Reframing health inequality? The rise, rise and fall of three competing policy frames

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Brown, Ally (2025) Reframing health inequality? The rise, rise and fall of three competing policy frames. Journal of Public Health. fdaf141. ISSN 1741-3842 (https://doi.org/10.1093/pubmed/fdaf141)

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Abstract

Background: Since the end of New Labour’s health inequality strategy, health inequalities in the UK have been widening. A recent critique suggested that New Labour policy actors were misdirected towards less effective solutions by the ‘international consensus’ understanding of health inequalities, which counterproductively medicalizes social inequality. This research explored whether social, economic and health policy actors at devolved levels shared this ‘international consensus’ policy frame of health inequality. Methods: The Scottish Government and Greater Manchester Combined Authority were chosen as case study polities. Thirty-four policymakers were interviewed, and a frame analysis was conducted of thirty social, economic and health policy strategy texts, published between 2017 and 2022. Results: The ‘international consensus’ policy frame was supported in these contexts by strong moral language, highlighting the social injustice of systematically distributed illness and death. However, political support was building behind health inequality framed in relation to ‘illness-related economic inactivity’ and ‘healthcare for disadvantaged groups’. These two alternative frames using the same term directed policy solutions towards individual-level reactive healthcare, rather than population-level preventive public policy. Conclusions: ‘Health inequality’ is understood in three competing ways in these policy settings. Alternative terms, such as ‘social inequalities in health’ and ‘healthcare inequality’, are preferable to minimize ambiguities.

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