may not be aware of.
Currently, the child health surveillance program exists in schools to track the general health of at-risk children when requested by a care provider. This program is not a continual assessment and is limited in its scope. It is done in isolation from the NHS system without a direct communication link.
Then how might we improve cardiovascular health and address these health inequalities? Through preventative detection methods and building communication channels between care providers.
Communication regarding the child exists between the teacher and parent and the parent and GP. To complete this communication circle, we are creating a channel for GPs and teachers to connect.
Our intervention is a program integrated into the primary school and NHS system. The central premise of this program is based on the child health surveillance program. General health observations and medical data are gathered over time by teachers and GPs to make more appropriate care decisions.
How does our solution work?
To further explain how this program functions, let’s explore the care providers’ roles: the GP, the teacher and the parent.
In terms of collecting medical information, the role of the GP remains the same.
The teacher spends most of the day with the child, observing their growth and development. Their role in this program is to monitor specific behavioural habits and the child’s lifestyle.
The parent is responsible for providing as much accurate information as possible to the GP and teacher regarding their socioeconomic position, family situation and health history.
Flagging
Communication between the GP and teacher is primarily through the concept of flagging. When a teacher notes the child meets the criteria for a risk factor, flagging happens, and the GP is notified. For this to work, the teacher’s observations are added to the child’s NHS profile.
The teacher is not responsible for making any health care decisions left to the GP.
Timeline
The teacher and parent update or confirm fixed information at the term start. Fixed information can be address and contact information.
At half term, the teacher reviews variable information based on their observations.
The child may have to see their GP at some point during the year. Variable and fixed information has been added to the child’s NHS profile.
Image sequence
This is what the program may look like.
A parent fills out an online form.
A teacher observes a child during lunch. Is their lunch packaged, or homemade? The student doesn’t participate in activities. Is the child out of breath and unable to keep up with their peers?
The teacher adds their observations to the system.
The doctor reviews data flagged by the system.
When the child visits the GP, the doctor does a general health assessment.
The GP and parent discuss the child’s health and future care.
The parent is now more informed about how they can keep their child healthy.
Future scope and scalability
Preventative care does not begin and end in primary school. We hope this program will be integrated into all levels of school across Glasgow, eventually involving the child. Ideally, this routine of tracking their health becomes more normalised and incorporated into their adult life.
We recognise that not all parents may wish to partake in this program. While this may prevent the child from being flagged earlier for cardiovascular disease risks, opting out is always available if requested.
How will our program improve the lives of those with CVD?
We hope that our program will improve the lives of those with CVD. Our goal aligns with three UN sustainable development goals, #1, No Poverty; #3, Good health and well-being. And #10 reduced inequalities.
Focusing on the city’s east end, we hope to tackle Glasgow’s low life expectancy by recognizing CVD risk factors. Areas of poverty due to historically poor living conditions may contribute to higher levels of cardiovascular disease.
Tracking primary school students through general health and well-being data, this program is an early intervention to encourage preventative care measures, hopefully improving the quality of life for
all its participants. This applies to everyone of all ages.
We can reduce inequalities by improving access to health care. By taking the onus off the individual, we acknowledge their barriers to health and care decisions. This program does not have any financial expectations from its participants.
Expected challenges of our program
- While we hope the implementation and outcomes of this project will be successful, we acknowledge there may also be challenges. The budget and administration required to build this program could be costly. Syncing systems between the NHS and school systems could be complex, with a steep learning curve. Teachers and doctors already carry a heavy workload, and the addition of this program may not be welcome.
- Finally, there is the challenge of students and their guardians. This program requires that parents divulge sensitive information about their socioeconomic situation. If a guardian wishes to opt-out, the child will not be tracked and could be unknowingly at an increased risk for CVD.
- If a child does not attend school regularly or does not attend in the first place, it will be challenging to track and monitor their health. It is not only the changes parents and children wish to make but also the responsibility doctors have for their patient’s health and well-being.
Reflection on the project
Reflecting upon our project and process, there are a few points that we wish to acknowledge. Primarily the challenges in communicating with our key stakeholders. Due to their time constraints, we were unable to make contact with staff at primary schools and limited our communication with medical experts. We were also unable to interview cardiovascular patients directly. These challenges have placed apparent limitations on the feasibility of our proposed program, but we are confident in the research we conducted that has informed our decisions and design process.
We are confident in our research which has informed our decisions and design process. Our program improves cardiovascular health, addresses health inequalities through preventative detection methods, and builds communication channels between care providers.