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Studying health inequalitiesAn applied approach$
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Jonathan Wistow, Tim Blackman, David Byrne, and Gerald Wistow

Print publication date: 2015

Print ISBN-13: 9781447305286

Published to Policy Press Scholarship Online: May 2016

DOI: 10.1332/policypress/9781447305286.001.0001

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A history of health inequalities in England

A history of health inequalities in England

(p.89) Five A history of health inequalities in England
Studying health inequalities

Jonathan Wistow

Tim Blackman

David Byrne

Gerald Wistow

Policy Press

This chapter provides a historical overview of policy and implementation in the period from the first statutory intervention in health in 1848 to the introduction of a universal health service in 1948 and more recent initiatives to address health inequalities under the Labour government of 1997 to 2010. It is argued that it is possible to see investing resources in immediate and universal access to medical services, the principal operating model for the NHS, as a diversion from health for all as opposed to health (medical) care for all. Indeed improvements in life expectancy have not been shared equally since the introduction of the NHS. Major reports on health inequalities (Black, Acheson and Marmot) have persistently emphasised the complex nature of health inequalities and the interrelationship of these with social and structural determinants. However, fundamental drivers of social inequality have not been prioritised following the publication of these reports. Furthermore, it is argued that medical imperialism has captured the terms of debate so that social determinants of health have received insufficient attention within the NHS given the restricted spending on prevention and the dominance of the medical model. This is described as a ‘category error’ given the nature of health inequalities.

Keywords:   universal personal medical services, medical model, prevention, black report, acheson report, health policy

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