Health Inequalities in NHS - Essay Example

HEALTH INEQUALITIES IN NHS Introduction The National Health Service (NHS) was founded on fifth July 1948 so as to provide health services to citizens of the UK. The system provides healthcare to all legal citizens of England. The money to pay for NHS originates from taxation. The principle holder of NHS funds is the Primary Care Trust (PCT). PCTs usually disburse funds to these bodies on a fixed rate or agreed contract, through the guidelines set by the department of health. The allocations of PCTs are highlighted in the operating framework of NHS to cover the expenditure review period; they get information from a need-based formula that provides equal access level to health services for the population at the same risk, so as to prevent or minimise avoidable risk. The health department is the one that allocates resources to the NHS. The NHS develops a formula for distributing the funds to the neediest PCTs. Many of these PCTs do not receive their full allocations, hence, the need for the quick action by the government so as to ensure that PCTs receive the right amount it requires. Health inequality has become a key issue in England. The heath department is responsible for resource allocation to the NHS. Despite the improved health of all groups of people in England, health inequalities between social classes have widened by a bigger percentage over the recent years. The rich people’s health is improving at a drastic rate as compared to that of the poor. Health inequality is not only among the financial social classes, but also exists amongst the elderly, the mentally ill and those with disabilities. All these groups of people have been found to receive worse health services than the normal population (Earle and Sharp, 2007). Causes of health inequalities The causes of health inequalities are normally complicated or intense they may include mostly lifestyle factors such as nutrition, exercise among others and also broader determinants such as housing poverty, education to name just a few. How ever there are those inequalities that are UN avoidable. These originate from three broad variations: the quality of health services, access to health services and services beyond the control of health systems, for example, wealth lifestyle, (Bourdieu 1999), genetics (Earle and Sharp, 2007)among others. It is evident that most population suffering these health inequalities does so in all the three accounts, they access poor health services moreover they suffer external disadvantages. A poor quality health service for the disadvantaged population is mostly a management problem. The right amount of funding is usually spent on the less advantaged population, but the mode of spending is the issue. The money is not being spent wisely. This may be due to the fact that the local service organization is poor, or some providers are not up to standard, therefore, the quick remedy for this is the rectification of the management actions. Poor access healthcare by the less advantaged population implies that they do not receive some health services that the rest of the population access. The most fundamental challenge faced by the health system is the poor access to life chances. Health inequalities sometime evolve from long time exposure to some sources ,for example, once income, the genetic, welfare service variation in utilization of health. However if, NHS is to handles the inequalities it should put more emphasis on the affected group in a unique way. These may include offering such populations particular preferences of NHS services these may include access to surgery, access to therapies, in so doing some polices may be abandoned. Types of health inequalities In the health system, inequalities exist from determinants to outcome. They include: Socio- economic and environmental factors, these include income housing employment and education. In a study, the proportion of infants born yearly with low birth wait depends on the Socio class of the father .8% of babies born to manual social background men suffered low birth weight in comparison to 6.5% of babies from fathers who were not from that social class. Another factor is the lifestyle and health behaviours related to health like consuming alcohol and smoking. Between 2006 and 2008 prevalence estimated between local authorities and ranged from 10.2% at Chiltern, to 35.3% in Blackpool. Access to health services is another form of inequality a survey [maternity survey 2006] established that women from a minority group in England accessed earlier the antenatal much earlier than white women (Weidner and Cain, 2003, p. 769). Health inequality may also arise as health outcomes. These may include the difference in death rates diseases and life expectancies. For example, the people living in less advantaged areas have a shorter life span and also spend a bigger percentage of their life in disability. The health expectancy in England for the population living in poor areas is 17 year lower than for those in rich neighbourhood.[ In England, inequality is one of the immense challenges faced. In 2010, the government, set up a commission to Address the way forward to combat these inequalities. The commission urged the need for specific national strategies to deal with the health inequalities and so as to overall good health. So as, to tackle inequality and lower the height of the social gradients the Marmot review [2010] addressed the need for sufficient scale actions and intensity not only to be universal, but also to be uniformly targeted. These strategies should target the lower side of the gradient and the overall society al large based on the degree of disadvantage. Apart fro being an issue of social justice and fairness, the goal of health equity would result to both social and economic benefits. These include increased productivity, low welfare and health cost, and improvement in income. The review suggested various indicators that would assist in overall monitoring of the implementation of strategies to reduce health inequalities. It put forward indicators that link to the social inclusion and health output and the development of children across social angle. Some of the indicators suggested were to support the supervision of the strategic direction to lower the heath inequalities. These were meant to capture quality of health. Another indicator was to support the readiness to school which was aimed at capturing the development in early years. Another was to capture the skill development during the school years and how the young people control their lives after school. Indicators were also set to support monitoring of household income so as to acquire the percentage of household with sufficient income and living healthy. The review team produced basic figures to support for main indicators of social health determinants, health outcome that correspond to proposed indicators for a fair society and healthy lives. The government has set up other enquiries to handle the issue of health inequalities. These include the black report [1980] the Acheson report [1998] among others. These reports brought about a series of key policies that put health inequality as a national priority. The Wanless report [2004] for instance focused on the wider determinants and prevention of health and effective action that could be taken to raise the health of the entire population and reduction of health inequalities. Recently the government has put forward white papers proposing changes in NHS and the long run vision of health in England. The government has responded to the issue laid by the Marmot review on fair society, strategies to tackle health inequalities by creating a national wellness service, shifted power to local communities, revising the health improvement budgets and proving financial incentives to progressing health outcome. All these are ways the government is undertaking to ensure there are little or no inequalities in the health system. The role of NHS in tackling inequalities By providing the services targeted and enhancing accessibility to the people, the NHS can prevent health inequalities. This can be achieved through following ways: one is through effective interventions. By treating screening and intervening, to change health habits are the main tools available for tackling health inequalities. Provision of preventive anti hypertensive and cholesterol reducing drugs is some of the measures identified and promoted by the government as effective in tackling health inequalities. The government has also put across the introduction of large scale vascular screening programme. However, these methods cost effectiveness is not known and also whether their implementation will target the lower social class so that they can have the intended impact on health inequalities. Thus, the government should intervene to ensure proper implementation. By getting people to change their lifestyle is one way NHS try to minimise the inequalities. This may prove to be difficult as evidence proves that this method is not effective to the lower social economic group. How ever social marketing should be evaluated to ascertain its success. This social marketing include public advise to stop smoking, (Lader and Goddard, 2004) accompanied by referral to other specialist health promotions. The NHS should further ensure that the heavy smokers who are often from the lower social class benefit fully from these interventions compared to the others. This process will demand training of NHS staff and other parties involved. The capacity of NHS to tackle inequalities involves not only the service provider that is the primary and secondary care, but also the crucially, PCT and SHAs .they Provide a leadership role throughout the society for issues concerning health. They do this through commissioning services and maintaining public health focus. They are responsible for planning service to meet the local population’s needs and to ensure proper access. PCTs and SHAs play a central role in providing information and in the coordination of efforts to handle health inequalities. Of late this has not been the case as they are said to now be providing the proper leadership as expected. Most senior specialist, working in the organisations are said to be falling thus they are not able to meet the main objective of reducing inequality in health Another responsibility of PCTs and SHAs is provision of high quality health care access. The government has announced its motive to improve access to GP services as away to tackle health inequalities. The GPs is to be introduced to deprived areas. However, this has not yet involved expected consideration between needs and inequalities and that centralising GPs services may cause access to be more difficult to the lower social class. Primary medical care provided by the general medical practitioner [GP] e.g. Nurses play a crucial role in tackling inequalities. They provide immunisation and screening. Secondary services are also crucial in talking these inequalities in health, thus should also be addressed The NHS has a valuable role to play in the provision of leadership across all government sectors and departments to promote a unified working to handle the issue of health economics. Conclusion The government spending on National Health Services has rapidly increased since its establishment in 1948. In its yearly operation, the UK government spends approximately 10 Billon pounds. In England, growth in health expenditure has by far outdone the rise in Gross domestic product and the growth in public expenditure. Health inequalities are inevitable but can be minimised. They stem from unavoidable inequalities in the society: of education, income employment and the environment surrounding. Health in England is improving, but over time the gap between the social groups have widened. Among men, it has increased by around 4% and 11% among women. Health inequalities are not only amongst the people of different social classes, but also exist between genders, different ethnic groups among the elderly and with mental health problems or learning disabilities. These people have worse health compared to the rest of the population. The cause of health inequalities are broad and comprise of life style factors, nutrition, among others and also wider broader determinants like poverty, housing and education. The government should step-in and provide ways to reduce these inequalities this can be made possible by use of the data and recommendations provided in the various commissions and reviews on health inequalities Reference Acheson D. Independent Inquiry into Inequalities in Health. London: The Stationery Office; 1998a. (Chair) Acheson D. “Report on Inequalities in Health Did Give Priority for Steps to Be Tackled.” British Medical Journal. 1998b;317(12):1659. Letter. Berkman L, Kawachi I, editors. Social Epidemiology. Oxford: Oxford University Press; 2000. Berridge V, Blume S. Poor Health: Social Inequality before and after the Black Report. London: Frank Cass; 2003. Read More