The subject of inequality is one that has been on the social
work agenda for a long time now as part of the development of
anti-discriminatory practice. However, it is only fairly recently
that it has begun to attract a level of attention among health
colleagues that even begins to approach the level long established
in social work and social care. This is not to say that the subject
has been totally neglected – far from it. Health inequalities have
been a subject of policy analysis for a significant period of time.
A new report published by the Policy Press seeks to update some of
that policy analysis and the research on which it was
The Acheson Report on health inequalities was published in
1998.2 The Policy Press study examines the impact of
that report and its recommendations. It took place between February
2001 and August 2002. In the first of its two phases it analysed
the aims, targets and resources associated with policies. In the
second phase it examined three case studies of policy development.
The work was based on detailed analysis of reports, plans and
strategies, supplemented by interviews with 30 policymakers across
The study found that good progress had been made in some areas,
particularly those relating to wider causes of ill-health (tax
credits, welfare to work and so on), but no progress in some
others, such as the reform of private medical practice. In
particular, the study highlighted three gaps, namely the need
Clear mechanisms for ensuring progress in tackling health
- Independent evaluation of the impact of policies
- The establishment and collation of research programmes on
interventions and their outcomes.
In addition, the authors of the report argue the case for
further improvements along the following lines:
- Better use of information and evidence.
- Identifying and rectifying inadequate data.
- More joined-up working and coordination, along with greater
- Support for officials and ministers who work across
The report also includes a long list of further recommendations
on how the progress made since the Acheson inquiry could be
strengthened and built upon. It is, therefore, a valuable document
for people involved in promoting greater equality in health and
health care services.
Of course, this can be seen to have significant implications for
social work and social care, in so far as the links between health
and social problems are well established.
Some of the implications are quite obvious – for example, the links
between health issues and neglect in the child protection arena.
Others, such as links between poverty and palliative care, might be
more surprising to some.3 But, whether obvious or
hidden, the significance of health inequalities continues to be of
major proportions. This study, therefore, has the potential to be a
very useful tool in raising awareness of just how unequal a country
the UK is when it comes to health, and how important such
inequalities are for the work that we do.
1 M Exworthy, M Stuart, D Blane and M Marmot,
Tackling Health Inequalities since the Acheson Inquiry,
The Policy Press, 2003
2 D Acheson, Independent Inquiry into “Health
Inequalities”, The Stationery Office, 1998
3 D Bevan, “Poverty and Deprivation”, in N Thompson
(ed), Loss and Grief: A Guide for Human Services
Practitioners, Palgrave Macmillan, 2002
Neil Thompson is an independent trainer and consultant with Avenue
). He is the author of Promoting Equality, Palgrave