While commending the Government for taking action to tackle health inequalities, the report is highly critical of policy design and implementation, which it says has made meaningful evaluation of initiatives impossible. In attempting to address inequalities, governments have rushed in with insufficient thought, a lack of clear objectives, have failed to collect adequate baseline data, made numerous changes and not allowed time for policies to bed in.
Lessons have not been learnt from the failings of previous policies, such as Health Action Zones which the Committee says was ill-thought out. The latest initiative, Healthy Towns, should have been a prime candidate for rigorous evaluation, but has been introduced in a way which makes this impossible by allocating funding to the strongest bidders rather than random towns.
The Government has not made even basic calculations about how much money has been spent on tackling health inequalities and the report recommends an in-depth funding study of a small sample of PCTs to track allocation of funds and the health outcomes achieved.
More public money must not be wasted on ineffective and possibly damaging interventions. A more rigorous culture of piloting, evaluating and using the results to inform policy must be introduced, with clearly defined goals and robust measurements for success. Future initiatives should, before implementation, adhere to a basic set of research guidelines.
Given the lack of evidence, the Committee realises that it is difficult to recommend what measures should be taken, but there is plenty of evidence that a healthier lifestyle greatly improves life expectancy. Steps the Government could take to improve this are:
- legislate to introduce a statutory traffic light food-labelling system
- publish a Planning Policy Statement on health that encourages walking and cycling and enables local planning authorities to limit the number of fast food outlets
- reduce smoking, in particular by reinstating tough targets to tackle tobacco smuggling (tobacco smuggling has a disproportionate impact on the poor)
- by awarding more points in the QOF (Quality and Outcomes Framework – where GPs are rewarded for hitting care quality targets) for success with smoking cessation, rather than the current system which gives points for simply identifying smokers
The Chairman of the Health Committee, Kevin Barron MP, said:
"There is no easy or quick solution to the challenge of tackling health inequalities. But, while our Committee commends the Government on its commitment to reducing the health gap, we were shocked by the lack of meaningful evidence and evaluation available on this subject. How can those involved in addressing health inequalities know for certain what works when proper evaluation has not taken place? And without proper evaluation, the Government’s ability to formulate evidence-based policy is impossible.
"The taxpayer must be reassured that money invested in policy initiatives is making a difference. At the moment, in relation to health inequalities, we cannot say with certainty that this is the case. Far more must be done to ensure money injected into implementing these policies is tracked and policy design must be sufficiently improved so that effective and accurate evaluation can take place, so that policy-making is based on sound evidence."