The Challenge of Joined-Up Government in Tackling Health Inequalities

Joined-up government (JUG) has been a notable feature of many national governments, not least the UK Labour government (1997 onwards) with its emphasis on welfare modernisation, tackling engrained social problems, and evidence-based policy. This article focuses on the ways in which JUG has been implemented in England although we draw comparisons with the different approaches in Wales and Scotland, as devolution has provided an interesting natural experiment. Certainly during its early years in power, the Labour government regarded JUG as a critical mechanism to achieve its goal of narrowing the "health gap" between different social groups since the requisite policy response is, by general agreement, inter-sectoral and cross-governmental. Responsibility for tackling the health gap does not reside within one policy sector or department but rather is a total or whole government issue. This article reviews previous efforts to promote JUG in the area of health inequalities, examines the factors which have shaped JUG over the past 13 years or so, and evaluates its implementation. Although JUG has helped keep health inequalities on the policy agenda, the evidence from newly introduced structures and processes (such as targets and cross-departmental units and committees) suggests that JUG remains poorly integrated within the government machinery. Many of the basic dilemmas of JUG thus continue to apply to policies aimed at tackling health inequalities. The article draws conclusions about the impact of JUG in recent years and the likelihood of reducing health inequalities. A new approach to governance in respect of "wicked problems" (such as health inequalities) is called for.