British Labour government policy to reduce inequalities in health: Responses in an inner London borough, 1997-2003.

The stimulus for this research was the publication of the Green and White papers: Our Healthier Nation (OHN) - Saving Lives (DoH, 1998/9). The aim was to ascertain factors affecting the pattern and speed of local reactions to the new policy. These factors were predicted to be similar to those found in analysis of pre-1997. Conservative government, public health policy. However, the particular hypothesis of the thesis was that tensions in the Labour Party and government concerning aspects of the wider determinants of health would also play a role in affecting local implementation. Of specific importance was the equivocal determinant of 'income inequalities'. A case study of one inner-London borough was undertaken. Data collection was by way of in-depth interviews, participant observation and a review of local and national policy documents. Findings based on fieldwork are: 1. The implementation process was protracted. Delays need to be distinguished from policy failure. 2. Staff views did influence the pattern of implementation. However, some widely-held beliefs did not affect local work developed in response to the policy. This was primarily because no permission had been granted by central government for local staff to act on these opinions. 3. Local NHS staff needed clear guidance on how to prioritise work, this was not provided until 2003. 4. Unresolved anomalies exist in NHS and local authority public involvement work relating to health inequalities reduction. This is because the policy highlights the wider determinants of health, including income distribution. The latter is a politically partisan subject. The 'neutral' state bureaucracy is less adept at facilitating 'citizen' influence over the issue than political parties have been. However, sections of the Labour Party itself appear to have some interest in directing involvement away from party organisation