Public Health Around the Globe: Inside England’s National Health Service
What can the United States, and Oregon in particular, learn from a health system that has delivered universal coverage for more than 75 years?
In the latest installment of our Public Health Around the Globe series, HSMP 574/674 students Areli Delgado Sepulveda, Craig Davis, and Ykanel Escamilla-Cheng take a deep look at England’s National Health Service (NHS) and the country’s public health infrastructure. Their student‑created newsletter examines how England organizes, funds, and governs healthcare and public health, and what lessons may be most relevant for U.S. and Oregon policymakers as conversations about universal coverage continue closer to home.
A Brief History of a Universal System: NHS
Established in 1948 in the wake of World War II, the NHS was built on a simple but radical idea: healthcare should be free at the point of use, funded through taxation, and available to every resident regardless of income. Today, the NHS serves more than 56 million people and remains one of the largest and most comprehensive single‑payer health systems in the world.
How The Healthcare System and Public Health Work Together
One of the defining features of England’s system is the close alignment between healthcare delivery and public health. The newsletter outlines England’s layered public health structure, which combines national coordination, through bodies like the UK Health Security Agency and the Office for Health Disparities and Improvement, with locally delivered services led by Directors of Public Health embedded in local councils.
Students also highlight Integrated Care Systems (ICSs), regional partnerships designed to improve population health, not just provide medical care. This is done by coordinating hospitals, primary care, public health, and local government. This model stands in sharp contrast to the fragmented governance and funding of public health in the U.S.
Equity and Efficiency: Strengths and Tensions
Using equity and efficiency as evaluation criteria, the newsletter takes an honest look at both the strengths and shortcomings of the NHS:
- Equity: Universal coverage eliminates financial barriers to care, but England still experiences stark health disparities by geography, income, and race/ethnicity. The students emphasize that healthcare access alone cannot overcome inequities rooted in housing, employment, education, and other social determinants of health.
- Efficiency: Administrative costs in the NHS are dramatically lower than in the U.S., illustrating the efficiencies of a single‑payer system. However, workforce shortages and long wait times for elective care underscore the risks of underinvestment and staffing constraints, even in a universal system.
Lessons for the United States and Oregon
The final section of the newsletter connects England’s experience to current U.S. and Oregon policy debates. Students explore what universal coverage can realistically achieve, how a strong primary care foundation can improve outcomes and control costs, and why closer integration of public health and healthcare matters. They also caution against oversimplification, noting that England’s challenges with wait times, workforce capacity, and prevention funding offer important warnings as Oregon explores proposals like Senate Bill 1089.
Download the full student PDF newsletter and explore England’s health system through a global public health lens.