The National Health Service (NHS) was founded in 1948 to replace an inefficient, ill-coordinated and financially unstable health care system and to reduce the barriers to the consumption of health care. In this article, it is argued that the geographic and social class equity objectives of the NHS have been poorly specified and that attempts to achieve them through government policy have been inadequate. The renewed interest in inequalities in health and health care and the problems of formulating and implementing policies aimed at reducing inequalities are discussed in general terms in section 1. Section 2 examines the inequalities of health care provision that were inherited in 1948, the development of policies to mitigate the problem and the current situation. Alternative demand and supply side policies to reduce inequalities in health and health care are presented in section 3. A summary of the proceeding arguments is set out in section 4.

For more than a decade control of public sector growth has been one of the key issues in Danish politics. In an attempt to contain further uncontrolled growth, the whole budgetary system has been gradually reformed, and political cutting operations have been a recurrent event. Serious questions, however, remain. First, it is questionable whether procedural and institutional reforms of the budgetary system have made it any easier for political decision-makers to carry through their cutting plans. Second, it is doubtful whether the policy-makers are able to keep within the financial limits, set up by themselves, when confronted with demands for solution of unforeseen, but politically pressing, problems. In such situations there will always remain a strong politicalpropensity to make an exception.

Policy analysis may benefit from specific conceptual contributions derived from Jurgen Habermas's critical social theory. In particular, Aaron Wildavsky's emphasis on the policy analyst's fostering of social and political ‘interactions’ can be given concrete empirical content derived from the critical theorist's account of social and communicative action. In addition, the critical theorist's distinction between action and ‘learning’ extends and sharpens Wildavsky's and Lindblom's account of policy outcomes. Once obstacles to social and political learning are distinguished from ordinary constraints upon citizens' action, policy analysis research (as formulated by Wildavsky and Lindblom) can be more concretely specified and then understood also and essentially to involve fundamental normative judgments of the legitimacy of policy-fostered ‘interactions’.

Policy-makers are gravely troubled by a lack of means to get things done. They might like to consider harnessing the ‘Guinness effect’: when a measurement is created, persons come forth to be measured by it. A number of moral and practical objections to the use of the Guinness effect in public policy can be raised, but many of these also apply to other policy devices or indicate that care is needed in designing measurements. They do not preclude the introduction of trial uses of the Guinness effect, especially given the voluntary character of undertaking measureable activities under the scheme. A number of activities by individuals and communities suitable for measurement are suggested. Local statistical bureaus might play the part of defining measurements and monitoring performance.