These findings may represent the difficulty of delivering the full set of services in a constrained setting with fewer providers and beds: the quality of the service may be beginning to suffer. Given current debates in the UK about migration, we also included descriptive statistics on the percentage of migrants represented in the healthcare workforce and in the general population. colorectal cancer), osteoarthritis, liver disease, sleep apnea, depression, and other medical conditions that affect mortality and morbidity. More detailed information on SHA and differences between two accounting methods can be found in online technical appendix. Ethical approval: Not needed, as the study relied solely on secondary, aggregated data and involved no human participants. There was no patient or public involvement in this research. Transparency: The lead author (the manuscript’s guarantor) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. 1 Movement toward securing the right to health care has been incremental. 2018. For example, to highlight the differences in total healthcare expenditure in the UK between the OECD’s System of Health Accounts (SHA) classification of healthcare spending and the previous accounting methods used, we used health spending data from the Office for National Statistics. To ensure the validity of the data presented, we selected indicators from sources that have well established processes for validating national data with country representatives. This analysis extends a body of work that has examined recent funding cuts in the NHS and their effect on performance. AG contributed to data collection, table and figure creation, and drafting of the manuscript. Hazell B, Robson R. Pharmaceutical waste reduction in the NHS. Pay for nurses in the UK, however, was lower than the average across countries in both nominal and relative terms. If data from either 2017 or 2010 were not available, we used the nearest available year (for example, data from 2016 instead of 2017). Structural capacity in UK and comparator countries, 2017 and change from 2010. An increasing number of cities and countries have begun taxing sugary beverages. Obesity is a common, serious, and costly disease. The numbers of general practitioners and specialists in the UK were similar to those in all other countries. Owing to recent increases in mortality in the UK in 2014-15, this gap once again increased, although it seems to be closing again as life expectancy improved in 2016 and 2017. However, health service outcomes and measures of population health status are among the lowest in the group and have worsened over the past decade. The BMI is a measure of your weight relative to your height. Social spending in the UK as a percentage of GDP was 19.6%, which was similar to the study average of 20.1% but above the OECD average (16.9%) and the EU average (18.8%). 2017. The OECD reports per capita spending for the UK to be $3943, which also reflects components of social care that are included in expenditures for other countries (supplementary figure A). IP is the guarantor. As the migration of healthcare professionals has decreased since 2015, as evidenced by an 87% drop in new nurses coming from the EU to work in the UK from 2016-17 to 2017-18,16 the existing staffing challenges facing the NHS will clearly be further exacerbated. 2016. An analysis published in JAMA breaks down the factors behind the high cost. Although numbers of nurses from outside the EU are increasing, this is not at a rate that compensates for the significant decreases in nurses coming from EU member nations. With regards to access to care, we found that the UK had average waiting times for specialist and primary care. Symposium: Obesity in developing countries: biological and ecological factors", "Effects of adiposity and metabolic dysfunction on cognition: a review", "Gut microbiota and its possible relationship with obesity", "Antibiotics: repeated treatments before the age of two could be a factor in obesity", "Meta-analysis of short sleep duration and obesity in children and adults", "Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies", "Obesity and short sleep: unlikely bedfellows? Detailed descriptions of all variables and what they capture is included in the supplementary technical appendix. Other national surveys of the UK population, such as the British Attitudes Survey, show a growing consensus among the general population that the NHS faces a major or severe funding problem (86% of respondents in 2017, up from 14% in 2014).13 General practitioners’ views of the health system were not as favourable as in comparator countries, with only 22% of primary care physicians reporting that they thought the healthcare system worked well (compared with the study average of 33%). Cancer survival rates were the lowest of the comparator countries for breast and colon cancer, with cervical and rectal cancer survival being the second lowest. When compared with the 35 member states of the OECD and the 28 member states of the EU, UK healthcare spending was about average. 554: 109th U.S. Congress (2005–2006) H.R. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. In recent years in the UK, this spending has declined and been replaced by funding from private sources (−4% over the period 2010-17). The UK performed slightly better than the study average for measures of patient safety, including postoperative pulmonary embolism after hip or knee replacement (UK, 316; study average, 330; OECD, 286; EU, 246/100 000 discharges), postoperative deep venous thrombosis (UK, 202; study average, 489; OECD, 347; EU, 351/100 00 discharges), and the prevalence of healthcare associated infections (UK, 5.2%; study average, 6.6%). The number of practising physicians in the UK was below the study average in 2017 (UK, 2.8; study average, 3.5 doctors/1000 population), and also lower than both the OECD and EU averages (OECD, 3.4; EU, 3.5 doctors/1000 population) (table 3). In some cases, differences between countries and over time were small and may have been influenced by the comparability of patients and supply-side factors across countries and over time. As countries organise their benefit packages for health and long term care differently, with some countries drawing different boundaries between what is and is not funded from the healthcare budget, we used data from the OECD’s SHA classification as a basis for comparison. Quality of care in UK and comparator countries, 2017 and change from 2010. The rate of influenza immunisation among the population over age 65 was higher in the UK than in all comparator groups (UK, 72.6%; study average, 54.1%; OECD 43.2%; EU 37.2%) with the exception of Australia (74.6%). Design Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries. The UK had the lowest survival rates for breast cancer (UK, 85.6%; study average, 87.4%) and colon cancer (UK, 60%; study average, 64.8%), and the second lowest for rectal cancer (UK, 62.5%; study average, 66.6%) and cervical cancer (UK, 63.8%; study average 66.6%). Compared with the wider OECD and EU averages, they were average at best. We found that both in absolute magnitude and as a proportion of the population, migrants in the UK make up less of the population than the average of comparator countries. We gathered perceptions of health systems, staff satisfaction, unmet need, time spent with general practitioner, patient-general practitioner experiences, care continuity, and waiting time indicators from various Commonwealth Fund international surveys, including the Surveys of Primary Care Physicians, the Health Policy Surveys of Older Adults, and the International Health Policy Surveys. A number of reviews have found that mortality risk is lowest at a BMI of 20–25 kg/m 2 in non-smokers and at 24–27 kg/m 2 in current smokers, with risk increasing along with changes in either direction. The prevalence of obesity was 42.4% in 2017~2018. Finally, our main comparison is with nine other countries, all of which spend more on healthcare than the UK does. Moreover, physicians in the UK were less likely to report being dissatisfied with their incomes than were those in many comparator countries. In particular, our study suggests that the NHS should look towards improving staffing ratios, long term care provision, and social spending, which are lower than comparator countries and have been declining in recent years. In the past 3 decades, the prevalence of childhood obesity has more than doubled in children and tripled in adolescents. In each domain, we selected measures that were available across most of the countries in the analysis. Top countries by type 1 diabetic children number 2019 Estimated number of elderly adults with diabetes in China 2017-2045 Expenditure worldwide on diabetes by market 2013-2018 Data for the UK represent the NHS and not the privately financed healthcare sector. Twenty four per cent reported waiting six days or more for an appointment, compared with an average of 20% across the countries. In each table, we present the average of each indicator across all 10 countries including the UK, along with the averages of OECD and European Union member countries. The UK had similar rates of infant mortality to other countries (UK, 3.9; study average, 3.8; OECD, 3.7; EU, 3.2 deaths/1000 live births), and they are decreasing at a similar rate to the average (UK, −0.3 deaths; study average, −0.2 deaths). This is higher than the increase across the OECD (an increase of 1%) and the EU member states (a decrease of 1%). The Health Foundation. The proportion of healthcare expenditures in the UK coming from public sources (general taxation and national insurance contributions, referred to as government/compulsory spending by the OECD) is close to the average of the comparator countries (UK, 79%; study average, 80%), but slightly higher than the averages of OECD and EU member states (OECD, 74%; EU, 75%). Relative risk of death over 10 years in white people who have never smoked in the United States by BMI. Mortality rates for acute myocardial infarction and ischaemic stroke were the second highest and highest respectively. Maternal mortality in the UK was 7.8 deaths/100 000 live births, which was greater than the mean of the comparators (5.5 deaths/100 000 births) and above the OECD and EU averages (7.0 and 6.4 deaths/100 000 births, respectively); this represents an increase from 2010 values by 0.8 deaths (table 7). 2019. The UK NHS is not the only health system facing the challenge of having to meet growing demand from patients while under pressure to reduce healthcare costs.6 However, few studies have looked abroad to understand whether other healthcare systems can provide lessons for the NHS.47 Where comparisons exist, they often focus on specific aspects of the system, such as spending, cancer care, or quality, and show a mixed picture of relative performance. Additionally, the UK was the only country to experience a decrease in the number of nurses from 2010 to 2017 (UK, −0.6; study average, 0.4; OECD, 0.9; EU, 0.5 nurses/1000 population). Finally, the UK seems to have much higher rates of informal care than the comparator countries, with high proportions of the workforce reporting that they are out of work or in part time employment because they are providing care.14 In 2017 long term care made up the second largest category of private household spending in the UK, accounting for 36% of out of pocket spending, after spending on medical goods which accounted for 38%.15 In both healthcare and areas of social spending, expenditures coming from the public purse are declining and greater amounts are coming from private sources. Life expectancy in the UK has been below the average over the past 20 years, although the gap narrowed over the period 2008-13 to a low of 0.3 years (fig 2). The proportion of foreign trained doctors as a percentage of total doctors in the UK in 2017 was greater than the mean of comparators and higher than the OECD and EU average (UK, 28.6%; study average, 21.4%; OECD, 18.2%; EU, 12.4%) (table 3). We examined the UK and nine comparator high income countries. In recent years, policy makers in the UK have advocated for more efficiency gains in the healthcare system or, in other terms, the transformation of existing healthcare expenditures into the same amount of, or more, health system outcomes. The numbers of beds in the UK are at the lower end of the distribution of comparator countries and well below the average of the OECD and the EU. 8 million participants", "Meralgia paresthetica: diagnosis and management strategies", "Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis", "Body size and risk of MS in two cohorts of US women", "Obesity and cancer risk: recent review and evidence", "Overweight and health problems of the lower extremities: osteoarthritis, pain and disability", "Erectile dysfunction and central obesity: an Italian perspective", "A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women", "Obesity and risk for chronic renal failure", "Body mass index and mortality in heart failure: a meta-analysis", "Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis", "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", "Poverty and obesity: the role of energy density and energy costs", "Halting the obesity epidemic: a public health policy approach", "The fundamental drivers of the obesity epidemic", "Putative contributors to the secular increase in obesity: exploring the roads less traveled", "Obesity Pathogenesis: An Endocrine Society Scientific Statement", "EarthTrends: Nutrition: Calorie supply per capita", "Can We Selectively Reduce Appetite for Energy-Dense Foods? However, UK social spending had been declining at a faster rate than all three groups over the previous five years. Thirty day mortality for acute myocardial infarction in the UK was among the highest relative to comparator countries (7.1%; study average, 5.5%), after Germany (7.7%), although it was comparable to the average OECD and EU rates (7.6% and 7.1%, respectively). Epidemiology – definition and classification of obesity In: This page was last edited on 30 January 2021, at 20:13. More than two-thirds of Americans are overweight, including at least one in five children. Data came from a range of databases compiled by international organisations, with most coming from the OECD. Given the greater population size of England, the UK performance metrics reported in this study are dominated by the performance of the English NHS. Fortunately, new national data have become available over the past few years that allow for a careful comparison not just of spending but also of broader health system performance including access, quality, and outcomes. All countries with the exception of the US were similar in terms of having nearly 100% of the population with healthcare coverage (table 1). Richards M, Thorlby R, Fisher R, Turton C. Unfinished business: An assessment of the national approach to improving cancer services in England 1995-2015. [Read CDC National Center for Health Statistics (NCHS) data brief]From 1999–2000 through 2017–2018, the prevalence of obesity increased from 30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%. The BMI range 22.5 to 24.9 is set as the reference. Bottom: Annual inflow of foreign trained doctors into UK. Measuring body composition in adults and children In: Kopelman P., Caterson I. The number of beds in the UK decreased at a rate similar to the averages. All data are presented as foreign trained workforce from European Union (EU) nations, non-EU nations, and total. 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The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per … 5 Causes of Obesity in America. Expressed as a proportion of gross domestic product (GDP), the picture was similar, with the UK spending approximately 8.7% of GDP compared with the study average of 11.5% of GDP in 2017 (fig 1). For example, private insurance in the UK largely reflects duplicative private insurance policies that allow people to access private healthcare in addition to the NHS. We examined 79 health systems metrics in the UK and nine comparable countries and found that the UK had lower spending and slower growth in expenditure than comparators. The United States is at the extreme end among other industrialized countries, with the largest gap between the rich and the rest of the population and by far the worst infant mortality rate, at 5.7 per 1,000 live births, compared to just 1.6 per 1,000 in Iceland. Burundi ranked first for electrical outages > days amongst Catholic countries in 2006. Is This the Beginning of Narcolepsy in a Five Year Old? Obesity is now epidemic in America. Although the UK had fewer avoidable admissions to hospitals for diabetes among the adult population (UK, 73; study average, 122; OECD, 138; EU, 135/100 000 population), it had more avoidable admissions for chronic obstructive pulmonary disease (UK, 232; study average, 204; OECD, 194; EU, 194/100 000 population). The numbers of preventable and treatable deaths in the population were the third highest and highest respectively. The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). In the U.S., for example, 58% of actively religious people are also involved in at least one nonreligious voluntary organization, compared with just 51% of the inactively religious and 39% of the unaffiliated. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. EM provided critical guidance on the project to make it as relevant to a UK audience as possible and contributed to the drafting of manuscript. In this study, based on aggregated data from recent years, the UK was consistently the country that spent the least on healthcare per capita compared with nine other high performing health systems. The UK reported among the lowest rate of adults with multiple chronic conditions (UK, 14%; study average, 18%). The role of migrants in the NHS has been a considerable focus in recent years, with regards to increasing demand pressures on the NHS from migrants as healthcare users, but also in terms of their role as providers of care. Additionally, the stock of foreign trained nurses has declined; more than 3000 EU nurses left the NHS in 2017 (supplementary figure B, right). This work suggests that although the NHS has done a remarkable job in managing the constrained funding environment, the broader challenges are such that if the UK wants an NHS that remains high performing and a nation with good health outcomes, it will almost certainly need to spend more on healthcare staffing, long term care, and other social services, which lag behind comparators. This is largely explained by the different function of private insurance coverage across the countries. Despite already low levels of labour, the UK is making do with fewer doctors and nurses, a challenge that is likely to be exacerbated in the context of Brexit. An overview of obesity management In: Puhl R., Henderson K., and Brownell K. Social consequences of obesity In: Seidell JC. Across the OECD and the EU, the numbers of medical graduates were slightly higher and had been increasing over the previous decade. However, to show the sensitivity of the interpretation to the selection of comparator countries, we also show the comparison of UK performance with the average performance of all OECD countries and all EU countries. This was also true for nurses, with foreign trained nurses representing 15% of the workforce in the UK in 2017 (study average, 9.3%; OECD, 6%; EU, 3.2%). Health service outcomes, as well as heath status, are suboptimal. The make-up of the UK population, in terms of size of total population and the percentage of the population over 65 years of age was similar to the study average (population in UK, 66.4 million; study average, 64.7 million; population over 65 in the UK, 18%; study average, 19%) (table 1). The focus of our analysis was on indicators from 2017, as well as the trends in data from 2010 when available and comparable. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. The average trend across the comparator countries has been the reverse, with a shift away from private funds to public funds shown by a mean of 4%. The numbers of nursing graduates in the UK were nearly half the number of nursing graduates in comparator countries (UK 29.4; study average 56/100 000 population) and lower than the OECD (44.3/100 000 population) and EU (37.4/100 000 population) averages. Rates of private health insurance coverage varied widely across countries. Policy makers should consider how recent changes to nursing bursaries, the weakened pound, and uncertainty about the status of immigrant workers in the light of the Brexit referendum result have influenced these numbers and how to respond to these challenges in the future. Life expectancy at birth in the UK was just below the average of the comparator countries (UK, 81.3 years; study average, 81.7 years) (fig 3). The future of the NHS: no longer the envy of the world? Unless migrants coming to the UK are somehow dramatically sicker than those going to other similar countries, they are unlikely to be putting disproportionately greater pressure on healthcare demand in the UK than elsewhere. Thirdly, our paper presents aggregate data for all of the UK, which does not take into account the large differences that exist in the NHS across the four constituent countries in the UK—namely, England, Scotland, Wales, and Northern Ireland. 2016. In line with previous international comparisons, the healthcare system included all groups of which the primary intent is to improve health.10. Contributors: IP led the design of the study, guided the data collection and creation of tables and figures, and drafted the manuscript. Main outcome measures 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. The percentage of the total population born outside of the country was slightly lower in the UK than in our comparator countries in 2017 (UK, 14.2%; study average, 17.1%), although it was quite close to the average OECD and EU member state (OECD average, 13.8%; EU average, 13.2%). Perhaps our relative assessment of the UK would be more favourable had a different set of countries been chosen, representing a group that spends a closer proportion of GDP on their healthcare systems to the UK, such as Portugal, Spain, and Italy. How does NHS spending compare with health spending internationally? UK waiting times were slightly longer for specialist care, with 19% reporting waiting two months or longer, compared with a group average of 12%, but fewer patients reported visiting the emergency department for a condition that could have been treated by a regular doctor (UK, 7%; study average, 9%). A smaller proportion of the UK population reported experiencing a problem with care coordination and a gap in hospital discharge planning than in all other study countries (UK, 19% and 28%, respectively; study averages, 27% and 39%, respectively) (table 6). However, rates were higher for postoperative sepsis after abdominal surgery (UK, 2454; study average, 2058; OECD, 1821; EU, 1949/100 000 discharges) (table 6). Ham C. Theresa May’s choice: give the NHS more money, or tell voters to expect worse care. However, the UK performed similarly to the average of the EU (161 and 93 deaths/100 000 population for preventable and treatable causes, respectively) (table 7). A 2019 analysis by the UConn Rudd Center for Food Policy and Obesity found that kids ages 2-11 saw twice as many ads for sugary drinks than for other beverages, and they also saw four times as many ads for certain drinks than adults did. Average length of hospital stay in the UK was 6.8 days, which was very close to the study average of 6.7 days and lower than the OECD average (7.3 days) and the EU average (7.4 days). In 1980, only two countries had a prevalence of obesity above 20%: South Africa (22.6%) and Iraq (28.8%). 2 Employer-sponsored health insurance was introduced during the 1920s. Unfortunately, comparative detailed data on the performance of the NHS across the four constituent countries of the UK (England, Scotland, Northern Ireland, and Wales), where the NHS is structured differently, are not available. Health insurance coverage varied widely across countries coverage across obesity in america compared to other countries 2019 OECD and the EU the. Groups of which the primary intent is to improve health.10 health spending internationally faster rate than all groups. Of databases compiled by international organisations, with most coming from the OECD is improve. 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