Direction of travel

What is the relationship between UK government policy on tackling health inequalities and the available research?  Not quite what we think, according to a paper published by the Socialist Health Association.  Its author reviews research and policy between 1997 and 2007, finding that, rather than being strictly evidence-based, policy in England and Scotland has rather been shaped around the transmission of research-based ideas. A similarly ambivalent approach to the use of the evidence base appears in an article published in the Journal of Epidemiology and Community Health.  Interviews with policy makers in six countries provides an insight into how they view barriers to and facilitators of the use of RCTs for social programmes.

On aggregate

While the proportion of the English population engaging in 3 or 4 key "unhealthy behaviours" (smoking, alcohol consumption, poor diet, limited physical activity) has decreased in recent years (down from 33% in 2003 to 25% in 2008), the focus of this improvement is amongst richer, better educated people.  Those with no educational qualifications are far more likely to engage in all four behaviours and this tendency has increased over time, with the result that the poorest and least well educated have seen no improvement and relative inequalities have increased.  The King's Fund takes data from the Health Survey for England between 2003 and 2008 to examine how health behaviours cluster, arguing that focus on individual health behaviours, while helpful, is not the solution: a more holistic approach is necessary.

Measure up

A review published in the BMJ takes a look at the measures used in reporting health inequalities.  It finds that most studies use relative measures of effect rather than absolute, which, as the study's authors point out "may influence readers’ judgments of the magnitude, direction, significance, and implications of reported health inequalities."  It should be noted that the review is a bit of a straw poll, as it only covered one year's worth of research in 10 leading medical, pulic health and epidemiology journals.

Could do better

A major review for the WHO published in the Lancet maps health inequalities in the 53 states of the WHO European region.  Commissioned to support development of the WHO's new health policy framework for Europe, Health 2020, the review highlights substantial variations between and within states.  Lead author, Professor Sir Michael Marmot stressed the importance of attending to the issue:  "health inequality needs to be one of the main criteria by which we assess the effectiveness of countries’ health systems, and the effectiveness of government as a whole."

Home, sweet home

The September issue of the Journal of Epidemiology and Community Health includes some articles on the relationship between housing and ill-health.  One study considers the effect of cumulative exposure to housing affordability stress and its association with poorer mental health, while another looks at the impact of housing improvement on common childhood illnesses amongst Indigenous Australian communities.  A new report from the UK Department for Communities and Local Government (DCLG) assesses routes for preventing homelessness.  Making Every Contact Count sets out nine "local challenges," including limiting use of bed and breakfast accomodation (especially for young people and families), adopting a No Second Night Out model and offering a housing options prevention service.  Supporting this strategy there is an evidence review on the cost of homelessness;  DCLG has also released current statistics on homelessness prevention and relief.

Hit or miss?

Giving evidence before the Commons Education Select Committee, Alan Milburn, the government's preferred candidate for chair of the soon-to-be Child Poverty and Social Mobility Commission, suggested that there was not "snowball's chance in hell" of meeting the 2020 target for eradicating child poverty in the UK.  The conversation also included some interesting discussion about how far reducing child poverty and enhancing social mobility were competing claims.  Childhood socio-economic disadvantage has regularly been linked with obesity but does social mobility have any significant health effects in this regard.  A study from the USA looks at family income trajectories and their association with obesity in adolescence. Elsewhere, a survey of current policy and practice considers the role of maternal employment in tackling poverty and promoting social mobility.

Not making it bettter

A brief study in the Journal of Epidemiology and Community Health aims to discover from systematic review evidence what kinds of public health interventions actually increase health inequalities, by providing disproportionate benefit to less disadvantaged groups.  The researchers conclude that media campaigns and workplace smoking interventions appear to increase inequalities, while structural workplace interventions and fiscal interventions, such as tobacco pricing, appear to reduce inequalities.