Sample Answer
Critically analyse and evaluate the concept of health and wellness, taking in to account the determinants of health, their relevance to health and wellbeing and the impact of inequalities of health on individuals and populations.
Introduction
This essay develops a health profile for adults aged 18–65 living in Tower Hamlets, an inner London borough. It uses this profile to explore key health risks, and to consider how a nurse could offer advice and support to promote health and wellbeing. The discussion links directly to the three learning outcomes by examining ideas of health and wellness, looking at determinants of health and inequalities, using epidemiological evidence to assess need, and considering how economics and health and social care policy shape public health and service provision.
Nurses are central to health promotion across the life-course. In every contact, whether in primary care, hospital, or community settings, nurses can identify risk factors, give brief advice, signpost to appropriate services and advocate for fair access to care. In adult nursing, this includes supporting people to manage long-term conditions, promoting healthy lifestyles, and recognising how social and economic factors influence the choices people are able to make. National guidance such as the “All Our Health” framework stresses that healthcare professionals are in a strong position to support behaviour change, particularly around physical activity and other modifiable risks.
In a borough such as Tower Hamlets, which is young, ethnically diverse and highly deprived, the nurse’s role in promoting health and addressing inequalities is especially important.
Background: Concepts of Health, Determinants and Health Profiles
The starting point for this essay is the 1948 World Health Organization (WHO) definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948). This definition is often criticised for being idealistic and difficult to measure, but it remains useful because it highlights that health is not only about the body. It includes emotions, relationships, daily functioning and participation in society. Later commentators argue that the WHO definition opened up a wider discussion about what counts as health and how far services should aim to support wellbeing rather than simply treat illness.
To understand why some communities enjoy better health than others, this essay draws on the Dahlgren and Whitehead “rainbow” model of the determinants of health. This model places the individual at the centre, surrounded by layers such as lifestyle factors, social and community networks, living and working conditions, and wider socio-economic, cultural and environmental conditions. It emphasises that health is shaped by far more than personal choice; income, housing, education, employment, and wider commercial influences all play a role.
In England there are clear inequalities in both life expectancy and healthy life expectancy. People living in the most deprived areas can expect to live fewer years in good health than those in the least deprived areas; recent data suggest a gap of around 20 years in healthy life expectancy between the most and least deprived areas for both men and women. These inequalities are strongly linked to the social determinants described in the Dahlgren and Whitehead model.
A health profile brings together data on demographics, lifestyle, morbidity, mortality and wider determinants to give a picture of the health of a community or population. Nationally, the Office for Health Improvement and Disparities (OHID) publishes local authority health profiles to support planning and commissioning. Such profiles are useful because they highlight both needs and strengths. However, they are usually based on quantitative data and may not fully capture people’s lived experience. These strengths and weaknesses are revisited in the conclusion.
Health Profile of Adults in Tower Hamlets
Community and Demographic Overview
Tower Hamlets is an inner London borough with a rapidly growing and very young population. Census 2021 data show that the population increased from around 254,100 in 2011 to 310,300 in 2021, a rise of 22.1%, far above the England average. It has one of the lowest proportions of older people in England; only about 8.4% of residents are aged over 60, and around 5–6% are over 65. This essay focuses on adults aged 18–65, who make up the majority of the population.
The borough is highly ethnically diverse. More than half of residents belong to minority ethnic groups, and 44.4% identify as Asian or Asian British. Tower Hamlets has the largest Bangladeshi community in the UK: around one third of residents (34–35%) are Bangladeshi or British Bangladeshi, and roughly one in six people of Bangladeshi origin in England and Wales lives in the borough. This ethnic mix influences patterns of disease and the kinds of culturally sensitive health promotion that are needed.
Economically, Tower Hamlets is one of the most deprived local authorities in England. Indices of Deprivation 2025 place it among the 20 most deprived districts nationally, with very high levels of income deprivation affecting both children and older people. A borough profile notes that in the least deprived neighbourhood only 2.5% of people are income-deprived, while in the most deprived neighbourhood around 31.8% are income-deprived. Tower Hamlets has the highest rate of child poverty in the UK, and recent analysis suggests that in some inner-city neighbourhoods around 71% of children live in income-deprived households when high housing costs are taken into account. Income deprivation is more than twice the England average, and unemployment is also higher than the national rate.
Housing is a major concern. Median private rent takes over half of median pay (around 54.7%), and rates of temporary accommodation are much higher than in England overall. Overcrowding and poor-quality housing are already known risk factors for respiratory disease, mental ill health and infectious disease, so they are important to consider in a health profile informed by the Dahlgren and Whitehead model.
