What Works in Tackling Health Inequalities? Pathways, Policies and Practice through the Lifecourse

Citation

Graham, H. (2007), "What Works in Tackling Health Inequalities? Pathways, Policies and Practice through the Lifecourse", Equal Opportunities International, Vol. 26 No. 8, pp. 879-882. https://doi.org/10.1108/02610150710836208

Even in societies like the UK which enjoy unparalleled levels of wealth and health, there are marked inequalities in people's health. Those in the poorest circumstances endure the poorest health, and the chances of living a long and healthy life increasing with increasing social advantage.

The book is concerned with why these socioeconomic inequalities in health persist and what national policies and local interventions can do to reduce them. The authors address these important questions by focusing particularly on patterns and policies in the UK. However, the evidence base on which they draw is much broader. It ranges over epidemiological surveys following up children from birth and across adulthood and qualitative studies of the experience of poverty as well as systematic reviews of interventions designed to tackle risk factors and improve health.

Asthana and Halliday tackle the evidence base by adopting a life course perspective. This is one which looks at how inequalities in people's circumstances take their toll on their health over the course of their lives. It is an approach supported by research: there is increasing evidence that childhood conditions – as measured by parental occupation or household income for example – exert an influence on adult health, over and above the effects of current circumstances. It is also an approach which goes with the grain of policy. In the UK policies are increasingly framed in life course terms. Thus, new programmes have been introduced with the aim of lifting children out of poverty (e.g. tax credits and improvements in benefits) and supporting their social and educational development (Sure Start). New programmes have been rolled out, too, to provide springboards into the labour market for groups like lone mothers and low‐skilled young people at risk of long‐term disadvantage.

The book falls into three parts. The first and third parts are relatively short and provide an overview of the research and policy context of health inequalities in the UK (part 1) and a concluding chapter (part 3). The largest sections of the 600‐page book are devoted to major life stages: to the early years, to later childhood and adolescence, to adulthood and to older age. Two chapters are devoted to each of these life stages. The first presents evidence on patterns and causes of health inequalities, while its companion chapter considers “what works” to address these causes. Thus, there are chapters on research evidence and policy responses for the early years, later childhood, adulthood and older age. The authors give particular attention to local‐level interventions and to evidence on the contribution they might make to improving health in the poorest groups.

Each chapter includes a wealth of detail. For example, chapter 2 on research on health inequalities, provides a very useful historical review of how understandings of health inequalities have evolved over the last three decades. Chapter 3, meanwhile, maps the history of UK health and policy since 1997. Chapter 4 takes the reader through the evidence on the socioeconomic influences on foetal and child development, ranging across genetic and paediatric epidemiology, developmental psychology and the sociology of the family. The companion chapter provides a 50‐page review of UK policy and practice to tackle social and health disadvantage.

Across these and other chapters, some common themes emerge. A key and recurrent theme is the mismatch between what is known about causes and what is known about measures to address them. Aetiological studies suggest that health inequalities are the outcome of deep‐rooted inequalities in people's life chances and living standards, with the effects of these broader determinants mediated through individual‐level risk factors like cigarette smoking. However, evaluative evidence relates primarily to these “downstream” mediating factors, with little research assessing the effects of policies relating to the broader “upstream” determinants. Moreover, most intervention studies focus on overall effectiveness (do the interventions reduce smoking and improve nutrition for the population as a whole?) and not its differential effectiveness (do they work for poorer groups?) As the authors note, “there is a lack of evaluation focusing on what works for particular socioeconomic, ethnic or vulnerable groups and those subject to multiple risks” (p. 566).

As a result, the authors are able to provide fewer and less complete answers than they would wish to the question “what works in tackling health inequalities?”

Nonetheless, the book fills an important gap. It bridges the worlds of research, policy and practice. It offers those seeking to understand and tackle health inequalities – as students, researchers or practitioners – a carefully crafted and balanced overview of scientific evidence. It offers these audiences, too, an overview of current UK policies with the potential to affect the lives – and therefore the health – of poorer groups. It is a book which is unlikely to be read cover to cover. But it provides a compendium of research, policy and practice on which to build more effective strategies to tackle health inequalities.

Hilary Graham is Professor of Health Sciences at the University of York and is Director of the Department of Health Public Health Research Consortium.