How can our Labour government’s health inequalities targets become achievable?

Socialist Health Association conference

How can our Labour government’s

health inequalities targets become achievable?

Alex Scott-SamuelEQUAL - Equity in Health R & D Unit

Department of Public Health

University of Liverpool

Health inequalities

Unfair or unjust differences

in health determinants or outcomes within or between defined

populations

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

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

Social democracy

Regulated / managed capitalism: capitalism ‘as if people (in one’s own country) mattered slightly’

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

Targets

should emerge from

the values and the objectives within a

strategy

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

Mean household income in quintile groups

£11030

£15,330

£20,120£33,590£8430

Social Trends 29ONS, London

post tax and benefits 1997-8

Labour’s inequality strategies

• selectivist, high-risk strategies - ie not inequality strategies at all

• midstream strategies

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

'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

Policy based evidence making

• teenage pregnancy

• the UK Cross Cutting Spending Review (CCSR) on Health Inequalities 2002

www.doh.gov.uk/healthinequalities/tacklinghealth.pdf

CCSR - policy based evidence making

‘political and bureaucratic

considerations loomed larger than research

evidence’

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

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

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.