Divergence or convergence? Health inequalities and policy in a devolved Britain

Abstract

Abstract:Since the advent of political devolution in the UK, it has been widely reported that markedly different health policies have emerged. However, most of these analyses are based on a comparison of healthcare policies and, as such, only tell part of a complex and evolving story. This paper considers official responses to a shared public health policy aim, the reduction of health inequalities, through an examination of the national policy statements produced in England, Scotland and Wales since 1999. Our findings differ from existing analyses, raising some important questions about the actuality of, and scope for, policy divergence since devolution.

“Never mind the logic, give me the numbers”: Former Australian health ministers' perspectives on the social determinants of health

“…This is consistent with Tesh All the health ministers consistently stressed the extent to which the power of organised professions within health, especially the medical profession, drove the health policy agenda and captured their attention, confirming other research which points to 'medical dominance' (Smith et al, 2009;Busfield, 2010). Medical power was evident across each of Kingdon's streams.…”

Fantasy paradigms of health inequalities: Utopian thinking?

“…As a result, many governments across the world have, at minimum, a rhetorical commitment to the reduction of health inequalities (see Commission on Social Determinants of Health, 2008 for an overview). In some countries, notably the UK, such policies may even acknowledge that the causes of health inequalities rest with material and social factors such as poverty, poor housing and social exclusion (Smith et al, 2009). It is, however, exceptional for national inequality reduction strategies to include more than a brief acknowledgement of these meso-level factors and even rarer to find an analysis of the causal pathways that result in the unequal distribution of these factors; the 'upstream' macro-level determinants shaping the structure of society.…”

“…It is, however, exceptional for national inequality reduction strategies to include more than a brief acknowledgement of these meso-level factors and even rarer to find an analysis of the causal pathways that result in the unequal distribution of these factors; the 'upstream' macro-level determinants shaping the structure of society. Indeed, when it comes to setting out visions for reducing health inequalities such strategies tend to provide a list of interventions that focus almost entirely on 'downstream' (proximal) health determinantssuch as smoking, unhealthy dietary choices, poor housing conditions, or failure to use contraception -implying that it is the social patterning of these factors which represent the causes of health inequalities (see Popay et al, 2010;Smith et al, 2009;Smith, 2013a).…”

“…Hence, despite the fact that official government documents and speeches have repeatedly, since 1997, acknowledged the underlying social and economic causes of health inequalities, they have also, as many researchers have noted, advocated the idea that health inequalities can be effectively reduced via short-term individual action (see, for example, Smith et al, 2009;Popay et al, 2010). This paradigm has been promoted and reproduced by a large body of state / third sector employees, who have developed diverse plans and projects, supported by public and other funds, to implement a wide range of downstream, outcome-focused activities in the name of reducing health inequalities.…”

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“…Whilst different approaches to performance assessment and targets were therefore clearly visible in the three countries, the discourse and thematic analysis of key policy documents suggests that this did not appear to inspire significantly different policy thinking about health inequalities at a national level 15 . Instead, a remarkably similar story emerged from this strand of the research.…”