This year, we were overwhelmed upon hearing that NHS is experiencing budget cuts due to the economic crisis. United Kingdom is a country which is very famous for their National Health Service (NHS) which has grown to become the world's largest publicly funded health service since 1948 (Mental Health Downturn,2009). The main principle is to provide good healthcare available to all regardless of wealth which is hard to find in other countries in the world. On top of all, NHS remains free for everyone who resides in UK. The national taxation funds NHS in England, Wales, Northern Ireland and Scotland although the managements are separated. They are similar in most aspects and belong to a single unified system although some differences have emerged between those systems. In the second quarter of 2008, UK experienced recession from two consecutive quarters of contraction in the output of the economy in the second and third quarter of the same year (INpho 38: The impact of the recession on health, 2009). Until the second quarter of 2009, there have been five consecutive quarters of contraction.
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There are a lot of consequences due to economic downturn on the health of UK dwellers either directly or indirectly including further rising of UK unemployment. Eventually, long term unemployment or with lower pay, the way of life and health are likely to be affected. UK unemployment rate has rocketed from 49 000 to almost 2.5 million in the three months to the end of November. One in five 16 to 24-years-olds are now without work after a rise of 32 000 to 951 000 laid off which is the highest record since 1992. The unemployment rate for 16 to 24-years-old is 20.3 % compared to the UK overall unemployment rate which is 7.9 % (Offices for National Statistics, 2011). From the evidence, we could see that the longer one works without pursuing her education, it becomes harder to get a job especially for ones who are just out of school. Besides, the high youth unemployment is wasted although they are capable to be the human capital for UK. "Britain is now perilously close to seeing one million young people struggling to find work," said Martina Milburn who is the chief executive of youth charity The Prince's Trust (BBC News, 2011).
However, the negative impacts of unemployment do not affect the young ones only. The results of unemployment actually work on everyone. Rising unemployment rates have been linked to increased overall mortality rate, high suicides and deaths cases from alcohol abuse. The ambulance service has provided data that recession has its own impacts on health and health service use within the East of England. Other than that, there is a higher prevalence of psychological ill health and associated increased demand for healthcare. In conclusion, we could say that unemployment could lead to stress, depression and mental illness especially to the breadwinners. Mental health problem is not only an economic cost but also human and social cost which consumed £110 billion a year (Friedli & Parsonage, 2007). This happens especially to parents who have many children and suddenly was laid off due to the recession. Worse, there is a pool of unemployment in the society waiting for limited job opportunity. Managing a family involves paying the house rent, mortgage, insurance, school fees and of course daily requirements such as food and health. Although NHS is free for everyone, emotional breakdown is not something that can be easily handled especially when it involves monetary term.
Current studies found higher rate of smoking, alcohol use and poorer diet among unemployed people. This is because personal circumstances and beliefs greatly influence people's lifestyle choices. The East of England 2008 Lifestyle Survey proved that unemployed people were more likely addicted to smoking and were less likely to drink responsibly or eat five portions of fruits and vegetables daily (INpho 38: The impact of the recession on health, 2009). It is true that when a man could not get a job, he turns to smoking as a way of relaxing even though the real fact that the habit costs him more money. Rather than drinking expensive wine or champagne, a man would prefer a cheap industrial methanol that could be bought at cheap price in cans. Depressed with no income, he is vulnerable to drink too much and that leads to committing suicide.
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Less budget for NHS means some of the facilities provided has to be cut such as less beds available for patients and less nutritious food as meals. A nurse I met at dialysis ward at University Hospital of Wales complained that because of the lack of fund, dialysis patients who have to wait for at least 4hours during every session is only served with a piece of biscuit and a cup of tea or coffee compared to two cups and a sandwich before this. Other than that, a senior nurse who is working in Rapid Response Medical Team at University Hospital of Wales also commented that at times, some patients has to have their surgeries postponed or cancelled due to lack of beds in hospital. John Appleby, chief economist at the King's Fund health think tank, said the money was "the bare minimum to meet the coalition's pledge. It is the width of the proverbial cigarette paper."
These conditions proved that economic downturn affects the health of people in UK. As the saying goes, health is wealth and this may affect the quality of life and socialeconomic status.
In Britain, class has been defined using the Registrar General's scale of Social Class and Socio-economic groups which consists of six major classes from 'Professionals' in class one to 'Unskilled' and 'Other' in classes 5 and 6. For class 3, it was sub-divided into manual and non-manual skills. Full time students are in Class 8 (Office of National Statistics, 2009) .However, it has been debated that he level of skill at work is not the best way of measuring social class. The Registrar General's scale contained absurdities such as equating major land owners to small tenant farmers. In contrast to the Registrar General's scale, the introduction of the National Statistics Socio-economic Classification (NS-SEC) argued that it should be based in the concept of employment relations and conditions rather than skills. Till this date, measures of social class are questioned for its efficiency and accuracy. Goldblatt has offered other measures such as home ownership, educational status and access to a car and has shown that all of these can be correlated to inequalities in mortality rates. Interestingly, many have questioned the relevance of class in a modern, pluralist welfare state. They believe that class is not important in defining who we are, how we behave or where our loyalties lay. Unfortunately, there is considerable evidence that British often identify themselves as members of a class and that proves the existence of significant relationship between class inequalities in health and life-chances.
The Marmot Review published on February 2010 contains the evidence that most people in England are not living as the best off in society and spend longer in ill-health. It showed that premature illness and death affects everyone below the top. It argues that policies created by the government have focused resources only on some segments of society without actions across the social gradient. This is important to improve health for all of us and to reduce unfair and unjust inequalities in health. It is found that people in the poorest neighbourhoods in England will die seven years earlier than people in the riches neighbourhood, on average. Besides that, people living in poorer areas not only die sooner but spend more of their lives with disability (The Marmot Review,2010). In brief, the lower one's social and economic status, the poorer one's health is likely to be. Health inequalities are a complex interaction of many factors which are strongly affected by one's economic and social status. Housing, income, education, social isolation and disability could affect us all especially during economic downturn.
The review suggests that in addressing health inequalities, it is not enough just to focus on the bottom 10 % because there are poorer ones all the way down from the top. The Marmot Review looks at the inequalities in health and well-being between social groups and explains how the social gradient on health inequalities in social status. It is true that the only way to rectify the matter is by reducing the steepness of the social gradient of health inequalities. However, scale and intensity are required proportionally to the level of disadvantage. Marmot's approach to address the condition is by creating conditions for people to take control of their own lives. It would emphasise the role of the local government, national government departments, private and voluntary sectors to play an important role. His approach is beyond economic costs and is towards sustainability of the environment. The Review comments that creating a sustainable future is in line with the actions which have health benefits to reduce health inequalities by promoting active transport, sustainable food production, sustainable local communities and zero carbon houses.
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Many would agree that health inequalities are caused by social capital, cultural explanation and material explanation. Some will argue whether it is a question of 'post hoc ergo propter hoc' (chicken or the egg).Is it the low social class that has led to the poor health or if the poor health has led to a deterioration of social status. Research on the Black Caribbean population in the UK patients found higher rates of psychopathology which were related to socioeconomic disadvantage (Psychol Med., 2008). In contrast, chronic diseases tend to present later in life after careers and social class are not found. Therefore, looking at the question from the opposite direction and suggesting that healthy will tend to rise through the social classes does not seem likely.
It would be better if the unemployment rate can be diminished but there are other ways that can be done to improve health among the unemployed. The most effective way is by mitigating the impact of recession such as re-employment in high quality secure employment, good quality apprenticeships or accessing higher education. Welfare state may help mitigate the impact in the absence of re-employment. Unfortunately, the economy is not expected to grow until 2010 and re-employment may not be an option for a significant number of people. On the bright side, there are many other alternative that can be done to help mitigate the impact of recession upon health like supporting people to improve their lifestyle behaviour. This could be done by ensuring that the existing health improvement schemes such as smoking cessation, obesity management, and drug and alcohol service are opened to the most vulnerable populations such as the homeless, migrants and those in irregular employment.
Other than that, better access to psychological therapies including the employment of support workers within the Improving Access to Psychological Therapies (IAPT) teams and more opportunities for volunteering and increasing levels of physical activity could also impact positively on mental health. It would reduce the mental illness and depression cases. The government should monitor and analyse the impact of the recession with a focus on the local demand for health and social services that includes unemployment rate, claimant count, levels of homelessness and housing repossessions, numbers of people accessing further education, data on health and social service use and health data which reflects choices of lifestyle.