How can our Labour government’s health inequalities targets become achievable?
1. Socialist Health Association conference
How can our
Labour government’s
health inequalities targets
become achievable?
Alex Scott-Samuel
EQUAL - Equity in Health R & D Unit
Department of Public Health
University of Liverpool
2. Health inequalities
Unfair or unjust differences
in health determinants or outcomes
within or between defined
populations
3. Equity (in health)
…from each according to his abilities,
to each according to his needs…
Karl Marx, Critique of the Gotha Programme (1875)
Distributional justice
4. Aim of capitalism
unequal distribution of the world’s
finite material (and human)
resources in order to create
personal gain and private profit
capitalism can’t exist without
inequality
5. Social democracy
Regulated / managed capitalism:
capitalism ‘as if people (in one’s
own country) mattered slightly’
6. Strategies reflect core
values
...he believes the government has been far too technocratic,
with too much emphasis on targets and delivery rather than
core values….'we have to make it clearer that we are a party
that believes in the redistribution of wealth and income'
Peter Hain, interview with Jackie Ashley, Guardian, March 17th
2003
8. Health inequalities strategy
- what health inequalities
strategy?
• Reducing Health Inequalities: an
Action Report
• New CommItment to Neighbourhood
Renewal - National Strategy Action Plan
• Cross Cutting Spending Review on
Health Inequalities
9. Mean household income in quintile groups
post tax and benefits 1997-8
£8430 £15,330 £33,590
£11030 £20,120 Social Trends 29
ONS, London
10. Labour’s inequality
strategies
• selectivist, high-risk strategies -
ie not inequality strategies at all
• midstream strategies
11. Refocussing upstream - the
poverty of outcome targets
‘socIal models (of health) require
social action supported by social
targets’
Whitehead M, Scott-Samuel A, Dahlgren G. Setting targets to
address inequalities in health. Lancet 1998, 351, 1279-82
12. 'When…outcomes are ultimately determined by exposures
resulting from public policy decisions, an outcome focus can
achieve little by comparison with action directed at the
policies concerned, or at the hazardous exposures to which
they give rise (such as) economic policies that cause poverty
and income inequalities, health and safety policies causing
stressful or dangerous working conditions, and utility pricing
policies that make heating and cooking fuel unaffordable'
Whitehead M, Scott-Samuel A, Dahlgren G. Setting targets to address inequalities in
health. Lancet 1998, 351, 1279-82
13. Policy based evidence
making
• teenage pregnancy
• the UK Cross Cutting Spending Review
(CCSR) on Health Inequalities 2002
www.doh.gov.uk/healthinequalities/tacklinghealth.pdf
14. CCSR - policy based
evidence making
‘political and bureaucratic
considerations loomed
larger than research
evidence’
15. CCSR - policy based
evidence making 2
The CCSR fails to address:
• macroeconomic policy
• globalisation and trade
• arms dealing
• patriarchy and gender inequity
• defence policy and war
• foreign policy
• international development
16. What is to be done?
• a short-life Commission for Health Equity
(CHE) to review health inequalities
knowledge and policy, and inform / reform
target setting
• a new critical health discipline
encompassing relevant political and policy
science
• a Politics of Health Group
17. New Labour is like cannabis
Both induce mild euphoria and a distorted sense of reality.
Both induce a tendency to talk endlessly in a meaningful way.
And everything takes on added significance despite the fact that
nothing much is happening.
WARNING
Cannabis is widely regarded as harmless but the long term effects of
New Labour are unknown.
Notas del editor
If we look at the distribution of household income in the UK , post tax and benefits it looks something like this - where this is the mean income of household in the poorest quintile and these are the mean incomes of household in the richest quintiles- The distribution is continuous but positively skewed . The mean income of the top quintile is surprisingly low considering the level of income amongst the very rich. The top of the skew goes a very long way up. If Geoffrey Rose was right in thinking that if variables are continuously distributed like this high risk approaches - all those which focus on the poor -are likely to be inefficient It seems to me that is entirely consistent with what this figure makes obvious - that disparity in income is almost entirely determined by the very rich. The disparity between the very poor and the rich is not that great. So it would seem odd, on two counts, that all the public health effort to combat social inequalities is focused down here.