I dreamed a dream: England reduces health inequalities and wins the world cup

✍ Scribed by Stephen Birch

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 73 KB
• Volume: 19
• Category: Article
• ISSN: 1057-9230
• DOI: 10.1002/hec.1637

✦ Synopsis

Fair Society, Healthy Lives: Strategic review of health inequalities in England post 2010 (The Marmot review) is the latest report on social inequalities in health to emerge from the United Kingdom. Like attempts to win the football (soccer) world cup, strategies for reducing health inequalities happen every few years in England and have generally had the same lack of success. Commissioned by the Secretary of State for Health in England to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010, the terms of reference covered identifying evidence most relevant to future policy for reducing health inequalities, translating evidence into practice and advising on possible objectives and measures for policies. The result is a 242 page report produced by the team of 11 commissioners (hereafter referred to as the England XI) 'captained' by Michael Marmot with a substantial backroom staff of individuals (Strategic review of health inequalities in England post 2010, 2010).

Setting aside the rather odd subtitle to the report (how can individuals reporting at the start of 2010 review health inequalities post 2010 without the help of a time machine?), the starting point for the report is the normative position that health inequalities which are preventable by reasonable means are unfair and that 'putting them right' is a matter of social justice. From this emerges a 'central ambition' to 'create conditions for people to take control over their own lives'-something akin to Fantine's dream in Les Miserables. The report documents a vast evidence based on social inequalities in health in the UK that have persisted and even increased despite over 60 years of a comprehensive publicly funded healthcare system and over 30 years of national reports producing policy recommendations for the reduction in these inequalities (Black et al., 1980;Acheson et al., 1998).

I HAD A DREAM MY LIFE WOULD BE, SO DIFFERENT FROM THIS HELL I'M LIVING

The call for action is clear and explicit. Reducing health inequalities 'is a matter of fairness and social justice' and action taken to do so 'will benefit society in many ways' namely, the economic benefits (avoiding productivity losses, reduced tax revenues, higher welfare payments and health-care costs) in 'reducing losses from illnesses associated with health inequalities'. The England XI go on to identify a wide range of interventions with evidence of effectiveness. But as with previous evidence-based reports, the evidence relates to the interventions improving the position of the poorest or sickest groups in