NHS reforms could “sabotage” the UK’s trend of improved health outcomes, MPs hearBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1727 (Published 17 March 2011) Cite this as: BMJ 2011;342:d1727
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The BMJ has extensively covered the government's proposed
restructuring of the NHS. Simultaneous changes in other government
departments are likely to impact on health, but these have received little
attention. Andrew Lansley's plans are part of a much wider programme of
public sector reorganisation and spending cuts, affecting all areas of
government from education to the environment. As the World Health
Organisation makes clear, health is not determined by healthcare but by
the conditions in which we "are born, grow, live, work and age" (1). These
social determinants are the primary drivers of health and disease.
The greatest risk factor of all is poverty. If government policies
force more people into poverty, then the health of the population will
suffer. To give one example, consider a possible increase in childhood
deprivation. Parents may lose their jobs, welfare payments may be reduced,
and local services such as libraries and youth clubs are likely to
experience funding cuts. The socioeconomic circumstances in which children
grow have significant long term health implications. Deprived childhood
conditions result in poorer adult health (2).
The NHS makes a huge contribution to people's lives, and must be
protected, but we should not forget the other influences on health.
1. WHO. Closing the gap in a generation: Health equity through action
on the social determinants of health. Geneva: Commission on Social
Determinants of Health, 2008.
2. Galobardes B, Lynch JW, Davey Smith G. Childhood socioeconomic
circumstances and cause-specific mortality in adulthood: systematic review
and interpretation. Epidemiol Rev 2004;26:7-21.
Competing interests: No competing interests