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Mackenbach has thoughtfully and objectively critiqued the effect of the English 1997–2000 strategy to reduce health inequalities.1 His analysis (consistent with others) is sobering; held up against endpoint targets of reducing inequalities in life expectancy and infant mortality, the strategy has not succeeded, despite a large government investment and effort that surpasses any other (European) country. However, it might be that inequalities would have deteriorated even further in the absence of the English strategy.
Mackenbach proposes three ingredients for the way forward: more and better advocacy to ensure governments have the mandate for more fundamental policy shifts (eg, income redistribution); more research on the differential effectiveness of interventions; better and more focused policy planning and implementation, matching activity with modifiable and influential determinants of health inequalities. In this commentary, we provide some reflections on Mackenbach's analysis and recommendations from the antipodes of New Zealand.
New Zealand had a centre-left government from 1990 to 1999 that also attempted to address health inequalities—albeit not to the same extent of budget, planning and monitoring as England. Activities ranged from fresh fruits and vegetables in deprived schools …