The structural/material explanation is that the material situation of the lower class is the most important factor in determining their poorer health. The producers of The Black Report thought the evidence for this was the most convincing.
The findings of The Black Report were that the health of the nation had improved generally but the improvement had not been equal across all social classes. Gaps in equalities of health between lower and higher social classes was widening.
Health standards were directly linked to social class, ill health increased down the social scale. The problem had little to do with the NHS. The key causes of inequalities in health were low income, unemployment, poor environment, poor education and sub standard housing.
There were 37 recommendations from the report which focused on two main areas. These were that the government should aim to reduce poverty in the UK and to spend more money on health education and prevention of illness.
At the time when the report was published there was a change of government, it was the conservatives whom were in government and they said spending more on health services would make no difference to health standards. They wanted to reduce public expenditure, so took the individualist approach and said people should eat, drink and smoke less. They argued that individual behaviour within social classes shaped health.
Their New Right-Community Care Act said healthcare should be private and insurance based for the majority of people, but there would be assistance for those on low incomes. They argued inequality was good and necessary as made people work harder, and people should be rewarded for there hard work not pay high rates of tax. The New Right claimed state provision of medicine and other welfare was bad for individual and society.
They believed people became dependant on the state and were unable to take responsibility for their own healthcare. They wanted to improve efficiency and accountability, reduce economic waste and broaden choice for patients. (Baggott, pg92)
The New Labour’s approach was similar, they said they had a responsibility to help the vulnerable, but required welfare recipients to help themselves out of ‘welfare dependency’ They said they would provide social opportunity for people who are experiencing ‘social exclusion’ but if they are to receive support then they had an obligation to help themselves. Their aim was to provide opportunities for those excluded rather than attempting to redistribute wealth to equalise society, they also set up the Acheson Report.
Acheson Report (1998) was an independent study into health inequality which was commissioned by the New Labour government in 1997. It was a comprehensive survey of the disadvantaged. The findings mirrored those of the Black Report that the root cause of inequalities was poverty. The conclusion of the report was that the gap between richest and poorest had to be reduced.
They found children from poor families weighed less than those from wealthy families. Infant mortality rates were higher in lower social classes and long term illness was higher in lower class men. It stated 2.2 million children live on income levels fifty per cent below the national average.
The recommendations of the report were that to reduce health inequalities it needed to tackle the wider determinants. The most vulnerable needed improved benefits and they should concentrate on pre-school provision and nutrition in schools. He stated that further policies were needed focusing directly on the needs of certain groups such as families, the young and ethnic. He also said access to health services needed to be improved. The impacts from the report were that it acted as a prompt to new policies, it engendered a climate of opinion favoring policies to tackle health inequalities and introduced a health inequalities dimension to current policies.
Some have argued though that the Acheson Report did not prioritise what should be done but instead gave a long list of what could be done. Since the Acheson Report the government have said that tackling health inequalities is a priority and put together the ‘Programme 4 Action’ which outlined targets and areas to tackle health inequalities.
The Programme 4 Action has set a target to halve child poverty by 2010 and eradicate it by 2020. They set up the new Child and Working Tax Credits in 2003 as a measure to tackle this issue. One of there other aims is to improve living environments for all communities and to improve the quality of housing. (http://www.communities.gov.uk) Another target was to end the ‘blight’ of fuel poverty by 2010 by improving home effiency on fuel poor households. They also promised to ensure fair treatment for the less fortunate and are supporting the development of energy industry initiatives to combat fuel poverty. (http://www.berr.gov.uk)
Their strategy for education has introduced Skills for Life- the national adult literacy and numeracy, which is aimed at giving skills to the disadvantaged in return enhancing opportunities for work. This has helped improve job opportunities for over 300,000 learners in two years since it was launched. The Acheson Report noted education as one of the most important routes to help people out of poverty as would give a better chance for people to get a good job with an adequate income.(www.dcsf.gov.uk)
The New Deal programme was introduced to help the unemployed to find and keep jobs along with the National Minimum Wage to boost the income of low paid workers. There aim from these policies is to reduce unemployment and raise incomes in return narrow the gap between poverty and social class.
The programme stated it was focused on supporting families, mothers and children, aswell as improving opportunities for children and young people. This was from the suggestion from the Acheson Report that there were health differences for mothers and babies of a lower socioeconomic status. From this they introduced Sure Start which provides guidance, training and support for early years to children. Also introduced were free nursery places for all 3 and four year olds. The government have also provided low income mother and expectant mothers with Healthy Start which are vouchers which can be exchanged for formula milk, cows milk, fruit, vegetables and minerals up until there youngest child turns four. (http://www.surestart.gov.uk)
All these measures are showing the government is trying to tackle some of the findings from the Acheson Report, though their strategies do emphasise that prevention is important which could imply they are doing it for financial reasons as it would be cheaper to prevent rather than cure.
New Labour is trying to narrow the gap of poorer health for the lower social class by trying to tackle poverty through Tax Credits, National Minimum Wage and New Deal. Though this is a step forward it does not appear to be enough especially with the credit crunch situation at the moment where people are being made redundant so there are even fewer jobs available. The government needs to imply more policies to ensure the gap of those on lower incomes are reduced. The National Minimum wage could be increased as it is relatively low compared to the national average. Working Tax Credits could also be increased making it more rewarding for parents to work rather than being on benefits. Another point is that instead of just looking at people’s physical health the government could look at other aspects such as psychological, environmental, spiritual and emotional. These aspects play an important role on the overall health of an individual.
Now we have looked at The Black Report, Acheson Report and Programme 4 Action it shows that all though the government, seem to be trying to reduce health inequalities there is still a long way to go. In order to improve the health of the lower social classes it needs to first improve their quality of life.
