Tackling Health Inequalities - Term Paper Example

Health Inequalities Tackling health inequalities is very important because first and foremost, health inequalities are preventable and are basically unfair. Thus, the whole of Government is doing its best to narrow down the health gap between underprivileged groups, communities and the rest of the country, as well as improving health overall (Introduction to health inequalities, 2005). The Government has launched the most comprehensive programme ever mounted to tackle health inequalities. In July 2003 Tackling Health Inequalities: A Programme for Action, was published by the Department of Health with the support of 11 other government departments. This document lays the foundation for achieving the Public Service Agreement (PSA) target to reduce inequalities in health outcomes by 10 per cent by 2010, as measured by infant mortality and life expectancy at birth (Intro to health inequalities, 2005). 'Health inequalities' are the differences found in different aspects of health between different groups in society, the differences in health between those who are rich and poor in society. During the last twenty years, in general population terms, life expectancy and prosperity have increased and death rates from major diseases have fallen (Judge et al, 2002). Despite the government's commitment to tackle the problem, health inequalities in Britain continued to increase, according to new research from the University of Bristol, published in this week's BMJ. Inequalities in health widened in the 1980s and 1990s, and the current government has repeatedly expressed its intention to reduce these inequalities. In February 2001 it announced national targets to reduce the gap in infant mortality across social groups and to raise life expectancy in the most disadvantaged areas faster than elsewhere by 2010. But the new 10-year analysis by Dr Mary Shaw and colleagues in the Department of Social Medicine and the University of Sheffield shows that inequalities in life expectancy have continued to widen in the early years of the 21st century, alongside a general trend of widening inequalities in income and wealth. (Health inequalities continue to widen, 2005). This health gap between different socio-economic groups exists virtually irrespective of the type of health indicator and socio-economic measures chosen for comparison and analysis. Furthermore, those who benefit most from social, fiscal and health advances are usually not those who are in greatest need. Inequalities in health are observed for a wide range of health outcomes. They are found in self-reported health measures, objective measures such as death and illness and in access to services. They are also evident across the lifespan throughout childhood, adulthood and old age (Judge et al, 2002). Broadly speaking, there are three types of inequality in health (Wider determinants, 2005): 1. Inequality in access to health care (for example, refugees in London often have difficulty in obtaining primary health care). 2. Inequalities in health/health outcomes (for example, there are six years' difference in average life expectancy at birth between the boroughs in London). 3. Inequalities in the determinants of health (for example, in education, employment or housing). Life expectancy continues to rise in the most advantaged areas of the country at a faster pace than in the poorest areas. Amongst men, for example, the difference between the local authority with the lowest life expectancy (Glasgow City) and the one with the highest (East Dorset) has risen to 11 years. Income inequalities also rose markedly in the 1980s and have been sustained throughout the 1990s and into the 2000s, although encouragingly a fall in income inequalities in the most recent time period can be seen. However, income inequalities are such that the poorest 10% in society now receive 3% of the nation's total income, whereas the richest 10% receive more than a quarter. Since the 1970s wealth inequality has increased, particularly so since 1995-6. Between 1990 and 2000 the percentage of wealth held by the wealthiest 10% of the population increased from 47% to 54%, and the share of the top 1% rose from 18% in 1990 to 23% in 2000 (Health inequalities continue to widen, 2005). Wealth inequalities better reflect the accumulation of lifetime (dis)advantage, and the growing inequalities in wealth seen in recent years do not bode well for future trends in health inequalities. According to the 2002 British Social Attitudes Survey, 82% of people thought the gap between those with high incomes and those with low incomes was too large. Although New Labour has succeeded in raising the living standards of some of the poorest people in Britain, inequalities in wealth have continued to grow and are likely to be transmitted to the next generation, they add (Health inequalities continue to widen, 2005). Numerous other publications added more solid proof to these findings, confirming that substantial health inequalities exist between individuals, groups, social classes, income brackets, races and genders and across geographical locations (e.g. north and south of the UK and within cities). In 1997 the Labour government established an Independent Inquiry into Health Inequalities chaired by Sir Donald Acheson. This inquiry report, published in 1998, reinforced the fact that health inequalities in the UK were still widening and evident across all aspects of health, all stages of life, and across various social and geographically defined groups. A few examples of the range and extent of these inequalities taken from Shaw et al are detailed below (Judge et al, 2002): - In terms of life expectancy in the UK (1992-96), the difference between men in social class I (professionals) and social class V (unskilled) was 9.5 years (6.4 years for women). - During the period 1991-95, residents in areas that make up the 10% of the UK with the worst health record a were more than twice as likely to die as a result of CHD before age 65 than those living in the areas that constitute the 'best health' 10% - In 1981-85 the standardised mortality ratios (SMR) in the 'worst health' b constituencies was 155 c, this rose to 178 in 1991-95. During the same period in the 'best health'constituencies it fell from 76 to 68 (Judge et al, 2002). There are various explanations for the associations found between socio-economic status and health. One explanation is that the association occurs simply as a result of the way in which health, social class and other variables of socio-economic status are gathered and analysed. In other words, according to this line of explanation, the association between poor health and lower socio-economic status would be an artefact of measurement. However, the associations that have been found have been remarkably consistent in shape and size across many studies, methodologies, and timescales and in relation to many plausible variables. They are, therefore, very unlikely to be a result of data collection and analysis techniques (Judge et al, 2002). A second explanation suggests that the association exists because of selection: people who have poor health are likely to be found in lower social classes and be living in poverty because their poor health has impacted on their educational attainment, employment prospects and their subsequent income, housing status and physical or geographical environment (Judge et al, 2002). Some differences health inequalities are obvious due to genetic inheritance, exposure to certain environments, individual choices and chance. In order to be acceptable, however, such variation must be randomly distributed across social groups. If such variations are unequally distributed across gender, ethnic or socio-economic groups or are associated with levels of education, income, occupation or access to services, then these should be considered to be unethical and therefore unacceptable to a modern society (Judge et al, 2002). The factors which have been found to have the most major influence - for better or worse - are widely known as the determinants of health. Whilst health and social services make a contribution to health, most of the key determinants of health lay outside the direct influence of health and social care, for example, education, employment, housing, and environment (Wider determinants, 2005). Different groups of people have very dissimilar experiences of the determinants of health. These different experiences will have essential effect on health. Some of the groups and categories involved are well known - in particular, gender, class, ethnic group, age and geographical area. Others might be less obvious - such as disability, single parenthood, quality of school, age of housing stock, type of road user (Wider determinants, 2005) Inequalities can become entrenched when these categories overlap (for example, in a combination of ethnic group, age, area). In these circumstances, there can be a 'snowballing' effect where it is unclear exactly how the determinants are related to each other - but it is clear that the combined negative impact is strong. Some factors, like age, are dynamic; people do not necessarily stay in poverty - they can move in and out of it (Wider determinants, 2005) Gender, like socioeconomic status, also influence individual opportunities and experiences across the life course. Whilst many experiences of childhood are the same for boys and girls, they are exposed to different risks. Men and women occupy different positions in the labour market and in the home that would bring different health risks. Mortality is greater in males at all ages. Across the whole of adult life, mortality rates are higher for men than women for all the major causes of death (Reducing health inequalities, 2006). The Health Visitor The aim of the health visiting service is to promote the health of the whole community and to help in promoting healthy lifestyles addressing concerns about physical and mental well being. Health visitors are an integral part of the NHS's community health services. All health visitors are qualified nurses or midwives, with additional special training and experience in child health, and health promotion and education. Health visitors aim to promote the health of the whole community. Health visitors are the most accessible health professionals in the community. Any individual contacting the local surgery or health centre will be able to get in touch with a health visitor (Health visiting service, 2005). Health visitors work towards improving and enhancing public health. The focus of their work is on preventative healthcare for the whole community. This may include tackling the impact of social inequality on health and working closely with at risk or deprived groups. Health visitors are registered nurses with training in assessing the health needs of individuals, families and the community. As well as its focus on child protection, this rewarding but demanding role increasingly involves dealing directly with the effects of social deprivation (Health visitor close up, 2004). Job activities vary according to the nature of the individual role, but may include: leading teams of health professionals; using negotiation and influencing skills to deliver child health programmes; working in partnership with families to develop and agree tailored health plans addressing parenting and health needs; running parenting groups; providing home visits to see individual patients; advising and informing parents on issues such as weaning and immunisation; working with at risk children and their parents; supporting government initiatives to tackle child poverty and social exclusion such as Sure Start, Home Start; analysing data and developing action plans to work through Primary Care Trusts; identifying the health needs of neighbourhoods, and groups such as the homeless; agreeing local health plans; maintaining and updating patient records; communicating via phone and email with a range of professionals; managing and leading interdisciplinary teams involved in the delivery of local health plans; using skills in community development to work with local communities to help them identify and tackle their own health needs; supporting and training new health visitors; managing and attending parent and baby clinics/sessions at surgeries and community centres, and specialist clinics on areas such as baby massage and exercise and child development; running groups dealing with a specific health aspect, such as smoking cessation; supporting self-help groups, such as working parents and special needs groups, as required; enabling communication between parents and other groups to share information and experiences; monitoring data to ensure that specific health targets are being met; encouraging members of deprived communities to participate in their own health care planning; planning and setting up health promotions displays; providing health improvement programmes to target patients with specific needs in areas such as cancer, mental health, coronary heart disease and strokes (Health visitor close up, 2004). One of the objectives of Tackling Health Inequalities: A Programme for Action is to build systems which enable the sharing of information on what local projects and action are making an impact on tackling health inequalities. The following are local projects that are using innovative methods to tackle inequalities and which practitioners could adapt to address their own specific local needs (Engaging Communities, 2005); Manchester NHS Employment Access Project This project was established in recognition of the huge contribution the NHS can make to regeneration as one of the largest employers in the City. The wards with the highest unemployment rates in Manchester border on to the three NHS Hospital Trusts in the city. The Manchester Health Inequalities Partnership, one of the seven thematic groups of the Manchester LSP, sponsored the project utilising Neighbourhood Renewal Funds (NRF) and Workforce Development Confederation resources from 2002/03.The Wythenshawe area of South Manchester takes in some of the most deprived wards in the country. The South Project was set up to help local Wythenshawe people gain jobs at Wythenshawe Hospital and in local health centres and GP practices (Engaging Communities, 2005). Creating employment opportunities in Northern Lincolnshire Recognising the links between unemployment and poor health, a partnership project has been developed in the 2 acute Trusts in northern Lincolnshire to offer unemployed people from disadvantaged communities a 'work taster' and training routeway for a variety of NHS organisations (e.g. pharmacy assistants, health care assistants etc.). The placements are customised to suit the individual client who works alongside experienced NHS staff to develop the appropriate skills. Individuals receive assistance with CVs, interview skills, a variety of occupational training as well as on the job training. Throughout the placement, participants are encouraged to apply for NHS vacancies (Engaging Communities, 2005). Housing for Healthier Hearts Plus Project in Bradford This is an innovative project which aims to improve the health, housing and living conditions of people suffering from various chronic illnesses. Based in Bradford Trident's New Deal for Communities areas of Little Horton, West-Bowling and Marshfields, the project is a partnership between Bradford City PCT, Bradford Council and Bradford Trident. The scheme involves a holistic health assessment including advice on lifestyle, support networks, aids and adaptations and referral to other agencies. The project also a housing inspection that may lead to security measures, aids and adaptations, works to address dampness and inadequate heating and repairs affecting the health of the occupants (Engaging Communities, 2005). Projects about supporting families, mothers and children. Addressing Inequalities in Maternal and Infant Health - the Bellevue Model. Expectant mothers felt supported, reassured, better informed and better prepared for childbirth; members of the primary care team felt they were able to give mothers and their families a higher quality service; and the model of care was highly satisfying for the midwives involved. The principles of an enhanced, community based maternity service have been incorporated into Birmingham and the Black Country Health Authority's strategic framework for the next triennium (Engaging Communities, 2005). PULSE: Sexual Health Services for Young people The aim of this project is to provide young people specific health services focusing on improving the health & well being of children and young people in the following areas (Engaging Communities): * teenage pregnancy and early parenthood * sexual and mental health. * drug, alcohol and substance misuse * smoking cessation * nutrition and dietetics Smoke Free Merseyside Passive Smoking and Children Campaign This campaign encompassed 4 PCT areas: South Sefton, Central Liverpool, Birkenhead and Wallasey, and St Helens and Knowsley. Smoking prevalence was 57% and 33% parents smoked in front of children. Most (90%) correctly defined passive smoking and 75% agreed children should avoid smoky-places, although only 47% avoid such places. Passive smoking was recognised as a serious childhood health risk but 25% indicated it didn't worry them. Overall, 90% had seen the campaign, 20% recalled radio adverts; 50% recognised the campaign slogan. Health professionals increased knowledge, skills and confidence through training, which had a direct and long-term impact on day-to-day client care (Engaging Communities, 2005). Tackling oral health in North Staffordshire Despite recent improvements, oral health of children in North Staffordshire is amongst the worst in the West Midlands. Epidemiological data, evidence based practice and creative partnership and community engagement have been used to tackle systematically the inequalities in oral and general health among children (0-11 years) (Engaging Communities, 2005). Conclusion and Recommendation Whitehead (1995) suggests there are four main levels of health policy action that are commonly found. These are: - Strengthening individuals; - Strengthening communities; - Improving access to essential facilitates and services - Encouraging macroeconomic and cultural change. Many of the policies that have the greatest potential impact on health have traditionally been outside the influence of the health sector (e.g. pensions, housing, transport). These policies have been introduced primarily for other reasons and this has consequently meant that their health and particularly their health inequalities impact have rarely been fully evaluated. Despite the lack of full health impact assessments of policies there is some evidence that policies at each of the above levels can help to improve health. Governments, however, must be aware that some policies will work better than others at reducing health inequalities. They must ensure that improving the health of some of the population does not happen at the expense of others and lead to a widening of the health inequalities experienced (Judge et al, 2002; Whitehead et al, 1995). The sensible policy response is one that is multifactorial in order to address material deprivation as well as inequalities in income and access, and to avoid focusing on one life stage (eg childhood) to the exclusion of others. Some overall lessons from Whitehead appear to be that: policies and interventions may need to be specifically targeted at those in greatest need; policies aimed at changing individual and group behaviour will have only limited success amongst deprived groups unless backed by economic and structural change to create supportive environments; change is likely to require long-term commitment to policies; interventions that are found to be successful need to be applied to large sections of those in need; and the greatest effects are likely to result from policies that provide adequate support for those in poverty and promote the redistribution of income and opportunities in relation to education and training which may prevent poverty (Judge et al, 2002; Whitehead et al, 1995). Reference list Addressing the underlying determinants of health [online]. (2005). Dept. of Health, Crown. Available from: [Jan. 02, 2006]. Engaging communities [online]. (2005). Dept. of Health, Crown. Available from: [Jan. 02, 2006]. HealthInequalities/HealthInequalitiesGeneralInformation/HealthInequalitiesGeneralArticle/fs/enCONTENT_ID=4079644&chk=8WiiZg> [Jan. 02, 2006]. Health visitor in close-up [online]. (2004). Graduate Prospects Ltd. Available from: [Jan. 02, 2006]. Health inequalities continue to widen [online]. (2005). University of Bristol. Available from: [Jan. 02, 2006]. Introduction to health inequalities [online]. (2005). Department of Health, Crown. Available from: [Jan. 02, 2006]. Judge, Ken, Phil Hanlon,Avril Blamey and Jill Muirie editor (2002). Health Inequalities in the New Scotland, Health Promotion Policy Unit and Public Health Institute of Scotland. Available From: [Jan. 02, 2006]. Preventing illness Preventing illness and providing effective treatment and care [online]. (2005). Dept. of Health, Crown. Available from: http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthInequalities/HealthInequalitiesGeneralInformation/HealthInequalitiesGeneralArticle/fs/enCONTENT_ID=4082746&chk=tK2rGT Reducing Health Inequalities: Implications for Interventions [online]. (2002). Public health agency of Canada. Available from: [Jan. 02, 2006]. Supporting families Preventing illness and providing effective treatment and care [online]. (2005). Department of Health, Crown. Available from: [Jan. 02, 2006]. Wider determinants of health and health inequalities [online]. (2005). London Health Commission. Available from: [Jan. 02, 2006]. Whitehead M., Benzeval M, and Judge K. (eds.) (1995). Tackling Inequalities in Health: An Agenda for Action; Kings Fund, 1995 Read More