Leadership needed to reduce inequalities in health

Abstract

As news broke last week of increasing deprivation in the UK, a seminar on May 7 to debate policies on reducing health inequalities in Europe seemed timely. Organised by the London School of Economics in conjunction with the European Commission, the objective was to debate how health inequalities are measured and to evaluate policies aimed at their reduction. Although there are methodological issues in measuring inequalities, and lack of access to reliable data in some countries, the bigger problem is identifying which policies promote health equity. Despite years of working to national targets to reduce health inequalities, data in the UK show the gap widening between the rich and the poor. In France, where health inequalities are also increasing, the main mechanism to tackle the problem is to promote access to health care, which is unlikely to be sufficient. In the Netherlands, a plan to reduce health inequalities was launched in December, 2008, and although it lacks quantitative targets it does aim to integrate government departments and focuses on prevention as well as cure. In Hungary, health inequalities are likely to increase further given the impact of the economic recession and deteriorating living conditions. European countries with generous family support policies, especially those that support both parents working, have low child poverty and infant mortality rates, but relative health inequalities persist. Leadership from the European Commission to ensure that comparable data between countries are collected, and to monitor policies, is welcome. But governments must act now, and until better data become available, the three themes identified by the Commission on Social Determinants of Health remain valid—improve daily living conditions; tackle the unequal distribution of power, money, and resources; and measure and understand the problem and assess the results of action. Translating these themes into country-specific measures is essential as, for example, the Marmot Review will do for the UK. Governments must then avoid cherry picking the voter-friendly recommendations, and implement those that will be most effective at promoting health equity.