Developing the evidence base for tackling health inequalities and differential effects
Version of Record online: 2 AUG 2007
Australian and New Zealand Journal of Public Health
Volume 31, Issue 4, pages 391–392, August 2007
How to Cite
(2007), Developing the evidence base for tackling health inequalities and differential effects. Australian and New Zealand Journal of Public Health, 31: 391–392. doi: 10.1111/j.1753-6405.2007.00102.x
- Issue online: 2 AUG 2007
- Version of Record online: 2 AUG 2007
(ESRC Seminar Series: Mapping the public policy landscape.) By Professor HilaryGraham and Professor MikeKelly . Published by The Economic and Social Research Council , London , 2007 . Paperback , 16 pages .
Reviewed by Jane Dixon, National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory
This booklet is the background material presented as part of a seminar series, ‘Mapping the public policy landscape’, sponsored by the United Kingdom's (UK) Economic and Social Research Council (ESRC). Introduced by the chief executive of the ESRC, this particular seminar's focus was to “encourage dialogue between the research and policy community to explore ways of developing evidence-based policy and policy-relevant evidence to tackle inequalities in health more effectively”.
The booklet contains material from two established UK health inequalities researchers: Professor Hilary Graham from the University of York, and Professor Mike Kelly, director of the Centre for Public Health Excellence at NICE (an acronym that is not spelled out). Both play leading roles in the World Health Organization's Commission on the Social Determinants of Health. It also contains a section on the UK Government's actions in relation to reducing health inequalities over the past decade, contributed by two Health Department officers: Maggie Rae and Ray Earwicker. That section concludes with five examples of team research devoted to building an evidence base of interventions to address health inequalities.
It is a curious booklet: part background briefing material, part reportage of the seminar proceedings, and part glossy public relations material promoting the efforts of the ESRC and the seminar co-sponsor, the Department of Health's Research and Development Directorate. The material provides an insider's guide to the research and policy development landscape relating to health inequalities in the UK. For an Australian academic interested in the topic it has limited utility, and it is frustrating even as a resource document.
No date is given for either the seminar or for the booklet's publication (maybe this appears on the ESRC website). Further, authorship is unclear: while the two research contributors are named on page 1, the two Department of Health officials who contribute material remain nameless until their section. For a report that aims to bridge the divide between the research and policy arenas, this privileging of one group over another appears counter-productive. Or possibly, this is a simple reflection of the public sector convention that bureaucrats should not be identified.
However, the most irritating feature is the unattributed executive summary. It is written as a synthesis of some major evidence on UK health inequalities and does not necessarily reflect the material that follows. Thus, it is unclear whether the summary is the outcome of deliberations at the seminar, the major points contained in previous publications by Graham and Kelly, or from their presentations at the seminar, or the ESRC's response to the seminar.
To compound the poor signposting in the booklet, three of the four figures used are not anchored to any text, and the photos used to portray social and economic inequalities appear equally unanchored. So while a picture is worth a thousand words, these communicate very little that is contextually specific.
Despite the frustrations with the overall booklet, there are a couple of useful sections. Hilary Graham provides a taxonomy of potential policy responses depending on whether a government aims to: a) improve the health of poor groups; b) narrow the health status gap between groups, or c) flatten or improve the health gradient for the whole population. Too often, researchers and policy makers do not distinguish what they mean when they refer to health inequalities and health inequities. Also too often in Australia, governments consider the first aim only, discounting the second and third aims, it seems, because they would require more than behavioural interventions or interventions that bolster the primary health care system.
Second, both Graham and Kelly concur that methodological creativity is needed to build an evidence base pointing to effective interventions. They identify three areas in which methodological leadership is urgently required: a) tracking the effects of non-health sector policies on health and health inequalities; b) tracking multiple policy effects across a range of health determinants; and c) including measures of health determinants along the causal chain in evaluations of policies and interventions. On this last point, I did wonder why there was no mention of Health Impact Assessment methodologies.
Third, Rae and Earwicker highlight the National Health Service's use of targets as a health equity instrument. Current policy states, for example, that by 2010 health inequalities as measured by infant mortality and life expectancy at birth should be reduced by 10%.
Primarily, this booklet is a resource tool for UK researchers. It might also provide a reference point for social historians of public health. If there could be clarity about how to cite the publication, the booklet might provide a reference point for those few Australian bureaucrats who continue to encourage their respective governments to invest in the research, evaluation and monitoring of interventions to mitigate health inequalities. Finally, while the booklet's presentation could be improved, it does offer the Australian Research Council, our equivalent to the ESRC, ideas on mechanisms for improving dialogue between researchers and policy makers.