Well done to Ben on being a runner-up in the secondary school category of our ‘Unofficial Guide to Medicine Essay Competition’ for their essay on “Consider social, geographical and biological factors for inequalities in healthcare. What can be done to tackle health inequalities?”
My name is Ben Lim, I am 16 years old and I live in Nottingham. Currently, I am studying Chemistry, Biology, Physics and Mathematics at AS Level; I would like to study Medicine at university and specialise in Infectious Diseases. Outside of school I enjoy playing the piano and volunteering at my local hospital and church.
Consider social, geographical and biological factors for inequalities in healthcare. What can be done to tackle health inequalities?
The UN declaration of Universal Human Rights states that ‘everyone has the right to… medical care and necessary social services’ (1). However, across the world there remains a huge difference in provision and quality of healthcare due to a complex myriad of individual problems, ranging in origin from society to geography and biology. Despite this, there is a simple aspiration that could have positive affects in all areas: rediscovering community. This ancient ideal of community uniquely incorporates the strengths of many political movements: the freedom of liberalism, the innovation of capitalism and the generosity of socialism.
The most obvious application of community is against social factors causing healthcare inequality; after all, society is comprised of united communities. These factors are often not dependent on a lack of resources or money; instead, it is the attitudes of the patients that has the greatest effect on the unequal outcomes of medical practice. In Western society, one major source of health-seeking inequality is the disparity between doctor contact hours of men and women. In 2008-9, UK women between the ages of 20 and 34 years had over twice the number of consultations with their General Practitioner compared to men of the same age. This gap in consultations was only rectified at the very extremes of age (2). While some of this can be attributed to women using medical services more often during their reproductive years, the difference continued into old age (80) suggesting that there is a significant disparity between male and female health-seeking behaviour. The reasons men are less likely to seek professional help are numerous and complex; embarrassment, fear of emasculation and a misunderstanding of medical practices play key roles (3). Additionally, men are more likely to abuse drugs (4) or have dangerous jobs (5), and so are often at greater risk of premature death. Consequently, it has become culturally accepted (and true (6)) that men live shorter lives than women. However, this need not be the case in a developed society – so can rediscovering the community help rectify this?
Community is comprised of a simple exchange: an individual has a responsibility to those around them and those around them have a responsibility towards the individual. This founding principle can be used to prevent inequality. For example, this idea is often used to great effect within drug addiction recovery programmes (7). Community discourages irresponsibility and even more importantly, the dissatisfaction that often leads to substance abuse is resolved – the sufferers now have something to contribute to. Correspondingly, the community must give back to the individual. This comes in many forms, from charity work such as that of Prostate Cancer UK (8) to education reforms, as seen in the 2002 education act (9) which instigated education about medical practice, substance awareness and safe sex practices. Each side works to support the other, leading to a change in the attitudes that cause inequality – applying this principle can catalyse the policy changes needed to reduce social factors of healthcare inequality anywhere.
The idea of community could be expanded to effectively reduce inequality across countries or even the world. For many, the biggest factor that affects the quality of their health is where they live. There is a strong correlation between GDP per capita and number of doctors per 1000 people (10), meaning that those living in Less Developed Countries (LDCs) generally have lower quality healthcare – additionally, the majority of LDCs lie within the tropics where deadly diseases and epidemics are more prevalent (11). In Equatorial Guinea, both these factors combine to produce a child mortality rate – a strong indicator of public health – of 67.20 per 1000 born in 2015 (12), among the worst in the world. Here, one of the main reasons for the lack of good healthcare stems from the high levels of corruption; Equatorial Guinea has an extremely poor Corruption Perception Index of 20 (13). We can compare this to a country in which an enforced approximation to ‘community’ has been in place nationwide for decades: Cuba. Despite having a GDP per capita less than a third of Equatorial Guinea’s ($11600 compared to $38000 (14)), it has an infant mortality rate of just 4.5 per 1000 births, and 6.72 doctors per 1000 people, both some of the world’s best (15). This comparison suggests that national health need not be dictated by economy, nor by geographical location. Instead, by giving priority to training doctors and welfare, Cuba has avoided the expected healthcare inequality, given it’s location and economy. Of course, the impingement on civil liberties that result from the communist system cannot be condoned. However, the voluntary redistribution of wealth is key to the ‘community’ ideal. The NHS works via a comparable system: taxes are redistributed to provide free basic healthcare. This has helped close the rich-poor resources divide; the NHS is used by citizens of all classes, and coverage of doctors is relatively even across the country. By rediscovering a national community, inequality, health and corruption can all be improved. The potential benefits of a global community are even greater: countries with greater resources providing help to those suffering with epidemic or economic crises. Such a system is partially realised in the plethora of emergency aid charities, the WHO and the UN, which in 2012 passed a resolution committing member states to collaborate to achieve ‘universal healthcare’ (16). Improved understanding and empathy between countries – a global community – could, if efficiently put into practice, create a system that would decimate inequality on the largest scale.
Unlike the aforementioned social and geographical factors that cause healthcare inequality, biological inequality is far more difficult to tackle. Whereas society can be changed or the economy supported, biological inequality is frequently uncontrollable: genetic predispositions can cause massive inequality in the health of a patient. For example, cystic fibrosis sufferers had a life expectancy of just 38 in 2010 (17) even in the most developed countries in the world, demonstrating that even with the best available healthcare, there remains health inequalities for those born with a particular disease. Many argue that this inequality in health is unavoidable and that resources dedicated towards resolving a disease that only affects around 70,000 people worldwide (18) are wasted. While from a totally objective viewpoint this is perhaps true, if the situation was viewed from a community standpoint, continued research and funding can be justified. Not only do members of a community have an obligation towards the weakest members of society, but by viewing the world as a community, the suffering experienced by a few becomes more personal and thus unacceptable. This leads to a greater willingness to fund research, even if it is unlikely to have a direct impact.
Part of the problem that contributes to biological causes for healthcare inequality is the differing expectations placed on those with an unavoidable disorder or illness. Especially in LDCs, those with diseases viewed as incurable are often disregarded: an astonishing 98% of Chinese orphans are disabled (19). Parents simply do not want (or cannot afford) to care for them, especially as it is thought that disabled children will not be able to return this care in later life, a huge issue in aging societies. This expectation of failure is unnecessary. In the modern era, a disease need not necessarily limit anyone to a certain lifestyle or health. Recently, a possible treatment for cystic fibrosis was discovered which reduced the decrease in lung function from 2.3% per year to 1.3% – a breakthrough development that may lead to a cure (20). This demonstrates that even debilitating diseases may be treatable, and that a change in expectation is necessary: a change that sees no disease or disability too great to be unworthy of research. Such a change is only possible within a community, where the true value of an individual is appreciated.
There is no complete solution to every area of healthcare inequality. Societies can be torn apart by uncontrollable factors, generosity is never guaranteed and genetic inequalities will always be prevalent. In spite of these obstacles community can enhance and inspire improvements in all areas, by harnessing mankind’s innate goodwill and empathy. Community may seem like an unachievable ideal but, in the words of Carl Schurz: ‘ideals are like stars; though we cannot touch them, we, like mariners, use them to chart our course’ (21). In an increasingly individualistic world, it is vital that healthcare professionals and institutions lead the way in fighting back against the surge of inequality seen in recent years (22) – and the simple ideal of community is the best way to do it.
- UN,1948; Universal Declaration of Human Rights, Article 25, Clause 1
- Prof. Julia Hippisley-Cox, 2009, NHS; Trends in Consultation Rates in General Practice 1995/1996 to 2008/2009: Analysis of the QResearch database, Page 16, Figure 3
- Anna Almendrala, 2016, Huffington Post; Here’s Why Men Don’t Like Going To The Doctor http://www.huffingtonpost.com/entry/why-men-dont-go-to-the- doctor_us_5759c267e4b00f97fba7aa3e
- Centre for Behavioural Health Statistics and Quality, 2012, Substance Abuse and Mental Health Services Administration; Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings Rockville, MD
- Health and Safety Executive, 2016; Index Of Data Tables, http://www.hse.gov.uk/statistics/tables/index.htm
- Office of National Statistics, 2013-2015; National Life Tables
- R.A. Boisvert, L.M. Martin, 2008, Occupational Therapy International; Effectiveness of a peer-support community in addiction recovery: participation as intervention
- Prostate Cancer UK, 2017; Prostate Cancer UK, http://prostatecanceruk.org/about-us
- Dept. of Education, 2002, HM Government; Education Act 2002, Part 6 http://www.legislation.gov.uk/ukpga/2002/32/contents
- Gapminder, 2017, Gapminder World; Income per Person and Medical Doctors (per 1000 people), http://tinyurl.com/zf7smzb
- UN Conference on Trade and Development, 2015; Map of the Least Developed Countries http://unctad.org/en/Pages/ALDC/Least%20Developed%20Countries/LDC-Map.aspx
- CIA World Factbook, 2017; Equatorial Guinea, People and Society, https://www.cia.gov/library/publications/the-world-factbook/geos/ek.html
- Transparency International, 2012; Corruption Perception Index, Equatorial Guinea http://issuu.com/transparencyinternational/docs/cpi_2012_report/5?e=0
- CIA World Factbook, 2017; Equatorial Guinea and Cuba, Economy, https://www.cia.gov/library/publications/the-world-factbook/geos/ek.html, https://www.cia.gov/library/publications/the-world-factbook/geos/cu.html
- CIA World Factbook, 2017; Cuba, People and Society, https://www.cia.gov/library/publications/the-world-factbook/geos/cu.html
- UN, 2012; Global Health and Foreign Policy, Social Protection and Universal Health Coverage, A/67/L.36
- Dr. Mackenzie, Dr. Gifford, 2014, Annals of Internal Medicine; Longevity of Patients With Cystic Fibrosis in 2000 to 2010 and Beyond: Survival Analysis of the Cystic Fibrosis Foundation Patient Registry
- CF Foundation, 2015; Patient Registry 2014 Annual Data Report (US)
- Nathan Vanderklippe, 2014, The Globe and Mail; The tragic tale of China’s orphanages, http://www.theglobeandmail.com/news/world/the-tragic-tale-of-chinas-orphanages-98-of-abandoned-children-have- disabilities/article17625887/
- James Gallagher, 2016, BBC News; Doctors excited by cystic fibrosis therapy
- Carl Schurz, 1859; Address at Faneuil Hall, Boston
- Deborah Hardoon, 2017, Oxfam; An Economy for the 99%: It’s time to build a human economy that benefits everyone, not just the privileged few
This is a very well written essay that has a very sophisticated and concise style and shows an excellent understanding of the topic of health inequalities. You have demonstrated good independent thought by suggesting one original solution that applies to all causes of inequalities: the idea of community. This is an interesting concept to discuss and you have done this very well by supporting your argument with good research and many references to the literature, providing the striking example of the differences in number of GP consultations between men and women. Well done for then moving on to consider health inequalities not only within the UK but also across the world, again demonstrating in-depth research, and for an excellent essay overall. Ben wrote a truly captivating and inspiring essay about overcoming inequality. It demonstrated a very unique and captivating idea that was based on comprehensive research. This combined with a mature and cohesive writing style made this essay a pleasure to read. Congratulations Ben on a fantastic essay.