L01
Health promotion
1.1
Socioeconomic status means one of the most powerful risk factors for poor health outcomes. Persons of lower socioeconomic status suffer disproportionately from nearly all diseases and have higher rates of mortality than people of higher socioeconomic status. http://futureofchildren.org/publications/journals/article/index.xml?journalid=60&articleid=374&sectionid=2510 This socioeconomic difference can leads to limited access to basic health care services. Social and economic factors shape risk behaviour and the health of drug users. They affect health indirectly by shaping individual drug-use behaviour; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication.

many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life. (Drug facts, 2012).
Drug facts, 2012 access online [www]http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction access on 12/11/14.

1.2
The state of public health Canada in 2008 stated Health inequalities are differences in health status experienced by various individuals or groups in society. The word Health inequalities is closely linked to “social determinants of health” (Marmot and Wilkinson, 1999) as it refers to the multiple influences upon health status, including socioeconomic status, diet, education, employment, homelessness, poor housing and income.
The life style factors which influence health inequalities. These include: smoking, alcohol consumption or drug use.

Marmot M, Wilkinson RG, editors. Social Determinants of Health. Oxford: Oxford University Press; 1999.
Public health agency of Canada, (2008) Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities. Accessed on http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2008/fr-rc/cphorsphc-respcacsp07a-eng.php .

153 young people accessed treatment services in Southwark in 2007/08 (Southwark DAT). The majority of these were over 15 years old and male. Cannabis was the most common drug used in Southwark (70% of service users) reflecting national patterns. The reported use of Class A substances was very low and there was little indication of injecting drug use. However, all data rely on self-reported drug use and are likely to underestimate drug use. There were estimated to be 452 problematic drug users amongst 15 to 24 year olds in Southwark is March 2005

(source : www.projectknow.com )

1.3
Barrier
Drug users in the UK have also been shown to face multiple problems in relation to accessing health care. lack of knowledge regarding benefit entitlement and a lack of easily available advice on this issue; difficulties with requirements to fill out application forms and attend appointments; and problems with the facilities used by Jobcentre Plus to handle client enquiries and consultations. Drug users face a variety of obstacles with regard to looking for employment; include poor self-confidence and mental health problems, physical health problems, a lack of education, training and skills, ongoing drug use, receiving treatment whilst working and stigmatisation by employers. By the employers take on individual with a history of drug misuse or criminal convictions is an obstacle rooted in social attitude and difficult to change their outlook (DWP, 2010).
Department for Work and Pensions (2008). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214409/rrep640.pdf

Drug Abuse: London Health
Drugs affect the brain and central nervous system which brings about a change in mood; often, people take drugs to lift their moods and experience a ‘high’. Drug abuse is usually characterised by regular use of illegal drugs.
Drug abuse is increasingly common, especially amongst young people aged between 16 and 24. Drugs are increasingly available, with young people finding it easier than ever before to track down their drug of choice; research also shows that children are being offered drugs at an earlier age than ever before.
Each year, drug abuse costs the NHS millions of pounds and over 140,000 people receive treatment for drug misuse in this country each year.
Drugs and the Law
Drugs are classified according to how dangerous they are (Class A are the most dangerous); the Misuse of Drugs Act classifies drugs as follows:
Class A: heroin, cocaine, ecstasy
Class B: cannabis, amphetamines (such as speed) and barbiturates (powerful sedatives)
Class C: ketamine, tranquilisers and GHB (gamma hydroxybutyrate)
Penalties
The penalties for being caught in possession of drugs or dealing drugs are extremely severe and may include lengthy stays in prison. Sentences for dealing are usually much stricter than those for possession; dealing a Class A drug could lead to a life sentence.

(LondonHealth, 2010) http://www.londonhealth.co.uk/drugs/ Barrier to healthcare drug users
. no fixed abode
.they use drug in hidden
.

The United Kingdom has the highest level of dependent and recreational drug use in Europe. The drug problem has steadily worsened over the last 25 years; heroin use in England has increased from a recorded 5,000 people in 1975 to 281,000 in 2006.

Camden has a high prevalence of drugs misuse. Camden’s estimated prevalence of crack and/or opiates use is the fifth highest in London. There are an estimated 26 problem drug users (PDUs) per 1,000 Camden residents aged between 15-64. Camden also has the highest rates of injecting drug use in London – 43% (1,872) of estimated drug users are thought to be injecting. Reasons for such high prevalence are likely to include a young and mobile population, high levels of deprivation, mental illness and homelessness (all of which are associated with drug misuse)
(NHS Camden, 2010) http://www.camdendata.info/AddDocuments1/Camden%20treatment%20plan%20strategic%20summary%20-%20Adult%20drug%20misuse%202010-11.pdf Residents in the north of the borough experience very high levels of deprivation as compared to other parts and this is reflected in the high proportion of drug users in the north compared to more affluent parts of the borough. Although problematic drug use is highest in the North (W10) of the borough, Earl’s Court (SW5) and West Chelsea (SW10) also have higher than average proportions of problematic drug use compared to theborough as a whole.
( substance misuse, 2010) http://www.rbkc.gov.uk/pdf/Chapter%209%20Substance%20Misuse%20new.pdf

Cannabis is associated with an increased risk of cancer, possibly higher than smoking tobacco alone due to the concentration of carcinogenic chemicals in cannabis. Cannabis can also cause a range of mental ill health, from short-term anxiety, depression and paranoia to more serious psychosis. If smoked with tobacco it can lead to nicotine addiction.

Cocaine is a highly addictive stimulant which acts on the central nervous system. Crack Cocaine is cocaine that has been neutralised by an acid to produce a hydrochloride salt resulting a rock-like crystal which relapses vapours when heat that are smoked. Both cause the coronary arteries to constrict, raising blood pressure and reducing blood supply to the heart, which can result in heart attacks and seizures. When Cocaine is mixed with alcohol, a third substance cocaethylene is produced which increases the toxicity of both substances and increases the risk of sudden death.

Heroin is a highly addictive opiate made from morphine which slows body functioning and reduces physical and psychological pain. It can cause respiratory depression, and overdose is often fatal.

London has the largest open drugs market in Europe and self reported drug use is higher in the capital ( 11.2%) than England as a whole (10.5%). Class A drug use is significantly higher in the capital with 4.1% of Londoners saying they have used cocaine in the past year compared to 2.4% across England and Wales. Within London there are significant differences in the prevalence of drug use. The eight inner London boroughs (Camden, Hammersmith and Fulham, Islington, Kensington and Chelsea, Lambeth, Lewisham, Southwark and Westminster) have higher rates (1.7% compared to 0.40%) in the four most outer boroughs of Harrow, Hounslow, Ealing and Brent.

There are an estimated 4810 PDUs in Southwark and 89% of use crack and 71% use heroin, demonstrating that poly drug use is the norm in Southwark. Using the Office of National Statistics 2008 midyear population estimate of 278,000 residents this gives a problematic drug user prevalence in Southwark of 1.73%. Prevalence of problematic drug use in Southwark compared with rates in Inner and Outer London Prevalence of Problematic Drug Users with 95% Confidence Intervals

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3.0

2.5

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1.5

1.0

0.5

0 Outer London Inner London Southwark Area

(JSNA, 2009) http://casouthwark.org.uk/sites/default/files/images/Substance%20misuse%20JSNA%202009.pdf INTRODUCTION
Southwark is a densely populated, geographically small and narrow inner London borough that stretches from the banks of the River Thames to the beginning of suburban London south of Dulwich. The population is relatively young, ethnically diverse, with significant contrasts of poverty and wealth. Southwark's population is estimated at 285,600. In terms of numbers this makes Southwark London's second largest inner London borough, just behind Wandsworth. Southwark's population has increased by 37,700 over the last 10 years (ONS Mid‐1991 Population Estimates) and is estimated to increase by 37,500 (13%) between 2010 and 2020. 80% of the population is under the age of fifty with a large proportion of the population aged between 20 and 45.
(Southwark JSNA, 2012) https://www.southwarkstats.com/public/download/DIRECT/D0002/SouthwarkJSNAExecutiveSummary.pdf Barriers to accessing primary care include convenience (access), apathy, procrastination and “self-medication”. Drug users are more likely to report physical health complications at an Accident & Emergency department (AED) than at a GP practice.
https://peerj.com/preprints/108.pdf