New research shows the idea of the 'postcode lottery' was first used in 1997 to express concern about how access to NHS drugs and treatment varied from place to place. But its meaning has since broadened to include regional inequalities in state services generally, and even in poverty and life expectancy.
When austerity policies were introduced in 2010, 'postcode lottery' stories declined as news stories focused more on reducing the public financial deficit than on inequalities.
But as the impact of austerity policies mounted the phrase was increasingly applied to struggling public services beyond healthcare. Instead of stories focused on individuals and their access to specific treatments, the media paid more attention to regional 'postcode lotteries', comparing the quality of health services more generally.
The study was carried out by Grace Redhead and Rebecca Lynch from the University of Exeter.
Dr Redhead said: "It might feel to us as if the phrase has always been around, but that's not the case. We have shown how it goes in and out of fashion and how its usage has changed a lot over time.
"The 'postcode lottery' means different things to different people. Some groups have talked about the risk of a 'postcode lottery' to try and protect the NHS and the idea of universal public services. But other people have pointed to the 'postcode lottery' as proof that universalism is impossible, and to justify NHS reforms. It's a useful term for both sides because it compels so much outrage, but it's not specific about the cause of the problem."
Researchers analysed newspapers' use of the term between 1997 and 2023. The concept of an 'NHS lottery' or a postcode lottery for health services first appeared in newspapers in the mid-1990s and followed the creation of the NHS 'internal market' in 1989–91. These reforms meant that the services available to patients might vary depending on where patients lived. Widespread news coverage of the reintroduction of the National Lottery in 1994 meant that soon people started to talk about a lottery in healthcare.
Dr Lynch said: "The popular slogan for the National Lottery, 'It could be you', was repurposed into anxieties about healthcare access – that 'it could be you' who gets substandard healthcare.
"But while the winners and losers of the National Lottery are determined by chance, the causes of regional inequality in health and healthcare are complex and deep-seated. It's not about luck – it's about the bigger picture of economic inequality and geographic disparities in investment in health and social care."
Researchers warned that sometimes the fear of a 'postcode lottery' has been used to criticise extra state investment or tailored health services in more deprived areas.
The earliest use of the term 'postcode lottery' that the researchers could find was in a September 1997 Evening Standard article about a 'postcode lottery' for cancer drugs, which reported that an oncologist had falsified a woman's address so that she could access the new cancer treatment Taxotere. This was followed by a November 1997 Daily Mirror article, reporting on the 'postcode lottery' case of two women who lived 20 miles apart in Somerset and Avon, of whom only one could access the drug.
The term was quickly picked up in other news stories about patients who couldn't access treatments such as IVF, or the MS drug beta-interferon, which were available in neighbouring health authorities. Health charities and politicians began to talk about 'postcode lotteries' in their campaigns.
