Policies towards reducing health inequalities

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 6

Abstract

The UK Government has announced proposals to put more GPs in post in under-doctored areas, and to introduce ?health trainers? in disadvantaged areas. The first proposal is intended to improve access to primary care services for people whose access is currently relatively poor, and the second proposal is intended to facilitate people in disadvantaged communities to make healthier choices regarding their lifestyle behaviours.

Neue Entwicklungen

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

Nothing over and above what I've written above.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung: The UK Government controls NHS policy, and is therefore clearly very influential and supportive with respect to these pilot projects.

• Wissenschaft: The public health community is likely to be in the main supportive, particularly with respect to the introduction of health trainers for disadvantaged areas (although there are those in the public health community who are never satisfied that the Government is ever doing enough in terms of health promotion/public health).

• Medien: Although health inequalities are sometimes raised in the media, I do not have the impression that they carry as much weight as, say, waiting lists/times in the public perception of the performance of the NHS, and I believe that a majority of the UK population are opposed to Government policy that attempts to interfere with lifestyles.

Stakeholder positions

Both proposals may, in principle, contribute to Government targets to reduce health inequalities between geographical areas and between social classes, which are:

1. By 2010, to reduce by at least 10% the gap in infant mortality between routine and manual groups and the population as a whole;
2. By 2010, to reduce by at least 10% the gap between the worst fifth of local authority areas in terms of at birth life expectancy and the population as a whole.

 Health inequalities, both in terms of health outcomes and in terms of access to health care, became an issue central to Government policy rhetoric and (indeed) action when the Labour Party was elected to Government in 1997. This is because the Labour Party is traditionally perceived as the Party that is most likely to improve the position of the disadvantaged; previous Conservative administrations had more or less ignored the evidence of widening health inequalities in the UK. The Labour Party, in appealing to its traditional 'grass roots' has therefore introduced a series of policy initiatives and targets to address health inequalities over the last eight years. I think probably the main stakeholder group that has moved the debate in this direction is that broadly defined as the 'public health community', some of whom are very influential at the public policy making level (this group comprises academics in, mainly, public health and sociology, practitioners and some policy makers - e.g. the Department of Public Health in the Department of Health).

Actors and positions

Regierung
Government	sehr unterstützend		stark dagegen
Wissenschaft
Public Health Community	sehr unterstützend		stark dagegen
Medien
Media	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

Not applicable.

Legislative outcome

Enactment

Actors and influence

Regierung
Government	sehr groß		kein
Wissenschaft
Public Health Community	sehr groß		kein
Medien
Media	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

Primary care trusts and GPs will clearly be involved in the pilot to introduce more GPs in under-doctored areas.

Monitoring and evaluation

Both policies (increasing the number of GPs in under doctored areas, and introducing health trainers for disadvantaged areas), are being introduced as pilots in the first instance. The former pilot is initially being introduced under the jurisdiction of six primary care trusts spread across England, which are expected to open a total of three new walk-in centres, two new GP practices, one nurse-led practice, and employ additional GPs, nurse practitioners and health care assistants. It is intended that some surgeries will also be open for longer hours, with some opening from 7am until 10pm, with the intention of improving access to GP services, and, specifically, by being concentrated in under-doctored areas, to narrow inequalities in access. It is also intended to extend the policy to 15 other areas in a 'second wave' of the policy. The primary care trusts involved in the first wave will offer invitations to tender in the Autumn of 2005, and it is very likely that the Department of Health will be monitoring the progress of this pilot in terms of its effect on access. The latter pilot (introducing health trainers) is initially being introduced in 12 areas. It is initially being introduced in the most disadvantaged areas, but the plan is to extend it to the rest of England in 2007. The health trainers will help people who have difficulty in reading and speaking English, provide information on smoking cessation services, and accompany people to screening appointments (among other things). A scientific reference group on health inequalities was established in 2003 to help monitor progress towards the Government's health inequalities ambitions, and it is likely that this group will monitor and evaluate the progress of the health trainers.  

Expected outcome

It is of course too early to guess at what the outcome of these new initiatives might be, as they have hardly yet been introduced at the pilot level. However, I would suspect that both might have a positive effect on access and outcomes (and indeed equity of access and outcomes) if they are introduced on a large enough scale. Of course, the extent to which people from disadvantaged backgrounds respond to the health and lifestyle advice from health trainers remains to be seen.  

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch
current    previous

These are new initiatives in the broader health inequalities agenda, so I haven't actually commented on the specific impact of these particular initiatives before.

References

Sources of Information

• Department of Health. More GPs for under doctored areas. Department of Health: London, 26 July 2005     
• Department of Health. Health trainers for disadvantaged areas. Department of Health: London, 11 August 2005.      
• Department of Health. Choosing health (White Paper). Department of Health: London, 2004 (www.dh.gov.uk/choosinghealth)
• Department of Health. Tackling health inequalities: a programme for action. Department of Health: London, 2003.
• Department of Health. The NHS plan. A plan for investment. A plan for reform. Department of Health: London, 2000. (http://www.dohdoh.gov.uk/nhsplan/)
• Department of Health. Tackling health inequalities: consultation on a plan for delivery. Department of Health: London, 2001. (http://www.doh.gov.uk/healthinequalities

Reform formerly reported in

Health Inequalities Targets Process Stages: Umsetzung

Author/s and/or contributors to this survey

Adam Oliver

Empfohlene Zitierweise für diesen Online-Artikel:

Adam Oliver. "Policies towards reducing health inequalities". Health Policy Monitor, September 2005. Available at http://www.hpm.org/survey/gb/a6/2