Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/16656
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Best Practice Guidelines for Monitoring Socioeconomic Inequalities in Health Status: Lessons from Scotland
Authors: Frank, John W
Haw, Sally
Contact Email: s.j.haw@stir.ac.uk
Keywords: Health inequalities
disparities
socioeconomic status
monitoring
epidemiology
Scotland
Issue Date: Dec-2011
Publisher: Wiley-Blackwell for Milbank Memorial Fund
Citation: Frank JW & Haw S (2011) Best Practice Guidelines for Monitoring Socioeconomic Inequalities in Health Status: Lessons from Scotland, Milbank Quarterly, 89 (4), pp. 658-693.
Abstract: Context: In this article we present "best practice" guidelines for monitoring socioeconomic inequalities in health status in the general population, using routinely collected data. Methods: First, we constructed a set of critical appraisal criteria to assess the utility of routinely collected outcomes for monitoring socioeconomic inequalities in population health status, using epidemiological principles to measure health status and quantify health inequalities. We then selected as case studies three recent "cutting-edge" reports on health inequalities from the Scottish government and assessed the extent to which each of the following outcomes met our critical appraisal criteria: natality (low birth weight rate, LBW), adult mortality (all-cause, coronary heart disease [CHD], alcohol-related, cancer, and healthy life expectancy at birth), cancer incidence, and mental health and well-being. Findings: The critical appraisal criteria we derived were "completeness and accuracy of reporting"; "reversibility and sensitivity to intervention"; "avoidance of reverse causation"; and "statistical appropriateness." Of these, the most commonly unmet criterion across the routinely collected outcomes was "reversibility and sensitivity to intervention." The reasons were that most mortality events occur in later life and that the LBW rate has now become obsolete as a sole indicator of perinatal health. Other outcomes were also judged to fail other criteria, notably alcohol-related mortality after midlife ("avoidance of reverse causation"); all cancer sites' incidence and mortality (statistical appropriateness due largely to heterogeneity of SEP gradients across different cancer sites, as well as long latency); and mental health and well-being ("uncertain reversibility and sensitivity to intervention"). Conclusions: We conclude that even state-of-the-art data reports on health inequalities by SEP have only limited usefulness for most health and social policymakers because they focus on routinely collected outcomes that are not very sensitive to intervention. We argue that more "upstream" outcome measures are required, which occur earlier in the life course, can be changed within a half decade by feasible programs and policies of proven effectiveness, accurately reflect individuals' future life-course chances and health status, and are strongly patterned by SEP.
Type: Journal Article
URI: http://hdl.handle.net/1893/16656
DOI Link: http://dx.doi.org/10.1111/j.1468-0009.2011.00646.x
Rights: The publisher does not allow this work to be made publicly available in this Repository. Please use the Request a Copy feature at the foot of the Repository record to request a copy directly from the author. You can only request a copy if you wish to use this work for your own research or private study.
Affiliation: University of Edinburgh
HS Research - Stirling

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