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Health inequalities: Research Concepts

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... to address all these layers of influence' DH Tackling Health Inequalities, 2001 ... policies which produced these positive trends have not reduced inequalities in ... – PowerPoint PPT presentation

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Title: Health inequalities: Research Concepts


1
Health inequalities Research Concepts Policy
Goals
What have we learned since the
Black report?
2
relationship between health inequalities research
public health policy
3
relationship between health inequalities research
public health policy
  • relationship transformed in last decade
  • key terms move across/between research policy
    domain, with research concepts embedded in policy
    goals
  • importance of clarity about boundary terms which
    carry research into policy and policy into
    research.

4
Determinants of health
5
Determinants of health
  • central to health policy but lack of clarity
    about
  • how determinants connect with individual
  • difference between the determinants of health and
    health inequalities

6
Determinants of health a cornerstone of policy
7
  • new approach to public health which aims to
    improve the health of our people to reduce
    inequalities in healthby addressing the wider
    determinants of health Investing in Health 2000
  • improving health the health of the worst off
    in particular by tackling the fundamental
    determinants of ill-health CMO England, 2001

8
Cross-government action will address the root
causes of ill-health health inequalities The
Governments aim is to reduce health inequalities
by tackling the wider determinants of health
inequalities Tackling Health Inequalities a
Programme of Action, 2003 acting on the
determinants of health in order to improve
population health reduce health inequalities
NZ National Health Committee, 1998
9
how determinants connect up to the individual
whose health is being determined
10
standard epidemiological model
social structure
social position
intermediate risk factors
health outcomes
11
The main determinants of health
12
  • We have adopted a socioeconomic model of health
    its inequalities. Figure 1 shows the main
    determinants of health as layers of influence,
    one over another Independent Inquiry into
    Inequalities in Health (Acheson report), 1998
  • Health well-being are influenced by many
    factors including past present behaviour,
    health care provision wider determinants
    including social, cultural and environmental
    factors Securing Good Health for the Whole
    Population (Wanless II report), 2004

13
But such models leave out social position
14
But such models leave out social position
fundamental social cause of healthaffects
multiple disease outcomes through multiple
mechanisms maintains an association with
disease even when the intervening mechanisms
change Link Phelan, 1995
15
  • social position marks the point at which
    societal-level factors enter shape peoples
    lives, influencing exposure to risk factors which
    directly affect their health
  • in societies where there are systematic
    inequalities in social position socioeconomic,
    gender, ethnic etc then societal-level
    resources enter peoples lives unequally

16
distinguishing between the determinants of health
health inequalities
17
  • the essential role played by the main
    determinants of health in the generation
    development of socioeconomic inequities WHO
    European Health Report, 2002
  • The Acheson report examined the determinants of
    health as layers of influenceTackling health
    inequalities will require us to address all these
    layers of influence DH Tackling Health
    Inequalities, 2001
  • to reduce health inequalities a multi-faceted
    strategy is required to tackle the economic
    environmental determinants of health Health in
    Wales, CMO Annual Report, 2002

18
Policies across the last 3 decades have been
associated with positive changes in health
determinants but have not reduced inequalities
in their distribution nor been associated with a
reduction in inequalities in health.
19
Health determinant socioeconomic
position
  • proportion of population with educational
    qualifications in higher non-manual occupations
    has risen sharply so too has average income.
  • policies which produced these positive trends
    have not reduced inequalities in socioeconomic
    position.
  • instead, social differentials in participation
    in higher education, in access to secure
    well-paid occupations, in income have all
    widened.

20
Health determinant smoking
  • from 1970-2000, prevalence of smoking declined
    sharply.
  • but policies associated with this overall
    improvement failed to dent the socioeconomic
    differentials in smoking.
  • instead, the gap in prevalence between manual
    non-manual groups has widened

21
This suggests
  • distinguishing between the overall level the
    social distribution of health determinants is
    important. The former is key for improving
    population health the latter for tackling health
    inequalities.
  • tackling health inequalities turns on reducing
    inequalities in the major influences on peoples
    health.

22
Social determinants of health inequalities
inequalities in social position
inequalities in health
structural inequalities
inequalities in resources risk exposures
23
Post-1997 policies tackling health determinants
their unequal distribution
  • changes to tax social security have raised
    average living standards..
  • and have been progressive rate of increase has
    been highest in the poorest households, tapering
    away to zero for higher income households.

24
Post-1997 policies tackling health determinants
their unequal distribution
  • increased investment in welfare services which
    directly support peoples lives, like health,
    education housing, means that welfare services
    make a more substantial contribution to overall
    living standards. ..
  • and this investment has had a differential
    effect, lifting living standards more in poorer
    than richer households.

25
conclusions
  • Through open dialogue between research policy,
    research concepts now inform policy goals
  • This makes clarity around boundary terms an
    important part of evidence-informed policy and
    practice

26
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