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The medicalisation of health inequalities and the English NHS: the role of resource allocation

Published online by Cambridge University Press:  04 September 2012

Sheena Asthana ,
Alex Gibson  and
Joyce Halliday
Sheena Asthana*
Affiliation:
Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
Alex Gibson
Affiliation:
Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
Joyce Halliday
Affiliation:
Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
*
*Correspondence to: Professor Sheena Asthana, Faculty of Health, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. Email: sasthana@plymouth.ac.uk
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Abstract

Tackling health inequalities (HI) has become a key policy objective in England in recent years. Yet, despite the wide-ranging policy response of the 1997–2010 Labour Government, socio-economic variations in health continued to widen. In this paper, we seek to explore why. We propose that a meta-narrative has emerged in which the health problems facing England's most deprived areas, and the solution to those problems, have increasingly come to be linked to levels of National Health Service (NHS) funding. This has been, in part, a response to key shortcomings in previous rounds of resource allocation. The very significant sums of money allocated with respect to ‘health inequalities’ reflects and reinforces the belief that the NHS can and should play a central role in promoting health equity. This medicalisation of HI focuses attention on the role of individual risk factors that lend themselves to medical management, but effectively sidelines the macroprocesses of social inequality, legitimising the kind of society that neo-liberal government has produced in the United Kingdom – one in which health (like other assets) has become a matter of individual and not collective responsibility.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 2 , April 2013 , pp. 167 - 183
Copyright
Copyright © Cambridge University Press 2012

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References

Acheson, D. (1998), Independent Inquiry into Inequalities in Health Report (The Acheson Report), London: The Stationery Office.Google Scholar
Asthana, S.Gibson, A. (2008), ‘Health care equity, health equity and resource allocation: towards a normative approach to achieving the core principles of the NHS’, Radical Statistics, 96: 6–26.Google Scholar
Asthana, S., Gibson, A. (2010), ‘Funding Implications for Rural PCTs of the New NHS Resource Allocation Methodology’, in All Party Parliamentary Group on Rural Services, The Implications of National Funding Formulae for Rural Health and Education Provision, Report, Written and Oral evidence, London, House of Commons, 97–115.Google Scholar
Asthana, S.Halliday, J. (2006), What Works in Tackling Health Inequalities? Pathways, Policies and Practice through the Lifecourse, Bristol: Policy Press.Google Scholar
Audit Commission (2010), Healthy Balance: A Review of Public Health Performance and Spending, London: The Audit Commission.Google Scholar
Barker, D. J. P. (1994), Mothers, Babies, and Disease in Later Life, London: British Medical Journal Publications.Google Scholar
Bevan, G. (2009), ‘The search for a proportionate care law by formula funding in the English NHS’, Financial Accountability and Management, 25(4): 391–410.Google Scholar
Blackman, T. (2006), Placing Health, Bristol: Policy Press.Google Scholar
Brunner, E. (2001), ‘Stress Mechanisms in Coronary Heart Disease’, in S. Stansfeld and M. Marmot (eds), Stress and the Heart: Psychosocial Pathways to Coronary Heart Disease, London: BMJ Books, 181–199.Google Scholar
Brunner, E.Marmot, M. (1999), ‘Social Organisation, Stress and Health’, in M. Marmot and R. G. Wilkinson (eds), Social Determinants of Health, Oxford: Oxford University Press, 17–43.Google Scholar
Bull, J.Hamer, L. (2001), Closing the Gap: Setting Local Targets to Reduce Health Inequalities, London: HDA.Google Scholar
Butterfield, R., Henderson, J.Scott, R. (2009), Public Health and Prevention Expenditure in England. Health England Report No. 4, Oxford: Health England Publications. http://www.healthengland.org/publications/HealthEnglandReportNo4.pdfGoogle Scholar
Conrad, P.Schneider, J. (1992), Deviance & Medicalization: From Badness to Sickness, Philadelphia: Temple University Press.Google Scholar
Costa-Font, J., Hernández-Quevedo, C.McGuire, A. (2010), Persistence Despite Action? Measuring the Patterns of Health Inequality in England (1997–2007). Working paper No. 20/2010, London: LSE Health.Google Scholar
Davey Smith, G. (ed.) (2003), Health Inequalities: Lifecourse Approaches, Bristol: Policy Press.Google Scholar
Department of Health (D H) (2003), Resource Allocation: Weighted Capitation Formula, London: Department of Health Publications. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4069186Google Scholar
DH (2004), Choosing Health: Making Healthy Choices Easier. CM6374. London: The Stationery Office.Google Scholar
DH (2006), The NHS in England: The Operating Framework for 2006/7, London: The Stationery Office.Google Scholar
DH (2007), High Quality Care For All: NHS Next Stage Review Final Report. CMD7432 London: The Stationery Office.Google Scholar
DH (2008), Report of the Advisory Committee on Resource Allocation, London: Department of Health Publications http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091484Google Scholar
DH (2009), ‘Mortality Target Monitoring: Update to Include Data for 2008’, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_106776 [10 April 2012].Google Scholar
DH (2010a), Putting Health in the Policy Picture Review of How Health Impact Assessment is Carried Out by Government Departments, London: Department of Health.Google Scholar
DH (2010b), ‘Exposition Book 2009–10 and 2010–11’, Department of Health, Gateway Reference 10568, http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Allocations/DH_091850 [10 April 2012].Google Scholar
DH (2010c), Healthy Lives, Healthy People: Our strategy for public health in England, London: The Stationery Office.Google Scholar
DH (2011), ‘Exposition Book 2011–2012’, Department of Health, Gateway Reference 15728, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124949 [10 April 2012].Google Scholar
Dorling, D. (2010), Injustice: Why Social Inequality Persists, Bristol: Policy Press.Google Scholar
Elliot, K., Bjogal, J., Williams, D. (nd), ‘Health Outcomes in Local Area Agreements (LAAs)’, http://www.idea.gov.uk/idk/aio/5130689 [31 January 2011].Google Scholar
Equality and Human Rights Commission (EHRC) (2010), How fair is Britain? Equality, Human Rights and Good Relations in 2010. The First Triennial Review, London: Equality and Human Rights Commission.Google Scholar
Gibson, A., Asthana, S. (2011), ‘A tangled web: complexity and inequality in the English local government finance settlement’, Local Government Studies, doi:10.1080/03003930.2011.642947 [11 December 2011].Google Scholar
Graham, H. (2002), ‘Building and inter-disciplinary science of health inequalities: the example of lifecourse research’, Social Science and Medicine, 55: 2005–2016.CrossRefGoogle ScholarPubMed
Graham, H. (2004), ‘Social determinants and their unequal distribution: clarifying policy understandings’, The Milbank Quarterly, 82: 101–124.Google Scholar
Hansard (2009), Written Questions, 12 January: Column 177W, London: The Stationery Office.Google Scholar
Hansard (2011), Life Expectancy (Inequalities), 3 March: Column 115WH, London: The Stationery Office.Google Scholar
Hertzman, C., Power, C., Matthews, S.Manor, O. (2001), Using an interactive framework of society and lifecourse to explain self-related health in early adulthood, Social Science and Medicine, 53: 1575–1585.Google Scholar
Hills, J.Stewart, K. (eds) (2005), A More Equal Society?, Bristol: Policy Press.Google Scholar
House of Commons Committee of Public Accounts (2010), Tackling Inequalities in Life Expectancy in Areas with the Worst Health and Deprivation. Third Report of Session 2010–11 Report, Together with Formal Minutes, Oral and Written Evidence, London: The Stationery Office.Google Scholar
House of Commons Health Committee (2009), Health Inequalities. Third Report of Session 2008–2009. Volume 1. HC 286-I, London: The Stationery Office.Google Scholar
House of Commons Health Committee (2010), Public Expenditure. Uncorrected transcript of oral evidence (to be published as HC 512-i). http://www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/uc512-i/uc51201.htm [10 April 2012].Google Scholar
Hunter, D. (2005), ‘Choosing health or losing health?’, Journal of Epidemiology and Community Health, 59: 1010–1013.Google Scholar
Hunter, D.et al. (2008), Partnerships in Public Health: A Healthy Outcome? Summary Findings of a Systematic Literature Review. http://www.dur.ac.uk/resources/public.health/news/PartnershipWorkinginPublicHealth-SummaryLiteratureReviewFindings.pdf [10 April 2012].Google Scholar
Hunter, D.J., Popay, J., Tannahill, C., Whitehead, M., Elson, T.. (2009), ‘Learning lessons from the past: shaping a different future’, Marmot Review Working Committee 3 Cross-Cutting Sub-Group Report 2009. http://www.ucl.ac.uk/gheg/marmotreview/Documents [10 April 2012].Google Scholar
Idea.gov, http://www.idea.gov.uk/idk/core/page.do?pageId=7532066 [31 January 2011].Google Scholar
Kawachi, I., Colditz, G., Ascherio, A., Rimm, E. B., Giovanucci, E., Stampfer, M. J.Willett, W. C. (1999), ‘A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the US’, Journal of Epidemiology and Community Health, 50: 245–251.Google Scholar
Kessel, A.Haines, A. (2010), ‘What the White Paper might mean for public health’, BMJ, 341: c6623.Google Scholar
Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J.Power, C. (2003), ‘Life course epidemiology’, Journal of Epidemiology and Community Health, 57: 778–783.Google Scholar
Lancet, (2010), ‘McPolicy: bringing you the Big Mac society’, The Lancet, 376: 1800.Google Scholar
Lawless, P. (2004), ‘Locating and explaining area-based urban initiatives: New Deal for Communities in England’, Environment and Planning C-Government and Policy, 22(3): 383–399.Google Scholar
Lawrence, F. (2010), ‘Health policy: extent of corporate influence revealed’, The Guardian, http://www.guardian.co.uk/politics/2010/dec/09/health-policy-extent-corporate-influence [10 April 2012].Google Scholar
Levin, E.Price, G. (2010), Delivering Changes in Housing Wealth Inequality, London: Communities and Local Government Publications.Google Scholar
Mackenbach, J. (2009), ‘Politics is nothing but medicine at a larger scale: reflections on public health's biggest idea’, Journal of Epidemiology & Community Health, 63: 181–184.Google Scholar
Mackenbach, J.Bakker, M. (2002), Reducing Inequalities in Health: a European Perspective, London: Routledge.Google Scholar
Marmot, M. (2004), Status Syndrome, London: Bloomsbury.Google Scholar
Marmot, M., Allen, J., Goldblatt, P., Boyce, T.et al. (2010), ‘The Marmot Review: fair society, healthy lives’. The Marmot Review, http://www.marmotreview.org/AssetLibrary/pdfs/Reports/FairSocietyHealthyLives.pdf [10 April 2012].Google Scholar
Morris, S., Carr-Hill, R., Dixon, P., Law, M., Rice, N., Sutton, M., Vallejo-Torres, L. Combining Age Related and Additional Needs (CARAN) Report (2007), 2007 Review of the Needs Formulae for Hospital Services and Prescribing Activity in England. Resource Allocation Research Papers 30, London: Department of Health, www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Allocations/DH_4108515 [10 April 2012].Google Scholar
Morris, S., Sutton, M., Dixon, P.et al. (2010), Research on the Health Inequalities Elements of the NHS Weighted Capitation Formula, Resource Allocation Research Papers 36, Department of Health, London: UCL, http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_122620.pdf [10 April 2012].Google Scholar
National Audit Office (NAO) (2010), Tackling Inequalities in Life Expectancy in Areas with the Worst Health and Deprivation, London: The Stationery Office.Google Scholar
Office for National Statistics (O NS) (2009), Infant and Perinatal Mortality in England and Wales by Social and Biological Factors, 2008, Newport: Office for National Statistics.Google Scholar
ONS (2010a), Life expectancy at Birth and at age 65 by Local Areas in the United Kingdom, 2006–08, Newport: Office for National Statistics.Google Scholar
ONS (2010b), Income Inequality Remains Stable, London, http://www.statistics.gov.uk/cci/nugget.asp?id=332 [10 April 2012].Google Scholar
ONS (2010c), Mid Year Population Estimates, 2007, London, http://www.statistics.gov.uk/statbase/product.asp?vlnk=15106 [10 April 2012].Google Scholar
Perkins, N., Smith, K., Hunter, D., Bambra, C.Joyce, K. (2010), ‘What counts is what works’? New Labour and partnerships in public health, Policy & Politics, 38(1): 101–117.Google Scholar
Porter, D. (2006), ‘How did social medicine evolve, and where is it heading’, PLoS Medicine, 3(10): e399.Google Scholar
Renault, E. (2006), ‘Biopolitics and social pathologies’, Critical Horizons, 7(1): 159–177.Google Scholar
Royal College of Physicians (2010), How Doctors can Close the Gap. Tackling the Social Determinants of Health through Culture Change, Advocacy and Education, London: Royal College of Physicians.Google Scholar
Scambler, G. (2001), ‘Critical realism, sociology and health inequalities: social class as a generative mechanism and its media of enactment’, Journal of Critical Realism, 4: 35–42.Google Scholar
Shaw, M., Davey Smith, G.Dorling, D. (2005), ‘Health inequalities and new labour: how the promises compare with real progress’, British Medical Journal, 330: 1016–1021.Google Scholar
Stafford, M., Nazroo, J., Popay, J.Whitehead, M. (2008), ‘Tackling inequalities in health: evaluating the New Deal for Communities initiative’, Journal of Epidemiology and Community Health, 62: 298–304.Google Scholar
Stone, M. (2007), Supplementary evidence (Def07A), in House of Commons Health Committee, NHS Deficits: First Report of Session 2006–07, Volume II, London: The Stationery Office Limited, Ev, 168–170.Google Scholar
The United Nations Children's Fund (UNICEF) (2007), Child Poverty in Perspective: An Overview of Child Well-being in Rich Countries. Innocenti Report Card 7, Florence: UNICEF Innocenti Research Centre.Google Scholar
UNICEF (2010), The Children Left Behind: A league table of Inequality in Child Well-being in the World's Rich Countries. Innocenti Report Card 9, Florence: UNICEF Innocenti Research Centre.Google Scholar
Wanless, D. (2004), Securing Good Health for the Whole Population, London: The Stationery Office.Google Scholar
Wilkinson, R. (1996), Unhealthy Societies: The Afflictions of Inequality, London: Routledge.Google Scholar
Wilkinson, R.Pickett, P. (2009), The Spirit Level: Why More Equal Societies Almost Always Do Better, London: Penguin.Google Scholar
Wise, J. (2010), ‘Is the UK turning the clock back on public health advances?’, BMJ, 341: 6691.CrossRefGoogle Scholar
Yorkshire and Humber Pubic Health Observatory (YHPHO) (2008), IMD 2007 Average PCT Scores, Yorkshire and Humber Pubic Health Observatory, York, http://www.yhpho.org.uk/resource/item.aspx?RID=10003 [10 April 2012].Google Scholar