Health Inequalities Targets

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Health inequalities research has a long history in the United Kingdom, and the development of Government policies that are intended to address the prevailing health inequalities had been gathering pace since the Labour Party returned to power in 1997. In 2003, the Government announced the following general health inequalities target: By 2010, to reduce inequalities in health outcomes by 10% as measured by infant mortality and at birth life expectancy.

Purpose of health policy or idea

In 2003, the UK Government announced the following specific health inequalities targets (the first explicit health inequalities targets in the UK):

(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.

The Government aims to reach these targets through a range of NHS and broader social and fiscal policies, many of which have been in place for some time. The NHS policies include reducing inequalities in access to health care and tackling the 'major killers' (heart disease and cancer), from which those on lower incomes disproportionately suffer. The 'wider' policies include introducing and increasing the minimum wage, improving employment opportunities for the long-term unemployed (the New Deal), improving both adult education opportunites and early learning opportunities for the children of vulnerable groups (Sure Start), and urban renewal policies.

A cross-Government Department delivery plan has been put forward on best practice, and the different Departments will be required to give binding commitments to implement policies based on 'best practice'. The whole process is overseen and monitored by a cross-Department group of senior officials, chaired by the Treasury and held accountable to the Cabinet. Policy implementation in this area is thus based an central directive rather than financial incentives.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

I am concerned about using the NHS as a mechanism to explicitly redistribute health outcomes, as this would mean prioritising people on the basis of factors that are exogenous to their health (e.g. their class, income, race etc.). In my view, the NHS should focus on equal access for equal need (i.e. prioritisation on factors that are endogenous to health). However, using other forms of public policy to explicitly redistribute health outcomes may be appropriate, as 'wider' policy is concerned with redistribution over persons who are not yet sick and is thus more appropriate for addressing the basic socio-economic injustices in society.

As a further point, although there is very little evidence on which policies can effectively reduce health inequalities, the trends in health differentials as measured by life expectancy over the 1990s suggest that at least part of the general target is likely to be met.

Political and economic background

For the Conservative administrations between 1979-97, health inequalities policy was not a priority. Whilst in Opposition, the Labour Party committed itself to addressing health inequalities once it returned to power. Soon after being elected in 1997, the Labour Government commissioned an independent inquiry in inequalities in health, published as the 'Acheson Report' in 1998. Much of the health inequalities policy debate, and the recent health inequalities targets, have been informed by the Acheson Report. It probably fair to say that the reason why health inequalities has been such a topical issue in the public policy debate over recent years is because the issue fits in with the political vision of the Labour Government.

Change of government

Change based on an overall national health policy statement

See: Department of Health (2000) The NHS plan. A plan for investment. A plan for reform. Department of Health, London.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Approach of idea

The approach of the idea is described as:
new:

Innovation or pilot project

Local level - New Deal, Sure Start, health inequalities impact assessment of NHS programmes

Stakeholder positions

In general, political parties and media outlets that are left-leaning are in support of policy to address health inequalities, and those that are right-leaning do not tend to support such policies (although, probably for political reasons, they generally refrain from being openly hostile to such policies). Local health care purchasers and providers are probably mixed in their opinion of these policies, with some probably considering the new targets as yet another inconvenient central directive that has to be met. The public health community in the UK, which has undertaken most of the research that demonstrates the existence of health inequalities, have generally been in support of policy initiatives in this area.

Adoption and implementation

The Government created a cross-Department spending review, which formulated a cross-Department delivery plan on best practice to address the existing health inequalities. The plan affects many areas of Government (see answers to earlier questions) The plan is used by the Departments as input into their spending plans for 2003-06. The plan leads to binding commitments for the Departments to take action on health inequalities, and is overseen by a cross-Department group of senior officials that are accountable to the Cabinet.

Monitoring and evaluation

The plan is structured around long-term targets to reduce the gap in health status between social groups and geographical areas. The plan is underpinned by short-term and medium-term 'milestones' drawn from a cross-government 'basket of indicators', which will be used in the future allocation of funding and assessment in both the NHS and local government.

On broader policy, there is some evidence that the efforts to address the determinants of health have moved in the 'right' direction. For example, there is some evidence that  the minimum wage and other incomes policy has led to a redistribution of wealth and has raised the income of the poorest families, and the New Deal has contributed to the lowest UK unemployment figures in decades.

Review mechanisms

Mid-term review or evaluation, Final evaluation (external)

Dimensions of evaluation

Process, Outcome

Expected outcome

There is some evidence that health inequalities, at least in terms of male life expectancy, narrowed during the 1990s, and if these trends continue then there is no doubt that the Government will meet at least some of its health inequalities targets. That is to say that the Government introduced targets that may be met even in the absence of any new deliberate policies to meet them. There are, however, possible serious negative consequences vis-a-vis the core objectives of the NHS. Using the NHS to redistribute health outcomes may mean that certain groups in society are explicitly prioritised as part of Government policy. This would undermine the principle of universality that has underpinned the NHS since its creation in 1948, which may feasibly undermine the broad support for the NHS as an institution.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

Too early to assess impact on health services.

References

Sources of Information

• Department of Health and Social Security (1980) Inequalities in health: report of a research working group chaired by Sir Douglas Black. Department of Health and Social Security, London.
• Department of Health (1998a) Inequalities in health: report of an independent inquiry chaired by Sir Donald Acheson. Stationery Office, London.
• Department of Health (2000) The NHS plan. A plan for investment. A plan for reform. Department of Health, London. (http://www.dohdoh.gov.uk/nhsplan/)
• Department of Health (2001) Tackling health inequalities: consultation on a plan for delivery. Department of Health, London.
• Department of Health. Tackling health inequalities: a programme for action. Department of Health: London, 2003.
• (http://www.doh.gov.uk/healthinequalities)
• http://www.neighbouhood.dtlr.gov.uk
• http://dti.gov.uk/energy/fuelpoverty/ index.htm
• http://www.surestart.gov.uk
• Oliver A, Nutbeam D. Addressing health inequalities in the United Kingdom: a case study. Journal of Public Health Medicine 2003; 25: 281-287.

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Adam Oliver. "Health Inequalities Targets". Health Policy Monitor, October 2004. Available at http://www.hpm.org/survey/uk/a4/5