Tackling Health Inequalities A Challenge Health And Social Care Essay

Tackling Health Inequalities A Challenge Health And Social Care Essay Tackling health inequalities is a challenge faced by policy makers and health practitioners This assignment will critically discuss how Coronary Heart Disease (CHD) may be tackled, drawing on the current evidence based thinking and social policies on tackling health inequalities. Over the past 30 years, there have been a number of strategies proposed to tackle health inequalities. They have all largely focused on improving the health of the most disadvantaged groups, reducing the gap between the best and worst off and improving health across the whole gradient. (Graham, 2004) The above will also be discussed below. The World health Organisation (WHO) 1999 global strategy of achieving health for all is fundamentally directed towards achieving greater equity in health between and within populations. This implies that all people have an equal opportunity to develop and maintain their health, through fair and equal access to resources for health. Targets in England also aim to improve the health of the disadvantaged groups and that of the population as a whole and also closing the health gap (Secretary of State for Health, 1999). Similar targets have been set up in Wales, Scotland and Ireland with the aim of tackling health inequalities (Graham, 2004). A health gradient approach in tackling health inequalities directs attention to the systematic differences in life expectancy and living standard associated with peoples position in the socio economic hierarchy (Graham, 2004). Tackling health inequalities needs to focus on the causes of health inequality and health damaging behaviours associated with peoples unequal position in the socio- economic hierarchy (Graham, 2004). Improving the health of the poor groups and improving their position relative to other groups is an important strategy in reducing the socio-economic gradient. However, the Department of Health (DOH) (2002a) emphasises that to meet national targets and make progress on tackling health inequalities interventions must reach more than the most disadvantaged. Marmot (2010) also points out focusing solely on the most disadvantaged will not reduce health inequalities Graham (2004) adds that, to improve the social gradient, policies need to be associated with absolute imp rovements in health for all socio-economic groups with a rate of improvement which increases at each step down the socio-economic ladder. The White Paper: Saving Lives: Our Healthier Nation, published in July 1999, aimed to improve the health of the population as a whole, improve the health of the worst off in society and narrow the health gap (DOH, 1999a). Narrowing the gap between the worse and better off, requires absolute improvement, raising the health of lower socio- economic groups faster than the higher socio economic groups (Graham, 2004). However, Graham (2004) points out that in a society where overall rates of health are improving absolute improvement in their health may be insufficient to narrow the gap between the worse and better off. Wagstaff ,Paci and Van Doorslaer,(1991) also add that focusing on the worst off can obscure what is happening to intermediate groups, experiencing poor health consequently compromising health across the socio-economic hierarchy. The White Paper set targets to be achieved by 2010, of which included reducing the death rate in people aged 75 years from CHD by at least two fir ths (DOH, 1999). A budget of  £96m was allocated to these programmes, however the White Paper aimed at the population as a whole and didnt set any specific national targets for reducing health inequalities (Shaw et al, 1999).Consequently there was no significant improvement in health inequalities. Public health policy has been redefined to give more emphasis to tackling systematic health differences of advantaged and disadvantaged groups (Graham, 2004). Improving the health of the worst off and reducing poverty is the governments main target in tackling health inequalities. However, targeted policies may have negative effects on the health of other groups, either in absolute or relative terms (Graham, 2004). The Black Report (1980) and the Acheson Report (1999) recommended prioritising the health of families with children, reducing income inequalities and improving standards of poor households (Acheson, 1998). Reducing child poverty and improving circumstances of children would have long term effects on reducing health inequalities (Acheson, 1999). The government set targets to reduce Child poverty by half, by 2010 and eradicate child poverty by 2020 (DOH, 1999). The elderly people are more likely to be diagnosed with CHD, and if in poverty this can worsen the condition. The S tate Retirement Pension needs to high enough to provide a financial security in old age, however the current government have increased the retirement age to 67 years, which may increase income inequalities in the elderly people. The older one gets the less hours they work earning less income. Furthermore, getting the unemployed into jobs across the gradient is another way of tackling poverty. Marmot (2010) argues that jobs need to offer a minimum level of quality; a decent wage and flexible hours to enable people balance work and family life. Good working conditions can reduce the risk of developing CHD. However, getting people into low paid, insecure and health damaging work will increase the exposure to poor health therefore increasing health inequalities. For individuals such as the permanently sick or house bound, employment may not be the solution out of poverty. Furthermore, it would be impossible to reduce unemployment if there are no jobs available (WHO, 2008). In April 1999, the government also introduced the National minimal wage, this policy was aiming at reducing in work poverty and decrease the number of individuals dependant on social security (DOH, 1999). Deprivation during utero and childhood has lifelong consequences in adulthood life. It is important that all pregnant women are able to afford an adequate diet and have a continuum of care from pre- pregnancy and through pregnancy (WHO, 2005b). Shaw et al (1999) suggested that maternity allowances should be increased, especially for women dependent on income support or low paid jobs. Also to increase benefits to support families with children. However with the current government and its initiatives to cut cost, this may not be achievable. Furthermore, physical, social and emotional health is important in child development and these have an influence on education, occupational opportunities and life chances (Marmot, 2010). Marmot (2010) suggests that giving every child the best start in life is crucial in tackling health inequalities across the gradient. He recommended increasing the proportion of overall expenditure to the early years and ensuring that the expenditure is focused progressively across the social gradient. This includes providing good quality in early years education and childcare proportionately across the gradient. However, educational and other individual-based approaches tend to be taken up disproportionately by the more affluent, which tend to widen health gap (Bambra et al, 2010) Quality housing free of cold and damp is a basic need for healthy living. Shaw et al (1999) point out that poverty can be reduced by raising the incomes and standard of living of poor families with children, disabled and elderly people. The Central and Local government should increase the value of welfare benefits and pensions and improve social infrastructures including social housing and public services (Shaw et al, 1999). Marmot (2010) also recommended creating and developing healthy and sustainable places, which will improve social capital thus removing barriers to community participation and action across the social gradient. Authorities should ensure urban planning such as increasing street lights and safe pedestrian walkways in order to improve physical activity. This promotes good physical and psychological well-being and safe behaviours, which are essential for health equality. Furthermore, access to big supermarkets through investment in active transport can improve access to healthier food choices among low income groups. However, improving access to supermarkets and advising people on healthy food will not be effective solutions if the price of fresh fruit and vegetables is high. Having a balanced healthy diet that has low and fat will reduce the risk of CHD (Lindsay and Gaw, 2004). Central government could restrict the food industry on the amount of fat and salt levels put in foods (Shaw et al 1999). Maintaining physical activity for at least 30mins at a time can reduce risks to CHD. Investing in public services for example leisure centres, play areas for children, physical activity can be promoted. However some of these public services come with a cost. Worrral et al, (1997) points out that there is unequal distribution of health resources as the more health resources go out to the richer households than to the poorer households. To improve access to health resources authorities need to conduct regular audits to enable the redirection of resources to the disadvantaged communities. The government published the New White Paper, Choosing health: Making healthier choices in 2004, which aims to support individuals and promote informed healthier choices especially those in disadvantaged groups (DOH, 2004). However, making choice is difficult to exercise if lacking the resources necessary, particularly the disadvantaged. Tackling smoking is a key intervention that can rapidly reduce the number of early deaths among CHD incidences. There have been a lot of campaigns and educational programmes encouraging individuals to make healthier choices. These have included preventing people from starting to smoke; smoking cessation especially disadvantaged adults and pregnant smoking women, and protecting non-smokers from tobacco smoke through introducing Smoke free zones (DOH, 2010). And a regulatory control of alcohol consumption such public houses and bars closing early and minimal age limit on alcohol consumption. However, enforcing smoke bans and alcohol regulations are viewed to be effective methods but asking poor people to change risky behaviour when they cannot afford a proper meal or warm clothing and yet use smoking as a means of escape from their plight might not be sufficient enough to reduce health inequalities. Individuals from worse social circumstances have considerably high level of cardiovascular risk than those ones from better off circumstances (Bambra et al, 2010).Marmot (2010) recommended the need for early detection and prioritising prevention of chronic diseases related to health inequalities across the social gradient. Harkin et al (2010) estimated that an equal uptake of effective primary prevention across all socio economically disadvantage groups can reduce inequalities. However equality in health care services may not be sufficient enough to end health inequalities. The DOH (2000) proposed a national screening programme for all people aged 40-74 to assess their risk of developing heart diseases. The use of statins is another key intervention that can rapidly reduce the number of early deaths among CHD incidences The use of cholesterol lowering drugs is based on an individuals level of risk for future cardio vascular events. If everyone in the UK aged 45- 74 with clinical evid ence of CHD were treated with statins for five years, about 22,000 deaths and major clinical events would be avoided(Davey smith and Ebrahim, 1999;1097). Recently attention has been given to the role of the National Health Service (NHS) in promoting public health and reducing inequalities in health. The NHS aims to develop a systematic approach to treating people at risk from chronic diseases and encouraging more people to adopt a healthy life style (Macintyre, 2000). Part of NHS funding is spent on prevention; however most of the major influences on population health such as poor housing, unemployment and poverty lie outside the NHS. More so, health promotion strategies focusing on individual behaviours such as smoking, diet and exercise are more commonly taken up by those in the affluent societies (Macintyre, 2000). Therefore these intervention need to engage fully the deprived populations otherwise this may widen the health inequalities. While the health of the population may be improving, policy makers have a considerable duty to inform and develop strategies which can contribute to greater equality in health. Allocation of resources in tackling Coronary heart disease should consider cultural and behavioural lifestyles, material circumstances and, psychosocial pathways within social class and across the gradient. Focusing on the most disadvantaged will not reduce health inequalities dramatically. More so, to reduce the stepwise social gradient in health targets should aim at bringing levels of the lowest socio economic groups closer to the national average standard.

Failure and futility Themes in “1984” and “Never Let Me Go” Essay

Comparison of how Orwell in 1984 and Ishiguro in Never Let Me Go use failure and futility in human relationships as a theme in their dystopian novels As humans, we judge ourselves by how others perceive us and seek to conform to a universally accepted code of ethics and laws. It is this inherent value that we possess, a conscience that make us different from animals and it is also what is missing to a large extent in Orwell’s â€Å"1984† and Ishiguro’s â€Å"Never Let Me Go†. The futility of relationships in these works is part of what makes the worlds in which they are based seem so bereft of hope and consequently, dystopia in nature. In Orwell’s vision of humanity’s future, the only truly acceptable thing to ‘love’ is Big Brother. The Party restricts all other love so as to break down the ties between family, friends and lovers whilst transferring this loyalty to the Party itself as a form of control. The Party is said to have, â€Å"cut the links between child and parent, and between man and man, and between man and women.† This does not just show the breakdown of re lationships, but the reduction of the self. The Party is removing the essential links that allow humanity to be more than a collective of individuals and instead uses this to its own ends, although what these are, beyond a desire for control, we never truly discover. It is partly this lack of knowledge of the Party’s overall goals that makes the situation seem so desperate, it is as though love is being removed without explanation or justification, making the whole process seem devoid of hope as there is no specific element against which to rebel. A similar lack of knowledge also plagues the children of Hailsham in â€Å"Never Let Me Go†. Their future is not clearly explained; instead it is an undercurrent to their education that leaves them prepared for, but not truly conscious of, their fate. As Miss Lucy says, the students have been, â€Å"told and not told.† The situation is much the same for the reader, we learn with the children about their function. Thus we can empathise with the characters; the reader feels a part of the story. Setting it in the 1990s also adds to this sense as it is easy to associate with our own lives. It is for this reason that cloning is a key feature of dystopic fiction from the late twentieth and early twenty first centuries as it does not seem a distant concept but a real possibility. Some may see keeping the children in the dark over their fate as a kindness, however in many ways it seems a further cruelty that they are allowed to hope when this will avail them nothing. Miss Lucy goes on to tell  the children that they had been, â€Å"created†, that they were, â€Å"brought into this world for a purpose†¦ [with] futures, †¦ decided.† This is an indication of what is to come for the students, gaining more meaning the further the reader progresses through the novel, it is in reflecting upon events that the true horror is revealed. It is also a symbol of their relationships with the outside world. They cannot become part of a society we would recognise, for this is not their â€Å"purpose† and so they are kept apart from it. The world of the chil dren seems lonely and isolated for this reason, especially so as it is told to them, and us, as fact by someone in a position of authority. This version of their future seems inevitable and so any hope Ishiguro builds in the minds of the reader in the rest of the novel seems almost foolish, as we have been told that Kathy and her companions have only one path to follow. Orwell uses similar devices in â€Å"1984†. We are told in the first chapter after Winston writes in his diary that â€Å"The Thought Police would get him† and yet through the novel, largely thanks to his relationship with Julia, we come to feel that there may be a chance for him. However, as in â€Å"Never Let Me Go†, this is crushed. Both Orwell and Ishiguro give their characters and their audiences hope and despite all else that is wrong in their worlds, they have an intrinsic human emotion to hold on to, but when both stories conclude, this feeling is shown to have been futile and misleading. The traditional structure of society in â€Å"Never Let Me Go† is altered, as there is clearly a subsection of humanity that the dono rs inhabit which is not apparent in our own lives. However, Ishiguro’s world is not so different from our own, Hailsham seems like it could easily be a twentieth century boarding school with the result that the events have a more profound effect on the reader. Orwell uses a slightly different technique as the structure of human life is reduced in â€Å"1984† rather than altered. It is carried out up to the point where, â€Å"No one dares trust a wife or a child or a friend†. Instead they turn to the only thing in their life that seems concrete, Big Brother. The Spies are the ultimate example of this because the Party has managed to sever the paternal bond, which should be stronger than almost anything else. The extent to which this is achieved is shown by Parson declaring he is, â€Å"proud† of his daughter for denouncing him as it proves that he, â€Å"brought her up in the right spirit.† It is as though the greatest achievement for a parent has become to create a tool for the  party. Winston sums this up by saying, â€Å"The terrible thing the Party has done was to persuade you that mere impulses, mere feelings, were of no account, while at the same time robbing you of all power over the material world.â₠¬  To protect and nurture your offspring is a natural instinct, but the Party has removed this and in doing so has reduced humanity. It is this that makes the breakdown in the family so crucial to Orwell’s dystopic literature, if the feelings had been punished there is hope for salvation but by removing them, there is no hope for a future where the family is once again a pivotal element within a person’s life. When Orwell was writing there was a strong feeling of despair amongst modernist authors and artists relating to the fracturing of society and the reduction of tradition’s role in people’s lives. This is clearly shown in â€Å"1984† through characters such as Parson. Orwell’s reduction of traditional structures is shocking but also hard to relate to, as it seems so extreme. It can be said that Ishiguro’s alteration may not have the same immediate impact, however this slight apathy is caused by the situation presented being all too possible. On reflection this serves to makes it more disturbing; many groups in society are marginalised and so it is not difficult to imagine a situation where there are ‘clones’ amongst us yet not with us who are treated as an inferior race. Ishiguro demonstrates this through the use of the word, â€Å"completion† when the donors die. This is much like a euphemism for death, something else that is treated as taboo, but â€Å"completion† has far more sinister connotations. It suggests the donors have fulfilled their â€Å"purpose†, particularly as the word â€Å"completion† is usually associated with a positive outcome. This can be interpreted as Ishiguro, as a post-modern author, suggesting that a society relying on such a complex structure, is capable of dehumanising and exploiting the death of fellow humans. This is unlike Orwell in â€Å"1984† who bemoans the fracturing of traditional structures, however both show how the breakdown in relationships and marginalisation of certain groups can remove some essence of humanity and it is through this that the authors present their works as dystopic. Winston identifies this loss when he says â€Å"The Proles are human beings†¦ We are not human† because in comparison to Party members, â€Å"They were not loyal to a party or a country or an idea, they were loyal to one another.† Winston himself recognises what it is to be human and sees how he is in some way lacking. He goes on to tell  Julia that they will inevitably be captured and this will leave them both, â€Å"utterly alone† and, â€Å"utterly without power of any kind†. The implication here is that the connection they share is what gives them power but that the Party can overcome this. Despite acknowledging what is necessary to be human and finding his own source of strength, Winston still sees himself as ultimately powerless. Rather than this moment being an epiphany, as you would expect from a traditional hero, Winston is filled with hopelessness and in turn shows his love for Julia as being ultimately futile as it cannot lead to any salvation at all. Julia’s cool acceptance of this only makes it seem more inevitable as she states, â€Å"Everybody always confesses. You can’t help it. They torture you.† The short sentences make each statement a fact rather than a possible future. However we are also given a small glimmer of hope when Winston says to Julia that the, â€Å"real betrayal† would be if they could, â€Å"make me stop loving you† and Julia responds that, â€Å"They can’t do that.† This gives the reader hope that maybe they can best the Party. They may forfeit their lives in doing so but by staying loyal they could prove that love is more powerful than the control of the Party. However this is crushed at the end when they both betray each other. Having demonstrated how important interpersonal relationships are to the nature of humanity, Orwell then shows how easily such relationships can be demolished. This perhaps more than any other feature of â€Å"1984† makes it d ystopic literature as, what is an inherent belief in many that love can overcome any challenge, is destroyed and with it the image of humanity. In â€Å"Never Let Me Go† we are led to believe that what Kathy and Tommy share could be their salvation as we believe that the ‘system’ can be overcome by love. This is shaped by countless stories with which all are familiar where love bests evil. Both Orwell and Ishiguro play on our expectation that a resolution will be found in order to shock the reader to a greater extent when it is shown that hope is lost. This happens in â€Å"Never Let Me Go† as the society presented places small value on these emotions. Miss Emily understands they have, â€Å"hoped carefully† that deferrals might exist, but has to explain to them it was only ever, â€Å"A wishful rumour.† It is this element that shows the dystopic nature of the novel as, up to this point we feel Kathy must achieve some kind of success to fulfil her role as principle character, but it doesn’t happen. The use of the word, â€Å"hoped†, is also key as this is essentially  what the story is about, it reminds the audience that for Kathy and Tommy, their love represents hope of future happiness and leading lives with a meaning beyond being someone else’s spare parts. Both â€Å"1984† and â€Å"Never Let Me Go† demonstrate how fundamental relationships are to human lives. They are what shape us, what allow us to interact with a greater society and what gives us hope. However in both novels relationships are broken down and shown to be futile, in neither do the protagonists find a way to escape their fate through love and nor do they get any real comfort from it as they are always fighting against systems that do not accredit a value to such emotions. It is when these relationships are finally proved to offer little to those involved that faith in a redeeming future is lost in and as such it is when the novels are shown to be dystopic. This is clearly a fundamental element of the authors’ dystopian literature as love tends to be what humankind clings to as the last vestige of hope in a dire situation and even this is removed from these works.

The An Lushan Rebellion in Tang China

The An Lushan Rebellion began in 755 as a revolt by a disgruntled general in the Tang Dynastys army, but it soon engulfed the country in unrest that lasted nearly a decade until its end in 763. Along the way, it nearly brought one of Chinas most glorious dynasties to an early and ignominious end. An almost unstoppable military force, the An Lushan Rebellion controlled both capitals of the Tang Dynasty for most of the rebellion, but internal conflicts eventually brought an end to the short-lived Yan Dynasty. Origins of Unrest In the middle of the 8th century, Tang China was embroiled in a number of wars around its borders. It lost the Battle of Talas, in what is now Kyrgyzstan, to an Arab army in 751. It also was unable to defeat the southern kingdom of Nanzhao — based in modern-day Yunnan — losing thousands of troops in an attempt to put down the rebellious kingdom. The only military bright spot for Tang was their limited success against Tibet. All of these wars were expensive and the Tang court was quickly running out of money. The Xuanzong Emperor looked to his favorite general to turn the tide — General An Lushan, a military man probably of Sogdian and Turkic origin. Xuangzong appointed An Lushan commander of three garrisons totaling more than 150,000 troops which were stationed along the upper Yellow River. A New Empire On December 16, 755, General An Lushan mobilized his army and marched against his Tang employers, using the excuse of insults from his rival at court, Yang Guozhong, moving from the area that is now Beijing along the Grand Canal, capturing the Tang eastern capital at Luoyang. There, An Lushan announced the formation of a new empire, called the Great Yan, with himself as the first emperor. He then pushed on toward the primary Tang capital at Changan — now Xian; along the way, the rebel army treated anyone who surrendered well, so numerous soldiers and officials joined the rebellion. An Lushan decided to seize southern China quickly, to cut off the Tang from reinforcements. However, it took his army more than two years to capture Henan, severely dampening their momentum. In the meantime, the Tang emperor hired 4,000 Arab mercenaries to help defend Changan against the rebels. Tang troops took up highly defensible positions in all of the mountain passes leading to the capital, completely blocking An Lushans progress. Turn of the Tide Just when it seemed that the Yan rebel army would have no chance to capture Changan, An Lushans old nemesis Yang Guozhong made a devastating mistake. He ordered the Tang troops to leave their posts in the mountains and attack An Lushans army on flat ground. General An crushed the Tang and their mercenary allies, laying the capital open to attack. Yang Guozhong and the 71-year-old Xuanzong Emperor fled south toward Sichuan as the rebel army entered Changan. The emperors troops demanded that he execute the incompetent Yang Guozhong or face a mutiny, so under intense pressure Xuanzong ordered his friend to commit suicide when they stopped in what is now Shaanxi. When the imperial refugees reached Sichuan, Xuanzong abdicated in favor of one of his younger sons, the 45-year-old Emperor Suzong. Tangs new emperor decided to hire reinforcements for his decimated army. He brought in an additional 22,000 Arab mercenaries and  a large number of Uighur soldiers — Muslim troops who intermarried with local women and helped form the Hui ethnolinguistic group in China. With these reinforcements, the Tang Army was able to retake both of the capitals at Changan and at Luoyang in 757. An Lushan and his army retreated east. End of the Rebellion Fortunately for the Tang Dynasty, An Lushans Yan Dynasty soon began to disintegrate from within. In January of 757, the Yan emperors son, An Qingxu, became upset by his fathers threats against the sons friends at court. An Qingxu killed his father An Lushan and then was killed in turn by An Lushans old friend Shi Siming. Shi Siming continued An Lushans program, retaking Luoyang from the Tang, but he also was killed by his own son in 761 — the son, Shi Chaoyi, proclaimed himself the new emperor of Yan, but quickly became quite unpopular. Meanwhile in Changan, the sickly Emperor Suzong abdicated in favor of his 35-year-old son, who became Emperor Daizong in May 762. Daizong took advantage of the turmoil and patricide in Yan, recapturing Luoyang in the winter of 762. By this time — sensing that Yan was doomed — a number of generals and officials had defected back to the Tang side. On February 17, 763, Tang troops cut off the self-proclaimed Yan emperor Shi Chaoyi. Rather than facing capture, Shi committed suicide, bringing the An Lushan Rebellion to a close. Consequences Although the Tang eventually defeated the An Lushan Rebellion, the effort left the empire weaker than ever. Later in 763, the Tibetan Empire retook its Central Asian holdings from Tang and even captured the Tang capital of Changan. The Tang had been forced to borrow not only troops but also money from the Uighurs — to pay those debts, the Chinese gave up control of the Tarim Basin. Internally, the Tang emperors lost significant political power to warlords all around the periphery of their lands. This problem would plague the Tang right up until its dissolution in 907, which marked Chinas descent into the chaotic Five Dynasties and Ten Kingdoms Period.

The Rise Of Social Media - 1845 Words

The rise of social media creates powerful new opportunities to communicate with colleagues, distributors, customers and the world. Social media platforms such as Twitter, Facebook, LinkedIn, YouTube and others are the emerging core of digital reputations both for Red Lion and its employees. Because social media can blend personal and professional lives, it’s important to exercise caution in using social media both at work and outside work. While new social media platforms are emerging and old platforms fading, a general definition of social media includes forms of electronic communication that create communities of users who share messages, content, videos, or other material. In addition to the platforms noted above, examples would include listserves, User Groups, blogs, microblogging, wikis, virtual social worlds (such as World of Warcraft or Second Life), and community ratings sites(such as Yelp and TripAdvisor). This document is designed to clarify the expectations the company has for employees who use social media platforms, and to help them use these platforms to enhance both the company’s and their individual reputations. As a general matter, the social media world is no different than the in-person world. The same laws, rules, policies, guidelines and best practices that govern our relationships with customers, distributors, vendors, the media (whether new or traditional), and the community all apply on-line. Employees are as responsible for their on-line posts asShow MoreRelatedThe Rise Of Social Media1248 Words   |  5 Pagesand getting the customer service culture right can make or break a business. The rise of social media There are around 7.2 billion people on the planet and nearly 3 billion are active on the Internet. From this vast audience, around 2.1 billion users are on social media and nearly 1.7 billion of them are active on these platforms. 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