CDE Appendix 1 Literature Review - Central East Local Health ...

More documents

Recommendations

Info

The Culture, Diversity and Equity Project: Literature Review • And fifth, there is a goal for the National Health Service to promote equitable access to services in relation to need and they’re taking the lead in working with other agencies to tackle the broader determinants of health. In addition, goals were set for the elimination of health inequalities (Raphael & Bryant, 2006). 20 Limitations and Challenge Some of the limitations and challenges of UK policies and strategies discussed in the literature are outlined below: • It has proven difficult to reorientate the health service to focus on health rather than healthcare issues at the local level. “To achieve this,” Benzeval argues, “local agencies require consistent and clear messages, reinforced by a range of policy levers such as performance management systems” (2002, p. 212). • There have been challenges collaborating intersectorally; though reducing health inequalities requires a broad social policy response, other sectors sometimes have more pressing goals and priorities that may be fundamentally out of sync with efforts to improve living standards, employment conditions and social security. Such inconsistencies in priorities can make it difficult to make substantial inroads in reducing health inequities (Judge & Mackenzie, 2002). • There have been challenges attributing causes and effects to interventions and policies that are aimed at broad health determinants and developing appropriate indicators to measure progress on intersectoral initiatives (Exworthy et al., 2006; WHO, 2008). 21 • There is a less progressive trend in more recent reports (e.g. Wanless 2004; Dept of Health, 2004) to focus more narrowly on individual health behaviours and healthcare service access issues to the exclusion of broader social structural determinants of health (Raphael & Bryant, 2006). • There remains a gap between the state of knowledge and analyses, and the implementation of the latter (Raphael & Bryant, 2006 ) • Objectives and targets are not always clearly linked and/or articulated (specifically in relation to the Health Action Zones) and “pathways of expected change” are not always “specified in sufficient detail for it to be possible to make a reasonable judgement about whether the target is feasible” (Judge & Mackenzie, 2002). Dominant Framework • Whole-of-government Health Equity Framework that considers broad socio-economic determinants of health. 20 Raphael & Bryant give the example, in this respect, of “the 2002 Spending Review Public Service Agreement – a kind of business plan – for the Department of Health which contained the goal ‘By 2010 to reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at birth’. To facilitate and support action, the government set up ‘cross-cutting spending reviews’ focused on health inequalities. These reviews are to be used by departments to inform spending plans for the 2003–2006 period. 21 Though it is perhaps too early to judge, there appear to be few visible, attributable impacts of such broad policy interventions in the UK context thus far, and existing time trends show little evidence of narrowing health gaps (e.g. poverty rates for working aged adults without children reach all-time high levels by 2002-2003) (Raphael & Bryant, 2006). Exworthy et al. (2006) draw attention to some of the difficulties in measuring success of such interventions due to the length of time required for such interventions to take effect. As they argue: the causal pathway between policy and outcome may be apparent only in the long term [years or decades], if at all. …[ Yet] the period in which the policy interventions are expected to deliver results and over what time periods these effects should be measured often are not clear” (Exworthy et al., 2006). 74
The Culture, Diversity and Equity Project: Literature Review Rating on Whitehead’s Action Spectrum • Comprehensive Coordinated Policy Other International Developments (Netherlands, Sweden, New Zealand, Barcelona) The following section lists some of the promising government policy/strategy developments and interventions relating to health equity encountered in the literature emanating from other parts of the world. Australia • Australian health authorities have developed, implemented, and provided training on health equity impact assessment (see Section 4.3E for more on the origins, development, employment, and usefulness of Health Equity Impact Assessment tools in various jurisdictions). Box 3.4: Health Equity Impact Assessments in Australia The Australian Better Health Initiative is part of a Council of Australian Governments Reform Package, which aims to improve health for all Australians. As part of the development of the Implementation Plan for New South Wales, a Rapid Equity Focussed Impact Assessment was conducted. Eight initiatives were assessed on their potential equity impacts, looking at inequities by age, gender, place of residence, ethnicity, and socioeconomic status. Concrete recommendations were formulated on how to improve the equity focus and potential positive impacts on health equity of the Initiative. Original Source: Harris, Harris & Kemp, 2006; Taken from WHO, 2008. Box 3.5: Expanding Capacity for Health Equity Impact Assessment in Australia: Learning by Doing An example of capacity building for health impact assessment is the “Learning by Doing” approach that was part of the New South Wales Health Impact Assessment Project. Learning by Doing includes formal training, access to resources and technical support, and continued building of consensus on the scope of health impact assessment. An equity focus needs to be incorporated into all training on health impact assessment. Original Source: Harris, 2007; Taken from WHO, 2008 The Netherlands • The Netherlands has been successful in putting health equity issues on the political agenda, having achieved broad consensus on the need to reduce health inequalities (See Stronks 2002 for summary of policy developments in the Netherlands from 1980 to 2000; also see Stronks & Gunning-Scheper, 1993). 75
Page 1 and 2:
Appendix 1: Health Equity Literatur
Page 3 and 4:
The Culture, Diversity and Equity P
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
HEALTH EQUITY LITERATURE REVIEW INT
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24: The Culture, Diversity and Equity P
Page 73: The Culture, Diversity and Equity P
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
REFERENCES ACAS [Advisory Conciliat
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139:
show all

CDE Appendix 1 Literature Review - Central East Local Health ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?