Abstract
BackgroundBetween 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.MethodsData were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000–2010 were more favourable as compared to the period 1990–2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.ResultsAfter the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000–2010 in England were not more favourable than those observed in the period 1990–2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.ConclusionsIn this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3505-z) contains supplementary material, which is available to authorized users.
Highlights
Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique
The “two-way interaction” parameter estimates for low-educated people in England show that more favourable trends after 2000 were found in all health measures, not statistically significant for obesity
Summary of findings After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000–2010 in England were not more favourable than those observed in the period 1990–2000
Summary
Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. It developed and implemented a strategy that—in the government’s own words—was “the most comprehensive programme of work to tackle health inequalities ever undertaken in this country” [16]. The English strategy to reduce health inequalities was shaped in two steps [40, 41], of which the first was taken in 1999, when the Department of Health issued “Reducing Health Inequalities: an Action Report” [16] This set out national actions across a broad front including raising living standards and tackling low income, family support policies, tax-reduction and long-term care for the elderly, anti-smoking policies, improving early education (“Sure Start”) and promoting healthy communities, as well as some broader policies in the areas of education, employment and housing. It largely followed the recommendations of the Acheson committee which were based on the best available evidence in the late 1990s [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
