nf0269: so part two [0.9] tackling inequalities in health [1.1] and we're going 
to look at the national and local policy context [0.9] are there any questions 
from the earlier two sessions before we start [3.1] okay well if you do think 
of any then ask them to your small group tutors [0.6] okay [4.0] so the key 
question then is [2.2] which policies and strategies are being employed to 
tackle health inequalities [0.5] and how effective are they likely to be [1.6] 
and i will say although this is s-, some of looking at some of this policy 
stuff is quite dry [0.4] and requires quite a lot of concentration [1.2] it is 
something that you can be examined on and that we have ex-, er er asked exam 
questions on in the past [0.3] in the overarching IMPSA and qualifying papers 
so it's worth paying attention to [1.9] okay so what i'm going to begin with is 
just er a very [1.0] brief thumbnail sketch of the health policy framework from 
nineteen-forty-five this isn't something you will be examined on but it will 
just provide you [0.5] with er a thumbnail sketch of [0.3] health 
policy er until up to the current date [1.7] okay so from nineteen-forty-five 
[0.5] to about nineteen-seventy-eight er we had er a health policy framework 
which really didn't concern itself [0.4] with health inequalities really until 
the nineteen-seventy [0.4] it wasn't an issue of political concern [0.4] partly 
because in the er immediate post-war period [0.4] health inequalities were er 
were at their lowest [0.2] and there was much more equality in health after the 
p-, [0.5] the war years [0.3] er but inequalities in health er started to 
increase [0.5] er [0.2] with the gap health gap between those who were better 
off and those who were poorer [0.5] er starting to increase er until it was 
really [0.5] becoming quite wide in the nineteen-seventies [2.2] and of course 
it was in the nineteen-seventies that the Black Report was commissioned because 
of this concern about this er [0.3] these ineq-, these inequalities in health 
experience between social groups [1.4] from [0.5] nineteen-seventy- [0.3] nine 
onwards er [0.4] we had quite a a long [0.2] almost twenty years [0.6] er a 
long 
period [0.3] when [0.2] there was [0.4] er [0.4] a really failure to 
acknowledge [0.6] er or in in government policy to acknowledge that health 
inequalities existed [0.3] and in fact the term health inequalities wasn't used 
in any policy documents or any policy speak during this [0.5] period [0.5] er 
and health ineq-, equalities were referred to as health variations [3.1] we had 
er in the early nineties the first ever national health strategy for England [0.
4] and there was also a health s-, er strategy put in place at that time for 
Scotland and Wales as well [0.9] and er some of you may recall that this first 
health strategy was called The Health of the Nation [1.1] and its overarching 
theme and concern was with er individual health [0.8] and [0.3] strategies [0.
7] aimed to [0.8] encourage individuals to s-, to take responsibility for their 
own health [0.6] so there was no action [0.3] to tackle inequalities [3.6] 
since nineteen-seventy-nine we've had a shift in emphasis in er the health 
policy framework [1.0] er we've talked about the Acheson Report [0.5] er the 
Acheson 
Report was used to inform er the new health strategy [0.5] which we currently 
have in place [0.5] and this strategy is called Saving Lives Our Healthier 
Nation [5.0] Saving Lives Our Healthier Nation represents the government's 
health strategy [0.9] and this strategy aims to [0.2] improve the health of 
everyone [1.1] but particularly to improve the health of the worst off [0.5] so 
it does acknowledge that er [0.3] there are groups [0.2] er who are experience 
health inequality [0.3] and this is near-, this is where efforts need to be put 
[0.3] to improve the health [0.4] er of those who are in the [0.2] the [0.2] 
the in the poorest health [1.7] and this er health strategy seeks to tackle the 
four main killers and you'll if you refer back to namex's lecture on lifespan 
[0.5] he looked at er [0.7] the incidence er [0.5] and the patterns for [0.4] 
er th-, [0.2] these four main killers [2.7] so we currently have a health 
policy framework which er aims to reduce coronary heart disease accidents [0.4] 
mental health and cancer et cetera [1.9] so [0.4] it's important to recognize 
er [1.6] what Saving 
Lives Our Healthier Nation aims to do because it does provide direction [0.4] 
for health work [0.4] so it does acknowledge the existence of health 
inequalities again this as i said this is a substantial change [0.9] er [0.5] 
it accepts the evidence that health is determined by social and economic 
factors [1.3] and it states that health inequalities need to be tackled [1.0] 
and it sees the way forward as people communities and government working 
together in partnership [2.3] if it can be criticized [0.3] er or certainly 
when it was published the criticisms were that no funding no specific funding 
was attached to reducing health inequalities [2.6] it actually itself [0.8] as 
a policy document doesn't address poor living standards or inadequacy of [0.4] 
of benefits [0.8] but having said that these are addressed in er in in other 
government documents and we'll be looking and these and other government 
policies we'll be looking at some of the social [0.5] policies that aim to 
address issues such as poor living standards [1.4] and it didn't when it 
was published [0.4] identify any national targets [0.2] er to reduce 
inequalities [0.3] but s-, these targets er since have been identified [0.5] 
and since February [0.3] two-thousand-and-one we've had [0.5] two [0.2] health 
inequalities targets to work towards [1.8] and these are [0.2] targets relating 
to infant mortality and life expectancy [0.6] the first target is to reduce by 
at least ten per cent by the year two-thousand-and-ten [0.6] the gap in infant 
deaths between manual groups and the population as a whole [1.3] and for life 
expectancy to reduce by again by at least ten per cent [0.6] er by two-thousand-
and-ten the gap in life expectancy between the fifth of health authorities with 
the lowest life expectancy at birth [0.3] and the population as a whole [1.4] 
so we now have got some targets to work towards [2.5] the government [1.8] 
works to [0.2] er s-, [0.3] reduce [0.2] health inequalities or sees itself as 
reduc [0.4] ing health inequalities by a number of overarching strategies [1.0] 
and these three strategies which are White Papers [0.2] er [0.3] i'm not sure 
if the N-H-S 
plan was a White Paper but [0.4] these three documents [0.3] all refer to in 
some shape or form [0.4] er the existence of health inequalities and the way in 
which health inequalities [0.2] er should be tackled [0.7] we've talked about 
er [0.2] the N-H-S plan [0.3] er in the first week that we were here [3.1] but 
then [0.3] it delivers these plans if you like [0.2] through a number of 
mechanisms [0.8] through Primary Care Trusts and N-H-S Trusts [0.3] where 
you'll all be working [1.0] er [0.2] through health improvement and 
modernization programmes [0.2] which i'll be talking a little bit about [0.6] 
and through national programmes and initiatives and again i'm going to talk 
about those in a minute [1.9] but Primary Care Trusts er [0.3] has anyone not 
heard of a Primary Care Trust you may do if you [0.5] er [1.6] if you do-, if 
you haven't lived here very long or if you've studied in another country and 
just come here to do medicine has anybody 
sf0270: [1.4] 
nf0269: Primary hair ca-, Trusts er [0.2] G-Ps are all part of a Primary hair 
crust in Ireland what are they do you have health boards [0.9] 
sf0270: 
yeah the health board 
nf0269: yeah 
sf0270: [0.4] 
nf0269: yeah Primary Care Trusts okay [0.4] they were they have replaced 
Primary Care Groups so they are relatively new so if you haven't heard them [0.
8] er [0.4] i'm n-, i'm not too surprised [0.5] they're part of the new 
framework for delivering the new N-H-S so they're key they're key to 
government's way of delivering health [1.0] they've evolved from Primary Care 
Groups so you may still and some Primary Care Groups still exist so you may 
peop-, hear people talking about Primary Care Groups [0.9] er but it's hoped 
that by two-thousand-and-four all groups will have transformed themselves into 
Primary c-, Care Trusts [0.3] which are much much [0.2] bigger on the whole [1.
9] and they're seen as pivotal [0.6] in terms of improving health and tackling 
health inequalities [1.2] and that by two-thousand-and-four pi-, Primary Care 
Trusts will be res-, responsible for at least seventy-five per cent of the N-H-
S budget [0.5] so [0.4] er [0.5] you 
know they'll huge [0.4] hu-, they'll hold huge budgets so for example for 
Coventry [0.4] there's just one Primary Care Trust now there were three Primary 
Care Groups [0.4] and there's and they've reorganized into one Primary Care 
Trust i think in Warwickshire [0.5] there are three [0.3] trusts is that right 
[0.7] how many tu-, tutors are nodding yeah there are three trusts which are [0.
5] north south and Rugby [0.9] is that right yeah [0.4] okay [0.8] er and some 
of you may have had speakers from the trusts has anybody had speakers from the 
trusts yet [0.7] 
su0272: [0.5] 
nf0269: yeah [0.4] yeah [0.3] good [0.4] good [1.3] so Primary Care Trusts are 
free- [1.4] standing N-H-S bodies accountable to their strategic health 
authority [1.7] and Primary Care Trusts [0.2] er [0.6] are responsible for 
commissioning care for their local population [0.8] so they're able to 
commission care from hospital trusts [0.4] so they will be commissioning er [0.
6] care from secondary care [0.8] and from other organizations as well so they 
can can commission flexibly [0.7] er and innovatively so they can commission 
aspects of care from [0.3] er local 
authorities from voluntary [0.3] and other statutory agencies [2.5] and they 
also provide [0.2] primary and they can also [0.4] commission other primary 
care but they also provide primary care themselves [0.9] and the primary care 
boards are made up of all the local stakeholders [0.2] in that locality [0.5] 
so there er there are elected family doctors [0.7] there are elected nurses 
community nurses [0.2] er midwives professions allied to medicine [0.3] social 
services for example you might have a so-, some social workers on there [0.4] 
and also er [0.6] representatives of the wider community [0.6] and it's the b-, 
the boards [0.2] that decide the priorities for the trust [0.4] and ensure that 
er [0.3] services are commissioned to meet the needs of the local population [1.
6] the trusts unlike Primary Care [0.2] Groups they have a much stronger [0.3] 
public health role [0.5] and the public health duties that were once until 
recently were held by [0.5] er the health authorities have now been passed on 
to the Primary Care Trusts [0.4] so [1.3] public health [0.7] is now the r-, 
the role of the Primary Care 
Trusts [0.5] er [0.5] so they're responsible for example for publishing er the 
annual public health reports [0.8] er [0.4] and for monitoring public health in 
localities [1.0] er and they're [0.2] also responsible trusts are responsible 
for [0.5] to [0.5] er facilitate better access to services [0.4] and to provide 
[0.2] better integrated services [0.5] so these are the roles that have been 
allocated by government to Primary Care Trusts [2.5] so the trusts will be af-, 
er er affe-, [0.4] the trusts will determine who comes to you in hospital [0.3] 
and a ki-, and the kinds of services that you're required to pr-, er [0.5] to 
er provide [0.4] er and if you're a doctor in a community trust a community 
based doctor you will you may be er part of the board or you may become part of 
the board [0.6] that's if there isn't s-, any substantial er reorganization of 
the health service by the time you qualify [1.7] so [0.3] Primary Care Trusts 
then have the potential to respond to local health needs [0.5] because they're 
er [0.2] they're responsible for a local 
geographical area [0.8] er so the potential is they could be quite responsive 
[1.2] they're required to work in partnership one of their strengths are that 
they're required to work in partnership [0.2] with other organizations like 
social services [4.4] they can commission very flexibly [1.5] and they can 
target [0.6] er prevention [0.3] and care and work towards equity in access to 
care [1.3] but what they can't do [0.2] is reduce poverty or income 
inequalities because it requires [0.4] er [1.5] wider social policy [0.2] to do 
that [2.9] the second mechanism i identified were HIMPs which is the Health 
Improvement and Modernization Programme [0.3] has anyone when they've been out 
in the community localities had a sp-, a HIMP [0.7] lec-, speaker yet [1.7] no 
it may well be you have have you yeah [0.7] may well be that some of you will 
have [0.4] er [0.5] someone from the trust [0.2] coming to talk about [0.5] the 
HIMP plan [0.2] the Health Improvement and moder-, Modernization Programme [0.
3] for your particular locality [1.3] so as i said earlier they've become the 
responsibility of the 
trust [0.8] and they set out the local strategic plan [0.3] for improving 
health [0.3] and importantly for tackling health inequalities [5.4] okay so the 
HIMP will set out er the plan and it will look at [0.4] er with oth-, other 
organizations how it can er [1.3] work to tackle the broader determinants of 
illness with other local [0.2] er [0.2] with other local groups and minimize 
the impact of hill ill health through providing [0.3] integrated services [2.1] 
so let's turn to look at national programmes rolling out policy [1.1] well it's 
clear if we're going to reduce health inequalities that we need to have [0.4] 
the kinds of policy in place [0.3] at national level [0.4] that er will [0.6] 
both improve [0.2] er [0.2] cash in kind [0.3] and improve cash in income [0.2] 
because we've seen that those [0.3] those are the main ways that we're going to 
reduce health inequalities [7.2] the government has put in place since nineteen-
ninety-seven [0.6] a number [0.9] of programmes that aim to improve cash in 
kind [0.5] and these are initiatives like [0.3] which i'm sure you've all heard 
of even if you don't know what they 
are [0.3] things like Health Action Zones Education Action Zones [0.3] Sure 
Start and regeneration programmes [0.9] as well as having er some cash in 
income programmes again [1.1] er regeneration programmes Welfare to Work 
programmes [0.4] and changes to benefits and pensions [0.3] er are likely [0.2] 
or are aimed to increase cash in income [0.5] and i'm just going to look at 
some of these not all of them now so that you have at least [0.3] some 
understanding of of what they're about [2.1] so the first one i'm going to look 
at is er a cash in kind programme which is Health Action Zones [3.2] Health 
Action Zones were launched er [1.5] and first of all drawn attention to when 
the N-H-S plan was er [0.7] launched [1.1] they're seen by the government as 
blazing the trail for modernizing the N-H-S [2.0] and Health Action Zones are 
an area based approach for improving health and reducing health equali-, health 
inequalities [0.8] so it's a local area based approach [3.5] the key objectives 
of Health Action Zones are t-, [0.3] that the zone will [0.3] identify and 
address 
local needs [2.6] increase the effectiveness and responsiveness of local 
services [0.5] and develop partnerships with other agencies [1.9] and [0.4] 
these [0.3] er these programmes or initiatives are coordinated usually by the 
National Health Service [0.7] now the government has made substantial amounts 
of money available for Health Action Zones [0.8] er and the latest figures 
suggest that about two-hundred-and-seventy-four-million pounds [0.4] have been 
made available for Health Action Zones [1.1] and this two-hundred-and-seventy-
four-million pounds [0.4] is going to twenty-six Health Action Zones that have 
been established [1.0] and they cover about thirteen-million people and will 
run for about seven years [3.0] we haven't got any Health Action Zones in 
Coventry or Warwickshire [0.3] er i don't know if any bids were made but people 
[0.4] er [0.5] groups [0.2] local groups had to put together bids so it would 
have been local health authorities [0.5] er bidding with with partners in 
education social services et cetera [0.6] er [0.2] to put a 
proposal forward for funding [0.9] twenty-six [0.4] proposals have been [0.2] 
er [0.5] successful and there's some and and i don't think there's any [0.3] 
any more [0.5] er [0.2] Health Action Zones going to be funded [0.8] but 
Leicester has one is that right [1.2] but you can see that substantial [0.4] 
amounts of money have been put into them [1.1] er they're currently being 
evaluated but it's early days [0.5] the evidence so far suggests that 
innovative projects have been put into place [0.6] er but there has been [0.3] 
er a flexible and i-, innova-, innovative er commissioning of services [0.2] 
and developments of services [0.7] but there's no evidence yet er on whether 
they have brought about any health improvements within those local areas [3.2] 
although they were seen as blazing the trail for modernizing the N-H-S [0.3] 
they seem to have when you [0.4] er hear government ministers talking about 
health policy they seem to be [0.4] less on the agenda than they were [0.7] er 
sort of two years ago [1.1] but if we look at [0.2] the strengths of Health 
Action Zones [0.4] er [0.6] and the strengths and weaknesses really of 
any area based approach to tackling health inequalities [0.5] and because 
they're they're the same [0.5] er [0.5] then the strengths are that [0.5] they 
could potentially seek to address locality based needs [1.8] they can build [0.
5] or could have the potential to build local solutions and there's some 
evidence that that's being done [1.9] and that they can strengthen and provide 
[0.2] money for [0.2] existing and new partnerships [2.5] working together [0.
6] to improve health in local areas and you can see the substantial among [0.3] 
amounts of money [0.4] gone into these projects [1.2] but the weaknesses if you 
like are that they can only ever reach [0.2] a small number [0.2] of of [0.2] 
people whom whose whose health is poor [0.6] you can see they were only 
actually covering although it was two-hundred-and-fifty-four-million [0.3] they 
were only actually covering thirteen-million people [1.9] er [0.9] and they're 
not necessarily in areas with the greatest needs so we know that there are for 
example [0.3] there are areas of Birmingham for example and other areas of the 
country [0.5] er which have [0.2] very very high levels of disadvantage and 
very very [0.3] and very very large numbers of people in very poor health that 
don't have [0.3] Health Action Zones [2.4] so they're not necessarily in areas 
with the greatest need [2.1] historically there's little or no evidence that 
area based approaches have ever been effective [0.6] area based approaches were 
tried in er i think the sixties and early seventies [0.4] when er the 
government put money into community development in health schemes [0.5] but the 
evidence from that was that er over time [0.5] er [0.8] er they've been shown 
to not produce any [0.4] any lasting effects in terms of health improvement in 
local areas [2.2] and of course [0.5] it's difficult to see how they can really 
impact on the root causes [0.3] of health inequality such as poverty and poor 
living standards [4.2] the second programme i'm going to talk about is Sure 
Start because [0.4] er [1.4] Sure Starts are operating in several of the areas 
that you're [1.2] you're [0.2] you're based in [0.2] er [0.3] Nuneaton has got 
a Sure 
Start programme and also er [0.6] Wood Wood End got one [0.3] yeah [0.4] er 
anywhere else anywhere in South Warwickshire [2.7] no [1.7] but if you listen 
to the news [0.3] read the local newspapers you'll of-, often [0.3] hear [0.3] 
references to Sure Start schemes [1.5] Sure Start is a programme a government 
funded programme [0.5] er which is aimed at impr-, improving children's life 
chances [0.8] so it's aimed at families with young children [1.6] and is a 
response to the Acheson Report that we need to target [0.2] parents and young 
children [1.8] it's a cross-departmental strategy involving the Department of 
Health and the Department of Education [1.2] and it aims to improve children's 
health [0.5] to reduce inequalities in children's health [0.6] to raise 
educational standards [0.3] to promote opportunities in local areas [0.3] and 
to encourage good parenting [5.0] the government again has set set aside [0.3] 
huge amounts of money for Sure Start programmes [0.5] er it's set aside f-, [0.
3] er [0.4] five-hundred-million [0.3] to deliver it [1.1] er and i-, it's er 
[0.5] it's projected that 
by the end of two-thousand-and-four there'll be five-hundred Sure Start 
programmes [1.2] and it's estimated that these programmes will cover or 
encompass one-third of all children in poverty [2.7] all programmes are 
multiagency [0.2] er agencies working together such as education social 
services [0.5] er together with health services and often [0.2] er many 
voluntary organizations within local areas [2.9] if we're looking at what the 
strengths of Sure Start might be [0.7] they're that they're er [0.2] can be non-
stigmatizing because Sure Start programmes aim to deliver [0.4] the Sure Start 
programme to [0.3] universally within an area [0.3] so all families with 
children under [0.2] under five [0.5] will be er offered the Sure Start 
programme so it doesn't stigmatize people by only offering it [0.3] to selected 
groups and it has been shown [0.4] that er [0.2] o-, offering services 
universally [0.5] er [0.6] to young families reduces stigma and therefore 
ensures better uptake of services [0.3] to those groups who most need care [1.
2] it's multifaceted [0.4] 
inte-, it's [0.3] different agencies working together [0.5] again like er h-, 
[0.2] er [0.3] the Health Action Zones [0.5] er they're locally driven 
programmes and they're programmes that er are designed to address local needs 
specifically [2.0] Sure Start programmes are required to acknowledge er [0.5] 
er [0.2] the the the fact that er [0.8] different groups have different needs 
[0.3] and they're required to deliver [0.3] culturally appropriate services [2.
6] and that they [1.0] will increase support to families with young children 
living in those particular areas [1.3] the weaknesses of Sure Start are the 
same as i've i've referred to in relation to er Health Action Zones [0.5] er 
because it's an area based approach it's got the same inherent problems [4.0] 
although [0.2] there's a there's now there's going to be about five-hundred 
programmes they're still only likely to reach a small proportion of of children 
who are poor [0.5] there's two-thirds of poor children who are not being er [0.
5] er covered by Sure Start programmes who would benefit 
from more intensive [0.2] support in their early lives [1.9] like HAZs there 
are no [0.2] there's no learn-, long term in funding for Sure Start [0.8] er [0.
4] local er Sure Start programmes have got to if they want to continue [0.5] er 
they've got to look at finding alternative funding to carry on the initiative 
[0.7] and also they're not tag-, tackling the root cause of prob-, [0.4] of 
poverty [0.3] which are things which are l-, related to er [0.5] overall social 
policies in the area of things like [0.4] er employment wages policies et 
cetera [4.2] okay [0.6] so we've looked at HAZs and Sure Start [0.2] which are 
[0.2] er very much health service er [0.3] i-, initiatives [0.5] we also need 
to look at the w-, the broader policies that the government's put into place [0.
4] it's at it's at this point i wish we'd still got the camera on you because 
several of you are starting to look sleepy again [1.6] okay [0.3] remember you 
might get an exam question on this [1.4] [laughter] what time are we [0.4] only 
another fifteen minutes [0.8] okay [1.8] let's look then at what the 
government's got in place in terms of 
regeneration programmes [10.3] the government is seeking to through [0.3] er [0.
5] regeneration programmes to regenerate local areas to put more life and money 
[0.5] and economic activity [0.3] into local areas to boost the er you know the 
[0.4] er [1.3] economic climate within areas [0.3] in the hope [0.2] that by 
regenerating very poor areas there will be [0.3] economic spin-offs for those 
who are are the poorest [1.6] we've got things like New Deal for communities [0.
2] er this is a a government programme [0.4] that targets money to most 
deprived areas and i think Wood End's got er and Henley in the north of 
Coventry have got a New Deal programme [1.1] er [0.8] so it it targets money on 
the most deprived areas [0.4] and has it aims to [0.3] er [0.7] to build 
initiatives within local areas which [0.4] reduce social exclusion and improve 
health so it has a very [0.6] clear health focus [0.4] and in fact next week 
when we're in we've got a s-, got a speaker i think haven't we from New Deal [0.
8] er who will be talking about [0.3] er [1.1] the New Deal programme in 
Coventry [0.5] 
nf0271: yeah 
nf0269: 
namex's c-, namex's looking worried here we have haven't we namex 
nf0271: 
nf0269: yes [laugh] [0.5] yeah we hope to have a New Deal speaker [0.3] as also 
we hope to have a Sure Start speaker who will be talking about [0.3] how sir-, 
Sure Start is being being implemented again in one of the local areas in 
Coventry and Warwickshire [1.5] so [0.6] regeneration programmes are aiming to 
tackle the local infrastructure [0.4] improve en-, employment [0.5] there's 
large amounts of money [0.3] er being invested in them [4.8] and they're 
covering er about thirty-nine neighbourhoods that are typically of between one 
and four-thousand households [1.5] so these money are these these [0.2] 
programmes are trying to tackle some of the root causes [0.3] of poverty within 
local areas [1.2] but again they've got er [0.3] they are [0.3] putting money 
[0.3] cash into areas [0.4] and trying to improve employment opportunities et 
cetera [0.4] but they have got many of the same problems that i've described in 
relation to HAZ and to Sure Start [1.0] in that they're short term 
funded [0.6] er er [0.3] et cetera [2.2] now you also need to just bear in mind 
that there are things like Welfare to Work programmes that the government has 
in place [0.3] confusingly one of them is also called New [0.2] New Deal [0.8] 
but it's different to New Deal for communities [2.0] New Deal er [0.2] is a 
Welfare to Work programme [0.6] which is designed to get specific [0.2] groups 
of the population [0.6] er back into employment [1.0] so it combines [0.5] 
training and employer incenti-, [0.2] incentives [0.4] er [0.5] er [0.3] 
together with making it very difficult for some groups [0.4] er [0.4] together 
in one programme so it aims [0.2] er New Deal is particularly aiming at getting 
lone parents back into employment [0.5] it's aimed at getting people off 
welfare [0.3] back into the work programme so off welfare benefits [1.0] it's 
aimed at lone parents young adults er eighteen to twenty-four [0.6] adults who 
are twenty-five-plus who are long term unemployed [0.5] and also looking at 
trying to get people with disabilities back into work [1.7] for some groups [0.
4] there where i've said coercion what i mean is [0.2] 
there are some groups er if they h-, who if they do not [0.5] er move into a 
New Deal programme or move into [0.4] sort er a training programme then there 
are [0.3] er it will affect their benefit [3.8] so there's little opportunities 
for some groups to er not to g-, to take part in this scheme [1.1] one of the 
problems with these kinds of programmes is they're only going to be effective 
if there are [0.4] well paid [0.5] jobs for people to move into [0.4] so for 
example [0.3] er [0.2] if if [0.2] these particular groups lone parents et 
cetera [0.4] er are to move into e-, [0.2] employment then [0.3] er they need 
to wo-, to move into employment [0.3] which has er [0.6] a healthy wage in 
terms of a wage that provides them [0.4] with access to a healthy living style 
[0.3] we're not going to reduce in-, [0.2] er inequalities if [0.3] health 
inequalities if the people are just moving from benefits to work [0.4] er 
without having an income [0.2] that provides them access to a healthy lifestyle 
[0.6] er [1.5] and [0.4] the evidence we have at the moment is [0.2] that er [0.
4] the New Deal programme isn't move-, necessarily moving 
people into well paid jobs that people [0.4] are moving into jobs [0.3] that 
have poverty level incomes or minimum wages [2.4] finally [0.6] er [0.2] we 
need to look at benefits and pensions and the [0.3] benefits and pensions 
programme that the government has in place [0.6] it's important because the 
majority of the poorest fifth of the population are dependent on welfare 
benefits [1.6] so for example ten-million people claim income support [0.2] in 
England [2.2] the evidence that we have is [0.2] that er [1.2] welfare benefits 
particularly income support fall short of the level [0.4] independent experts 
er say is needed [0.2] to be a modern [0.5] minimum [3.1] so that would be the 
modern minimum if you like for er t-, to [0.2] er support [0.5] good health [0.
2] in these groups [3.1] there is evidence that the current government has 
increased benefits er [0.7] er for younger children [0.2] er er and for 
families and there've been er above inflation increases in things like [0.5] er 
[1.0] er child benefit [0.4] and other initiatives er have been put in place 
like [0.2] the childcare tax credit and the working family tax 
credits [0.5] er which aim to provide additional [0.5] er [0.8] resources 
through [0.3] through income t-, the income tax system [0.4] to those families 
who are the poorest and they're particularly aimed [0.4] at providing [0.2] er 
people with additional income [0.3] that will enable them to be slightly better 
off in work than they were on welfare benefits [1.3] and that er [0.3] these 
are likely to to narrow some of the discrepancies between social groups but not 
eradicate them [2.6] the government has aimed to er [0.5] lift er about f-, [1.
1] er [0.2] four-point-five-million children [0.4] out of poverty [0.2] in the 
next ten years or i think it claimed it had [0.3] lifted four-point-five-
million over the last Parliament but the latest figures suggested [0.5] that 
they'd only actually er lifted about half a million children [0.3] out of 
poverty through their welfare and tax benefits [2.0] okay [0.3] if we look at 
[0.3] er older adults er 'cause again these are we saw that about twenty-five 
per cent [0.5] of [0.5] er [0.2] pensioner couples live in poverty so there's 
high rates of poverty [0.4] amongst older adults [0.4] we have 
seen [0.2] some increases in benefits to these small [0.3] to these groups but 
they're small [0.5] er and they've resulted in in single pensioner households 
for example being about eight pounds better off so we haven't seen [0.3] 
substantial increases in in welfare benefits and pensions [0.2] we've seen 
shifts at the margins [1.7] so let's sum up then [0.2] okay [0.2] we've looked 
at er [1.6] the evidence on er how health inequalities can be tackled [0.5] it 
suggests it can only really be tackled effectively through national programmes 
[1.3] we have got a government that [0.3] is who has acknowledged that [0.3] 
health inequalities exist [0.5] and that health inequalities need to be tackled 
and has [0.4] er [0.2] indicated that it has er [1.0] er [2.7] it sees it as 
part of its work to tackle them [0.6] we've got evidence of of some [0.2] 
income in cash [0.7] initiatives and some [0.2] er cash in kind [0.9] 
initiatives [0.7] er [0.5] but also the evidence is suggesting that [0.4] er 
benefits increases are are insignifi-, [0.4] insufficient to lift people out of 
poverty [0.3] or to significantly improve people's material 
conditions [1.9] what we're going to talk about er [0.8] oops wrong one [1.2] 
this afternoon [0.6] is we're going to talk about [1.1] we've looked at how the 
government [0.5] is setting about [0.2] tackling health inequalities [1.4] 
we're going to look at [0.8] what it means for you at the level of health care 
practice both generally and specifically as a doctor [2.2] that reminder is 
that er [0.2] your for-, your first formative assignment's due in on Friday [0.
2] the first [1.0] if you need any help than see your small gue-, group tutor 
today or you can just e-mail me if if you don't do that [0.4] if you are 
struggling just a minute [2.4] if you are struggling [0.5] or you need [0.6] 
additional support because of a learning need such as dyslexia [0.4] then see 
us early enough it's very difficult [0.2] particularly when it comes to the 
summer term if you're only seeing us a few w-, [0.3] a few [0.5] days before 
your assignment's due in [0.3] so see us early enough so we can provide you 
with some real support [1.3] okay you've got about five minutes before we do 
some small group work