Health policy: in sickness and in health

The focus in this chapter is on characterizing the nature of recent health policy initiatives and exploring the interplay of powerful structural interest groups which influence the shape of these policies. This chapter is made up of two parts, focusing initially on health service systems, particularly the National Health Service (NHS) in England and then moving upstream to public health policies specifically analysing the approach taken to social inequalities in health. Policy in the former area of organizational change is politicized and thus has been high on the policy agenda whereas in the latter area while social inequalities in health have widened, policy approaches have narrowed. However, the policies manifested in the two case studies of recent reforms in the NHS and public health approaches to social inequalities in health have much in common. Both have emphasized, at least until recently, the importance of the market and market principles, highlighting the salience of ‘choice’ for patients in selecting their health care and for the public in selecting their lifestyle. In general terms, both reflect the importance of neoliberal ideology in shaping health policy.