Policies to tackle inequalities in child health: why haven't they worked (better)?
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
- Correspondence to Catherine Law, MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK;
- Received 12 August 2011
- Accepted 23 November 2011
- Published Online First 21 December 2011
The UK Labour Government that came to power in 1997 had issued a pre-election promise to investigate and tackle inequalities in health.1 The new government also championed policies to promote children's well-being and life chances. Both policy stances were in stark contrast to those of the preceding administration, under whom child poverty had risen to record levels2 and inequalities in mortality had widened.3 Such stated commitments to both children and equity were unprecedented and so it is particularly important to assess whether these commitments, and the policies which flowed from them, resulted in a reduction in child health inequalities, and if not, why not.
The new direction in policy for health inequalities stimulated commentary and analysis.4,–,7 Recently, Johan Mackenbach, a respected Dutch commentator on health inequalities, has analysed the overall strategy to reduce inequalities under the Labour Government (1997–2010). He argues that, despite being the first European country to adopt a ‘systematic policy’ to reduce health inequalities, England's strategy did not succeed, and he offers a number of explanations for this.8 9 In this paper we focus on how the Labour Government's strategies for children, as well as health inequalities, impacted on child health inequalities.
Health inequalities are the “virtually universal phenomenon of variation in health indicators (eg, mortality rates…) in association with socioeconomic status and ethnicity”.10 (Such variation can also occur by other characteristics such as gender, age and disability, but the focus of this paper is socioeconomic inequalities, reflecting that of the Labour Government.) Inequalities in health are largely preventable, and therefore, unfair.11 They are particularly unjust for children, to whom any emphasis on individual responsibility for health (as opposed to a social determinants approach) should not apply. Children cannot, for instance, exercise personal responsibility for their …