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'Variation of care in public health is hard to avoid, and must be properly addressed'

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Inequality is often the chosen topic of discussion in healthcare, the latest term under the microscope being ‘unwarranted variation’, taken to mean variants that serve no benefit to a patient’s care

Variation of care received is often seen as something to avoid. If we do not give equal standards of care to everyone, surely it’s a bad thing, yes?

Yet when looking at public health, variation in health and care is hard to avoid. Walk for ten minutes down the road anywhere in the country and health outcomes for those living in said area have likely seen a dramatic change, and often not for the better.

When looking at where money is spent in public health, it often targets the areas of greatest deprivation, yet the health outcomes are still poor. Why is this?

We’re sometimes told it is due to social determinants of health - things out of people’s control, such as whether they are in work, how they grew up, or what results they obtained in their GCSEs. All of this and more can be linked to a person’s health, yes. But someone’s health in their later years cannot purely be informed by their life as a child.

So how can those in public health strive to make things better?

One is to look at the source of inequality. Our economy is designed to create inequality. I don’t suppose those who conceived capitalism, at least in its current diluted form, thought they would do it just to ‘stick it’ to the poor. But the evidence is clear, the rich get richer, and the poor pretty much stay poor. If you want to make big changes in public health, rather than fight the fundamentals of your country’s economy, why not try and get to the root of the problem - and fix it?

A suggestion that comes up on occasion is the idea of a national wage. Not a minimum wage or the rebranded national living wage, but an amount that is paid to everyone irrespective of their condition, even if they’re not employed. Perhaps it sounds wacky, but it came up again recently with the suggestion that a vast number of jobs will be lost to technology in the future. It would also start to remunerate people that have and do work for free, such as parents or carers. But most importantly, it puts everyone on a level playing field.

It might not be my idea of a utopia, where everyone has what they need and there is no money, but it seems like a reasonable step and could start to address the biggest problem in public health: inequality.

Perhaps I’m setting us nurses up for failure, asking my peers to become economists and politicians as well as clinicians. But it’s worth a go. I don’t want to live in a world where me or anyone else ‘has’ whilst others go without.

Anthony Johnson is Student Affairs Editor, Nursing Times, studying adult nursing at KCL and is one of the founders of the #BursaryOrBust campaign

Twitter @Ant8Johnson8

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New Student Affairs Editor Alan believes that nurses need to become masters of their own profession and leaders in healthcare.

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