THE HEALTHCARE SYSTEM IN THE UK: OBESITY, A SIGNIFICANT

HEALTH CONCERN

COORDINATOR: PROF. GEORGE CHALTIKYAN

TECHNISCHE HOCHSCHULE DEGGENDORF

BACHELOR INTERNATIONAL TOURISM MANAGEMENTHEALTH&MEDICAL TOURISM

(SEMESTER 4)

GLOBAL HEALTH CARE MANANGEMENT

STUDENT: ALEXANDRA GABRIELA VELESCU

MATRICLE NUMBER: 556867

DATE OF SUBMISSION: 26.06.2017

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 AGENDA

INTRODUCTION 2

1. UNITED KINGDOM: The structure and functioning of the

health care system 3

1.1 Overview of the United Kingdom 3

1.2 The history of health care 4

1.3 Evolution & challenges in the health care system 5

1.4 Health care system: reforms 6

2. OBESITY - BRITAIN: THE FAT MAN OF EUROPE 8

2.1 Magnitude of obesity in UK 8
2.2 Who is affected? 8
2.3 Consequences of obesity 9
2.4 Measures to combat obesity 10
3. CONCLUSION 12
4. REFERENCES 13

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ABSTRACT

This paper presents the synthesis of investigations presented in literature or other

sources, regarding the health care system in the United Kingdom. The focus of the paper
is concerning the development of the health care system. Also the impact of obesity in
the country, as well as the approach and measures undertaken to confront it is being
analyzed in this paper.

The aspects explored in the first part of the paper are the history of the health care
system, its evolution, as well as challenges, issues faced and reforms of the health care
system. In the second part of the research, a synthesis about the magnitude of obesity in
the UK, its economic and social consequences, as well as statistics about adults and
children facing obesity will be provided.

The topic of this paper was chosen for a number of reasons, one of that being the fact
that UK is one of the few countries, which provides a free walk in the system of
healthcare with very few supplementary charges.

With few exceptions, the system copes well with serious and urgent illness, but less well
with minor (although no less distressing for the patient) conditions.

Obesity was chosen as a focus in this paper since it is a major public health problem
associated with serious chronic diseases such as type 2 diabetes, hypertension and
hyperlipidemia. Also, obesity is estimated to be the fourth largest risk factor contributing
to deaths in England, after hypertension, smoking, and high cholesterol, according to the
NHS Atlas of Risk1.

KEY WORDS: United Kingdom, NHS, health care, obesity, child obesity

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INTRODUCTION

The national healthcare system in the UK is called the NHS (National Health Service). The
NHS is in charge of healthcare in the UK. The Department of Health centrally governs the
National Health Service. The Secretary of State for Health is responsible to Parliament for
the provision of health services within the NHS.

Primary care in the UK is based on protocols created by the NICE (National Institute of
Clinical Excellence) and provides for situations where the patient should be sent to a
secondary (local hospital) or a tertiary center (specialized hospitals in certain areas).

The medication received from the NHS family doctor in the UK is subsidized by the state.
The patient pays 7.20 for a drug, regardless of his real price. Also, children under the
age of 18, the elderly over 60, patients with certain chronic diseases and those who
benefit from state financial aid have all the NHS medication free of charge.

The life expectancy at birth in the United Kingdom has increased between 1981 and 2008,
with 5.1 years for women and 6.9 years for men, reaching 82.1 years and 78.0 years,
respectively.

The sharp increases in adult and child obesity are among the most pressing public health
concerns. Obesity rates in the UK are the highest in Europe and have increased
dramatically over the past few years to such an extent that in excess of 20% of the
population are now obese and the costs to the UK economy exceed 3 billion per year.

The high prevalence of obesity in adults within England is alarming, with national
averages of over 40% of males overweight and more than 20% obese in the 16-75 year
age range, while in women the averages are lower for the overweight classification but
higher for obesity.

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UNITED KINGDOM: The structure and functioning of the health care system

1.1 OVERVIEW OF THE UNITED KINGDOM

The United Kingdom comprises four geographic and historical partsEngland, Scotland,
Wales, and Northern Ireland. The United Kingdom contains most of the area and
population of the British Islesthe geographic term for the group of islands that includes
Great Britain, Ireland, and many smaller islands. Together England, Wales, and Scotland
constitute Great Britain, the larger of the two principal islands, while Northern Ireland and
the republic of Ireland constitute the second largest island, Ireland.

Throughout history, the United Kingdom has played an important role in developing the
concept of parliamentary democracy and progress in literature and science. In the
nineteenth century, the British Empire reached its peak with not less than a quarter of the
Earth's surface. In the first half of the twentieth century, the United Kingdom of Great
Britain saw its power diminished mainly due to the World War Two and the withdrawal of
the Republic of Ireland from the Union. The other half century witnessed the
dismemberment of the colonial empire and the rebuilding of Britain into a modern and
prosperous European nation.

The population of the United Kingdom has been increasing since at least 1086, the date of
Domesday Book, which provides the earliest reasonable estimate of Englands population.
There is little concrete information, however, concerning birth or death rates,
immigration, or emigration until 1801, the date of the first official census.

Gradually the greater medical knowledge, improved nutrition, and concern for public
health that characterized the 19th and 20th centuries yielded a lower mortality rate and
an overall increase in population, even as birth rates began to drop.

Britain is a constitutional monarchy: Queen Elizabeth II is the head of the United

Kingdom, as well as other fifteen Commonwealth countries, putting into the UK a personal
union with these other states.

The sovereign has theoretically broad powers, but in practice only performs ceremonial
functions. It is the sovereign who promulgates the laws issued by the Parliament. The

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current sovereign of the United Kingdom is Queen Elizabeth II, who ascended the throne
in 1952 and was crowned in 1953.

The British government led by David Cameron held a referendum for the United
Kingdom's withdrawal from the European Union in 2016. A majority voted to
leave the European Union. On 29 March 2017, Theresa May's
administration invoked Article 50 of the Treaty on the European Union in a letter to
the President of the European Council, Donald Tusk. The UK is set to leave by March
2019.

1.2 THE HISTORY OF HEALTHCARE

The National Health Service (NHS) was founded in 1946, and is responsible for the public
healthcare sector of the UK. Before this, healthcare in UK was generally available only to
the wealthy, unless one was able to obtain free treatment through charity or teaching
hospitals

The organization and access to health care in Britain before 1948 had significant
drawbacks. In 1911, the chancellor, Lloyd George, established a system of National
Health Insurance. For contributors of certain income, this system provided certain
advantages. Contributions were not graduated according to income but were paid
approximately half by the employee and half by the employer.

Britains health care system, before 1948, did work as wanted. It was a combination of
institutions which were not accessible according to need. Two main limitations were lack
of access to hospital care and lack of access to health care for dependents (the families of
working men). Many of these had no formal health cover and had to use self-medication
or medicines bought over the counter from the local pharmacist

The National Health Service was part of a wider, post-war aspiration, expressed in
November 1942 in the Beveridge report, to slay the five giants of want, disease,
ignorance, squalor and idleness. The founding principles of the NHS emphasized the
values of inclusion, equity, equality, and accessibility to health care regardless of the
individuals ability to pay.

The National Institute for Health and Clinical Excellence (NIHCE) was established to
evaluate clinical interventions and determine whether they are sufficiently cost-effective
to be supported by the NHS. There is a concern that NIHCE appears to be over-focused

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on single factors in a treatment programme the efficacy of a particular drug or
treatment method.

1.3 EVOLUTION & CHALLENGES IN THE HEALTH CARE SYSTEM

Starting in 1990, the UK government applied one of the most significant changes for the
NHS in recent times - creating the internal market. Doctors must now be part of the
internal market, which later became the NHS Trust, to be able to compete for patients. It
started with 57 trusts, and by the middle century, all healthcare in the UK was provided
through these trusts.

British health policy in recent years has been characterized by a devolution but also by a
new diversity in service provision, which draws on the cooperation between the public and
the private sector and which emphasize the value of patient choice and responsiveness of
health care provision in general.

Those diversities are supported by a quality assurance initiative, in the context of which
the government introduced standard-setting institutions such as the National Service
Frameworks (NSFs), specifying standards for key conditions, and the National Institute
for Clinical Excellence (NICE), which evaluates and recommends the utilization of new
health technologies within the NHS.

The governments 2010 Equity and excellence: Liberating the NHS White Paper has set
out the future vision for an organization that still remains true to its founding principle of
available to all, free at the point of use and based on need and not ability to pay, by its
name National Health Service.

Records from the NHS show that the numbers of people visiting an emergency room in
England have risen from just over 4.5 million per quarter in 2004 to almost 6 million per
quarter by the end of 2017 - almost a 25% increase.

The Kings Fund, an independent health care charity stated that the National Health
Service is halfway through its most austere decade ever. Figures from the World Bank
reflect this: In 2009, the UK spent 9.8% of its GDP on health care; by 2014, it fell to
9.1%, according to the World Bank.

Along with this came more people, who are living longer and with multiple conditions like
diabetes and heart disease that require treatments, meaning also rising costs. Meanwhile,
hospital bed numbers have fallen, number of people visiting emergency rooms have risen,

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and the demand in the community for social care (such as home care or equipment) has
increased with limited services to provide it, resulting in fewer hospital beds.

Overall the ideological and organizational challenges that the United Kingdom healthcare
system is facing are not dissimilar to those faced by many other national healthcare
systems across the world. Nonetheless, nowadays, the public health system in the UK is
on the brink of collapse.

The Red Cross describes a "humanitarian crisis," doctors describe working and treatmnent
conditions similar to the "Third World": the public health system (NHS), the pride of the
country in 1948, is going through an unprecedented crisis in the winter of 2017, with
which the head of government, Theresa May, is up to date, reports France Presse.

As every winter, the National Health Service in the UK is one step closer to a collapse,
according to doctors and hospital organizations. The Free Health System, the world's fifth
largest employer (1.5 million employees) is a sacred institution. "Our national religion",
said former Conservative Minister Nigel Lawson. But the NHS is also a model in crisis that
is experiencing an aging population, demographic growth and austerity policies.

Emergency waiting time explodes: 23% of patients have waited more than four hours
before seeing a doctor last week. Everywhere there are no beds, ambulances, doctors.
Dr. Richard Kerr, a member of the Royal College of Surgeons, said he never saw such a
deterioration in his 26-year career.

The situation is so alarming that the Red Cross was called to help. "We are facing a
humanitarian crisis," said General Manager Mike Adamson.

Conservative Prime Minister Theresa May condemned these remarks, which he described
as "irresponsible and exaggerated". In order to decongest hospital emergencies, she
asked the general practitioners' offices to be open 7 days a week from 8am to 8pm,
otherwise they could lose government aids.

1.4 HEALTH CARE SYSTEM: REFORMS

In a number of areas the NHS has made improvements. After a decade of unprecedented
increases in funding, the health service has managed under the pressure of flat budgets
and rising demand.

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The main focus now is concentrated on the patients and their well-being. The NHS has
become more efficient. Patient choice has been extended to primary care, mental health
services and community care. Transparency on data and outcomes has greatly increased.

However, savings have been made through short term efficiencies and reforms to
services which are still not sustainable. When looking across the NHS, there has been
disappointing progress towards a more lasting workforce, a more integrated health
service, greater capacity in out of hospital care, and greater patient choice.

There is now widespread recognition that the NHS must reform further and faster than
ever before. As Simon Stevens, chief executive of NHS England, has argued, We are at a
pivotal moment. Either we move to something different or we begin to see services run
into the sand.

There is initiatives to raise efficiency and effectiveness: We will invest in new options for
our workforce, and raise our game on health technology - radically improving patients
experience of interacting with the NHS. We will improve the NHS ability to undertake
research and apply innovation including by developing new test bed sites for worldwide
innovators, and new green field sites where completely new NHS services will be
designed from scratch. NHS England (2014), Five Year Forward View.

Since 2009 it has been widely recognized that NHS spending is failing to keep pace with
rising demand.(Appleby, J. et al (2009), How cold will it be? Prospects for NHS funding:
2011-17, The Kings Fund). To address this gap, in 2009 Sir David Nicholson tasked the
NHS with delivering 15-20 billion of efficiencies by 2014-15, savings to be reinvested in
front line care. (The Daily Telegraph (2009), NHS chief tells trusts to make 20bn
savings, 13 June).

Current ambitions for NHS reform rest on the success of Sustainability and
Transformation Plans (STPs). The 44 STPs covering the whole of England are the main
delivery vehicle for the Five Year Forward View, which aims to strengthen prevention and
primary care, develop new care models that reduce the burden on acute hospitals and
deliver much better value for money. These changes are also needed to deliver the
financial targets agreed by NHS England i.e. to achieve 22 billion in efficiency savings by
2020-21, thereby needing no additional financial support from the taxpayer.

The idea of STPs is that local health economies, rather than individual NHS organizations,
are best placed to decide together how to reform health and social care in their areas.
STPs will encompass all health bodies primary, secondary, tertiary, mental-health

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providers and commissioners and also local authorities, who are responsible for social-
care and public-health provision.

OBESITY - Britain: 'the fat man of Europe'

2.1 MAGNITUDE OF OBESITY IN UK (birghmingham, gov.uk,

The latest World Health Organisation (WHO) estimates are that approximately 1.2 billion
people in the world are overweight, of which at least 300 million are obese. In some
countries, including the USA and the UK, the rates of obesity have more than doubled in
the last 25 years, and being overweight has become the norm for adults.

Obesity rates in the UK are the highest in Europe and have increased dramatically over
the past few years to such an extent that in excess of 20% of the population are now
obese and the costs to the UK economy exceed 3 billion per year.

The high prevalence of obesity in adults within England is alarming. A study conducted by
the University of Birmingham states that between 1993 and 2008 there was a sharp
increase in the proportion of both males and females in England who were clinically
obese: by 83% for men and 52% for women.

In 2008, 24.1% of males and 24.9% of females in England were classified as obese (body
mass index (BMI), up from about 13.2% of males and 16.4% of females in 1993. By
2004, England had one of the highest levels of obesity (22.7%) in Europe, at almost twice
the EU average of 13.4% (Information Centre 2008a).

2.2 WHO IS AFFECTED?

Obesity is a medical condition in which excess body fat has accumulated to the extent
that it may have a negative effect on health. People are generally considered obese when
their body mass index (BMI), a measurement obtained by dividing a person's weight by
the square of the person's height, is over 30 kg/m2, with the range 2530 kg/m2 defined
as overweight. Obesity increases the likelihood of various diseases and conditions,

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particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain
types of cancer, osteoarthritis and depression.

Obesity is most commonly caused by a combination of excessive food intake, lack of

physical activity, and genetic susceptibility. A few cases are caused primarily by genes,
endocrine disorders, medications, or mental disorder.

One in four people in England suffers from obesity, according to the UN Food and
Agriculture Organization, and England is called "the fat man of Europe". Doctor Alison
Tedstone, director of Diet and Obesity- Public Health England, is of the opinion that
obesity is closely linked to poverty. Moreover, communities that are not so wealthy are
home to more obese children. Income, worse social status and ethnicity have an
important impact on the risks of developing obesity. For example, women and children in
socio-economically poor groups are at increased risk of developing obesity.

According to data from the 2015 Health Survey for England, 27% of adults in England are
obese and a further 36% are overweight, making a total of 63% who are either
overweight or obese. What is more alarming is the fact that just under a tenth are
morbidly obese (3%) of all adults, and the rates for morbidly obese children are also
rising.

Men in England are more likely to be overweight or obese than women. 68% of men were
overweight or obese in 2015 compared with 58% of women. Women are more likely to be
morbidly obese than men. 3.6% of women were morbidly obese in 2014, compared to
2.2% of men, figures provided by Carl Baker in his research.

Today nearly a third of children aged 2 to 15 are overweight or obese (Health and Social
Care Information Centre (2015) Health Survey for England 2014) and younger
generations are becoming obese at earlier ages and staying obese for longer.

2.3 CONSEQUENCES OF OBESITY

Obesity imposes a substantial financial burden. The treatment costs in the English
National Health Service (NHS) were recently estimated to be half a billion pounds, around
1% of total NHS expenditure (National Audit Office, 2001).

A study commissioned by consultancy firm McKinsey and Company, reveals obesity has
the second-largest economic impact on the UK, behind smoking, generating an annual
loss equivalent to 3% of GDP (2015). The study says: Obesity is a major global
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economic problem caused by a multitude of factors. Today obesity is jostling with armed
conflict and smoking in terms of having the greatest human-generated global economic
impact. (McKinsey Global Institute)

The effect of obesity on employers is also considerable. In 1998 there were more than 18
million days of medically certified sickness absence due to obesity (National Audit Office,
2001). The broader costs of obesity to society, including direct and indirect costs, are in
excess of 2 billion (National Audit Office, 2001).

Obesity has additional effects: obese individuals may suffer from social stigmatization and
discrimination (Expert Panel on the Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults, 1998).

A UK employment tribunal has become the first to consider obesity as a disability in 2015.
A Northern Ireland tribunal has applied the European Court of Justice (ECJ) decision in
FOA, acting on behalf of Karsten Kaltoft v Billund Kommune [2015] IRLR 146 ECJ that
obesity can by itself amount to a disability.

Mr. Bickerstaff worked at Randox Laboratories in Co Antrim where he said he was

harassed by colleagues, in particular Mr. Butcher, because of his weight.

In one instance, Mr. Butcher had said that the claimant was so fat he could hardly walk.
In another, the respondent said Mr. Bickerstaff was so fat he would hardly feel a knife
being stuck into him. The employment judge said it was satisfied that Mr. Butcher had
been harassed for a reason which related to his disability, namely his morbid obesity
condition. It heard evidence of the claimants excessive body mass index (48.5), sleep
apnea and gout.

Unite regional secretary Jimmy Kelly said: Workers who suffer abuse on grounds related
to their obesity now have the added protection of being able to pursue their
employer/abuser in the Tribunal for humiliating, degrading or violating treatment.
Previously such cases would likely been heard in the civil courts as a stress at work
claim.

2.4 MEASURES TO COMBAT OBESITY

The British government launched in 2016 a strategy to combat child obesity by charging
companies selling soft drinks containing sugar, and the money gained to be invested in

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programs that encourage physical activity and a balanced diet for school children.
(Susanne Plunkket, REUTERS)

By appealing to food and beverage producers to reduce their sugar content, the London
government has pointed out that one-third of UK children aged 2 to 15 are already
overweight or obese.

"Obesity is a threat both to children's health and our economy, with the cost of the
national health system rising to billions of pounds each year. The fee for the soft drink
industry is an important step forward in the fight against obesity, Said Secretary of State
at the British Ministry of Finance, Jane Ellison.

The tax is applied to all refreshments with a sugar content of over 5 grams per 100
milliliters, beverages with higher content being charged even more. However, Gavin
Partington, chairman of the British Soft Drinks Association, said it was a "punitive charge"
that would result in the loss of more than a thousand jobs without having a significant
impact on obesity.

The British Department of Health says that soft drinks are the main source of sugar for
children and that a child can get their recommended daily intake of sugar by drinking a
single dose of cola containing nine teaspoons of sugar. British Public Health Minister
Nicola Blackwood also said that the strategy to combat obesity also includes a measure
whereby primary schools must provide every child with at least 60 minutes of vigorous
physical activity each day and at least 30 Minutes of this period must take place during
classes at school.

Also in 2016 it was announced that obese people will no longer be able to take routine
operations through the UK National Healthcare System (NHS).

Vale of York Care Commissioning Group - a UK home care service - has announced that
overweight people will have to wait a year for a surgery that is not urgent until they reach
a certain weight. Service representatives say this is "the best way to get the most out of
the limited resources available," reports The Independent.

The Royal College of Surgeons described the decision as "the most serious decision the
NHS has seen," amid worries that the healthcare system is starting to fail because of the
funding crisis.

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CONCLUSION

Great Britain represents all that is good and bad with centralized, single-payer health
care systems. Health care spending is fairly low (7.5% of GDP) and very equitable. Long
wait lists for treatment [] pervades the system. (Michael Tanner, coauthor of Healthy
Competition: Whats Holding Back Health Care and How to Free It).

Although the health medical system in the United Kingdom is one of the most efficient in
the world, it still has disparities and issues to confront. Despite providing health care
services with equal access, the health care system has drawn particular attention to the
need to tackle inequalities in all health provision areas.

The United Kingdom is known as the country with the generous healthcare system in the
globe. Interestingly, the country has been dealing with the fiscal deficit quite well, but it
is not known for how long will it last.

A major problem faced by United Kingdom is the obesity. Being known as the fat man of
Europe, UK is experiencing an imminent problem. With nearly a third of children aged 2-
15 overweight or obese, tackling childhood obesity requires that everyone to take action.

Government, industry, schools and the public sector all have a part to play in making food
and drink healthier and supporting healthier choices for children. The benefits for
reducing obesity are clear it will save lives and reduce inconsistencies.

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REFERENCES

- The UK Healthcare System, Sen Boyle

http://www.commonwealthfund.org/usr_doc/UK_Country_Profile_2008.pdf?section=4061

- The UK Health Care System, Josh Chang, Felix Peysakhovich, Weimin Wang, Jin Zhu

- Health and Social Care Information Centre (2015) Health Survey for England 2014

- https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-
action/childhood-obesity-a-plan-for-action

- www.expat.com

- Health Systems in Transition, Sen Boyle, Health System Review 2011

- Health care systems in the EU - a comparative study, Dr.med. Elke Jakubowski, MSc.
HPPF, 1998

- Statistics on Obesity, Physical Activity and Diet England, Published 28 April 2016

- Obesity statistics, by Carl Baker, briefing paper, Number 3336, 20 January 2017

- NHS reform at pace and scale, Reform 45 Great Peter Street London SW1P 3LT

- Progress on NHS reform, Cathy Corrie and William Mosseri-Marlio, March 2015

- 2015 International Profiles of Health Care Systems Edited by Elias Mossialos, Martin
Wenzl, Robin Osborn and Dana Sarnak, January 2016

- The impact of obesity on employment in England, Stephen Morris, London: Tanaka

Business School, 2004

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