MEMORANDUM BY THE DEPARTMENT OF HEALTH PUBLIC
HEALTH (PH1) (contd.)
11. HEALTH INEQUALITIES
11.1 The Independent Inquiry into Inequalities
in Health, which the Government asked Sir Donald Acheson,
a former Chief Medical Officer, to chair, published its report
in November 1998. This identified the need to look at health inequalities
in terms of prevention and treatment and informed the development
of the Saving Lives: Our Healthier Nation White Paper.
Published alongside the White Paper, Reducing Health Inequalities:
An Action Report set out a wide range of action underway across
Government to tackle health inequalities.
11.2 The Modernisation Action Team on Prevention
and Inequalities, established in April 2000, will advise the Government
on how these issues should be handled. Its advice will be incorporated
in the National Plan to be published in July.
Action for the Department of Health
11.3 The four main targets in Saving
Lives correlate with health inequalities and so the health
of the worst off will be improved substantially by working towards
the targets. We are also taking action to ensure that there is
fair access to treatment.
11.4 There is currently a wide-ranging review
of the formula used to make resource allocations to health authorities
and PCGs/PCTs. The intention is for resource allocation to reflect
more fully the Government's wider social agenda; in particular
policies on reducing health inequalities, social exclusion and
fairness.
11.5 The National Priorities Guidance makes
it clear that the Government aims to improve health, reduce inequalities
and modernise services. The priorities include preventive objectives
that will improve public heath. The burden of diseases such as
CHD and stroke fall heavily on the most disadvantaged: targeted
action on prevention and treatment will also tackle inequalities.
The guidance integrates the health and health services agenda.
Ethnic Minority Health
11.6 The Department commissioned an independent
researcher, Ziggi Alexander, to do a scoping study of black and
minority ethnic issues in the DH, and published it in January
2000. We wanted someone outside the DH, but with relevant expertise
to make an assessment of how we were doing on race equality issues
across all aspects of the Department's work, and to identify gaps.
It is clear from this study and from evidence such as the interim
results of the Health Survey for England, published in June 2000,
that there are significant health inequalities across different
minority ethnic groups and that we are not yet doing enough to
meet their needs. From Ziggi Alexander's study and the Macpherson
Report, it is clear the DH will not achieve sustainable change
if we simply tackle "race" issues as a separate theme
or initiative.
11.7 The Department's intention therefore
is to address the needs of black and minority ethnic health communities
in everything we do as part of our programme of modernisation
and specific priorities for action; in other words to mainstream
such issues. This will ensure the delivery of high quality health
and social care services that are sensitive and meet the needs
of the diverse communities served.
11.8 The evolving structures and functions
arising from national strategies including: Modernising Government;
The New NHS: Modern, Dependable; Saving Lives: Our Healthier Nation
and Modernising Social Services White Papers will support
DH in mainstreaming race equality into all our service provision.
The DH published The Race Equality Agenda of the Department
of Health in January 2000, which set out a substantial plan
of action to address these issues. Effective mainstreaming of
race equality will involve a shift in organisational culture at
every level, and we recognise that these actions are the beginning
of what will be a long-term process of change.
11.9 Health and local authorities have a
common agenda in delivering seamless services for their ethnic
minority populations. For example, linkworkers, advocates and
interpreters, are appointed by Health Authorities and Trusts to
help professionals achieve better dialogue with the patients.
An adjustment to the resource allocation formula (the English
Language Difficulties Adjustment) means that Health Authorities
with large ethnic minority populations are fairly treated. The
number of linkworkers in the NHS has grown steadily, and more
are being funded as part of the mainstream work of the NHS.
11.10 The Performance Assessment Framework
and the National Service Frameworks (see paragraph 4.3 onwards)
for mental health and coronary heart disease are being used to
set national standards and define service models for black and
minority patients, and are helping to provide opportunities to
monitor how local needs are being addressed.
Healthier Prisons
11.11 Improving the health of prisoners
and their families is important to the Government's commitment
to reduce inequalities and narrow the health gap; it should help
encourage rehabilitation and contribute to a reduction in re-offending.
A strategy is being developed to encourage health improvement
in prisons, bringing together policy and practice to:
(i) develop the health of prisoners;
(ii) prevent the deterioration of prisoners'
health during or because of custody; and
(iii) encourage prisoners to adopt healthy
behaviours that can be carried back into the community.
11.12 To help deliver on this strategy prisons
and Health Authorities are jointly assessing prisoners' health
needs at establishment level. These assessments will feed into
Health Improvement Plans. The work is being steered by the Prison
Health Policy Unit and Prison Health Task Force. The Policy Unit
is also a WHO Collaborating Centre for the 14 nation Health in
Prisons project.
Infant Mortality
11.13 The Government acknowledges the importance
of improving child health and of reducing inequalities in infant
mortality. (see Annex A).
Oral health
11.14 There are strong links between poor
levels of oral health and social deprivation. Strategies to improve
oral health should be part of planning in HAZs working closely
with other initiatives including Employment Action Zones, Healthy
Living Centres and Education Action Zones. Health Improvement
and Community Plans should address oral health issues (see Annex
B).
Action across Government
11.15 Saving Lives makes clear that
because the root causes of ill health are so varied, we cannot
deal with them by focusing on "health" alone. We must
tackle in the round all the things that make people ill. Action
must be taken across Government—and through partnership
between the various local and regional organisations in England—to
reduce health inequalities as discussed above.
11.16 The New Deals, Sure Start,
action on social exclusion, education reforms, the national minimum
wage, tax and benefit reforms and the Government's commitment
to strategic policies on transport and the environment—together
with Health Action Zones, Education Action Zones and Employment
Action Zones—form a critical mass of policies that are finally
beginning to tackle inequalities in health. Policies on housing,
transport, crime and the environment will help to improve public
health. Action is underway across government to tackle inequalities
and address the wider determinants of health. Examples include:
— The New Deals (Employment, Communities
etc).
— Working Families Tax Credit.
— Minimum Pension Guarantee.
— A cut in VAT on domestic fuel.
— £100 winter fuel allowance for
every pensioner household.
11.17 It is clear that changes are not going
to happen overnight, but local Health Authorities are being required
to make the reduction of health inequalities part of their Health
Improvement Programmes. However, the message is clear: the Government
is committed to tackling the underlying problems associated with
inequalities and the action it is taking is at the centre of social
policy.
11.18 Opportunity for All: Tackling Poverty
and Social Exclusion, the Government's First Annual Report
published in September 1999, demonstrates a significant contribution
to tackling two of the major determinants of health and health
inequalities and reinforces the goal to end child poverty in twenty
years (SEU lead on DSS Poverty and Social Exclusion Work)
11.19 A report to the Prime Minister by
the Cabinet Office, Sharing the Nation's Prosperity: Variations
in economic and social conditions across the UK, demonstrates
that the economic and social divide is not a straightforward north/south
issue, but is dependent upon variations within as well as between
regions.
11.20 The Prime Minister has set five key
modernisation challenges—one of these is to focus the NHS
on what it can do to tackle health inequalities and the causes
of ill health. This will form part of the National Plan for the
new NHS in July.
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