Reducing inequalities in health: political and organisational implications for the British National Health Service.

Tackling health inequalities with any hope of success requires an understanding and appreciation of a number of issues concerning the nature and operation of services. Focussing on the British experience, the paper considers notions of need and demand insofar as these have a bearing on health inequalities. Need and demand are not finite, absolute states but are relative notions which are affected by users' attitudes and knowledge and by providers' preferences and interests. Drawing upon recent work, the paper argues that the existence of the National Health Service (NHS) has not fundamentally altered the nature of health inequalities in Britain. Those living in the North of the country generally enjoy poorer health than those living in the South. Inequalities between socio-economic groups are also much in evidence. The paper considers possible policy implications and comes out in favour of process change rather than major structural change of the kind witnessed in recent years in Britain where the NHS has undergone two major upheavals within a decade. This disruption has had the effect of diverting attention away from important policy issues at all levels of service planning and provision.(ABSTRACT TRUNCATED AT 250 WORDS)