According to Marmot and Wilkinson, health inequalities are “the systematic, structural differences in health status between and within social groups within the population” (Marmot and Wilkinson, 1999). Health inequalities relate to other socioeconomic factors that determine health status in society.
These factors may include diet, housing, employment, and access to healthcare among others. Thus, the focus of healthcare inequalities concentrates on factors that reduce accessibility to healthcare services for different socioeconomic groups.
Conditions which determine accessibility to healthcare services usually present serious challenges to policymakers in their attempts to address them. This is because most of these causes have relations with other multifaceted factors. Consequently, the solutions must also reflect the nature of these causes.
We should note that policies that can adequately address healthcare issues should be long-term, need multiple inputs and continuous improvements as new socioeconomic challenges emerge. We have also witnessed lack of clear evidence regarding the effectiveness of existing policies that seek to address healthcare inequalities. Thus, the UK government is continuously looking for new approaches for addressing existing healthcare inequalities.
Evaluation of the effectiveness of the UK Government strategies in addressing inequalities in health
The UK government strategies of providing healthcare services have marginally contributed to the effectiveness of addressing disparities that exist in healthcare provisions.
Debates and politics about the portfolio of the department of health in the ministry have negatively affected works of the National Health Services (NHS). The UK government has set targets that aim at reducing main causes of deaths in the UK. These include reducing cancer deaths among the elderly, reducing strokes, accidents, and mental illnesses.
The challenge is that policymakers did not address these targets to reflect healthcare inequalities that exist in the society. It is only under rare circumstances that these targets may indicate a minimal reflection of health disparities.
Changes in the structure of the organisation also affect the provision of healthcare services to address inequalities. This has led to the creation of Primary Care Trusts (PCTs) that will address healthcare disparities, and commissioning hospital services among other functions (Department of Health, 1999).
Creating Target and Performance Cultures
Existing inequality in healthcare has prompted the UK government to initiate a culture of targets and performance. Consequently, it has come up with some few strategies. First, we have Public Service Agreements (PSAs). Ministries have developed a department (spending) to ease their works with the finance ministry. PSAs can play a fundamental role in reducing disparities in the provision of health services.
However, this department lacks the structure of fulfilling this role since that was not its primary aim. Deakin and Parry propose the linkage between the PSAs policy, outcomes and accountability because of the social policy this department can address (Deakin and Parry, 2000).
Second, the famous Acheson Report has no provisions for reducing health inequalities. The report notes that causes of health inequalities are complex and involve elements which interact. Therefore, the government did not provide any provision for addressing such inequalities. Consequently, it introduced some targets in 2001 (Acheson, 1998).
These targets focused on children under one year in reducing mortality by at least 10 percent mainly in poor areas. Likewise, health authority targets to reduce the gap that exists in life expectancy in areas with low life expectancy at birth by at least 10 percent and spreads it to the entire population.
In order to ensure the effectiveness of these targets, the government developed some indicators to monitor their progresses on a long-term basis.
Structures and Processes
The UK government has put in places structures and processes that ensure effectiveness in addressing health inequalities. First, there is the Joined-up Government (JUG) process and structure. This structure requires various departments of the government to work together in solving multifaceted problems through the creation of policies.
This is may not be effective because it is not a system of nationwide approach in tackling health inequalities. The problem is that many ministries and their departments may participate in policies formulation, but the responsibility to implement these policies rests with one of them (Lurie, 2002).
In the UK, public policy reforms have created fragmented departments among various services providers. These fragmentations in policies have hindered the achievement of the main goals set in the policy document. Flinder found out that issues that are not within any coordinating committee do not get any attention; thus, they end up neglected (Flinders, 2002).
There also exists “massive competition for resources among these different branches of JUG” (Flinders, 2002). These factors affect service and resource provisions in various departments such as health, and education among others. In addition, not all ministries related to health take initiative for enhancing change.
Second, there is also Cross-cutting Review. This exists to inform the government spending in areas which are not within the main portfolio of the ministries. In the year 2001, health inequalities became the topic of review. The review revealed that there is a need for long-term agendas for addressing health inequality issues.
They also indicated the need to put health in equalities among the mainstream elements. The review team identified areas of focus, such as improving housing, nutrition improvement programmes, focusing on poverty areas and improving provisions of healthcare services.
The UK government embarked on a modest redistribution of resources to the disadvantaged masses. The government concentrates on providing modest employment to these masses in order to improve their socioeconomic status. However, this approach may not solve health inequalities because it lacks the basic agenda of redistributing wealth in a progressive manner.
The UK government has also introduced some forms of tax credits for adults in employment some benefits. They mainly target single parents and disabled persons in society. These approaches in wealth distribution will have marginal significant in addressing basic socioeconomic and multifaceted factors resulting into health inequalities (Dolowitz, 2003).
Health inequalities mainly affect the vulnerable majorities in society who are mainly children. Consequently, the UK government has launched strategies to reduce health disparities that affect mostly children. First, the government borrowed the idea of Sure Start from the US government.
This policy strives to improve the life chances of children from poverty-stricken areas through changing their patterns of living together with their families. The programme targets children in poverty areas, but the area of focus and number of children in poverty remain low. The programme has no clear guidelines on how it will cover the entire country.
Second, there is also a Child Poverty programme. The UK government set targets of reducing children living under poverty by 25 percent by the year 2004. According to Brewer and Gregg “the UK has one of the highest rates of child poverty (measured as households with income below 60 percent of the median income) of Organization for Economic Cooperation and Development (OECD) countries” (Brewer and Gregg, 2001).
This programme strives to improve the living standards of children from regions stricken with poverty through introducing new benefits, increasing welfare benefits. This is a subsidy programme whose focus is on poor households for the benefits of the children.
Observers have noted some positive improvement as the number of children in poverty reduced below 60 percent. However, critics of these programmes believe that such improvements cannot result from policy implementation because the policy is also responsible for creating residual group whose lives the policy has not touched (Guy, 1997).
The UK government has “initiated a number of policies targeting certain location so as to address the issue of poverty and poor populations” (Illsley, 1999). Health Action Zones (HAZ) programme has an interagency approach in tackling issues of poverty and deprivation. HAZ targets at least 13 million people. HAZ main focus is to formulate and implement strategies that can eliminate poverty in parts of England.
HAZ has some drawbacks in terms of structural changes that continuously affect its implementation agendas. The government also uses it as it main reference point for creating short-term agendas which are difficult to achieve and implement effectively (Illsley, 1999).
The UK has spent quite considerable amount of time and resources in its attempts to address issues of health inequalities. The country views these issues in terms of policy problems.
A number of reports and research works have identified multifaceted factors, which are responsible for the existing state of health inequalities in the UK. These works provide the government with the basic background and foundation on which to lay their approaches for addressing health inequalities.
These policies have helped address some challenges facing the health sector in the UK, but they have also met crucial challenges that we cannot ignore. The major challenge is how the government can effectively address and implement health inequalities policy agendas.
In addition, there have been significant progresses in addressing health inequalities, and the government has realised that incorporating all stakeholders in the policy formulation and implantation may be the best approach in tackling socioeconomic determinants in healthcare provisions.
Challenges are clear indicators that some of the approaches the UK government is using for tackling health inequalities may not be the best approaches. Thus, these poor outcomes call for immediate formulation of new policies for tackling emerging problems. The UK should also borrow from countries like the US that have implemented most of their health care policies successfully.
The UK government must realise that some of its approaches may not be effective. In this regard, the country must reformulate these policies, for instance, the UK agendas’ on tackling healthcare disparities lack clear focus and as a result, they may not yield the desired results.
This is the case of socioeconomic policies that aim at addressing poverty and health care inequalities. Thus, the UK should focus on its long-term agenda for challenges problems in the provision of healthcare services effectively.
Most of the policy initiated to address health inequalities never provided the main issues responsible for health inequalities. At the same time, these reports fail to provide clear guidelines on how the government should implement some of their findings.
Acheson, D 1998, Independent Inquiry into Inequalities in Health, The Stationery Office, London.
Brewer, M and Gregg, P 2001, Eradicating Child Poverty in Britain: Welfare Reform and Children since 1997, Institute for Fiscal Studies, London.
Deakin N and Parry R, 2000, The Treasury and Social Policy: The Contest for Control of Welfare Strategy, Palgrave, Basingstoke.
Department of Health 1999, Saving Lives: Our Healthier Nation. White Paper Command 4386, The Stationery Office, London.
Dolowitz, P 2003, ‘A Policy-maker’s Guide to Policy Transfer’, Political Quarterly, vol. 74, no. 1, pp. 101–8.
Flinders, A 2002, ‘Governance in Whitehall’, Public Administration, vol.80 no. 1, pp. 51–75.
Guy, K 1997, Our Promise to Our Children, Health Canada, Ottawa, ON.
Illsley, R 1999, ‘Reducing Health Inequalities: Britain’s Latest Attempt’, Health Affairs, vol. 18, no. 3, pp. 45–46.
Lurie, N 2002, ‘What the Federal Government Can Do about the Non-medical Determinants of Health’, Health Affair, vol. 21, no. 2, pp. 94–106.
Marmot, M and Wilkinson, G 1999, Social Determinants of Health, Oxford University Press, Oxford.
Fig 1: The Health Inequalities Umbrella
Table 1: Life Expectancy by Deprivation Deciles, showing the Slope Index of Inequality, Enfield London Borough, Males, 2005-09
Table 2: Aspects of health where ethnicity and health inequality may be
Linked (Source, The Health of Londoners Project, November, 1999)
|Determinants of health||Prevalence of ill-health; |
|Service use||Health/Service |
Mobility and migration.
|Prevalence of specific |
Diseases e.g. diabetes,
Health behaviour and
|Health Services: |
Voluntary and private
Table 3: The extent of health inequalities
The last ten years have witnessed large improvements in health for everyone.
Life expectancy at birth for men & women in social class I (professional), social class V (unskilled manual) and all, 1972-2005, England & Wales (Source: Professor Hilary Graham)