The National Health Service has a lot of health inequalities regarding to people with gender, race and social class, this has become of interest to myself because there are a lot of issues that relate to the health inequalities of the National Health Service therefore I would be looking at the inequalities of the social class. For this I will be looking at how the NHS began and how the NHS has proceeded throughout the years. I will also be looking at how the government supports and funds the NHS. For the social class inequalities what health impacts there are between the upper and lower class, how private health care benefits those who receive private health care. How the Black Report provided evidence that there are health inequalities between social structure and how poverty affects the lower class.
The National Health Service was introduced in 1948, when health care sectary Aneurin Bevan (Labour) opened Park hospital in Manchester it bought plans for free good healthcare for all, this meant that for the first time all occupations of the healthcare came under one organisation such as nurses, doctors, dentists and opticians. With the approach of that good health care must be available to everyone regardless of the individuals' wealth. It was the initial for anyone in the world to receive free health care on the basis of their citizenship not on fees. This came with the ideological perspective of that the health care system that all health care would be available to all and financed entirely from taxes, where people pay for the healthcare system according to their personal income.
The post war Labour Government took into place the NHS in 1948 as illnesses were soaring and thousands of people were dying from diseases which now could have been cured in today's society these diseases included pneumonia and meningitis. Many of people suffered and tragically died because they could not afford to pay for treatment of healthcare or it was unavailable for numerous working class citizens.
Published in 1942 by William Beveridge, the Beveridge Report showed the need for dramatic change for the healthcare system. The report was designed to tackle the five giants of illness, poverty, disease, unemployment and unawareness in which Beveridge recommended the establishment of the National Health Service it recommended that the government should find ways to tackle ways of fighting the five giant evils.
Since 1948 when the National Health Service was born, the NHS has proven to be a success and fundamental to the society of the United Kingdom (UK). It has enabled families to go and seek medical advice in confidence, and receive treatment regardless of their financial background.
Since the NHS has been in place there has been a dramatic change throughout the 20th and 21st century life expectancy has increased from the average age of 45 years for men and 49 years for women in 1901 to over 75 years for men and over 80 years for women in 2006 - 2008. Also infant mortality has declined the chances of a baby surviving the first year of life has greatly decreased, according to the Office for National Statistics (ONS). However this is may be profound but the NHS has not exactly had the 'smoothest' of runs throughout the years, firstly with the conservatives opposing the NHS in 1948 then conservatives coming in and out of power throughout the years left years of neglect on the NHS, having lack of resources such as doctors, nurses and equipment. Labour having to somewhat reboot the NHS and make plans and changes to improve the inequalities and resources to the NHS.
The social democratic approach is to provide welfare state, which this consists of a view that social welfare is seen has a type of social citizenship, with the vision that social welfare is a basic right.
With the NHS being established by the post war labour government, it is usually associated with the social democratic approach having a more concern of social welfare, and focusing on the poor and working class citizens rather than focusing on the wealthier class citizens who can afford to pay for their own health care. The Beveridge Report was to tackle one of the 'five giants' illness and providing free health care to everyone still remains a key aspect of the Labour government.
There still is a lot of ideological issues in the NHS that still remain the nature of the provision, the NHS still remains free to everyone and is paid through national insurance (NI) and taxes which still tackles one of the five giants, illness. Where society has changed and life expectancy has increased and infant mortality has declined throughout the years.
Health Inequalities of the Social Class
Throughout the years there has been remarkable health improvements and social economic in the UK. People from all walks of life are living healthier and living longer in today's society than ever before. Although this remains true there are still a lot of health inequalities that occur in the health care. This was established when a report published by Sir Douglas Black called 'The Black Report', showed evidence that health inequalities exist in the health care system, he based the report on mortality rates between social classes, 'A method of comparing death rates between different sections of the population' (Townsend and Davidson 1990). This also stimulated new research that social class as a key influence of people's life chances.
With the National Health Service running for more than sixty years there is still a gap between social classes in all sections of societies applying to all aspects of health including life expectancy, infant and maternal mortality and the general level of health. With the gap between the social classes still emerging, there are still geographical differences between women and men; women tend to live longer by five years on average than men.
The social stratification suffers quite a significant gap within the health care system this may be because of the two tier system in the NHS where people who can afford to receive private health care treatment gives them the advantage of no queues meaning that they would not have to wait on waiting lists, where as the lower class who may not be able to afford private health care would have to wait to a maximum of 18 weeks between referral and treatment. For people who pay for private health care they are often to have a 'choice' where they can chose their own consultant and where they would like to be treated, unrestricted visiting hours, where as this may not apply towards lower class citizens because they cannot afford to go private.
The Black report does show evidence that there are health inequalities between social classes. For instance, life expectancy at birth for the upper class increased by six years over the last quarter of the 20th century, while infant mortality had risen by less than two years for the lower class by the end of the century (ONS, 2002). There is also double the infant mortality to the lower class compared to the upper class. Despite the improvements and changes that had been made in 1948 to suit all groups in the post war period. Statistics from the health sector has shown that the poor have shorter life expectancies and poorer health despite the Black Report.
Social class is 'complex' topic that involves status, wealth, culture, background and employment. There are a number of different influences of health, several of the health influences including social class. In 1943 Sigerist wrote, "The task of medicine is to promote health, to prevent disease, to treat the sick when prevention is broken down and to rehabilitate the people after they have been cured. These are highly social functions and we must look at medicine as basically a social science." (Socialist Health Association)
The connection of social class and the health inequalities does not give very clear explanations of the reason why there is a gap between the social classes; people have many different variations of the cause. Such as the 'Material Explanation' where this explanation blames poverty, poor housing conditions, lack of resources in health and education as well as more dangerous occupations for the poor health in the lower social class. Poverty being a obvious cause towards ill health. Life expectancy is lower in less developed countries, but diseases that affect the developed world such as Britain tend to be diseases that are more self inflicted and can be avoided to an extend such as obesity, smoking and drinking alcohol to an extreme content. These tend to be more common occurrences for the poor or lower class than the more wealthier and upper class citizens.
The cultural explanation, propose that lower class citizens chose to have less healthier lifestyles, having unhealthy diets (eating fatty foods), smoke cigarettes, and drink a lot more alcohol than wealthy and upper class citizens. With healthier foods being more expensive than quick easy solution foods that contain a lot of unhealthy substances, this would be more of a priority than knowing what is healthier for them. People who work long shifts in factories or work all day tend not to seek any activities outside of work because they may not want to after working because of feeling too tired this does not give them adequate exercise for the cardio-respiratory system.
From the Black report that raised a lot questions to the health inequalities had lead to further reports, such as the Acheson Report that was published in 1998 by Sir Donald Acheson, a former chief medical officer. It found little cause for congratulation and also called for the issue of poverty to be addressed. The Acheson Report
In today's society problems occur in poor healths which are related to obesity, smoking and the influence of alcohol and accidents. Where as in the past poor health was related to sanitation and infectious diseases. Although poverty is still a cause of poor health except poverty should not be equated to social class. Poverty can extend in variations and definitions of the word meaning 'Poverty', because it is very different to third world countries and those of the developed countries such as the UK. Poverty is going to affect the elderly and children more because they are most vulnerable and likely to be affected by poor health. Poverty is a real predicament. The Black Report and the Acheson Report both suggested trying to condense the inequalities of income in societies but these have grown instead. Social exclusion may be a result of poverty such as mental health and substance abuse.
The National Healthcare Service still remains to have the ideological perspective of free healthcare for everyone no matter what circumstances they are under or backgrounds as well as the healthcare being paid through taxation and national insurance, which the NHS still remains heavily funded by the taxation since 1948. Since the establishment of the NHS there has been dramatic change of life expectancy, infant and maternal mortality has dramatically improved since the early 19th century. The government and the public have acknowledged the value of the National Health Service which meets the peoples' healthcare needs through taxation on the basis of citizenship rather than payment or contribution. Although this is a major improvement since the post war there still is a significant gap between the social classes for the National Health Service perhaps the greatest challenge for the government and the National Health Service is to focus on and address the problems of health and health inequalities of the service, with one of them being the health inequalities of social classes.
Throughout the assignment I perhaps had a political of the New Right theory and did not entirely believe in the NHS, however as I gathered research for my assignment I began to rethink my political view of the healthcare and the welfare system. I did not believe that people should be able to pay for private healthcare and get the 'best' and quickest treatment in the NHS itself. While people would have to wait for up to a maximum of 18 weeks, seems quite unfair. I believe that the NHS should be funded from taxation because if it was not then people would not be able to pay for healthcare it would be like taken back to the early 19th century where people died from diseases and illness because they could not afford to pay for treatment which could be easily treated in today's society. With people still living in poverty today there are no major diseases or illnesses that can relate to death, with the only major health issues are mostly self inflicted causes such as smoking, substance abuse and obesity. Which all to some extend can be avoided.
Collins, R. (unknown),"Proud of the NHS at 60"http://www.labour.org.uk/proud/labour_nhs accessed 22nd November 2009
School of Economics and political Science (2000), "The Beveridge Report and the Welfare State" http://www.lse.ac.uk/resources/LSEHistory/beveridge_report.htm accessed 22nd November 2009
(Unknown) (2009) "Life expectancy" http://www.statistics.gov.uk/cci/nugget.asp?ID=168 accessed 22nd November 2009
Homfray, M. (2009) Lecture Notes, Glyndwr University
Unknown, 2009. "Health Inequalities" www.dh.gov.uk/en/Publichealth/Healthinequalities/index.htm accessed 22nd November 2009