Debates in Contemporary Health in the UK - a Socioeconomic Perspective - Essay Example

Exploring and analyzing concepts and debates in contemporary health in the United Kingdom: A Socioeconomically perspective Introduction The issue of public health in contemporary Britain is a misnomer. Britain is now healthier than ever before as the life expectancy has increased and some of the life threatening killer diseases has taken a retreat due to the public health and advances in treatment. But, at the same time the problem of health inequalities remain a issue in the amidst of the observation that the general health of the population is improving. This is due to the reason that the health of the least and the less well offs either improve very slowly than rest of the population or in some cases goes quite worst leading to the problem of health inequality. This issue is challenging for the physicians and the care givers. It also suggests the fact though the UKNHS policies and interventions really strive to reach each and every people but they also fail in some specific sections of the population. In this article the conceptual problems leading to this discrepancy of policy and manifestations are elucidated and discussed.(Unal,2004) Though there has been literature regarding the issues there has been very little work done as to how to improve from this issue. The Health Development has the task of developing the evidence base in health to inform policies and practice to reduce inequalities. The HAD has done reviews on issues like low birth weight, social supports in pregnancy, prevention of drug abuses, sexually transmitted diseases and HIV, physical activities , injury prevention. Management of obesity and lifestyle diseases but the Geriatric problems has been undermined in this issue. In fact the HAD reviews implicated that the dimensions of social positions and social differences such as ethnicity, disability, gender, age , place and geography was though not been explicitly denied as important but are underdeveloped empirically and theoretically. Thus the question of social work requires much more prominent role in policy making in health planning services. Magnitude of Social Inequalities In Britain social inequalities has been evaluated by occupations. The occupation of the male head household was used to determine social class positions of all the members of the society including the aged population. Hence in the mind of policy makers the women were thus not distinguished for the social class positions and hence their was little allowance for kinds of social difference other than the occupation of the male head to determine for the health inequalities. Though the society has changed with the women and the geriatric population actively been employed, the decline of manual work that has taken place but the policy makers abide by the earlier rule of occupation based data capture for formulating policies. There are a number of factors of social differentiation in modern Britain like ace, sexuality which should be the separate dimensions for addressing inequalities. Earlier research has suggested that in other countries racism and cofactors have been an issue for social determinants of health and they are more disadvantaged than the wider population. Factors like discrimination in these countries have also crippled them to the menace of health inequalities. This evidence should be considered in any country and the dimensions should be assessed and predicted to understand the health penalty of social inequality. Social Gradients and Exclusion The evidence on the links between the socioeconomic status and the and their health has generated 2 kinds of policy responses. Firstly the poorest circumstances and the poorest health is related, amongst the most socially excluded, those with most risk factors and difficult to reach ones.tis parameter is important in linking health inequalities to the social exclusion agenda and thus focusing on policies at the community levels. As per the policy intervention terms this leads to lift the worst out off extreme situations in which they found themselves. If effective also it will benefit a very niche fraction of the population. In case of the second approach it reveals that those are in poorer circumstances are in the poorest health. This means that not only the poorest groups and communities who have poorer health than those in the most advantage positions. There are large number of people who may not be defined as socially excluded are relatively disadvantaged in health terms like the aged population. Prevention and other interventions could be useful in providing major improvements in their health and as a consequence will provide proportionate savings in the national health care systems. Selection of Health Determinants For the first time in the history of Britain health equity is placed along the health gain as the core objective of the public health policy. The present goal is to improve health and reduce health differences between groups occupying unequal positions in the society. addressing the determinants is the key for achieving the 2 goals of promoting health and addressing the health inequlities. Determinants of health was earlier wrongly put as an investment in research and lessspending to treat the root cause of the disease. So the debate will focus on the major non genetic and non biologic influences on the health. This will include concepts like smoking and all other wider determinants and the healthcare services are also included for the discussion. (Mulvihill,2003) Health and well being are impacted by various factors including past and present behavior , healthcare system and the wider determinants. Public health policy has recognized the growing importance of the wider determinants of health which includes income, housing , lifestyle. Much of the Government policy will now seek to address these issues which have been traditionally outside the health domain. A general classification of the list of wider determinants are useful in identifying their important influences on population health but they cannot explain hoe these determinants and the individual risk factors are linked in connection to a persons life. To address the key determinant that is the social position should be considered which the hierarchical position around which is the axes of differentiation pivots. Most of the health researchers now regard that the social position as the fundamental cause of health. This is because this pivotal link in the causal change through which the social health determinants connects to the peoples health. So it marks the societal level factors such as the structure of the occupation market and the education system that influence the peoples live and thus influencing the extent to which the risk factors that directly affects the workplace hazards, poor diet and unhealthy environment. As because the social position mediates both their access to the societal resources and their exposure to risk it has a great correlation with health over time and across different diseased states. Environmentally transmitted infectious diseases have given way to chronic diseases in which behavioral aspects play a larger role but the socioeconomic gradient has been endured. In present context deaths with very different causes and age profiles like accidents and coronary heart diseases continue to manifest. Studies have revealed how a adults socioeconomic position is powerfully directed by the socioeconomic position of their parents so the evidence of family background has become more important for future socioeconomic conditions. Difference between Health Determinants and Health Inequalities While focusing on the unequal distribution of determinants is important for focusing on the health policy there should be demarcation of the total overall health benefit levels. This means that when health equity is the goal, the priority of a determinants oriented strategy will be to reduce the inequalities in major influences on people’s health. Objectives for health inequality are likely to determine to focus on reducing overall exposure to health damaging factors to formulate the range of national and local targets like living standards improvement and reduction in smoking. When the goal is to narrow health gap the key policies should be those which brings standards of living , housing, diet and local services in the poorest groups closer to those enjoyed by majority of the population and by “poor” means “sociologically poor” which may even consider the economically sound geriatric population. If the health inequality aim is to reduce the wider socioeconomic gradient in health then the policy should have the objective to lift the level of health determinants across the society towards the levels in the highest economic group. Policy evaluations and health equity audit has been primarily concerned with the impact of newer interventions targeted at poorest communities. The impact of these important initiatives will be influenced by the wider policy environments with the other policies amplifying or moderating their progressive effects. Tackling the determinants to health inequalities should be the Governments commitment. Health Gaps, and Health Gradients and Health disadvantages in health inequalities National policy documents suggests that goal of greater equality in health has been interpreted in a number of different ways. This means tackling health inequalities should address to improve health of the poor and reducing the health differences between the poor and the better offs and lifting up the levels of health across the socioeconomic hierarchy closer to the top. Defining health inequalities as the poor health of the poorer people has the important advantages on policy a. It will direct the focus to the groups and communities who have lost in general rise in the living standards and life expectancy b. It sets the clear goals and the criteria for the monitoring and the evaluation c. It aligns the health equity policies with the policies to promote the social inclusions and to regenerate the communities and driving them to the interventions to improve the life chances and health opportunities of the poor group.the targeted groups than can be defined in the spatial terms using area based measures of disadvantage by their household circumstances or through markers of individual vulnerability like being a care leaver. Thus it is must to have an effective policy Effective policy is one which achieves positive changes in the targeted outcomes in the disadvantaged group, in their predisposing social conditions, in their intermediate risk factors and on their health. Policy monitoring evaluations can thus be limited to to disadvantaged populations to which the recipient belongs by using a case control design to compare outcomes in a similar group without the policy intervention and measuring changes in the recipient group against the broader population trends. While offering policy advantages defining the health properties of populations has limitations because it conflates inequalities and disadvantage. This is two important social implications. a. While the goal of improving health includes everyone the goal of reducing health inequalities reaches only a minority b. Better health of the poorest can be associated with the widening health gap between them and rest of the population. In a society where the rates of health are improving more quickly in the better off groups improving the health of the worst off ca leave them slipping further behind than those at the top of the social ladder. So this is the reason the Governments vision of narrowing health inequalities turns not only on absolute improvements on health of the poor groups but rather on a determination to narrow the health gap between the worst off in the society and in the better off. (Millward,2003) Narrowing Health Gaps As we learn that the health inequality is a gap between the health of the best off and the worst off , narrowing means to improve the health of the poorest and doing so at a rate that outstrips the wider population. The important policy goal of this are a. I focuses the attention on the overall gain in health have been at the cost of persisting and widening the inequalities between the socioeconomic groups and the areas b. It will help in target setting with Englands health inequality targets seeking to close the health gap between the disadvantaged groups and the population as a whole. c. It provides a clear criteria for monitoring and evaluation. “ An effective policy is the one which achieves both an absolute and relative improvement in health of the poorest groups( on their social conditions and in the prevalence of the risk factors). Analysis of the policy impact therefore still require data on absolute changes in the targeted outcomes among those worst off groups. In addition information is required on absolute changes in the targeted outcomes among those with whom they are being compared , example includes amongst the high socioeconomic groups or among the population as whole. Such information is needed to estimate whether the rate of improvement in disadvantaged group is greater than that in the comparison group , a faster rate of improvement is the essential criterion of effectiveness when narrowing gaps is the policy goal.(Ellis,2004)(Hilldson,2004) Focusing on the health gaps can limit the policy vision due to the following reasons: a. Problem and the policy response are confined to the small proportion of the population b. The life expectancy target is aimed at the 205 areas with the lowest life expectancy and the infant mortality targets include around 40% of births but it has been criticized for not focusing on the disadvantaged group with the worst health problems and outcomes c. It can encourage perspectives which identify the lifestyle of the disadvantaged groups as the cause of health inequalities . Much les attention is given to the privileges enjoyed at the top of the socioeconomic ladder which facilitates the rate of health improvements and have outpassed those of the other socioeconomic groups.(Bull,2004) d. It can obscure the pervasive effects which the socioeconomic inequality has on health not only at the bottom but across the socioeconomic ladder. Reducing Health Gradients. The penalties of inequalities in health affect the whole social hierarchy and usually increase from the bottom to the top. Thus if the policies only address those at the bottom of social hierarchy inequalities in health will again start to exist. Perspective of the Debate and WHO dictum Tackling the health gradients is in line with the international health policy. The founding principle of the WHO was that the enjoyment of the highest standards of health is the fundamental human right and should be within the reach of all whwther socioeconomical, ethical, or on gender based differentials. So thus the health facility enjoyed by the best off should be extended to the worst offs also. A focus on socioeconomic differentials rather than on the social disadvantages widens the frame of health inequality policy a. It is an inclusive goal improving the health of poor groups and narrowing the health gaps are necessary but not sufficient to the level up health across socioeconomic groups which means the policy objectives should be pursued in tandem b. It directs attention to the majority of the population and to those groups lying at the top of the ladder on one hand and the bottom on the other hand. While the health in these intermediate groups is better than amongst the poorest groups their compromised health makes a larger contribution to the toll that socioeconomic inequality affects health of the population. c. The effects of the policies to handle these health inequities should therefore be extended beyond those in the poorest circumstances and the poorest health.(Bunker,2001) d. It locates the causes of health inequality not in the disadvantaged circumstances and health damaging behaviours of the poorest groups but also in the systemic differences in the life chances living standards and the lifestyles associated with the peoples unequal positions in the socioeconomic hierarchy.(Capewell,1999) Thus to Reduce health gradients –monitoring of policy impact should be envisaged. Assuming that health and living standards for those at the top of the economic ladder continue to improve an effective health policy will be the one one that will meet two important criteria a. Improvements in the health or a positive change in its underlying determinants for all the socioeconomic groups upto the highest group achievable b. The rate of improvement which increases at each step down the the socioeconomic ladder. This means in other words a differential rate of improvement is required, greatest for the poorest groups and rate of gain progressively decreasing for the higher socioeconomic groups. The policy goal of addressing health inequities has separate meanings. Each will add a further dimension to the policy challenge. Improving the health of the poorest is the goal in line with national trends. Narrowing health gaps and reducing the health gradient both require a reversal of the trends evident for the major dimensions of health such as life expectancy. References Bunker, J. (2001). Medicine matters after all: measuring the benefits of medical care, a healthy lifestyle, and a just social environment. London: Stationery Office/Nuffield Trust. Bull, J., McCormick, G. Swann, C. and Mulvihill, C. (2004). Ante- and post-natal home-visiting programmes: a review of reviews. London Health Development Agency. Capewell, S., Morrison, C. E. and McMurray, J. J. (1999). Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart81: 380-6. Ellis, S. and Grey, A. (2004). Prevention of sexually transmitted infections (STIs): a review of reviews into the effectiveness of non-clinical interventions. London: Health Development Agency. Hillsdon, M., Foster, C., Naidoo, B. and Crombie, H. (2004) The effectiveness of public health interventions for increasing physical activity among adults: a review of reviews. London: Health Development Agency. Millward, L. M., Kelly, M. P. and Nutbeam, D. (2003). Public health interventions research: the evidence. London: Health Development Mulvihill, C. and Quigley, R. (2003). The management of obesity and overweight: an analysis of reviews of diet, physical activity and behavioural approaches. London: Health Development Agency. Unal, B., Critchley, J. A. and Capewell, S. (2004). Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation109: 1101-7. nutritional interventions. London: Health Development Agency. the effectiveness of interventions to reduce the risk of sexual Read More