Health and health service

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how is health defined?

  • 'health' was often seen as synonymous with the absence of disease.
  • health is about more than the absence of disease and the who defines as "a state of complete physicl, mental and social well-being and not merely the absence of disease" (WHO 1986) 
  • this means the concepts of health and wellbeing are more loosely defined and more contested (Winslow 1920) 

health service are one of 3 public ealth policy areas: 

1) health service: In UK, vast majority of health spending and debate about health polic is focussed on community-based health service (e.g gps) hospitals and specialist. 

2) Health Portection: surveillance of infectious diseas to prevent and control new diseas outbreaks, including via vaccinations. 

3) Prevention: improving health through prevention of disease. including via education, healthy environment and policy. 

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The birth of NHS:

"NO COUNTRY FOR SICK PEOPLE"

  • this is the biggest single experiment in social service that the worl has ever seen under taken (Bevan 1948) 
  • post war britian was determined to 'win th peace' too and health care could no longer only be available for just a few. 
  • with an increasing number of voluntary hospitals and emergency medical services, that was a consensus that we needed a NHS by 1945 (Timmus 1996)
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Passing the NHS Act:

  • all consultants would be allowed to continue in private practice in NHS 'pay beds' and their salary demand were met (Timmus 1996) 
  • "first health service in any western society to offer free medical care to the entire population" (Klein 1983) 
  • "offers free and universal entitlement to state-provided medical care" (Klein 1983) 
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marketisation (1): Thatcherism and Health:

  • britian was "the sick man of Europe" in 1979 and british welfare state was prscribed free-market-reforms to try improve efficency and repuce publc spending
  • process of marketisation of the NHS statred in early 1980s - Thatchers government was too politically prgmatic to privatise the NHS wholesale. 
  • compulsory competitive tendering, of cleaning and other services introduced. 
  • for the threat of infectious disease to greater rates of caner and heart diseas was increase cost but reforms were ideological. 
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marketisation (1): Thatcherism and Health:

  • britian was "the sick man of Europe" in 1979 and british welfare state was prscribed free-market-reforms to try improve efficency and repuce publc spending
  • process of marketisation of the NHS statred in early 1980s - Thatchers government was too politically prgmatic to privatise the NHS wholesale. 
  • compulsory competitive tendering, of cleaning and other services introduced. 
  • for the threat of infectious disease to greater rates of caner and heart diseas was increase cost but reforms were ideological. 
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Marketisation (2): Internal market:

  • in 1989, two white papers working for patients and caring for people outlined the government could set up a 'quasi market' in health service. 
  • in 19090 the NHS and communicty care Act created the Internal market. 
  • the purches of provision of healthcare in the UK was split up with the govenment-funded GPs 'purchasing' healthcare from the NHS authorities, who competed against one another for the GPs custom. 
  • Marketisation led to some 'efficency gains' - greater competition but didnt promote quality and the cost of new administriative structures outweighed any gains. 
  • But New labour continured wit hthe quasi-market models. (Mays and Tan 2012) 
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Marketisation (3): health and Social care Act 2012

2012:

  • the final stage in the process in england. 

David Cameron 2011 "from the health secretary, i dont just want to know about waiting times, i  want to know how we drive the NHS to be a fantastic business" 

"the only people celebrating the passing of lansley's controversial bill in march 2012 were the private sector who wanted to get their hand on the large slice of the £100 billion health budget" 

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health Policy & Lobbying: Industry influence:

  • health policy communities dominanted by powerful coroprate that inhabit public health improvements (hastings 2012) 
  • "unt the influence" on Alcohol policy: recent Government U-turn on minimum Unit pricing. "was result of the extraordinaty access granted to companies and industry by individual MPs and many government deparments" (Gornail 2014) 
  • childrens food trust Uk was described the involvement of supermarkets and food and drink indusry in government via "self-regulation" as "the irresponsibility deal" (Hashem 2012) 
  • Pharmaceutical companies lobby to help them hid results and islead clincians, policy makers and the public for profit (Goldscre 2012) 
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what can we do now?

  • Diagnosis and treatment problems within prevention has led to some to refer to NHS as the ;national sickness service'" (Malyneux 1971)
  • the ecological nature of public health means that where we live, work and study shapes our health much more than health-service alone
  • the WHO has challenged the governments to adopt the principle of 'health in all policies' approch from now on. 
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Summary:

  • "health" is contested and complex to define 
  • we need to save the NHS - without that there is little hope of sustaining any free universal service 
  • even best health servies didnt make us a healthy country - health is shaped by many other cultural, social and economic factors.
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