Health variations Newsletter
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Issue 1, January 1998, pp.2-3.

Health Variations Programme
Hilary Graham


Introduction
Tackling health inequalities is at the heart of the public health strategy of the Labour government. The Health Variations Programme focuses on the causes of the inequalities which this strategy seeks to address.

The Health Variations Programme aims to advance understanding of the social factors which underlie socio-economic differences in health in ways which contribute to the development of strategies which narrow the health gap between socio-economic groups.

The Health Variations Programme consists of projects based in research units and university departments across the UK. Thirteen projects are already up and running. The research teams and projects are listed on the back page of the newsletter; full details are available in the Programme information pack (available from the Programme office) and on the Programme website. Another tranche of projects are scheduled to start by the end of the year.

While the projects focus on different points in the pathways which link poor socio-economic circumstances to poor health, they address common underlying questions. Some of these questions are covered in this edition of the newsletter; others will be discussed in subsequent issues:

  • life course influences: how does the toll which poor health takes on health accumulate through childhood and across adulthood?
  • area effects: do the socio-economic characteristics of the area in which people live have an effect on their health over-and-above the effect of their own socio-economic background and circumstances?
  • income dynamics: what are the effects on health of shorter and longer term exposure to low income?
  • psycho-social processes: what impact do psychological and social difficulties like low self-esteem, depression and lack of social support have on socio-economic differences in health?
  • policy impact: what impact do welfare policies, particularly with respect to employment, social security and housing, have on health inequalities?
  • ethnicity: how does the socio-economic patterning of health vary both between and within ethnic groups?
  • gender differences: how does the socio-economic patterning of health vary between men and women?


The UK tradition of health inequalities research
The Health Variations Programme carries forward the long tradition of research begun by the public health surveys of the last century. It is a tradition which has created a rich database, including longitudinal studies which track the health and social circumstances of the same individuals over time. The thirteen projects in the first phase of the Programme draw on a number of these longitudinal studies; the list may well be extended when projects in the second phase come on stream.
UK interest in health inequalities

Focusing on the social determinants of health inequalities, the Health Variations Programme complements other programmes of research, including the Department of Health's own research initiative on variations in health status (1992-2002). This focuses on evaluations of interventions to reduce variations in health (further information available from http://www.open.gov.uk/doh).

The Health Education Authority has also launched a Health Promotion Research Strategy for England (1996- 99), to provide information on the need for, and effectiveness of, health promotion activities. The research strategy is set within a public health framework and emphasises the need for perspectives and policies which recognise the link between social disadvantage and health (further information can be found at http:llwww.hea.org.uk).

Health inequalities in Europe
An editorial in The Lancet in 1997 described health inequalities as 'the UK's biggest issue'. It is an issue not unique to the UK. A recent European survey uncovered similar inequalities in all European countries, with the highest risks of ill-health and premature death recorded among those in the poorest socio-economic circumstances. It emphasised how the inequalities evident today reflect the impact of factors at work in previous decades, with poor health in adulthood reflecting both earlier and current exposure to health-damaging environments (see Chris Power's article, Health Variations Programme Newsletter, Issue 1, pp.14-15).


"Inequalities in health are determined by socio-economic differences in life time exposure to various factors and the explanantion of the international pattern that we saw should therefore not be sought in the late 1980s but in the preceding decades. The need for an historical perspective is strengthened by the fact that inequalities in health are dynamic."
J. P. Mackenbach et al (1997) The Lancet, 349, p.1658


There is growing concern that inequalities are widening, not only in the UK (see Margaret Whitehead's article, Health Variations Programme Newsletter, Issue 1, pp. 4-5) but in other European countries including Sweden, Norway, Finland, Denmark and Spain.

Health inequalities research in Europe
These trends are moving health inequalities up the research and policy agenda across Europe. Like the UK, other countries are investing in major programmes of research into health inequalities. As in the UK, there is a dual emphasis on identifying causal pathways and identifying effective interventions.

Netherlands. Two major five-year programmes were launched in 1989 and 1994. The first programme focused on the nature, scale and determinants of health inequalities. It also established a documentation centre, covering research literature from 1985, published in a regular bulletin available from:

Documentation Centre
Socio-Economic Inequalities in Health
Department of Public Health
Erasmus University Rotterdam
PO Box 1738
3000 Dr Rotterdam
The Netherlands
Email: schrijvers@mag.ffs.eur.nl

The second programme has an additional focus on the identification and evaluation of interventions to reduce inequalities.

Finland. A new research programme on the causes of socio-demographic differences in health and welfare and on policies to address them was launched in 1997 with projects scheduled for 1998-2000. The programme covers socio-economic, gender and ethnic differences as well as regional and urban/rural differences.

Sweden. The Swedish government announced a national long-term research programme on health inequity in a research policy bill passed in 1996. The new programme, to be launched in 1998, will focus on the social processes influencing health inequalities, including gender and socio-economic differences. An Expert Meeting reviewing European research on health inequalities was held in September 1997 to inform the development of the new programme. Copies of the report of the Expert Meeting can be obtained from:

Birgit Arve-Pares
Swedish Council for Social Research SFR
Box 2220
S 1093 15 Stockholm
Sweden
Fax: +46-8-4404112
Emai1: bap@socforsk.se

Equity in health is the first objective of the World Health Organisation's European strategy, Health for All, by the year 2000. Along with the Health Variations Programme, the new European investments in health inequalities research are designed to inform policies to equalise opportunities for health into the next millennium.

Hilary Graham is Director of the ESRC Health Variations Programme, Lancaster University.
Key longitudinal studies used in the Health Variations Programme

ONS-LS Office for National Statistics Longitudinal Study - a study based on a 1 per cent sample of those enumerated at the 1971 census in England and Wales (approximately 500,000 individuals). Data on this sample have been added from the 1981 and 1991 Censuses and from vital registration records (births, cancers, deaths).

NCDS National Child Development Study - a longitudinal survey of individuals born in one week in March 1958 in England, Wales and Scotland. Information was collected at birth and at the ages of 7, 11, 16, 23 and 33.

HALS Health and Life Style Survey - a survey of 9,000 adults carried out in 1984 in England, Wales and Scotland. Two-thirds of the sample were re-interviewed in 1991.

BHPS British Household Panel Survey - a national longitudinal survey of 5,000 households begun in 1991, with household members aged 16 and over interviewed every year.