The NHS Role in Tackling Health Inequalities

The NHS Role in Tackling Health InequalitiesAt the turn of the 21st century, kindly wellness inequalities remain to be the key public health problems in advanced European countries. There is strong variation in liveness prediction between and within the countries, which has accumulated over the past 3 or 4 decades (Fox, 1989 Drever Whitehead, 1997 Kunst, 1997 Marmot Wilkinson, 1999 Elstad, 2000 Mackenbach Bakker, 2002). NHS pited health inequalities with infant mortality rate and heart expectancy at the core to reduce them by 10 % by the end of 2010. These deuce health inequalities were announced in February 2001, with the another(prenominal) complementary targets, the areas of smoking and teenage pregnancy. These targets were set to reduce the broad spectrum of inequalities covering the commonplace st deemgy to holler all of the major health inequalities including gender, race, age, etc. (DH, 2001).The secretary of state, nationally announced a comprehensive strategy t o reduce health inequalities, challenge the NHS as a key impostor to live up to its founding and enduring values of universality and fairness to shut the unjustified gaps between individuals with whatsoever background, fair NHS services with high part and good outcomes to everyone (Darzi L., 2007).The independent scientific retrospect of the national health inequalities was published in 1998. This notify suggested policy developments to accept health inequalities. This deal showed the increasing gap between the different loving groups. This resulted in the consideration of these increasing gaps needed action upstream as good as downstream (Acheson Inquiry, 1998).As the NHS and discussion section of Health continuously poured efforts to reduce the health inequalities. The overall performance can be defined as such(prenominal)(prenominal) achieved more to do (DH, 2009).This review w severely analyze the role of NHS in tackling health inequalities, as targets were set to re duce infant mortality and to increase the life expectancy in men and women across UK, faster than elsewhere in world.2.0 AimsTo understand health inequalitiesTo briefly review of the Acheson Inquiry recommendationsTo study the role of the NHS as a key player in tackling health inequalities in UK.3.0 Material MethodsStudy will review reports and documents published by the Department of Health and the NHS. analyse of literature will be done from the data available on the websites of the Department of Health, the NHS and other government websites. Discussion of role of NHS as key player in tackling health inequalities in UK and a comment on the target achieved over a decade.4.0 Review of LiteratureIn 1980, the United Kingdom Department of Health and Social Security published a report of the Working Group on Inequalities in Health, also known as Black breed. This report showed great extent of of which ill-health and death are unequally distributed among the population of Britain, and suggested that these inequalities mother been widening rather than diminishing since the establishment of the NHS in 1948(Gray AM. 1982). The Black report place four types of explanations of health inequalities artefact, selection, cultural or behavioural, and materialist (Blane D., 1985). Since then there were many studies contributed to broader understanding of the health inequalities (Smith et al 1990). After 1997 NHS had made empower progress, as in 1997 NHS was in relatively poor health, due to this low investment hampered proper planning. In regards with different health inequalities NHS was not simply big enough or capable enough to meet the expectations of the patients (Darzi L., 2007).The steepest inequalities health is observed at two stages of the life course early childhood and midlife. Less distinction is observed in adolescence and in older age (Kuh Ben Shlomo, 1997). Actual health inequalities were considered and taken note by the scientific independent inquiry c alled as Acheson Report in November 1998, which reviewed the indicate of health inequalities in UK. Acheson report suggested that, there is convincing evidence that, provided an appropriate agenda of policies can be defined and given priority, many of these inequalities are remediable (Acheson Inquiry, 1998).The Acheson report is supposed to be the cornerstone for the policy development over the last 11 years informing action on the national target and the cross-government strategy, the program of action. The report focused on socio-economic inequalities which showed the increasing gap between different social groups. It suggested almost 39 recommendations (Appendix I).After considering the all the facts and recommendations, the NHS announced the two national health inequalities targets in February 2001, one relating to the infant mortality and the other to life expectancy. These targets were considered to reflect the efforts taken to reduce the broad spectrum of inequalities at n ational take aim across UK. These targets can be formulated under the specific terms socio-economic groups and geographical areas so that they can cover more general strategy to address all of the major health inequalities including gender, race, age as well as health in specific disadvantaged groups such as lone parents and the dispossessed (DH, 2001).Englands new health strategy, like this across the UK, represents a major advance in the vision and remit of public health policy. Protecting and improving pile up levels of health no abundanter provide a sufficient justification for investment in public health this investment must also end product a more equal distribution of health between socioeconomic groups. As a result, public health goals which were previously expressed only in terms of population averages now include a concern with how health is distributed across society. It is a concern summed up in the goal of tackling health ine character (Hilary G., 2004).5.0 Unders tanding Health InequalitiesInequalities are a matter of life and death, of health and sickness, of well-being and misery. The fact that in UK today people in different social circumstances experience avoidable differences in health, well-being and length of life is, quite simply, unfair. Inequalities in health arise because of inequalities in society in the conditions in which people are born, grow, live, work, and age. So close is the link between particular social and economic features of society and the distribution of health among the population, that the magnitude of health inequalities is a good marker of progress towards creating a fairer society (Marmot, 2010).The documents on plans, actions and performance standards are designed to spell out what it means to tackle socioeconomic inequalities in health. Their descriptions suggest that it has a variety of meanings. At some points, tackling health inequalities is described as a commitment to break the link between poverty and ill health and to improve the health of the worst off (Milburn, 2001 as Cited in Hilary G., 2004). Health inequalities can be stated as the disparity in health status between rich and poor and the health gap between the worst off in society and the better off (Wanless D., 2001). At other points, health inequality is a concept which covers the whole population. Health inequality exists between social classes and right across the spectrum of advantage and disadvantage (Hilary G., 2004).6.0 Review of Acheson ReportThe Acheson report was published in 1998 from then it has been considered as the corner stone for tackling health inequalities. This independent scientific review considered the developments over the 20 years and place some possible policy developments to address health inequalities. The report showed the data with increasing gap between social groups, in early 1970s, the mortality rate among the men of the working age was almost twice as high as for those working in socia l class V (unskilled) as for those in social class I (professional). By the earlier 1990s, it was almost three times higher. This resulted in the consideration of this increasing gap needed action upstream as well as downstream in other words from outside the NHS, as well as within it.The report also address that social determinants affect peoples health across their lives the early years are a particularly important stage of life, where poor socio-economic circumstances have long lasting effects. Consequently, it gave priority to policies and interventions with the potential to reduce inequalities in access to the determinants of good health among parents, particularly present and future mothers, and children.It suggested almost 39 recommendations (Appendix I) which focus more or less the 4 major themesThe social determinants of health, such as poverty and income, education, employment, environment and housingThe life course, including lifestyle factors such as smoking, nutrition and alcohol use of goods and servicesOther dimensions of health inequalities beyond socio-economic status namely ethnicity, gender and ageMeasures to improve the in effect(p)ness of the NHSs systems of care, not least in terms of resources and access to services.The report gave high priority to mothers, children and families. Tackling health inequalities is a complex and long-term challenge, requiring action across the layers which influence the health. The relationship between these layers is shown below in Fig. 1 (an updated magnetic declination of the Dahlgren and Whitehead diagram that appeared in the Acheson report).Fig. 1 The main determinants of healthSource Barton and Grant (2006) adaptation of Dahlgren and Whitehead (1991) from UN Economic Commission for Europe (2007) Resource manual(a) to Support Application of the Protocol on Strategic Environment Assessment.7.0 National Health Inequalities Strategy, Programme for ActionThe national health inequalities target was set in 2001 the aim was to reduce the health outcomes in infant and the overall increase in life expectancy by 2010. The national health inequalities strategy programme for action was built on the board front set out in Acheson, which focused on the importance of the working across government and in partnership both with other service providers and with the local communities (DH, 2003).Four themes of the programme for actionsupporting families, mothers and children reflecting the high priority given to them in the Acheson report salty communities and individuals strengthening capacity to tackle local problems and pools of deprivation, alongside national programmes to address the needs of local communities and socially excluded groupspreventing illness and providing effective treatment and care by means of tobacco policies, improvements in primary care and tackling the big killers coronary heart disease (CHD) and crabby personaddressing the underlying social determinants of health emphasising the need for concert action across government at national and local levels up to and beyond the 2010 target date.Annual status report has to be published passim the lifetime of strategy, these developments were monitored against the NHS to the wider determinants of health (reflecting Achesons proposal for action on broad front), and 82 departmental commitments (DH, 2003)These Annual status reports showed the improvement in health in accredited terms across all social groups, against a range of indicators including life expectancy, infant mortality, cardiovascular disease and cancer, and reported on developments against the cross-departmental commitments (DH, 2010).8.0 Role of the NHS in tackling health inequalitiesAs NHS is the key player in tackling health inequalities target set in 2001- By 2010 to reduce the inequalities in health outcomes by 10% as measured by the infant mortality and life expectancy at birth.8.1 Life expectancy-The life expectancy gap between the areas with lowest life expectancy and the national average is caused principally by premature deaths from cancer, circulatory diseases and respiratory diseases with smaller effects from suicide and violence in men. The over 50s contribute 79% of the gap in women and 70% of the gap in men. It follows that the priorities for NHS action which will have the greatest impact on narrowing the gap areaddressing cancer and circulatory diseases within manual social groups because these major killers exhibit strong social class gradients.Improving the life expectancy of the over 50shigh quality care in disadvantaged areas, especially primary care.Key areas of interventions to narrow the gap in life expectancy are reducing smoking, prevention and effective management of other risk factors in primary care, targeting over-50s, and working pro-actively with partners on issues affecting life expectancy.8.2 Infant mortality-Deaths under one year of age tally about 3,000 per year. The two major cau ses of neonatal deaths are immaturity related conditions and congenital malformations and both show a strong social class gradient. The social class gradient is greater for post-neonatal deaths. Just under 50% of all post-neonatal deaths are accounted for by two causes signs, symptoms and ill-defined conditions (predominantly SIDS) and congenital anomalies.The underlying determinants of mortality and ill-health in infants includelow birth weightmaternal smoking (smoking during pregnancy)paternal smokingmaternal anthropometry/nutritional statusfailure to breast feedquality and quantity of health carematernal agethe physical environment (housing condition)the family and social environmentKey areas for interventions to narrow the gap in infant mortality are reducing smoking in pregnancy, improving nutrition in women, reducing teenage pregnancy, increasing breast-feeding, effective ante-natal care, improving the quality of midwifery, obstetric and neonatal services and high quality fami ly support.The NHS set to improve the action to address health inequalities (Appendix II)Raise the profile of health inequalities and focusing on resultsMaking it clear it is not good enough to achieve top line targets at the expense of widening inequalitiesMake health inequalities an integral part of planning, commissioning and rakePromote Health Equity Audit, Local Delivery Plan and its impact on the health inequalities.Partnership working and influencing partners to tackle the wider determinants of health and health inequalities senesce must be measuredUse of the Health Care Standards and their underpinning criteria.The WHO guiding principle, that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every world being, was reiterated in the 1998 World Health Declaration (Hilary G., 2004). The report on health profile of England 2009 states there are improvements in number of critical areas eg. Decrease in mortality rates, increase in lif e expectancy and further reduction in infant and perinatal mortality (DH, 2010). These achievements can be defined as much achieved more to do(DH, 2009). Now the NHS is focusing to be the World Class NHS whom services will be (Darzi L., 2007)-FairPersonalizedEffectiveSafe all over recent years health inequalities have increasingly featured as an NHS priority. This has been evident in their incorporation into other Public Service Agreement health targets, and the findings of the Wanless report noted the association between lower socio-economic status and poor health outcomes, and the cost consequences for the NHS (Wanless D., 2004).The contribution of the NHS to the 2010 target was recognized in the Treasury-led cross stabbing review (DH, 2002). This review considered the implications of the Acheson report for departments across government and the NHS. It identified NHS interventions as more likely than other interventions to help deliver the short-term target with reducing smoking in manual groups and preventing and managing other risk factors for coronary heart disease and cancer, but it recognised that the social determinants were crucial for a long-term sustainable reduction in health inequalities.9.0 DiscussionThe Black Report concluded that inequalities in early 1980s were not mainly attributable to failings in the NHS, but rather to many other social inequalities influencing health income, education, housing, diet, employment, and conditions of work. Then Black Report recommended a wide strategy of social policy measures to fleck inequalities in health. After 10 years of Black report the social class differences in mortality were still increasing, after this there were many studies undertaken addressing inequalities in health(Smith et al 1990). Then Acheson report was published in 1998 an independent scientific review of the inequalities in health, and in 2001 the national targets for tackling inequalities in health were set in which Department of Hea lth and NHS played a key role the success can be stated as the much achieved more to do (DH, 2009). The Marmot review recommends action on health inequalities requires action across all the social determinants of health and needs to involve all central and local government departments as well as the third and private sectors. Action taken by the Department of Health and the NHS alone will not reduce health inequalities (Marmot, 2010).10.0 finishThe above study shows the NHS had played a key role in tackling health inequalities along with the Department of Health over the past decade. This resulted in the highest life expectancy ever in UK and gradual decrease in the infant mortality. Overall development in past decade is shown in Appendix III, which shows factors such as employment, housing conditions, educational achievement, crime and child poverty without which the overall improvement in the health inequalities is not possible. The role of NHS in tackling health inequalities hav e also improved the overall performance of the NHS itself in and made the NHS a World Class NHS visioning fair, personalized, effective and safe services ahead.