Friday, August 7, 2009

[EQ] Better evidence about wicked issues in tackling health inequities

Better evidence about wicked issues in tackling health inequities

Mark Petticrew, Professor of Public Health Evaluation1

Peter Tugwell, Professor of Medicine, and Epidemiology & Community Medicine2

Vivian Welch, Research associate2

Erin Ueffing, Field Administrator, Cochrane Health Equity Field and Campbell Equity Methods Group2

Elizabeth Kristjansson, Associate Professor2,3

Rebecca Armstrong, Senior Research Fellow, Cochrane Public Health Review Group4

Jodie Doyle, Managing Editor, Cochrane Public Health Review Group4

Elizabeth Waters, Professor, Jack Brockhoff Chair of Child Public Health, and Coordinating Editor, Cochrane Public Health Review Group4


1 Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

2 Institute of Population Health, University of Ottawa, Ottawa, ON, Canada

3 School of Psychology, University of Ottawa, Ottawa, ON, Canada

4 McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Australia


Journal of Public Health Advance Access published online on July 28, 2009

Available online at: http://jpubhealth.oxfordjournals.org/cgi/content/full/fdp076#FDP076C16

“…….The need for better evidence continues to be emphasized by both researchers and users of research. ‘Better evidence for a better world’ was the theme of this year's Campbell Colloquium for example, a gathering of researchers and policy-makers who aim to systematically build the evidence on the effectiveness of social policies and programs, including those aimed at improving social welfare, reducing crime and improving educational outcomes.

 

This resonates with continuing political interest in making policies more evidence informed. In keeping with this spirit of evidence-based enquiry, it is reasonable to consider what ‘better evidence’ might look like.

 

One important way to improve current evidence on health and social outcomes is to consider, and report on, the impact of interventions on health equity. Currently much research on the effects of interventions, which address the social determinants of health is focused on the mean population-level effects and less on the differential effects within populations, such as on differences in effectiveness for those who are disadvantaged.

 

This ‘evidence with a utilitarian bias’1 results in insufficient evidence on how to adequately address health inequalities. Primary studies often fail to collect, analyse and present data on differential effects, and even where such data are available, systematic reviews often fail to use it.2,3

 

‘Better evidence’, then, means evidence that explores the effects of interventions within different sections of society, and that can be used to tackle inequalities in health. In the absence of this information we may proceed on best guesses and practical experience; however, in both clinical and population-level interventions, we know that current practice and conventional wisdom are often poor guides to what works………….”

 

Related Document:

The social determinants of health: developing an evidence base for political action.

Kelly M, Morgan A, Bonnefoy J, et al.
Final Report to World Health Organization Commission on the Social Determinants of Health from
the Measurement and Evidence Knowledge Network. (2007) Geneva: World Health Organization. http://www.who.int/social_determinants/resources/mekn_report_10oct07.pdf.

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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[EQ] Health Inequalities Intervention Tool

The Health Inequalities Intervention Tool -  updated 2009

Department of Health/Association of Public Health Observatories – 2009

URL: http://www.lho.org.uk/LHO_Topics/Analytic_Tools/HealthInequalitiesSpearhead2007.aspx

UK Department of health: http://www.dh.gov.uk/en/Publichealth/Healthinequalities/Bestpractice/index.htm

This Tool is a new interactive online resource which draws together key data and modelling to help areas with the worst health and deprivation (the Spearhead Group) improve life expectancy quickly.

It presents both a national and local picture, showing:

·         Life expectancy in each Spearhead local authority

·         The gap in life expectancy between each Spearhead local authority and England

·         A breakdown of the causes of the life expectancy gap by disease type and age

The Tool also contains a ready reckoner, which allows Spearhead Areas to estimate the potential effect on their life expectancy gap if certain interventions are increased, specifically:

·         support for people to give up smoking

·         control blood pressure through prescribing antihypertensives in people without diagnosed cardiovascular disease.

·         control cholesterol through prescribing statins in people without diagnosed cardiovascular disease.

·         actions to reduce infant mortality


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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO website: http://66.101.212.219/equity/
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.