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The Acheson report: challenges for the College
  1. N J Spencer
  1. Professor of Child Health, School of Postgraduate Medical Education and Department of Social Policy and Social Work, University of Warwick, Coventry CV4 7AL, UK
  1. Professor Spencer. email:n.j.spencer{at}warwick.ac.uk

https://doi.org/10.1136/adc.80.6.576

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    The Acheson report “Inequalities in health: report of an independent inquiry”,1 has been published 18 years after the Black report (“Inequalities in health: report of a research working group).2 This 18 year period has seen an increase in income inequality in the UK: 24% of the population had an income below half the average after housing costs in 1995–96 compared with 7% in 1977.3 Families with children have been hardest hit: 31% of children live in households with less than half the average income after housing costs3 and more than one million children live in families without a wage earner.

    This article aims to open a debate among paediatricians and within the Royal College of Paediatrics and Child Health. The evidence for the adverse effects of poverty on child health is overwhelming4 and the Acheson report, with its explicit focus on maternal and child health, offers an opportunity to use the College’s considerable influence to advocate for government policies that reduce poverty among families with children.

    The Acheson report’s findings and recommendations on maternal and child health

    In common with Black, Acheson adopts the socioeconomic model of health and its inequalities, which traces the roots of ill health to such determinants as income, education and employment, as well as the material environment and lifestyle. Three crucial areas are identified:

    • 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 health of families with children

    • further steps should be taken to reduce income inequalities and improve the living standards of poor households.

    Priority is given to families with children because childhood is seen as a critical and vulnerable stage where poor socioeconomic circumstances have lasting effects. In addition, interventions related to parents, particularly present and future mothers, and children are …

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