According to the NHS (2013) the UK is perceived as healthier that it has ever been in its history. This is mainly due to the enhancement of life expectancy, the eradication of diseases, and the advantages brought by public health reforms and technology. However, the problem of health inequalities remains omnipresent. Even if the health of the population is improving, the health of the poor or those less well-off is either improving really slow or it gets worse. This is a main challenge for the policy makers, who see that even though their interventions work, they fail in some sections of the population.
Health inequalities in the UK
To understand the impact of health inequalities, we need to start from the beginning. Economic and social changes, the downfall of manual work, the development in women’s employment, as well as migration patterns and the change of the family structure have modified the population’s nature. Additionally, the NHS (2013) believes that these changes also affect the data about health. They also add that occupation-based classification attracts social inequality in Britain. Moreover, living standards improve the higher one moves on the social ladder, but so do a range of people’s wellbeing factors, such as education, employment opportunities and, last but not least, health.
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Researchers believe that in an intricate society as Britain, there are “a number of axes of social differentiation” (Anthias (1990) as cited by the NHS (2013)). These refer to ethnicity, gender, sexuality, age, area, community and religion. Furthermore, it is believed that these classifications are linked but represent separate dimensions of inequality. Exposure to racism is a major factor why the wider population is disadvantaged, and this can take and additional effect on the health of black and Asian communities (Karlsen, 2002).
The table provided illustrates a pathway, in the same time giving examples of determinants or factors that operate at different stages along the way. It runs from social structure to health and wellbeing. As it can be seen, education impacts on a person’s health and wellbeing through social position and intermediary factors that are associated with it. Besides the environmental and behavioural factors (housing quality, exposure to smoking) the table also presents health and social services among the intermediary factors. These not only have a strong role in preventive care, but they also contribute so reducing the effects of illness and injury on health.
We need to keep in mind that the figure does not provide a complete picture. It shows examples from a key set of pathways. This can refer to poor health and disability which can affect an individual’s socioeconomic circumstances, which influences health and all the way to social position.
In addition, due to a person’s social standing, which can alter access to societal resources (education and job opportunities) and exposure to risks, this has a strong relation with health over time and across different diseases.
In order to make sure that health inequalities are eradicated, the NHS (2004) comes up with a series of changes that can be applied. Attention needs to be given to the baseline data collected and compare it within and across the New Deal for Communities. Moreover, the planning agenda needs to be more focused towards local health and make sure that goals are realistic and measurable. Last but not least, planned activities need to be specified, resourced and targeted towards change.
However, David Buck (2014) states that reducing health inequalities should not be left only to local authorities. Although they have an essential role to play when dealing with these issues, Buck proposes a joint commitment by the leaders of communities on how they approach and deal with this situation by using the “big levers: commissioning, incentives and accountability”.
Further, if health inequalities are not solved, it can have disadvantages not only on the population, but also on the economy. The Marmont Review (201) as cited by Jane Dreaper (2010) states that inequality in health accounts for £33bn of lost productivity every year. She also advises the NHS to start spending more on prevention than the 4% it currently does, so as to provide more help to those who need it.
When identifying and analysing challenges I have decided to focus on diet and lifestyle factors.
Diet and nutrition
The Department of Health (England) states that food poverty is “the inability to afford, or to have access to, food and to make up a healthy diet”. The Faculty of Public Health (2009) also adds that the poorer an individual is, the worse their diet and the more diet-related diseases they suffer from. This represents a risk which can backfire to diseases such as cancer, coronary heart disease and diabetes. It has been found that poor diet accounts for 30% of life years lost to early death and disability (National Heart Forum, 2004).
Inequality in health has a strong correlation to food poverty. People with low incomes suffer from poor diets, due to low intakes of fruit and vegetables, and also dental caries among children, to name a few. Already the government is trying to solve the issue, but the actions needs to be more than health professionals giving advice to individuals. The “food environment” needs to change, referring to accessibility, affordability and culture. By strategically including public health professionals in key areas and developing programmes, the barriers to healthy eating can be broken down and nutrition improvement can be achieved (Faculty of Public Health, 2009).
Some barriers to healthy eating have been tackled and presented. One of the main factors is the low income and debt. This can restrict an individual’s access to fresh fruit and vegetables, which are normally more expensive. Additionally, this is influenced by the poor accessibility to affordable healthy foods. In disadvantages neighbourhoods, shops are starting to close down, and the construction of supermarkets out of town proves to be difficult due to transport links and impossibility to pay for the fair. Furthermore, foods which are high in fat, sugar and salts are cheaper and more available, making it one of the biggest factors of poor nutrition. The same findings have been stated by Hillary Shaw in her study conducted in Birmingham (Hillary Shaw 2012).
The Health Survey of England conducted a survey in 2008 regarding participation in all types of physical activity at work, and during leisure time. The results showed that social class is a great factor in participation, but it differs regarding gender.
(Health Survey for England 2008)
This measurement includes physical activities carried out during work. However, when this is excluded, a connection between physical activity and income is observed among men, but not women. This can also be explained by active transport, such as walking or cycling, since people on lower income may walk or cycle more due to not owning a car or affording public transportation.
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Furthermore, The Active People Survey conducted in 2011/12, with 500 participants, found a relation between socioeconomic factors and participation in sport. The figures in the table below use the notations of the National Statistics Socio-Economic Classifications (NS-SEC). From the findings, we can observe that 43% of the adults in groups 1 and 2 take part in sport for at least 30 minutes once a week or more, compared to 27% of adults in groups 5-8.
(Active People Survey 2011/12)
The National Institute for Health and Clinical Excellence (NICE) affirmed that the figures reported from the above surveys are influenced by the built and natural environments people live in. People from lower social standings tend to live in areas or neighbourhoods which have poor access to environments that support physical activities (parks, gardens or safe areas), and tend to live near busy roads. To add, people from lower socioeconomic groups tend to live in areas that do not present a framework for public transportation, therefore they rely on walking or cycling for transport and to access employment (The Marmont Review 2010). More, fear of traffic can be another factor in allowing children to play outside, walking or cycling. The Institute of Public Policy Research (2002) revealed that children in the 10% most deprived wards in the UK are more than three times as likely to be pedestrian casualties as children in the 10% least deprived wards.
Affordability may also be a barrier to taking part in sports and activities. This is due to gym membership costs that are out of the range for many people with low incomes. The Health Survey for England (2007) showed that 13% of men and 16% of women cite lack of money as a barrier to exercise. Even though, taking part in activities such as walking or hiking are less costly, 45% of men and 34% of women stated that work commitments represent another obstacle to being active. Therefore, people from a lower social standing may not have the money and the time to take part in physical activities.
One example for these findings is provided by Rowenna Davis (2011). She compared two neighbourhoods in Glasgow which are close to one another, but differ in every way: Jordanhill, a posh area, and Parkhead, a poor neighbourhood. The ladder area is known for having worse housing, not enough parks and poor transportation links. Moreover, researchers believe that children living in this area are more likely to start smoking, drinking and having a poor diet.
People in poorer social classes are believed to die sooner due to a series of factors. The dominant factor among men is smoking, accounting for nearly half of the difference in risk of premature death between the social classes. Additionally, smoking is more concentrated in Britain’s poorest families, with low income lone parents having the highest rates of smoking. This is also influences the high rate in illnesses in this category, such as cancer and heart disease (NHS 1999)
Smoking during pregnancy also has its say in this issue. It not only hurts the mother, but also the unborn child. The highest rates have been recorded among expectant mothers under the age of 0 and women who have left school at the minimum leaving age and with no educational qualifications. These results show to be three times higher among women from a bad social standing than women in the rest of the categories (NHS 1999).
There are many charities nowadays that are trying to solve the health inequality prove by helping those who need aid. One of the charities I have identified is the Gleaning Network UK. This initiative’s goal is to save thousands of tonnes of fresh fruit and vegetable which are wasted on UK farms. These crops cannot reach the market because they fail the cosmetic standards of due to overproduction. The Gleaning Network UK uses teams of volunteers, local farmers and redistribution charities in order to salvage this food and give it to those that need it. In 2013, they have saved 48 tonnes of produce which were made into 200,000 meals that helped communities around 6 major cities (Gleaning Network UK, 2014).
The British Heart Foundation is also fighting to stop health inequalities, by providing support to those who smoke and want to quit, with the help of “No Smoking Day”. This is one of the UK’s biggest annual health awareness campaigns which creates supportive environments for everyone and provides sources of help and advice. Already in 2013, 20% of the smokers aware of this campaign made an attempt to stop smoking, reaching an estimate of 1 million quitters (No Smoking Day website 2014).
Regarding exercise and physical activity, one of the most prolific charities I have found is the Right To Play. They believe that play and exercise if a tool for education and health, so volunteers teach children and youth that through sport one can be taught about values and goals. Their vision is “to create a healthy and safe world through the power of sport and play”. Even though the organisation works at a global level, it helped many communities in the UK to start taking up sports and leading a healthier life (Right to Play website 2014).
Improving people’s lifestyles and eradicating food poverty need to be top priorities for primary care organisations and local authorities. Moreover, collaboration of organisations, charities and councils need to focus on developing strategies which will reduce barriers to a healthy life.
One of the first recommendations drawn from the charity examples from before is to establish a local “food poverty partnership” with organisations including health services, local authorities and voluntary organisations to develop a local food poverty strategies. One successful example is the Cyrenians in Edinburgh, Scotland, a charity which started an initiative of “turning waste into opportunities”. Their aim is to get food waste down to zero, by working with local restaurants and shops and socially disadvantaged people from different communities. The food that the eateries and shops do not use anymore is donated to charities which will prepare meals for those who need it. Moreover, they provide jobs for those who also wish to work in the fields of collection and cooking (Cyrenians 2014).
The next recommendation focuses on working with local communities and understanding their priorities, barriers and opportunities. With the help of community meetings and surveys, healthy living can be promoted. One of the best examples in this case is the Good Gym organisation. This charity encourages people to combine their exercise routine with volunteering, matching busy workers with elderly “coaches” who receive their paper or deliveries in exchange of an incentive for their weekly visitors to keep on running. The Good Gym works with the NHS, charities and local community centres, and talks to people from poor neighbourhoods trying to understand their situation and what can be done. As a result, the foundation organises monthly group runs in east London, performing useful activities along the way. Up till now, the members have distributed flyers for a local hospice, tidied up community gardens and hauled compost on to a school roof (Barkham 2012).
When tackling smoking, care providers, local councils and the organisations involved need to put together treatments that will prove to be effective. The GP should consider holding brief interventions to those trying to give up smoking, also providing advice, self-help materials and suggestions for more intensive support. Individual behavioural counselling will be essential when lending a help for those seeking motivation to quit. Additionally, mass-media campaigns need to become the main means of sending the message of “stop-smoking” across, by using radio commercials, internet and TV ads. The same strategies have been used by the NHS with their “No Smoking Day” campaign. This movement has recorded an increase of 10% over the last 4 years of those who want to smoke.
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