Adjusting my lens wider, I want to get a more comprehensive view of the state of the NHS in the UK. I found it quite difficult to gather patient specific content on a Northern Irish patient, but there is a lot more scholarship around this topic on a UK scale. Diving into the broader picture, it's evident that the NHS is under substantial strain, with increasing demands and financial pressures.
I created a mind map to begin and grasp what the NHS looks like in 2024:
Nine major challenges facing health and care in England
I found this comprehensive article on health.org with a lot of patient specific content surrounding the health service.
Life expectancy improvements have stalled, and health inequalities have widened, with those in deprived areas living shorter lives in poorer health. The UK's ranking for female life expectancy has fallen, and healthy life expectancy has stagnated. The COVID-19 pandemic has exacerbated these inequalities. Social and economic factors, such as income, employment, education, housing, and transport, significantly shape population health. However, these factors are unevenly distributed, and cuts in public services spending have left many without essential resources, contributing to increased stress and inability to maintain health.
In the UK, the leading risk factors for preventable ill health and mortality include smoking, poor diet, physical inactivity, and harmful alcohol use. These risk factors are heavily influenced by social and economic conditions. For instance, individuals' ability to adopt healthier behaviours depends on various factors including their income, kind of work, the availability of shops in their community, and access to safe spaces for exercise. Commercial influences also play a role, particularly in determining the cost and availability of unhealthy products and how they are advertised.
The trends for these risk factors are increasingly concerning. Childhood obesity rates have risen sharply in recent years, smoking rates remain high among those working in routine and manual jobs and individuals with poor mental health, alcohol-related deaths are on the rise, and levels of physical activity have decreased compared to the past.
Inequalities in exposure to these risk factors are also significant and, in some cases, widening. This is most noticeable with childhood obesity rates, which are highest and growing fastest in children from the most deprived areas. More than twice as many children from the poorest areas in England were obese in 2021/22 compared to those in more affluent areas. The prevalence of obesity has increased from 24.6% to 31.3% among those living in the most deprived areas between 2013/14 and 2021/22, compared to an increase from 11.7% to 13.5% in the least deprived.
Smoking prevalence has almost halved over the past three decades, from 29% in 1992 to 13% in 2022, thanks to effective policies like banning smoking in public places and introducing advertising restrictions, as well as providing support for people wanting to quit. However, inequalities still persist. In 2019, 17% of adults in the most deprived areas in England smoked, compared to 9% in the least deprived areas. Among pregnant women, nearly 11% smoked at the time of delivery in the most deprived areas, compared with 7% in the least deprived areas.
<aside> ⭐ REFLECTION: I find the statistics around childhood obesity really saddening. I was an overweight child and it is very difficult to change contributing factors at such a young age. Prevention is definitely better than cure in this instance and I think there is a lot of scope for digital intervention in managing the health of our younger generations.
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Multiple factors contribute to the rise in people living with major illnesses in England, including changes in risk factors, social and economic conditions, and demographic changes. The burden of illness is disproportionately higher in deprived areas. Projections suggest that by 2040, nearly 20% of the adult population will live with a major illness, increasing the demand on the NHS, particularly in primary and community settings. This demographic shift will also impact the ability to fund these services, as the ratio of the working-age population to the older population with major illness is expected to decrease by nearly a third from 2019 to 2040.
<aside> ⭐ REFLECTION: It was great to get more of a patient orientated view of health. Public health is something that can benefit hugely from digital intervention, especially in a society such as the UK where technology is a staple in most households. Something that is important to consider is technology access. While healthcare is something that is available to everyone, moving it to a more technology based landscape does pose risk of excluding those who cannot get access to technology. That is why it is important to consider alternative access routes when rolling out a digital solution in public health.
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