England is the largest nation that forms part of the United Kingdom with a population of 50,2 million inhabitants. It operates as a parliamentary democracy within a constitutional monarchy. The UK joined the EU in 1973 and since then its economy has gone onto become one of the largest in the EU with an increasingly services-based focus, although it maintains industrial capacity in high-tech and other sectors. The City of London is a world centre for financial services. The United Kingdom voted to leave the EU in a referendum on 23 June 2016 and is due to leave the EU on 30 March 2019.
Its welfare model derives from a liberal regime, where state influence is weaker than that of the market and modest benefits are in place. In the English system a model was developed, the so called Beveridge system, that is based upon the principle of universal access to care that is free at the point of use. Healthcare in England is mainly provided by England’s public health service, the National Health Service, which provides healthcare to all permanent residents of the United Kingdom is paid for from general taxation.
The issue of health inequalities has been researched for a significant period of time in England. The Black Report (1980) was the first major report to demonstrate the correlation between poverty and health. Although it was shelved for political reasons by the Conservative government, it is still an important historical milestone. Following the election of New Labour in 1997 social justice emerged as a key political commitment together with an explicit emphasis on tackling health inequalities. The Independent Inquiry into Inequalities in Health Report (1998) by the Department of Health to review the evidence on inequalities in health in England proved to be of major national and international significance and led to further action in the area of health inequalities.
Health inequalities have been high on the agenda of politicians in England since New Labour came into power in 1997. Since then the issue of health inequalities has become a shared responsibility across government. An aspect that has changed over the years is that policy responses in England have progressed from a centralised to decentralised approach with more power for regions and local authorities. Public Health programmes are moving from NHS coordinated initiatives to local government actions, which are addressing specific needs of certain areas of the country and/or population groups. The direction of initiatives is thus coming from the national level, while the action is taking place at the lower level. It is expected that this trend will continue in the future.
The Health and Social Care Act 2012 is the most extensive reorganisation of the structure of the National Health Service in England to date. The act removed responsibility for the health of citizens from the Secretary of State for Health, which the post had carried since the inception of the NHS in 1948. It abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) and transferred between £60 billion to £80 billion of “commissioning”, or health care funds to several hundred “clinical commissioning groups”, partly run by the general practitioners (GPs) in England but a major point of access for private service providers. A new executive agency of the Department of Health, Public Health England, was established under the Act on 1 April 2013.
An overview of policy responses addressing health inequalities in can be found in our Policy Database.
An overview of projects and initiatives that are currently taking place or that have successfully been finalized, and that are addressing health inequality issues, can be found in our Project Database.
Please find below an overview of key actors in England working on health inequality issues:
- NICE National Institute for Health and Clinical Excellence. NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.
- Association of Public Health Observatories (APHO). It represents and co-ordinates a network of 12 public health observatories (PHOs) working across the five nations of England, Scotland, Wales, Northern Ireland and the Republic of Ireland. It is the focus for joint public health intelligence work with organisations across these nations, and those working in Europe and beyond.
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Please find below an overview of relevant documents addressing health inequality issues in England. Further publications can be found in our Publications Database.
- Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010. Marmot Review. In November 2008, Professor Sir Michael Marmot was asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities.
- Tackling Health Inequalities: 10 Years On (2010). A review of developments in tackling HI in England over the last 10 years, examines the changes in policies, determinants and outcomes that have shaped HI in England over the last 10 years and sets out the key lessons and challenges. It provides the context and background for the recently announced post 2010 strategic review of HI commissioned to look forward to 2020 and beyond.
- Healthy Communities resource. This website explores local government’s role in supporting health improvement and tackling health inequalities. The Healthy Communities web resource will support local councils by providing them with information and advice ranging from latest news, policy guidance and events to JSNAs and best practice in exercising strong leadership, working in true partnership and delivering integrated health improvement.
- House of Commons Select Committee on Health: Report on Health inequalities (2009)
The House of Commons Select Committee on Health, reporting on Health Inequalities in early 2009, concluded that although health in the UK was improving, in the previous ten years inequalities between the social classes had widened, as well as between the two genders and different ethnic groups. The Committee also noted that elderly people and those suffering from mental health problems or learning disabilities also have worse health than the rest of the population.
- Health Inequalities: progress and next steps (2008). This document outlines the Government’s approach to hit the 2010 health inequalities Public Service Agreement targets, assessing what has and has not worked, and setting the direction of travel beyond 2010. The partial equality impact assessment sets out some of the current health inequalities and potential interventions to reduce and eliminate these inequalities.
- Addressing Health Inequalities: A guide for general practitioners
- Systematically Addressing Health Inequalities. Department of Health.
- Public Health White Paper 2010. Department of Health
- Our Health and Wellbeing Today 2010. Department of Health
Health and Social Care Act 2012 Department of Health
- Inclusion Health. Department of Health
- How doctors can close the gap. A publication by the Royal College of Physicians London.
- As part of their main website called NHS choices , The National Health Service (NHS) has set up a page dedicated to both gay, lesbian and bisexual users of health services, and another one for transgender users. There they provide key information related to mental and sexual health, tobacco and drugs consumption, alcohol abuse, gender identity clinics, parenting and coming-out. Helping these individuals, the site also serves as a critical source of information that is available for healthcare professionals dealing with individuals experiencing these types of issues.
- The Liverpool based Armistead Centre is hosting health services for LGBT users in NHS Liverpool Community Health. Their aim is to raise awareness on the health needs of LGBT people, increase their access to health services and improve their health outcomes. Through its BOLD group (Be Out with Learning Difficulties) it also offers services to diverse range of users including young and older LGBT people, their parents and LGBT people with learning.
Are you aware of any other key resources that should be added to this list?
Please let us know!