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Challenging health inequalities

Challenging health inequalities: From Acheson to Choosing Health

Elizabeth Dowler
Nick Spencer
Copyright Date: 2007
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  • Book Info
    Challenging health inequalities
    Book Description:

    This book offers a unique multi-disciplinary perspective on tackling health inequalities in a rich country, examining the New Labour policy agenda for tackling health inequalities and its inherent challenges. The book presents an overview of progress since the publication of the seminal and ambitious 1998 Acheson Inquiry into health inequalities, and the theoretical and methodological issues underpinning health inequalities. The contributors consider the determinants of inequality - for example, early childhood experience and ethnicity - the factors that mediate the relationship between determinants and health - nutrition, housing and health behaviour - and the sectoral policy interventions in user involvement, local area partnership working and social work. Challenging health inequalities offers a combination of broad analysis of progress from differing perspectives and will be key reading to academics, students and policy makers.

    eISBN: 978-1-84742-253-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-v)
  3. List of tables and figures
    (pp. vi-vi)
  4. Acknowledgements
    (pp. vii-vii)
  5. Notes on contributors
    (pp. viii-xiv)
  6. ONE Introduction
    (pp. 1-16)
    Nick Spencer and Elizabeth Dowler

    New Labour has been in government in the UK for almost 10 years. From early in its period of office, it set out to challenge the official indifference to the public health significance of health inequalities. Within six months of taking office, the Acheson Inquiry into inequalities in health was convened with the remit of recommending policies aimed at reducing health inequalities. The inquiry report was published in 1998 by the Department of Health for England and Wales (Acheson, 1998). It is timely to take stock of progress in reducing what the report describes as ‘unacceptable inequalities in health’ and...

  7. TWO Progress in tackling health inequalities: a policy maker’s reflections
    (pp. 17-30)
    Ray Earwicker

    Health inequalities were identified in 1997 as a priority for the new government elected in May of that year. Prime Minister Tony Blair told the House of Commons that ‘inequalities do matter and there is no doubt that the published statistics show a link between income, inequality and poor health. It is important to address that issue and we are doing so’ (Hansard, 1997).

    This message was taken up in the home countries of the UK — in Scotland, Wales and northern Ireland. In England, Sir Donald Acheson was commissioned to survey the position on health inequalities and identify possible responses....

  8. THREE Inequalities in mortality rates under New Labour
    (pp. 31-46)
    Danny Dorling, Mary Shaw and George Davey Smith

    New Labour came to power in 1997 to the theme of D:Ream’s ‘Things can only get better’. As the lyrics to its campaign tune said, it thought that it had found the cause of all that was wrong in Britain and that it was the party that would be the cure to the disease of prejudice and greed. It was going to be an angel — and things could only get better.

    Prior to 1997, throughout the long 18 years of Conservative government, Labour had referred to the issue of increasing social inequalities in health as an area of particular concern....

  9. FOUR Explaining inequalities in health: theoretical, conceptual and methodological agendas
    (pp. 47-68)
    Simon J. Williams, Michael Calnan and Alan Dolan

    How are we to explain inequalities in health? Are some pathways more important than others? Are there limits to current epidemiological research? What light does lay knowledge shed on inequalities in health, both past and present? Do we need to dig deeper into the causes of inequalities? How do these issues translate into future policies and practices designed to tackle inequalities in health and ‘narrow the gap’? These are some of the questions confronting health inequalities researchers today. The importance of these questions, moreover, seems to have grown rather than diminished in the light of the UK government White Paper...

  10. FIVE Inequalities in pregnancy and early years and the impact across the life course: progress and future challenges
    (pp. 69-94)
    Nick Spencer and Catherine Law

    Pregnancy and early childhood are particularly vulnerable stages in the life course at which adverse socioeconomic circumstances have lasting effects. Inequalities at this early stage of life have been shown to impact on adult health (Hertzman et al, 2001; Jefferis et al, 2002; Spencer, 2003) but they are also themselves the result of intergenerational inequalities (Spencer,2004; Kahn et al, 2005). For infants surviving the first year of life, the effects of adverse pregnancy outcomes track into early childhood to contribute to inequalities in early childhood health (Pharoah et al, 1994; Jefferis et al, 2002) and form the early components of...

  11. SIX Inequalities and ethnicity: evidence and intervention
    (pp. 95-110)
    Hannah Bradby and Tarani Chandola

    The Acheson Report (Acheson, 1998) included a chapter on ‘Ethnicity’, an important dimension of inequalities in health in the UK. The chapter acknowledged the difficulties in defining ethnicity and considered evidence on health inequalities from different definitions of ethnicity. Apart from documenting the patterns of morbidity and mortality among the major ethnic groups living in Britain, the report noted differences in socioeconomic status between ethnic groups. Unemployment, poverty and poor housing conditions among Pakistani and Bangladeshi households were highlighted as potentially contributing to their poorer health in general. However, there remains considerable debate about specific factors that underlie both ethnic...

  12. SEVEN Housing conditions and health
    (pp. 111-126)
    David Ormandy

    There are some very obvious wide differences in housing. This chapter largely deals with conditions in the UK, particularly in England, because of the availability of data and the policy changes that have occurred. However, the principles and discussions can be applied elsewhere in the UK. There are differences in housing archetypes — detached, semi–detached, terraced, maisonettes and flats, and houses in multiple occupation; and differences in housing age, which for the purposes of this chapter reflect major changes to the building control requirements — pre–1920, 1920–45, 1946–79, post–1979. There are differences of location — urban, rural, north...

  13. EIGHT Inequalities in food and nutrition: challenging ‘lifestyles’
    (pp. 127-156)
    Elizabeth Dowler, Martin Caraher and Paul Lincoln

    This chapter examines work on inequalities in food and nutrition in the UK since the late 1990s, looking at how problems have been constructed and measured, responses by government and civil society, and future challenges. It begins by summarising data on social inequalities in food and nutritional intakes and outcomes, focusing largely on income and occupationally based inequalities, and outlines why these outcomes are thought to occur. The relationship with health, and particularly health inequalities, is briefly discussed. The location of the Acheson Inquiry within the food and nutrition policy context of the time, and developments since, are discussed in...

  14. NINE Behaving badly? Smoking and the role of behaviour change in tackling health inequalities
    (pp. 157-174)
    Nick Spencer

    Changing health behaviour is a prominent theme in both government health policy and professional practice and, prior to 1997, formed the basis of the government’s strategy for addressing health inequalities, or health variations as they were then officially known (Warden, 1995). By 1998, it appeared that the emphasis had shifted from changing behaviour to changing the underlying material and structural conditions associated with both adverse health behaviours and poor health among the disadvantaged. The new Labour government accepted the conclusions of the Acheson Inquiry (Acheson, 1998), echoing those of the Black Report (Townsend and Davidson, 1982), that tackling health inequalities...

  15. TEN Health inequalities and user involvement
    (pp. 175-192)
    Jonathan Tritter and Helen Lester

    Patient and public involvement has been suggested as a mechanism to engage individuals more fully in their own healthcare and to reorient service provision around the needs of users rather than providers (Tritter and Macallum,2006). Yet, patterns of health inequality are also reflected in those who tend to be involved and those who are members of ‘hard to reach’ groups. The Acheson Report (Acheson, 1998) includes no explicit mention of involvement but has had a significant influence in integrating a sensitivity to diversity in most activities seeking to engage patients, carers and members of the public. Unless user involvement draws...

  16. ELEVEN Gilding the ghetto again? Community development approaches to tackling health inequalities
    (pp. 193-212)
    Mick Carpenter

    The publication of the Acheson Report (Acheson, 1998) ended nearly two decades of political denial of health inequalities following the publication of the 1980 Black Report (Townsend et al, 1992). The key policy issue since 1997 has been whether new Labour is making progress in tackling health inequalities, including whether the government’s initial commitment to tackling them has strengthened or diminished since Acheson. Since much assessment has sought to provide a bird’s-eye view of the adequacy of macro-level policies, this chapter seeks to provide a complementary ‘worm’s-eye’ view of the actual and potential role of local initiatives, particularly those informed...

  17. TWELVE A new agenda for social work: tackling inequalities in physical health
    (pp. 213-232)
    Eileen McLeod, Paul Bywaters, Peter Beresford, Suzy Croft and Mark Drakeford

    Unlike other disciplines represented in this book, a focus on addressing inequalities in physical health was not already established in social work discourse at the time of the Acheson Inquiry. However, in the intervening period, a major theoretical shift has occurred. Social work’s contribution to tackling inequalities in physical health has gained recognition as a crucial component of theorising social work’s engagement with inequality (Mullender, 1999; McLeod and Bywaters, 2000; Davies, 2002). The fundamental reasons why inequalities in physical health should be on social work’s agenda are that:

    inequalities in physical health are endemic among social work service users; and...

  18. THIRTEEN Challenging health inequalities: themes and issues
    (pp. 233-248)
    Elizabeth Dowler and Nick Spencer

    This book engages with the contemporary challenge of health inequalities in rich, industrialised countries, with particular focus on the UK, drawing on different disciplinary perspectives and policy instruments. It reviews the trajectories of problem analysis and policy responses following theIndependent inquiry into inequalities in health(Acheson, 1998) in England and Wales, which was set up and published early in the heady days of the new Labour government, elected in the UK with a landslide victory in 1997 on a mandate to reduce ‘unacceptable inequalities in health’ among other ills. Even at the time, the process of the inquiry, with...

  19. Index
    (pp. 249-256)