The government is pouring millions of pounds into initiatives to narrow the gulf of health inequality between the rich and the poor in the UK without knowing whether its policies are actually working, an inquiry by MPs has found.
In its scathing report, published over the weekend
, the House of Commons’ Health Select Committee called into question the logic of spending huge amounts of cash on programmes to close the health gap without the support of prior “meaningful” research to assess their potential success.
In its damning conclusion, the report claims the go
vernment has wasted millions on “social experiments to reduce health inequalities” without knowing “whether these experiments have worked or whether the money has been well spent”.
Although, on the whole, the health of the general population is on the rise, the last ten years have see
n inequalities between the upper and lower end of the social spectrum widen substantially – growing 4% amongst men and 11% in women – despite the government’s 2002 target of reducing health inequalities by 10% by 2010, which is now likely to be missed.
Most recent figures from 2006 show tha
t, while a girl born in the Kensington and Chelsea borough of London has a life expectancy of 87.8 years, for a girl born in Glasgow City it is more than ten years less (77.1 years), highlighting the stark differences still existing across the nation.
‘Impossible’ to evaluate success
The government has launched a whole host of different measures over the last decade to help foster a more uniform picture of health across the country, but, according to Committee, its approach to designing and introducing new policies have made it “impossible” to carry out a “meaningful
evaluation” of their success.
“All too often governments rush in with insufficient thought, do not collect adequate data at the beginning about the health of the population which will be affected by the policies, do not have clear objectives, make numerous changes to the policies and its objectives and do not maintain the policy long enough to know whether it has worked”, the report claims.
And several of the government’s initiatives have attracted criticism. For example, the Sure Start programme, born in 1999, is designed to provide support to disadvantaged families in the early years of life by improving the health and emotional development of young children, making more childcare available, and helping parents with employment.
While a national evaluation shows some success, the initiative “has yet to demonstrate significant improvements in health outcomes for either children or parents,” the report claims. Furthermore, it cites concern over the recent move to extend this policy to all areas of the country, as this could divert focus from the disadvantaged families in most need of such support.
In addition, Spearhead status – awarded to primary care trusts in areas with the worst deprivation back in 2004 with the aim of accelerating progress in a number of health outcomes, such as heart disease and stroke – appears to have “done little to galvanise areas to tackle health inequalities”, MPs say.
And now, the report claims, the latest Healthy Towns initiative – under which nine towns in England have been served a share of £30 million to help encourage their residents to lead healthier lifestyles – “has all the failings of previous policies”, indicating that the government has “learnt nothing from past mistakes”.
‘Damaging’ experiments
According to the Committee, the reforms discussed in its report are “experiments on the public and can be as damaging – in terms of unintended effects and opportunity cost – as unevaluated new drugs or surgical procedures”. It argues that “such wanton large-scale experimentation is unethical,” and calls for a more “rigorous culture of piloting, evaluating and using the results to inform policy”.
The Committee also slammed the government for failing to put in place certain measures that it believes will help to boost the nation. For example, it says that ministers and the Food Standards Agency are “continuing to procrastinate” about whether to implement a traffic light food labelling scheme to help all consumers clearly identify the nutritional content of food, four years after it was first recommended.
It also criticises the current target in the Quality and Outcomes Framework – an annual reward scheme for GPs – that rewards doctors for identifying smokers but not for helping them to give up and, while applauding the smoking ban, says the government should be focusing on tackling cigarette smugglers to help further boost the health of the lower classes.
The report concludes that the government “has not made even basic calculations about how much has been spent on tackling health inequalities”, and so recommends that it takes a closer look at how PCTs are spending the cash they receive for this, as well as the health outcomes achieved.
BMA and NHS Confederation support
Both the NHS Confederation and the British Medical Association have backed the report’s findings. Steve Barnett, chief executive of the NHS Confederation, said his organisation supports the recommendation for a “more rigorous evaluation of information to produce effective policies that close the gap in the system,” and that “an independent evaluation of suggested government policies will ensure that money is being spent on worthwhile programmes”.
And the BMA’s Head of Science and Ethics, Dr Vivienne Nathanson, said: “There is no bottomless pit of resources to tackle health inequalities so it is essential that the government spends taxpayers’ money wisely and on projects that will work,” and she stressed the importance of ensuring that “policies are part of a joined up, cross departmental approach.”
But Health Minister Dawn Primarolo insists that the government’s health inequalities programme is backed by “a wide evidence base and expert advice”. She claims that “major cross-government programmes – such as Sure Start, Family Nurse Partnerships and Healthy Schools, and efforts to tackle obesity – are based on research and feedback and evaluation is a key part of programme development”.
