This paper aims to examine the health care system in England in comparison with the health care system in the United States. Thus, in England, all residents “are automatically through the National Health Service, including hospital, physician, and mental health care” (Tikkanen et al., 2020, para. 1). Health care is accessible for all population groups and provided through the agency’s budget formed by general taxation. In addition, voluntary supplemental insurance and services in private medical centers are available for citizens and non-residents as well.
The cost of health care may be regarded as the major difference between the health care systems of England and the United States. Thus, in the United States, medical assistance is not only paid but frequently highly expensive depending on the ability of insurance and the policies of insurance companies. At the same time, the availability of health care delivery is a controversial issue in both countries. It is possible to admit that in England and the United States, it is limited, however, on the basis of different reasons. Thus, Americans have fewer issues connected with long waiting, however, the costs of medical assistance frequently force people to reject treatment. In turn, the issue of long waiting lists is crucial in England due to the dependence of the NHS on taxation. At the same time, both medical systems may be characterized by the presence of health care disparities on the basis of race and ethnicity and gender health care gap. However, both systems pay particular attention to the prevention and management of communicable and non-communicable diseases and health promotion. Their strategies and programs are determined by the prevalence of similar risk factors that lead to the occurrence of serious illnesses. These factors include obesity, low physical activity, smoking, alcohol consumption, and poor nutrition.
Vulnerable Population: Mentally Ill Patients
In the present day, the issue of mental illnesses has become highly essential for the health care systems of both England and the United States due to a growing number of patients. Thus, in England, according to the Survey of Mental Health and Wellbeing, “1 in 6 people aged 16+ had experienced symptoms of a common mental health problem, such as depression or anxiety, in the past week” (UK Parliament, 2021, para. 1). However, the government aims to improve this situation by spending £12.1 billion on England’s learning disability, mental health, and dementia services in 2020-2021 (UK Parliament, 2021). Mental health care is predominantly provided by National Health Service (NHS) funded by direct government taxation – that is why it is completely free for all population groups. Other options available for citizens include private medical centers and private medical insurance.
In England, the quality of health care is intrinsically bound with its complexity. Thus, a patient’s mental health care is traditionally regarded as the part of his overall health care and approached on the basis of his full medical history. That is why in a prevalent number of cases, in order to receive mental health-related assistance, a patient should be referred to a psychologist or a psychiatrist by his general practitioner (GP) (“How to access mental health services,” 2019). In general, the choice of practitioner is flexible – in other words, patients have an opportunity to choose specialists and change them if they are not satisfied with their diagnoses. However, there is a range of mental health services that do not require GP’s referring, including services for alcohol and drug problems and NHS psychological therapies services (IAPT) (“How to access mental health services,” 2019). In addition, multiple mental health care services for employers and students are freely available as well.
At the same time, the availability of mental health care in England is highly controversial. While it is free and accessible for all population groups, waiting lists may be regarded as a serious issue. Varying across the county, the waiting time may last up to 86 days (UK Parliament, 2021). In general, for the first treatment, the average waiting time is 21 days, while for the second treatment, it increases to 53 days (UK Parliament, 2021). This problem is closely connected with the dependence of NHS on government funding. Thus, its cutting inevitably leads to long waiting lists and overcrowding in mental health institutions.
The countries’ different cultures characterize people’s attitudes to mental health care as well. Although the quality and accessibility of mental health care along with its awareness have substantially improved in England, due to reserve culture, it is still associated with stigma. In other words, mental health issues are regarded as personal problems that should be solved by a person by himself without attracting others’ attention. That is why seeking therapy sessions are frequently kept secret. However, this perception of mental health care has been started to change due to efforts of charity-run organizations, government policy initiatives, and the Royal family’s intervention. In turn, in the United States, the practice of regular visiting a psychologist is normalized and regarded as routine; people are not afraid to confess if they have mental health disorders.
At the same time, for Americans, the issue of mental illnesses is crucial as well, especially during the pandemic. According to recent research, “nearly 1 in 5 Americans has some type of mental health condition,” and spending on mental health services and treatment currently exceeds $225 billion (Leonhardt, 2021, para. 3). In general, the responsibilities of psychologists and psychiatrists both in England and the United States are relatively the same. At the same time, access to mental health care in the United States is not free and even prohibitively expensive – thus, an hour-long common therapy session may cost from $65 to $250 (Leonhardt, 2021). Therefore, the quality and accessibility of mental health assistance depend on people’s ability to pay, medical insurance, and medical insurance companies’ conditions. In addition, the accessibility of mental health care is negatively impacted by a lack or absence of specialized centers and clinics in rural areas. Non-governmental and out-of-network medical facilities may be presented, but being outside the system, they offer too expensive services for community members.
Women’s Health and Maternal Child Health
In England, access to Women’s health and maternal child health services is free due to NHS funded by the government. However, similar to access to mental health services, the availability of health care for women is negatively impacted by waiting lists, gender health inequality, and the incompetency of health care providers who may be inattentive to patients’ concerns related to their health (Gregory, 2021). In general, on the basis of a national survey, it is possible to conclude that women feel comfortable when they address specific women’s health topics, including menstrual wellbeing (77%), gynecological cancers (72%), gynecological conditions (71%), and menopause (64%), talking to professionals (Department of Health & Social Care, 2021). At the same time, 84% of women reported that there had been times when they were not listened by their health care providers (Department of Health & Social Care, 2021). In addition, the accessibility of health care in terms of location and timing was confirmed by 40% and 24% of women, respectively (Department of Health & Social Care, 2021). The main issues related to this situation include a lack of women’s health services’ geographical diversity, shortages of women’s health-related specialists, and poor training provided for them.
Regardless of the fact that in many countries across the globe, men traditionally face more considerable health risks, in England, one of the largest female health gaps exists. According to the research of University College London, women receive worse treatment in comparison with men who have the same health conditions, “make fewer visits to the GP, receive less health monitoring, and take more potentially harmful medication” (Winchester, 2021, para. 2). Another Saving Lives, Improving Mothers’ Care Report demonstrates that “between 2016 and 2018, 217 women, or 9.7 women per 100,000, died during or up to six weeks after childbirth from causes associated with their pregnancy” (Winchester, 2021, para. 6). In addition, in England, there are health care disparities on the basis of race and ethnicity. This means that women from Black, Asian, and minority ethnic groups are more vulnerable to health care issues, especially related to maternity and childbirth, due to discrimination and socioeconomic disadvantages.
At the same time, health care disparities based on racial discrimination and structural racism exist in the health care system of the United States as well. As the access to health care services is not free, the morbidity and mortality rates of women from minority ethnic groups increase due to the absence of insurance, discrimination, comorbidities, socioeconomic disparities, and unemployment. In general, the United States has the highest maternal mortality ratio among other developed nations, with approximately 17 deaths in 100,000 live births, and failed to reduce it in the past decades (“Maternal health in the United States,” n.d.). Other differences in the efficiency and quality of the health care system in the United States related to women’s health may be presented in the following way:
- U.S. women have a higher chronic disease burden in comparison with English women – 20% of them aged 18-64 have more than two chronic conditions against 12% of women in England;
- U.S. women have a higher level of emotional distress in comparison with English women;
- However, the rates of breast cancer screening are slightly higher in the United States (80% against 7%) – that is why the rates of breast cancer-related deaths are lower there;
- Women in the United States report considerably higher out-of-pocket costs for women’s health care services and medical bill issues;
- Therefore, 38% of women refuse to receive medical health due to costs in comparison with only 5% of English women.
- At the same time, fewer women in the United States wait for specialists or experience their absence (Gunja et al., 2018).
Management of Communicable and Non-Communicable Diseases
In England, the rates of premature mortality from non-communicable diseases are higher among other developed nations. The most common conditions include neurological, cardiovascular, musculoskeletal, and respiratory diseases, diabetes, and cancer. Concerning communicable diseases, they include mumps, measles, tuberculosis, scarlet fever, and whooping cough (“Infectious and communicable diseases,” 2021). In relation to both communicable and non-communicable illnesses, health care disparities on the basis of race and ethnicity exist.
Similar to England, the United States has high rates of non-communicable diseases as well with cardiovascular disease as the most common reason of deaths in the country. In general, both countries, through NHS in England and CDC in the United States, pay particular attention to the prevention and management of these conditions having similar strategies. For communicable diseases, they include local disease surveillance, the maintenance of alert systems, the investigation and management of outbreaks, and the implementation of national action plans with their subsequent monitoring. Both countries’ action plans for the management of non-communicable diseases include addressing factors that lead to the occurrence of illnesses and social determinants of health. In addition, the health care systems of England and the United States aim to raise public awareness in relation to diseases’ prevention and management.
Theory and Practice of Health Promotion
Both countries aim to promote people’s health, encouraging them to conduct healthier lifestyles to improve their wellbeing and reduce the health care system’s burden. In England, Public Health England (PHE) is responsible for the protection and improvement of the nation’s health and the reduction of health inequalities (“About us,” n.d.). Through the employment of more than 5,500 staff for several centers across the country, PHE promotes a healthier lifestyle, protects people from public health hazards, raises public awareness concerning strategies for individual health improvement, supports NHS and local authorities in the implementation of social care strategies and services. The main areas of health promotion where progress is observed include diet and physical exercise, mental health and wellbeing, alcohol and drugs, smoking, and sexual health.
In the United States, CDC is responsible for health promotion. It supports various national programs dedicated to smoking cessation and the promotion of smoke-free public spaces, clinical preventative services, access to healthy food and clean water, women’s reproductive health, and disease self-management (“Promoting health for adults,” 2022). In addition, both countries aim to reduce health care disparities and provide equal access to health care and preventative services for all citizens.
Behavioral and Lifestyle Factors that Affect Health and Illness
In both England and the United States, high rates of diseases, especially non-communicable ones, are closely connected with people’s lifestyle and behavioral factors. Risk factors traditionally include poor nutrition, obesity, alcohol consumption, smoking, and insufficient physical activity. According to recent studies, males aged 18-24, especially from more deprived groups, frequently consume fast food and ready meals, 77% of them are engaged in at least one health risk behavior, including smoking, alcohol consumption, and physical inactivity (Birch et al., 2019). Alcohol consumption may be regarded as the major problem and the most substantial risk factor (Country Health Profile 2019, 2019). At the same time, the levels of smoking and obesity are slightly decreasing, especially among the young population. In the United States, obesity due to the consumption of fast food, sugar, and canned meals and low physical activity remains the major risk factor that causes the majority of non-communicable diseases.
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