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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 > Tools and resources

Tools and resources

In this section main tools used to implement and monitor national policies in the field of health inequalities are listed.

Applied by the Health Sector

Funding
The Department of Health has a Health Inequalities Unit located within the Policy and Strategy Directorate, to support the delivery of the two PSA targets.Financial resources are allocated to the above mentioned Health Inequalities Team.

The Scientific Reference Group on Health Inequalities
The Scientific Reference Group on Health Inequalities, chaired by Sir Michael Marmot (UCL), was developed to oversee regular Status Reports on developments to the 2010 target and the wider, social determinants of health, and to:

• assess and report on progress across the national headline indicators and towards the national target
• provide guidance on the measuring and monitoring arrangements across the full range of targets and indicators relevant to health inequalities
• to identify risks to progress in meeting the national target and associated indicators and to review possible responses
• to consider developments in research and evaluation and identify opportunities and gaps for further work

Membership includes representatives from the Commission on Social Determinants of Health, Department of Health England, UCL, University of Bath, University of York, London Public Health Observatory, National Institute of Clinical Excellence, Healthcare Commission and Regional Public Health Directorates.

The group also provides the core membership of the UK Group on the Social Determinants of Health that includes representatives from the other departments and scientists with a specific interest in social determinants issues.  

Health Inequalities Intervention Tool
The Department of Health has jointly developed a Health Inequalities Intervention Tool with the Association of Public Health Observatories, to support Spearhead Primary Care Trusts with their Local Delivery Planning and commissioning. The Health Inequalities Intervention Tool has been designed to help achieve the Department of Health’s Public Service Agreement target for life expectancy, by 2010. This is to reduce, by at least 10%, the gap between the Spearhead areas and the population as a whole.  

The Health Inequalities Intervention Tool has been designed to support Spearhead Primary Care Trusts with their Local Delivery Planning and commissioning.

The Health Inequalities Intervention Tool supports Spearhead areas by providing information on the following:

• Life expectancy in Spearhead local authorities
• The gap in life expectancy between the Spearhead local authorities and England
• A breakdown of the life expectancy gap by cause of death and age

The Health Inequalities Intervention Tool also allows Spearhead areas to estimate the potential effect on their life expectancy gap if certain interventions are increased, specifically:

• Interventions to reduce infant mortality
• Smoking cessation
• Antihypertensive prescribing in people without existing cardiovascular disease
• Statin prescribing in people without existing cardiovascular disease

The tool was launched in 2007 and although it is not possible to measure the tools contribution to addressing SDHI at this stage due to time lag, positive user feedback has lead to the planned expansion of this tool from spearhead areas to all areas in England.

Health Inequalities Basket of Indicators
The London Health Observatory were commissioned by the Department of Health to develop a local basket of inequalities indicators including measures of health status or health outcomes, measures of the determinants of health, measures of access to services and process measures.
The main purpose of the local basket of indicators is to help support local action to achieve the PSA targets and monitor progress towards reducing health inequalities.

Community Health Profiles
Community Health Profiles have been developed to provide a snapshot of health for each local council in England using key health indicators which enables comparison locally, regionally and nationally as well as over time. They are designed to help local councils and the NHS decide where to target resources to tackle health inequalities in their local area. Health Profiles are quality assured by the Association of Public Health Observatories, and have clear and explicit methodology, which should eliminate the need for local production of identical indicators.

Reviews and Status Reports
There have been regular status reports on the PSA target on health inequalities. The Review of the health inequalities infant mortality PSA target (2007) considers why, despite a general improvement in infant mortality rates, health inequalities in infant mortality between different social groups remain. The review identifies a range of issues and makes recommendations relevant to the health inequalities 2010 PSA target. Its recommendations are being shared with the NHS and others prior to DH issuing further guidance.

The above tools are used by local NHS commissioners and planners with a systematic approach in spearhead areas.  Positive feedback has been received from NHS commissioners and planners. This has lead to planned expansion of the Health Inequalities Intervention Tool from spearhead areas to all areas of England.  

Health Equity Audit
This tool enables Primary Care Trusts to identify how fairly services or other resources are distributed in relation to the health needs of different groups and areas. It helps to prioritise action to provide services relative to need.

Health Action Zones

Health Action Zones (HAZ) were established in 1998 in an attempt to target the disadvantaged communities, where the need for public health action is greatest. The purpose of the Health Action Zone is to bring together the actors working on health improvement.

Sure Start
Improving support for child development through 489 local Sure start programmes and initiatives - sure start ensures that children from the most disadvantaged areas are ready to make the most of their education. Sure start bring together early education, childcare, health and family support.

Applied by the Non-Health Sector

Department of Work and Pensions
The DWP uses a variety of tools and levers to reduce child poverty, principally through the tax and benefits systems.  It also consults on its plans across a wide range of stakeholders, including the Department of Health. An independent review was used to support the development of the 2007 child  poverty strategy - Working with Children. This review included consultations with key stakeholders and target groups.

The commissioning of an independent review (the Harker Review) has been a powerful tool for assessment and review of current progress and strengthening purpose and direction in a renewed (2007) strategy which sets out support at work in a broader context of social support for children. This review helped make the links between employment issues and the wider social determinants of health, including child care and lone parents. The establishment  of the joint child poverty strategy unit reflects the findings of the review.