Health inequalities in England, Scotland and Wales: stakeholders' accounts and policy compared

B.E. Harrington, K.E. Smith, D.J. Hunter, L. Marks, T.J. Blackman, L. McKee, A. Greene, E. Elliott, G.H. Williams

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives The election of a Labour government in 1997 brought the issue of health inequalities firmly back on to the policy agenda across the UK. Since then, in the wake of devolution, the need to tackle health inequalities has been highlighted as a policy priority in all three mainland UK countries, albeit with varying degrees of emphasis. This paper reports on a major cross-national study, funded by the Economic and Social Research Council, investigating how National Health Service bodies, local councils and partnerships make sense of their work on health inequalities, and examining the difference made by the contrasting approaches that have been taken to performance assessment in England, Wales and Scotland.
Study design Case studies, semi-structured interviews and analysis of key policy statements.
Methods In order to explore how health inequalities have been approached by the three governments (noting that there was a change in governments in Wales and Scotland during this time), key policy statements published between May 1997 and May 2007 were analysed. Concurrently, data from stakeholder interviews carried out in 2006 in case study areas in each country were analysed to determine the extent of alignment between policy and practice at local level.
Results This paper suggests that claims about the extent of health policy divergence in post-devolution Britain may have been exaggerated. It finds that, whilst the three countries have taken differing approaches to performance assessment and the setting of targets, policy approaches to health inequalities up until 2007 appear to have been remarkably similar. Furthermore, the first round of interview data suggest that variations in local understandings of, and responses to, health inequalities cannot always be clearly distinguished along national lines.
Conclusions Based on the policy analysis, devolution in the UK does not appear to have resulted in substantively different national policy approaches to health inequalities. Indeed, the overall analysis suggests that (prior to the 2007 elections in Scotland and Wales) the differences between local areas within countries may be of as much interest as those between countries.
LanguageEnglish
Pagese24-e28
Number of pages5
JournalPublic Health
Volume123
Issue number1
Early online date13 Dec 2008
DOIs
Publication statusPublished - 31 Jan 2009

Fingerprint

Wales
Scotland
England
stakeholder
Health
health
decentralization
policy approach
Policy Making
performance assessment
Interviews
interview
election
economic research
National Health Programs
Health Policy
social research
health policy
divergence
health service

Keywords

  • health inequality
  • health policy
  • devolution
  • performance assessment
  • UK

Cite this

Harrington, B. E., Smith, K. E., Hunter, D. J., Marks, L., Blackman, T. J., McKee, L., ... Williams, G. H. (2009). Health inequalities in England, Scotland and Wales: stakeholders' accounts and policy compared. Public Health, 123(1), e24-e28. https://doi.org/10.1016/j.puhe.2008.10.010
Harrington, B.E. ; Smith, K.E. ; Hunter, D.J. ; Marks, L. ; Blackman, T.J. ; McKee, L. ; Greene, A. ; Elliott, E. ; Williams, G.H. . / Health inequalities in England, Scotland and Wales : stakeholders' accounts and policy compared. In: Public Health. 2009 ; Vol. 123, No. 1. pp. e24-e28.
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Harrington, BE, Smith, KE, Hunter, DJ, Marks, L, Blackman, TJ, McKee, L, Greene, A, Elliott, E & Williams, GH 2009, 'Health inequalities in England, Scotland and Wales: stakeholders' accounts and policy compared' Public Health, vol. 123, no. 1, pp. e24-e28. https://doi.org/10.1016/j.puhe.2008.10.010

Health inequalities in England, Scotland and Wales : stakeholders' accounts and policy compared. / Harrington, B.E.; Smith, K.E.; Hunter, D.J. ; Marks, L.; Blackman, T.J.; McKee, L.; Greene, A.; Elliott, E.; Williams, G.H. .

In: Public Health, Vol. 123, No. 1, 31.01.2009, p. e24-e28.

Research output: Contribution to journalArticle

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AU - Harrington, B.E.

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AU - Blackman, T.J.

AU - McKee, L.

AU - Greene, A.

AU - Elliott, E.

AU - Williams, G.H.

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N2 - Objectives The election of a Labour government in 1997 brought the issue of health inequalities firmly back on to the policy agenda across the UK. Since then, in the wake of devolution, the need to tackle health inequalities has been highlighted as a policy priority in all three mainland UK countries, albeit with varying degrees of emphasis. This paper reports on a major cross-national study, funded by the Economic and Social Research Council, investigating how National Health Service bodies, local councils and partnerships make sense of their work on health inequalities, and examining the difference made by the contrasting approaches that have been taken to performance assessment in England, Wales and Scotland.Study design Case studies, semi-structured interviews and analysis of key policy statements.Methods In order to explore how health inequalities have been approached by the three governments (noting that there was a change in governments in Wales and Scotland during this time), key policy statements published between May 1997 and May 2007 were analysed. Concurrently, data from stakeholder interviews carried out in 2006 in case study areas in each country were analysed to determine the extent of alignment between policy and practice at local level.Results This paper suggests that claims about the extent of health policy divergence in post-devolution Britain may have been exaggerated. It finds that, whilst the three countries have taken differing approaches to performance assessment and the setting of targets, policy approaches to health inequalities up until 2007 appear to have been remarkably similar. Furthermore, the first round of interview data suggest that variations in local understandings of, and responses to, health inequalities cannot always be clearly distinguished along national lines.Conclusions Based on the policy analysis, devolution in the UK does not appear to have resulted in substantively different national policy approaches to health inequalities. Indeed, the overall analysis suggests that (prior to the 2007 elections in Scotland and Wales) the differences between local areas within countries may be of as much interest as those between countries.

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