NHS & HEALTH INEQUALITIES

Evaluate the Ability of the NHS to Impact on Health Inequality



Evaluate the Ability of the NHS to Impact on Health Inequality

Introduction

The secretary of state for health recently announced the establishment of six “modernisation action teams” to help develop a national plan for a national health service. The government has committed itself to improving public health and reducing inequalities in health. The decision to set up a “modernisation action team” (Shaw 1999) on prevention and inequality is consistent with these goals. It is not clear, however, what this team is expected to do that is different from the analysis and recommendations contained in various recent government reports. Saving Lives: Our Healthier Nation said its aim was “to improve the health of everyone and the health of the worst off in particular.” It acknowledged the role of social, economic, and environmental factors in influencing population health and inequalities in health but did not confine itself to non-NHS initiatives to improve population health. The Acheson inquiry gave careful consideration to recent trends in, possible causal models for, and policies to reduce inequalities in health and made 39 policy recommendations, three of them relating to the NHS. (Blair 2000) So, attention has recently been given to the role of the NHS in promoting public health and reducing inequalities in health.

Discussion

The Department of Health has described this team as covering “prevention—tackling inequalities and focusing the health system on its contribution to tackling the causes of avoidable ill-health.” (Department of Health 2007) It also says that all the teams have a remit “to address variations in performance and standards across the care system as a major contribution to tackling health inequalities.” Both these statements could be taken to suggest that the scope of the prevention and inequality team might be confined to the role of the NHS. The prime minister said in the House of Commons in relation to this action team: “There is the challenge on prevention: to balance spending on tackling the causes of ill-health with treating illness; to develop a more systematic approach to treating people at risk from chronic diseases; and to persuade more people to play their part in achieving better health by adopting a more healthy life style.” (NHS Centre for Reviews and Dissemination 2006) This implies giving priority to the detection and treatment of people at known and proximate risk of killers such as cancer or heart disease, and that there will be further attempts to change individual behaviours by exhortation.

It would be disappointing if this action team was confined to this sort of agenda. Though the NHS has a role in promoting health, preventing disease, and ameliorating the health damage caused by disadvantage, most of the major drivers of population health and of the distribution of health lie outside the NHS.11 Health ministers have acknowledged the importance of air pollution, unemployment, crime and disorder, poor housing, poverty, limited educational achievement, the general environment, and other forms of social ...