The communities we live in are part of the foundations for our wider health and wellbeing. The
places we live, work and play have the potential to support healthy and happy lives –
encouraging social interaction, access to community groups and cultural resources, and where
necessary, providing clear links to health services. Equally, these settings can be characterised
by health pitfalls; from a high street full of fast food shops to a lack of green space, some areas
face multiple challenges to promoting health.
All communities are different, facing their own unique mix of health issues – issues in which
local authorities have an unparalleled understanding.
The movement of public health to local authorities was a landmark moment, providing an
unprecedented opportunity for taking a truly local approach to improving health and wellbeing.
The Department of Health announced the new role of Health Trainers in the Choosing Health
WhitePaper in 2004. Health Trainers are a new workforce to be recruited from the community
and working in the NHS and other local organisations, including local authorities, businesses,
the voluntary and community sector or one by one clients.
As part of the plan to reduce health inequalities, Health Trainers will encourage individuals to
improve their own health and wellbeing. They will have experience and understanding of
what it means to live, or be part of, their community. The expectation is that their
diversity, including age, ethnicity, race and gender will reflect the local area.
They may also be people working in the area who gain extra skills to be a Health Trainer as
part of their existing role.
“Health improvement services offer a less formal setting, in which advice feels less judgmental
and more conversational increasing the acceptability of the intervention.”

‘An integral part of the health trainer role is promoting emotional wellbeing and supporting
clients with low level mental health issues, such as social isolation, anxiety and stress.
Mrs Dinc will use her knowledge of health issues in her local (Turkish) community, to help
people improve their general health and wellbeing.
She will focus on:
• strengthen immune system
• improving access to healthy lifestyles
• improving the amount of exercise people take
• the importance of practising safe sex
• helping people stop smoking
• the positive effects of lowering alcohol intake
• the benefits of breastfeeding, etc.
After Covid-19 outbreak everybody realized the importance of being healthy and serious
results of smoking, being obese or having weak immune system. She’ll provide information
and support on a one-to-one basis, and in groups. (Please refer to target market section)
Mrs Dinc’s day-to-day duties include:

• Helping people understand how their behaviour affects their health
Physical health and mental health are inextricably linked, with poor mental health
being both a determinant and consequence of poor physical health. Research has
shown that individuals suffering from depression for example, have a 65% increased
risk of diabetes, and correspondingly, individuals with diabetes are two to five times
more likely to have depression. (Mental Health Foundation. Economic burden of
mental illness cannot be tackled without research investment. London: Mental Health
Foundation, 2010)

• Supporting and motivating individuals to change harmful habits
A significant proportion of the disease burden faced by the NHS is caused by smoking,
poor diet and lack of exercise. For example, in 2005/6 1.7 million hospital episodes in
England were related to smoking (Information Centre 2007). The health consequences
of smoking have long been recognised (Doll and Hill 1954). Smokers are more likely
to suffer from coronary heart disease, lung cancer and respiratory diseases such as
chronic obstructive pulmonary disease (COPD). Smoking remains the greatest single
cause of illness and premature death (17 per cent of all deaths of adults aged 35 and
over in 2005) with more than 106,000 premature deaths every year attributable to
smoking (Department of Health 2008b). While overall smoking prevalence is falling in

England (from 39 per cent in 1980 to 24 per cent in 2005), inequalities in smoking
behaviour persist (Information Centre 2007). Nearly three-quarters of current smokers
aged 16 and over reported that they wanted to give up smoking, with health being the
most common reason (Information Centre 2007).
And Smoking significantly worsens COVID-19, according to a new analysis by UC
San Francisco of the association between smoking and progression of the infectious

In a meta-analysis of studies that included 11,590 COVID patients, researchers
found that among people with the virus, the risk of disease progression in those
who currently smoke or previously smoked was nearly double that of non-smokers.
They also found that when the disease worsens, current or former smokers had more
acute or critical conditions or death. Overall, smoking was associated with almost a
doubling of the risk of disease progressing.
Obesity increases the risk of developing type 2 diabetes (by up to 80 times compared to
the non-obese) and coronary heart disease (by 2–3 times) and is associated with
hypertension and other debilitating conditions (McPherson et al 2007). Despite
government targets to halt the growth in obesity, rates of obesity in both adults and
children have continued to rise rapidly (Wanless et al 2007) and are projected to
continue to rise (Butland et al 2007). In 2006, 24 per cent of adults aged 16 or over in
England and 16 per cent of children aged 2 to 15 were classified as obese, an increase
from 15 per cent in 1993 for adults and 11 per cent in 1995 among children
(Information Centre 2008). Poor diet and a sedentary lifestyle both contribute to the
problem of obesity. These are in turn influenced by a range of factors including appetite
control in the brain, force of dietary habits, and psychological ambivalence
experienced by individuals in making lifestyle choices (Butland et al 2007). The Chief
Medical Officer has recommended that adults take at least 30 minutes of moderate

intensity activity at least five times a week. For children the recommended level is 60
minutes or more of physical activity every day. In 2006 40 per cent of men and 28 per
cent of women, 70 per cent of boys and 59 per cent of girls met the recommended levels
(Information Centre 2008). The government recommends that everyone should
consume at least five portions of fruit and vegetables a day; 28 per cent of men and 32
per cent of women, 19 per cent of boys and 22 per cent of girls consumed recommended
levels in 2006 (Information Centre 2008). Again, there are socioeconomic inequalities
in both the level of physical activity and consumption of fruit and vegetables
(Information Centre 2008).

These issues present significant challenges to the government and to the NHS. Effective
strategies need to be identified to improve the population’s health and to reduce health
inequalities. In addition to societal policies (such as the smoking ban and the provision
of cycling lanes), the government has committed to supporting individuals to modify
these behaviours. Choosing Health set out recommendations to create a ‘health

promoting’ NHS. The report focused mostly on giving advice as well as offering access
to NHS Stop Smoking services and practical support on healthy eating, exercise, weight
gain, and clinical treatment for obesity (Department of Health 2004). More recently
the government published a comprehensive strategy (Department of Health 2008a) to
tackle obesity in response to the Foresight report on obesity.
Please see for more information
Roengrudee Patanavanich, MD, LLM, PhD, Stanton A Glantz, PhD, Smoking Is
Associated With COVID-19 Progression: A Meta-analysis, Nicotine & Tobacco
Research, , ntaa082,

• Explaining the benefits and importance of healthier food and lifestyle choices
You know that healthy habits, such as eating well, exercising, and avoiding harmful
substances, make sense, but did you ever stop to think about why you practice them? A
healthy habit is any behaviour that benefits your physical, mental, and emotional
health. These habits improve your overall well-being and make you feel good.
Healthy habits are hard to develop and often require changing your mindset. But if
you’re willing to make sacrifices to better your health, the impact can be far-reaching,
regardless of your age, sex, or physical ability.
• Recording activity levels and results and using these to motivate clients.
Mrs Dinc will record her client’s results and use them to motivate clients and improve
their wellbeing.

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