Health, public health and health inequalities

Jane Thomas, Salim Vohra and Sean Tunney


This chapter starts by asking the question 'What do we mean by health?’ People are fascinated by health. It certainly sells news in all its formats, and the number of people using the internet to find out about health problems has increased dramatically in the last few years. There are other dimensions to health also reported in the media. Health is increasingly seen as a business in parts of the UK, particularly in England. The level of health service funding is contentious. And the factors that influence our health are key topics for discussion. The COVID-ig global emergency puts an additional spotlight on health. The crisis highlights the links between politics, health and the economy.

After looking at public health, well-being and tools for analysis, the chapter continues by considering what determines health. This is complex. It requires investment in research studies to provide evidence that can help us understand whether, for example, damp housing causes health problems. Or is it just the mould in damp housing? Evidence is often inconclusive, which sparks further debate and research. But to consider these questions as important probably requires some commitment to, and care for, others. We will also look at ethical issues in this chapter.

Throughout the chapter, we specifically draw out questions on health-related problems for debate (Thomas, 2018). Climate change, for instance, is of an all-encompassing significance. The debates around this topic are on how climate change should be dealt with and who will be the winners and losers. Academic arguments need to marshal evidence. It is important for students to look at questions from different angles and to use a variety of theories to analyse social processes.

The chapter ends with some success stories. Manyofthe UK’s responses to health problems have been successful and creative. Again, we need to critique and ask how and why we have managed to see improvements, such as falling smoking rates, declining TB incidence and increasing levels of cycling, for example.

What do we mean by health?

People can mean different things when they say they’re ‘feeling healthy’. For some, health is the absence of disease, whereas others define health as a more positive feeling of well-being. These differences are reflected in divergent definitions of health and mental health provided by different authors and agencies. Even the World Health Organization (WHO) uses various definitions. The most famous of these is that ‘health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Notwithstanding the WHO’s positive definition of health, we start by assessing ill health in the UK.

Measuring health

Some of the most reliable sources of information on the health of a country are basic data on births and age at death. These data are generally undisputed, and studying them can provide powerful evidence of social problems affecting some groups more than others. As the economist John Maynard Keynes said when promoting government intervention to combat unemployment: ‘In the long run we are all dead’. But government policy influences which groups, statistically, have a longer run.

Demographics is the study of populations' characteristics, such as the number of 2O-to-3O-year-olds in the population or place of birth. Epidemiology looks at diseases and health problems across populations - from accidents at work to viruses like COVID-19 and hepatitis - and indicates how many people in the population are affected by these issues, that is, their prevalence, and their causes.

In the UK, some health problems have been improving over the last ten years, such as dementia among the elderly. We can apply epidemiological and demographic analysis to this issue. The epidemiology indicates that the number of people with dementia per 100,000 of the population has fallen. This may be due to healthier lifestyles, increased education and improved preventive care for conditions such as heart disease. However, because of the changing demographics of the UK population, there are now more people aged 65 and over, so the number of individuals living with dementia has increased significantly.

Epidemiologists’ analysis of mortality data takes into account different populations’ age profiles via a formula called ‘standardisation’. This enables comparisons between, for example, the nations of the UK and other countries. Epidemiologists also investigate associations between diseases like COVID-19 and factors such as poverty, class, ethnic group, air pollution and obesity.

After World War II, the main causes of death in the UK became cancer and cardiovascular disease, which are ‘non-communicable diseases’ (NCDs). Within the kingdom, there is variation. Heart disease rates in Scotland are particularly high, and higher again in the most deprived areas of Scotland. Some cancers have shown poorer one-year and five-year postdiagnosis survival rates in comparison to other European countries and the USA. Therefore, UK services aim to address this by speeding up diagnostics, reducing waiting times and investing in increased treatment capacity. Additionally, staff have run campaigns to improve public recognition of cancer symptoms and encourage specific population groups to seek a medical opinion. This ‘social marketing’ needs to be carefully targeted at the most ‘at-risk’ groups. Single men over 50 working in lower-paid jobs, for instance, may be less likely to go to a doctor if they find a lump.

Some NCDs, like cardiovascular disease, may be prevented by lifestyle changes, such as healthy eating, promoted in Northern Ireland and the three nations of Great Britain. NCDs are increasing globally, alongside continuing malnutrition and high infant mortality in low-income countries. Yet, for other health issues, 'pandemic' conditions can arise, meaning most countries are affected and there is a world-wide epidemic, as happened with COVID-ig. Human immunodeficiency virus (HIV) is typically considered to be a pandemic because it has spread globally. Global public health initiatives are necessary to protect health across countries, in part because, as the adage goes, 'bugs don’t respect borders’.

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