Nick is a thirty-year-old Caucasian male who recently enrolled in your patient panel. He comes in today because he desires to “kick the habit” of tobacco use. He had tried to quit before and succeeded twice, only to start up again. He denies any health problems but has a strong family history of COPD and lung cancer. His father died of lung cancer three months ago, and he has been dreaming of him since then. He does not want to end up the same way.

Past medical history

The patient denies medical problems. He had a vasectomy four years age at his ex-wife’s request, no other surgeries. He has noticed a recurrent morning cough and increased production of mucus over the past two months or so.

Medications

– none

Allergies

– none

Stage of change

– contemplation

Diagnosis

– tobacco abuse and addiction

Patient education

Through the use of tobacco, nicotine is one of the most heavily used addictive substances and the leading preventable cause of disease, disability, and death in the United States (Brunton, Chabner, & Knollman, 2011). According to the Center for Disease Control and Prevention, cigarette smoking accounts for around one of every five deaths in the United States (Center for Disease Control and Prevention).

When a person is addicted to a substance, they have a compulsive urge to seek out and use the substance, even when they understand the harmful effects it can have (Brunton, Chabner, & Knollman, 2011). Tobacco products are addictive. With each inhalation of a cigarette the smoker pulls nicotine and other harmful substances into the lungs, where it is absorbed into the blood stream (Brunton, Chabner, & Knollman, 2011). Nicotine is shaped like the natural brain chemical acetylcholine. Acetylcholine is a chemical called a neurotransmitter; this carries messages between the brain cells or neurons (Brunton, Chabner, & Knollman, 2011). Theses brain cells or neurons have specialized proteins called receptors, into which specific neurotransmitters fit. Nicotine locks into acetylcholine receptors. Nicotine attaches to acetylcholine receptors that release a neurotransmitter called dopamine. Dopamine is released normally when a person experiences something pleasurable. Smoking causes neurons (brain cells) to release excess dopamine, which is the cause of feelings of pleasure when smoking (Brunton, Chabner, & Knollman, 2011). This effect wears off quickly, causing the smoker to get the urge to light up another cigarette for another dose of the drug (Brunton, Chabner, & Knollman, 2011).

Nicotine is the primary addictive component in tobacco, but it is not the only important ingredient (Brunton, Chabner, & Knollman, 2011). People who smoke have a reduction in the level of an enzyme called monoamine oxidase (MAO) in the brain and body. Lower levels of MAO in the brain may lead to higher dopamine levels and this leads to the reason people continue to smoke and continue to get the pleasurable effects from smoking (Brunton, Chabner, & Knollman, 2011).

Long-term use of nicotine products leads to addiction. The way nicotine is absorbed and metabolized by the body enhances its addictive potential (Brunton, Chabner, & Knollman, 2011). Each inhalation brings rapid distribution of nicotine to the brain, but it quickly disappears along with the pleasurable feelings. This triggers the smoker to seek that same pleasurable sensation throughout the day (Brunton, Chabner, & Knollman, 2011). Over the course of the day tolerance develops, requiring more frequent doses or higher doses to get the same effect. Nicotine, heroin, and cocaine have similar effects on the brain (Brunton, Chabner, & Knollman, 2011).

Many people who have a nicotine addiction are in denial. They may be social smokers, meaning they only smoke when out with friends, or they believe they can stop when they are ready (Center for Disease Control and Prevention, 2008). Recognizing the signs of addiction is important for the getting over the addiction. Common signs of addiction include requiring increased use of tobacco to get the same satisfaction, experiencing withdrawal when nicotine levels are low, having the desire to quit but not being able to, experiencing cravings and urges to smoke, and continuing to smoke despite being aware of the health risks (Center for Disease Control and Prevention, 2008).

The physical symptoms of nicotine addiction are caused by withdrawal. Withdrawal occurs because the brain can no longer naturally produce adequate levels of dopamine. Nicotine withdrawal symptoms include anxiety, frustration, irritability, depression, difficulty concentrating, increased appetite, and weight gain (Brunton, Chabner, & Knollman, 2011).

Some of the health risks associated with nicotine use include chronic obstructive lung disease (COPD), lung cancer, asthma, gum disease, mouth and esophageal cancer, heart disease, and stroke. The carcinogens in tobacco products cause abnormal cell growth that can develop into cancer (Brunton, Chabner, & Knollman, 2011).

Deciding to quit smoking is the first step toward becoming a non-smoker and better health (Center for Disease Control and Prevention). After quitting, the risk of stroke can be reduced to that of a non-smoker in as little as two years after quitting (Center for Disease Control and Prevention). Heart rate and blood pressure return to the non-smoker levels after only two hours of not smoking. The rate of heart disease related to smoking is decreased to fifty percent and the rate of lung cancer is substantially reduced (Center for Disease Control and Prevention).

Steps to nicotine abuse and addiction recovery that may help are to set a date to quit; this allows the person to get in the mindset to stop (Center for Disease Control and Prevention, 2008). Knowing the triggers that make the person want to smoke is another important factor. Some triggers commonly observed that increase the desire to smoke are after a meal, while driving, drinking alcohol, boredom, stress, coffee, and being around other people that smoke (Center for Disease Control and Prevention, 2008). Having a strong support system is another important factor in quitting. Informing the people around the smoker of the decision to quit may help to support the decision as well as holding the smoker accountable for the goal of quitting. It is easier to stop smoking if the people around support the effort to stop smoking (Center for Disease Control and Prevention, 2008).

If the smoker is thinking about quitting, or has made the decision to quit, there are several products to help in the process of quitting and prevent many of the withdrawal symptoms. Nicotine replacement is an alternative to stopping cold. Many people find it easier to use a replacement therapy such as the nicotine patch, inhaler, or nicotine gum. This may make the transition easier and more comfortable for the person trying to quit (Center for Disease Control and Prevention, 2008).

Tobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. Effective treatments exist; however, that can significantly increase the rate of long-term abstinence. Counseling and medications are effective when used by themselves. The combination of counseling and medications, however, is more effective than either alone (Center for Disease Control and Prevention, 2008).

Products designed to help quit tobacco abuse and addiction

Bupropion SR

treatment should begin one to two weeks before the quit date. The starting dose for tobacco cessation is 150mg orally every morning for three days, then 150mg orally twice daily. This dosage should be continued for seven to twelve weeks. For long-term dosage, use of bupropion SR 150 mg for up to six months post-quit may be used (Center for Disease Control and Prevention, 2008).

Common side effects include insomnia and dry mouth. Insomnia may be addressed by taking the evening pill at least eight hours before bedtime, with at least eight hours between doses (Center for Disease Control and Prevention, 2008).

Nicotine gum

is available in both regular and flavored forms. The gum dosage is available in two milligrams and four milligram doses. Smokers should use at least one piece every one to two hours for the first six weeks (Center for Disease Control and Prevention, 2008). The gum should be used for up to twelve weeks with no more than twenty-four pieces to be used per day. Common side effects of the gum include mouth soreness, hiccups, dyspepsia, and jaw ache. These effects are generally mild and transient, often caused by the patient’s chewing technique (Center for Disease Control and Prevention, 2008). This can be alleviated by correct chewing techniques. The gum should be chewed slowly until taste emerges, then parked between the cheek and gum line to facilitate absorption. The gum should be slowly and intermittently chewed and parked for around thirty minutes or until taste dissipates from the gum (Center for Disease Control and Prevention, 2008).

Nicotine Inhalers-

A dose from the nicotine inhaler consists of a puff or inhalation. Each cartridge delivers a total of one milligram of nicotine over eighty inhalations (Center for Disease Control and Prevention, 2008). Recommended dosage is six to sixteen cartridges per day. Duration of the therapy is up to six months. Side effects include local irritation in the mouth and throat, coughing, and rhinitis. The severity of the irritation is mild and the frequency of symptoms decline with continuous use (Center for Disease Control and Prevention, 2008).

Nicotine lozenges

are available in two milligrams and four milligram doses (Center for Disease Control and Prevention, 2008). Generally, smokers should use at least nine per day in the first six months of therapy, and should be used for up to twelve weeks, with no more than twenty lozenges used per day (Center for Disease Control and Prevention, 2008). The two milligram is recommended for smokers that have the first cigarette more than thirty minutes after waking. The four milligram is used for patients that have the first cigarette within thirty minutes of waking (Center for Disease Control and Prevention, 2008). The most common side effects include nausea, dry mouth, hiccups, and heart burn. Use of the four milligram lozenges may also cause increased rates of headaches and coughing. The lozenge should be allowed to dissolve in the mouth rather than chewing or swallowing it (Center for Disease Control and Prevention, 2008).

Nasal spray-

The nicotine nasal spray produces higher peak nicotine levels than other nicotine replacement therapies (NRT) and has the highest dependency potential (Center for Disease Control and Prevention, 2008). A dose of the nasal spray consists of one 0.5 mg dose delivered to each nostril (1mg total). Initial dosing should be one spray per hour, increasing as needed for symptom relief (Center for Disease Control and Prevention, 2008). Minimum dosage is eight doses daily with a maximum of forty doses per day. Each bottle contains around one hundred doses. Recommended duration of therapy is three to six months (Center for Disease Control and Prevention, 2008). Patients should not sniff, swallow or inhale through the nose while administering doses, as this increases irritation. The spray is best delivered with the head slightly tilted back. Users report moderate to severe nasal irritation in the first two days of use. Nasal congestion and transient changes to taste and smell are also reported (Center for Disease Control and Prevention, 2008).

Nicotine patches

– treatment of eight weeks or less have been shown to be as effective as longer treatment periods (Center for Disease Control and Prevention, 2008). Patches of different doses are available. Dosing regimens should be based on patient characteristics such as amount smoked and degree of dependence (Center for Disease Control and Prevention, 2008). The step down dosage includes four weeks of twenty-one milligram per day patches, then two weeks of the fourteen milligram per day patches, then two weeks of the seven milligram per day patches (Center for Disease Control and Prevention, 2008). There is a single dose regimen available in twenty-two and eleven milligram per day patches for other step down regimens. Up to fifty percent of patients using the patch will experience a local skin reaction. These skin reactions are usually mild and self-limiting, but may be worsened during the course of therapy (Center for Disease Control and Prevention, 2008). Local treatment with a one percent hydrocortisone cream or a five percent triamcinolone cream, and rotation of patch sites may ease the skin irritation. Other side effects of the patches include insomnia and vivid or strange dreams. At the start of each day the patient should place a patch in a relatively hairless area, typically between the neck and waist, rotating the site daily to reduce irritation (Center for Disease Control and Prevention, 2008). The patch should be applied as soon as the patient wakes on the quit day. If insomnia is a problem, the patient should remove the patch prior to going to bed (Center for Disease Control and Prevention, 2008).

Varenicline

is an approved non-nicotine agent for smoking cessation (Center for Disease Control and Prevention, 2008)

.

The FDA added a warning regarding the use of this agent. Depressed mood, agitation, changes in behavior, suicidal ideation, and suicide have been reported in patients attempting to quit smoking when using Varenicline (Center for Disease Control and Prevention, 2008). Any history of psychiatric illness should be discussed before using this medication. Side effects of the medication include nausea, trouble sleeping, and abnormal or vivid dreams (Center for Disease Control and Prevention, 2008).

The patient should start Varenicline one week before the quit date, with a dose of 0.5 milligram daily for three days followed by 0.5 milligram twice daily for four days, followed by one milligram twice daily for three months. Varenicline is approved for maintenance therapy for up to six months (Center for Disease Control and Prevention, 2008). The patient should quit smoking on day eight, when the dosage is increased to one milligram twice daily. To reduce the insomnia problem, the second dose should be taken at dinner time rather than bedtime. To reduce the nausea, the medication should be taken on a full stomach (Center for Disease Control and Prevention, 2008).

Varenicline is a non-nicotine medication. The mechanism of action is due to its partial nicotine receptor agonist and antagonistic effects (Center for Disease Control and Prevention, 2008). Because Varenicline is eliminated almost entirely unchanged in the urine it should be used with caution in patients with severe renal dysfunction. It is not recommended to be used with other nicotine replacement therapies because of its nicotine antagonistic properties (Center for Disease Control and Prevention, 2008).

Plan of treatment

Patient will be advised that the increased cough and mucus production is related to the use of tobacco products and that once he no longer smokes the frequency of cough and mucus production will decrease as this is related to irritation in the lungs caused by tobacco use. A smoker’s cough is a persistent cough that develops in long-term smokers. At first it may be dry, but over time it usually produces phlegm. The cough is usually worst upon awakening and improves throughout the day. The airways are lined with tiny hair like cells called cilia, which catch toxins in inhaled air and move them upward toward the mouth to be expelled. Smoking paralyzes these cells. Instead of toxins being caught in transit, toxins enter the lungs and create inflammation. This leads to coughing as the lungs attempt to clear these toxins. As the Celia begins to repair themselves during the night and attempt to remove the accumulated substances from the lungs, the result is coughing upon arising. This cough will usually fade as the Celia is allowed to repair themselves from the abstinence of cigarette smoking.

Treatment will consist of smoking cessation counseling and support, Varenicline 0.5 mg daily, starting immediately, orally once daily for three days, then 0.5 mg orally twice daily for four days, followed by one mg orally twice daily for three months. Follow up should be in three days to evaluate side effects and patient response. The next follow-up will be dependent on patient progress and response to medication. The patient will be instructed on the community resources for smoking cessation support groups and how to cope with the stress of not smoking and how to manage daily frustrations related to smoking cessation. Dietary counsel will be offered for possible nutrition advice and weight management. The patient will be encouraged to enroll in an exercise program or to increase physical activities during the initial phase of smoking cessation. A chest x-ray will be ordered, at the patient’s convenience, to rule out COPD or other lung issues.

References

Brunton, L., Chabner, B., & Knollman, B. (2011).

Goodman & Gilman’s: The pharmacological basis of therapeutics

(12 ed.). McGraw-Hill.

Center for Disease Control and Prevention. (2008).

Clinical practice guidelines: Treating tobacco use and dependency

. Retrieved from CDC.gov:

http://www.bphc.hrsa.gov/buckets/treatingtobacco.pdf

Center for Disease Control and Prevention. (n.d.).

Smoking and tobacco use

. Retrieved from Center for disease control and prevention:

http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/you_can_quit/nicotine

Health concerns have become a fundamental issue in the 21

^st

century. People around the world are taking a more active role in matters concerning their health. The internet is loaded with information that is geared towards educating people on making healthier choices. Many factors come into play for the effective functioning of the body organs. Electrolytes such as sodium, potassium, calcium and magnesium are minute and easily can be overlooked but the impact of a deficiency of one of them on the body can be fatal. There is a paucity of information available as concerns magnesium specifically. Most people are ignorant on the importance of this electrolyte and its interplay with human health and disease. Recent study findings indicate that the role of magnesium in health and diseases processes in the human body cannot be undermined. The study findings were published in the BMC Bioinformatics journal.

Chemical processes in the body are mediated by hormones and enzymes. Enzymes are protein compounds that act as catalyst or controls for the various reactions. The enzymes do not work in isolation and require various co factors for effectual working. Magnesium acts as a cofactor for over 300 enzymes in the human body. Of particular importance is the subset of enzymes that are tasked with regulating the process of energy (ATP) formation and utilization. The study revealed that human proteins contained binding sites for magnesium. This being the case, a deficiency of magnesium would therefore affect a wider range of biological processes.

The human DNA is the hereditary material that encodes genetic instruction used in the development and functioning of the human body. The DNA is responsible for synthesis of over 100,000 proteins. This is a highly specialized process. Each protein is coded for by a specific portion of DNA known as proteome. Recently discovered ‘magneseome’ is the portion of DNA that codes for the proteins that bind magnesium. Consequently, deficiency of magnesium will affect the synthesis of specific proteins in the body and have impact on health and disease.

In the recent past calcium has become a popular electrolyte supplement advocated for by nutritionists and clinicians with all effort geared to avoiding or combating calcium deficiency. Calcium garnered its popularity after an inaccurate definition of osteoporosis by WHO despite contrary research findings that showed that excess calcium in the body increases risk of heart disease and subsequent mortality.

Magnesium research.

Information gathered from magnesium related studies has build up over the last 40 years with each year having about 2000 study findings published. Cumulatively, magnesium has been shown to have over 100 health benefits. The article will highlight several key therapeutic uses for magnesium.

Fibromyalgia

: this is a chronic disorder that causes muscle pain, joint tenderness and fatigue. Deficiency of magnesium is a common feature of patients with fibromyalgia. Magnesium malate composed of low doses of magnesium (50mg) mixed with malic acid has been shown to provide relief for the muscle pain and joint tenderness when administerd to fibromyalgia patients.

Atrial fibrillation

: this is a disorder of heart rhythm and can be fatal. Study findings revealed that magnesium supplements decrease atrial fibrillation when used in isolation or together with other drugs.

Diabetes Type 2

: results from study conducted in 2007 found that 13.5-47.7% of patients with type 2 diabetes have magnesium deficiency. Long term complications of diabetes include peripheral neuropathy and coronary artery disease. Research has shown that patients with lower intracellular magnesium levels are likely to develop the fore mentioned complications. Oral supplementation with magnesium has been shown to be of immense benefit to patients. It results in reduction in fasting glucose, increasing levels of HDL, improving sensitivity to insulin and better metabolic control.

Premenstrual syndrome

: magnesium insufficiency has been found to be a common feature of women who suffer from premenstrual syndrome. Expectedly, magnesium has been shown to ease fluid retention, a common feature of premenstrual syndrome. In the course of a 3 month study period, women aged 18-45 were given 250mg of magnesium daily. The results showed that there was a roughly about a 34% reduction in symptoms associated with premenstrual syndrome. Together with vitamin B6, magnesium supplementation has been shown to alleviate premenstrual symptoms that are related to anxiety.

Cardiovascular disease and mortality

: low magnesium levels correspond to an increased risk of mortality from cardiovascular disease. Magnesium confers a protective effect on the cardiovascular system. It achieves this through various mechanisms. It lowers the blood pressure, it prevents spasms of the coronary arteries, it counters formation of clots within the blood vessels and acts as calcium channel blocker. Mitochondria are intracellular components that act as the site of energy production. The heart muscle is densely populated with mitochondria which require sufficient magnesium for ATP synthesis.

Migraine disorders

: the journal of Neural transmission recently published an article titled “why all migraine patients should be treated with magnesium”. The study found that the levels of magnesium in the body are not accurately reflected from routine investigations. This is because the bulk of magnesium is found in bone (67%) and that within the cells is 31%. Subsequently only 2% of body magnesium stores is in the extracellular space and this is what is picked up during investigations. The researchers advocated for empiric supplementation of magnesium in patients with migraines because lab results for magnesium levels in the body were unreliable. It has been demonstrated that magnesium supplementation orally reduces the incidence of headache days among children suffering from frequent migraine headaches. Magnesium used together with I-carnitine is effectual in reducing migraine frequency in adults.

Aging

: aging is a mandatory process of life. Magnesium insufficiency has been shown to hasten the rate of aging. This was clearly demonstrated among individuals who participated in extended space flight missions. Deficient magnesium levels in these individuals have been associated with accelerated aging of the heart tissue at a rate that is 10 times faster than normal. Neoroendocrine changes and sleep changes that are related to the natural process of aging can be reversed by magnesium supplementation. A possible explanation in which magnesium is able to undo the processes of aging is that it is essential for DNA stability and is essential during DNA replication.

Best sources of Magnesium in the diet.

Nature is generous to us. This is because magnesium is best sourced from food. Leafy green foods are good examples of dietary sources of magnesium. This is because they contain chlorophyll the pigment necessary for photosynthesis. Chlorophyll contains an atom of magnesium at its center. Without the atom of magnesium, the plant would not be able to employ the sunlight to synthesis energy. However elemental magnesium is colorless and foods that are not green contain it. After ingestion, magnesium is absorbed more effectively if combined with food cofactors than when it is in its elemental form.

The below listed foods are rich in magnesium. The list indicates how much magnesium would be sourced from a 100 grams serving of the corresponding food.

• Crude rice bran(781mg)
• Dried seaweed agar(770)
• freeze-dried chives(640mg)
• dried coriander leaf(694mg)
• dried pumpkin seeds(535mg)
• unsweetened dry cocoa powder(499mg)
• dried basil(422mg)
• flax seeds(392mg)
• cumin seeds(366mg)
• dried brazil nuts(376mg)
• freeze dried parsley(372mg)
• sesame seeds(346mg)
• almond nuts butter(303mg)
• roasted cashew nuts(273mg)
• defatted soy flour(290mg)
• dried sweet whey(176mg)
• dehydrated bananas(108mg)
• puffed millet(106mg)
• freeze dried shallots(104mg)
• freeze dried leeks(156mg)
• raw salmon(95mg)
• dehydrated onion flakes(92mg)
• raw kale(88mg)

Magnesium supplement formulations are also available commercially. This will be of benefit to individuals who need higher doses of magnesium or those whose palates do not tolerate the fore mentioned foods. Taking glycine together with magnesium enhances absorption of the later increasing amounts available to the body. Stool softening and laxative properties are some extra benefits on magnesium therapy experienced when a person is taking magnesium citrate or oxide.

The National Health Service has a lot of health inequalities regarding to people with gender, race and social class, this has become of interest to myself because there are a lot of issues that relate to the health inequalities of the National Health Service therefore I would be looking at the inequalities of the social class. For this I will be looking at how the NHS began and how the NHS has proceeded throughout the years. I will also be looking at how the government supports and funds the NHS. For the social class inequalities what health impacts there are between the upper and lower class, how private health care benefits those who receive private health care. How the Black Report provided evidence that there are health inequalities between social structure and how poverty affects the lower class.

The National Health Service was introduced in 1948, when health care sectary Aneurin Bevan (Labour) opened Park hospital in Manchester it bought plans for free good healthcare for all, this meant that for the first time all occupations of the healthcare came under one organisation such as nurses, doctors, dentists and opticians. With the approach of that good health care must be available to everyone regardless of the individuals’ wealth. It was the initial for anyone in the world to receive free health care on the basis of their citizenship not on fees. This came with the ideological perspective of that the health care system that all health care would be available to all and financed entirely from taxes, where people pay for the healthcare system according to their personal income.

The post war Labour Government took into place the NHS in 1948 as illnesses were soaring and thousands of people were dying from diseases which now could have been cured in today’s society these diseases included pneumonia and meningitis. Many of people suffered and tragically died because they could not afford to pay for treatment of healthcare or it was unavailable for numerous working class citizens.

Published in 1942 by William Beveridge, the Beveridge Report showed the need for dramatic change for the healthcare system. The report was designed to tackle the five giants of illness, poverty, disease, unemployment and unawareness in which Beveridge recommended the establishment of the National Health Service it recommended that the government should find ways to tackle ways of fighting the five giant evils.

Since 1948 when the National Health Service was born, the NHS has proven to be a success and fundamental to the society of the United Kingdom (UK). It has enabled families to go and seek medical advice in confidence, and receive treatment regardless of their financial background.

Since the NHS has been in place there has been a dramatic change throughout the 20th and 21st century life expectancy has increased from the average age of 45 years for men and 49 years for women in 1901 to over 75 years for men and over 80 years for women in 2006 – 2008. Also infant mortality has declined the chances of a baby surviving the first year of life has greatly decreased, according to the Office for National Statistics (ONS). However this is may be profound but the NHS has not exactly had the ‘smoothest’ of runs throughout the years, firstly with the conservatives opposing the NHS in 1948 then conservatives coming in and out of power throughout the years left years of neglect on the NHS, having lack of resources such as doctors, nurses and equipment. Labour having to somewhat reboot the NHS and make plans and changes to improve the inequalities and resources to the NHS.

The social democratic approach is to provide welfare state, which this consists of a view that social welfare is seen has a type of social citizenship, with the vision that social welfare is a basic right.

With the NHS being established by the post war labour government, it is usually associated with the social democratic approach having a more concern of social welfare, and focusing on the poor and working class citizens rather than focusing on the wealthier class citizens who can afford to pay for their own health care. The Beveridge Report was to tackle one of the ‘five giants’ illness and providing free health care to everyone still remains a key aspect of the Labour government.

There still is a lot of ideological issues in the NHS that still remain the nature of the provision, the NHS still remains free to everyone and is paid through national insurance (NI) and taxes which still tackles one of the five giants, illness. Where society has changed and life expectancy has increased and infant mortality has declined throughout the years.

Health Inequalities of the Social Class

Throughout the years there has been remarkable health improvements and social economic in the UK. People from all walks of life are living healthier and living longer in today’s society than ever before. Although this remains true there are still a lot of health inequalities that occur in the health care. This was established when a report published by Sir Douglas Black called ‘The Black Report’, showed evidence that health inequalities exist in the health care system, he based the report on mortality rates between social classes, ‘A method of comparing death rates between different sections of the population’ (Townsend and Davidson 1990). This also stimulated new research that social class as a key influence of people’s life chances.

With the National Health Service running for more than sixty years there is still a gap between social classes in all sections of societies applying to all aspects of health including life expectancy, infant and maternal mortality and the general level of health. With the gap between the social classes still emerging, there are still geographical differences between women and men; women tend to live longer by five years on average than men.

The social stratification suffers quite a significant gap within the health care system this may be because of the two tier system in the NHS where people who can afford to receive private health care treatment gives them the advantage of no queues meaning that they would not have to wait on waiting lists, where as the lower class who may not be able to afford private health care would have to wait to a maximum of 18 weeks between referral and treatment. For people who pay for private health care they are often to have a ‘choice’ where they can chose their own consultant and where they would like to be treated, unrestricted visiting hours, where as this may not apply towards lower class citizens because they cannot afford to go private.

The Black report does show evidence that there are health inequalities between social classes. For instance, life expectancy at birth for the upper class increased by six years over the last quarter of the 20th century, while infant mortality had risen by less than two years for the lower class by the end of the century (ONS, 2002). There is also double the infant mortality to the lower class compared to the upper class. Despite the improvements and changes that had been made in 1948 to suit all groups in the post war period. Statistics from the health sector has shown that the poor have shorter life expectancies and poorer health despite the Black Report.

Social class is ‘complex’ topic that involves status, wealth, culture, background and employment. There are a number of different influences of health, several of the health influences including social class. In 1943 Sigerist wrote, “The task of medicine is to promote health, to prevent disease, to treat the sick when prevention is broken down and to rehabilitate the people after they have been cured. These are highly social functions and we must look at medicine as basically a social science.” (Socialist Health Association)

The connection of social class and the health inequalities does not give very clear explanations of the reason why there is a gap between the social classes; people have many different variations of the cause. Such as the ‘Material Explanation’ where this explanation blames poverty, poor housing conditions, lack of resources in health and education as well as more dangerous occupations for the poor health in the lower social class. Poverty being a obvious cause towards ill health. Life expectancy is lower in less developed countries, but diseases that affect the developed world such as Britain tend to be diseases that are more self inflicted and can be avoided to an extend such as obesity, smoking and drinking alcohol to an extreme content. These tend to be more common occurrences for the poor or lower class than the more wealthier and upper class citizens.

The cultural explanation, propose that lower class citizens chose to have less healthier lifestyles, having unhealthy diets (eating fatty foods), smoke cigarettes, and drink a lot more alcohol than wealthy and upper class citizens. With healthier foods being more expensive than quick easy solution foods that contain a lot of unhealthy substances, this would be more of a priority than knowing what is healthier for them. People who work long shifts in factories or work all day tend not to seek any activities outside of work because they may not want to after working because of feeling too tired this does not give them adequate exercise for the cardio-respiratory system.

From the Black report that raised a lot questions to the health inequalities had lead to further reports, such as the Acheson Report that was published in 1998 by Sir Donald Acheson, a former chief medical officer. It found little cause for congratulation and also called for the issue of poverty to be addressed. The Acheson Report

In today’s society problems occur in poor healths which are related to obesity, smoking and the influence of alcohol and accidents. Where as in the past poor health was related to sanitation and infectious diseases. Although poverty is still a cause of poor health except poverty should not be equated to social class. Poverty can extend in variations and definitions of the word meaning ‘Poverty’, because it is very different to third world countries and those of the developed countries such as the UK. Poverty is going to affect the elderly and children more because they are most vulnerable and likely to be affected by poor health. Poverty is a real predicament. The Black Report and the Acheson Report both suggested trying to condense the inequalities of income in societies but these have grown instead. Social exclusion may be a result of poverty such as mental health and substance abuse.

Conclusion

The National Healthcare Service still remains to have the ideological perspective of free healthcare for everyone no matter what circumstances they are under or backgrounds as well as the healthcare being paid through taxation and national insurance, which the NHS still remains heavily funded by the taxation since 1948. Since the establishment of the NHS there has been dramatic change of life expectancy, infant and maternal mortality has dramatically improved since the early 19th century. The government and the public have acknowledged the value of the National Health Service which meets the peoples’ healthcare needs through taxation on the basis of citizenship rather than payment or contribution. Although this is a major improvement since the post war there still is a significant gap between the social classes for the National Health Service perhaps the greatest challenge for the government and the National Health Service is to focus on and address the problems of health and health inequalities of the service, with one of them being the health inequalities of social classes.

Throughout the assignment I perhaps had a political of the New Right theory and did not entirely believe in the NHS, however as I gathered research for my assignment I began to rethink my political view of the healthcare and the welfare system. I did not believe that people should be able to pay for private healthcare and get the ‘best’ and quickest treatment in the NHS itself. While people would have to wait for up to a maximum of 18 weeks, seems quite unfair. I believe that the NHS should be funded from taxation because if it was not then people would not be able to pay for healthcare it would be like taken back to the early 19th century where people died from diseases and illness because they could not afford to pay for treatment which could be easily treated in today’s society. With people still living in poverty today there are no major diseases or illnesses that can relate to death, with the only major health issues are mostly self inflicted causes such as smoking, substance abuse and obesity. Which all to some extend can be avoided.

Bibliography

http://www.nhs.co.uk/tools/documents/historyNHS.html

http://news.bbc.co.uk/1/hi/events/nhs_at_50/special_report/23511.stm

Collins, R. (unknown),”Proud of the NHS at 60″http://www.labour.org.uk/proud/labour_nhs accessed 22nd November 2009

School of Economics and political Science (2000), “The Beveridge Report and the Welfare State” http://www.lse.ac.uk/resources/LSEHistory/beveridge_report.htm accessed 22nd November 2009

(Unknown) (2009) “Life expectancy” http://www.statistics.gov.uk/cci/nugget.asp?ID=168 accessed 22nd November 2009

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