Review calls for renewed action to create a fairer society

Politicians from all parties must renew their commitment to tackling health inequalities if we are to create a fairer society, say researchers in the British Medical Journal today.

Their views come as an independent review by Professor Sir Michael Marmot is published, outlining the most effective strategies for reducing health inequalities in England from 2010.

The review is critical of the poor record of policy success in tackling health inequalities and advocates two aims: to improve health and wellbeing for all and to reduce health inequalities. To achieve these it wants social justice, health, and sustainability to be at the heart of all policies.

But David Hunter, Professor of Health Policy and Management at Durham University and colleagues question whether "there is sufficient genuine and sustainable political will to tackle health inequalities."

There are few votes in health inequalities, they warn, and "although the report is at pains to point out, as others have, that we are all adversely affected and our lives diminished by the growing health gap, this message could easily get lost."

They outline three reasons for the lack of progress. The first is a focus on individual lifestyle interventions rather than action at a governmental level. "The response to the Marmot report must avoid this at all costs," they say.

The second - a deep seated inability to join up policy and delivery across government is, they argue "evidence of how fossilised our institutional structures have become and how incapable they are of providing effective solutions to the complex problems we face."

The third reason for policy failure, they say, lies in the realm of politics. "With the economic outlook bleak and an election looming, the temptation will be for politicians to say that we can't afford to deal with health inequalities just yet. The imperative is to show that we can't afford not to."

The policy changes needed for Marmot's recommendations to succeed can occur only if these three obstacles to progress are confronted, they conclude. Underpinning these must be a real political commitment at all levels, because a fairer society will benefit all.

A good start in life is the key to reducing health and social inequalities in society, according to an analysis article also published on bmj.com today. Clyde Hertzman and colleagues argue that governments in both rich and poor countries should be investing more in programmes to support early child development.