Improving the Health of the Poorest Fastest

The aim of improving the health of the poorest, fastest is to reduce health inequalities. This lies at the heart of the public health white paper Health Lives, Healthy People (PHWP).1 Health inequalities have been defined as “differences in health status or in the distribution of health determinants between different population groups”. 2 Tackling health inequalities is a notoriously challenging social policy issue.  Despite considerable attention over the last decade in England, measurable progress has proved difficult to achieve despite overall improvements in health, as generally the more favoured people are, socially and economically, the better their health.3

It is estimated that inequality in illness accounts for lost productivity of between £31-33 billion per year, lost taxes and higher welfare of around £20-32 billion per year and additional costs to the NHS of around £5.5 billion per year.3

The current government wants to be judged on it reduction of health inequalities 4 and has set out its plans to reduce health inequalities in the PHWP, with other government policies complimenting a social determinants to health approach to address health inequalities; child poverty,5 child protection,6 welfare reform,7 social mobility,8 big society9 and natural environment.10

Evidence of the possible benefits

An analysis of the previous government’s policy to reduce health inequalities suggests that it did not work and another approach is needed.11 To succeed, cross-government policy is required, as set out in Health in All Policies approach,12 with actions taken both nationally and locally.  Coordinated action across government is being overseen by the cabinet Sub-Committee for Public Health,13 ensuring that all relevant government departments play their part in reducing health inequalities.

The Marmot review3 explored the most effective evidence-based strategies for reducing health inequalities, in England, in 2010.  The PHWP is the government’s response to the report taking five of the six policy options as set out by Marmot (excluding a healthy living standard for all).

Evidence of the possible risks

While the government has made clear its intention to narrow health inequalities, other policies across government may unintentionally have opposite effect.141516 and there are concerns about how difficult it is to achieve effective coordination in this area.17

Implications for health and well-being

The policy to improve the health of the poorest, fastest, is challenging.   Any national health inequalities strategy faces a range of issues: the scale of implementation, of evidence of differential effectiveness, of evaluation and of timescale.  The current policy is based on a comprehensive view of the evidence. However reducing health inequalities will take many years,18 and the effects of this latest policy will take time to emerge.

Author: Stephen Gunther, Speciality Registrar Public Health

UK area affected: England only

References:

1. Department of Health (2010). Healthy Lives, Healthy People, CM8134. London: Stationery Office.

2. World Health Organisation. Health impact Assessment: Glossary of terms used. http://www.who.int/hia/about/glos/en/index1.html (Last accessed 8th August 2011).

3. Marmot M (2010). Fair society, Healthy lives: The Marmot Review. London: The Marmot Review.

4. The New Public Health System Podcast. http://www.kingsfund.org.uk/events/past_events_catch_up/public_health_system.html (Last accessed 2nd August 2011).

5. HM Government (2011). A New Approach to Child Poverty: Tackling the causes of Disadvantage and Transforming Families Lives, CM8061. London: Stationery Office.

6. Department for Education (2011). The Munro Review of Child Protection: Final Report – A child-centred system, CM8062. London: Stationery Office.

7. Department for Work and Pensions (2011). Welfare reform Bill 2011. http://www.dwp.gov.uk/policy/welfare-reform/legislation-and-key-documents/welfare-reform-bill-2011/index.shtml (Last accessed 16th August 2011).

8. Cabinet Office (2011). Opening doors, breaking barriers. A Strategy for social mobility. London: Stationery Office.

9. Cabinet Office. Big Society. http://www.cabinetoffice.gov.uk/big-society (Last accessed 16th August 2011).

10. Department for Environment, Food and Rural Affairs (2011). The Natural choice: securing the value of nature, CM8082. London: Stationery office.

11. Mackenbach JP. The English strategy to reduce health inequalities. The Lancet 2011;377(9782):1986-8.

12. Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K (eds) (2006). Health in All Policies. Prospects and potentials. Helsinki: Ministry of Social Affairs and Health and European Observatory on Health Systems and Policies.

13. Department of Health. Health secretary sets out future of public health. http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117228 (Last accessed 8th August 2011).

14. Dowler C. Funding formula changes boosts South. Health Service Journal, 24 March 2011.

15. Hacking J. (2011) Memorandum for the Health Committee Inquiry into Public Health. http://fullfact.org/sites/fullfact.org/files/2011/08/Manchester_Evidence_Public_Health_Select_Committee.pdf (Last accessed 16th August 2011).

16. Pearce N., Davey Smith G. Is Social Capital the Key to Inequalities in Health? Am J Public Health 2003 93: 122-129.

17. HM Parliament. Corrected transcript of oral evidence, HC 1048-ii. House of Commons, oral evidence, taken before the Health Committee: Public Health, Tuesday 21st June 2011. http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/c1048-iii/c104801.htm (Last accessed 16th August 2011).

18. Marmot M, Friel S, Bell R, Howeling AJ, Taylor S (2008). Commission on Social Determinants of Health. CSDH Final Report: Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Geneva, Switzerland: World Health Organization.