Wealth and health inequalities part 2
The National Health Service (NHS) was set up as part of the post-war Welfare State. Its original aims were to provide a comprehensive, integrated service free at the point of use. Its intention was to provide the best possible care for all citizens and, wherever possible, prevent ill health.
The NHS has not been able to fully meet these aims due to the unexpected cost of healthcare and an ever-increasing demand for limited resources. The NHS has treated more patients every year and introduced many new treatments. With limited resources it has had to deal with increased patient expectations, and the cost of new technologies and drugs. The care needs of the increasingly elderly population are also putting a significant strain on the NHS. As such it is often said to be 'a victim of its own success'.
There are many reasons for inequalities in health in the UK. Although some parts of the country have poorer health records than others, this is linked to poverty rather than geography. Differences between the poorest and richest parts of Glasgow are greater than average differences between Scotland and South-East England.
There are significant differences in life expectancy of at least 10 years between different groups in society. Those living in poverty generally have poorer life chances and poorer health because of lower living standards, including poor housing and poor diet.
Those in lower paid, unskilled jobs have a greater risk of accidents at work and can suffer from stress linked to unemployment. Professionals enjoy healthier lifestyles, not just because they have a better standard of living but also because they are more likely to be aware of health issues than unskilled workers. Similarly, women are more aware of health issues and more likely to consult doctors than men. As a result, women appear to have higher sickness rates than men, but this may reflect the fact that more male ill health is unreported.
Evidence of these health inequalities were published the Black Report (1980), the Acheson Report (1997), and most recently in a report by the UN’s World Health Organisation (WHO). It found that a boy from Lenzie, an affluent area in East Dumbartonshire could expect to live up to 28 years longer than a boy from Calton, a deprived area in Glasgow. Below is a summary of how Scotland’s male life expectancy compares to other countries around the world.
Obesity is another challenge for the NHS. Rates of obesity in Scotland are increasing, especially among young people, who are increasingly adopting a lifestyle with little or no physical activity and a diet high in saturated fat. In Scotland it has been described as an epidemic, and is a big health challenge for the NHS and the Scottish Government. Recent statistics have suggested that two thirds of men and more than half of women in Scotland are overweight. Obesity, along with heart disease and cancer, are seriously threatening the health of the nation.
As well as requiring treatment for specific health problems that are linked with old age, the elderly are the biggest consumers of general healthcare in the UK. They are more likely to have accidents, which take longer to heal, and are also more likely to suffer from such major causes of ill health as heart disease and cancers. As well as specific healthcare, they need to be looked after in other ways as they become infirm and incapacitated. Thousands of old people take up hospital beds.
Under the Care in the Community policy, local authorities are now responsible for the care of old people for whom medical treatment in hospital is not required. Social workers and medical staff assess the needs of old people to determine what level of support is needed for their proper care. Most old people stay in their own homes, which may be adapted to meet any mobility or other problems they have. Sheltered housing is also specially designed accommodation to meet the needs of the elderly. Residents can remain independent of full time care but professional carers will visit to provide specific needs such as meals or physiotherapy. Full residential care is provided for old people who cannot cope on their own and those who need more intensive support are placed in nursing homes.
Although healthcare is free at the point of use, social care is subject to means testing. The Scottish Parliament now provides free personal care (such as help with washing, dressing and meals) for all old people in Scotland, and this as recently been proposed by the UK Parliament for some older people in England too.
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