The UK National Health Service must be protected from international trade agreements, which pose “a great threat” to universal systems of health care, Members of Parliament have been warned.

The NHS is a model of an equitable healthcare system but it is coming under constant pressure to be brought into line with the free trade agreements (FTAs) being promoted by the World Trade Organisation (WTO) and within the European Union, according to Margaret Whitehead, professor of public health at the University of Liverpool. However, experience worldwide illustrates clearly that equity within healthcare cannot be achieved in a commercial market, and public health services should not be defined as a commodity on a commercial market, so it is therefore crucial to exclude publicly-financed health services from FTAs, Prof Whitehead told the House of Commons Health Select Committee’s inquiry into health inequalities last week.

Specifically, the Committee is looking at the extent to which the NHS can contribute to reducing health inequalities, given that many causes of these problems relate to other policy areas such as employment, housing and education. Prof Whitehead stressed that one of the “potentially pivotal” contributions which the NHS can make is through maintaining the commitment to a universal health service, covering the entire population, as a matter of basic human rights. There is a major role for national government and the NHS at all levels to preserve, in the face of many reforms, the system’s essential components and to “guard against erosion by countervailing forces,” she told the panel.

Moreover, she said, to avoid the “medical poverty trap” - patients being pushed into debt by their out-of-pocket healthcare expenses - the burden of payment for essential health services and drugs must be constantly analysed. This is a problem particularly in the developing world, the USA and Eastern Europe, while in the UK vigilance is required, in scrutinising any proposed reforms for their potential impact on the NHS founding principle of services being free at the point of use, she said.

Health inequalities and other social problems are no less common in the richest developed countries, such as the UK and USA, than in those which are less affluent, but there is a very strong tendency for these problems to be worse in more unequal societies, said Richard Wilkinson, professor of social epidemiology at the University of Nottingham. “It is widely known that the UK has appallingly high rates of obesity, teenage pregnancies and prison populations, and that it does not perform well compared to other rich countries on measures of health,” he told the MPs. The USA is almost the only other developed country which does consistently worse, while Japan and the Nordic countries do very much better.

Gaps getting wider
Despite record-breaking levels of wealth and health, inequalities are persisting in the UK and the evidence suggests that the gaps are getting wider, said Hilary Graham, professor of health sciences at the University of York. The NHS’ role in influencing health and reducing in equalities is secondary, she suggested; services which screen and treat those at risk of early death are important but, on their own, they cannot change the social conditions which generate risk in current and future generations.

While the Department of Health emphasises the responsibility of local NHS services for delivering health inequalities targets, there is in fact a strong argument for shifting this responsibility to government departments with the capacity to reduce inequalities in living conditions, Prof Graham suggested.