How the health inequalities in the UK can be minimized?
Author: Yudai Kaneda
12 January 2022
In recent years, there has been growing interest from around the world in reducing health disparities, partly due to the policy goal of 2009 WHO General Assembly resolution to reduce health disparities. According to the US Health Resources and Services Administration, the official definition of health disparities is "population-specific differences in disease, health status, and access to health care."(Health Resources & Services Administration, 2020) This means that factors that significantly impact an individual's health status vary depending on whether the individual is part of a "specific group," such as economic status, gender, and nationality. This is a different way of thinking from the old idea that "poor health is one's own fault."
One of the primary causes of health inequalities is poverty. In the United Kingdom (UK), it has long been pointed out that the poverty rate was increasing due to the uncertainty caused by leaving the EU and the increase in immigration. In addition, it has been pointed out for a long time that many children are living in relative poverty, and in fact, as of 2013-2014, 3.7 million children were reported living in poverty in the UK.(The UK government, 2015) Children growing up in low income families have been shown to be associated with poor cognitive, social, and behavioral development and mental health issues, (Wickham et al., 2016, Lai et al., 2019) which can have negative health consequences. Furthermore, previous research has suggested that these adverse effects can continue into adulthood.(Bateson et al., 2004)
To make matters worse, the novel coronavirus infections that spread from China to the rest of the world in 2019 have highlighted the issue of health disparities. In England and Wales, people living in deprived areas were found to be more likely to die if they were exposed to the novel coronavirus infection, the UK government's Office for National Statistics (ONS) reported on May 1, 2020.(Office for national statistics, 2020) This is thought to be related to the fact that many people living in poverty are more likely to live in cramped housing, which increases their risk of contracting the new virus, and they are also more likely to have multiple chronic underlying conditions, which increases their risk of severe illness after infection.
Meta-analyses have shown that when inequality is too high, the population's overall health, including high-income individuals, deteriorates, even in economically prosperous countries.(Kondo et al., 2009) Therefore, in this context, it is crucial to work actively from the outside to intervene and try to correct the health disparity. Thus, in this report, I will provide examples of interventions that have been implemented in the UK to reduce health inequalities among families living in poverty. Then, I will demonstrate how these interventions work at the individual, regional, local, and national levels and discuss how health inequalities can be minimized.
Body of discussion:
(1) Individual level
First, as an intervention at the individual level, there is "social prescribing" in the UK,(NHS, 2021) led by clinicians (GPs), which has also been incorporated into medical education in the UK. Social prescribing is about connecting patients with social factors that are not good for their health to non-medical support resources to change their social situation. For example, in the case of isolation, GPs can prescribe appropriate " places and frequencies of outings," such as local sports facilities or community activities, and actually connect the patient to them. If the patient has financial problems, the GPs will refer them to the social workers. Referral to a specific destination is essential, and this can be a very effective intervention for individual patients, as randomized controlled trials (RCTs) have shown that between an approach that instructs people to "exercise" and an approach that actually connects them to a person in charge of a project or program for exercise, the latter results in significantly more hours of exercise per week.(Hikichi et al., 2017)
In addition to the above activities of GPs, there are also community nursing professionals called health visitors who work in public health centers and have their area of responsibility for children from 0 years old (after 11 days of age) to 5 years old and their parents.(The UK Government, 2011) For example, through mother's classes, weaning classes, and home visits after the birth of a newborn, they conduct parenting classes, infant health checkups, and, to a limited extent, medical examinations and prescribe medicines. By intervening with parents and children from an early stage, they support childcare, identify risks to children's development at an early stage, and work to prevent future health problems.
The previous study has shown that people living in poverty face barriers to accessing health care due to lack of education and distrust of health care.(Lazar and Davenport, 2018) Therefore, these interventions can be said to be highly effective. However, there is a severe shortage of doctors and nurses in the UK. In fact, according to statistics published by the OECD in 2009, 47,407 doctors, or 31.4% of all doctors, were educated in foreign medical schools, and the current situation is that the shortage in the number of doctors in their own country is being resolved by introducing foreign doctors.(OECD, 2009) The same is valid for nurses. In the UK, nurses have been added to the Department of Health (DH) shortage occupation list due to growing concerns about nurse staffing levels by the National Health Service (NHS). A survey of NHS employers reported that nurse turnover ranged from 5% to 27%, with higher rates of turnover in critical care areas, and 93% of NHS trusts reported that they were experiencing nurse shortages.(Khan et al., 2019) These factors make it challenging to reach out to many people and increase the burden on doctors and nurses.
(2) Local/Community level
An example of an intervention at the local level is the distribution of free condoms by NHS Greater Glasgow and Clyde.(NHS Greater Glasgow and Clyde, 2021) People who need condoms can apply to general practitioners (GPs), pharmacies, universities and fill out a request form to obtain them without verbally asking for them. This will improve the situation where people on low incomes cannot afford or have access to proper sanitary products. Also, as an example of this kind of initiative, on November 24, 2020, Scotland became the first country in the world to pass a bill to provide free sanitary products to all.(The Scotish Parliament, 2019) A survey of more than 2,000 people conducted by the Scottish charity Young Scot had revealed that about one in four people attending schools and universities in Scotland struggled to access sanitary products.(Young Scot, 2018) Scotland is already the first country in the world to provide free sanitary products in educational institutions, and the passage of this bill will help protect these systems. The success of individual initiatives is also having a positive impact on other regions. For example, in January 2020, free sanitary products were introduced in all primary and secondary schools in England. The success of such initiatives at the local level is also being applied elsewhere, such as in some states in the US, where laws have been passed requiring the provision of free sanitary products in schools.
(3) National level
One of the interventions at the national level is the medical security system. The National Health Service (NHS), the UK's health care system, was established in 1948. It aims to be universal, covering all citizens when they need medical care, to provide a comprehensive range of medical services, and to be almost free at the time of use. Since the funding source taxes, disparities in access based on people's ability to pay are supposed to be almost non-existent. Oliver has reported that the cost burden of health care for users is 2.6% and that differences in financial ability to pay are not a barrier to accessing health care services.(Oliver, 2001) However, there is no immediate access to medical services in the UK. Rather, and there are waiting periods for various reasons. In addition, the NHS also has a so-called "pay-bed" private medical department, so those who can afford it can choose private medical services to get off the waiting list. Therefore, there is a limitation in that people's socioeconomic disparities and different social classes may affect the waiting period. However, since 2000, the budget of the NHS has been greatly expanded, and there have been reforms in the reimbursement to general doctors and improvements in the quality of medical care.(NHS, 2000) It is appreciable that the NHS takes a head-on approach to the problem and continuously implements reforms to cope with the recent sharp rise in medical costs. Moreover, even after the NHS budget was expanded, the ratio of total medical expenses to the UK's GDP has remained low, so it can be said that the government is providing medical services efficiently.(OECD, 2020)
In addition, over a period of only eight years from 2003 to 2011, the amount of salt in bread was gradually reduced without consumers noticing, resulting in a 15% reduction in salt intake per capita and a 40% reduction in the number of deaths from myocardial infarction and stroke, which are diseases that typically manifest the problem of health disparity.(Sharma et al., 2019) Furthermore, as a measure to combat child poverty, a system called "Special Assistance for Children" has been established, which provides subsidies to schools based on the number of children whose parents are either unemployed or have low incomes. Each school uses these funds to increase the number of instructors, support after-school learning, and provide breakfast before school starts. Tax credits have also been introduced to provide cash benefits to low-income families with children and low-income families with working parents. Between 1997 and 2010, the child poverty rate was successfully reduced by about 30%, from 26% to 18%.(Tomoko Y, 2019) One of the strengths of the UK is that it has many successful examples of such interventions at the national level.
In conclusion, it can be said that individual and organizational level interventions that can be implemented to reduce health disparities, while effective, are limited, and it is necessary to accumulate successful experiences of community-wide efforts and eventually improve policies at the national level based on them. The health disparities can be minimized by accumulating data and research, gathering enough evidence to persuade the government, and creating a political and social trend in which the people speak out and focus on the health disparities.
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About the Author
Yudai Kaneda (Johnny Yudai Schwarz)
Born in Frauenfeld, Switzerland.
Half German and half Japanese, and currently a fourth-year medical student at Hokkaido University in Japan.
Since this September, has been studying at the University of Edinburgh in the UK, specializing in health policy and global health.