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Systematic review of the effectiveness of the health inequalities strategy in England between 1999 and 2010
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  • Published on:
    Understanding how the English inequalities strategy was implemented
    • Nicholas R Hicks, Honorary Senior Research Fellow Nuffield Department of Primary Health Care Sciences, University of Oxford

    Holdroyd et al’s systematic review of the effectiveness of the English health inequalities strategy found that ambitious national targets set in 2001 for reducing inequalities in infant mortality and life expectation by 2010 were largely met. This is the only period in the last 50 years when inequalities in mortality between rich and poor have narrowed in England making this a considerable achievement and an historic result.

    If policy makers are to maximise learning from this achievement, it’s important that they have a clear understanding of the interventions undertaken. The factors determining the distribution of health are complex and multifactorial. In any complex system, a strategy aimed at influencing outcomes needs to be as much about the approach to intervention as about the content of the policies (1). The papers Holdroyd et al cite are incomplete descriptions of the strategy as they omit the key elements that were central to the, resourcing, cross-sectoral incentivisation, metric generation and harnessing of power. Key elements of the intervention strategy included:

    • The NHS Plan (2) that set out Government's commitment to the publication of national inequalities targets. The targets were published in February 2021. The detailed rational for the setting and construction of those targets was explained in a technical paper (3). Without knowing the exact impact of any one action the architects of the strategy believed that if inequalities...

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    Conflict of Interest:
    The author was seconded from the NHS to the Secretary of State's Strategy Unit, Department of Health and was involved with the drafting of the inequalities chapter of the NHS Plan (July 2000).