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Richard Mitchell and Professor Daniel Dorling from the University of Leeds and Dr. Mary Shaw from the University of Bristol on the parliamentary constituencies of Britain revealed a number of social policy scenarios. The study traced the impact of the variations to society that might be brought through the effective execution of three social and economic policies. Firstly, they examined the efficacy of the policy of modest redistribution of wealth to counteract the health inequalities. During the decades 1980s and 1990s there were a considerable variation in the wealth possessions of rich and poor reflected in the major variations in their health enumerated by mortality rates. The study revealed that by returning to the inequalities in wealth of 1983 about 7500 deaths annually could have been prevented. (Reducing health inequalities in Britain)
The study assessed the impact of such policy to be most effective in the Birmingham Ladywood constituency in the West Midlands and found that in the early 1990s, 275 constituents under the age of 65 years died per annum which is estimated to be 93 more than that of the national average of 182. Out of such 93 excess deaths 17 are assessed to be due to poverty in manual working classes and inequality of wealth and income. The policy entailing redistributive effect could have reduced the differences in life chances to this effect. Second is the policy for attainment of full employment that implies that people may be temporarily in jobs, no one is in loner term receipt of unemployment benefit. The studies in Birmingham Ladywood constituency revealed that about 8800 people were found unemployed during 1990 having vulnerable to death prior to attaining the age of 65 years and it has been estimated that the 14 out of 93 excess deaths are only due to such unemployment.
The policy of full employment could have prevented deaths to such an extent. Thirdly, it is believed that about one-third of the children in Britain live in poverty and it is their stated objective to bring those children out of poverty. It aims at enhancing the life chances of the 20% of children whose parents work in the most poorly paid occupations those were raised to equate those of their peers not living in poverty. The impact of this policy on Birmingham Ladywood constituency would prevent about 8 of the children in the age group of 0-14 years out of the 93 excess deaths. In this manner, the three policies combined tantamount to the saving of 39 lives out of the 93 excess deaths. (Reducing health inequalities in Britain)
Concentrating on all these facts the British Government initiated the most complete program ever formulated in the nation to handle and solve health inequalities. The Department of Health with the cooperation of 11 other Departments of the Government committed to reduce health inequalities and brought out the policy document 'Tackling Health Inequalities: A Program for Action' during the year 2003. The Public Service Agreement in this regard is to reduce the inequalities in health outcomes by 10% by 2010 in terms of infant mortality and life expectancy. Such a broad objective is aimed to be attained by achieving two particular detailed objectives, firstly, to reduce by at least 10% in the gap in mortality between routine and manual groups and the population as a whole in case of the children under one year by 2001 and secondly, to reduce by at least 10% the gap between the fifth of areas with the most low levels of life expectancy at birth and the population as a whole among the local authorities, by 2010. (Introduction to health inequalities)
It has been emphasized that the primary requirement for achieving the targets of the PSA is to work in partnership and to address the various inherent causes of health inequalities in collaboration. In response to the Treasury-led cross cutting review of health inequalities made in 2002 a small team in the Department of health with cross government concentration was established. The functioning of this Unit was remolded with the objective and targets of Public Service Agreement of reducing inequalities in health outcomes. (Introduction to health inequalities) The task of the Health Inequalities Unit is concentrated on the drive delivery of the government commitments outlined in the program, stressing upon their implementation and that they attain the required results essential to attain the PSA health inequalities objective. (Programme for Action overview and documents)
The program envisaged a clear practical strategy seen to be evidence based in targeting resources and efforts in case of the four delivery mechanisms: firstly, supporting the families, mothers and children; secondly, engaging the support of communities and individuals; thirdly, preventing illness and providing efficient treatment and care and finally, dealing with the underlying determining factors of health. The Program for Action at the first instance strived to strengthen the support for mothers, families and children especially in the early years along with further enhancing the scope for children and young people. The primary efforts in this direction are Sure Start, inclusive of local programs and nursery places for all the children in the age group of three to four years, the emergence of Child Tax Credit, and the emerging children's NSF. (Programme for Action overview and documents)
The Program for Action then concentrated on the recommendation made in the Acheson Inquiry Report of preventing illness and providing effective treatment and care that emphasized on the fact that the major achievements in reducing health inequalities can be achieved from tackling those health problems that result most commonly among the disadvantaged populations and those are amenable to efficient prevention and treatment. The Program for Action concentrated on strengthening of disadvantaged communities and strengthening of individuals ensuring that within a decade or two no body is seriously disadvantaged or affected by where they live. The Acheson Inquiry Report concentrated on the necessity for effective interventions to broad impacts on health inequalities. Government Departments were impressed upon to address such inherent determinants like improving the quality of housing, tackling joblessness and inactivity, bettering education attainment and dealing with low basic skills. However, attaining of better health returns it is essential to have stronger links between such areas. By taking concerted action by means of joined up policy making and implementation across departmental boundaries there seems a possibility of narrowing the gap in health outcomes. (Programme for Action overview and documents)
Mark Exworthy and colleagues at University College of London inquired into the impact on policy formulations made in line with the recommendations of Acheson Commission. They could find out that in almost all the Government Departments there existed a considerable amount of activity associated with tackling health inequalities incorporating commissioning of the independent inquiry into inequalities which prevailed in Health. Such policies have effectively dealt with the most of the recommendations in the Inquiry report. The policy formulation was concentrated across the central government. Initially, the policies were dissimilar and identified by funding challenges and one-off initiatives that could be isolated from the mainstream activities. However, they are presently become more systematic and coherent. The new mechanisms and structures are according more stress on systems and processes that back policies to reduce health inequalities. (Tackling health inequalities since the Acheson Inquiry)
However, such steps are necessitated to join up and embed such policies more fully into the mainstream policy, planning and provisions. This is evident particularly in two national objectives of dealing with health inequality i.e. The new Public Service Agreements -- PSAs coming out of the 2002 Spending Review, the Department of Health's Consultation on a plan for delivery and the Treasury's Cross-cutting spending review on health inequalities of 2002. Most of the government Departments have acknowledged the relevance of their existing and new policies for addressing the health inequalities. However, the study identified many scopes for improvement in policy making across government in achieving the goal, such as, better utilization of prevailing information and evidence, detection and rectification of insufficiency in data, promoting of more efficient 'joined up' working among and inside departments by means of central co-ordination, increased interdepartmental co-operation, increased scrutiny mechanisms and greater budget flexibility.
It also emphasized on the adequate provision of support for officials and ministers those work across departmental boundaries by means of developments in skills and capacity, and incentives for career promotion. Irrespective of the fact that much progress have been made in the sphere of policy formulation in line with the Acheson Inquiry recommendations the study indicated three primary weaknesses, such as deficiency of appropriate mechanism to promote and ensure progress in the policies to address the health inequalities, a necessity for independent, regular evaluation of the progress of policies in terms of their influence on individuals, intermediate markers of progress and targets and a necessity to formulate and collate research studies on successful interventions and returns. (Tackling health inequalities since the Acheson Inquiry)
Health inequalities kill thousands" (27 September, 1999) Retrieved at http://news.bbc.co.uk/1/hi/health/456807.stm. Accessed 3 September, 2005
Introduction to health inequalities" Retrieved…[continue]
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