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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