Public health Flashcards
Life expectancy at birth 1841-2012, England and Wales
Widening gap in outcomes between social classes
The black report 1980
- pre-1979 Labour administration commissioned Sir Douglas Black to examine in equalities in health status
- Conclusion:
- The poorer health experience of lower occupational groups applied at all stages of life
- The class gradient seemed to be greater than in some comparable countries and was becoming more marked
Gradient in mortality rate by social class
Whitehall I
Inequalities in access to healthcare
Access to healthcare: The inverse care law
- The Availability of good medical care tends to vary inversely with the need for the population served
- This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced
- The market distribution of medical care is a primitive and historically outdated social form and any to it would further exaggerate the maldistribution of medical resources
Waiting times for NHS cardiac surgery
Access to general practitioners in Scotland
The black report 1980
- 37 recommendations including
- Redressing the balance of the health care system so that more emphasis wass given to prevention, primary care and community health
- Radically improving the material conditions of life or poorer groups, especially children and people with disabilities by increasing or introducing certain cash benefits
Life expectancy (LE) and healthy life expectancy (HLE) for males at birth, England 2014-16
Number of deaths as a result of heart disease
Percentage of low birth weights
A cycle of low income
How does poverty affect health
- Poverty can affect health in a number of ways
- Income provides the pre-requisites for health, such as shelter, food, warmth and the ability to participate in society
- Living in poverty can cause stress and anxiety which can damage people’s health
- Low income limits people’s choices and militates against desirable changes in behaviour
Absolute versus relative poverty: income versus income inequality
- In the development world, it is not the richest countries that have the best health but the most egalitarian
- The US and UK both have particularly high levels of inequality
- In Europe, Sweden, Norway and Finland have the lowerst inequality
Trends in UK income inequality 1979-2005/6
Life expectancy by social class, men, England and Wales between 1972-76 and 1992-96
Policy developments 1990-2000
- 1992- health of the nation published
- UK’s first health strategy
- 1997- New labour elected
- New haelth strategy published in 1999 (our healthier nation)
- Tacit acknowledgement of the existence of health inequalities
The marginalisation of PH policy
- Since the 1970s, PH policy marginalised
- The drive for efficiency allied to the rise of a target- driven culture within the NHS
- Strategies aimed at the prevention of ill health often lack evidence of cost-effectiveness
- Prevention strategies may be expected to reduce the burden of treatment on the NHS
- However, they may also have longer-term costs that impact on public services in the future
- E.g. If strategies to reduce alcohol consumption are successful, this may have an impact on healthcare cost, not to mention the costs of pensions and long-term care
- However, they may also have longer-term costs that impact on public services in the future
The marginalisation of PH policy
- Neo-liberalism dominant political orthodoxy
- Adopts a largely laissez faire approach to the market
- Seeks to avoid intervention for fear of being accused of operating a nanny state
- This is reflected in contemporary health policy
Healthy lives, Healthy people
- Coalitition Government Public Health White Paper
- Protecting the population from serious health threats; helping people live longer, healthier and more fulfilling lives; and improving the health of the poorest fastest
Healthy lives, Healthy People
- Focussed on empowering individuals informed choice and avoiding state intervention
- Stressed the necessity of working with the private sector to improve health outcomes
- Key focus: ‘Nudge theory’
Nudge theory
- A nudge as we will use the term, is any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives
- To count as a mere nudge, the intervention must be easy and cheap to avoid
- Nudges are not mandates
- Putting fruit at eye level counts as a nudge, banning junk food does not
Healthy lives, Healthy people
- Public health responsibility deal
- DoH to work collaboratively with business and the voluntary sector in 5 areas: food, alcohol, physical activity, health at work and behavioural changes
- Gave companies such as fast food retailers, processed drink manufacturers and producers of alcoholic drinks a role in influencing government policy
Annual change (months) is absolute gap in life expectancy between most deprived 20% of LAs and rest of England
Range in life expectancy at birth, England 2011-16
HI’s and Public Health Policy
- The poorest people in society suffer a disproportionate burden of both morbidity and mortality
- Unclear exactly how health inequality arises but a principle driver appears to be disparity in income
- Those most likely to need healthcare are those who find it most difficult to access healthcare
- There is a long-running and continuing tension between state intervention and individual liberty
- Preventative health policy marginalised throughout 1980s onwards
