Health Inequalities

Third Report of Session 2008-09 Volume 1
House of Commons Health Committee
15 March 2009

Available online PDF [143p.] at: http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf

“……..Health inequalities are not only apparent between people of different socio-economic groups—they exist between different genders, different ethnic groups, and the elderly and people suffering from mental health problems or learning disabilities also have worse health than the rest of the population. The causes of health inequalities are complex, and include lifestyle factors—smoking, nutrition, exercise to name only a few—and also wider determinants such as poverty, housing and education. Access to healthcare may play a role, and there are particular concerns about ‘institutional ageism’, but this appears to be less significant than other determinants.

Lack of evidence and poor evaluation
One of the major difficulties which has beset this inquiry, and indeed is holding back all those involved in trying to tackle health inequalities, is that it is nearly impossible to know what to do given the scarcity of good evidence and good evaluation of current policy.

Policy cannot be evidence-based if there is no evidence and evidence cannot be obtained without proper evaluation. The most damning criticisms of Government policies we have heard in this inquiry have not been of the policies themselves, but rather of the Government’s approach to designing and introducing new policies which make meaningful evaluation impossible.

Even where evaluation is carried out, it is usually “soft”, amounting to little more than examining processes and asking those involved what they thought about them. All too often Governments rush in with insufficient thought, do not collect adequate data at the beginning about the health of the population which will be
affected by the policies, do not have clear objectives, make numerous changes to the policies and its objectives and do not maintain the policy long enough to know whether it has worked. As a result, in the words of one witness, ‘we have wasted huge opportunities to learn’. Simple changes to the design of policies and how they are introduced could make all the difference, and Chapter 3 of this report sets these out. Professor Sir Michael Marmot’s forthcoming review of health inequalities offers the ideal opportunity for the Government to demonstrate its commitment to rigorous methods for introducing and evaluating new initiatives in this area which are ethically sound and safeguard public funds….”

Report

Summary
1 Introduction
2 Health inequalities – extent, causes, and policies to tackle them
The extent of health inequalities
Measuring health inequalities
Causes of health inequalities
Access to healthcare
Lifestyle factors
Socio-economic factors
3 Designing and evaluating policy effectively
Lack of evidence
Inadequacy of evaluation
Difficulties in evaluating complex interventions
Poor design and introduction of interventions
Better evaluation
The ethical case for evaluation
Solutions
Conclusion
4 Funding for health inequalities
To what extent should health spending be redistributed to tackle health inequalities?
5 Specific health inequalities initiatives 50
6 The role of the NHS in tackling health inequalities
Clinical interventions to tackle health inequalities
7 Tackling health inequalities across other sectors and departments
8 A new approach to tackling health inequalities

Conclusions and recommendations
List of written evidence
List of further written evidence
List of unprinted evidence
List of Reports from the Health Committee

The report can be downloaded in pdf or HTML at: http://www.publications.parliament.uk/pa/cm/cmhealth.htm