Paul is Specialty Registrar in Public Health and Visiting Research Fellow for the Nuffield Centre for International Health and Development. That’s a really long way of saying he’s an expert in health care systems across the world. Most recently, he’s been to Swaziland, a small country in Southern Africa, to help build a new health care system there. He’s read what the Burnet News Club have been saying about health care in the UK and responded to some of you. Find out what he had to say!
Are We Lucky to Have The NHS?
Dear Burnet News Club Members,
Thank you for your comments on health and the NHS. This subject is never far from the top of the UK’s political agenda so I think it’s very important that we keep discussing it. My expertise is in Public Health – I look at the health of the population as a whole as well as inequalities in health and attempting to find ways to improve health on a large scale. So far, I have lived within the English, Scottish, US and Swazi health systems and have knowledge of some others so I hope I can provide some answers to the interesting questions you have raised.
Human Right to Health care
A good place to start a discussion on the NHS is by talking about human rights. Following the Second World War, the countries of the world got together and produced a document called the Universal Declaration of Human Rights. This set out standards which every human being should be able to expect in their lives, protected by their government. The first part of article 25 of this document states:
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
This is a very important statement which sets out a country’s responsibility to provide health care. It also means that countries have a responsibility to provide living and working conditions which promote good health and prevent bad health. To this date, the USA is the only wealthy country not providing universal health care, i.e. health care available to every single citizen.
Personal Responsibility vs. Social Responsibility
The wording of the Universal Declaration of Human Rights may sound simple and give governments a basis on which they can build a health care system. However, people with different political points of view often disagree on a question which was brought up by a number of Burnet News Club members: How much are we personally responsible for our own health and how much are we responsible for each other’s health as a community or society? For example, VulneraSanentur4 from Faringdon asks: “Why should we pay for other people’s health care, if their injury or disease is self-inflicted?” while TabbyCat0.5 from Crampton Primary School suggests: “People who don’t bother to look after themselves shouldn’t have free health care because it is their own problem and their own decision.”
This is a common discussion when talking about health care; attempting to divide patients into those who become ill through personal choice, and those who fall ill through no fault of their own (no choice). However, this idea of choice is more complicated than it may at first seem. While there are decisions we make which are a completely free choice, most of our decisions are influenced by a wide range of different factors.
Let’s take a seemingly straightforward example. Many people think that people who are obese are responsible for the ill effects caused by obesity, including heart disease, diabetes, cancer etc. This is due to the idea that people who are obese have made a “choice” to eat more than is healthy and/or to exercise less than is healthy. However, there are a number of other factors influencing their situation. Let us take two fictional characters, Anna and Jameela.
· Anna’s parents are very health conscious and she grew up eating many vegetables and exercising daily.
· Anna found early on that she was naturally gifted at sports, as such she joined a number of sporting clubs at school and was much admired by pupils across the school.
· Anna’s parents are comfortably-off financially and do not have to worry how much food and activities cost.
· Anna and her family are all well aware of the health impacts of overweight and obesity and so are careful if they notice their weight increasing.
· Anna lives in an area with few food shops or fast food restaurants. She does not pass any on her way home from school.
· Very few of Anna’s friends are overweight.
· Anna has excellent self-confidence and self-esteem. She is happy in life.
· Jameela’s parents love food and the family enjoy sharing take-aways regularly. They are not into exercise, preferring to enjoy other activities together such as going to the cinema or spending a day at the beach.
· Jameela found the sports at school difficult and was sometimes mocked for not being very good. Other pupils sometimes call her “podgy” and so she avoids swimming and other sports which may show off her body.
· Jameela’s parents do not have a lot of money to spare and so often try to buy food which is filling and cheap. They are not always able to pay for activities Jameela would like to do.
· Jameela and her family know that being obese is not good for you but are not aware of the extent of the impacts.
· Jameela lives on a road which contains a number of fast food outlets. On her way home she passes many advertisements showing high-calorie food aimed at children.
· Most of Jameela’s friends are overweight or obese.
· Jameela often finds herself feeling down and stressed. She often finds that eating a hearty take away with her family makes her feel comforted and calm.
While these two characters show two very different stories, they are both “normal” experiences of people living in the UK. As we can clearly see, Anna has many influences which will help her to eat and exercise healthily while Jameela has the opposite. We may see one of these people at the hospital thirty years later, obese with diabetes – should we be finding out what experiences a patient has had during their whole life to see how responsible they are for their bad health? I would argue that this is not only unethical but also impractical.
Given that there are many influences upon our health, do we have any responsibility for each other’s health? Are there other moral or ethical reasons we should look after other people’s health? Most people agree that we do have some responsibility for our fellow human beings. Just consider the following question:
If you were alone with a friend and they collapsed unconscious, should you try to help?
Would you call for help? An ambulance? Or would you walk away leaving them alone? The vast majority of people consider it a moral duty to help people in need when we are able. This is the moral basis behind the NHS. However, there is disagreement about how far this duty extends. This brings us neatly on to who should pay for health care.
“Free” Health care
A number of you wrote in and brought up the fact that the NHS is free at the point of use. MandyCandy90 from Kobi Nazrul Primary School asked “Would people like to live in a country with no free health care?” while BlueRaven from Ravenscroft Primary School told a story about her neighbour with a severe illness who was helped by the NHS: “Because we had free care she lived for a little longer.”
However, it is important to remember that health care does cost money. As Purpleunicon62 from William Patten Primary School points out: “Who pays the price when something is free? The government because when you pay taxes who does it go to? It goes to policeman, firefighters, teachers and the NHS.”
The NHS is able to provide health care to everyone because people pay money in taxes to cover the costs. Although some people get a lot sicker than others and their care costs more money, the cost is shared by the whole population of the UK so that everybody is able to receive care and nobody becomes poor through having to pay for health care. Although there are different ways of funding health care systems throughout the developed world, most are based on this principle. The USA is different however, with people given more responsibility for paying for their own health care. Unfortunately, this leads to poorer health (particularly for people with less money), care that isn’t good enough and many people becoming bankrupt in order to pay for health care bills. Can you imagine becoming very poor, perhaps even losing your home, because a member of your family was ill with cancer?
On the other hand, the government already asks people to pay for some aspects of their health care. For example, in England adults have to pay for eye-tests, dental care and prescriptions for drugs (in Scotland and Wales, eye-tests and prescriptions are free). There have been suggestions in the media that the NHS could start charging for GP or hospital visits. The idea behind this is to discourage people from going to the doctors unless they are sure they are ill. While this may work for some people, it is important to remember that there are already people who wait too long to go to the doctor when they are ill. These people have poorer health and their treatment is often more expensive because they waited longer than they should have and their condition got worse. We need to ensure that we support people to ask for help when they need it.
Is the NHS worth the money?
Although the large cost of the NHS in the UK (more than£100bn) is often discussed in the news, our current system is the cheapest in the developed world in terms of cost per person. The US system, where the government gives the least amount of health care and protection, is the most expensive – both for the government and for individuals.
It is also important to remember that providing health care does not only benefit the patient, but also society at large. Here are a few ways in which we all benefit from the NHS:
- Vaccines make sure that infectious diseases which killed many people in the past are now very rare or are not seen in the UK.
- Keeping people healthy means that they are able to work more, providing services and products and paying taxes.
- Paying for the population’s health care means that the government has a financial reason to make life healthier for the population, e.g. safer roads, cleaner air and water, facilities for exercise, better education etc.
- Helping adults to stay healthy ensures that they are better able to look after children if they are parents or carers.
- Preventive programmes such as “Stop Smoking” campaigns can help reduce the risk to the population including by second-hand smoke.
If there was no NHS…
HB Writer from Hillbrook Primary School asks: “If there was no NHS would you have to leave the country to visit a hospital?”HeeH If we decided to get rid of the NHS, we would be most likely to adopt another system which provides health care for everyone. What would change would be the way in which we pay for it, and the way in which it is provided. Many countries have found systems which work well, though they all have advantages and disadvantages. If we decided not to use one of these systems, we can look to the USA for possible results – poor health, inequality and financial insecurity due to health problems.
I hope I have answered some of the questions you have raised. As you can see, this is not a simple topic and we have only focussed on the medical aspect of the NHS! Please continue to discuss and debate these issues so that we can ensure that we have a healthy UK in the future!