Chronic Obstructive Pulmonary Disease is a progressive lung disease characterized by long-term respiratory symptoms such as cough and difficulty breathing (Landis et al., 2018). COPD is a fairly common disease, with approximately 1.2 million people diagnosed in the UK (Stone et al., 2022). Furthermore, Sarkar et al. (2019) state that “COPD prevalence will increase from 1 79% to 2 19% in England and 2 03% to 2 20% in Scotland from 2011–30, with a projected total health cost of £2 53 billion by 2030” (p. e478). Even though this disease is incurable, its occurrence can be prevented if the causes are known. Therefore, this essay will analyse the social determinants and inequalities associated with Chronic Obstructive Pulmonary Disease in the UK.
Social Determinants
Social and economic circumstances can significantly impact the patient’s condition. All chronic diseases are the quintessence of social and economic factors that lead to inequalities in overall health among different population groups. These factors are driven by income, segregation, disease susceptibility, location, medical care, and more. However, the condition of people depends not only on their purchasing power, but on their attitude to their own health, lifestyle and habitat.
Accordingly, there are significant differences in the issue of health determinants. Marmot et al. (2020) found that life expectancy, especially in poor areas, is declining yearly due to social determinants. For example, the Black Report found that, due to economic inequality, the mortality rate among patients from the lowest working class is almost widowed higher than among rich people (Department of Health and Social Care, 1980). Consequently, social determinants are one of the key factors determining people’s health in the UK.
Causes
A person’s socioeconomic status most often determines social determinants of health. Turner-Musa et al. (2020) note that the most common causes of poor health in the population include access to health care, housing and living conditions, and low income. The inability to receive the necessary medical care on time leads to deterioration in the patient’s health being detected too late when the disease has passed into the chronic stage. In addition, even after being diagnosed with COPD, people cannot always adhere to the doctor’s recommendations and often cannot afford treatment.
However, the main reason for developing Chronic Obstructive Pulmonary Disease is the patient’s living conditions. First, housing with high humidity and dust levels is unsafe (Sarkar et al. 2019). In addition, smoking is often cited as one of the main causes of COPD. Children who grow up in families with smoking parents are more likely to suffer from lung diseases than their peers.. Secondly, air pollution has a significant impact on the development of COPD (Doiron et al., 2019).
People, who live in industrial areas or areas with high levels of air pollution experience, have lung diseases much more often. Moreover, poor neighbourhoods are most often characterized by “a lack of healthy food options, recreational facilities, safety, and lightning” (Turner-Musa et al., 2020, p. 170). Such living conditions adversely affect the health of residents and contribute to the spread of disease throughout the area.
Employment and working conditions are other important social determinants of COPD. First, unemployment causes a lack of a stable income and, as a result, a lack of proper healthcare. In addition, patients with already diagnosed Chronic Obstructive Pulmonary Disease often cannot pay for treatment. Iheanacho et al. (2020) note that the economic aspect of COPD treatment is one of the patients’ most common problems.
Second, a person’s work environment impacts their susceptibility to Chronic Obstructive Pulmonary Disease (Health and Safety Executive, 2022). People who work with chemicals, dust, and fumes are more likely to experience COPD. Yang, Jenkins, and Salvi (2022) claim that “major occupational groups at risk include people working in farming, agriculture, industrial manufacturing and processing, and mining” (p. 505). Moreover, De Matteis et al. (2019) found that sports occupants have a greater risk of developing COPD. This statistic especially concerns people involved in sports from an early age.
Finally, the last factor that significantly affects people’s health is the models of social behaviour common in society. It primarily implies discrimination and oppression based on race, age, gender, and orientation. Turner-Musa et al. (2020) argue that European countries, including the UK, “have a history of racial bias in medical treatment and research, which in some instances, has led to mistrust of the medical system” (p. 171). Thus, the long-term existence of discrimination in medical care has formed distrust in the medical system as a whole among the oppressed groups of society.
Impact
Social determinants significantly impact people’s health, particularly the emergence of chronic obstructive pulmonary disease in the UK. Members of distinct population groups are often found to be chronically ill due to the nature of access to health care. Moreover, people from the lower working class are twice as likely to have health problems (Department of Health and Social Care, 1980). First, their health is affected by polluted air. Statistically, “air pollution contributes to about 50% of the risk of COPD” (Yang, Jenkins, and Salvi, 2022, p.501). Secondly, most often this category of the population is forced to work in hard jobs, which increases the risk of COPD even by never-smokers by 15% (Matteis et al., 2019).
In addition to the appearance of COPD, social determinants often cause complications and death among patients. Complications of Chronic Obstructive Pulmonary Disease can range from minor symptoms, like runny nose, cough, fatigue, and fever, to more severe “symptoms of dyspnoea, sputum purulence, and sputum volume” (Ritchie and Wedzicha, 2020, p. 422). Although according to MacLeod et al. (2021) in 51.4% of cases COPD resolves without serious complications, such a risk is always possible, especially for patients who cannot afford permanent treatment. As a result, 20-40% of patients with COPD have chronic cough and sputum, which, if left untreated, can cause serious complications (MacLeod et al., 2021).
Drivers of Social Determinants
Access to primary care is one of the fundamental human rights. However, many citizens of the UK often cannot afford to seek qualified help. Drivers of social determinants of COPD in the UK are unemployment, low income, lack of social protection, and increasing social inequality. People who do not have enough money to ensure regular access to quality health care are much more likely to experience serious chronic diseases (Westwood et al., 2020). Moreover, existing financial support programs for patients may often be ineffective and may not meet the needs of all vulnerable patients.
Even though people of colour are much less likely to experience discrimination and oppression in the modern world, the real situation is much worse. Turner-Musa et al. (2020) note that members of racial and ethnic minorities “are less likely to have access to hospitals and pharmacies” and have to “wait for days to get urgent care and prescriptions” (p. 170). As a consequence, they experience a worsening condition, the improvement of which often requires expensive treatment.
Inequalities
Inequality related to racial, social, and financial discrimination is a key driver of social determinants of health in the UK. According to Maddock et al. (2022), “ethnic minorities compared with white groups had increased odds of any healthcare disruption” (p. 6). Most of these violations are related to the fact that people of colour cannot receive the necessary medical care in time due to societal racial biases. Accordingly, approximately 1,500 ethnically people of colour in London suffer from the disease without receiving the necessary care (Maddock et al., 2022). In addition, even in case of emergency assistance, members of racial minorities are forced to wait for medical assistance.
Another manifestation of inequality and unfair treatment in health care is age-related discrimination. Maddock et al. (2022) note that in the UK, there is a significantly higher incidence of non-compliance with healthcare standards in older than in younger people. This leads to the fact that about a quarter of elderly patients do not receive the amount of care that their condition requires (Maddock et al., 2022). Furthermore, there is a significant class disparity in the modern healthcare system of the UK. Members of the low working class often cannot afford medical services and have limited “access to medications” (Maddock et al., 2022, p. 8).
These restrictions are often associated with income inequality and the lack of additional financial support for medical services. In particular, this applies to low-skilled migrants who cannot afford health insurance services, which leads to the number of 6,000 people in need of health care services (Maddock et al., 2022). Consequently, inequality becomes the main reason for the development and deterioration of the conditions of patients with Chronic Obstructive Pulmonary Disease.
Possible Changes
One of the most important changes is eliminating discrimination in society. All people should receive quality health care regardless of race, ethnicity, social and economic status, age, or sexual orientation. Even though any social discrimination is prohibited by law, certain categories of the population continue to be oppressed. Therefore, Smith et al. (2021) emphasize the need to “better communicate patterns and causes of health inequalities, or even evidence to support particular responses” (p. 114458). In this way, it will be possible to prevent unequal treatment of patients in the healthcare sector effectively.
At the local level, it is important to create communities to help people with Chronic Obstructive Pulmonary Disease. The organization of such a community in each region will allow people to quickly and immediately receive help. Such communities can help directly to the patients and carry out information activities, raising general awareness about COPD and increasing self-management capabilities for patients (Jolly et al., 2018).
Moreover, communities must interact with doctors who can provide expert opinions on public health issues. According to McKee et al. (2021), there is a strong need for “an increased focus on prevention and health promotion that takes a multisectoral approach to the social, political, and commercial causes of poor health” (p. 1988). However, most changes must be made at the governmental level to have a nationwide effect. At the national level, it is possible to fund the health care system for lung disease more than is currently the case. The main stakeholders should be the state and patients. This may lead to higher insurance payments, but it will improve health outcomes and the amount of drugs needed.
Government Actions
To date, the UK government is trying to eliminate inequalities in the healthcare sector. First of all, the authorities actively encourage patients to testify about all cases of unequal treatment in order to act on the problem locally. Mwoka et al. (2021) note that “the core housing policy issue in the UK is affordability” (p. 20). Therefore, the authorities are trying to make housing more affordable by controlling purchase and rental prices. As a result, in recent years the number of people with unsuitable housing has decreased in the country. However, more and more people are smoking, despite the imposition of taxes and higher prices for tobacco products. Perhaps the state should change its smoking policy and introduce more bans.
In addition, to equalize income inequality, developing and implementing more social and financial assistance programs for people from vulnerable groups is necessary. The economic aspect is one of the most common causes of complications and mortality among patients with COPD (Iheanacho et al., 2020). For example, people whose health may be adversely affected by working conditions receive special compensation in case of injury at work. Another important step is tobacco control campaigns, as smoking is one of the most common causes of COPD (Marteau, Rutter, and Marmot, 2021).
Moreover, programs are being developed and implemented to raise the level of public health. Sufficient public awareness can guarantee that people will seek medical attention for the first symptoms of respiratory diseases (Marteau, Rutter, and Marmot, 2021). Furthermore, this approach will help prevent complications due to proper self-management in patients diagnosed with COPD (MacLeod et al., 2021). However, this change will only be effective if the system for providing medical services to vulnerable categories is improved.
Conclusion
Thus, Chronic Obstructive Pulmonary Disease is a common disease that, in addition to medical factors such as genetics, may be due to social determinants. Among the main social determinants of COPD are access to healthcare, living conditions, low income, and patients’ personal beliefs associated with distrust in the healthcare system. However, the main reason that causes the appearance of COPD and its exacerbation in patients can be considered social and economic inequality and unfair treatment. As a result, the incidence of Chronic Obstructive Pulmonary Disease is rising among vulnerable and discriminated populations.
Reference List
De Matteis, S. et al. (2019) ‘The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort‘, European Respiratory Journal, 54(1), 1900186. Web.
Department of Health and Social Care (1980) Black Report. Web.
Doiron, D. et al. (2019) ‘Air pollution, lung function and COPD: results from the population-based UK Biobank study‘, European Respiratory Journal, 54(1), pp. 1-12. Web.
Health and Safety Executive (2022) Work-related Chronic Obstructive Pulmonary Disease (COPD) statistics in Great Britain. Web.
Iheanacho, I. et al. (2020) ‘Economic burden of chronic obstructive pulmonary disease (COPD): a systematic literature review‘, International journal of chronic obstructive pulmonary disease, 15, pp. 439-460. Web.
Jolly, K. et al. (2018) ‘Systematic review of the effectiveness of community-based self-management interventions among primary care COPD patients‘, NPJ primary care respiratory medicine, 28(1), pp.1-8. Web.
Landis, S. et al. (2018) ‘Demographic and clinical characteristics of COPD patients at different blood eosinophil levels in the UK clinical practice research datalink‘, COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(2), pp. 177-184. Web.
MacLeod, M. et al. (2021) ‘Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis, treatment, prevention and disease impact‘, Respirology, 26(6), pp. 532-551. Web.
Maddock, J. et al. (2022) ‘Inequalities in healthcare disruptions during the Covid-19 pandemic: Evidence from 12 UK population-based longitudinal studies‘, BMJ open, 12(10), pp.1-13. Web.
Marteau, T.M., Rutter, H. and Marmot, M. (2021) ‘Changing behaviour: an essential component of tackling health inequalities‘, Bmj, 372(332), pp. 1-4. Web.
Marmot M. et al. (2020) Health equity in England: The Marmot Review 10 years on. London: Institute of Health Equity.
McKee, M. et al. (2021) ‘The changing health needs of the UK population’, The Lancet, 397(10288), pp. 1979-1991. Web.
Mwoka, M. et al. (2021) ‘Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission‘, Journal of Urban Health, 98(1), pp.15-30. Web.
Ritchie, A.I. and Wedzicha, J.A., (2020) ‘Definition, causes, pathogenesis, and consequences of chronic obstructive pulmonary disease exacerbations‘, Clinics in chest medicine, 41(3), pp.421-438. Web.
Sarkar, C. et al. (2019) ‘Environmental correlates of chronic obstructive pulmonary disease in 96 779 participants from the UK Biobank: a cross-sectional, observational study‘, The Lancet Planetary Health, 3(11), pp. e478-e490. Web.
Smith, K.E. et al. (2021) ‘Public understandings of potential policy responses to health inequalities: Evidence from a UK national survey and citizens’ juries in three UK cities‘, Social Science & Medicine, 291, p.114458. Web.
Stone P. W. et al. (2022) ‘Comparison of COPD primary care in England, Scotland, Wales, and Northern Ireland‘, NPJ primary care respiratory medicine, 32(1), pp. 1-7. Web.
Turner-Musa, J. et al. (2020) ‘Examining social determinants of health, stigma, and COVID-19 disparities. ‘ Healthcare, 8(2), pp.168-174. Web.
Westwood, S. et al. (2020) ‘Older LGBT+ health inequalities in the UK: Setting a research agenda‘, J Epidemiol Community Health, 74(5), pp.408-411. Web.
Yang, I.A., Jenkins, C.R. and Salvi, S.S. (2022) ‘Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment’, The Lancet Respiratory Medicine, 10(5), pp. 497-511. Web.