http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre/Images/Developing%20the%20evidence%20base%20for%20tackling%20health%20inequalities%20and%20differential%20effects_tcm6-17859.pdf
Tackling health inequalities in Britain needs closer co-ordination between
all major policy areas including health, education, housing, employment and
taxation, according to the authors of a new ESRC publication.
Developing the Evidence for Tackling Health Inequalities and Differential
Effects, which accompanied a seminar organised jointly with the Department
of Health, says that despite major advances in health care and overall
improvements in health there is still a yawning gap between different
social groups. There are serious differences between affluent and
disadvantaged groups - including ethnic minority groups - in rates of
obesity, high blood pressure, accidents and smoking.
The report emphasises that poor health is not simply about individual bad
habits, in terms of junk food, drugs, alcohol and cigarettes and lack of
exercise. Poor health, and the health inequalities that often result, are
rooted in broader inequalities between rich and poor, with social
disadvantage linked to a poor start in life, early school leaving, and poor
living and working conditions in adulthood, the researchers say.
Hilary Graham, Professor of Health Sciences at the University of York who
is leading the Department of Health's Public Health Research Consortium,
emphasises the importance of including the right information when
evaluating interventions in fields such as education and young people,
employment and crime, housing and child protection. 'It is important to
include information on people's health and lifestyles in evaluations of new
initiatives and policies to tackle social disadvantage and exclusion. This
will provide a baseline for seeing which social initiatives are making a
difference to the health gap.' However, she warns that it may take time for
changes to show their effects: 'Policies introduced ten, 20 or even 50
years ago will be influencing the effects of initiatives introduced today.'
Describing the development of the public health evidence base and evidence
based guidance, Professor Mike Kelly, Director of the Centre for Public
Health Excellence (CPHE) at NICE, says that the Health Development Agency
produced a series of Evidence Briefings on health inequalities and the
effectiveness of interventions between 2000-2005. The briefings covered a
range of topics including the promotion of physical activity and
breastfeeding and measures to prevent drug and alcohol misuse, teenage
pregnancy and accidental injury. However, he says there are some surprising
gaps in the evidence. 'For instance, there is little review level evidence
about the sexual behaviour of young heterosexual males and its impact on
rates of teenage fertility and little work has been done on social
exclusion and the transmission of HIV/AIDS.'
NICE involves practitioners in producing public health guidance to improve
the likelihood of it being implemented. NICE's public health guidance is
field tested of health visitors, school nurses, teachers and medical
practitioners as well as undergoing a consultation with stakeholders.
The report also provides an overview of the Government's approach to health
inequalities, including key reports and initiatives since 1997. Maggie Rae
and Ray Earwicker (Department of Health) say that evidence has informed
policy development on health inequalities since the ground-breaking Acheson
report published in 1998. The debate on the evidence base for public health
interventions has gathered momentum in the last couple of years, notably
since the release of the Wanless review in 2004. This has highlighted the
need for more research related to inequalities.
Brief summaries of some of the approaches used by researchers to build the
evidence base on which interventions might tackle the health gap are also
provided in the report.
The examples include:
an evaluation of the effectiveness of Stop Smoking Services an overview of
tobacco control interventions and their effectiveness on social
inequalities in health a study on how data from an assessment of the New
Deal for Communities can be used to inform policy on health inequalities an
examination of the differential social effects of national tobacco control
policies and a project to identify priorities for new systematic reviews
and new primary studies addressing health inequalities.
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