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Doran

Technical Brilliance, Social Blindness? Health Inequalities and the NHS. Tim Doran. University of Manchester. HERON Meeting, 7 April 2011. Doran. Health Inequalities and the NHS. NPCRDC. Topics: A bit of history Health inequalities in the UK

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Doran

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  1. Technical Brilliance, Social Blindness? Health Inequalities and the NHS Tim Doran University of Manchester HERON Meeting, 7 April 2011 Doran Health Inequalities and the NHS NPCRDC

  2. Topics: • A bit of history • Health inequalities in the UK • The role of the NHS in tackling health inequalities Doran Health Inequalities and the NHS NPCRDC

  3. Health inequalities Inequalities in the UK Role of the NHS History Doctors and health inequalities • Rudolph Virchow • Omnis cellulaecellula • Virchow’s node • Virchow’s triad • ‘embolism’ • ‘leukaemia’ • Cellular pathology • Anthropology • Autopsy Health Inequalities and the NHS NPCRDC

  4. Health inequalities Inequalities in the UK Role of the NHS History Typhus outbreak, Upper Silesia 1848 “The absolute separation of school and church is more necessary in Upper Silesia than anywhere.” “Artificial epidemics... are indicators of defects in political and social organization, and affect predominately those classes that do not participate in the advantages of the culture.” “The answer to preventing outbreaks in Upper Silesia is quite simple: education, freedom and welfare.” Health Inequalities and the NHS NPCRDC

  5. The twentieth century Recent history Health inequalities Inequalities in the UK Role of the NHS Inequalities in mortality Standardised mortality ratios, 1921 - 1925 Health Inequalities and the NHS Pritchard J, “Mortality Mosaics” 2008

  6. The twentieth century Recent history Health inequalities Inequalities in the UK Role of the NHS Inequalities in mortality Standardised mortality ratios, 2001 - 2005 Health Inequalities and the NHS Pritchard J, “Mortality Mosaics” 2008

  7. The twentieth century Recent history Health inequalities Inequalities in the UK Role of the NHS Geographical and social inequalities Health Inequalities and the NHS Doran et al, BMJ 2004;328:1043-5.

  8. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Determinants of health Role of health care services Health Inequalities and the NHS Dahlgren G, Policies and Strategies to Promote Social Equity in Health

  9. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Tackling health inequalities Role of health care services “GPs have an important role in reducing health inequalities. With unrivalled access to the heart of communities, we can influence the health inequalities agenda as practitioners, commissioners and community leaders.” [1] “It’s not my job to solve the problem. My job is to solve the patient’s problem, not society’s problem. [Health] outcomes… are actually nothing to do with the health service but to do with wider society.” [2] Health Inequalities and the NHS 1) Royal College of GPs 2008; 2) British Medical Association 2009

  10. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Tackling health inequalities Role of health care services • Ensure that resources are distributed between areas in proportion to their relative needs • Respond appropriately to the health care needs of different social groups • Promote a wider approach to developing healthy public policies Health Inequalities and the NHS Benzeval et al Tackling Inequalities in Health 1995

  11. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Meeting clinical need Coronary heart disease mortality and coronary revascularisation CHD mortality rates, 2002-04 Revascularisation rates, 2004/5 Health Inequalities and the NHS SEPHO, Atlas of Coronary Heart Disease 2006

  12. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Access to care Distribution of GPs Patients per GP Health Inequalities and the NHS Benzeval M, Judge K. JPHM 1996; 18: 33-40

  13. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Access to care Distribution of GPs, 1996 Patients per GP Undersupply (percentage) Health Inequalities and the NHS Benzeval M, Judge K. JPHM 1996; 18: 33-40

  14. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Primary Care Aggressive case-finding and careful audit • Glyncorrwg, • population of ~1,800 • ranked bottom 5% for area deprivation (64% SCV) • Health centre, 1964 – 1987: • screening for BP, smoking, cholesterol, diabetes, PEFR, BMI, alcoholism • fully computerised in 1988 • Outcomes: • Glyncorrwg SMR 0.95 • Gwynfi SMR 1.60 Health Inequalities and the NHS Tudor Hart J et al, British Medical Journal 1991; 302: 1509-13

  15. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention The Quality and Outcomes Framework Achievement by area deprivation quintile Reported achievement 2005-06 2006-07 2004-05 Health Inequalities and the NHS Doran et al. Lancet 2008; 372: 728-736.

  16. Health inequalities Inequalities in the UK Role of the NHS Contribution of clinical medicine Clinical intervention Recommendations for clinicians/medical educators • Consider the impact of their practice on health inequalities • Harness the power of student advocacy and action on the social determinants of health • Generate and share information on best practice concerning the social determinants of health • Highlight and advocate policies and programmes that benefit the health of socially disadvantaged groups • Work with public health specialist teams and local authorities to develop programmes to promote and protect people’s health and tackle health inequalities RCP How Doctors can Close the Gap 2010 Health Inequalities and the NHS

  17. Summary • Health inequalities • Are responsible for millions of years of lost life • Are not inevitable • Are socially determined • Require sustained political interventions • The role of the NHS • Is fundamental to tackling health inequalities • Identifying and meeting need • Provide access & continuity • Primary and secondary prevention Health Inequalities and the NHS NPCRDC

  18. Further information: tim.doran@manchester.ac.uk

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