If we look at the distribution of household income in the UK , post tax and benefits it looks something like this - where this is the mean income of household in the poorest quintile and these are the mean incomes of household in the richest quintiles- The distribution is continuous but positively skewed . The mean income of the top quintile is surprisingly low considering the level of income amongst the very rich. The top of the skew goes a very long way up. If Geoffrey Rose was right in thinking that if variables are continuously distributed like this high risk approaches - all those which focus on the poor -are likely to be inefficient It seems to me that is entirely consistent with what this figure makes obvious - that disparity in income is almost entirely determined by the very rich. The disparity between the very poor and the rich is not that great. So it would seem odd, on two counts, that all the public health effort to combat social inequalities is focused down here.
How can our Labour government’s health inequalities targets become achievable?
Socialist Health Association conference How can our Labour government’shealth inequalities targets become achievable? Alex Scott-Samuel EQUAL - Equity in Health R & D Unit Department of Public Health University of Liverpool
Health inequalities Unfair or unjust differencesin 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 capitalismunequal 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 democracyRegulated / 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 incomePeter Hain, interview with Jackie Ashley, Guardian, March 17th 2003
Targetsshould emerge from the values and the objectives within a strategy
Health inequalities strategy - what health inequalities strategy?• Reducing Health Inequalities: anAction Report• New CommItment to Neighbourhood Renewal - National Strategy Action Plan• Cross Cutting Spending Review onHealth Inequalities
Mean household income in quintile groups post tax and benefits 1997-8£8430 £15,330 £33,590 £11030 £20,120 Social Trends 29 ONS, London
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) requiresocial 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 unaffordableWhitehead 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 2002www.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 2The 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. WARNINGCannabis is widely regarded as harmless but the long term effects of New Labour are unknown.