CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
• The (1980) Black Report, which is described by Benzeval (2002) as “by far the most significant event in recent
history” in the UK’s “long [150 year] history of conducting research on health inequalities”. This formative
report described how “lowest employment-level groups showed a greater likelihood of suffering from a wide
range of diseases and dying prematurely from illness or injury at every stage of the life cycle” and concluded
that “the material conditions under which people live their lives: availability of income, working conditions, and
quality of available food and housing, etc. were the primary determinants of these findings” (Raphael & Bryant,
2006; see Black & Smith, 1992). While the Report had little immediate impact under the Thatcher and Major
Conservative Governments (1979-1997), it would later come to play a significant role in shaping research and
policy developments in the succeeding Labour Government era (1997-present).
• One month into the new Labour Government’s first tenure, the first-ever Minister for Public Health in England
launched the development of a new health strategy - Saving Lives: Our Healthier Nation - that had
'tackling inequalities’ at its heart. Having as one of its two aims “to improve the health of the worst-off in
society and to narrow the health gap'” , the final Saving Lives policy document of July 1999 not only
addressed the social causes of ill-health and inequalities but specifically noted that “tackling inequalities
generally, is the best means of tackling health inequalities in particular” (cited in Benzeval, 2002, p.205; see
Saving Lives 1999). In response to criticisms that this strategy failed to set national targets for the reduction of
health inequalities, a new and revised strategy - NHS Plan: a Plan for Investment, a Plan for Reform - was
developed by the Department of Health in July 2000 that introduced its first national target: 'to narrow the
health gap in childhood and throughout life between socioeconomic groups and between the most
deprived areas and the rest of the country' (ibid.; citing UK Department of Health, 2000).
• In July 1997, Sir Donald Acheson was asked to chair an Independent Inquiry into Inequalities in Health to
'identify priority areas for future policy development…to reduce health inequalities' (Acheson, 1998). The
subsequent Acheson Report, published in 1998, considered a wide range of evidence on contributing health
determinants and concluded in its synopsis, in a manner echoing the findings of the (1980) Black Report:
• The weight of scientific evidence supports a socioeconomic explanation of health inequalities. This traces the
roots of ill health to such determinants as income, education and employment as well as to the material
environment and lifestyle (Acheson, 1998; cited in Raphael & Bryant, 2006).
The Report offered 39 main recommendations over 13 areas which spanned a range of health determinants including
“poverty, income, tax and benefits; education; employment; housing and environment; mobility, transport and
pollution, among others” (ibid.). Of these recommendations, the Inquiry Committee argued that three were
particularly crucial:
• All policies likely to have an impact on health should be evaluated in terms of their impact on health
inequalities.
• A high priority should be given to the health of families with children.
• Further steps should be taken to reduce income inequalities and improve the living standards of poor
households (Acheson, 1998).
Among the major policy initiatives to arise in response to the Acheson Report was the UK Department of Health’s
(1999) Reducing Health Inequalities: An Action Report. Benzeval (2002) distinguishes this action plan as the first
UK government action plan to officially acknowledge the wide range of social policies influencing health
inequalities and the first to treat such policies as suitable arenas for government action. Reducing Health Inequalities
for instance emphasized the need to tackle 'the causes of poverty and social exclusion, not just the symptoms'
(Department of Health, 1999).The major themes and corresponding policy initiatives pursued in this action strategy
are listed in Box 3.1 as follows:
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