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National Level Policies

The National Level Policies section of the portal provides an overview of
the actual situation concerning actions to tackle health inequalities in the
different European countries.

This part of the portal is currently being developed, the information for the remaining countries will continuously be completed.

In addition to the national level portraits of the individual countries the
overview analysis has been conducted and its initial results have been
published in EuroHealth magazine (EuroHealth, 11:2 p.24).

Download the final 'Closing the Gap' publication: Taking Action on Health Equity.

This publication contains summaries of what each of the 21 ´Closing the Gap´ partners are doing to address health inequalities in their countries, as well as the conclusions and recommendations of this 3-year initiative.

Results of the same country

List all good practice projects of the actual country.

You are here: > National Level Policies > England > Policies, strategies and other documents > Driven by health sector

Policies and Strategies that are Driven by the Health Sector

The Tackling Health Inequalities: A Programme for Action (2003) is the first health inequalities strategy to meet the 2010 target to reduce inequalities in health outcomes by 10% (as measured by infant mortality and life expectancy at birth). It has also addressed the wider challenges set by the underlying causes of health inequalities. The Programme is coordinated by the Health Inequalities Unit, a small team in the Department of Health. The Health Inequalities Unit makes links and connections between a wide range of different bodies and initiatives to ensure a health inequalities perspective is included in their work. Examples of cross-government programmes and initiatives put in place as a result of the Health Inequalities Programme for Action include:

• National Strategy for Neighbourhood Renewal - developed to support an integrated approach to regeneration in the most deprived communities, including the New Deal for Communities Programme
• UK Fuel Poverty Strategy - formulated to support housing improvements targeted at vulnerable households
• Sure Start - designed to support the development of pre-school children from poorer families by increasing the availability of childcare for all children, improving health and emotional development for young children and supporting parents in their aspirations towards employment.
• NHS Health Trainers Initative - developed to motivate and help people to set goals by developing personal health plans, giving practical support to carry out those plans and identifing with the individuals their barriers to change. The initiative was first targeted at the most disadvantaged areas to make it easier for individuals in these communities to make healthier choices.

The 2007 Status Report on the Programme for Action states that there has been evidence of good progress in four areas. These include reducing child poverty and narrowing inequalities in housing quality, educational attainments and uptake of flu vaccinations. There has been a narrowing of inequalities in absolute terms (but not in relative terms) in four other important areas - circulatory (heart) disease and cancer mortality, child road accidents casualties, and teenage pregnancy. Other areas, like smoking, show a general reduction in prevalence but no narrowing of the gap between social groups.

The Sure Start Programme has proved to be important in tackling health inequalities in disadvantaged families, mothers and children. For example, the midwifery team in Southampton University Hospitals NHS Trust worked in conjunction with local Sure Start Centres to enable women, and their families, from vulnerable groups to access Sure Start services. They also provide easier access to midwifery services in the community and provide continuity of care through pregnancy, birth and afterwards up to six weeks. One of the primary aims was to reduce the incidence of low-birthweight babies. For the women cared for by the teams, there was a substantial reduction in the incidence of low-birthweight babies from 12.6% to 7.9% between 2003 and 2006. In addition, the midwifery teams attached to Sure Start were able to support 31% of women to give birth in a birth centre or at home, compared with 25% of women cared for by other teams.

The New Deal for Communities (NDC) Programme, launched in January 1999, provides 39 of the poorest neighbourhoods with the resources and support to tackle their problems and regenerate their communities in an intensive way through local partnerships comprising key local bodies and organizations, such as public agencies, local businesses, voluntary bodies and residents. The 39 NDC areas share a £2 billion budget over 10 years to develop projects to tackle theme-related problems in their neighbourhood (unemployment, crime, education, health, housing and physical environment) through the provision of local facilities and services, and resident engagement and empowerment. Populations in the NDC areas tend to have worse self-reported health than the national average but the degree to which health inequalities exist varies.

The NDC partnerships are working with others, notably primary care trusts (PCTs), to improve health standards among NDC residents. Around 8% of the budget has been devoted to health interventions. Outputs between 1999/2000 and 2005/06 include an additional 223 new or improved health facilities used by over 135,000 people and over 1.8 million instances of health advice or provision.

There were modest and positive improvements between 2002 and 2006 in relation to smoking and those feeling that their health was good or fairly good. These changes tend to mirror both reductions nationally but more in disadvantaged areas. Overall, to date, the NDC evaluation has found more evidence of positive change for 'place-based' outcomes (physical/environmental outcomes) than for 'people-based' outcomes. However, by 2006 it was possible to identify positive statistical relationships between the NDC and a range of interventions including health.

The Programme for Action 2007 status report stresses the time lag between interventions and the achievement of results. This notion of time lag was amplified in the first Status Report (2005), which also highlighted the differential impact of 'lead times' between different diseases, the gap between changes in exposure and changes in disease rates. Time lags and lead times provide part of the explanation for the lack of more rapid progress.