Primary health care in the United Kingdom

General practice is one of the three bases of care in the British National Health Service (NHS); the other two are hospital and community services. Each is administered separately. There are 30,000 general practitioners (for a population of 57 million), who are independent and can organize their work as they see fit. Few are single-handed (13 percent) and the majority work in groups of three to five physicians. They are paid by capitation fees, and fees for specific services, and also receive reimbursements for staff, premises rental, and local taxes (rates). They work in close association with practice teams that include nurses, midwives, and social workers. There are no universal hospital privileges but many general practitioners hold appointments in local hospitals. Important trends in the NHS include mandatory vocational training of general practitioners for three years; the growing importance of attempts by the Royal College of General Practitioners to shift care from the hospital to the community; increased patient participation; clashes between the government and the medical profession over restricted funding of the NHS; definition and improvement of "quality," and a need for improved data collection; and long waits for hospital services.     

Universal health coverage in the United Kingdom

This United Kingdom has had universal health coverage since 1948, provided through its government-funded National Health Service (NHS). In recent years, increasing workload and treatment costs have put a considerable strain on the NHS. The government has responded to these challenges through a controversial program of organizational changes in the NHS. In its most recent policy initiatives, the government proposes to increase the proportion of national income spent on the NHS and make much greater use of private-sector health care providers.     

Addressing the contradictions: health promotion and community health action in the United Kingdom

Within mainstream health education/promotion in the United Kingdom, the last few years have witnessed an upsurge of interest in community development, sometimes coupled with an undermining of the fundamental principles of this approach. This article addresses some of the contradictions and dilemmas that this development has presented for the community health movement. Current trends in health promotion policy and practice are examined in relation to broader health and welfare policy of the 1980s, the history of community development in health, and the background to the World Health Organization's "Health for All by the Year 2000" and health promotion initiatives. The possibilities and limitations of utilizing the rhetoric, to support community health action, are explored with reference to recent attempts by the community health movement to "reclaim" Health for All.     

Addressing health inequalities in the United Kingdom: a case study

Health inequalities research has a long history in the United Kingdom, and the development of government policies that are intended to explicitly address the existing health inequalities has been gathering pace since the Labour Party returned to power in 1997. In this paper, using the influential Acheson Report as a reference point, one of us (D.N.) describes how health inequalities policies have been developed, and the other (A.O.) assesses how, ideally, such policies ought to be developed. Although progress in the development of health inequalities policies has been made, the policies, and the evidence that has informed them, have been less than ideal.     

Geographies of the impact of retirement on health in the United Kingdom

This paper explores how the impact of retirement on self-assessed illness varies spatially across the UK. Curves of age-specific limiting long term illness rates reveal a ‘retirement kink'—where the rise in illness rates with age slows or declines at retirement age indicating possible health improvement after retirement. The kink is negligible in the affluent South East and most prominent in the coalfield and former industrial districts. It is likely that the kink is attributable to hidden unemployment and health-related selective migration but additionally that in certain areas retirement is associated with improvements in self-assessed health.     

The relationship between household income and childhood respiratory health in the United Kingdom

Growing empirical evidence on the association between household income and adverse child health outcomes has generated mixed results with some North-American studies showing a significant inverse relationship and some British studies identifying a much weaker association. We use data from the rich UK Millennium Cohort Study (MCS) dataset and check the robustness of these recent findings by focusing on the impact of household income on adverse childhood respiratory outcomes (i.e. asthma and wheezing). We also identify pathways, such as mother's child-health-related behaviours, parental health and grandparental socioeconomic status, through which income might influence child health. Our econometric strategy is to use, both in a cross-sectional and in a panel data context, detailed information in the MCS dataset to directly account for as many potential confounding factors as possible that might bias the income-child health nexus. Overall our results show that household income has a weak direct effect on child health after we control for potential mechanisms that mediate the income-child health association. We argue that our evidence should inform government health and broader fiscal policies aimed at reducing health inequalities in childhood.     

Gender differences in relationships between urban green space and health in the United Kingdom

Natural environments, or ‘green spaces’, have been associated with a wide range of health benefits. Gender differences in neighbourhood effects on health have been found in a number of studies, although these have not been explored in relation to green space. We conducted the first UK-wide study of the relationship between urban green space and health, and the first such study to investigate gender differences in this relationship. An ecological approach was used. Two land use datasets were used to create a proportional green space measure (% by area) at the UK Census Area Statistic ward scale. Our sample consisted of 6432 urban wards, with a total population of 28.6 million adults aged 16–64 years in 2001. We selected health outcomes that were plausibly related to green space (cardiovascular disease mortality, respiratory disease mortality and self-reported limiting long-term illness) and another that was expected to be unrelated (lung cancer mortality). Negative binomial regression models examined associations between urban green space and these health outcomes, after controlling for relevant confounders. Gender differences in these associations were observed and tested. Male cardiovascular disease and respiratory disease mortality rates decreased with increasing green space, but no significant associations were found for women. No protective associations were observed between green space and lung cancer mortality or self-reported limiting long-term illness for either men or women. Possible explanations for the observed gender differences in the green space and health relationship are gender differences in perceptions and usage of urban green spaces. We conclude that it is important not to assume uniform health benefits of urban green space for all population subgroups. Additionally, urban green space measures that capture quality as well as quantity could be more suited to studying green space and health relationships for women.     

Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom

Clinical effectiveness (CE) and evidence-based practice (EBP) are the cornerstone of modern-day health care. Although many studies have explored attitudes and perceived knowledge of individual professions, few have compared these factors between professional groups, especially in the allied health professions (AHP) and health science services (HSS). We report a study comparing the knowledge and practice of 14 different professional groups from the AHP and HSS in terms of EBP and CE. The aim was to highlight any differences between the 14 professional groups along with the needs of the groups. A postal questionnaire survey was completed by a random sample of 1,000 members of AHP and HSS across the United Kingdom. There were significant differences between professional groups with, in general, professionals from the HSS groups rating their knowledge and application of CE and EBP as lower than members of the AHP. Differences were also noted between individual professional groups. For example, podiatrists, radiographers, and orthoptists reported having less knowledge of CE and EBP than physiotherapists, occupational therapists, dietitians, speech and language therapists, and psychologists. Barriers to implementing EBP were similar for all groups, with lack of both time and money cited as the main issues. A number of differences between professions were recorded that highlight the difference in educational and policy approach required for greater uptake of EBP.