Socio-economic inequalities in health have moved up the policy agenda and rather than one approach in tackling teenage pregnancy. These approaches can be understood by ensuring an improvement to the health of the poorest of the poor ones, through narrowing the gaps between those in the poor society and the rich ones that are to do well, to addressing the association between socio-economic position and health across the population (Graham, 2004). Public health policy in older industrial countries is in a process of change. A narrow concern with promoting population health is giving way to a broader vision of the goals of policy. The broader vision combines a focus on health gain with a commitment to reducing inequalities in its social distribution.
This commitment is the cornerstone of the United Kingdom new public health policies because England's new strategy seeks 'an improvement to the health of the lowest class in society and also narrow the gap. 'Tackling health inequalities' is a core driver of policy (Secretary of State, 1999). Development in the UK is in step with that elsewhere in Europe. Here, the goals of public health policy have been redefined to give greater emphasis (Gadikou E. E, Murray C. J and Frenk J, 2000; Chang W. C, 2002) to tackling systematic differences in the health of advantaged and disadvantaged of us that are ill, and some of us that are not. In so many studies about tackling health inequalities (Braveman A, Krieger N and Lynch J, 2000; Marmot M, 2001), it has been said that health inequalities are more widely understood to refer, not to variations between individuals, but no differences between social groups.
In most countries, including the UK, health inequalities are shorthand for socio-economic inequalities in health, whether measured at the individual or are level. Health inequalities which relate to other structures of inequality like gender or ethnicity are typically labeled in these terms as gender inequalities in health, ethnic inequalities in health etc. to tackle health inequalities is therefore to tackle unfairness (Milburn A, 2001). To tackle health inequalities in teenage pregnancy, then good health is the way forward to every individual and not just a particular group or set of people. Decreasing health disadvantages, narrowing health gaps and decreasing health gradients can be used to tackle health inequalities (Graham, 2004)
Tackling Health Inequalities:
There has been a very large amount of research on the causes of health inequalities in the world but less evidence on how to reduce, tackle or bring it to a stop. The major aim of tackling health inequalities is to build a more equal distribution of health between the social groups so that every individual gets to benefits. Health inequalities were known in the UK after the Black Report was published. The Black Report showed that there had been an improvement in health across social classes with the help of National Health Scheme (NHS). It is clear that the simplest way to tackle health inequalities is to improve on the social determinants of health in which the World Health Organization (WHO) defined the social determinants of health as 'the condition in which people are born, grow, adapt, work and age including the health system. The figure below shows a summary of these conditions as proposed by Dahlgren and Whitehead (1991).
Figure 1
Dahlgren G. and Whitehead M. (1991)
In UK in the year 1980 when the Black Report was first produced on the issues of health inequalities. Sir Michael Marmot who is an epidemiologist at University College London, published an article on the relationship between health and poverty on the Fair Society, Healthy Lives. He described his article Fair Society as a social gradient in health. Michael Marmot said that the causes of health inequalities includes lifestyles such as smoking which remains more common, drug abuse, obesity, is increasing fastest, teenage pregnancy, amongst the poor in England on the study The Economist. Tackling health inequalities is described as a commitment 'to break the link between poverty and ill health' and 'also improve the health of the lowest class' (Millburn A, 2001).
Reducing Health Disadvantages:
At one end of the continuum, health inequality describes the poor health of poor groups and communities. Hansard (1998) said health inequality is the link between poverty and ill health. In this perspective, health inequality is a concept which captures the health consequences of poverty. Health inequalities are the health disadvantages which result from social disadvantage. It is an understanding of health inequalities which is in line with the government's commitment goal 'to make health better to the poor'. It is an important policy goal in which poor groups and poor communities endures rates of morbidity and mortality which the rest of the population has left behind (Townsend and Davidson, 1982; ONS, 2001).
There is a powerful moral argument for tackling these absolute health disadvantages. It is an argument which asserts that health is a basic need which no one should be unnecessarily denied. It is 'a very elementary freedom, the ability to survive rather than succumb to premature mortality'. It is a moral position which puts the health of the (global) poor at the top of the policy agenda. World Health Organisation (WHO, 1999) reported that 'first and foremost, there is a need to reduce greatly the burden of excess mortality and morbidity suffered by the poor'. In a country as rich as the UK, there are few who would not regard the poor health of poor communities as compromising the elementary freedom to survive. Average standards of health achieved two decades ago should be achievable by the poorest now.
Defining health inequalities as health disadvantages aligns public health policy with other elements of the government's welfare programme. It provides a bridge between the public health and social exclusion agenda, steering both towards interventions targeted at groups vulnerable to social disadvantage. However, while offering policy advantages, defining health inequalities as health a disadvantage is not without its problems. It turns socio-economic inequality from a structure which impacts on all to a condition to which only those at the bottom are exposed. It is the lowest socio-economic groups and the poorest communities who are 'suffer the outcome', 'health inequalities which is the lifestyle of the people and from low income, poor education, bad housing, poverty, pollution, low educational standards, and joblessness' (DoH, 1998). Firstly, tackling health inequality is not a population wide strategy but it is one confined to sub-groups which make up a relatively small proportion of the population. Secondly, tackling health inequality does not extend to bringing levels of health in the poorest groups closer to the national average. In a society where overall rates of health are improving, absolute improvements in their health maybe sufficient to narrow the gap between the worst and better off. As a result, better health among the poorest group has been associated with a widening gap in life expectancy between the bottom and the top.
Narrowing Health Gaps:
At the mid-point on the continuum is a position which focuses not only on the poor health of poor groups but also on their health relative to other groups. Here, health inequalities are defined in terms of health gaps. The Chief Medical Officer (CMO England, 2001) refers to health inequality in terms of 'the gap in health between the best off and the worst off in the society'. The targets for tackling health inequalities, however, adopt a different formulation of the health gap in terms of the health differentials (DoH, 2001) those in the poorest circumstances and the average for the population. The health gap is a measure of health inequality widely used in research to compare the health of those at the extreme ends of the socio-economic hierarchy. This concept of health inequality is an important driver for policy which draws attention to the fact that population averages mask wide differences in health between social groups. The moral case for addressing health gaps is enshrined in the constitution of the World Health Organisation (WHO). It suggests that, in any given society, those in the best health set a standard which all should be able to enjoy. If this is so, it is those in the poorest groups who face the most profound denial of their fundamental human right. This has been an important focus of equity-oriented public health strategies and in England, health inequality targets are health gaps targets (Botting, 2007).
Narrowing health gaps therefore represents a more ambitious goal than remedying health disadvantages. This measure/concept of health inequality is an important driver for policy making which magnets attention to the fact that the society averages mask wide differences in health between groups. As the national average improves, narrowing gaps requires special efforts to ensure that figures (DoH, 2002) are not only keeping up, but closing the inequality gap.
Reducing health gradients~
To further the continuum, health inequalities as an issue in the UK and other European countries is not only about the differences in health between the good, the bad and the ugly but instead, the relationship between socio-economic position and health in a systematic way. Reduction in health gradients have endured across epidemiological periods, proofs in the 19th century where infectious/communicable diseases were really the major cause of death but now, chronic or Cardio-Vascular disease (CVD) diseases has come to stay to take over.
Health inequalities follow a social gradient and to tackle this socio-economic gradient in health is really a challenging policy (DoH, 2002). The moral case for tackling socio-economic gradients lies in the moral equality of people with respect to health and just as World Health Organization constitution states, the highest attainable standards of health (WHO, 1948) should favour everybody regardless the colour, race, religion, belief, socio and economic conditions and this principle has long guided Public health in England. A socio-economic differential has a focus compared to social disadvantages which widens the frame of health inequality policy in three ways:
The research for what causes health inequality in the society in a systematic difference in life chances, the kind of lifestyles they live and living standards with people's unequal positions in the socio-economic hierarchy
Tackling health inequalities becomes a population-wide goal to improving health which involves everybody.
Reducing health gradients provides a comprehensive goal to one that subsumes remedying disadvantages and narrowing health gaps within the broader goal across socio-economic groups.
Reduction in socio-economic gradient in teenage pregnancy, there should be an improve at a faster rate to health in other socio-economic groups and policies to remedy health disadvantages, closing the health gaps and reduce health gradients need to be pursued in tandem.
Conclusion
The story of health inequality is clear because the poorer you are, the more likely you are to be ill and to die younger. The recent rise in teenage pregnancy rates calls for urgent action to reduce or stop the rise and also initiate a decrease in these rates. To effectively tackle teenage pregnancy, health inequalities related to teenage pregnancy need to be tackled; the root cause of these inequalities need to be tackled. Health inequalities affect everyone and are avoidable (Woodward & kawachi, 2000). Health inequalities are also increasingly been seen as an injustice (Graham, 2004). In other words, good health is the right of every individual and not just for a particular group or groups of people. These concepts which can be used to tackle health inequalities can be complementary rather than mutually exclusive.
