Choosing_Health,_Health_and_Social_Care

Choosing Health In the early days of the current government there appeared to be a high commitment to public health, this was evidenced with the appionment of the minister for public health (Baggott 2000). However, as with many former governments, policies aimed at improving public health are often embedded in rhetoric rather than reality as evidenced in the continued, rising tax demands placed upon the public to fund national health and welfare services. In addition, as older adults in society live longer, and the health gap between the affluent and less affluent increases, demands on health services are escalating, however with growing demands and pressures on the government, spending on public health has increasingly been constrained and under prioritised (Wall& Owen 2002). In order to serve public health better there was a need for a more holistic, as health interventions only focussed on acute and chronic conditions, rather than a wide range of, issues affecting public health. The White paper Choosing Health (2004), was borne out of a desire to re-establish the NHS as a service that promotes health and prevents disease instead of treating the consequences (DoH, 2004). The paper details government plans to initiate the required action to encourage and enable individuals to make healthier choices and provides a set of principles to support people in making lives healthier. Examining the political approach adopted within the paper is essential in understanding the changing paradigm of the public health agenda. Government public policy is already captivating action through society to tackle the causes of ill health and reduce inequalites.The Choosing Health white paper (2004) was published to enable people to organize the health agenda for the future. The paper contains policy information and publications relating to commitments made by the white paper, the choosing health agenda is the beginning point for national renewal for changing health of the people in England through pratical acceptable action. Some of the actions set out an immediate change, but in other areas, considerable changes will only be observed over a number of years through sustained action (DOH 2004). The targets are set out in order to choose health and tackle health inequalities with the help of new ideas and action from experience. However, the fundamental aim of the Choosing Health paper (2004) is to develop a society where more people especially those in the deprived and bottom ends of the social scale are encouraged and enabled to make healthier choices and improvements in health are made faster in those marginalised excluded areas. Choosing health (2004) sets out how services will work to give more opportunities, support and information, and how the Government and services will provide information about a persons health information; practical support will be provided by the government so that every citizen will be motivated and develop emotional well-being; easy access will also be provided to services, the main aims are to inform and support people as individuals, and help to shape the commercial and cultural environment they live in so it is easier to choose a healthier lifestyle (Dowler & Spencer 2007). It may be argued that with the publishing of Choosing Health (2004) that this indicated a return to upstream positions and considerations. However when looking at the strategies that followed it can also be argued that Choosing Health (2004) is a strategy the government were forced into as the political equilibrium shifted between interventionist and laisse faire approaches; essentially the Government became more entwined in societies health and NHS policy, driven by the NHS and its growing need for attention (Ham 2004). However health services have seen a significant improvement after 1948 after the establishment of the NHS which paved the way for free universal immunization, screening and treatment for ill health and premature death (Wall& Owen 2002). Public health got a new face which was based on something that was done for the population for their own good; rapid improvements were made on the big killers such as for infectious diseases however more ‘inter-actable’ issues such as cancer and coronary heart diseases came to the front. Similarly Choosing Health (2004) makes allowance for the heterogeneity of health; in others health (or poor health) is not longer seen as homogenous in that society all has the same needs and requirements as in the Beveridge era. The responsibility for promoting health has moved from the government or the NHS to the individual, this in itself has many implications for change in the future, which calls for innovative approaches to its delivery. (Taylor&Field 2007). The White paper ‘Choosing Health’ (2004) outlined their agenda as being fundamentally about a shift in approach from tackling illness to promoting or maximising health potential (DOH 2004).To affect this change the government proposed a strategy of empowering people towards making better choices, which would be supported by moves to deliver a more individualised and person centred care (DOH 2004).The White paper also represents a shift refocusing the empathise on improving health through individual action to make healthier life choices, by tipping the balance away from government led interventions. Hunter (2005) argues that the governments thinking about public sector reform has significantly moved in the direction of market style solutions based on the exercise of choice and personal engagement in determining the outcomes (Hunter 2005:1010). The priority areas identified by the white paper ‘choosing health’ (2004) are smoking, obesity, diet and exercise sexual health, alcohol and mental health (DOH 2004). However getting the right balance between state control and personal responsibility is a challenging issue, that has been at the centre of health promotion since the 1980s,the balance between rights and responsibilities is a further issue that is addressed by the ‘white paper’particulary where individuals rights impinge on those of others Choosing health (2004) proposes greater control when the choices and actions of some groups have damaging consequences for others(DOH 2004). There as also been the need for the government to move away from the command and control approach, this was started with the movement towards contracting out services and the contract culture that has emerged with market forces being seen as a way of introducing effiency onto the NHS (Taylor&Field 2007:236). The fundamental aim endorsed within the white paper is that of informed choice, and individuals right to make their own choice, thus the notion of free choice can be illusory particularly in disadvantaged communities where life choices are severely constrained (Dowler & Spencer 2007:60).There is some acknowledgement within the white paper pointing out that economic status and social disadvantage limits and restricts choice. it could be argued that it would be preferable to adopt a more upstream approach in tacliking poverty and deprivation head on rather than their consequences (REF).Although the ‘choosing health paper acknowledges the need to focus on tackling inequalities it isn’t one of the core principles, in essence the governments aims to reduce health inequalities is not by tackling the wider determinants of health but by promoting choice, with the main aim is to encourage and enable disadvantaged groups to make healthier choices(Dowler&Spencer 2007). | |