Health_Inequalities

The issue of health inequalities has been the focus of much debate since the 1980’s. Describe the main inequalities in health with reference to social class, gender and ethnicity. Discuss the effectiveness of recent government responses in tackling these inequalities in relation to social class. “Within the health sector there has been a plethora of policies explicitly focusing on reducing health inequalities. In many cases it seems unclear how this will be achieved”. (Scott-Samuel,2004,EQUAL, University of Liverpool) The Acheson report (1998) investigated many areas where there were significant health inequalities in the UK and made 39 recommendations, although only three of these were prioritised. In this essay the aim is to look at a few examples of inequalities within the healthcare system. Gender seems to play a major role in health inequalities. It has been reported that men are less likely to access health services than women. Macho attitudes play a significant part in this, perhaps as a nation we initiate this from an early age and deter boys of making a fuss when upset or hurt. A men’s health group reported that for every £1 spent on men’s health, £8 is spent on women’s health (BBC News, May 1999). Results speak for themselves; men have a lower life expectancy, a higher suicide rate and a higher death rate from cancer than women. The Samaritans report that 75% of suicides are male (BBC News, May 1999), which once again raises the question whether this is a result of the macho attitude and men belief that seeking medical advice or emotional support is not acceptable. Drop in clinics at local pubs and sports venues have been suggested to encourage men to access health services effortlessly. Risk behaviours are more common among men. Smoking is higher and men are twice as likely to consume excess alcohol as women. Reports and studies show that most men only turn to health services when the situation is desperate or have been influenced by their partner. Therefore medical intervention is often on a larger scale than would have been initially necessary. “I believe in greater equality. If the next Labour Government has not raised the standards of the poorest by the end of its time in office, it will have failed” (Tony Blair, 1996, quoted in Howarth et el 1998 p9) Reports show that people in higher social classes tend to have greater access to health services than those from the lower social classes. Social class is usually derived by a person’s occupation, education, income, wealth and place of residence. All of these attributes tie in with each other. A good education can lead to better job prospects which tend to lead to higher disposable income which normally generates improved living standards. Diet can play a significant part in health issues, most people are aware of what is a good diet but if they are on a low income it is not always feasible to buy the correct food. Smoking is another issue that causes health problems, although this is one that research shows that people on a lower income are more likely to do. Margaret Whitehead, Professor of public health at Liverpool University stated “………….it is very much more difficult to quit if you are living in hardship and struggling from day to day”.(Whitehead, 2002, The Heart of the Matter) The Black Report (1980) reported that there were large differences in mortality and morbidity that was favoured by the higher social classes. The Archeson Report (1998) painted a very similar picture, health inequalities were determined by various things mainly poverty, housing, income, education and employment. The problems highlighted were found mainly in the lower social classes. It reported that in the mid 1990’s one in four of the total population in the UK was living in poverty. Education was highlighted as a major key by the inquiry team; they recognised that it could play an important part in reducing health inequalities. By educating children it would help them gain the knowledge and skills to live a healthier life. They also recommended introducing additional resources for schools in less well off areas. The main differences in the two reports were that the Black Reports recommendations were costed whereas the Acheson Report’s were not. “It is completely unacceptable that in modern Britain your chance of a healthy life depends on your ethnic background and your income” (Yvette Cooper- Public Health Minister, BBC News 13/6/2000). Ethnicity can be a significant cause in health inequalities. The most obvious are of course the language and cultural barriers. It has been reported that “By the age of five, ethnicity already appears to have a significant impact on a child’s health, behaviour and cognitive abilities” (Easton, BBC News, 19/10/08). There are major differences in children starting school at the age of five from difference ethnic backgrounds. One of the differences was mental development, this could be slower due to parents speaking English as a second language or maybe not at all and having difficulty in reading and helping their children with homework or for some being uneducated themselves. Dietary differences also has an impact on health, it has been reported that black children are three times as likely to be obese than as a classmate from an Indian background and twice as likely as a white (Easton,BBC News,19/10/08). Until 1991 ethnic origin was not collected in census information or in any official statistics so information was very limited. Figures from the Census 2001 suggested that 40% of Londoners belonged to a black or minority ethnic group (lho.org.uk) hence the requirement for diverse healthcare in the UK. Although the reporting of health inequalities within the ethnic minorities has often proved difficult as far as detailing language, religion, culture and residential status. “The health inequalities … are not only unjust condemning millions of men, women and children to avoidable ill-health, they also limit the development and the prosperity of communities, whole nations and even continents. And so the challenge ahead is not to draw back from our ambitions but to make them more urgent” (Gordon Brown, Prime Minister, Guardian News, 7/11/08) The Saving Lives – Our Healthier Nation White Paper was published in 1999, it was an action plan to save lives and promote healthier living along with reducing health inequalities. Its aim was to attempt to tackle what was described as the four main killers, cancer, coronary heart disease and mental illness. The Secretary for Sate for Health reported that the government was setting new tougher and challenging targets in each of the above areas with a forecast of: • Reducing the death rate from cancer in people under 75 by at least 1/5 • Reducing the death rate from coronary heart disease, stroke and related illnesses in people under 75 by at least 2/5 • Reducing the death rate from accidents by at least 1/5 and reducing the rate of serious injuries from accidents by at least 1/10 • Reducing the death rate from suicide and undetermined injury by at least 1/5 The timescale for these goals was 2010. The NHS Plan was published in 2000; this highlighted the need of addressing health inequalities, in the main by improving and modernising the NHS. To be able to access health services was high on the agenda particularly within primary care which would in the future improve children’s health, improve nutrition and reduce smoking. The Plan also drew attention to the necessity of working with other public services and agencies such as the Sure Start programme to help address poverty in particular families with children, supporting parents to be, and helping with early childhood development. Along with the New Deal programme to help people get into work or with their needs for education. The national minimum wage was introduced to tackle poverty and low income of the poorest families. Prevention as well as treatment was also a commitment and recommendation to assist in reducing health inequalities in the future. Government initiatives also included giving £15million to Cancer Research UK and the British Heart Foundation to launch advertising campaigns. A report published in the Guardian newspaper (20th November 2002) highlighted a speech made by the health secretary Alan Milburn to health professionals. He outlined measures to tackle the health inequalities in the NHS, he said “a sea change in attitudes” was needed to refocus the debate away from health services and onto illness prevention. “In my view the time has now come to put renewed emphasis on prevention as well as treatment so that we develop in our country genuine health services and not just sickness services,” said Mr Milburn. (Guardian Newspaper 20/11/02, Patrick Butler) Conclusion There seems to have been much debate relating to health inequalities over the last 25 years or more. The Black report which was published in 1980 under a Conservative government highlighted problems which were similar to those painted in the Acheson Report (1998) under the Labour government. Both parties showed great concern about the health inequalities and have tried to address some of the recommendations made. The three major findings referenced gender, ethnicity and social class as the main problems re: health inequalities and renewed government action is trying to eliminate such major health inequalities within these groups. Although some still may say the gap is widening. Higher quality care for all and re-designing patient access and choice may be the key to reduce the gap in health inequalities within the UK. References Acheson D, Independent inquiry into inequalities in health, report London, 1998 Black D, DHSS Report, 1980 The NHS Plan, DOH, 2000 Socialist Health Association, Tacking Health Inequalities in the UK: What is the Government Doing', 2008 Butler, Society Guardian, Government pledges action on rich-poor health gap 2002 Easton M, BBC News,Health, Ethnicity & the five year old, 2008 BBC News,Health, Young Men need better health care, 2001 BBC News,Health, Men need more health care, 1999 Boseley, The Guardian, Sure Start success in helping children of poor families hailed, 2008 Lho.org.uk, Health Inequalities, Health Intelligence, 2005