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Best Practice Guidelines for Monitoring Socioeconomic Inequalities in Health Status: Lessons from Scotland
Author(s) -
FRANK JOHN,
HAW SALLY
Publication year - 2011
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/j.1468-0009.2011.00646.x
Subject(s) - medicine , socioeconomic status , health equity , life expectancy , population health , population , public health , critical appraisal , mortality rate , environmental health , demography , gerontology , surgery , nursing , alternative medicine , pathology , sociology
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.