The NHS Role in Tackling Health Inequalities

The NHS Role in Tackling Health Inequalities At the turn of the 21st century, social health inequalities remain to be the key public health problems in advanced European countries. There is strong variation in life expectancy between and within the countries, which has accumulated over the past 3 or 4 decades (Fox, 1989; Drever Whitehead, 1997; Kunst, 1997; Marmot Wilkinson, 1999; Elstad, 2000; Mackenbach Bakker, 2002). NHS targeted health inequalities with infant mortality and life expectancy at the core to reduce them by 10 % by the end of 2010. These two health inequalities were announced in February 2001, with the other complementary targets, the areas of smoking and teenage pregnancy. These targets were set to reduce the broad spectrum of inequalities covering the general strategy to address all of the major health inequalities including gender, race, age, etc. (DH, 2001). The secretary of state, nationally announced a comprehensive strategy to reduce health inequalities, challenging the NHS as a key player to live up to its founding and enduring values of universality and fairness to shut the unjustified gaps between individuals with any background, fair NHS services with high quality and good outcomes to everyone (Darzi L., 2007). The independent scientific review of the national health inequalities was published in 1998. This report suggested policy developments to tackle health inequalities. This report showed the increasing gap between the different social groups. This resulted in the consideration of these increasing gaps needed action upstream as well as downstream (Acheson Inquiry, 1998). As the NHS and Department of Health continuously poured efforts to reduce the health inequalities. The overall performance can be defined as much achieved more to do (DH, 2009). This review will analyze the role of NHS in tackling health inequalities, as targets were set to reduce infant mortality and to increase the life expectancy in men and women across UK, faster than elsewhere in world. 2.0 Aims: To understand health inequalities To briefly review of the Acheson Inquiry recommendations To study the role of the NHS as a key player in tackling health inequalities in UK. 3.0 Material Methods: Study will review reports and documents published by the Department of Health and the NHS. Review of literature will be done from the data available on the websites of the Department of Health, the NHS and other government websites. Discussion of role of NHS as key player in tackling health inequalities in UK and a comment on the target achieved over a decade. 4.0 Review of Literature: In 1980, the United Kingdom Department of Health and Social Security published a report of the Working Group on Inequalities in Health, also known as Black Report. This report showed great extent of of which ill-health and death are unequally distributed among the population of Britain, and suggested that these inequalities have been widening rather than diminishing since the establishment of the NHS in 1948(Gray AM. 1982). The Black report identified four types of explanations of health inequalities: artefact, selection, cultural or behavioural, and materialist (Blane D., 1985). Since then there were many studies contributed to broader understanding of the health inequalities (Smith et al 1990). After 1997 NHS had made clear progress, as in 1997 NHS was in relatively poor health, due to this low investment hampered proper planning. In regards with different health inequalities NHS was not simply big enough or capable enough to meet the expectations of the patients (Darzi L., 2007). The steepest inequalities health is observed at two stages of the life course: early childhood and midlife. Less inequality is observed in adolescence and in older age (Kuh Ben Shlomo, 1997). Actual health inequalities were considered and taken note by the scientific independent inquiry called as Acheson Report in November 1998, which reviewed the evidence of health inequalities in UK. Acheson report suggested that, there is convincing evidence that, provided an appropriate agenda of policies can be defined and given priority, many of these inequalities are remediable (Acheson Inquiry, 1998). The Acheson report is supposed to be the cornerstone for the policy development over the last 11 years informing action on the national target and the cross-government strategy, the programme of action. The report focused on socio-economic inequalities which showed the increasing gap between different social groups. It suggested almost 39 recommendations (Appendix I). After considering the all the facts and recommendations, the NHS announced the two national health inequalities targets in February 2001, one relating to the infant mortality and the other to life expectancy. These targets were considered to reflect the efforts taken to reduce the broad spectrum of inequalities at national level across UK. These targets can be formulated under the specific terms socio-economic groups and geographical areas so that they can cover more general strategy to address all of the major health inequalities including gender, race, age as well as health in specific disadvantaged groups such as lone parents and the homeless (DH, 2001). Englands new health strategy, like this across the UK, represents a major advance in the vision and remit of public health policy. Protecting and improving aggregate levels of health no longer provide a sufficient justification for investment in public health; this investment must also yield a more equal distribution of health between socioeconomic groups. As a result, public health goals which were previously expressed only in terms of population averages now include a concern with how health is distributed across society. It is a concern summed up in the goal of tackling health inequality (Hilary G., 2004). 5.0 Understanding Health Inequalities: Inequalities are a matter of life and death, of health and sickness, of well-being and misery. The fact that in UK today people in different social circumstances experience avoidable differences in health, well-being and length of life is, quite simply, unfair. Inequalities in health arise because of inequalities in society in the conditions in which people are born, grow, live, work, and age. So close is the link between particular social and economic features of society and the distribution of health among the population, that the magnitude of health inequalities is a good marker of progress towards creating a fairer society (Marmot, 2010). The documents on plans, actions and performance standards are designed to spell out what it means to tackle socioeconomic inequalities in health. Their descriptions suggest that it has a variety of meanings. At some points, tackling health inequalities is described as a commitment to break the link between poverty and ill health and to improve the health of the worst off (Milburn, 2001 as Cited in Hilary G., 2004). Health inequalities can be stated as the disparity in health status between rich and poor and the health gap between the worst off in society and the better off (Wanless D., 2001). At other points, health inequality is a concept which covers the whole population. Health inequality exists between social classes and right across the spectrum of advantage and disadvantage (Hilary G., 2004). 6.0 Review of Acheson Report: The Acheson report was published in 1998 from then it has been considered as the corner stone for tackling health inequalities. This independent scientific review considered the developments over the 20 years and identified some possible policy developments to address health inequalities. The report showed the data with increasing gap between social groups, in early 1970s, the mortality rate among the men of the working age was almost twice as high as for those working in social class V (unskilled) as for those in social class I (professional). By the earlier 1990s, it was almost three times higher. This resulted in the consideration of this increasing gap needed action upstream as well as downstream in other words from outside the NHS, as well as within it. The report also addressed that social determinants affect peoples health across their lives; the early years are a particularly important stage of life, where poor socio-economic circumstances have long lasting effects. Consequently, it gave priority to policies and interventions with the potential to reduce inequalities in access to the determinants of good health among parents, particularly present and future mothers, and children. It suggested almost 39 recommendations (Appendix I) which focus around the 4 major themes: The social determinants of health, such as poverty and income, education, employment, environment and housing The life course, including lifestyle factors such as smoking, nutrition and alcohol consumption Other dimensions of health inequalities beyond socio-economic status namely ethnicity, gender and age Measures to improve the effectiveness of the NHSs systems of care, not least in terms of resources and access to services. The report gave high priority to mothers, children and families. Tackling health inequalities is a complex and long-term challenge, requiring action across the layers which influence the health. The relationship between these layers is shown below in Fig. 1 (an updated version of the Dahlgren and Whitehead diagram that appeared in the Acheson report). Fig. 1 The main determinants of health: Source: Barton and Grant (2006) adaptation of Dahlgren and Whitehead (1991) from UN Economic Commission for Europe (2007) Resource Manual to Support Application of the Protocol on Strategic Environment Assessment. 7.0 National Health Inequalities Strategy, Programme for Action: The national health inequalities target was set in 2001 the aim was to reduce the health outcomes in infant and the overall increase in life expectancy by 2010. The national health inequalities strategy programme for action was built on the board front set out in Acheson, which focused on the importance of the working across government and in partnership both with other service providers and with the local communities (DH, 2003). Four themes of the programme for action: supporting families, mothers and children reflecting the high priority given to them in the Acheson report engaging communities and individuals strengthening capacity to tackle local problems and pools of deprivation, alongside national programmes to address the needs of local communities and socially excluded groups preventing illness and providing effective treatment and care by means of tobacco policies, improvements in primary care and tackling the big killers coronary heart disease (CHD) and cancer addressing the underlying social determinants of health emphasising the need for concerted action across government at national and local levels up to and beyond the 2010 target date. Annual status report has to be published throughout the lifetime of strategy, these developments were monitored against the NHS to the wider determinants of health (reflecting Achesons proposal for action on broad front), and 82 departmental commitments (DH, 2003) These Annual status reports showed the improvement in health in real terms across all social groups, against a range of indicators including life expectancy, infant mortality, cardiovascular disease and cancer, and reported on developments against the cross-departmental commitments (DH, 2010). 8.0 Role of the NHS in tackling health inequalities: As NHS is the key player in tackling health inequalities target set in 2001- By 2010 to reduce the inequalities in health outcomes by 10% as measured by the infant mortality and life expectancy at birth. 8.1 Life expectancy- The life expectancy gap between the areas with lowest life expectancy and the national average is caused principally by premature deaths from cancer, circulatory diseases and respiratory diseases with smaller effects from suicide and violence in men. The over 50s contribute 79% of the gap in women and 70% of the gap in men. It follows that the priorities for NHS action which will have the greatest impact on narrowing the gap are: addressing cancer and circulatory diseases within manual social groups because these major killers exhibit strong social class gradients. Improving the life expectancy of the over 50s high quality care in disadvantaged areas, especially primary care. Key areas of interventions to narrow the gap in life expectancy are: reducing smoking, prevention and effective management of other risk factors in primary care, targeting over-50s, and working pro-actively with partners on issues affecting life expectancy. 8.2 Infant mortality- Deaths under one year of age total about 3,000 per year. The two major causes of neonatal deaths are immaturity related conditions and congenital malformations and both show a strong social class gradient. The social class gradient is greater for post-neonatal deaths. Just under 50% of all post-neonatal deaths are accounted for by two causes: signs, symptoms and ill-defined conditions (predominantly SIDS) and congenital anomalies. The underlying determinants of mortality and ill-health in infants include: low birth weight maternal smoking (smoking during pregnancy) paternal smoking maternal anthropometry/nutritional status failure to breast feed quality and quantity of health care maternal age the physical environment (housing condition) the family and social environment Key areas for interventions to narrow the gap in infant mortality are: reducing smoking in pregnancy, improving nutrition in women, reducing teenage pregnancy, increasing breast-feeding, effective ante-natal care, improving the quality of midwifery, obstetric and neonatal services and high quality family support. The NHS set to improve the action to address health inequalities (Appendix II): Raise the profile of health inequalities and focusing on results Making it clear it is not good enough to achieve top line targets at the expense of widening inequalities Make health inequalities an integral part of planning, commissioning and delivery Promote Health Equity Audit, Local Delivery Plan and its impact on the health inequalities. Partnership working and influencing partners to tackle the wider determinants of health and health inequalities Progress must be measured Use of the Health Care Standards and their underpinning criteria. The WHO guiding principle, that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, was reiterated in the 1998 World Health Declaration (Hilary G., 2004). The report on health profile of England 2009 states there are improvements in number of critical areas eg. Decrease in mortality rates, increase in life expectancy and further reduction in infant and perinatal mortality (DH, 2010). These achievements can be defined as much achieved more to do'(DH, 2009). Now the NHS is focusing to be the World Class NHS whom services will be (Darzi L., 2007)- Fair Personalized Effective Safe Over recent years health inequalities have increasingly featured as an NHS priority. This has been evident in their incorporation into other Public Service Agreement health targets, and the findings of the Wanless report noted the association between lower socio-economic status and poor health outcomes, and the cost consequences for the NHS (Wanless D., 2004). The contribution of the NHS to the 2010 target was recognized in the Treasury-led cross cutting review (DH, 2002). This review considered the implications of the Acheson report for departments across government and the NHS. It identified NHS interventions as more likely than other interventions to help deliver the short-term target through reducing smoking in manual groups and preventing and managing other risk factors for coronary heart disease and cancer, but it recognised that the social determinants were crucial for a long-term sustainable reduction in health inequalities. 9.0 Discussion: The Black Report concluded that inequalities in early 1980s were not mainly attributable to failings in the NHS, but rather to many other social inequalities influencing health: income, education, housing, diet, employment, and conditions of work. Then Black Report recommended a wide strategy of social policy measures to combat inequalities in health. After 10 years of Black report the social class differences in mortality were still increasing, after this there were many studies undertaken addressing inequalities in health'(Smith et al 1990). Then Acheson report was published in 1998 an independent scientific review of the inequalities in health, and in 2001 the national targets for tackling inequalities in health were set in which Department of Health and NHS played a key role the success can be stated as the much achieved more to do (DH, 2009). The Marmot review recommends action on health inequalities requires action across all the social determinants of health and needs to invol ve all central and local government departments as well as the third and private sectors. Action taken by the Department of Health and the NHS alone will not reduce health inequalities (Marmot, 2010). 10.0 Conclusion: The above study shows the NHS had played a key role in tackling health inequalities along with the Department of Health over the past decade. This resulted in the highest life expectancy ever in UK and gradual decrease in the infant mortality. Overall development in past decade is shown in Appendix III, which shows factors such as employment, housing conditions, educational achievement, crime and child poverty without which the overall improvement in the health inequalities is not possible. The role of NHS in tackling health inequalities have also improved the overall performance of the NHS itself in and made the NHS a World Class NHS visioning fair, personalized, effective and safe services ahead.

Confidentiality and Informed Consent

In the article by Martindale, Chambers, and Thompson, we learn that Informed consent and confidentiality. A person should be informed of their right to confidentiality and the treatment they are consenting to in the therapeutic relationship. This study Is significantly Important because we are shown that there has been not very much previous research done on how well we manage consent, how Informed the patient Is, how honest they are, and what they actually know about the policies of the provider. Professionals in many settings create and utilize very ifferent techniques of informed consent and confidentiality.In professions where professionals constantly see people who are troubled. who see the everlasting devastation of grief, pain, and the disparities of people in situations that they cant change, it can be very taxing and wearing on even the most seasoned professional person, but do we actually communicate well to the patient that they have rights? In the article, we see that so many patients are so desperate to receive care that they Instantly Just â€Å"sign papers† so that the can see the psychologist.If a patient Is that esperate, how do we know that mental health professionals are performing to their maximum standards of Informing the patient about their care standards and things like who has the appropriate access to their medical information? We, as counseling psychology graduate students and professionals alike, have a strong moral and ethical responsibility to ourselves, our colleagues. and our clients to make sure that we provide appropriate documentation, informing the patients clearly of their rights and responsibilities, so that we do not potentially negatively affect the lives of other eople.In the article by Martindale, Chambers, and Thompson, In the four themes that emerge, â€Å"being referred; the participant's feelings, mental health difficulties, and their Impact; relationships with workers and carers; and autonomy (Martindale et al, p. 355)†, we see that many clients have concerns about continuing care. I think the most difficult and problematic Issue to handle there Is the patient's mental health and stability. In chapter 5 of the textbook, the ACA Code of Ethics, Section 8. 5. on informed consent states: â€Å"Responsibility to Clients.When counseling minor clients or adult clients who lack the capacity to give voluntary, Informed consent, counselors protect he confidentiality of information received in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards. (Welfel, 2012, p. 142)†. It is the professional responsibility of the provider to be aware that the client has good mental standing to be able to know their rights. However, how dowe know upon first seeing the client that they are In a good mental standing to be completely informed? This puts providers in a tough situation.What happens to the clients they counsel who never k now of their consent rights and their confidentiality? How can we test for that if it we have no idea if the client is being honest with us? How do we know the frequency of occurrence? How do we know It Is not happening all the time? That Is why It is absolutely imperative to have open and t Of2 nonest communlcatlons wlt n tne cllent as oTten as posslDle. As graduate students, It is important for us to foster a supportive working relationship with our advisor, so hat we are absolutely sure the client is informed about what comes next in their therapy process.What if clients are too scared to ask how many sessions they have left? What if they are a â€Å"yes† person and can't say no to more or less treatment options? What if they have concerns but are too scared to ask about what is upcoming? I have personally seen a therapist who, after every session, had me fill out a questionnaire about my ability to see things clearly in the session; if I understood what my objectives were , if I understood her clearly, and if there was anything I was ersonally hesitant to share or anything that bothered me about our last session.This was extremely problematic for me because I always answered â€Å"no problems with last session† for fear that I would disappoint my provider or that she would then bring up the issue that I had experienced a problem with. I always felt uncomfortable, but continued to answer the questionnaires and continue care anyway because I needed it. In Martindale, Chambers, and Thompson's article, there are some limitations to the study. Primarily collected data were from mainly white omen.There seemed to be no measure of marginalized communities, under represented populations, or any data from the people who seem to struggle the most: people needing critical care. How would ethnic minorities respond to a provider who may not understand their cultural differences? How do we make sure those people are being informed appropriately? What about m arginalized communities who are in crisis and need care? How do we handle special situations appropriately? What about people who can't consent to appropriate care guidelines?

Demonstrative Communication Essay

â€Å"Communication is an exchange of information, verbal pr written message and is the process of sending and receiving message†. () With communication there must be a sender and a receiver for it to take place. In this paper I will provide examples how effective and ineffective demonstrative communication can be positive or negative on situations. Also I will explain how demonstrative communication involves listening and responding. Demonstrative communication is nonverbal and unwritten communication thought facial expression or body language. Effective ways for a sender and receiver to communicate in a demonstrative way would be to send the right message. Sender would want to make sure the receiver comprehends and understands the sender. For example Kinesics: â€Å"refers to the many behaviors of the body†() these would include posture, gestures, and facial expressions. To make a positive gesture one could give the sender two thumbs up letting them know they did a great job. Letting the sender know they understand the message. A negative gestures would be a frown or to raise an eyebrow. This would provide feedback to the sender letting them know you disagree. Effective communication is a two way street for the sender and receiver. Ineffective ways for sender and receiver to communicate would be if the sender was demanding or ordering the receiver for something, and persuading or lecturing them. For example, using words like â€Å"you must† this may make the receiver think you are being demanding and they may resent you. Lecturing the receiver is another negative way to communicate with them. This may cause them to feel like they are wrong. Hepatic is a powerful form of communication. This would include giving the sender a pat on the back letting them knows you understand and everything was great. A native communication result would be a slap in the face. This would lead to many problems. Demonstrative communication between the sender and receiver will be positive if the sender does not overload the receiver with to much information at one time. If the receiver provides active listening or reading, this will allow the receiver to engage in what the sender is trying to get across to them. Demonstrative communication can also be negative if the receiver has a lack of eye contact or crossing of the arms. Things like this tell the sender one may not be interested in their message they are trying to get across. Provide feedback is a part of responding and giving the sender insurances that you are listening and understood what was being said. With demonstrative communication for example, one can respond by providing feedback like, â€Å"What I’m hearing is†¦Ã¢â‚¬  This lets the sender know you are listening to the message.

6 Copywriter Jobs Even a School Leaver Can Handle to Earn Some Cash for Living

The graduation from a school means a new and very responsible stage in the lives of young people. They are going to face new life challenges and are definitely a bit nervous about this matter. Each school leaver wishes to attend a college or university. Of course, the financial matter will be one of the most important and urgent factors that will affect the next few years. Many students try to combine their learning with a job. Possibly, it is easy to find a good job. Nevertheless, if you are a student you must take into account time for your studies. Accordingly, you will need a specific job, which can be combined with the learning process. Undoubtedly, any work via the Internet may be a good option. One may choose out of a tremendous variety of online jobs. However, students require definite offers. The most suitable are copywriter jobs. These jobs are quite creative and require a definite level of knowledge and skills. Talented students can earn some fine income and simultaneously, pay enough attention to their academic duties. Please, consider the following job opportunities: Translator Due to a very intensive development of international relations, the need for exact and qualified translations has increased for many a time. If you know, at least, one foreign language, you may earn money making translations. Mind that your salary will depend on the sphere your translation is related to, as well as on the language itself. The rarer the language is, the higher salary you will receive. Essay Writing Even school leavers may be good at composing all types of essays. In fact, many essay writing companies hire inexperienced authors without a degree. They require a real writer’s talent, responsibility, proper knowledge of definite disciplines, the eagerness to improve your skills and similar qualities. Online Copywriting Similar to essay writing, you may become a copywriting specialist. This job requires excellent writing skills, good knowledge of certain spheres of life and personal qualities that can fit this position. Article Writing You may, likewise, write articles on different issues. You may work for a newspaper, a private organization or some news agencies that need article writers. Proofreading Many students experience some difficulties when writing and checking their written assignments. You may help them proofreading and editing their papers. If your grammar is all right and you are familiar with different writing styles, you may earn money thanks to such offer. Blog Writer Blogging is another job advantage, which is sought-after. You may become a blogger of some famous online journal or even blog posts for your college’s web page. These were the most popular and acceptable job positions for students who wish to earn some money while studying. Nonetheless, you may find some other advantageous job opportunities, which might be more suitable for you. For instance, you may work as a social media manager, virtual assistant, medical transcriptionist, web developer/designer, tech support specialist, etc.