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E Exworthy, M Stuart, D Blane, M Marmot. (Pp 68; £14.95). The Policy Press, Bristol, 2003. ISBN 1-86134-504-6
A decade ago, the then British government shunned the very mention of the phrase “health inequalities”. Its successor, by contrast, began by commissioning the Acheson Inquiry (1998) and has since introduced a large number of policy initiatives across a number of government departments to reduce health inequalities. This useful book reviews in detail how three areas of policy highlighted by Acheson have been implemented so far (tax and benefit reform, performance management, and transport).
It is a short book that nevertheless touches on some large themes. To take an example: it is easier for governments to target identifiable deprived neighbourhoods than to target deprived people, many of whom live in affluent or middle income areas. The book acknowledges that such an approach to health inequalities is likely to fail in the long run (and that governments are more concerned with the short run).
Similarly, the authors show how the government’s approach seems to be based on economics rather than social justice: poor health is a poor use of human resources, and policies focus on employment and the future workforce (children) rather than, say, the quality of life of older people. The authors might have been more explicit about the government’s failure to promote policies such as progressive taxation and improving public transport.
The book will not cheer those who wish to see government policies evidence based. Robust evidence for the effectiveness of many of the policies is missing (an absence somewhat glossed over in the Acheson report), while the sheer number of initiatives means that the effectiveness of any one of them will be impossible to evaluate. It will not be possible to assess whether the policies as an aggregate have reduced health inequalities for some years to come. Inevitably, therefore, this book’s early intelligence is both very welcome and rather tantalising.
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