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EDITORIALS: Ilona Koupil Tackling health inequalities in the enlarged European Union BMJ 2005; 331: 855-856 [Full text]

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Health inequalities within UK.

Somasundari Gopalakrishnan, Sam Ramaiah, Director Of Public Health   (24 October 2005)

Health inequalities within UK. 24 October 2005
Somasundari Gopalakrishnan, Honorary attachment Public Health Department, Walsall tPCT, 27-31, Lichfield Street.Walsall. WS1 1PE, Sam Ramaiah, Director Of Public Health Send response to journal: Re: Health inequalities within UK.	We read this editorial with interest. It is interesting to see that Britain in its role as the president of European Union is trying to solve the health inequalities in Europe while within the UK we face major problems with health inequality and inequity. Although, a major reason for inequality could be the difference in socio-economic status, one cannot ignore the inequities of healthcare provision, which vary from region to region. Recent guidelines from the National Institute of clinical excellence (NICE) have eliminated the post code lottery prescribing to some extent in areas of cancer and chronic disease management, but still a lot of work needs to be done in all areas of health. In addition, we need to concentrate on disease prevention especially in health deprived areas. As mentioned in the paper, differences in health in these areas could be due to ethnicity, religion or place of residence. The effect of ethnicity depends on the food habits(1) , level of physical activity(2) and cultural beliefs(3). More resources should be allocated to areas where such factors contribute to inequality. Current government’s obsession with waiting times and targets in healthcare has shifted the focus away from the preventive aspect to certain extent. Following the example of developing countries, a ‘support led’ policy has been shown to be effective in dealing with health inequalities(4). This clearly shows that intelligent and equitable investment in social policies can improve health and welfare. In developed countries health inequalities are tackled increasingly by focus on primary prevention, though in reality the issue of health awareness in deprived areas must receive greater attention. Finally emphasis must be laid on implementing policies that can realistically yield tangible benefits within the allocated timescales. Although the health spending in UK has consistently increased to over 7% of national income in accordance with the recommendations of the Wanless report, most of this money has gone into acute hospital treatment. As we increase our health spending to match the European average, a growing proportion of this should be allocated for disease prevention and improving health. Laudable progress has been made by the efforts of the Health Development Agency (now taken over by the National Institute of Health and Clinical Excellance) to tackle health inequalities in the UK. References: 1.Ogden J, Chanana A.:Explaining the effect of ethnic group on weight concern: finding a role for family values. Int J Obes Relat Metab Disord.1998; 22(7):641-7. 2.Lindstrom M, Hanson BS, Ostergren PO: Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour. Soc Sci Med. 2001;52(3):441-51. 3. James DC.:Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model. Ethn Health. 2004 ;9(4):349-67. 4.David A Leon,Gill, WaltLucy, Gilson:International perspectives on health inequalities and policy.BMJ 2001; 322:591-594. Competing interests: None declared