Health inequalities in Britain

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 Economic and Social Research Council (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.