Intended for healthcare professionals


Can higher NHS spending in deprived areas reduce health inequalities?

BMJ 2014; 348 doi: (Published 29 May 2014) Cite this as: BMJ 2014;348:g3388
  1. Azeem Majeed, professor of primary care,
  2. Michael Soljak, clinical research fellow
  1. 1Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
  1. Correspondence to: A Majeed a.majeed{at}

Yes, but housing, education, and employment matter too

Dealing with the health inequalities associated with socioeconomic status has been a longstanding objective of the National Health Service in England.1 In a linked article (doi:10.1136/bmj.g3231), Barr and colleagues examine the association between NHS resource allocation and changes in “mortality amenable to healthcare” in England.2

In 1999, the government introduced a new objective for the allocation of NHS resources in England, which was “to contribute to the reduction in avoidable health inequalities.”3 To help achieve this objective, a health inequalities component was introduced into the NHS resource allocation formula in 2002, which resulted in more rapid growth of NHS spending in deprived areas.

In their paper, Barr and colleagues suggest that the NHS funding formula for primary care trusts (now replaced by clinical commissioning groups) has contributed to a narrowing in the absolute differences in mortality amenable to healthcare between the most affluent and the most deprived local authorities in England. Between 2001 and 2011, NHS spending in the most deprived areas increased by 81% compared with 70% in the most affluent areas (from £1074 (€1319; $1806)/head to £1938/head …

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