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United Kingdom is an island nation commonwealth realm consisting of Great Britain (the countries of England, Scotland, and Wales) and Northern Ireland together governed by a constitutional monarchy. It is located in the North Atlantic Ocean about 35 km northwest of France, and forms a part of the European continent. The nation covers a total area of 243,610 sq km of which 241,930 sq km Is land and 1,680 sq km are water.1 Agriculture in the UK is highly mechanized, intensive, and efficient by European and world standards, with about 60% of food needs of the country being produced with less than 2% of the labour force. Measured against its requirements and size, the UK comparatively has large reserves of coal, natural gas, and oil resources, but these reserves are on the decline and the UK as of 2005 has become a net importer of energy.1 As of July 2009 the population of United Kingdom is estimated at 61,113,205 of which 16.7% (male 5,233,756/female 4,986,131) are in the age group of 0-14 years, a further 67.1% of the population (male 20,774,192/female 20,246,519) lies in the age group of 15-64 years and the rest 16.2% (male 4,259,654/female 5,612,953) fall under the age group from 65 years and over. Of the estimated 61 million people living in the United Kingdom over 90% live in major cities and urban areas.1
Historically UK has been a leading trading power and financial centre of the world, it still forms one of the biggest economies in the world and is one of five trillion dollar economies of Western Europe with a national GDP of $2.165 trillion in 2009.1 The biggest contributor by proportion to the UK GDP is the financial services sector comprising the troika of banking, insurance, and business services, while the industrial sector in UK continues to decline in importance. Since in 1992, Britain's economy enjoyed the longest period of expansion on record during which time growth outpaced most of Western Europe. Since recovering from recession in 1992 UK economy had maintained a healthy growth rate between 2-4 % of the national GDP till 2007, this figure fell sharply in 2008 to 0.7 % and spiralled further to -4.3 % for 2009 largely because of the global economic recession hitting the UK economy with force due to the size and importance of its financial sector.2 The global economic recession has caused the housing market in UK to crash leading to house prices collapsing, high consumer debt on the economy, spiralling unemployment rates and a severely weakened public financial system.
Health Status - United Kingdom
In United Kingdom, over the last 50 years, there have been impressive social economic and health care system improvements as compared of the rest of the world. People from different demographic sections of the society based on age, income, sex, class and region are healthier and living longer than ever before. According to WHO the life expectancy at birth for both sexes has seen a steady risen from 76 years in 1990 to 79 years in 2006, also, the healthy life expectancy (HALE) at birth for both sexes in the UK has risen sharply in the past years from 71 years in 2003 to 79 years in 2005.3
As of 2006 the infant mortality rate for both sexes in the United Kingdom was 6 per 1000 live births while the Adult mortality rate (probability of dying between 15 to 60 years) both sexes was 80 per 1000 population. Maternal mortality ratio in the United Kingdom stands at 8 per 100 000 live births according to WHO statistics. 3
As compared to world averages the United Kingdom mortality rates are considerably lower, UK is ranked at 194th of 224 countries on the CIA world factbook, with an infant mortality rate of 4.85 as of 2009 which is better than mortality rates in other developed nations such as United States (6.22), Canada (5.04), Russia and (10.56) European Union (5.72).1
As can be seen from the WHO Survey 2005 Chart, chronic diseases account for 85% of all deaths in the United Kingdom while Infectious diseases account for 12 of the remaining 15% of all deaths. Of the chronic diseases cardiovascular diseases (38%) and cancer (25%) and are the biggest threats together result in 63% of all deaths in the UK. Over the next 10 years until 2015 WHO estimated that death from chronic diseases will decrease by 0.8% but the deaths from diabetes which stood at 1% in 2005 will soar to 25%, also from 2005 to 2015 the deaths from infectious diseases will fall of 7%.4
Health Care System - United Kingdom
In the majority of countries health care systems work as assorted systems of public government funded organizations (or social health insurance establishments) combined with private health care institutions paid for through individual spending or health insurance or health care financing (Mossialos & Dixon, 2002).United Kingdom Healthcare System is regionalized with England, Northern Ireland, Scotland and Wales each having its own structure of publicly financed and privately paid for healthcare organizations offering conventional western medicine and also alternative, holistic and complementary treatments approaches if desired. The legislative responsibility for developing and maintain health services in UK rest with the Secretary of State in England, the Minister for Health and Social Services for Wales, the Minister for Health, Social Services and Public Safety for Northern Ireland, and the Minister for Health and Community Care for Scotland. These legislative figures are ably supported by the Department of Health in England, the NHS Directorate in Wales, the Department of Health, Social Services and Public Safety in Northern Ireland, and the Scottish Executive Department of Health in Scotland.
All UK permanent residents are afforded free public healthcare at point of need, paid for by government taxation. Of the total expenditure on health in UK WHO figures put government expenditure at 87.1% (2005) while the rest 12.9% (2005) expenditure is paid for through private medical insurance (Laing and Buisson 2001). The bulk of government spending on healthcare occurs through its nationalized health care system - National Health Scheme (NHS). In 2009 U.K. Govt. (Central + Local) expenditure was £110.5 billion pounds which was 7.68% of the total GDP of 1439 billion pounds. In the past 10 years govt. expenditure on healthcare has steadily been increasing from 5% in 2000 to an estimated 8.43% for the fiscal year 2010.5 This is figure is exceptionally low compared to other developed nations such as U.S.A. (15.3%, 2006), France (11.1%, 2006), Canada (10%, 2006).
But the facet in which UK Health Care System stands out against systems from around the world is that it covers and is accessible by 99% of the population of the country. The system comprises of General Practitioners (GP) based usually out of their residence. GPs provide primary care and their reference is mandatory in order to seek access to specialty care. Most GPs are contracted by and paid for directly by local government institutions through a combination of salary and fee-for-service. Private providers are free to set their own reimbursement rates and methods. WHO survey (2000) ranked UK health care system 18th in a evaluation of health care systems from round the world.3
Current economic crisis has severely weakened UK public finance structure leading to the new pay deals being offered to NHS staff being below the rate of inflation rise. With inflation in UK at a 16-year high, NHS unions have come together and are demanding that government reopen pay negotiations again for 2011. The unions are disputing the three-year pay contract fixed in early 2009 and are claiming that hundreds of thousands of NHS workers struggling to make ends meet on the current pay rates.