Critically analyses the ability of the NHS to impact on health inequalities



Critically analyses the ability of the NHS to impact on health inequalities

This paper critically analyse the ability of the NHS to impact on health inequalities. After witnessing the reception of this week's Comprehensive Spending Review? the UK's Labour government has every reason to feel confident about its strategy for a fairer division of national resources. The Chancellor of the Exchequer? Gordon Brown? presented a remarkable reinvestment plan for Britain's public services. Health? as he announced earlier this year?1 is a major beneficiary of this new money. But beneath the gloss burnishing his proposals? details of how progress in public health will be made are worryingly absent.

Take one example—in 1997? a new Labour government? turning afresh to an issue that had been largely ignored since it was last in power two decades previously? launched a serious initiative to tackle worsening inequalities in health. One of its early acts was to commission Prof Donald Acheson? a former Chief Medical Officer? to conduct an independent inquiry into inequalities in health. His final report was published in 1998. It is fair to ask? 4 years on? what the Labour government has achieved. Acheson concluded that despite advances in medicine? little had been done to close the gaps in health status between rich and poor. He observed that inequalities existed from birth to death? and that these variances were to be found irrespective of social indicator (eg? income or ethnicity). He recommended that all government policies having an influence on health should be evaluated for their impact on health inequalities. He placed particular emphasis on families with children? reducing income inequalities? and on improving living standards for the poor. He saw that the greatest gains could be achieved by focusing on common health problems? such as heart disease and cancer.

Nobody could accuse the government of inactivity in response to this report.? Labour has created neighbourhood renewal programmes? a children and young people's unit? the child tax credit? employment zones? a fuel poverty strategy? health action zones? health improvement programmes? healthy living centres? a healthy schools programme? the national minimum wage? a national school fruit-scheme? NHS Direct? primary care trusts? Sure Start? the social exclusion unit? and the working family tax credit—all of which include health inequalities as part of their remit. New national targets have been set—namely? by 2010 to reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at birth. By the end of 2001? the government had created an impressive multisectoral response to poverty? social exclusion? and inequality? all directed towards long-term targets. Has the government delivered? Only partly so. The government's own recent consultation exercise? the results of which were published quietly last month?6 has exposed wide cracks in its raft of policies. The consensus view is that the government is relying too heavily on the NHS to deliver its targets. It must look still further at the wider determinants of health ...