Social Care Provisions in UK
Poverty is one of the major causes of the uprising of health problems especially in poor nations and countries worldwide. Government and other people are burdened by the fact that the promotion of health is one of the most important responsibilities of every individual. However, the effect of poverty in the population cannot be denied if we look at the health of the people experiencing it. Recent studies have shown that wealthier nations are healthier as compared to economically challenged nations and countries (, 2005). It was held by and (2002) that in meeting the specific needs of the vulnerable populations and groups worldwide, there must be a balance between accessible, high quality universal services, and targeted programs. With this, the World Health Organization have acknowledged the help of non-government organizations to the poor people who are not able to access on proper health care system, sewage disposal, clean water, food safety.
A second influence on the development of a new policy agenda for health promotion has been the rediscovery of the determinants or ‘root causes’ of excess morbidity and premature mortality which are external to individuals and provide the context for their behaviour and actions. Several widely used models of health ( & , 1991, , 1998, & , 1994) illustrate the range of contextual factors, including the economic, psychosocial, cultural and physical environments that shape overall population health and inequalities in health relating to socio-economic status, gender, age and other social positions.
Health promotion is increasingly characterized by working with key stakeholders or agents in decision making processes that affect outcomes ( 2001), although the means of achieving collaborative practice are still not fully understood. Working with people and communities, ‘people-centered health promotion’ ( & 1998) requires an ecological and holistic approach to health, one that can capture complex social phenomena ( 2001). Within health promotion, key principles of sustainability and community development are focused on. Health promotion approaches to justify the effectiveness of their practice and to demonstrate measurable outcomes. Internationally it has resulted in a number of initiatives, particularly in Europe, which aim to build an ‘evidence base’ for health promotion. Although in the process of the development of these initiatives, there have been debates on what constitutes evidence in health promotion (, 2000; & , 2001) and the criteria by which evidence is defined have been subject to philosophical and theoretical scrutiny ( & , 1998), there remains a danger that initiatives will encourage the very value systems they seek to challenge by buying into the notion of the existence of objective evidence.
Public health is the promotion of health at a community level by the government. It includes prevention of disease through supplying clean water, proper waste disposal, and legislation for clean air, health education programs, and medical care for the whole community through doctors, nurses, and hospitals (). Government acceptance of responsibility for public health began in UK with the Public Health Act in 1848. Now, the welfare state, National Health Service, and health education and protection measures are government responsibility. In early 19th century, concerned social reformers tried to improve the living conditions of the poor. In 1842, recommended that investing in public health would improve the health and reduce the death rates among the poor. He contended that the expense of basic public health measures would be less than the cost of having to support a poor and unhealthy population ().
With the government taking over the responsibility, developments in public health included the introduction of environmental health officers to investigate potential hazards such as hygiene in shops and restaurants, the launching of health education campaigns, such as anti-smoking campaigns to reduce cancer and heart disease, and road safety campaigns to encourage drivers to slow down and pedestrians to take care when crossing the road. Food safety became one of the biggest issues of public health in UK. The government implemented laws on food safety, such as the (1990). In 2000, the British government established the Food Standards Agency to coordinate action on food safety and the protection of public health ().
Since 1997, the Government has set out a major program to improve public health and address health inequalities. The program includes action to eradicate child poverty, improve poor housing, raise employment, and strengthen communities, in order to address the deep-rooted causes of ill-health. It also includes major programs to prevent cancer and heart disease, and modernizing public health. The department’s approach is to create an environment where people are encouraged and supported to adapt healthy lifestyles. This may be done by providing clear information to enable people to make their own decisions about choices that may have some impact on their health, offering tailored support, personalized services and equal access, and by partnership working across communities (). The Department of Health in 2004 also issued the following standards, the minimum level of service that patients and service users have a right to expect, that health care organizations, including the NHS Foundation Trusts, and private and voluntary providers of NHS care are expected to meet in terms of safety; clinical and cost effectiveness; patient focus; accessible and responsive care; care environment and amenities; and, public health. The standards were divided into two categories – core and developmental. These standards are part of National standards, local action, the NHS three year planning framework, and are in line with actions set out in the NHS improvement plan (, 2004).
In UK, the Independent Inquiry into Inequalities in Health ( 1998) was guided by a socio-economic model of health. This model emphasized the impact of over-arching general, societal, living and working conditions, which themselves influence the quantity and quality of social and community networks, which in turn condition health lifestyle attitudes and behaviors. The Report notes the evidence of long-standing and widening gradients in mortality between the higher and lower socio-economic groups in UK and prioritizes the implementation of policies which will reduce income inequalities and lead to the redistribution of resources to those who find themselves, unavoidably, outside the labor market. The authors of the Report are adamant that the policy emphasis must move ‘upstream’, from the de-contextualized individual to the social and economic structure: ‘We consider that without a shift of resources to the less well off, both in and out of work, little will be accomplished in terms of a reduction of health inequalities by interventions addressing particular “downstream” influences’ (, 1998, ).
This view is reinforced by the growing evidence of a strong relationship between income inequality and premature mortality within developed societies (see, especially, 1996). One plausible explanation for this relationship is the relative strength or weakness of the psychosocial fabric, in particular, features of everyday life which engenders and promotes social cohesion. ‘Social capital’, which has been defined by (1995) as ‘the features of social organization such as networks, norms and social trust that facilitate co-ordination and collaboration for mutual benefit’, is the concept now widely employed to capture this societal attribute. It is hypothesized that more egalitarian societies generate higher levels of social capital which in turn reduce health inequalities and increase life expectancy. (1998) argues that the notion of social capital revitalizes social approaches to public health and health promotion, since it permits examination of the processes whereby social connections operating through different networks can act as a buffer against the negative health impact of relative (as well as absolute) deprivation.
Recognizing the multi-faceted nature of health, its production and maintenance, the tendency has been to assume that health promotion practice should encompass a similarly broad sweep. (1997) have argued that this tendency is unhelpful because it masks tensions between competing paradigms and agendas. Specifically, they warn that ‘the creation of …“global” health promotion models could inhibit constructive debate around alternative perspectives on health’ (). They conclude by noting that ‘permanent tensions’ exist that need not necessarily be resolved. They identify three initial areas for attention: professional and political matters, technical and methodological dilemmas, and research questions. The challenge for practitioners is how they manage these tensions in order to deliver action that addresses contemporaneous policy agendas (, 1997, ).
The effectiveness and cost-effectiveness of health promotion interventions are under increasing scrutiny in the new evidence-based cultural climate within the health sector in UK. While there is some concern about the extent to which expectations relating to the success of health promotion practice are more pronounced than those relating to clinical practice, the problem most commonly identified by researchers is the unwillingness of funding and commissioning agencies to accept the validity and viability of non-experimental evaluation strategies.
As such, this will divert limited resources from knowledge development in collecting evidence to satisfy a managerial agenda driven by searches for efficiency, cost effectiveness and quality assurance in public expenditure, which, in the UK at least, has led to an obsession with targets and indicators. Much better that those resources are invested in the development of approaches which address the complex holistic nature of the social change processes that constitute health promotion. It is also important that the methods and criteria of effectiveness used are consistent with the fundamental principles of health promotion, empowerment, participation, collaboration and equity.
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