The Black Report was a 1980 document published by the
Department of Health and Social Security
The Department of Health and Social Security (commonly known as the DHSS) was a ministry of the British government in existence for twenty years from 1968 until 1988, and was headed by the Secretary of State for Health and Social Services.
Hi ...
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...
, which was the report of the expert committee into health inequality chaired by Sir Douglas Black. It was demonstrated that although overall health had improved since the introduction of the
welfare state
A welfare state is a form of government in which the state (or a well-established network of social institutions) protects and promotes the economic and social well-being of its citizens, based upon the principles of equal opportunity, equita ...
, there were widespread
health inequalities
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...
. It also found that the main cause of these inequalities was economic inequality. The report showed that the death rate for men in social class V was twice that for men in social class I and that gap between the two was increasing, not reducing as was expected.
Commissioning
The Black report was commissioned in March 1977 by David Ennals, Labour Secretary of State, following publication of a two-page article by Richard G. Wilkinson in
New Society
''New Society'' was a weekly magazine of social inquiry and social and cultural comment, published in the United Kingdom from 1962 to 1988. It drew on the disciplines of sociology, anthropology, psychology, human geography, social history and so ...
, on 16 December 1976, entitled Dear David Ennals '' The report was nearly ready for publication in early 1979.
In the General Election on 3 May 1979, the Conservatives were elected. The Black Report was not issued until 1980 by the
Conservative Government Conservative or Tory government may refer to:
Canada
In Canadian politics, a Conservative government may refer to the following governments administered by the Conservative Party of Canada or one of its historical predecessors:
* 1st Canadian Mi ...
. The Black report was published on August Bank Holiday with only 260 copies made available on the day for the media. The foreword, by Patrick Jenkin rejected "the view that the causes of health inequalities are so deep rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern." He made "it clear that additional expenditure on the scale which could result from the report’s recommendations – the amount involved could be upwards of £2 billion a year – is quite unrealistic in present or any foreseeable economic circumstances, quite apart from any judgement that may be formed of the effectiveness of such expenditure in dealing with the problems identified."
The report had a huge impact on political thought in the United Kingdom and overseas. It led to an assessment by the Office for Economic Co-Operation and Development and the World Health Organization of health inequalities in 13 countries.
Impact
Professor Clare Bambra in 2016 compared the report with the later Acheson Report and the subsequent report by
Michael Marmot
Sir Michael Gideon Marmot (born 26 February 1945) is Professor of Epidemiology and Public Health at University College London. He is currently the Director of The UCL Institute of Health Equity. Marmot has led research groups on health inequa ...
. The Acheson report was released into a more favourable climate than either. She said that at least between 1997 and 2003, health policy across the UK reflected some of the ideas set out in the Black and Acheson Reports. There was a consistent emphasis on the need to tackle the social and economic determinants of health inequalities as well as a commitment to employing cross-cutting government policies to tackle health inequality. Most importantly, by 2004, national targets to reduce health inequalities were also introduced with a focus on life expectancy and Infant Mortality Rate. A series of initiatives were introduced -
Health Action Zone
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
s, Healthy Living Centres, Health Improvement Programmes and the
New Deal for Communities New Deal for Communities was a regeneration programme led by the government of the United Kingdom for some of the England's most deprived neighbourhoods. The programme was established by Tony Blair's Labour Government and was overseen by the Nei ...
. But, perhaps because of these initiatives, from 2004 to 2007, public health policy moved away from social and economic determinants and instead focused more on health services and lifestyle behaviours. The health inequalities targets were abandoned across the UK in 2011. The effect of policy in reducing health inequality was modest.
Related publications
Penguin Books
Penguin Books is a British publishing house. It was co-founded in 1935 by Allen Lane with his brothers Richard and John, as a line of the publishers The Bodley Head, only becoming a separate company the following year. Whitehall Report published in 1987 came to the same conclusions as the Black report, as did the Acheson Report later in 1998, and the Marmot Review in 2010.