Can we reduce health inequalities? An analysis of the English strategy (1997-2010)

Abstract

International audience ; Background England has been the first European country to pursue a systematic policy to reduce socioeconomic inequalities in health. This paper assesses whether this strategy has worked, and what lessons can be learned. Methods Review of documents. Analysis of entry-points chosen, specific policies chosen, implementation of these policies, changes in intermediate outcomes, and changes in final health outcomes. Findings Despite some partial successes, the strategy failed to reach its own targets, i.e. a 10% reduction of inequalities in life expectancy and infant mortality. This is due to the fact that it did not address the most relevant entry-points, did not use effective policies, and was not delivered at a large enough scale for achieving population-wide impacts. Interpretation Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the over-all targets. Funding None