In what way did the Acheson Report represent a radical approach to health policy? How far did it inform New Labour’s’ policy on reducing inequalities in health?
A government commissioned report on health inequalities led by Sir Donald Acheson has been marked as extremely influential in shaping future UK health policies. The Acheson report highlights the area in which health inequalities could be reduced and provides the direction of health policies promoted by the Department of Health. The report focuses on several areas such as poverty that seems to have disproportionate effect on children. Increased benefit levels have been recommended for women of childbearing age, expectant mothers, young children and older people suggesting mothers on income support tend to have inadequate diets. The report also calls for more funding support to schools in deprived areas, better nutrition and the concept of health-promoting schools. Benefit levels for providing nutritional meals to children should be increased and food should be more affordable for fulfilling nutritional needs of children. The report also focuses on smoking and drinking problems urging for restrictions on smoking in public places, a ban on tobacco advertising and promotion, mass educational initiatives, increases in the price of tobacco and the prescriptions for nicotine replacement therapy. The Acheson report also suggests close links between health and mortality rates.
The Acheson report has been instrumental in shaping, directing and implementing several changes in the NHS Health policy. Several studies and research reports have been published on the impact and influence of the Acheson report on changes within health care policy. The Acheson report identified three crucial areas on social gradient and health inequalities and suggested that
a high priority should be given to the health of families with children;
all policies likely to have an impact on health should be evaluated in terms of their impact on health inequalities;
steps should be taken to reduce income inequalities and improve the living standards of poor households.
The Acheson Report and UK Health Policies
The Acheson Report 1998, an Independent Inquiry into Inequalities in Health was similar to the Black Report 1980 and can be considered as a Department of Health review of the evidence on inequalities in health in England.
The Department of Health has responded to the Acheson report by taking an official course of action. The Department of Health mentions that tackling health inequalities is a top priority for the Government, and is focused on narrowing the health gap between disadvantaged groups, communities and the rest of the country, and on improving health overall. The strategy for addressing this problems is published in, ‘Tackling Health Inequalities: A Programme for Action’ that lays the foundations for meeting the Government’s target to reduce the health gap on infant mortality and life expectancy by 2010.A programme for action include a three-year plan for tackling health inequalities and to help local organisations improve the way services are delivered to disadvantaged groups.
The programme for action in response to the Acheson report is based on
Supporting families, mothers and children
Engaging Communities and Individuals
Preventing Illness and providing Effective treatment and Care
Addressing the underlying determinants of health
The Acheson report suggests that socioeconomic inequalities in health and expectation of life have been found in England for many years and there have been data identifying differences in longevity by one’s socioeconomic position. Inequalities of health are measured in terms of mortality, life expectancy or health status and could be categorised by socioeconomic status, ethnic group or gender. The Acheson report suggested that there are differences in the health status of mothers, babies, people of lower socioeconomic status and people who smoke or drink heavily. The report definitely shows that death rates are falling in England and the rates have fallen since 1896. Thus life expectancy seems to have risen in the last few years although healthy life expectancy has not been rising. In fact the proportion of people with long standing illness has risen from 15 percent to 22 percent (Acheson Report, 1998).
The Acheson report thus gave new insights on health policies and identified issues that contribute to an increased rate of mortality and possible ill health. It identified several socioeconomic determinants including income distribution and household below average income, education, employment, housing, homelessness, public sector, transport and health related behaviour. Following the report, the Choosing Health White Paper given by the Department of Health sets out the key principles for supporting the public to make healthier and more informed choices in regards to their health. Through the paper, the Government has provided information and practical support to get people motivated and improve emotional well-being and also provide access to services to encourage people to make healthy choices. The government has also drawn up a food and health action plan that focuses on the ways that better health can be achieved through better nutrition at all stages of life and for different groups in society, recognising and addressing different needs, particularly those of disadvantaged groups (Choosing Health, DH, 2004). The government has also set up the Health Improvement Plan and a new NHS plan for tackling health inequalities
81% of people in higher socio-economic groups consider themselves to be in good health now, compared with 61% of people in the lowest groups 76% of people in the higher groups expect to be in good health in 10 years’ time, compared to 53% of people in the lowest groups (DH, 2004).
Putting forward the NHS improvement plan, the Government reiterated the NHS commitment that the NHS is motivated to prevent disease and improve health in general. The Government policies are focused on the fact that inequalities in health cannot be accepted and the fundamental objective is to create healthier choices for disadvantaged groups.
The NHS Improvement plan was laid down in 2004 to not only counter health inequalities but also provide better quality of care to patients and provide safer and more effective treatment.
The NHS Improvement Plan set out modernisation and health plans
putting patients and service users first through more personalised care;
a focus on the whole of health and well-being, not only illness; and
further devolution of decision-making to local organisations. (DH, 2004)
According to the Government report and Action Plan laid out in then Choosing Health White paper the nutritional priorities were given as follows:
increase in the average consumption of a variety of fruit and vegetables
increase in the average intake of dietary fibre to 18 grams per day
reducing average intake of salt to 6 grams per day
reduce average intake of saturated fat
maintaining the current trends in reducing average intake of total fat
reducing the average intake of added sugar
(Choosing Health White paper, 2004)
The Government took several steps to ensure that the recommendations of the Acheson report is considered for any further changes within the NHS. Accordingly major steps have been taken to ensure consumer awareness on the consumption of healthy foods and development of good food habits. Reducing the proportion of fat, salt in the diet has been recommended and retailers and caterers have been asked introduce healthier range of foods and offer such foods in convenient stores, centre locations and in remote areas of the city.
In a plan to tackle health inequalities, the Government has focused on many plans including –
Offer people personal health plans with support from the NHS.
Recruit NHS health trainers to provide advice and support for people to develop their personal health plans.
Provide services in the areas of highest need.
Offer disabled people the option of taking up a health check. (DH, 2004)
Considering the Acheson report on the exaggerated problems of health care among pregnant women and children, the government has also provided eligible pregnant women with vouchers that can be exchanged for fresh fruit and vegetables, milk and infant formula through a new scheme called Healthy Start. A Sure Start scheme is also in place for providing training, guidance and support for early years to children. Practitioners encourage changes in parental behaviour and improve the social and emotional development and physical health of children in the early years. Community Parental Support Projects are also in place that involves training of lead workers in 500 communities. ‘Healthy Schools’ programmes are encouraged to target deprived schools including Pupil Referral Units. The Government has promoted the concept of healthy schools by 2006, working towards a healthy school status by 2009.
The concept of Healthy schools, Sure Start and the Concept for providing Parental Support as well as providing people with personal health plans are some of the steps that the government has taken to ensure the promotion of health. Some of the objectives of the Action Plan have been given as follows. Following the Acheson report, the government focus has shifted from the one aimed to meet national targets to a different approach that could be given as follows
standards are the main driver for continuous improvements in quality;
there are fewer national targets;
there is greater scope for addressing local priorities;
incentives are in place to support the system; and
all organisations locally play their part in service modernisation. (Care Standards Planning Framework, 2004).
We discuss several studies which deal with the Acheson report. Oliver and Nutbeam (2003) point out that health inequalities has been considered seriously for an approach to improve health care and government policies have been developed to explicitly address existing health inequalities that has become an important issue since Labour has returned to power in 1997. The development of health inequalities policies, have been critically examined to assess how such policies could or should be developed. The authors point out that progress in the development of health inequality policies has been made although the progress is less than expected or ideal.
Kisely and Jones (1997) have written on the issues of public health ten years after the Acheson report. They point out that the issue of communicable disease control and the role of public health medicine is of considerable concern in the light of outbreaks and NHS reorganisations. The Acheson report seems to have highlighted several issues in this regard. Yet as Kisely and Jones the Report’s findings have yet to be fully implemented. The paper calls for a further review of public health function and should include the removal of the specialty from management costs, and the clarification & standardisation of the roles of the Director of Public Health (DPH), CPHM and other members of the multi-disciplinary public health team (Kisely and Jones, 1997). Possible organisational implications for a public health approach have also been suggested.
Tarlov (1999) has delineated four conceptual frameworks providing the bases for constructing public policy strategies for improving population health and this include: (1) Determinants of population health. (2) Complex systems: (3) An intervention framework for population health improvement. (4) Public policy development process with two phases of public consensus and policy action.
The Acheson report can be judged in this context and has provided both a consensus and a policy framework.
The research studies and analysis of the Acheson report suggests that the 1998 Acheson report has been extremely influential in shaping Health care policies in the UK and reducing inequalities in health.
Primary health care in London–changes since the Acheson report. BMJ. 1992 Nov 7;305(6862):1130-3.
Public policy frameworks for improving population health. Ann N Y Acad Sci. 1999;896:281-93.
Health inequality and public policy: one year on from the Acheson report. J Epidemiol Community Health. 1999 Dec;53(12):748.
Commentary on the Acheson report. Health Econ. 1999 Jun;8(4):297-9.
Barnes R, Scott-Samuel A.
The Acheson report: beyond parenthood and apple pie? J Epidemiol Community Health. 1999 Jun;53(6):322-3.
The Acheson report: challenges for the College. Arch Dis Child. 1999 Jun;80(6):576-8.
Better benefits for health: plan to implement the central recommendation of the Acheson report. BMJ. 1999 Mar 13;318(7185):724-7.
Inequalities in health. Report on inequalities in health did give priority for steps to be tackled. BMJ. 1998 Dec 12;317(7173):1659.
Oliver A, Nutbeam D. Addressing health inequalities in the United Kingdom: a case study. J Public Health Med. 2003 Dec;25(4):281-7.
Kisely S, Jones J.
Acheson revisited: public health medicine ten years after the Acheson Report. Public Health. 1997 Nov;111(6):361-4.
Also see: DH publications:
Choosing Health White Paper, DH, 2004
NHS Plan, DH publication 2004
Acheson Report, DH publication, 1998
Inequalities in health, DH publication 1998
NHS Improvement Plan, 2004