Intended for healthcare professionals

Letters Allocation of NHS Resources

Tensions between healthcare equity and health equity must be debated

BMJ 2012; 344 doi: (Published 25 June 2012) Cite this as: BMJ 2012;344:e4133
  1. Sheena Asthana, professor of health policy1
  1. 1Faculty of Health, Education and Society, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
  1. sasthana{at}

Bambra has based her analysis of what would happen if NHS allocations were based on age alone on a false premise.1 Nobody has suggested that age alone should determine allocations. Andrew Lansley said that those deciding allocations should be looking at the “respective burden of disease” and that age was the principal determinant of disease burden. He also stated clearly that funding for health inequalities will be based on indices of deprivation.

Nevertheless, with regard to the part of the formula that supports the objective of equal opportunity of access for equal needs, deprived areas would lose out if greater weight is given to age than is currently the case. We should be asking whether this is unfair.

For most conditions age is a far more important determinant of morbidity and mortality than deprivation. Thus the health communities grappling with the highest burdens of chronic illness and disability—in crude terms—serve the most ageing areas. Currently, these areas do not tend to receive the highest NHS allocations.

The most deprived areas are the most generously funded. They have the highest mortality and morbidity rates—in standardised terms. However, because they also tend to have younger demographic profiles, they have comparatively low crude burdens of disease and thus comparatively low needs for curative NHS care.

We need more honest debate about the tensions that arise between the principles of healthcare equity and health equity. Targeting health resources to deprived populations over and above rates of underlying morbidity has been an ineffective response to health inequalities, which remain entrenched. Moreover, it has exacerbated healthcare inequity by underestimating the healthcare needs of older but less deprived populations.


Cite this as: BMJ 2012;344:e4133


  • Competing interests: None declared.


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