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Issue 6, July 2000, pp.7.

Reports from the Programme conference:
A framework for researching the impact of public policy on inequalities in health
Margaret Whitehead

Because many of the causes of the health divide lie in broader policy arenas, outside the health sector, there is a great need to develop ways of assessing the impact of broader social and economic policies. The task is fraught with evaluation dilemmas, but pragmatic solutions are evolving, including the use of 'natural policy experiments'. These take advantage of variations in policy formulation or implementation in different localities and countries. Our ESRC study selected one such experiment - the differing social welfare policies in operation in the UK and Sweden - and assessed their impact on the health-related circumstances of lone mothers and people at risk of or experiencing unemployment.

This presentation outlined the conceptual framework (Figure 1) that had been refined for the task and its potential value for policy development. Essentially, it was helpful in our study in pointing out distinct and empirically testable mechanisms generating inequalities in health, and also in distinguishing between several entry points where policy might potentially have an impact. It can, in combination with adequate individual level data on factors such as exposure levels and distributions, be used for health inequality impact analysis. The ultimate aim is to identify effective policy levers for making improvements.

Figure 1: Framework for researching policy impact on health inequalities

The impact of social position on health through differential exposure (I), differential vulnerability (II), and differential consequences of disease (III). Consequences of disease might feed back into a causal pathway (IV). The modifying effect of social context and policy on social stratification (A), differential exposure (B), differential vulnerability (C), and differential social consequences of disease (D).

Source: Diderichsen and Hallqvist, 1999

Associated references:
Burström, B., Whitehead, M., Lindholm, C. and Diderichsen, F. (forthcoming, 2000) 'Inequality in the social consequences of illness: how well do people with long-term illness fare on the labour markets of Britain and Sweden? International Journal of Health Services.
Whitehead, M., Burström, B. and Diderichsen, F. (2000) 'Social policies and the pathways to inequalities in health: a comparative analysis of lone mothers in Britain and Sweden, Social Science and Medicine 50, 255-270.
Whitehead, M., Diderichsen, F. and Burström, B. (2000) 'Researching the impact of public policy on inequalities in health' in H. Graham (ed.) Understanding Health Inequalities, Buckingham : Open University Press.