Previous chapters have explored the relationship between health and place across different scales showing consistent evidence of spatial inequalities in health within local areas, between the regions and countries of the UK, as well as within and between countries internationally. They have shown that the causes of geographical inequalities in health are complicated and multifaceted, a combination of compositional (people), contextual (environment) and ultimately political and economic factors. This chapter examines how public policy has had an impact on health divides using a case study of the UK since the 1980s. It provides an overview of health inequalities policy since 1979, drawing on the key actions during this period. The successes and failures of UK policies in terms of reducing health inequalities are critically examined with reference to the wider context of the neoliberal political economy and the social and spatial determinants of health.

The UK is chosen as a case study because the Thatcher governments of 1979–90 played an important role in the promotion of the international neoliberal policy agenda, which remains influential today; because the Blair Labour governments from 1997 to 2010 implemented the most extensive health inequalities strategy in Europe; and because the coalition and Conservative governments since 2010 implemented austerity. The chapter critically reflects on how policy has had an impact on health inequalities from 1980 to 2015, analysing some of the key developments in this period. It ends by reflecting on what could or should have been done, drawing on evidence from a series of government-commissioned reviews into tackling health inequalities.

Thatcherism and health inequalities, 1979–97

The need to reduce health inequalities across the UK contributed to the decision to establish the National Health Service (NHS) in 1948. Yet, despite this universal, free at the point of use health service, by the 1970s it was becoming increasingly evident that free access to healthcare had not been enough to stem socioeconomic and spatial inequalities in health. In as far as a health inequalities policy existed at this time, it was within the NHS. So, in 1977, the Labour government (1974–79) faced fresh calls to do something about the issue. They responded by asking the Chief Scientist, Sir Douglas Black, to appoint a working group of experts to investigate the issue and to make policy recommendations for the government.