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The opportunities of living in a good state of health and with impairment are unequal. The probabilities are much higher for people who live in more advantaged conditions than for those further down the socioeconomic ladder. This paper offers an insight of evidence on these health inequalities. It starts by considering some key aspects before summarizing the determinants and models of socioeconomic disparities with regard to health. In the past century, since the death rates were high, the mortality offered the standard scale of the health of the UK population. Today, greater emphasis focuses on people’s experience of impairment and ill-health: to mental and physical ill-health issues and to sensory, cognitive and physical impairments that make it difficult to conduct everyday activities. Although the pace is slow, however, research and policy has begun to focus on well being instead ill-being.

The definition of health inequalities often describes the fact that health differs between individuals: some people have good health, and some do not. The term, however, commonly conveys the systematic differences in the health groups occupying unequal status in society. Moreover, the health professionals recognize this term as shorthand for disparities in health among socioeconomic groups. Hence, this study concerns with other different forms of social inequality, with reference to poverty, disability and ethnic inequalities. These new appearances of research in this paper highlight how features of inequality reinforce and overlap each other.

Understanding the socio-economic influence on health

Explaining the effects of socio-economic influences on health

A significant evidence of research in the health field establishes the fact that individuals of low socioeconomic status are much likely to suffer from illness, to be physically and cognitively impaired, experience loss of functioning and higher mortality. As explained in Figure 1 by Alberts et al. (1997), this association stands true for all prime causes of functioning loss, morbidity, mortality, and disability. This figure reinforces education as a measure of socioeconomic status and living conditions; similar data by using occupation, wealth, or income will usually show the same relationship. For example, Warner and David (200) also in Table 1 below explained a similar relationship between wealth across adult ages and self reported health holds.

The Reciprocal Causation and Health Gradient

The impact of socioeconomic conditions on health believed to start in the prenatal environment and continue all life. Parents’ socioeconomic conditions influence childhood conditions, for example, exposure to infectious agents and toxins. This condition influences health immediately, and much likely continues for years afterwards, and the improvement in effects is moderately slight by changes in status in the later years. The health gradient caused by socioeconomic status expands through childhood and during the adult working years and subsequently contracts after retirement. While evaluating the impact of lifetime socioeconomic conditions on health further complicated by the fact that health factor influences wealth and income, especially among adults. The statistics shows that those with poor or fair self-reported health in the past ten years not only gained much lower wealth, but their wealth grows at a lower rate than of others over the next ten years.

A Case Study of Race, Ethnicity, and Status

The health gradient factor by socioeconomic status is significant for ethnic and racial differences because socioeconomic conditions differ vastly by ethnicity and race. For example, In the United States,  fewer older Hispanics and black possess a high school or a college degree than whites and more likely to suffer from poverty.  Although, older Asian possesses high education, but when compared with whites, more than twice percentage of them lives in poorer conditions. Similar data for Alaska Natives and American Indians though not available, but 1995 household census showed that levels of socioeconomic status among  Asians similar to those for Alaska Natives and levels of poverty among American Indians similar to blacks. These socioeconomic differences, coupled with such variations at younger stages, explain ethical and racial differences in health outcomes.

Assess the relevance of government sources in reporting on inequalities in health

Many countries have started reporting similar health programs to eliminate health inequalities, for instance: 

1. New Zealand:  The New Zealand Health Strategy (2009).

2. The United States: Healthy People (2011) are a charter of national health goals. It aims to enhance the quality and life span of healthy life, and to reduce health disparities.

3. Australia: Better healthy living for Australians: national aims, strategies and targets for superior health outcomes into the new millennium (2006).

The Role of Reporting of Inquiries in the United Kingdom Policy towards Inequalities in Health

The United Kingdom government approach to tackle health inequalities characterizes by two inquiries: the Acheson Report and the Black Report. As their affect upon policy is remarkably different, they are critical in understanding the relationship between policy and evidence. The Black Report (1980) on health inequalities authorized by the Labour government in the year 1977, classified four possible areas of health inequalities: natural selection, artefact, structural and cultural, but did not observe any role of health care in eliminating health inequalities. The published account met rejection by ruling conservative government because recommendations were too expensive and because of their political opposition to the issue. Hence, the Black Report left no effect on the policy for nearly a decade.

Independent Inquiry into Inequalities in Health

The newly elected conservative government installed an independent inquiry in the year 1997, named as Second Black Report. The government instituted the inquiry to review the latest information available on health inequalities to highlight priority areas for development of policy for future. The Acheson Report concluded that the scientific reasoning recommends socioeconomic explanations of disparities in health. It supported a model, which comprised of various layers including the socioeconomic environment and individual lifestyles. While addressing social factors, the reports considered education, poverty, unemployment, transport, nutrition, housing, the lifestyle, gender, health care and ethnicity. The account gave 40 recommendations; three of them received support and claimed to be significant, namely:

1. All policies aiming to render an impact on health should be evaluated in terms of their impact on inequalities of health;

2. The health of families with children should receive a high priority;

3. Further steps will be necessary to decrease income inequalities and modify the living styles of poor households.

This report presented only three suggestions on health care and well-being, stressing its perceived contribution to tackle the analysed problem in health. The Acheson Report received support and welcomed by the ruling government, suggesting that some of its recommendations, the executive power was already implementing. Academics welcomed this report though it was not universal and it also received certain critiques by the professional practitioners of health care.

Discussing reasons for barriers to accessing healthcare

A wide range of evidence points out that split between the public and private funding of health services affects access, and use of medical services by different socioeconomic groups. Individuals do not have equal access to health care facilities because of monetary reasons that cause desperation to them. At the macro level, there is concrete evidence of a positive influence of public financing on overall morbidity and mortality rates but this leaves a question for discussion as to whether this is an outcome of a uniform improvement in health care across the population.

Public funding and provision of health care services can increase the opportunities for poor patients that are otherwise too expensive, and thus contribute to the elimination of social inequalities in health care utilization. For example, there is an evidence of a country supporting this. In France, the facility of free complementary health insurance for the weakest and poorest section the society has improved considerably their improvement in health status; thus bringing their consumption curve closer to the population of the country. Hence, social differences are less harsh in those countries where the public health expenditure is high.

The prime reason of barrier made between health systems concerns the nature of primarily sources of funding; mainly social insurance versus tax. On the one hand, the health systems based on social insurance, characterized by a large number of insurance organizations are independent of health care providers, and weaker section of the communities have limited access to these insurance providers.  Health care produced by a combination of private and public providers involve multiple players in this sector. On the other side, in national health systems of many countries, one central organization handles financing and provisions and usually there is enormous mismanagement of public funding, which directly affects to people in obtaining better health care facilities.

 Understanding the models of health promotion

Analysis of the links between government strategies and models of health promotion

In September 2008, the UK Minister for Health inducted Women’s Health and Well being Strategy to be implemented in two phases from 2008 -2012. It established government dedication to improving women’s health and well-being, with special attention to the links between diversity, gender and disadvantage. This strategy supports the health promotion model for wellness of women and reflects the latest development of more holistic and flexible understanding of female health and good conditions of living. The health promotion model for women well being emphasizes from treating women as a homogenous group, looking at how gender and sex interact with social factors including indigenous status, socioeconomic status, linguistic, cultural diversity and sexual orientation for shaping women’s health and well being.

The aim of the UK Sexual Health Promotion Policy (2005) is to eliminate health inequalities and provide fair and effective treatment for STD, HIV/AIDS to all people irrespective of their race, ethnic and gender. This scheme aims further at strengthening some health promotion agencies contribution to sexual health protection, and their capacity to assess the influence of health promotion strategies. The tactics also evaluate the impact of public health interventions to minimize both levels of high risk sexual behaviour, and new cases of STIs and HIV. The strategy emphasizes to develop a model for the national monitoring of HIV/AIDS and STD prevention activities and to map sexual health promotion measures both within and outside the Health Promotion Agencies.

The United Kingdom government emphasizes that its citizens are the wealth of the country; as such their mental health is always significant to them. Its Mental Health Model is the spiritual and emotional resilience that enable individuals to survive the pain and enjoy life.

Explaining the role of Physicians/professionals/nurses in fulfilling government targets for health promotion

Several findings show that there is a significant relationship between regional and national health disparities and the amount of medical facilities available, especially concerning doctors and other professionals. It is also a well-known fact that the consumption of specialists’ and physicians’ services expands with medical density, and such effect is more significant for lower socioeconomic group’s as such weaker section approach to specialist’s services is minimal. In systems where physicians and professionals are scarce, approach to care is most likely to be impossible for all, but more for low socioeconomic groups because of transport/time and income, for example. At the macro level, however, in those countries where resources are abundant, the health care system gives more attention to the allocation of available medical resources and develops systems that target better those require care the most.

A case study of financial incentives for doctors

In most developed countries, for example, US, UK and Canada, there are three prime methods of availing health care services:  salary, capitation and fee for service. Under FFS (fee for service), physicians can increase the price of services they offer. The FFS method has several disadvantages for poor people, for instance, access to a more abundant and wider range of insurance providers’ benefits only higher section of the society. Further, Zuvekas and Hill (2004), comparing health benefits models with a different mode of payment systems, recommend that FFS, capitation and salary systems do not increase access to preventive care for weaker section of the society.

Some national and international professional codes articulate and highlight the ethical code for health professionals. For instance, the ICN code (2005) states, that the nurses share with community the responsibility to meet the health needs of the public, especially for low socioeconomic groups and vulnerable population. The General Medical Council of the UK claims that physicians and health professionals must work for protecting the health of the patients and public. The UN health codes also specifically call professionals to recognize the needs of health care while considering socially, economically, and political factors that impact health and to support appropriate health polices of their respective countries.

Explaining the role of routines involved in promoting healthy living

The current United Kingdom government has implemented targeted policies to tackle disadvantage and poverty that accelerates health inequalities.

1) Health Action Zones:Theseintegral partnerships came into existence after 25 years of deprivation and poor health in the UK, covering 15 million people. Each HAZ targets to design and implement a strategy, which eliminates health disparities. The HAZ, however, have suffered from continuous organizational change as its creation was in 1997 and increasingly implemented by the government as the carrier for reforms in other sectors, for instance, HAZ resources allocation to the Primary Care Trusts.

2)In the year 2000, the NHS plan furtherstrengthen the policy on tackling inequalities in health, though it addressed both preventive and acute health services. It set targets and sets aside funds for improving child nutrition and health, encouraging smoking cessation, tackling teenage pregnancy, and action on alcohol and drug related crime. It suggested new and improved challenging targets for a large number of screening programs that include retirement health checks, heart ailments, and breast and cervical cancer. It also created the way for establishing new incorporated public health groups at regional level to work towards inequalities in areas of deprivation.

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