Immune System Health and Society Flashcards
Racism, Health and Medicine
Describe the social aspects of genetics ?
Eugenics is the scientifically erroneous and immoral theory of “racial improvement” and “planned breeding,” which gained popularity during the early 20th century. Eugenicists worldwide believed that they could perfect human beings and eliminate so-called social ills through genetics and heredity.
Racism, Health and Medicine
Examples of structural racism ?
The market for blood and used body parts
- Even publicly financed systems like the NHS have buyers (commissioners) such as the clinical commissioning group and integrated care systems.
- We also have providers of health care: so in the NHS mainly GP’s, GP practices which are partners, partnerships and independent portioners largely.
What are clinical commissioning groups ?
What are Integrated Care systems (ICS) ?
- Clinical commissioning groups (CCGs) were created following the Health and Social Care Act in 2012, and replaced primary care trusts on 1 April 2013.
- They were clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area.
- As of 1 April 2021, following a series of mergers, there were 106 CCGs in England. However, they were dissolved in July 2022 and their duties taken on by the new integrated care systems (ICSs).
- CCG functions were subsumed into integrated care systems, with CCGs ceasing to exist as statutory organisations in July 2022. Until then they remained the organisations responsible for getting the best possible health outcomes for their local population.
What were the jobs of CCG ‘s ?
-This involved assessing local needs, deciding priorities and strategies, and then buying services on behalf of the population from providers such as hospitals, clinics, community health bodies, etc. It is an ongoing process.
-CCGs needed to constantly respond and adapt to changing local circumstances. They were responsible for the health of their entire population and measured by how much they improve outcomes.
CCGs were:
-membership bodies, with local GP practices as the members
-led by an elected governing body made up of GPs, other clinicians including a nurse and a secondary care consultant, and lay members
-responsible for approximately 2/3 of the total NHS England budget; equivalent to £79.9 billion in 2019/20
-responsible for commissioning healthcare including mental health services, urgent and emergency care, elective hospital services, and community care
-independent, and accountable to the Secretary of State for Health and Social Care through NHS England
-responsible for the health of populations ranging from under 100,000 to over a million, although their average population is about a quarter of a million people.
Altruism: Altruism is the principle and moral practice of concern for the welfare and/or happiness of other human beings or animals, resulting in a quality of life both material and spiritual
- Altruism is the basis of donor schemes for blood and organ donations. This is the belief that people will want to donate their blood and organs simply to help others and because it is the right thing to do. The NHS relies entirely on altruism for blood and organ donation.
- We will discuss whether altruism is enough and efficient to create and adequate supply of blood and replace body parts.
- The debate about using the market and commercial principles versus the use of altruism raises major economic and ethical issues. Should we use gifts and payments to improve the supply of blood and organs or will this be damaging to our approach to healthcare.
- Trust is crucial to the way we donate and use blood and organs. The debate on whether we should use the market for commercial use is partly based on trust and partly based on moral values, but in any case there’s considerable moral and ethical issues in this area of healthcare.
- The NHS aims to maintain blood stocks for 6 days
- Blood stock levels tend to drop in winter.
Why do we rely on blood donations ?
- Why do we have a system of pleading the public to donate blood ?
-Why do we rely on donations instead of paying people like any other market situation ?
The case against a market for blood
-Represses altruism
-Erodes the “sense of community”
-Sanctions “profits” in hospitals and clinics and subjects medicine to market place rules.
-Increases blood supply from poor, unskilled and unemployed i.e. redistributes blood from poor to rich
-Commercialisation may increase infection risks. You may get blood from people who are more risky in terms of their behaviour eg. homeless people who are IV drug users and could potentially have STIs
The case for a market for blood
-Supply can be increased by removing obstacles to donors
-Offering financial rewards, either direct payment, gifts or exemption from payment in the future on the basis of blood donated.
-Unclear which alternative is cheapest and whether it is likely to ensure quality/safety and an adequate quantity.
More recent debate ?
- the idea that voluntary donors are better than non-voluntary donors is quite old.
- More recent evidence from field trials does not support the conclusion that paying for blood is bad and that voluntarily donating is better
Demand for organs ?
- Kidney transplant is the most commonly needed transplant
- Most people who donate are deceased donors however there is a substantial number of live donors in recent years as well
- Survival rates after kidney transplant seem to be going higher all the time
What do we do if we cant have a transplant or if we are on a waiting list
- A lot of patients may be unaware of the opt out scheme so its still crucial to get families consent when someone dies suddenly regardless of assumed consent.
- clinical leads for transplant in hospitals will do that difficult job of speaking to family members that they are not going to make it and asking consent to them to whether they will donate their loved ones organs
- before opt out scheme we would nudge people to register on the organ donation website by redirecting them when they would do their road tax on the DVLA website
Should we pay for human organs ?
