What is Health Inequality?
According to the Institute of Public Health (2016) health inequalities
can be described as preventable and unjust differences in health
status that are experienced by certain population groups.
The World Health Organisation (2016) understands that health
inequities are avertible inequalities in health between teams of
individuals inside countries and between countries. These
inequities arise from inequalities among and between societies.
Social and economic conditions and also their effects on
people’s lives confirm their risk of ill health and the actions that
are taken to stop them becoming unwell or treat illness once it
What Causes Health Inequality?
Buck and Maguire (2015) state that the health of individuals is determined by a complex mix of factors which include
income, housing and employment, culture and lifestyle and access to health care and other services.
Statistics from Barnado's (2016) indicate that over 25% of children living in the UK are living in poverty which is equal to 3.7
million children. 1.7 million of these children are living in what is known as severe poverty which affects just under 1/2 of
the total children living in poverty or around 12% of all children living in the UK.
The World Health Organisation (2016) states that there is ample evidence in that social factors which include education,
employment status, income level, gender and ethnicity have a marked influence on how healthy an individual is, In all
countries there are wide imbalances in the health status of different social groups. There is a correlation, the lower an
individual’s socio-economic position, the higher their risk of poor health.
Development theory has largely been concerned with inequalities in standards of living such as inequalities in
income/wealth, education, health and nutrition (Conceicao and Bandura, 2009).
What are the Effects?
Inequalities have many effects on health. According to Kawachi and Woodward (2000), It is well known amongst professionals that
social, cultural and economic factors cause substantial inequalities in health and they argue that individuals should be striving
to achieve a more even share of good health, beyond improving the average health status of the population. They state that
there are four arguments for the reduction of health inequalities.
1. Inequalities are unfair. Inequalities in health are undesirable to the extent that they are unfair, or unjust. Their view is that
inequalities become "unfair" when poor health is itself the consequence of an unjust distribution of the underlying social
determinants of health (for example, unequal opportunities in education for children).
2. Inequalities affect everyone. Conditions that lead to marked health disparities are detrimental to all members of society. Some
types of health inequalities have obvious spillover effects on the rest of society, for example, the spread of infectious diseases,
the consequences of alcohol and drug misuse, or the occurrence of violence and crime.
3. Inequalities are avoidable. Disparities in health are avoidable to the extent that they stem from identifiable policy options
exercised by governments, such as tax policy, regulation of business and labour, welfare benefits and health care funding. It
follows that health inequalities are, in principle, amenable to policy interventions.
4 Interventions to reduce health inequalities are cost effective. Public health programmes that reduce health inequalities can also
be cost effective. The case can be made to give priority to such programmes (for example, improving access to health care
in families with children) on efficiency grounds. On the other hand, few programmes designed to reduce health inequalities
have been formally evaluated using cost effectiveness analysis.
(Kawachi and Woodward, 2000).
The chart on the right represents the contribution of different factors to children’s health:
(Healthy People 2010, US Department of Health and Human Services, 2000)
Poverty and Health Inequalities
Gwatkin (2000) states that poverty and inequality are both predominantly factual concepts, equity is a question of values
and is closely associated with the concept that is social justice. When applied to health equity, it traditionally is
linked to the reduction of inequalities, inequity referring to differences in health considered unfair and unjust.
According to the Child Poverty Action Group (2016) some health issues that are associated with the effects of poverty are
'Poverty is also associated with a higher risk of both illness and premature death'.
'Children born in the poorest areas of the UK weigh, on average, 200 grams less at birth than those born in the richest
'Children from low income families are more likely to die at birth or in infancy than children born into richer families'.
'They are more likely to suffer chronic illness during childhood or to have a disability'.
Barnado's (2016) state that 3 year old children who live in households with incomes below about £10,000 are 2.5 times
more likely to suffer with a chronic illness than children in households with incomes above £52,000 and that infant
mortality is 10% higher for infants in the lower social group than the average.
Chadwick revolutionalised public health provision in the 19th century when he recognised the need for sanitary
conditions in a country ravaged by poor hygiene.
Black Report (1980)
The Black Report (1980) was commissioned by David Ennals in 1977 when he chaired an expert committee
investigating why the NHS had apparently failed to reduce social inequalities in health (BMJ, 2002).
According to Gray (1982) the UK Department of Health and Social Security published the Report of the Working
Group on Inequalities in Health also known as the Black Report (named after chairman Sir Douglas Black,
President of the Royal College of Physicians).
The Report showed in great detail the extent of which ill health and death are unequally distributed among the
British population, and suggested that these inequalities have been widening rather than diminishing since the
establishment of the National Health Service in 1948' (Gray, 1982).
The Black Report (1980) stated many recommendations for health equality including some which aimed to stamp
out poverty. Recommendations 24-27 were presented as first steps towards the abolition of child poverty
which were set as goals for the 1980s.
UK government and political parties at the time of the report resulted in the report receiving very little attention.
Acheson Report (1998)
Almost two decades passed since The Black Report was written before a newly-elected Labour government in 1997
placed a reduction in health and social inequalities high on the political agenda and another working group led
by Sir Donald Acheson was commissioned to examine the evidence, identify the issues and make
recommendations to the UK government (NHS, 2016).
The report by Acheson (1998) states that it was commissioned by the Minister for Public Health to review the latest
available information on health inequalities and 'summarise the evidence of inequalities of health and the
expectation of life in England and identify trends' basing the review on data from the Office for National Statistics
(ONS), the Department of Health (DH) and elsewhere.
The report was additionally commissioned to identify, in the light of the review, 'priority areas for future policy
development that are likely to offer opportunities for Government to develop beneficial, cost effective and
affordable interventions to reduce health inequalities' (Acheson, 1998).
According to Blane et al. (2003) 'The Inquiry's report and its recommendations were instrumental in fostering
widespread recognition that health inequalities need to be addressed, and that tackling their wider determinants
is crucial to this process'.
Wanless Report (2008)
'In March 2001 the Chancellor commissioned Derek Wanless to examine future health
trends and to identify the key factors which will determine the financial and other
resources required to ensure that the NHS can provide a publicly funded,
comprehensive, high quality service available on the basis of clinical need and not
ability to pay' (Department Of Health, 2008).
Because of his assessment of the National Health Service, according to The NHS
Confederation (2008) the 2002 budget included major increases in NHS spending until
the year 2008 from £57.1 billion to £90.7 billion in England alone. He was able to do this
through examining the demand and cost pressures in the NHS over the next two
decades and recommended the amount of spending needed for it to thrive.
His review, Securing Good Health for the Whole Population 'focused particularly on
prevention and the wider determinants of health in England and on the cost-
effectiveness of action that can be taken to improve the health of the whole population
and to reduce health inequalities' (Wanless, 2004).
Marmot Report (2010)
• According to Marmot (2010) in November of 2008 he was asked by the Secretary of
State for Health to chair an independent review to propose the most effective
evidence-based strategies for reducing health inequalities in England from 2010. The
strategy includes policies and interventions which address the social determinants of
• 'The Marmot Review into health inequalities in England was published on 11 February
2010. It proposes an evidence based strategy to address the social determinants of
health, the conditions in which people are born, grow, live, work and age and
which can lead to health inequalities. It draws further attention to the evidence that
most people in England aren't living as long as the best off in society and spend
longer in ill-health. Premature illness and death affects everyone below the top'
(Local Government Association, 2010).
Social Inequality and Child Health
Despite the scientific and technological advances of recent times and their impact on the delivery of quality
healthcare, major disparities in child health exist both between and within countries. Across the globe, over 25,000
children under the age of 5 die every day, the majority, but by no means all, in developing countries. Infant
mortality is 10 times higher in the world's least-developed countries than in the industrialized world, and under-five
mortality is 25 times higher (United Nations Children's Fund 2008). Vast discrepancies in child health also exist within
high and low income countries (Denburg and Daneman, 2010).
The American Psychological Association (2016) suggests that socioeconomic status (SES) is a key factor which
influences the quality of life for children. 'Increasing evidence supports the link between lower SES and negative
psychological health outcomes, while more positive psychological outcomes such as optimism, self-esteem and
perceived control have been linked to higher levels of SES for youth'.
Amick (1995) suggests that parents are often blamed for the health problems of children, however it is evident that
much of children's compromised potential has origins outside of family life and this failure has roots in social,
economic and environmental circumstances which affect children's health and well-being directly.
Bridging the Gap Between Rich and Poor
According to the London School of Economics and Political Science (2012) over
the past twenty years the rich have been getting richer and the poor have
been getting poorer and generally less able to improve their lot in life, however
there are now encouraging signs that policies to narrow the gap between the
rich and the poor are slowly beginning to take effect and people are now
more able to work their way out of poverty.
'The study, for the Joseph Rowntree Foundation, also concludes that the
introduction of Working Families Tax Credit in 1999 seems to have increased
employment and job retention, increasing the incomes of many low-income
families. There is also no evidence that employers have used WFTC to keep pay
increases down. This may have been helped by the simultaneous introduction
of the National Minimum Wage'. (LSE, 2012)
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