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Determinants of Health Update November 2021

Welcome to this month’s Determinants of Health Policy Update from HLA:THINK

Through these regular updates we will share with you some of the key developments in different areas of health and care policy, all through publicly available resources.

If you are interested in the work of HLA:Think and would like to get involved,

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The elective backlog

Data from NHS England suggests that there are currently 5.72 million people who are on the NHS waiting list; the highest number recorded since 2007. However, the backlog seen is not evenly distributed across the country and is growing disproportionately in certain regions. A recent editorial in the BMJ highlighted that clinical commissioning groups (CCGs) in the most deprived areas of the country have faced a 55% increase in their waiting list numbers compared to a 36% increase in the least deprived regions. Similarly, according to a recent analysis by the King’s fund, patients living in impoverished areas are 1.8 times more likely to have to wait over a year to receive hospital treatment.

Differences in COVID-19 infection rates are thought to be playing a major element; a factor itself linked to long standing inequalities. The latest NHS England’s operational planning and contracting guidance for 2021/2022 has acknowledged the need to prioritise tackling the elective list backlog. The Government has also announced an additional £8 billion pounds in funding over the next three years to tackle this issue. Other countries, such as New Zealand, are tackling this by prioritising individuals from minority ethnicity backgrounds in elective surgery waitlists.

Climate change

The WHO predicts climate change will cause an extra 250 000 additional deaths per year between 2030 and 2050. This is mainly through its effects on air pollution, food supply, living conditions and sanitation. As well as the human costs, the WHO projects a financial cost as high as 4 billion USD per year.

Low and middle income countries with less developed health infrastructure are outlined to be at the highest risk of bearing the brunt of this cost. A recent United Nations report details that communities who are least able to protect themselves from the consequences of climate change will be hit hardest and first. A number of direct consequences of climate change include food shortages, adverse weather events and increase in zoonotic or vector-borne diseases. Some indirect consequences include the disruption to social determinants of good health such as livelihoods, access to healthcare and community support structures.

Humanitarian crisis at Poland-Belarus border

For weeks, a large group of people, mostly from the Middle East, has been stranded in Belarus at a border crossing with Poland, trapped as forces from the two countries face off against each other. The United Nations Refugee Agency and International Organisation for Migration have recently issued a statement calling for humane treatment of refugees at the Poland-Belarus border. With the fast-approaching winter, temperatures at the border have dropped below 0°C and there have been reports of people, including children, dying from hypothermia and malnutrition.

Although, the Red Cross is urgently providing relief efforts, the supply of food and medical help is scarce. Research published in the BMJ highlights that refugee children have increased health needs. The WHO and European commission have also found that refugee children are also at risk of increased morbidity and mortality. This has led to international recommendations of a comprehensive individualised health assessment by a paediatric nurse or clinician as soon as the child arrives in the country of destination. Currently, no plans have been announced to resolve the conflict and non-government organisations are continuing to ask for access to humanitarian aid at the border.



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