Health and inequalities

An overview of government policy and initiatives relating to child health inequalities.

Public Health Outcomes Framework

The vision for the Public Health Outcomes Framework, which was updated in November 2013, is to improve and protect the nation’s health and wellbeing, and to improve the health of the poorest fastest. The second of the two outcomes in the framework seeks to reduce differences in life expectancy and healthy life expectancy between communities, through greater improvements in more disadvantaged communities.

Accident prevention is one of the 17 key areas identified as a responsibility for local authorities within the Public Health Outcomes Framework. The framework notes that injuries disproportionately affect children from lower socio-economic groups. It includes the following indicators which relate to health inequalities and childhood accidents:

  • indicator 0.1: healthy life expectancy
  • indicator 0.2: differences in life expectancy between communities
  • indicator 1.1: children in poverty
  • indicator 1.2: school readiness
  • indicator 1.3: pupil absence
  • indicator 1.10: killed and seriously injured casualties on England's roads
  • indicator 1.15: statutory homelessness
  • indicator 1.16: utilisation of outdoor space for exercise / health reasons
  • indicator 2.4: under 18 conceptions
  • indicator 2.5: child development at 2-2.5 years
  • indicator 2.7: hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0-14 and 15-24 years
  • indicator 4.1: infant mortality
  • indicator 4.3: mortality rate from causes considered preventable.

Marmot Review

The Public Health Outcomes Framework draws heavily on Fair Society, Healthy Lives: The Marmot Review of Health Inequalities in England (2010). An update to the report was released in 2012 which showed that while life expectancy had improved for most of the 150 local authority areas in England that were due to take over responsibility for public health in April 2013, inequalities in these areas had also increased.

The Marmot Review stresses the importance of taking a life-course perspective and recognising that disadvantage accumulates throughout life. It emphasises that the close links between early disadvantage and poor outcomes can only be broken by taking action to reduce health inequalities before birth, and continuing these throughout the life of the child. This is reflected in the review's“Give every child the best start in life” policy objective, which aims to give every child the best start in life in order to reduce health inequalities across the life course.

Health and wellbeing boards

The recent NHS and Social Care Act sees the lead responsibility for public health transferring from the NHS to local authorities. Newly-established health and wellbeing boards situated in local authorities are expected to be the key to unlocking the wider social determinants of health such as education, housing, employment and community safety, all of which relate to health inequalities.

Child Poverty Strategy

The Government’s Child Poverty Strategy says that: “a focus solely on household income is likely to overlook other factors that are crucial for children’s longer term development and that can compound disadvantage over time. A sustainable approach to tackling child poverty needs to address a wide range of factors such as family, home environment, health and education.”

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Updated December 2013