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<!DOCTYPE TEI.2 SYSTEM "base.dtd">




<title>How Can Health Inequalities be Tackled?</title></titleStmt>

<publicationStmt><distributor>BASE and Oxford Text Archive</distributor>


<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

original recordings are held at the Universities of Warwick and Reading, and

at the Oxford Text Archive and may be consulted by bona fide researchers

upon written application to any of the holding bodies.

The BASE corpus is freely available to researchers who agree to the

following conditions:</p>

<p>1. The recordings and transcriptions should not be modified in any


<p>2. The recordings and transcriptions should be used for research purposes

only; they should not be reproduced in teaching materials</p>

<p>3. The recordings and transcriptions should not be reproduced in full for

a wider audience/readership, although researchers are free to quote short

passages of text (up to 200 running words from any given speech event)</p>

<p>4. The corpus developers should be informed of all presentations or

publications arising from analysis of the corpus</p><p>

Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>




<recording dur="00:26:40" n="3350">


<respStmt><name>BASE team</name>



<langUsage><language id="en">English</language>



<person id="nf0268" role="main speaker" n="n" sex="f"><p>nf0268, main speaker, non-student, female</p></person>

<personGrp id="ss" role="audience" size="l"><p>ss, audience, large group </p></personGrp>

<personGrp id="sl" role="all" size="l"><p>sl, all, large group</p></personGrp>

<personGrp role="speakers" size="3"><p>number of speakers: 3</p></personGrp>





<item n="speechevent">Lecture</item>

<item n="acaddept">School of Health and Social Studies</item>

<item n="acaddiv">ls</item>

<item n="partlevel">UG1/PG</item>

<item n="module">Health in the Community</item>




<u who="nf0268"><kinesic desc="projector is on showing slide" iterated="n"/> okay are we ready to start <pause dur="3.1"/> okay so how can <pause dur="0.2"/> inequalities in health <pause dur="0.4"/> be tackled <pause dur="2.4"/> so in this session we're going to look at <pause dur="0.5"/> why tackle health inequalities <pause dur="0.2"/> why tackle these # <pause dur="1.0"/> unequal patterns of health that we've been looking at <pause dur="0.2"/> very carefully over the last few weeks <pause dur="1.6"/> so we're looking at why tackle them <pause dur="0.9"/> then we're going to start to look at what the evidence says <pause dur="1.0"/> about how health inequalities can be tackled <pause dur="3.1"/> and then we're going to # start to look at <pause dur="0.4"/> # <pause dur="1.2"/> later on this morning <pause dur="0.6"/> policies that are in place to tackle health inequalities <pause dur="1.1"/> and to start to think about how effective <pause dur="0.2"/> these policies are likely to be <pause dur="0.6"/> # to reduce health inequalities <pause dur="3.3"/><kinesic desc="changes slide" iterated="n"/> so <pause dur="0.2"/> just to remind you <pause dur="0.2"/> we've looked at <pause dur="0.3"/> the four main explanations for inequalities in health <pause dur="2.7"/> are they just an artefact of the way <pause dur="0.2"/> the stastistics statistics are collected <pause dur="0.6"/> are they due to social selection <pause dur="0.3"/> are they <pause dur="0.2"/> due to lifestyles and <pause dur="0.2"/> behaviour <pause dur="0.4"/> or are they due to material circumstances <pause dur="1.5"/><kinesic desc="changes slide" iterated="n"/> oops <pause dur="1.0"/><kinesic desc="changes slide" iterated="n"/> and that <pause dur="1.2"/> probably wasn't a clever way to do

that <pause dur="1.8"/> and again <pause dur="0.2"/> <gap reason="name" extent="1 word"/> looked quite # thoroughly at the evidence that suggests <pause dur="0.2"/> that # <pause dur="1.7"/> the only explanation that can effectively <pause dur="0.3"/> explain <pause dur="1.1"/> inequalities in health <pause dur="0.3"/> is the fact that # <pause dur="0.5"/> is the explanation related to poor material circumstances <pause dur="1.9"/> culture and health behaviour on its own can only <trunc>es</trunc> explain about twenty to thirty per cent of the differences health differences between social groups <pause dur="3.8"/> but <pause dur="0.2"/> social and material circumstances # <pause dur="0.7"/> in particular low income <pause dur="0.4"/> # poor access to physical resources like housing <pause dur="0.4"/> and the psychosocial stress of <pause dur="0.2"/> # living with low income <pause dur="0.5"/> # affects people's health both physically <pause dur="0.3"/> and mentally <pause dur="0.3"/> and shapes people's health behaviour <pause dur="0.4"/> and we looked at how people's health behaviour <pause dur="0.3"/> was <trunc>sh</trunc> # in in <trunc>re</trunc> how <pause dur="0.3"/> was shaped by <pause dur="0.3"/> in the area of # access to food and eating <trunc>beha</trunc> <pause dur="0.2"/> behaviour <pause dur="0.4"/> and in relation to cigarette smoking so we looked at that last time we were in <pause dur="5.1"/><kinesic desc="changes slide" iterated="n"/> okay so <pause dur="1.3"/> why <pause dur="0.3"/> should <pause dur="0.3"/> health inequalities be a concern <pause dur="0.5"/> of doctors really why are we

teaching you this why <pause dur="0.4"/> why is it considered important # that you study this <pause dur="0.4"/> # other than the fact that <pause dur="0.2"/> the General Medical Council said says that it's part of your curriculum <pause dur="0.4"/> there are a number of reasons why # you need to <pause dur="0.5"/> # <pause dur="1.2"/> understand and be aware of how health inequalities can be tackled <pause dur="0.8"/> i mean first of all because they have a profound effect on people's lives and have a profound effect <pause dur="0.3"/> on the lives of the patients that you're going to be dealing with on a daily basis <pause dur="0.6"/> and as Frank Dobson said in nineteen-ninety-seven <pause dur="0.4"/> <reading>inequality in health is the worst inequality of all <pause dur="0.8"/> there is no more serious inequality <pause dur="0.3"/> than knowing that you'll die sooner because you're badly off</reading> <pause dur="1.0"/> and i think that sums up very clearly <pause dur="0.5"/> # <pause dur="0.2"/> why <pause dur="0.5"/> we should concern ourselves with this issue <pause dur="1.5"/> so <pause dur="0.8"/> inequalities in health are really <pause dur="0.2"/> an issue of of natural justice <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> so continuing that <pause dur="0.4"/> why else might we need to # <pause dur="0.6"/> think about reducing health

inequalities <pause dur="0.5"/> well first of all we need <pause dur="0.2"/> to <pause dur="0.2"/> to do so because # health inequalities have substantial costs attached to them <pause dur="0.8"/> and by reducing them we'd be reducing the costs <pause dur="0.3"/> associated with premature deaths and illness <pause dur="0.4"/> both to individual patients <pause dur="1.1"/> and to the state <pause dur="1.3"/> so the cost to the state of # <pause dur="0.2"/> caring for people # <pause dur="0.3"/> # who are experiencing the health effects <pause dur="0.4"/> of <pause dur="0.3"/> health inequalities is substantial <pause dur="5.4"/><kinesic desc="changes slide" iterated="n"/> another reason is that because <pause dur="0.2"/> if we don't take account of or you don't take account of health inequalities <pause dur="0.5"/> in your medical practice <pause dur="0.3"/> then your practice # can confound the effects <pause dur="0.3"/> can worsen if you like <pause dur="0.2"/> or make more complex the effects of <pause dur="0.4"/> # poor <sic corr="material">masiterial</sic> circumstances on people's health and again we'll be looking at that issue <pause dur="0.3"/> this afternoon <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> and lastly <pause dur="0.9"/> we need to concern ourselves with <trunc>ine</trunc> inequalities actually 'cause the government says that you must <pause dur="0.5"/> # <pause dur="0.3"/> health inequalities is a key theme <pause dur="0.3"/> in the government's health and social policy <pause dur="0.4"/> and the government has

put in place a number of policies which we're going to look at # <pause dur="0.6"/> # in a minute <pause dur="0.3"/> that have <pause dur="0.4"/> that influence medical practice on a day to day basis <pause dur="0.4"/> so you will be seeing <pause dur="0.2"/> when you're out in in hospitals and in the community <pause dur="0.4"/> # how medical practice is being shaped by <pause dur="0.4"/> # initiatives from the government <pause dur="3.8"/> so what i'm going to turn to now is to look at <pause dur="1.3"/> what does the evidence say on how <pause dur="0.2"/> health inequalities can be most effectively <pause dur="0.2"/> tackled <pause dur="1.7"/><kinesic desc="changes slide" iterated="n"/> so the main evidence that we can draw on are <pause dur="0.2"/> evidence from a number of reports which took # <pause dur="0.4"/> which reviewed all the evidence on health inequalities and <pause dur="0.4"/> # put forward ways in which they thought health inequalities can be most effectively tackled <pause dur="1.4"/> the Black Report # <pause dur="0.5"/> you heard <gap reason="name" extent="1 word"/> refer to <pause dur="0.6"/> # those of you that came to <gap reason="name" extent="2 words"/>'s lecture <pause dur="0.8"/> will # remember that <gap reason="name" extent="1 word"/> <pause dur="0.3"/> talked about the Black Report and the fact that <pause dur="0.3"/> it was commissioned by the outgoing # Labour government in the late seventies <pause dur="0.4"/> but reported to <pause dur="0.4"/> the incoming Conservative

government in nineteen-eighty <pause dur="0.8"/> # <pause dur="1.3"/> and # the report those of you who'll remember <pause dur="0.2"/> Nick talking about how the report <pause dur="0.4"/> really was wasn't circulated widely there was only about two-hundred copies of the report <pause dur="0.3"/> actually distributed <pause dur="0.3"/> because of the fact it was considered to be quite radical <pause dur="0.5"/> # and that it wasn't in the government's interest to to circulate the report <pause dur="0.4"/> but as things happen once you try to # <pause dur="0.3"/> squash the circulation of something it has a life of its own and in fact was published as a Penguin book and was <pause dur="0.5"/> and the <trunc>re</trunc> the findings were very widely publicized <pause dur="1.2"/> but <pause dur="0.2"/> Douglas Black # and colleagues # concluded that <reading>while <pause dur="0.2"/> the health care service can <trunc>pl</trunc> can play a significant part in reducing inequalities in health <pause dur="0.6"/> measures to reduce differences in material standards of living <pause dur="0.2"/> at work and in the home <pause dur="0.5"/> and in everyday social and community life <pause dur="0.3"/> are of even greater importance</reading> so the Black Report was concluding <pause dur="0.3"/> that we need <pause dur="0.2"/> to # <pause dur="0.4"/> give people better access to <pause dur="0.3"/> # a a a better <pause dur="0.2"/>

standard of living at home and at work and in everyday life <pause dur="1.7"/> the same conclusions were # <pause dur="2.1"/> came to in a a report that was published in the nineteen-eighties which was <pause dur="0.5"/> # <pause dur="0.2"/> commissioned by the Health Education Authority called The Health Divide <pause dur="4.0"/> neither the <pause dur="0.4"/> findings from the Black Report or The Health Divide were # <pause dur="0.6"/> put into action <pause dur="1.0"/> so during # the nineteen-eighties we continued with # # a set of health policies <pause dur="0.4"/> that were concerned with really <pause dur="0.2"/> changing individual behaviour <pause dur="0.4"/> rather than # <trunc>aim</trunc> <pause dur="0.4"/> aiming at reducing health inequalities between groups <pause dur="2.4"/> in <pause dur="0.2"/> the nineteen-seventies or the late i'm sorry nineteen-nineties # <pause dur="0.3"/> with a new government came to power <pause dur="0.4"/> # the <pause dur="0.2"/> the government was it came into power commissioned a <trunc>re</trunc> <pause dur="0.2"/> a an independent <trunc>inq</trunc> <trunc>i</trunc> inquiry <pause dur="0.5"/> into that should say into inequalities in health <pause dur="0.5"/> which was published # <trunc>b</trunc> in nineteen-ninety-eight <pause dur="0.5"/> and this report was <pause dur="0.2"/> chaired by Sir Donald Acheson <pause dur="0.6"/> who # <pause dur="2.9"/> <trunc>w</trunc> was <pause dur="0.2"/> before # <pause dur="0.5"/> this period had been <pause dur="0.3"/> during the i think late

eighties and nineties <pause dur="0.3"/> the Chief Medical Officer for Health at the Department <pause dur="0.5"/> at the Department of Health <pause dur="0.8"/> # and he <pause dur="0.2"/> also <pause dur="0.2"/> prior to that was the dean of # <pause dur="0.3"/> the medical school at Southampton <pause dur="1.4"/> and in fact we were very lucky 'cause our guest lecture <pause dur="0.4"/> lecturer here on the last day of the module last year was actually Sir Donald Acheson who came to talk about the independent inquiry <pause dur="2.3"/><kinesic desc="changes slide" iterated="n"/> so <pause dur="0.5"/> the independent inquiry into inequalities in health was <pause dur="0.2"/> # commissioned <pause dur="0.5"/> by the Labour government and reported in nineteen-ninety-eight <pause dur="0.5"/> its remit was to review and summarize the evidence on inequalities in health in England <pause dur="0.3"/> to identify priority areas <pause dur="0.3"/> for the development of policy <pause dur="3.2"/> but <pause dur="0.4"/> it was limited to making recommendations that fell within the government's overall financial strategy <pause dur="1.4"/> so this report <pause dur="0.3"/> this # <pause dur="0.5"/> # <pause dur="0.6"/> inquiry reviewed and took evidence from <pause dur="0.4"/> # a huge number of people and reviewed # all the <trunc>re</trunc> # the research studies within this area <pause dur="1.6"/><kinesic desc="changes slide" iterated="n"/> # it drew the

same conclusions as the Black Report and The Health Divide <pause dur="0.6"/> and the report when it was published <pause dur="0.3"/> was accepted by government with # some government action in key areas and that's what we're going to look at this morning <pause dur="2.1"/><kinesic desc="changes slide" iterated="n"/> okay so it's if we think about what its conclusions and recommendations were <pause dur="0.7"/> # these were that firstly <reading>inequalities in health reflect <pause dur="0.4"/> differential exposure across the life course <pause dur="0.2"/> to the risks associated with socio-economic <trunc>permit</trunc> # position</reading> <pause dur="1.8"/> and it recommended <pause dur="0.6"/> firstly a need to intervene on a broad front <pause dur="2.1"/> it recommended the <trunc>n</trunc> # that it was important that poverty and income inequality were reduced <pause dur="3.0"/> it said that people's # people in poor <pause dur="0.3"/> social and material <trunc>ne</trunc> and <pause dur="0.6"/> <sic corr="circumstances">circumstanceses</sic> needed to have their material needs met <pause dur="1.7"/> it said that parents and children should be given priority <pause dur="1.7"/> and also that provision of equitable access to effective health care # <pause dur="0.3"/> # was important <pause dur="0.2"/> so i'm just going to talk about # some of these

individually now <pause dur="1.2"/> so let's take the first recommendation which was the need to intervene on a broad front <pause dur="7.2"/><kinesic desc="changes slide" iterated="n"/> by this it <pause dur="0.4"/> meant <pause dur="0.2"/> that health inequalities need to be tackled at a number of levels <pause dur="1.1"/> that it's less effective <pause dur="0.6"/> to focus <trunc>s</trunc> <pause dur="1.5"/> purely on any one point <pause dur="1.9"/> that we need upstream and downstream approaches to tackling health inequalities <pause dur="0.9"/> we need upstream approaches which deal with the wider influences on health such as income <pause dur="0.4"/> benefits <pause dur="0.4"/> employment education housing childcare <pause dur="4.0"/> <trunc>a</trunc> and that we need these as well as approaches and this is the approach that's <pause dur="0.3"/> predominated in the past <pause dur="0.5"/> as well as the the <pause dur="0.2"/> the approach that only deals with the downstream aspects of health <pause dur="0.3"/> such <pause dur="0.2"/> aspects of health behaviour <pause dur="0.4"/> such as lifestyles <pause dur="0.7"/> smoking diet et cetera <pause dur="0.9"/> so we need to look upstream to find out why people are falling into the river <pause dur="0.4"/> as well as downstream approaches that pulls them out <pause dur="0.3"/> # and rescues them and gives them mouth to mouth <trunc>re</trunc> <pause dur="0.2"/> # <pause dur="0.8"/> mouth to mouth as the we pull them out of the

river <pause dur="0.5"/> so we need to look at why people <pause dur="0.4"/> are falling into the river that's what's meant by upstream approaches <pause dur="2.4"/><kinesic desc="changes slide" iterated="n"/> so what it means then is that we need to concentrate on <pause dur="0.7"/> different <pause dur="0.5"/> aspects # and different <pause dur="0.3"/> # <pause dur="0.6"/> influences on health <pause dur="0.2"/> that it's no point these are the downstream approaches here <pause dur="1.1"/><kinesic desc="indicates point on slide" iterated="n"/> that it's <pause dur="0.6"/> we won't reduce health inequalities by just trying to change aspects of individual lifestyle and health <pause dur="0.2"/> and health behaviour <pause dur="0.9"/> that we need to start to make changes and have policies that change the socio-economic the cultural <pause dur="0.5"/> # environmental and material conditions that affect people in their everyday lives and are clearly the main influence <pause dur="0.2"/> and main determinant <pause dur="0.3"/> of how long people live <pause dur="0.3"/> and of people's health experience <pause dur="2.9"/><kinesic desc="changes slide" iterated="n"/> okay the second recommendation <pause dur="0.3"/> was # reducing poverty <pause dur="0.5"/> and this # <pause dur="0.2"/> is # this was highlighted very clearly in the Acheson Report <pause dur="0.3"/> that we were not going to # we're not going to reduce <trunc>h</trunc> health inequalities <pause dur="0.4"/> unless we reduce poverty <pause dur="4.6"/> okay <pause dur="5.6"/> it drew attention

to the need to reduce poverty in the U-K <pause dur="0.4"/> because there has been a significant rise in the proportion of people <pause dur="0.5"/> # who live in poverty in the U-K <pause dur="1.1"/> and the way that we <pause dur="0.2"/> measure poverty in the U-K <pause dur="0.4"/> # or the main way that we look at poverty <pause dur="0.4"/> # and i'll <trunc>tr</trunc> <pause dur="0.3"/> <trunc>t</trunc> <pause dur="0.5"/> draw a line between those if you like who # can be said to be living in poverty and those who are better off <pause dur="0.4"/> is by looking at the proportion <pause dur="0.2"/> of households <pause dur="0.5"/> or <trunc>th</trunc> or the proportion of individuals <pause dur="0.4"/> who have incomes <pause dur="0.2"/> which are below fifty per cent of average income <pause dur="1.1"/> and you can see here from these figures in nineteen-seventy-nine we had about <pause dur="0.4"/> nine per cent of the population <pause dur="0.4"/> who had incomes that were less than fifty per cent of average income and that was about four-point-four-million <pause dur="0.8"/> i'm <trunc>us</trunc> i'm going back to nineteen-seventy-nine because that's when # the figures are available from this it's from that date that this <pause dur="0.3"/> these kinds of figures were collected <pause dur="1.2"/> but we can see <pause dur="0.7"/> by two-thousand two-thousand-and-one

we've had a substantial <pause dur="0.5"/> rise in the proportion of people <pause dur="0.4"/> who have incomes <pause dur="0.2"/> of fifty per cent <pause dur="0.4"/> # <pause dur="0.9"/> of less than fifty per cent of average income <pause dur="0.3"/> so the latest figure <trunc>m</trunc> figures we have from the government suggest that <pause dur="0.5"/> virtually a quarter of the population <pause dur="0.4"/> # live in poverty </u><gap reason="break in recording" extent="uncertain"/> <u who="nf0268" trans="pause"><kinesic desc="projector is on showing slide" iterated="n"/> we look at poverty in the U-K the figures that i've just shown you the national figures if you like <pause dur="0.6"/> hide the distribution of poverty between social groups <pause dur="0.5"/> # because different groups are at different degrees at risk of being in poverty poverty <pause dur="0.4"/> like health is not equally distributed <pause dur="0.4"/> between the population <pause dur="3.4"/> # <pause dur="0.2"/> households with # people with disabilities are much more likely than other households to have low income <pause dur="1.3"/> # we also know that black and minority ethnic households <pause dur="0.2"/> are more likely to have incomes less than fifty per cent of average income <pause dur="0.3"/> than white households <pause dur="1.2"/> # and these are figures again from # the latest set of statistics on households below

average income <pause dur="0.2"/> which are published by # the government <pause dur="0.3"/> and you can see <pause dur="0.2"/> that households that # where the head identifies # <pause dur="0.2"/> him or herself as as white <pause dur="0.3"/> # <trunc>a</trunc> <pause dur="0.7"/> about twenty-two per cent of those households <pause dur="0.3"/> have incomes less than fifty per cent <pause dur="0.2"/> of # average income <pause dur="0.5"/> but you can see when we look at # particular <pause dur="0.3"/> # ethnic minority groups <pause dur="0.3"/> # we can see how the proportions # for these groups are significantly higher <pause dur="0.3"/> than for those households that classify themselves identify themselves as as as <pause dur="0.3"/> as white <pause dur="0.2"/> and you can see that for some groups <pause dur="0.3"/> # the proportions with of <pause dur="0.3"/> households <pause dur="0.7"/> of <pause dur="0.2"/> with incomes of less than fifty per cent is very very high so if you look at the figure for example <pause dur="0.6"/> for black non-Caribbean households <pause dur="0.3"/> where it's half of all households have poverty level incomes <pause dur="0.7"/> and you look at Pakistani and Bangladeshi households <pause dur="0.3"/> # where sixty-nine per cent of those households have <pause dur="0.2"/> # what can be <trunc>ident</trunc> classified as # <pause dur="0.2"/> as living in poverty or having a poverty level income <pause dur="0.2"/> of

less than fifty per cent of average income <pause dur="1.6"/> so some of those groups # are <pause dur="0.2"/> living with very very <pause dur="0.3"/> high levels of poverty <pause dur="2.4"/><kinesic desc="changes slide" iterated="n"/> if we look at # poverty levels by different kinds of family <pause dur="0.8"/> type <pause dur="0.5"/> you can also see <pause dur="0.2"/> that the type of <pause dur="0.2"/> # <pause dur="0.3"/> # <pause dur="1.0"/> household that you are also increases your risk of being at poverty <pause dur="0.2"/> being in poverty and you can see <pause dur="0.4"/> that the group # <vocal desc="cough" iterated="n"/><pause dur="1.4"/> the largest group in poverty consists of <pause dur="0.6"/> # households with children so for example <pause dur="1.0"/> this is <pause dur="0.2"/> all people are in poverty you can see that <pause dur="0.3"/> over fifty per cent of all people in <trunc>povert</trunc> households in poverty is made up of <pause dur="0.4"/> # households with children <pause dur="0.3"/> so that's households where there's # <pause dur="0.4"/> two adults and children <pause dur="0.3"/> and also households where there are <pause dur="0.3"/> # a single adult with children so we've got about fifty-four per cent of households <pause dur="1.9"/> you can also see from this <pause dur="0.2"/> that <pause dur="0.3"/> # even <pause dur="0.2"/> though # <pause dur="0.5"/> for example when you look at pensioner households or pensioner couples households <pause dur="0.4"/> # <pause dur="0.7"/> they only constitute nine per cent <pause dur="0.5"/> of the total number of people the total #

number of people in poverty <pause dur="0.3"/> but if you look at the the proportion <pause dur="0.3"/> of pensioner households who are in poverty <pause dur="0.3"/> then a quarter <pause dur="0.4"/> of all pensioner households have poverty level incomes <pause dur="5.3"/><kinesic desc="changes slide" iterated="n"/><vocal desc="cough" iterated="n"/> okay so a key recommendation <pause dur="0.2"/> # and a key way to reduce health inequalities <pause dur="0.2"/> is to reduce poverty <pause dur="3.4"/> the Acheson Report also recommended very clearly that <pause dur="0.5"/> # <pause dur="0.2"/> policies should be aimed at <pause dur="0.3"/> # <pause dur="0.6"/> tackling and improving the health <pause dur="0.2"/> tackling health inequalities <pause dur="0.3"/> and improving the health of parents with children <pause dur="0.8"/> and this is because health inequalities in adult life are set in part in utero <pause dur="0.2"/> and in the first years of life <pause dur="0.5"/> and i think we've heard <gap reason="name" extent="1 word"/> talk about that and <gap reason="inaudible" extent="1 sec"/> Nick Spencer <pause dur="0.3"/> when he's talking about life course epidemiology <pause dur="0.2"/> documenting very clearly <pause dur="0.3"/> how # <pause dur="0.3"/> health inequalities and # poor <pause dur="0.3"/> poor health in adult life <pause dur="0.4"/> # <pause dur="0.8"/> is related to # <pause dur="0.6"/> things like low birth weight health in utero and in very very early life <pause dur="2.6"/> # <pause dur="0.6"/> the government committed itself to eradicating child poverty in twenty years and

halving it in ten <pause dur="0.2"/> it took seriously its recommendation to to <pause dur="0.3"/> # prioritize the parents and children and we'll see that later when we look <trunc>s</trunc> more specifically <pause dur="0.5"/> at # some of the policies that the government's put into place <pause dur="1.0"/> # and this is because # that households with children as we've just seen are the largest single group in poverty <pause dur="1.0"/> about a third of all children are living in households with incomes less than than fifty per cent of average income which is really quite high a third of all <pause dur="0.3"/> the country's children <pause dur="0.2"/> have poverty level incomes and also <pause dur="0.3"/> it's important because <pause dur="0.2"/> child poverty rates # in Britain have increased faster <pause dur="0.2"/> than those in other comparable countries <pause dur="4.8"/><kinesic desc="changes slide" iterated="n"/> so <pause dur="1.1"/> if <pause dur="0.3"/> if we're looking at <pause dur="0.7"/> this <pause dur="0.6"/> we need to tackle on a broad front to reduce poverty <pause dur="0.3"/> and to reduce <trunc>mater</trunc> # and to improve people's material conditions <pause dur="0.4"/> and improve <trunc>me</trunc> people's material conditions by <pause dur="0.3"/> giving them access to # <pause dur="0.4"/> incomes which enable them to # have access to the sorts of lifestyles <pause dur="0.2"/> and the material

circumstances that they need for good health <pause dur="0.2"/> like access to healthy housing and healthy environments <pause dur="3.2"/><kinesic desc="changes slide" iterated="n"/> there are two <pause dur="1.7"/> main ways that you can reduce poverty and improve people's <trunc>li</trunc> living standard <pause dur="1.8"/> and these are <pause dur="0.2"/> through # <pause dur="1.7"/> initiatives and policies that improve <pause dur="0.5"/> people's access to income in kind <pause dur="1.4"/> and policies that improve access to income in cash <pause dur="0.5"/> so by income in kind i mean # <pause dur="1.5"/> not providing people with money in their hand but providing them with access <pause dur="0.2"/> to <pause dur="0.3"/> to <pause dur="0.4"/> income in kind if you like through services that have no cost attached to them <pause dur="0.7"/> so the N-H-S <pause dur="1.4"/> # <pause dur="0.3"/> indirect taxes like V-A-T <pause dur="2.5"/> # education local government services <pause dur="3.2"/> as well as providing or improving <pause dur="0.6"/> access to income in cash through <pause dur="0.2"/> employment policies wage policies <pause dur="0.3"/> through regeneration programmes which i'm going to talk about in a minute <pause dur="0.4"/> and to # by improving <pause dur="0.3"/> income in cash through things like # <pause dur="0.4"/> increases in benefits and pensions <pause dur="1.4"/> just to show you why # <pause dur="0.4"/> access to <pause dur="0.4"/> income in kind is important <pause dur="1.4"/><kinesic desc="changes slide" iterated="n"/> if we look at

this slide <pause dur="0.2"/> you can see that # <pause dur="1.3"/> this is an analysis <pause dur="0.2"/> by Shaw et al # and it's actually published in <pause dur="0.4"/> # <pause dur="0.2"/> the book The Widening Gap so those of you that have done the reading to prepare for today's session <pause dur="0.4"/> may well have looked at this # slide because the data's in the book this is a summary of the data that you see published in the book <pause dur="1.5"/> what they show here <pause dur="0.8"/> is the amount of income <pause dur="0.5"/> that # the poorest ten per cent of households <pause dur="0.3"/> as well as the richest ten per cent of households <pause dur="0.3"/> get from things like wages <pause dur="0.7"/> from cash benefits <pause dur="1.2"/> and also from benefits in kind <pause dur="0.3"/> and what it shows is that to those who are very poor <pause dur="0.5"/> and have poverty level incomes <pause dur="1.4"/> that benefits in kind <pause dur="0.5"/> make a substantial <pause dur="1.1"/> contribution <pause dur="0.4"/> to the overall incomes of <trunc>o</trunc> <pause dur="0.2"/> although it's not real money <pause dur="0.3"/> # but it was real money this is what it would <pause dur="0.4"/> contribute but it does make more of a <pause dur="0.2"/> has more benefit for those who are in the poorest ten per cent of households <pause dur="1.2"/> so if they didn't have that <pause dur="0.2"/> if you didn't have access to <pause dur="0.6"/> benefits in kind <pause dur="0.7"/> then this group of households would be substantially poorer <pause dur="0.8"/> so for example if we

had # a health care system that wasn't free at the point of access <pause dur="1.7"/> # if we didn't have free education <pause dur="1.7"/> if <trunc>post-ta</trunc> <pause dur="0.5"/> tax income was structured differently <pause dur="0.3"/> or <trunc>indir</trunc> indirect <pause dur="0.3"/> taxes like # V-A-T <pause dur="0.2"/> were structured differently <pause dur="0.4"/> then this group <pause dur="0.4"/> would be <pause dur="0.2"/> much much worse off than they are now <pause dur="0.5"/> so that's why it's important that <pause dur="1.8"/> services like the N-H-S <pause dur="0.4"/> # <pause dur="0.2"/> are do remain free at access and are delivered in ways that are responsive to the needs of those who are the poorest <pause dur="0.8"/><vocal desc="clears throat" iterated="n"/><pause dur="0.9"/><kinesic desc="changes slide" iterated="n"/> just before we finish <trunc>thi</trunc> think it's important <pause dur="0.2"/> to acknowledge that <pause dur="0.5"/> while the independent inquiry said very clearly about how we need to tackle health inequalities and the government has taken <pause dur="0.2"/> some of that on on board <pause dur="0.4"/> the <trunc>inde</trunc> the the independent inquiry can be criticized for a number of reasons <pause dur="0.4"/> # and it's # been criticized partly because <pause dur="0.2"/> it didn't adequately prioritize <pause dur="0.3"/> # its thirty-nine recommendations it made a huge number of recommendations <pause dur="0.3"/> and things like poverty <pause dur="0.2"/> # were easily lost in a sea of other recommendations <pause dur="0.5"/> many of the recommendations were too vague <pause dur="0.5"/> and the recommendations were not costed