Level 2 Certificate in
Health and Wellbeing
Figure 1.3: Determinants of health and well-being adapted from Dahlgren and Whitehead (1991).
Determinants that have a negative impact on health
There are many social and environmental risk factors and lifestyle behaviours that negatively affect health and
well-being and offer a risk to health status. Some of these are listed in table 1.2 (Labonte. 1998).
Table 1.2: Risk factors and behaviours that negatively influence health and well-being
Psychological Behavioural Physiological Social and Environmental
Lack of social support
Poor social networks
Low social status
Low perceived power
Loss of meaning or
purpose in life
Release of stress
Crime (Murder, rape, theft,
property damage etc)
War, riots, terrorism
Poor nutritional intake
Steep power hierarchy
within a community or
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An average bottle of wine used to be around 9% alcohol by volume (ABV) with six units in a bottle, but now
it is more likely to be double that volume at around 13.5% or higher and may contain at least ten units. The
same applies to beers, lagers and ciders; the latter of which is also cheaper. The impact of this is that many
people are unwittingly drinking in excess of the recommended guidelines and increasing the risk factors for
their health (Lawrence and Bolitho. 2011). For example:
• A pint of high-strength lager (strength 5.2%) = 3 units.
• A standard can of lager, beer or cider (strength 5%) = 2 units.
• A standard glass of wine (175ml, strength 12%) = 2 units.
• A small measure (single shot) of spirits (25ml, strength 40%) = 1 unit.
Drinks of Britain
Figure 2.3: Alcohol content and units in popular drinksUnits. They all add up.
Pint cider: ABV 5.3%
red wine (125ML): ABV 12.5%
SAMBucA Shot: ABV 42%
BottLe LAGer: ABV 5.2%
ALcoPoP: ABV 5%
hALf Pint cider: ABV 5.3%
SinGLe Gin & tonic: ABV 40%
douBLe coGnAc: ABV 40%
chAMPAGne (175ml): ABV 11.5%
douBLe whiSky & coke: ABV 40%
hALf Pint LAGer: ABV 5.2%
Pint Bitter: ABV 5%
ALcoPoP: ABV 5%
PiMMS: ABV 25%
douBLe whiSky: ABV 40%
Excessive intake and use of alcohol is linked as a contributory factor for many accident and emergency
hospital admissions, a number of health conditions and other causes of morbidity, including:
• cirrhosis of the liver
white wine (175ml): ABV 13%
Pint LAGer: ABV 5.2%
• cardiovascular disease 2.3 UniTs (coronary heart 3 UniTs disease and stroke)
• weight gain
• depression and anxiety
• stomach ulcers
• various cancers (mouth, throat, liver, breast)
• risk of falls (in older adults)
• house fires
• car accidents
• domestic violence
• crime-related deaths (murder).
BottLe of wine: ABV 13.5%
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Physical activity recommendations in weight management
The CMOs report ‘Start Active, Stay Active’ states that reaching guidelines will bring significant health benefits
for all, but for those who are overweight or obese achieving a healthy weight is likely to require a greater level
of activity than the 150 minutes recommended. Any programme of increase physical activity should also be
accompanied by dietary changes to reduce calorie intake.
Guidelines for early years
Children under five have now been included in the CMOs’ guidelines, which reflects concern over the levels
of habitual physical inactivity and sedentary behaviour among young children. Key points to note regarding
this group are:
• Children of school age who can stand and walk need opportunities to play that will allow them to
develop fundamental movement skills and master their physical environment.
• Physical activity, especially in the form of play, is a basic and essential behaviour that must be encouraged
in the first five years of life, while sedentary behaviours should be limited.
• Children also need the freedom to create their own opportunities for active play, lead their own activities,
direct their own play and engage in imaginative play.
• Physical activity mainly comprises unstructured, active play and learning locomotor, stability and objectcontrol
Typical activities providing health and developmental benefits
Active play: activities that involve movements of
all major muscle groups, i.e. the legs, buttocks,
shoulders and arms, and translocation of the trunk
(movement of the trunk from one plane to another).
Development of locomotor, stability and objectcontrol
• Climbing frame or bike riding
• More energetic sessions of activity, e.g. running
and chasing games
• Water-based activities
• Running, jumping, hopping, galloping and
• Balancing, riding and climbing
• Kicking, catching, throwing, striking and rolling
• Dance, gymnastics or water-based activities
• Walking/skipping to shops, a friend’s home, a
park or to and from a nursery
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Reduces inhibitions (including fear, a safety
User becomes more chatty and talkative.
Affects judgement and reduces the speed at
which information can be processed.
Can affect visual and auditory senses (seeing and
Numbs physical pain.
Emotions tend to become exaggerated, i.e.
everyone becomes the person’s best friend or
maybe their worst enemy (aggression).
Movements become uncoordinated.
Balance may be affected (depending on the
quantity of alcohol consumed, the person may
be unable to stand or walk), their speech may be
The blood vessels relax and dilate increasing
blood flow to the skin and tissues.
Blood pressure lowers.
Heart rate increases to compensate for reduced
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Effects of Alcohol Misuse on the Body
Headaches, Blackouts, Delusions,
Paranoia, Forgetfulness, Impaired
Judgement, Decline in IQ, Dementia,
Epilectic fits, Wernickes disease (due
to vitamin deficiency), Haemorrhage,
Peripheral neuritis, Korsakoff’s
psychosis & Death
A small amount of alcohol escapes unused
via the breath 2-4%
Fatty cells, tissue scarring jaundice,
hepatitis, irreversible cirrhosis- the liver
breaks down 90% of alcohol consumed.
A small amount of alcohol
escapes unused via urine
Bad digestion, malnutrition,
A small amount of alcohol escapes unused via
Depressed testicular production, impotence, breast
growth due to female homones not brown down by liver
Peripheral neuritis- degeneration of the
nervous system supplying limbs
Pressure on portal circulation- risk of
haemorrage. Increased incidence of
cancer- 40x if smoker
Corrosive effect- risk of cancer
Degeneration, weakness, pain
Weak & ‘fatty’ heart, weakening
of heart muscles, high blood
pressure. Anaemias due to
decreased absorption of vitamins
Gastritis, peptic ulcer
(direct corrosive effect)
Pins and needles
Inflammation (corrosion from alcohol)
Malfunctions, shakiness, tremors
Degeneration- risk of fracture
Failure to ovulate, spontaneous abortion
Physical and emotional effects of withdrawing from alcohol
Not all drinkers experience withdrawal symptoms when they stop using alcohol, but for those who do, the
experience is very unpleasant. Withdrawal symptoms mostly affect people who are highly dependent on
alcohol. Alcohol dependent drinkers will sometimes have a drink to avoid experiencing these symptoms,
which is known as ‘relief drinking’ (Alcohol Concern, 2010).
Withdrawal symptoms usually commence three to six hours after the last drink and can last for up to a
week (Davies, 2009). They are relieved when alcohol is consumed. Table 3.1 summarises the physical and
psychological withdrawal symptoms.
Physical symptoms include:
• hand tremors (the shakes)
• convulsions (Grand mal).
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Figure 1.2: Map of health inequalities in England
Smoking is more common in
Wales (24%) and Scotland
(24%) than in England (19%).
Smoking rates also vary by
region in England. The map of
health inequalities (figure 1.2)
reflects where the higher rates
of premature death, linked
to socioeconomic status and
incidence of smoking, can be
found. For example, smoking
prevalence was higher in
Yorkshire and the North West
(both 21%) than it was in
London (16 %).
Smoking is the leading cause
of preventable disease and
premature death in the UK.
Over 100,000 people die
annually in Britain as a result
of smoking. This equates to
18% of all deaths in adults
aged 35 and older.
Revenue earned from tobacco tax
In 2011-2012, the Treasury received £9.5 billion in revenue from tobacco tax (excluding VAT). Including VAT
(at an estimated £2.6 billion) total tobacco revenue was £12.1 billion. This is equivalent to around 2% of total
Government revenue. The price of a pack of 20 premium brand cigarettes currently costs around £7.45, of
which £5.80 (78%) is tax.
According to the Office for National Statistics (ONS) ‘Consumer Trends’ report, the total UK household
expenditure on tobacco has more than trebled from 1980 to 2011. In 2011 £18.3 billion was spent on
tobacco. Tobacco smuggling costs the treasury and, although it is estimated to have dropped since 2008,
it is estimated that smuggling of illicit cigarettes accounts for 10% of the market (about £1 billion tax loss
annually). Smuggling is far higher for hand rolled tobacco and is estimated to account for almost half of the
loose tobacco smoked in the UK.
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Section 3: Key components of tobacco products and their
effects on the body
Substances and chemicals found in tobacco products
It is frequently cited that over 4000 different chemicals are found in tobacco smoke. One research study
(Rodgman and Perfetti, 2009) found 7357 chemical compounds. The content of each cigarette varies slightly
by component, but there are likely to be over 7000 different chemicals in a cigarette. Of these chemicals the
number quoted to be carcinogens also varies (from 40-70) depending on the source of information.
Tobacco smoke is a complex chemical system comprised of gas and particulate components, the mixture of
chemicals in each phase varies according to the way a cigarette is smoked. Some of the chemicals and their
other uses are neatly summarised in figure 3.1.
Figure 3.1: Some chemicals in tobacco smoke and their other uses
Effects of nicotine on the body
Nicotine is the main drug compound found in tobacco. Nicotine is an alkaloid compound; a type of chemical
often found in plants as a natural defence against being eaten by insects and mammals. Once in the human
body, nicotine mimics the common neurotransmitter chemical acetylcholine giving it a psychoactive effect. It is
this same effect which makes it highly addictive. All of the nicotine inhaled in a puff of smoke can be absorbed
across the lung fluid membranes into the blood. The nicotine passes into the bloodstream and reaches the
brain within seconds of inhaling the smoke.
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