Leslie Boydell Institute of Public Health

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Health inequalities in Ireland implications for
research and policy
Leslie Boydell Institute of Public Health
Domains and dimensions of health
systems research 31st August 2007 www.publichealt
h.ie
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Of all forms of inequalities, inequalities in
health are the most inhumane
Martin Luther King
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Three distinguishing features, when combined,
turn mere variations or difference in health
into a social inequity in health. They are
systematic, socially produced (and therefore
modifiable) and unfair
Dahlgren and Whitehead
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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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In Ireland, north and south

• All cause mortality rate in lowest occupational
  classes is 100-200 higher
• For circulatory disease, it is 120 higher
• For cancers, it is 100 higher
• For respiratory disease, it is gt200 higher
• For injuries and poisoning, it is gt150 higher

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In Ireland

• Mortality rate from transport accidents is 354
  higher
• Hospitalisation for mental illness among
  unskilled workers is 6x higher

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• 37 of women with medical cards smoke during
  pregnancy vs 12 of mothers without
• 27 of babies born to unemployed mothers were
  breastfed vs 67 of babies born to higher
  professional women

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In Northern Ireland

• Children from disadvantaged backgrounds are 2x as
  likely to die before their 15th birthday
• The average suicide rate in economically deprived
  areas is 2x that of non-deprived areas

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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• Policy context

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Policy context

• National Report for Ireland on Strategies for
  Social Protection and Social Inclusion 2006-2008
  
• National Action Plan for Social Inclusion
  2007-2016

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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Research into health inequalities in Ireland

• Descriptive of inequalities and the social
  gradient
• Health of specific groups
• Service access and utilisation
• Evaluations of interventions
• Methods of measurement
• Methods of working
• Lifecourse

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Gaps

• User perspective or research into lived
  experience
• Intervention research
• Analysis of mainstream data sources and surveys
  limited by data collected
• Methods

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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Global Commission on the Social Determinants of
Health
Purpose

• To achieve policy change by
• learning from what we know
• about the social determinants
• of health
• www.who.int/social_determinants/resources/en

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Activities

• Mechanisms by which social determinants generate
  health inequalities
• Relationships between the determinants of health
• Policy entry points

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Distinctions

• Structural determinants of health (eg income and
  education)
• Intermediate determinants (eg living and working
  conditions, population behaviour and food
  availability)

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• To eradicate
• inequalities in health,
• we need to eliminate
• the social determinants
• of health inequalities

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Limitations of evidence base

• Studies explaining what can be done to reduce
  health inequalities
• Systematic studies of policy effects on inequity
• Difference between the determinants of health and
  the determinants of health inequalities often
  confused
• Health of populations and the health of
  individuals often elided
• Links between proximal, intermediate and distal
  determinants of health poorly conceptualised

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• Further research is
• needed but enough is
• presently known for
• effective action
• Dahlgren and Whitehead

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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Policy-making
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Policy-making

• Rarely an event
• Timing of decisions determined by political
  considerations
• Decisions tend to be driven by underlying beliefs
• Social climate will determine what is popular or
  acceptable
• Competing interests will influence what decisions
  are made

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Policy-making
Scientific plausibility
Political acceptability
What is practically implementable
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What we need to understand

• Policy entry points
• Place of evidence in policy making
• How to achieve best fit with dominant political
  vision and desired outcomes
• Importance of local infrastructure for
  implementation
• Political nature of policy making
• Prepared advocate

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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So what is needed in Ireland?

• Research into what works
• Strong advocacy
• To maximise public involvement
• Intervene with children
• To tackle the social determinants of health
  inequalities
• Policies which have greater beneficial effects on
  disadvantaged groups

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So what is needed in Ireland?

• To address the gradient
• Work on knowledge transfer
• Research into the effects of policies on the
  unequal distribution of the major factors which
  influence health

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As a research community we need to

• Increase awareness across government and academic
  disciplines of the centrality of non-health
  policies and interventions for improving health
  and tackling health inequalities

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As a research community we need to

• Ensure that policy evaluations include measures
  of health determinants, risk factors and health
  status
• Ensure that evaluation of policies and
  interventions include effects on subgroups

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As a research community we need to

• Ensure that policy evaluations include measures
  of health determinants, risk factors and health
  status
• Ensure that evaluation of policies and
  interventions include effects on subgroups

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As a research community we need to

• Interdisciplinary research and a variety of
  methods
• Research designs and evaluation strategies that
  capture the effects of policies on health
  determinants and outcomes
• More research funding on interventions to reduce
  inequalities

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As a research community we need to

• Consider the relationships between the different
  dimensions of inequalities and how they interact
• Study differential responses to similar
  interventions between different groups
• Ensure an inequalities dimension included in
  topic based research

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As a research community we need to

• Make tackling health inequalities a priority
• Develop strategy
• Gather information
• Integrate action across all health programmes

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What can the health services do?

• Pursue community and public involvement work in
  partnership with other sectors
• Improve access for and differentially address the
  needs of disadvantaged and marginalised groups

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What I will cover

• Inequalities in health in Ireland
• The policy context
• Research into inequalities in health in Ireland
• International inequalities research
• Getting research evidence into policy
• Future needs for inequalities research in Ireland
  and contribution of the health system

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