In society around the world these is debate about the inequalities in the health and healthcare that we observe among populations and among places. Research seeks to improve understanding of the causes of health variation. Such knowledge should provide evidence about how best to influence the causes of health inequality and produce health gain for human populations (Curtis, 2004, p 1-2). The concept of ‘health’ is open to differing interpretations.
The bio-medical perspective on health focuses on presence or absence of diagnosed diseases, but broader definitions include the idea of health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ (Curtis, 2004, p 1-2). The inequalities in the health of the nation (Townsend et al. , 1988) have been subject to extensive debate and policy initiatives over a number of years.
Many of the ‘problems’ and needs have been long identified but are still awaiting resolution. “Health inequalities are the systematic, structural differences in health status between and within social groups within the population. The term “health inequalities” is closely linked to “social determinants of health” (Marmot and Wilkinson 1999) as it refers to the multiple influences upon health status, including socioeconomic status, diet, education, employment, housing, and income.
It is thus concerned with the “causes of the causes” of disease. Inequalities in health care do exist (notably in access to care) but these are not considered the principal cause of inequalities in health status (Marmot 1999). The social determinants of health and health inequalities pose particular problems for policymakers. The causes are multifaceted and the solutions must be too. Policies may need to be long-term, require the collaboration of multiple agencies, and generate few outcomes measures initially.
Unless policy processes are understood, current and future policies may not achieve their goals. Indeed, some policies such as those that have reduced overall levels of smoking have unwittingly increased socioeconomic inequalities in smoking (Jarvis 1997; Evans 2002). Also, the lack of evidence about effective policies is significant given the policies to tackle health inequalities that have been proposed by the government” (Marmont, Michael, 2003).
Overt racism from individuals remains a very significant problem in the UK, as suggested by findings of the Fourth National Survey of Ethnic Minorities. Just over one quarter of white respondents had a preference for a doctor of their own ‘ethnic origin’ and while 60 per cent of this group stated that this was because they had difficulty understanding a non-white doctor, and thus, for them, overt racism cannot be assumed to be proven, for the other 40 per cent the reasons given suggest, ‘more clearly contained elements of prejudice’ (Nazroo, 1997:122-3).
It has been estimated that there were 382,000 racist incidents in England and Wales during 1995, but only 12,200 of these incidents were reported to and recorded by police (British Crime Survey and Home Office, cited in Social Exclusion Unit, 2000, para. 2. 46). Anti-racism and inequality Anti-racism is more than implementing equal opportunity policies (Dominelli, 1988:136). It requires an understanding and recognition of the processes and expression of racism including the power relationships between black and white people.
It seeks to challenge racist assumptions and cultural stereotypes in favor of policies, structures and practices that are sensitive to, and valuing of, cultural differences. Nonetheless, the focus on ‘difference’ between cultures in anti-racist practice has been criticized for its tendency to homogenize ethnic identities and reify cultural boundaries, as well as to affect, in a similar way identities pertaining to disability and sexuality.
In this respect, the efforts in the NHS to link equality with quality, and the increasing emphasis on ‘managing diversity’ as opposed to managing minority problems, are suggestive of a new organizing theme and language for the pursuit of equal opportunities in public services into the twenty-first century. There are of course a number of dimensions to equal opportunity understood in this broader sense (Dylan Ronald Tomlinson, Winston Trew, 2002, p 82-95).