On health inequality.

Abstract

The UK Labour government has attempted to bring the issue of health inequality into the public policy debate. For example, soon after its election in 1997, the government commissioned the independent Acheson inquiry. The Acheson inquiry team had a remit to review the latest available evidence on health inequalities and were also asked to identify priority areas for future policy development. The resulting Acheson report proposed 39 recommendations to alleviate health inequalities, with the recommendations relating to a broad array of public policy (e.g. measures relating to poverty, education, housing, nutrition and the health service, among others). In the year that the Acheson report was published, the government released the consultation paper, Our healthier nation. The two key health policy objectives stated within the consultation paper are to improve general population health and to narrow health inequalities. This provided further evidence of the government's concern in this area. The government's interest in alleviating avoidable health inequalities has also led it to review the capitation formulae that are used to allocate funds to health authorities. Traditionally, these formulae have been based on the concept of providing equal access to health care services for equal need. However, it has often been argued on a theoretical level that this concept may actually exacerbate health inequalities, and that in order to narrow avoidable health inequalities, greater positive discrimination towards those with relatively poor expected health is required. It is less clear how this can be achieved in practice; hence, the results of the capitation review are eagerly anticipated. Moreover, a host of other measures introduced by the government, such as the national minimum wage, may directly or indirectly serve to narrow the health differentials. Clearly, the government does appear to be paying some attention to health inequality, but what is the extent of this problem?