Desperately seeking reductions in health inequalities: perspectives of UK researchers on past, present and future directions in health inequalities research.

Kayleigh Garthwaite,Clare Bambra,Jamie Pearce,Katherine E Smith

doi:10.1111/1467-9566.12374

Kayleigh Garthwaite, Clare Bambra + Show 2 more

Open Access

https://doi.org/10.1111/1467-9566.12374

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Abstract

Following government commitments to reducing health inequalities from 1997 onwards, the UK has been recognised as a global leader in health inequalities research and policy. Yet health inequalities have continued to widen by most measures, prompting calls for new research agendas and advocacy to facilitate greater public support for the upstream policies that evidence suggests are required. However, there is currently no agreement as to what new research might involve or precisely what public health egalitarians ought to be advocating. This article presents an analysis of discussions among 52 researchers to consider the feasibility that research‐informed advocacy around particular solutions to health inequalities may emerge in the UK. The data indicate there is a consensus that more should be been done to learn from post‐1997 efforts to reduce health inequalities, and an obvious desire to provide clearer policy guidance in future. However, discussions as to where researchers should now focus their efforts and with whom researchers ought to be engaging reveal three distinct ways of approaching health inequalities, each of which has its own epistemological foundations. Such differences imply that a consensus on reducing health inequalities is unlikely to materialise. Instead, progress seems most likely if all three approaches are simultaneously enabled.

Highlights

The UK has been recognised as a global leader in health inequalities research and policy, with recent government-led policy efforts to reduce health inequalities being described as ‘historically and internationally unique’ (Mackenbach 2011: 1249)
As well as providing a contemporary update, our research considers the views of a broader range of researchers and policy actors representing a variety of academic disciplines, career stages and academic or policy-related institutions (52 researchers and 58 policy actors compared with the nine senior researchers and seven senior civil servants involved in the earlier studies)
What have we learned so far? Researchers’ reflections on the legacy of health inequalities research and policy in the UK Post-1997 policy advice and limited learning The findings reveal there is widespread concern among researchers about the failure to adequately learn from the multiple policies and inter

Summary

Introduction

The UK has been recognised as a global leader in health inequalities research and policy, with recent government-led policy efforts to reduce health inequalities being described as ‘historically and internationally unique’ (Mackenbach 2011: 1249). Despite the raft of policies intended to reduce health inequalities, introduced between 1997 and 2010, the UK’s health inequalities have continued to widen by most (though not all) measures – see (Bambra 2012, Barr et al 2012, Thomas et al 2010, Thorlby and Maybin 2010) This failure has prompted multiple commentaries and calls for advocacy to facilitate greater public support for the kinds of upstream policies that available evidence suggests may be required (Bambra et al 2011, Mackenbach 2011). Advocacy involves strategically ‘selling’ public health objectives to a range of non-academic audiences This way of thinking about advocacy, which Carlisle (2000) has termed representational, implies that health inequalities researchers would first need to achieve some kind of consensus on the policy (or societal) changes they are trying to sell. Advocacy clearly involves something more than the widely accepted model of researchers working with senior civil servants to try to develop evidence-informed policy responses to health inequalities (see, for example, Petticrew et al 2004)

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