Health Inequalities: Trends, Progress, and Policy

Bleich, Sara N.; Jarlenski, Marian; Bell, Caryn N.; LaVeist, Thomas A.

doi:10.1146/annurev-publhealth-031811-124658

Cited by 225 publications

(200 citation statements)

References 47 publications

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“…For example, Campos-Matos et al point to a ‘real or perceived lack of evidence on health inequalities’ in Portugal as a barrier to taking policy action to address health inequalities [14]. The UK has regular and systematic reporting of national health inequality monitoring, whereas the USA does not [15]. Low- and middle-income countries often do not have sufficient integration of health inequality monitoring into their health information systems; some middle-income countries, however, have institutionalized regular health inequality monitoring in some health topics.…”

Section: Key Challengesmentioning

confidence: 99%

National health inequality monitoring: current challenges and opportunities

Hosseinpoor

Bergen

Schlotheuber

et al. 2018

Global Health Action

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National health inequality monitoring needs considerably more investment to realize equity-oriented health improvements in countries, including advancement towards the Sustainable Development Goals. Following an overview of national health inequality monitoring and the associated resource requirements, we highlight challenges that countries may encounter when setting up, expanding or strengthening national health inequality monitoring systems, and discuss opportunities and key initiatives that aim to address these challenges. We provide specific proposals on what is needed to ensure that national health inequality monitoring systems are harnessed to guide the reduction of health inequalities.

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Section: Key Challengesmentioning

confidence: 99%

National health inequality monitoring: current challenges and opportunities

Hosseinpoor

Bergen

Schlotheuber

et al. 2018

Global Health Action

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“…Modeling age-adjusted rates has been used in other studies examining trends in population-level health inequalities. 20 We estimated initiation rates for each income quintile; income-specific rates were estimated at provincial and hospital levels. Age-adjusted rates were estimated at the provincial level.…”

Section: Breastfeeding Initiation Ratesmentioning

confidence: 99%

“…Other covariates are known to predict breastfeeding at the individual-level; 4, 5 stratifying on these characteristics may yield differing trends in breastfeeding inequalities over the study period. 20,23 Observed trends in inequalities are not generalizable. Other studies using different populations will likely find differing trends.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Have we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: A population-based epidemiological surveillance study

Nickel

Martens

Château

et al. 2014

Can J Public Health

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“…36,106,176 Previous studies have found reductions in absolute socioeconomic inequality in overall mortality in England in the 2000s 177 and reductions in both absolute and relative inequality in life expectancy. 178 This is all in line with our findings.…”

Section: Overall Mortalitymentioning

confidence: 99%

“…[103][104][105] In England, data from 2001 to 2013 showed that preventable hospitalisations make up one in every five hospital admissions, and have increased by 48% in the last 12 years. 106 Common causes of preventable hospitalisations include urinary tract infection/ pyelonephritis, pneumonia, chronic obstructive pulmonary disease (COPD), convulsions and epilepsy, and ear, nose and throat infections. Studies suggest that preventable hospitalisation can be reduced by improving primary care supply and quality.…”

Section: Preventable Hospitalisationmentioning

confidence: 99%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

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Health Inequalities: Trends, Progress, and Policy

Cited by 225 publications

References 47 publications

National health inequality monitoring: current challenges and opportunities

National health inequality monitoring: current challenges and opportunities

Have we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: A population-based epidemiological surveillance study

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

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