Ken Judge

Income inequality and population health

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined.

Public Opinion and the National Health Service: Patterns and Perspectives in Consumer Satisfaction

This paper examines the nature of public opinion concerning the National Health Service. Data from two series of national surveys covering the period 1983–92 are used to analyse trends in opinion. OPCS data for 1991–2 are examined in more detail to investigate the determinants of satisfaction with health services. A range of demographic, socio-economic and health status characteristics, as well as media coverage of health-related issues, are found to be significantly related to expressions of satisfaction with the NHS, in addition to recent experience of using health services. The complexity of the formation and expression of public opinion is acknowledged. In particular, the importance of taking note of the methodological implications and political context associated with expressions of public opinion is emphasised.

Caring for older people: an assessment of community care in the 1990s

Caring for Older People provides a unique insight into the world of community care in the 1990’s. It presents findings from a national study of social care from the perspectives of older service users, their carers and care managers. Descriptive findings from this longitudinal study – conducted by the PSSRU from 1994 and funded by the Department of Health – are set in the context of the history of community care and developments since the passage of the 1990 NHS and Community Care Act. The study’s findings highlight important challenges for policy and practice development in the new millennium. Link to Ashgate Publishing

Public opinion and the privatization of welfare: some theoretical implications

The social policy of the Thatcher government is characterized by an abrupt shift in the direction of the private sector. To what extent does this reflect what people want? The Institute of Economic Affairs conclude from the only suitable national opinion survey that such a move is strongly supported. Our reanalysis of their data shows that this strand in public opinion can coexist with, and need not contradict, an equal public enthusiasm for state welfare. Such results have important implications for our understanding of social policy. We conclude, therefore, with a discussion of contrasting marxist and liberal accounts which seeks to show that the evidence of ambivalence in popular attitudes about the welfare state supports particular developments in theory.

Off Target: A Critical Review of Setting Goals for Reducing Health Inequalities in the United Kingdom

Health policy in the United Kingdom is devolved to the four home countries. Nevertheless, England, Northern Ireland, Scotland, and Wales share a common commitment to reducing health inequalities and have set explicit targets in areas such as life expectancy, cancer mortality, long-standing illness, and smoking prevalence. However, many of the targets leave much to be desired in terms of their limited conceptual scope and their selection of methods and approaches. At one level this might be regarded as relatively unimportant. The mere fact of having health inequalities targets is laudable. But because the United Kingdom has been in the vanguard of research and policy development to reduce health inequalities, a critical appraisal of the strengths and weaknesses of the approaches adopted in the four home countries is timely. Following a description of the health inequalities targets, the article focuses on experiences in England and Scotland as examples of contrasting approaches to target setting and describes progress toward meeting targets in each country. The authors then outline key emerging issues in relation to developing targets and measuring progress, including conceptual dilemmas, biased reporting, implementation failure, and statistical fallacy.

Pricing Personal Social Services

After a long period of neglect the use of charges as policy instruments in the personal social services is, at last, beginning to occupy the attention of policy-makers in both central and local government. The main catalyst in this was the Layfield inquiry into local government finance, and one of the recommendations of Layfield,1 which was subsequently accepted by the government, was that charges for all local authority services should be the subject of a separate review. It remains to be seen what the outcome of the review is but, regardless of what action is taken on the broader front, an evaluation of pricing policy in the personal social services is essential. The present use of charges is replete with inconsistencies, variations, conflicts and anomalies, and there is a clear case for rationalisation at the earliest opportunity.