Department of Public Health, Erasmus MC, 3000 CA Rotterdam, The Netherlands.
J Epidemiol Community Health. 2011 Jul;65(7):568-75. doi: 10.1136/jech.2010.128280. Epub 2011 Apr 1.
England was the first European country to pursue a systematic policy to reduce socio-economic inequalities in health. This paper assesses whether this strategy has worked, and what lessons can be learnt. A review of documents was conducted, as well as an analysis of entry-points chosen, specific policies chosen, implementation of these policies, changes in intermediate outcomes, and changes in final health outcomes. Despite some partial successes, the strategy failed to reach its own targets, that is, a 10% reduction in inequalities in life expectancy and infant mortality. This is due to the fact that it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets.
英国是第一个采取系统政策来减少健康方面社会经济不平等的欧洲国家。本文评估了该策略是否有效，以及可以吸取哪些经验教训。我们对文件进行了审查，并分析了选择的切入点、选择的具体政策、这些政策的实施、中间结果的变化以及最终健康结果的变化。尽管取得了一些局部成功，但该策略未能达到其自身的目标，即减少预期寿命和婴儿死亡率方面的不平等 10%。这是因为它没有解决最相关的切入点，没有使用有效的政策，也没有达到实现全人群影响所需的规模。只有当政府有民主授权来进行必要的政策变革、能够制定出明显有效的政策，并且这些政策能够达到实现总体目标所需的规模时，健康不平等才能得到实质性的减少。
