The Acheson Report

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The Acheson Report

Inequalities in health are long-standing and their determinants are deeply ingrained in our social structure.

Since 1980, although health and expectation of life have generally improved, the social gradients of many indicators of health have deteriorated, or at best - remained unchanged.

Although this period was also marked by substantial economic growth, income differentials widened to a degree not seen since World War II. It also saw the reversal in the trend to greater equality seen in the 1960s and 1970s.

Average incomes grew in real terms by about 40 per cent between 1979 and 1994/5, but this growth was far greater (60-68%) amongst the richest tenth of the population. For the poorest tenth, average income increased by only 10 per cent (before housing costs) or fell by 8% (after them).

There has been some improvement in the relative position of the poorest groups in the period since 1992, but income inequality is still pronounced and is worse than in many other developed countries.

The differences in incomes between those on means-tested benefits and those with other sources of income are a major determinant of income inequality in the United Kingdom.

Among the poorest fifth of the population, the majority have incomes set by the level of means-tested benefit.

People on low income, defined as below half average income, are more likely to be unemployed, lone parents and their children, people with disabilities or pensioners and to live in social housing.


Some minority ethnic groups, especially Pakistanis and Bangladeshis, are over-represented in the poorest fifth of the income distribution.

A similar picture emerges if poverty is defined as the receipt of Income Support. Almost a quarter of all households include at least one person receiving Income Support. Measured over a two-year period, this figure rises to more than a third.

The number of people receiving Income Support has risen from just over 4 million in 1979 to 9.6 million in 1996.

Comparisons over time are difficult but recent work has shown that the proportion of the population with below half average income has more than doubled since 1979, to reach 18% in the mid 1990s.

Many studies and analyses have demonstrated the association of increasingly poor health with increasing material disadvantage. For instance, all cause mortality is correlated with Townsend deprivation score, an index that combines indicators of unemployment, lack of car, not being an owner-occupier and overcrowding.

The highest mortality rates for both men and women are found among those who live in areas with the highest scores (most deprived), and the lowest in those from areas, which are least deprived.

People living in households with incomes of £350 or more per week have significantly lower rates of self-reported long standing illness than those living in households with an income of £200 per week or less.

However, available evidence is insufficient to confirm or deny a causal relationship between changes in income distribution and the parallel deterioration in inequalities in some areas of ill health.

We welcome the Government's declared intention to redress income inequalities through:

  • The establishment of a national minimum wage.
  • Welfare to Work.
  • Other measures.

This approach should be accompanied by efforts to:

Redistribute resources, in cash or kind, to those who, for reasons such as age or disability, are unable to work, and to those families for whom work is not available or appropriate.

We consider that without a shift of resources to the less well off, both in and out of work, little will be accomplished in terms of a reduction of health inequalities.