Are we getting what we pay for?

The British NHS delivers health care free at the point of access to whomever needs it. It is often claimed to be the envy of the world. But does it deliver health? Or could the resource put into the health service be better spent elsewhere? In this article, we discuss the determinants of health in the United Kingdom in the past, the rise of public health and the impact medical technology has had on health. We discuss resource distribution in health care, and apply the principles of health economics to the wider context of the delivery of health, rather than health care. With a background of rising demand for health care and rationing of resources in the UK, combined with inequalities in life expectancy related to position in society, we conclude that wealth redistribution, environmental regulation, improved nutrition and better education must come first in the priorities for achieving a healthy population. (c) 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights