Much of Contemporary Health Studies is written from a social determinants of health perspective, and the book also affords time to the ways in which inequalities in health are a significant and enduring problem within the UK, and indeed more globally. Debates about equality and social divisions continue to emerge in the media. The BBC recently focused upon the persistence of the health gap between the rich and the poor in relation to cancer diagnoses (see http://www.bbc.co.uk/news/health-20294961). The news report, based upon empirical research by Cambridge University staff discusses how patients living in the poorest areas of England were less likely to have their cancers detected earlier than those who live in richer areas. Given that early diagnosis increases the effectiveness of treatment, this is clearly an important issue. Chapter 4 provides an introduction to the range of health inequalities that are now documented within the UK, whilst chapter 12 outlines some of the global disparities in health. Despite all of the existing evidence, and the different explanations offered by academics (again see chapter 4), health inequalities remain, as evidenced via many recent news reports. Ultimately these inequalities lead to early deaths for many individuals and so the reading of statistics in this area is more than uncomfortable.
Health inequalities are sadly widespread and is also evident too within the provision of services. The media often reports about the postcode lottery, in which some people are able to access treatment whilst others are denied it based upon the area in which people live; health services are in many ways provided based upon post-codes. Inequalities in health care can be seen in the way that some groups are treated according to their personal characteristics. For example, gay men using health care services recently reported negative experiences related to their sexual orientation (see http://www.nhs.uk/news/2012/04april/Pages/stonewall-gay-bisexual-men-health-report.aspx) therefore inequalities exist in the way that some individuals are treated through existing provision. Inequalities in health care can similarly be seen in the quality of provision for specific conditions. Diabetes treatment has been described as a postcode lottery (see http://www.nhs.uk/news/2012/04april/Pages/stonewall-gay-bisexual-men-health-report.aspx). Another recent BBC news report highlighted the issues with failings in the care that is available for schizophrenia patients. This reporting followed the publication of an independent inquiry into care for people with the condition. The authors of the report called for people with mental health problems to be treated in the same way as other patients (see http://www.bbc.co.uk/news/health-20300506). This report also alludes to the negative impact that NHS budgetary cuts are likely to have on service provision.
The current policy environment is also for many commentators one that is likely to result in greater inequalities as discussed in an earlier blog (see The UK National Health Service). The economic cuts that services such as the NHS are expected to make are seen as negative in numerous ways. Reporting on concerns voiced by the Royal College of Nurses about the loss of jobs within the NHS in order to save money, the Daily Mail describes a situation of a future crisis related to the demands of an ageing population who will not have adequate nurses to support them (see http://www.dailymail.co.uk/health/article-2232158/NHS-axe-60-000-staff-budget-cuts-warns-union.html). Therefore this may result in more health inequalities; given that savings have to be made, resulting inequalities seem more likely in the future of health care provision. The UK economic cuts and other changes to broader welfare provision are also likely to cause greater inequalities, with the policy context of any society continuing to act as an important determinant of health (see chapter 11). Indeed, the global picture for inequalities is also looking worse that it has for many years, with the BBC reporting that the rich are increasing their share of wealth in many countries, which causes greater economic inequalities (see http://www.bbc.co.uk/news/world-20156365). These patterns of wealth distribution have similarly been reported in higher income countries including the UK with the same effect. Ultimately greater economic inequalities also mean worse health inequalities as has been well evidenced via the Spirit Level book (see http://www.equalitytrust.org.uk/). The existence of health inequalities, although well-evidenced still causes great debate within policy circles and the effect of any government policy in this area takes years to be seen. The current UK government has discussed the adoption of a nudge approach in which persuasion is key; however whether this is enough to address inequalities remains to be seen, especially given the significant reduction in funding for services such as the NHS (see http://www.bbc.co.uk/news/uk-england-16761811).