how can our labour government’s health inequalities targets become achievable?
DESCRIPTION
Alex Scott-Samuel 2003TRANSCRIPT
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.