Social inequalities of health present challenges both within and between countries. Life expectancy in Sierra Leone is 34 years while in Japan it is 81.9 years (Marmot, 2005). In Sierra Leone, under-5 mortality was around 316 per 1000 born alive children to 3 per 1000 in Iceland. It could be argued that there are differences between countries and that these might involve genetic differences between countries. Yet, social inequalities of health occur within the UK even though it has a comprehensive welfare system. Public Health England (2017) shows that there is a 9 year life expectancy difference between males in the most deprived and least deprived areas, and a 7 years difference for females. Healthy life expectancy in the least deprived areas is 70 years and 50 in the most deprived areas – a difference of twenty years. UK government began to address the health inequalities in 1997 (Mackenbach, 2010). Overall, health in the UK is improving. However, the gap between the poor and the affluent has only slightly narrowed. This essay examines the strategies in cross cutting review 2002 for tackling health inequality and looks into the performance of the Sure Start initiative.
Social inequities in health can be defined as systematic differences in health status between different socioeconomic groups. They are systematic, socially produced and unfair.(Whitehead, 2006). It is unlikely that the social gradient in health can be eradicated entirely, but it is possible to make it less steep. (Marmot et al. 2010). Social inequalities in health happen due to inequalities in standard of living and the factors that make these come into existence. These inequities in socio-economic factors including the power to choose, money and access to resources. The determinants of health are affected by these socio-economic factors. They are the conditions within which people are born, grow, live, work and age. They include education, employment, housing, and health care services (Marmot et al., 2010).
Health inequalities are especially unjust for children. Children cannot take responsible for their own weight and diet. In addition, they cannot in choose a parent who can provide a high standard of life. (Law, Parkin, & Lewis, 2012). In 1998, the ruling party, Labour Government commissioned an independent report, Acheson’s report developing a comprehensive plan to tackle health inequalities. Acheson (1998) recommended that education can influence socio-economic status, and advocated an integrated policy to provide affordable, high quality early childhood education with additional resources targeted at supporting disadvantaged communities. Those recommendation provided the preliminary impetus for the Sure Start initiative.
In 1999, the Sure Start Learning Programme (SSLP) was established. The SSLP aimed to work with parents to enhance the intellectual, physical and social development of disadvantaged children, (Department of Health, 1999). It was built on existing early childhood education practice. Services included child care, learning, outreach services, breastfeeding support and primary health services for children and mothers. SSLP is responsive to local needs. For example, it even delivered classes of yoga or skills training for employees to adapt to local needs. (Lally, Trodd,2016)
By 2002, the concept of Sure Start Children’s Centres (SSCC) had been established. This was a modification of the SSLP. SSCCs connected maternal, such as mid-wife, and child care health practitioners working in one location with a wide range of services inherited from SSLP. This was a radical shift in means of service delivery, integrating maternal and early year service together. SSCC emphasis was on primary health promotion and preventive service.
In the beginning, there were difficulties sharing children’s health information between health agents and early year outreach staff because of data protection concerns. This is probably due to the culture of bureaucracy. Bureaucracy involves a level of division of labour which might seem efficient at first sight. However, people working in this system might become unresponsive and
slow to respond to change. Civil servants work based on following rules rather than serving individual citizens (Caffrey, 2015). The national evaluation of SSLPs suggested some ways to enhance the situation.
In 2011, evaluation revealed that Sure Start is locally beneficial, evidence suggesting that children in Sure Start areas benefited when compared with similar areas not serviced by the programme. Evidence included children being less likely to be overweight and more likely to have better physical health and parents providing a less chaotic and better learning environment at home. In the other word, Sure Start successfully improves the living standard of any given area. (Wolfe, 2011).
Regarding analyse the design of Sure Start, Whitehead (2005) developed a typology of actions to reduce health inequalities. This analysis is to address the underlying theory about the cause of problem and how to improve the situation. These four types are to strengthening individuals, to strengthening communities, to improving living and working conditions and associated access to essential services, and or finally to promoting healthy marco-policies.
To strengthening individual is addressing the cause of person deficit by person-based approach. Person-based approach is intended for developing health-related behavior. It included one-to-one counselling, health information campaign. The aim is to empower individual to believe they have right to access to the essential services which improve their health In strengthening communities, it is though developing social bonding and mutual support. The interventions can be horizontal and vertical. Horizontal social interactions is to link people in the same community to work together. Vertical social interaction is gather different groups of members to build inclusiveness and social participation. Improving living and working condition is to the daily living and working conditions to improve health. Promoting healthy macro-policies is to local the cause of health inequalities on a broader sense. Health inequalities is directly influenced by the uneven distribution of wealth in the society. Implementing policies to encourage equal opportunities to change the living standard, employment and opportunities to different groups in the population (Whitehead, 2007).
Sure Start provided outreach services and professional health practitioners to address the causes of individual . It focused on knowledge, identified the factors promoting individual self esteem and the autonomy to choose. Also, provides opportunities for personal education and development. It fulfilled the strengthening individuals typology. In addition, the coordination of multiple agencies in one location helped provide some valuable social capital to disadvantaged children. Unhealthy habits, such as uptake unhealthy food, are often inherited from parents and are hard to change. Healthcare worker were able to interact and allow parents and children to practice healthy lifestyle in the Sure Start location. Healthcare worker could contribute their healthy culture to the disadvantaged families. As a result children can acquire health competencies. They are empowered and realised they have the capacity to make independent choices concerning their health. Sure Start child centres provided a location for all staff to work at. It provided a place to allow horizontal and vertical integration of communities. People in the same area and background could gather in the children’s centre to build horizontal social cohesion. In addition, the health and education professionals could perform vertical community development. Presumably, combining vertical and horizontal integration reinforced social solidarity and reduced any individual stigma. The design of Sure Start strengthened the community in disadvantaged areas. Sure Start provided a place to empower people in disadvantaged area to be helpers of others. Some parents were trained and worked in Sure Start. These parents were able to regain confidence and actualize themselves as capable people. While Sure Start is not able to provide them with solid material and resources such as housing or money, it could provide them with symbolic value and opportunities to realise their capabilities to chose and achieve the lifestyle they want to have.
Sure Start could not improve living and working condition directly. However, it provided a high standard conditional centre for families to meet and solve local issues such as water leakage from buildings and need collective enquires to convince landlord to fix it. Sometimes, Sure Start also provided employment skills and low cost childcare.(Lally, A in Trodd, L, 2016). Sure start also provided a centre, health professionals could work in the early years focus. Healthcare worker can seeing local citizen with professional health equipments and with privacy. (Pugh., Duffy.,2014). It could also likely provide a decent place to meet the need for childcare during in day time and strengthen parents skill to work in a better place. Sure Start program itself is a macro-policies. It was intended to reach all families, aiming to improve living standards by providing childcare and education (Lally, Trodd, 2016).
Sure start not only successfully addresses the education related determinants of health, it also addresses the need for access to health services. Hart, J. T. (1971) explained the phenomenon of health service, and stated that health care service provision is inverse to demand. In other words, the areas with greater demand had fewer health services. Where Sure Start Centres provide health care service, disadvantaged areas have more preventive care, reducing sickness and biopsychosocial problems.
Despite its success, Sure Start itself cannot stand along in tackling health inequalities. It is likely that addressing one or two determinants of health is not enough to eradicate health inequalities. Furthermore, there are a lot of different aspects where government can work differently to create a better result.
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