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UK has around 150 nurses and midwives per 10,000 people

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The UK is just behind the countries of Scandinavia and Central Europe as well as smaller nations like Cuba, Bermuda and Andorra when it comes to health worker density, according to a major study.

It also showed the UK is among the top five nations when it comes to meeting global health goals but is still struggling when it comes to childhood obesity, alcohol consumption and smoking levels.

“The balance of physicians, nurses, midwives and pharmacists in a country’s workforce underpins the types of care that are available” 

Rafael Lozano

The latest estimates on the state of the world’s health, published in a special edition of The Lancet, show that in 2017 the UK was ranked fifth in terms of meeting the United Nations’ Sustainable Development Goals for health.

However, findings from the Global Burden of Disease (GBD) study show progress in health worldwide is not inevitable with a shortage of health workers partly to blame.

The GBD study, which is presented in seven new papers in The Lancet, is co-ordinated by the Institute for Health Metrics and Evaluation at the University of Washington in the US and involves more than 3,500 collaborators from more than 140 countries.

For the first time, the estimates include an analysis of “health worker density” looking at numbers of nurses and midwives, doctors and pharmacists.

The authors worked out having more than 30 doctors, 100 nurses and midwives and five pharmacists per 10,000 people was the optimum when it came to ensuring access to healthcare and quality services.

Countries were scored on how well-resourced their health systems were from 0 to 100 with 15 – including Sweden, Germany and New Zealand – scoring the maximum and the UK scoring 99.

The other nations scoring the maximum of 100 were Cuba, Andorra, Norway, Switzerland, Finland, Iceland, Denmark, Belgium, Slovakia, Austria, Bermuda and the Czech Republic.

A breakdown of results for different countries shows that in 2017 the UK was estimated to have around 150 nurses and midwives per 10,000 people. Numbers were expected to increase by nearly 9% by 2030, with an estimated 168 nurses and midwives per 10,000 by then.

The study suggests there were about 27 doctors per 10,000 population in 2017, with numbers expected to increase by more than 25% to 34 by 2030.

Meanwhile, there were about six pharmacists per 10,000 people with numbers expected to increase by about 18% to eight by 2030.

However, the analysis suggests many other nations are facing a staffing shortfall, with nearly half of countries having less than 30 nurses or midwives and fewer than 10 doctors to serve 10,000 people.

While the study authors said the figures could not predict the quality of care on offer, they said the make-up of the health workforce was key.

“The balance of physicians, nurses, midwives and pharmacists in a country’s workforce underpins the types of care that are available to the population,” said lead author Professor Rafael Lozano.

University of Washington

Lozano Rafael

Lozano Rafael

“While increasing the overall number of health workers will be important for many countries, it’s vital that this growth ensures a varied workforce composition,” he said.

The authors noted they did not look at doctors and nurses according to speciality, which may be important when it comes to analysing workforce shortfalls in relation to health trends in each nation.

The GBD study is the only annual, comprehensive, peer-reviewed assessment of global trends in health, providing global and national estimates for around 280 causes of death, 359 diseases and injuries and 84 risk factors in 195 countries and territories worldwide.

Those behind the study said the data for 2017 painted a “disturbing” picture with a worrying slowdown in progress in key areas.

For example, the study shows improvements in mortality rates for adults were less pronounced overall and stagnated and got worse in some countries in 2017.

“Although many high-income countries, including the USA and the UK, experienced large gains in life expectancy for many decades, the pace of progress has stalled in recent years, particularly in the past decade, and within-country inequalities in life expectancy have widened,” said the paper on mortality rates.

Meanwhile, the study suggests no countries are on track to meet the United Nation’s Sustainable Development Goals to improve health by 2030.

While the UK scores highly in many areas when it comes to these goals, the study shows it continues to be in the danger zone for childhood obesity, alcohol consumption and smoking – in common with other well-off nations.

Scores are middling for the incidence of HIV and levels of child abuse, with the UK also doing less well when it comes to suicide rates.

Predictions for 2030 suggest all of these areas will continue to be an issue with the score for child obesity getting worse and the UK slipping down one place to number six in global rankings.

The study shows half of all deaths worldwide were caused by just four risk factors in 2017 – high blood pressure, smoking, high blood glucose and high body mass index.

In addition, lower back pain, headache disorders and depressive disorders were the three leading causes of disability – and have remained so for nearly three decades.

The prevalence of obesity continues to rise in almost every country in the world with more than one million deaths estimated to be due to type 2 diabetes in 2017, found the study.

Total fertility rates have declined since 1950 with 91 countries – including the UK – where women have less than two children each on average, although more than 100 nations are experiencing a “baby boom”.

Meanwhile, the study identifies some emerging adverse trends with conflict and terrorism an increasing threat to global health resulting in a 118% increase in related deaths between 2007 and 2017.

An editorial accompanying the study, also published in The Lancet, hoped the findings would shock national governments into action.

“GBD 2017 is disturbing. Not only do the amalgamated global figures show a worrying slowdown in progress but the more granular data unearths exactly how patchy progress has been,” it said.

“GBD 2017 is a reminder that, without vigilance and constant effort, progress can easily be reversed,” it added.

It stated that the study was a reminder of the need to find innovative ways of tackling existing and new health challenges.

“GBD 2017 should be an electric shock, galvanising national governments and international agencies not only to redouble their efforts to avoid the imminent loss of hard-won gains but also to adopt a fresh approach to growing threats,” the editorial said.

Sustainable development goals index: UK scores

  • Disaster mortality – 100
  • Child stunting – 98
  • Child wasting – 99
  • Child overweight – 41
  • Maternal mortality ratio – 87
  • Skilled birth attendance – 100
  • Under-5 mortality – 87
  • Neonatal mortality – 80
  • HIV incidence – 54
  • Tuberculosis incidence – 80
  • Malaria incidence – 100
  • Hepatitis B incidence – 93
  • Neural tube defect prevalence – 100
  • Non-communicable disease mortality – 85
  • Suicide mortality – 61
  • Alcohol use – 30
  • Road injury mortality – 100
  • Family planning need met with modern contraception methods – 99
  • Adolescent birth rate – 66
  • Universal health coverage service coverage index – 95
  • Air pollution mortality – 84
  • WaSH (water, sanitation and hygiene) mortality – 92
  • Poisoning mortality – 86
  • Smoking prevalence – 46
  • Vaccine coverage – 94
  • Health worker density – 99
  • Intimate partner violence – 91
  • Non-intimate partner sexual violence – 68
  • Water – 100
  • Sanitation – 100
  • Hygiene – 100
  • Household air pollution – 100
  • Occupational risk burden – 60
  • Mean particular matter 2.5 – 80
  • Homicide – 100
  • Conflict mortality – 100
  • Physical violence – 79
  • Sexual violence – 86
  • Child sex abuse – 52
  • Well-certified death registration – 98
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