Health Inequalities Research Research Articles

The politics of ideas: The complex interplay of health inequalities research and policy

Public health research is overtly orientated towards influencing policy and yet, despite official commitments to ‘evidence-based policy’, most analyses conclude that the impact of public health research has been limited. Based on an analysis of post-1997 UK policy statements and interviews with 112 key actors, this paper argues that the failure of ‘evidence-based’ policy to emerge relates to the fact it is ideas, not evidence, which travel between research and policy, and that these malleable entities are translated as they move between actors. By unpacking six factors that appear to have shaped the ‘interplay of ideas’ about health inequalities, this paper draws attention to the ways in which policy influences research (as well as vice versa). The paper argues that two distinct ‘idea-types’ are evident within the data, each of which helps explain the difficulties in achieving ‘evidence-based’ policy responses to health inequalities: ‘institutionalised ideas’ and ‘chameleonic ideas’.

OP34 Assessing the Social Determinants of Teenage Pregnancy: A Time-Space Analysis using an Obstetric Database from 1950-2010

BackgroundTeenage-pregnancy is a known social problem and has remained at the forefront of policy within the UK. The social aetiology of teenage pregnancy is known to be linked with deprivation....

La recherche qualitative sur les inégalités sociales de santé: le parcours de vie

OBJECTIVES: Adopting a lifecourse perspective is more and more frequent in the health inequalities research field. This article describes such an approach, as applied in a study on poverty and social exclusion. METHODS: In this study, life histories were collected through open interviews and focused on the meaning of lived experiences. An original analysis table was used, in which words are grouped within categories identifying the different components of a lifecourse. RESULTS: Whether it refers to experiences lived in childhood or adulthood, the life history enables the placing of these within the individual’s lifecourse. The horizontal analysis of different individual stories makes it possible to identify experiences that have harmful, or conversely, beneficial effects. When transferring results, reporting the experiences lived by the populations using the same words they did to describe them can help those responsible for program development or implementation understand the genesis of social health inequities. CONCLUSION: The analysis of life histories, based on the different components of a lifecourse, allows the identification of key moments in the interviewees’ life evolution and, in an action perspective, to do so while taking health and social intervention fields into account. Such results make it easier to design actions to counter social health inequities – and above all their chronic nature – that are suited to the realities encountered.

Educational inequalities in health in European welfare states: A social expenditure approach

A puzzle in comparative health inequality research is the finding that egalitarian welfare states do not necessarily demonstrate narrow health inequalities. This paper interrogates into this puzzle by moving beyond welfare regimes to examine how welfare spending affect inequalities in self-rated across Europe. We operationalise welfare spending in four different ways and compare both absolute and relative health inequalities, as well as the level of poor self-rated health in the low education group across varying levels of social spending.The paper employs data from the EU Statistics of Income and Living Conditions (EU-SILC) and includes a sample of approximately 245,000 individuals aged 25–80+ years from 18 European countries. The data were examined by means of gender stratified multilevel logistic regression analyses. The results show that social expenditures are associated with lower health inequalities among women and, to a lesser degree, among men. Especially those with primary education benefit from high social transfers as compared with those who have tertiary education. This means that lower educational inequalities in health – in absolute and relative terms- are linked to higher social spending. The four different operationalisations of social spending produce similar patterns.

Examining Reporting Heterogeneity in Parent-Reported Measures of Health Using Anchoring Vignettes

Much health inequalities research, particularly in relation to children, relies on subjective measures of health. The use of such measures has been criticized because the response categories may be interpreted by different socioeconomic groups in different ways. This study employs data from a representative online panel from the Netherlands to examine whether parents from different socioeconomic backgrounds differ systematically in how they rate their child's respiratory health using anchoring vignettes. This study finds no evidence that Dutch parents from different socioeconomic backgrounds differ in how they rate their child's respiratory health.

The IADR initiative on global inequalities in oral health

The International Association for Dental Research (IADR) aims, through the Global Oral Health Inequalities Research Agenda (GOHIRA) initiative, to articulate an agenda that if properly implemented will reduce inequalities in oral health within a generation. The World Health Organization (WHO) has recently asserted: ‘We live in a world in which the burden of disease and ill-health is a major barrier to development and realisation of every individual's capabilities. Basic, clinical and population research can transform human wellbeing and has the potential to unite and empower countries.' Thus, we have a responsibility to ensure that the achievement of improved oral health, with concomitant reduction in the global burden of oral disease, is approached in this way. The IADR GOHIRA initiative places emphasis on transdisciplinary, inter-sectoral research, ensuring that oral health is integrated into strategies to reduce health inequalities in general. Detailed proposals across the major oral/maxillofacial diseases of dental caries, periodontal diseases, oral cancer, oral infections and developmental anomalies, and ways in which these might be implemented recognising the major import of social determinants of health, are now published in a special issue of <i>Advances in Dental Research</i>, May 2011, available at http://adr.sagepub.com/content/23/2.toc.

THE SUSTAINING RELEVANCE OF W. E. B. DU BOIS TO HEALTH DISPARITIES RESEARCH

AbstractWilliam Edward Burghardt Du Bois is considered one of the most prolific and brilliant scholars of our time. While his contributions to civil rights, sociology, history, African American studies, and urban studies are universally recognized, his legacy in the public health and epidemiology discourses is not as widely acknowledged by contemporary health researchers. His seminal work The Philadelphia Negro: A Social Study (1899) and his report “The Health and Physique of the Negro American” (1906) may be considered early harbingers in general of public health—and more specifically, social epidemiology—research. During the late nineteenth and early twentieth centuries, Black and White differences in mortality and morbidity were largely attributed to notions of biological racial inferiority. Efforts by Du Bois to challenge these predominant notions resulted in the systematic empirical investigation of social factors contributing to Black health risk and health disparities. More than one hundred years after Du Bois's pioneering scholarship, racial/ethnic and social disparities remain a central challenge for public health and medical professionals. Given the persistence of health disparities and the increasing focus on neighborhood social and physical environments as fundamental factors contributing to health inequalities, this paper seeks to historically situate Du Bois's scholarship, describe the methodological and conceptual significance of his seminal studies, and articulate the importance of incorporating Du Bois's legacy to advance the next generation of racial/ethnic health inequality research.

Disability and employment: sustainability of 'the Nordic model'

There is a need to integrate comparative welfare state studies with public health and health inequality research. Up to now, these two research disciplines have been apart and separated by institutional and disciplinary boarders within and between countries. This is now about to change.1 This is an important step forward as it entails the potential to shed new light on one of the hottest issues related to the future of the welfare state: employment problems and worklessness, especially among disadvantaged groups. In many countries, the fear of dwindling labour force participation is a cause of great political concern since it threatens the economic fundament of the welfare state, especially in the Nordic countries. This is a serious threat to all modern economic systems, but in particular to the Nordic model. The defining features of the Nordic model are: generous and universal welfare benefits; and free or cheap social and health services. In order to pay for such comprehensive public welfare provision, it relies on relatively high tax rates and a broad tax base—i.e. high employment; the Nordic model is hardly sustainable without a high rate of labour market participation. Over the past 15 years the Nordic countries have performed quite well, and contrary to common economic thinking, they have been …

New trends in health inequalities research: now it's personal

New trends in health inequalities research: now it's personal

Research, policy and funding – academic treadmills and the squeeze on intellectual spaces1

Abstract:In recent years, there has been a great deal of collective rumination about social scientists' role in society. In the post‐1997 UK context, public policy commitments to ‘evidence‐based policy’ and ‘knowledge transfer’ have further stimulated such reflections. More recently, Michael Burawoy's 2004 address to the American Sociological Association, which called for greater engagement with ‘public sociology’ has reverberated throughout the discipline, motivating a series of debates about the purpose of sociological research. To date, most such contributions have been based on personal experience and anecdotal evidence. In contrast, this paper responds directly to Burawoy's suggestion that we should ‘apply sociology to ourselves,’ in order that we ‘become more conscious of the global forces’ driving our research (Burawoy 2005: 285). Drawing on an empirical research project designed to explore of the relationship between health inequalities research and policy in Scotland and England, in the period from 1997 until 2007, this paper discusses data from interviews with academic researchers. The findings suggest that the growing pressure to produce ‘policy relevant’ research is diminishing the capacity of academia to provide a space in which innovative and transformative ideas can be developed, and is instead promoting the construction of institutionalized and vehicular (chameleon‐like) ideas. Such a claim supports Edward Said's (1994) insistence that creative, intellectual spaces within the social sciences are increasingly being squeezed. More specifically, the paper argues we ought to pay far greater attention to how the process of seeking research funding shapes academic research and mediates the interplay between research and policy.

Indicators for Measuring Material Affluence of Adolescents in Health Inequality Research in Developing Countries

The aim of the present study was to (i) develop a material affluence scale (MAS) for measuring adolescent SES in health inequality research in developing countries, (ii) compare the association of the MAS with the parental SES measures (parental occupation and education), and (iii) evaluate the association of parental SES and MAS with key health and health behaviour indicators. We used school-based cross-sectional survey conducted in thirty districts within three administrative regions in southern Ghana (a West African country) among adolescents ages 12–18-year old (N = 1,195) as an example. Principal Component Analysis (PCA) was used as the main statistical technique. MAS categorised adolescents into material affluence groups (MAS scores for the poorest, poor, average, affluent and most affluent were−1.679, −0.355, 0.354, 0.725 and 1.022 from the first principal component quintile respectively), it has adequate internal coherence (α = 0.622) and moderately correlates with parental SES (r = 0.39, p < 0.001). MAS and parental SES showed similar pattern of strength and direction of association with selected health and health behaviour indicators. MAS presents a viable alternative method for measuring adolescent’s SES in health inequality research in developing countries and could be useful as well in western countries.

Locating diversity: race, nativity and place in health disparities research

Nancy Krieger has been one of the leading voices in documenting how social ‘axes of difference’, including race, ethnicity and class make people vulnerable to poor health and limit their access to effective health care. We discuss the importance of ‘locating’ diversity in health inequalities research. This includes critically dissecting racial and ethnic axes into more nuanced social categories that incorporate differences based on immigration and other factors. It also involves considering how diverse population groups vary in their perception and use of space for health-related activities and exposures. Examples relating to immigrant populations’ health and access to health care are discussed.

User involvement, research and health inequalities: developing new directions

Placed in the context of broader discussions and developments about service user involvement in research and evaluation, this paper looks at the role that user involvement research may play in health inequalities research. It examines the pressures for and against such user involvement research, its different expressions and ideological relations, and what particular contribution it may have to offer in researching health inequalities. In considering how it may help in developing substantive understandings of these issues and the role it may play in the future, particular attention is paid to the issue of enabling the diverse involvement of service users in order not to reinforce existing exclusions and barriers in research, policy and practice.

Health inequalities in Scotland and England: the contrasting journeys of ideas from research into policy

Both the UK's Labour Government and Scotland's devolved Labour–Liberal Democrat coalition Executive have committed themselves to reducing health inequalities. Furthermore, both institutions have emphasised the importance of using evidence to inform policy responses. In light of such political commitments, a significant amount of work has been undertaken in the field of health inequalities in order to: (i) review the available research evidence; (ii) assess the extent to which policies have been based on this research evidence; and (iii) evaluate the success (or failure) of policies to tackle health inequalities. Yet so far only limited attention has been given to exploring how key actors involved in research-policy dialogues understand the processes involved. In an attempt to address this gap, this article draws on data from semi-structured interviews with 58 key actors in the field of health inequalities research and policymaking in the UK to argue that it is ideas, rather than research evidence, which have travelled from research into policy. The descriptions of the varying journeys of these ideas fit three types—successful, partial and fractured—each of which is outlined with reference to one example. The paper then employs existing theories about research-policy relations and the movement of ideas in an attempt to illuminate and better understand the contrasting journeys. In the concluding discussion, it is argued that the third approach, which focuses on the entrepreneurial processes involved in the marketing of ideas, is most helpful in understanding the research findings, but that this needs to be discussed in relation to the political context within which negotiations take place.

A Review on Socioeconomic Position Indicators in Health Inequality Research

Socioeconomic position (SEP) refers to the socioeconomic factors that influence which position an individual or group of people will hold within the structure of a society. In this study, we provide a comprehensive review of various indicators of SEP, including education level, occupation-based SEP, income and wealth, area SEP, life-course SEP, and SEP indicators for women, elderly and youth. This report provides a brief theoretical background and discusses the measurement, interpretation issues, advantages and limitations associated with the use of each SEP indicator. We also describe some problems that arise when selecting SEP indicators and highlight the indicators that appear to be appropriate for health inequality research. Some practical information for use in health inequality research in South Korea is also presented. Investigation into the associations between various SEP indicators and health outcomes can provide a more complete understanding of mechanisms between SEP and health. The relationship between specific SEP indicators and specific health outcomes can vary by country due to the differences in the historical, socioeconomic, and cultural contexts of the SEP indicators.

Historical Advances in Health Inequality Research

The socioeconomic inequalities in health have recently become an important public health concern in South Korea, and the issue has gained increasing attention from many South Korean researchers due to the increasing income inequality and widening social polarization following its economic crisis in the late 1990s. However, despite the mounting literature on health inequalities published in recent years, the history of research on health inequality in South Korea is premature in comparison to the long histories in several Western countries. Understanding the historical background underlying the issue of health inequality research may aid in establishing and accumulating scientifically solid evidence in South Korea. It may also direct the South Korean research community to develop research agendas that are more politically and academically appropriate for South Korean society. This paper describes the historical development of health inequality research in the West and introduces several important issues contributing to the advancement of health inequality research. Specifically, the major studies conducted before and after the UK Black Report are presented. In addition, the history and current status of health inequality research in South Korea are documented and evaluated. Finally, several research agendas for the quantitative and qualitative improvement of health inequality research in South Korea are proposed.

Commentary: Social capital, social class, and the slow progress of psychosocial epidemiology

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Health and Status Attainment

The issue of whether health influences mobility and status attainment has tended to be neglected in the main traditions of social mobility research. Health inequality research, however, indicates that health strongly affects transitions into and out of employment, but that the occupational mobility of the steadily employed is practically unaffected by health. This latter finding is surprising, because a plausible conjecture is that health variations influence occupational achievement also among those in continuous working careers. In this article I investigate the topic in a sample of Norwegian men born in 1946 who have been steadily employed over the course of three decades ( n= 330). Using ordinary least squares regression, I analyse whether health is associated with subsequent changes in occupational prestige, managerial position and income change. The results indicate that health variations have no impact on occupational trajectories during young adulthood. After age 40, however, significant health effects are revealed in relation to attainment of managerial position and income change, but not to changes in occupational prestige. This suggests that occupational trajectories are health-selective to some extent even among men in continuous working careers, but that these tendencies first emerge in mid-life when health has become more differentiated, and health effects are constrained by how occupational careers are typically structured in present-day societies.

Gender differences in the relationship of partner's social class to behavioural risk factors and social support in the Whitehall II study

In most countries health inequality in women appears to be greater when their socio-economic position is measured according to the occupation of male partners or spouses than the women's own occupations. Very few studies show social gradients in men's health according to the occupation of their female partners. This paper aims to explore the reasons for the differences in social inequality in cardiovascular disease between men and women by analysing the associations between own or spouses (or partners) socio-economic position and a set of risk factors for prevalent chronic diseases. Study participants were married or cohabiting London based civil servants included in the Whitehall II study. Socio-economic position of study participants was measured according to civil service grade; socio-economic position of the spouses and partners according to the Registrar General's social class schema. Risk factors were smoking, diet, exercise, alcohol consumption, and measures of social support. In no case was risk factor exposure more affected by the socio-economic position of a female partner than that of a male study participant. Wives’ social class membership made no difference at all to the likelihood that male Whitehall participants were smokers, or took little exercise. Female participants’ exercise and particularly smoking habit was, in contrast, related to their spouse's social class independently of their own grade of employment. Diet quality was affected equally by the socio-economic position of both male and female partners. Unlike the behavioural risk factors, the degree of social support reported by women participants was in general not strongly negatively affected by their husband or partner being in a less advantaged social class. However, non-employment in the husband or partner was associated with relatively lower levels of positive, and higher negative social support, while men with non-working wives or partners were unaffected. Studying gender differences in health inequality highlights some of the problems in health inequality research more broadly. We are brought face to face with the fact that the development of conceptual models that can be applied consistently to aetiology in both men and women are still at an early stage of development. Closer attention is needed to the different processes behind material power and ‘emotional power’ within the household when investigating gender differences in health and risk factors.

The politics of health inequalities research in the United States.

In this article, based on a speech to the European Association of Health Policy, the author discusses the political context in which health inequalities research has historically operated in the United States. The discussion focuses on the limitations of research that uses income, consumption, and status as the primary categories of research practice, and demonstrates these limitations by critically analyzing The Health of Nations (by Kawachi and Kennedy). The author concludes that it is essential to use categories of analysis that focus on class relations as well as race and gender relations and their reproduction through the international and national institutions, to study their impact on the health and well-being of populations.