As the finer points of the Health and Social Care Bill continue to be scrutinised in the Lords this week, and fierce political and public debate over the reforms rages on, the Government’s health headache seems firmly here to stay.
And the debate goes beyond the passage of the Bill itself. Last week, respected epidemiologist and author of the landmark health inequalities review Fair Society, Healthy Lives, Sir Michael Marmot, added his voice. On the second anniversary of the report’s publication, Sir Michael criticised what he considers a disappointing lack of government action to address the root causes of health inequalities in England, and called specifically for the health impact of current economic policy to be considered.
His comments were prompted by the publication of figures from the UCL Institute of Health Equity, formerly the Marmot Review Team, which show that while life expectancy in England is increasing, health inequalities widened in most councils between 2007-2009 and 2008-2010.
These figures will be disappointing to many, and there is a clear need for the Coalition to take ownership of the issue. Health inequalities is an embedded social problem which will require cross-party, and indeed cross-boundary, commitment to address. Sir Michael’s call to action around the broader determinants of health in 2012 is clear and this Government has a responsibility to put equality at the centre of its policy, at the Department of Health and beyond.
Much has been made of the Government’s commitment to place patients at the heart of the NHS and the mantra of “no decision about me without me”. There certainly is the potential to introduce a more meaningful level of engagement with patients and the public, but this will need to extend to groups where levels of health literacy and engagement have traditionally been lower. All patients (and potential patients) must be empowered to obtain, understand and use health information, otherwise they will be unable to make appropriate decisions about their health. Publishing health data and nudging behaviour alone will not achieve this.
One action that can, and should, be taken would be to place a much greater emphasis on levelling access to information through community-based health education, to drive the pull factor for good healthcare. Ready for health a report by MHP Health Mandate, highlighted clear variation in local authorities’ preparedness to deliver quality services, tailored to meet local need. Getting the local approach consistently right will be vital in ensuring that communities of patients are not left behind.
This effort must go beyond the Department of Health, and be supported by mindful education, community and economic policies that will fortify, rather than undermine attempts to improve the health of those living in areas facing the greatest health challenges. Andrew Lansley’s role as Chair of the Cabinet Committee on public health, bringing together representatives from across the Government, should support work in this area.
At present, the Government is being forced to defend its commitment to the principles of the NHS. This is a hard one to win, as positions on the NHS are as entrenched as they are passionate. Actions will speak louder than words and concerted efforts to reduce health inequalities would certainly send a clear signal. This is not an issue for passing the buck.