Health Inequalities: Progress and Next Steps a critical response

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Health Inequalities Progress and Next Steps a
critical response

• Alex Scott-Samuel
• EQUAL Equity in Health RD Unit
• University of Liverpool

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Health inequalitiesUnfair or unjust differences
in health determinants or outcomes within or
between defined populations

• Equity in health
• Distributional justice from each according to
  their abilities, to each according to their needs

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Fundamental causes of health inequalities

• Phelan JC, Link BG et al. Fundamental Causes of
  social inequalities in mortality a test of the
  theory. Journal of Health and Social Behavior
  2004, 45,
• 265285

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Link and Phelans fundamental causes of health
inequalities

• Health inequalities are caused by inequalities
  in
• power
• money
• prestige
• knowledge
• beneficial social connections

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Useful concepts

• Causes of inequalities upstream and downstream
• Focus of inequalities policies - universal and
  selective / targeted

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Refocusing upstream
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Why are current policies for tackling health
inequalities ineffective?

• upstream policy based evidence making which
  disregards health equity
• outcome focused, selective / targeted health
  policy solutions
• downstream focus sustains inequalities through
  greater impact on poor of competing health
  risks
• differential diffusion of knowledge and of policy
  uptake continues unchallenged

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Health Inequalities Progress and Next Steps
promising signs
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Health Inequalities Progress and Next Steps
promising signs
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Health Inequalities Progress and Next Steps
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Prescriptions for effective health inequalities
policy

• Acknowledge impact of all upstream determinants
  of health inequality
• Make effective though targeted policies available
  to all and introduce future policies universally
• Augment individualistic inequalities policies
  with structural ones starting with the NHS

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Structural policies in the NHS

• welfare rights advice in all primary and
  secondary care settings
• abolition of prescription, dental and optical
  charges
• cheap bedside telephones and free car parking in
  hospitals
• reductions in NHS income inequalities

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Dr Alex Scott-SamuelEQUAL - Equity in Health
RD UnitDivision of Public HealthUniversity of
Liverpoolalexss_at_liverpool.ac.uk