Policies towards reducing health inequalities

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

Featured in half-yearly report: Health Policy Developments Issue 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.

Recent developments

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
current    previous

Nothing over and above what I've written above.

Purpose and process analysis

Current Process Stages

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

Initiators of idea/main actors

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

• Scientific Community: 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).

• Media: 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

Government
Government	very supportive		strongly opposed
Scientific Community
Public Health Community	very supportive		strongly opposed
Media
Media	very supportive		strongly opposed
current    previous

Influences in policy making and legislation

Not applicable.

Legislative outcome

Enactment

Actors and influence

Government
Government	very strong		none
Scientific Community
Public Health Community	very strong		none
Media
Media	very strong		none
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

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

null

Reform formerly reported in

Health Inequalities Targets Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

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