Dear Colleagues
I have attached below some information on some papers from the latest issue
of the Journal of Public Health Medicine which may be of interest to some
of you.
These include
1. Addressing health inequalities in the United Kingdom: a case study. Adam
Oliver and Don Nutbeam
2. Socio-economic position and health: what you observe depends on how you
measure it. Sally Macintyre, Laura McKay, Geoff Der, and Rosemary Hiscock
3. Caring-related inequalities in psychological distress in Britain during
the 1990s. Michael Hirst
4. Equity of access to tertiary hospitals in Wales: a travel time analysis.
Stephen Christie and David Fone
More info below
Best wishes
David McDaid
LSE health and social care
Addressing health inequalities in the United Kingdom: a case study
Adam Oliver and Don Nutbeam
J Public Health Med 2003 25: 281-287.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/281?etoc
Health inequalities research has a long history in the United Kingdom, and
the development of government policies that are intended to explicitly
address the existing health inequalities has been gathering pace since the
Labour Party returned to power in 1997. In this paper, using the
influential Acheson Report as a reference point, one of us (D.N.) describes
how health inequalities policies have been developed, and the other (A.O.)
assesses how, ideally, such policies ought to be developed. Although
progress in the development of health inequalities policies has been made,
the policies, and the evidence that has informed them, have been less than
ideal.
Key Words: United Kingdom * health inequalities policy * equity * Acheson
Report
Socio-economic position and health: what you observe depends on how you
measure it
Sally Macintyre, Laura McKay, Geoff Der, and Rosemary Hiscock
J Public Health Med 2003 25: 288-294.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/288?etoc
Background A number of different socio-economic classifications have been
used in relation to health in the United Kingdom. The aim of this study was
to compare the predictive power of different socio-economic classifications
in relation to a range of health measures.
Methods A postal questionnaire was sent to a random sample of adults in the
West of Scotland (sampling from 1997 electoral roll, response rate 50 per
cent achieved sample 2,867)
Results Associations between social position and health vary by
socio-economic classification, health measure and gender. Limiting
long-standing illness is more socially patterned than recent illness;
income, Registrar General Social Class, housing tenure and car access are
more predictive of health than the new National Statistics Socio Economic
Classification; and men show steeper socio-economic gradients than women.
Conclusion Although there is a consistent picture of poorer health among
more disadvantaged groups, however measured, in seeking to explain and
reduce social inequalities in health we need to take a more differentiated
approach that does not assume equivalence among social classifications and
health measures.
Key Words: social classifications * inequalities in health * self-reported
health * gender
Caring-related inequalities in psychological distress in Britain during the
1990s
Michael Hirst
J Public Health Med 2003 25: 336-343.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/336?etoc
Background This paper examines recent trends in inequalities in
psychological distress associated with the provision of unpaid care by
those who look after frail older people and younger disabled adults and
children. Caring activities intensified during the 1990s, associated with
increasing amounts of time devoted to the more demanding types of care and
to those relationships that typically make heavy demands on the carer.
Heavy involvement in caregiving is often associated with symptoms of
anxiety and distress, and the intensification of care may increase rates of
distress in carers relative to that in non-carers.
Methods A secondary analysis was carried out of data drawn from the first
10 waves of the British Household Panel Survey covering 1991-2000, based on
around 9000 adults interviewed personally in successive waves. Symptoms of
psychological distress, including anxiety and depression, were assessed
using the 12-item General Health Questionnaire.
Results Carers present higher rates of distress than noncarers and the
health gap widens as the definition of caregiving focuses on those living
with the person they care for, and those devoting 20 h or more per week to
their caring activities. Differences in distress rates between carers and
non-carers are greater for women than for men. There is no support for the
hypothesis that inequalities in distress associated with caregiving have
increased over time.
Conclusion There was no change during the 1990s in the extent of
inequalities in psychological distress associated with caregiving in
Britain. The need to maintain carers' emotional and mental health is as
compelling as ever it was.
Equity of access to tertiary hospitals in Wales: a travel time analysis
Stephen Christie and David Fone
J Public Health Med 2003 25: 344-350.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/344?etoc
Background The objective of the study was to investigate the implications
for equity of geographical access for population subgroups arising from
hypothetical scenarios of change in configuration of National Health
Service tertiary hospital service provision located in Wales.
Methods For each of three scenarios, the status quo and centralization of
services to one of two locations, we used a travel time road length matrix
in geographical information software to calculate the proportion of the
population living within 30, 60, 90 and 120 min travel of each hospital
site and the associated mean, median and 90th percentile travel times. We
analysed data for the total resident population of Wales, for residents
aged 75 or more years, for residents of the most deprived 10 per cent of
enumeration districts, and for residents of rural areas.
Results Centralization of services reduces geographical access for all
population subgroups. Access varies between population subgroups, both
between and within different scenarios of service configuration. A change
in service configuration may improve access for one subgroup but reduce
access for another. The interpretation may also vary according to whether
the defined cut point for comparing access is based on short or long travel
times. Measurements of absolute and relative access are sensitive to the
assumed travel speeds.
Conclusion Access for the total population does not imply equity of access
for subgroups of the population. Comparisons of access between scenarios
are dependent on which measure of access is the indicator of choice.
Results are sensitive to the road network travel speeds and further local
validation may be necessary. This method can provide explicit information
to health service planners on the effects on equity of access from a change
in service configuration.
Key Words: geographical access * travel time * equity
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