Interpreting and addressing inequalities in health:
from Black to Acheson to Blair to ...?
Professor Robert Evans from the University of British Columbia
Published by the Office of Health Economics (OHE), May 2003
Summary at:
http://195.200.28.182/ohe/ohehome.nsf/Resource/interpreting%20brief/$file/In
terpreting%20Briefing.pdf?openElement
<http://195.200.28.182/ohe/ohehome.nsf/Resource/interpreting%20brief/$file/I
nterpreting%20Briefing.pdf?openElement>
Website: http://195.200.28.182/ohe/ohehome.nsf
<http://195.200.28.182/ohe/ohehome.nsf>
".........In this paper Robert Evans reviews the literature on the causes of
health inequalities, and examines the extent to which the causes will be
tackled by the measures proposed in the Acheson report and by the subsequent
response of the UK government. The research shows focusing on how income
inequality affects health inequality is not enough.
There is a more complex relationship between income inequality and social,
environmental, behavioural and biological factors that produce health
outcomes.
The Acheson report and Vision, the UK government's response, are supposed to
be based on such findings. Both look at:
- broadening public health beyond traditional medical
intervention into a wider social context such as diet, immunization
and screening
- the importance of intervention at an early age to reduce stress in adult
life and have a lasting positive health benefit
Professor Evans concludes:
* The Acheson report and the UK Government's response From Vision to Reality
(Vision) are politically cautious in devising health care reform in Britain,
but have taken an important first step.
* Tackling health inequality rather than simply focusing on traditional
medical intervention is a new direction for Government.
* The Government ignores the big issues from the wider social context such
as public transport and income redistribution
* The leadership and coordination role of the NHS for medical and social
reform at the local level is crucial to the success of any future policy
development.
In his book Professor Evans asks the basic questions of why some regions /
countries are significantly healthier than others, why unhealthy behaviours
such as smoking are concentrated at the lower end of the social spectrum and
whether understanding such factors has shaped the formation of the new
health care policy in Britain.
Social gradient has an impact on health inequalities - both Acheson and the
Government ignore it. Despite the dramatic increases in health and living
standards of the whole population, and the introduction of the NHS in 1948,
poorer people still die younger. Preventive health care measures included in
Vision, such as anti-smoking or immunization, tend to be more effective at
the upper ends of the social spectrum - smoking for example is concentrated
at the lower end.
Both the Acheson report and Vision extend a classic public health programme
into a broader social context. This reflects the complexity of the problem.
The NHS will play an important role in coordinating public health and social
initiatives. If the reforms are to work they will need careful monitoring,
and courage by the Government, to abandon failure as well as expedite
success....."
* * * *
This message from the Pan American Health Organization, PAHO/WHO, is part of
an effort to disseminate information
related to Equity, Health inequality; socioeconomic inequality in health;
socioeconomic health differentials. Gender,
Violence, Poverty, Health Economics, Health Legislation, Ethnicity, Ethics,
Information Technology and Virtual Libraries,
Research & Science issues.
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