Public health

Question 1

Life expectancy at birth 1841-2012, England and Wales

Answer 1

Question 2

Widening gap in outcomes between social classes

Answer 2

Question 3

The black report 1980

Answer 3

• 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

Question 4

Gradient in mortality rate by social class

Answer 4

Question 5

Whitehall I

Answer 5

Question 6

Inequalities in access to healthcare

Answer 6

Question 7

Access to healthcare: The inverse care law

Answer 7

• 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• The market distribution of medical care is a primitive and historically outdated social form and any to it would further exaggerate the maldistribution of medical resources

Question 8

Waiting times for NHS cardiac surgery

Question 9

Access to general practitioners in Scotland

Answer 9

Question 10

The black report 1980

Answer 10

• 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

Question 11

Life expectancy (LE) and healthy life expectancy (HLE) for males at birth, England 2014-16

Answer 11

Question 12

Number of deaths as a result of heart disease

Answer 12

Question 13

Percentage of low birth weights

Answer 13

Question 14

A cycle of low income

Answer 14

Question 15

How does poverty affect health

Answer 15

• 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

Question 16

Absolute versus relative poverty: income versus income inequality

Answer 16

• 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

Question 17

Trends in UK income inequality 1979-2005/6

Answer 17

Question 18

Life expectancy by social class, men, England and Wales between 1972-76 and 1992-96

Answer 18

Question 19

Policy developments 1990-2000

Answer 19

• 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

Question 20

The marginalisation of PH policy

Answer 20

• 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

Question 21

The marginalisation of PH policy

Answer 21

• 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

Question 22

Healthy lives, Healthy people

Answer 22

• 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

Question 23

Healthy lives, Healthy People

Answer 23

• 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’

Question 24

Nudge theory

Answer 24

• 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

Question 25

Healthy lives, Healthy people

Answer 25

• 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

Question 26

Annual change (months) is absolute gap in life expectancy between most deprived 20% of LAs and rest of England

Answer 26

Question 27

Range in life expectancy at birth, England 2011-16

Answer 27

Question 28

HI’s and Public Health Policy

Answer 28

• 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