Key points
- Different groups in the population vary in terms of the rate at which they suffer from health problems, their life expectancy, and the ease with which they can access health services. These gaps are known collectively as health inequalities.
- Health inequalities exist between different groups in the population, for example, between socioeconomic groups, ethnic groups and between women and men. Life expectancy and other measures of health can vary strongly between different geographical areas as a consequence of differing socioeconomic profiles. For example, in London the life expectancy of the local population falls by one year with each station along the Jubilee line between Westminster and Canning Town, and in Glasgow there is a divide of 28 years in life expectancy between the richest and poorest areas.
- Health inequalities are created and maintained by a variety of factors. Environmental factors beyond the individual’s immediate control play an important role as well as individual lifestyle choices – in particular, varying rates of smoking between different groups. Researchers disagree on which factors are most influential: some emphasise the material conditions in which a person lives, others stress the importance of social and psychological factors and others identify lifestyle choices as the most significant factor.
- There is evidence of inequality in terms of the accessibility and quality of health services provided to different groups. Health professionals therefore have some power to influence health inequalities, although many of the contributing factors lie beyond the scope of health services.
- In 2001 the then Labour government set high-profile targets to achieve 10 per cent reductions in two areas by 2010: in infant mortality rates between socioeconomic groups, and in life expectancy between those living in deprived areas and the general population. Although overall infant mortality rates have decreased and life expectancy increased across all groups, the gaps between groups have not been closed. Our review of NHS performance from 1997 to 2010, published in April last year, identified the lack of progress in reducing health inequalities as the most significant health policy failure of the last decade. These targets have recently been abolished by the coalition government, but the final set of data relating to these targets will be published in October 2011.
- To inform future strategy on health inequalities after 2010, the previous government commissioned Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010, a major review into health inequalities, led by Professor Sir Michael Marmot. This report emphasised the role of a healthy start in life, education, employment, welfare programmes and pro-active prevention to address health inequalities and recommend broad-based action on these.
- The coalition government proposes a new 'health premium' designed to 'promote action to improve population-wide health and reduce health inequalities' as part of a ring-fenced public health budget (however, the weighting given to health inequalities in the formula for allocating NHS funding has been reduced from 15 per cent to 10 per cent, correct as of September 2011). There will be new duties on the Secretary of State, NHS Commissioning Board and clinical commissioning groups to have regard to the need to reduce health inequalities. More details on the coalition’s proposals will be published in a series of public health papers throughout autumn 2011.
