Association for Public Policy Analysis & Management

Across Western Europe the marked increase in life expectancy in
recent decades is not always correlated to life spent in good health;
indeed, the greater the income disparities within a country the
greater the health and social inequalities. Conventional explanations
for health inequalities, such as lack of access to medical care and
unhealthy lifestyles, provide only part of the explanation. The more
intransigent causes are the social determinants of health, including
access to and opportunities in education, employment, housing,
public transport and welfare services.
All countries, whatever the maturity of their health and social care
services, experience varying levels of in-country health inequalities,
with excess mortality and reductions in healthy life years
correlated to regional deprivation.
Across all Western European countries, ‘vulnerable’ or ‘troubled
families’, defined as those that are in contact with several
departments of the local authority, including the child or youth
welfare system, are a growing concern. These families rarely
succeed in breaking the negative spiral, which leads to persistent
poverty, deprivation and transgenerational dependency on public
support. Living in vulnerable families accentuates the risks of poor
life outcomes for those most dependent on family structures,
especially children and adolescents. The current failure to address
the social determinants of health for these vulnerable families is
creating avoidable cost and social pressures on society.
The report illustrates how taking a life cycle approach to vulnerable
families can improve targeting, prioritization and impact of services
at all stages of life. It provides current research evidence as well as
good practice examples focused on:
••maternity and infancy – providing a strong foundation for the
rest of life
•• childhood and adolescence – establishing healthy behaviours
and building resilience
•• adulthood and working life – creating the conditions for a
productive life
•• elderhood and increasing frailty – achieving equality in length
and quality of life
•• an integrated, whole system approach – improving outcomes
at all life stages.
Giving each child the best possible start in life is likely to deliver
the best societal and overall health benefits. However, breaking
the cycle of dependency for future generations also requires
improvements in the living and working conditions of adult and
elderly family members.
Deloitte believes that addressing inequalities for the most
vulnerable members of society will lay the foundation for reducing
health inequalities more generally and that sustainable change is
achievable if all policy makers, public service providers, agencies
and other stakeholders are prepared to:
•• work across institutional and professional boundaries and with
the wider public sector to take collective decisions on how and
where to invest in joint actions to achieve better outcomes
•• take a coordinated, case management approach with a
community-based gatekeeping point for accessing services
•• deploy analytics and digital technology effectively in both the
planning and provision of services
•• provide appropriate levels of health and social care funding,
based on economic evaluation of cost-benefits and consider
introducing new models of integrated funding and aligned
incentives across all parts of the system.
Across all countries in Europe there is significant scope to work
together more effectively to tackle the social determinants of
health and reduce health inequalities. This is a moral and economic
imperative, if countries are to provide an equitable, secure, and
healthy future for everyone.