Medical Geography, Policies

Question 1

Key terms

Answer 1

Policy- An approach/strategy employed by an organisation. Policy can have both intended and unintended consequences.Impacts can. be both positive/negative.
Intervention- Interference in someones affairs/behaviours by an external body.

Question 2

Prevention

Answer 2

• Majority of ill health is preventable
• An ounce of prevention is worth a pound of cure (Henry de Bracton)
• Preventive health care
  1) Primary, eliminate a disease from occurring before it happens e.g. immunisation
  2) secondary, reduce impact of a disease after it has occurred e.g. early screening to detect disease early
  3) Tertiary, soften the imact of chronic illnesss e.g. surgery or treatment to slow down progress, support groups. Making living with the disease more bearable

Question 3

Prevention (part 2)

Answer 3

• People at high risk of disease only make up a small proportion of the pop. To improve health, it can be better to focus efforts on people of low risk even if individual gains might not see any gains.(Prevention paradox, Rose. 1981)
• Policy can be introduced/influence across multiple scales within a country (from individuals, communities/neighbourhoods to national scale)
• National policies are more effective
• National scale policies are much harder to and more expensive to do however, so needs to have a glance between the scale of policies
• Three A’s of a good policy
  1) Availability
  2) Acceptability
  3) Accessibility
• Need to hit all 3 and hit them hard for the police to be a success

Question 4

Policy and Austerity (Responses to the recession)

Answer 4

• Declining global economy led to a period of rising unemployment and wider societal effects
• Response to the recession:
  1) Intervention in the banking sector to stop them crashing
  2) Changing fiscal policy interest rates fell and the period of austerity (cut backs in spending combined with focus on deficit deduction)

Question 5

Policy and Austerity (Health implications of the recession)

Answer 5

• Declining fertility, with younger individuals postponing child bearing
• amongst individuals who are giving birth, we see lower birth weights. This is hypothesised to be related to stress
• In the aftermath of the recession, suicide rate in Europe and Canada increased by several percentage points, said to have been as a result of higher unemployment (Magerison,C.et al.2016)
• Studies have also shown the prevalence of clinically diagnosable depression and anxiety significantly increased in the U.S, Europe and East Asia during the immediate aftermath of the Great Recession (Magerison,C.Et al.2016)
• A rise in suicides due to unemployment (Mckee,M.2013)
• Mental health effects such as stress, family tension and dislocations of youth who are unemployed (pettifog,A.2013)
• The result of the Austerity will lead to the North of England suffering dispraportinately, suicide rates risen at a higher rate in the north most likely due to the North of England already affected by higher rates of poverty, unemployment and welfare receipt. (Bambra,C.2015)

Question 6

Policy and austerity (Changing health related behaviours0

Answer 6

• -Many British families now suffering to afford foods, having to buy cheaper foods which tend to be unhealthier (Pettifog,A.2013)
• People tend to drink less however problem drinkers tend to binge drink more (Mckee,M.2013)
• evidence linking the recession to diet/nutrition. In the U.S greater individual level financial strain during the crisis was associated with a lower likelihood of making healthy decisions about food. (Magerison,C.Et al.2016)
• Less transport related mortality due to less people on the roads.

Question 7

Policy and Austerity (Reasons for mortality rise)

Answer 7

• Random fluctuation
• Influenza
• Ageing pop
• Austerity, amount of spending since recession has stayed the same, effects potentially having an effect now. Cutbacks on meals on wheels for frail and elderly declined by more than 200,000
• Life expectancy has not declined overall, but we have seen falls in poorer areas.

Question 8

Sugar tax

Answer 8

• The use of price as a deterrent from consuming sugar.
• Will it work?:
  1) Estimate impact in England of 20% sugar tax
  2) 2400 fewer cases of diabetes
  3) 15M saved in health care costs (Collins, et al.2015)
  4) Obesity may decline between 0.5% and 0.2%
  5) Largest benefits for younger pop for obesity and teeth decay, but not type 2 diabetes (Briggs et al.2017)
• Criticism include:
  1) Will hit the poorest hardest
  2) We should work alongside business not against it
  3) Why focus just on soft drinks? Fruit juices also high in sugar
  4) Will cost more to implement (1bn) than it will make revenue (520m)
  5) Reduction offset but increases of other high calorie drinks- substitution effect. (Fletcher. Et al.2010)
• The Mexican congress passed an excise tax on sugar sweetened beverages and a sales tax on several high energy dense foods (Arantxa Colchero,M.Et al. 2016)
• An excise tax of 1 peso (a 10% increase) on non dairy and non alcoholic beverages with added sugar. Arantxa Colchero,M.Et al. 2016)
• An average increase change of -12% by December 2014
• An average increase of the purchase of untaxed beverages of 4% mainly related to bottled water Arantxa Colchero,M.Et al. 2016)

Question 9

Policy is good right?

Answer 9

• NHS, free availability for all
  1) Availability, is the service provided?
  2) Acceptability, are there social/cultural barriers to uptake. some religious may not allow women to be seen by a male GP. also Geographic availability
  3) Affordability, can individuals pay for the service instead.
• Building more hospitals (or health services in general) doesn’t necessarily guarantee improvements in pop health.
• Health care spending is not associated with better pop level health.
• Can be substantial variations in awareness to its availability, due to language or cultural differences (Goddard,M.2001)
• Shows that due to waiting times people prefer to go private showing that the NHS availability isn’t great
• People who do not have health insurance are increasingly paying up to 14,880 for operations such as hip or knee replacement or cataract removal (the guardian.2017)
• Profit driven hospital firms are experiencing 15-25% year on year rises in the number of uninsured “self payer”, with the increase mainly driven by long waiting times (The guardian.2017)