It’s hard to imagine what life was like in the UK before the National Health Service. It was a time when healthcare was unreliable and of course treatment had to be paid for. Now the UK has a free, state-run NHS. Funded by taxpayers and with a budget of more than £100 billion, it’s the largest publicly funded health care system in the world.
I wonder what Aneurin Bevan, the Welsh miner turned Labour politician, who created the NHS immediately after World War II would think of the service today and how far it has come since July 5th 1948? My elf friends and I think he would have been be pretty interested to read a recent study in The Lancet that examines UK health performance and compares it to comparable countries in the European Union and elsewhere in 1990 and 2010.
The report uses data from the Global Burden of Diseases, injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns and how the UK outcomes compare with 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway and the USA; EU15+). Here are just some of their findings:
- For both mortality and disability, overall health has improved in the UK from 1990 to 2010
- Life expectancy in the UK has increased by 4.2 years from 1990 to 2010
- The performance of the UK in terms of premature mortality is significantly worse than EU15+ for age-standardised death rates and life expectancy in 1990 and its relative position worsened by 2010
- In terms of premature mortality in the UK, worsening ranks are most notable for men and women aged 20-54 years
- The contributions of Alzheimer’s disease, cirrhosis and drug use disorders to premature mortality have risen from 1990 to 2010
- In 2010, compared with EU15+, the UK had lower rates of age standardised ‘years of life lost’ for road injury, diabetes, liver cancer and chronic kidney disease but significantly greater rates for heart disease, obstructive pulmonary disease, lower respiratory infections, breast cancer, preterm birth complications and other cardiovascular and circulatory disorders
- The years lived with disability (YLDs) have not changed substantially from 1990 to 2010 but age-specific mortality has fallen, consequently the importance of chronic disability in the UK is rising
- Major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse) and musculoskeletal disorders
- The leading risk factor in the UK was tobacco, followed by increased blood pressure and high body mass index (BMI)
The authors concluded:
There is some evidence that policy is responding accordingly, but this response will need to be accelerated and monitored if the UK is to rapidly improve it’s position as a leader in population health among high income countries.
In April 2013 a new system for public health and health care in England will be implemented. As health policy has been devolved to the four nations of the UK, Scotland, Wales and Northern Ireland will have different arrangements. In 2009 Public Health Wales was created to improve the health of the population of Wales, for example. In England several new organisations are going to exist, such as the NHS Commissioning Board, Public Health England, Health Education England and local Clinical Commissioning Groups. A large portion of the public health responsibilities and funding will also be transferred from the health service to local governments in England. The aim being that the underlying social, economic and physical environment factors that influence our health can be addressed more effectively.
It is clear from the findings of this study that further progress is needed to reduce premature mortality and also the burden of disability. This will require improved public health, prevention, early intervention and treatment options. The NHS has come such a long way in the last 65 years, it seems that there is still much to do.
C Murray, M Richards, J Newton, K Fenton, H Ross Anderson, C Atkinson, D Bennett, E Bernabé, H Blencowe, R Bourne, T Braithwaite, C Brayne, NG Bruce, T Brugha, P Burney, M Dherani, H Dolk, K Edmond, M Ezzati, A Flaxman, T Fleming, G Freedman, D Gunnell, RJ Hay, S Hutchings, S Ohno, R Lozano, R Lyons, W Marcenes, M Naghavi, C Newton, N Pearce, D Pope, L Rushton, J Salomon, K Shibuya, T Vos, H Wang, H C Williams, A Woolf, ALopez, A Davis, UK health performance: findings of the Global Burden of Disease Study 2010, The Lancet, Volume 381, Issue 9871, 23–29 March 2013, Pages 997-1020, ISSN 0140-6736, 10.1016/S0140-6736(13)60355-4.