1. Leslie Boydell Institute of Public Health Domains and dimensions of health systems research 31 st August 2007 www.publichealth.ie Health inequalities in Ireland: implications for research and policy

2. Of all forms of inequalities, inequalities in health are the most inhumane Martin Luther King

3. Three distinguishing features, when combined, turn mere variations or difference in health into a social inequity in health. They are systematic, socially produced (and therefore modifiable) and unfair Dahlgren and Whitehead

4. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

5. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

6. All cause mortality rate in lowest occupational classes is 100-200% higher For circulatory disease, it is 120% higher For cancers, it is 100% higher For respiratory disease, it is >200% higher For injuries and poisoning, it is >150% higher In Ireland, north and south:

7. Mortality rate from transport accidents is 354% higher Hospitalisation for mental illness among unskilled workers is 6x higher In Ireland:

8. 37% of women with medical cards smoke during pregnancy vs 12% of mothers without 27% of babies born to unemployed mothers were breastfed vs 67% of babies born to higher professional women

9. Children from disadvantaged backgrounds are 2x as likely to die before their 15 th birthday The average suicide rate in economically deprived areas is 2x that of non-deprived areas In Northern Ireland:

10. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

11. Policy context

12. National Report for Ireland on Strategies for Social Protection and Social Inclusion 2006-2008 National Action Plan for Social Inclusion 2007-2016 Policy context

14. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

15. Descriptive of inequalities and the social gradient Health of specific groups Service access and utilisation Evaluations of interventions Methods of measurement Methods of working Lifecourse Research into health inequalities in Ireland

16. User perspective or research into lived experience Intervention research Analysis of mainstream data sources and surveys limited by data collected Methods Gaps

17. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

18. To achieve policy change by learning from what we know about the social determinants of health www.who.int/social_determina nts/resources/en Global Commission on the Social Determinants of Health Purpose:

19. Mechanisms by which social determinants generate health inequalities Relationships between the determinants of health Policy entry points Activities:

20. Structural determinants of health (eg income and education) Intermediate determinants (eg living and working conditions, population behaviour and food availability) Distinctions

21. “To eradicate inequalities in health, we need to eliminate the social determinants of health inequalities”

22. Studies explaining what can be done to reduce health inequalities Systematic studies of policy effects on inequity Difference between the determinants of health and the determinants of health inequalities often confused Health of populations and the health of individuals often elided Links between proximal, intermediate and distal determinants of health poorly conceptualised Limitations of evidence base

23. “Further research is needed but enough is presently known for effective action” Dahlgren and Whitehead

24. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

25. EvidenceExperienceJudgement ResourcesValues Policy-making

26. Rarely an event Timing of decisions determined by political considerations Decisions tend to be driven by underlying beliefs Social climate will determine what is popular or acceptable Competing interests will influence what decisions are made Policy-making

27. Scientific plausibilityPolitical acceptability What is practically implementable Policy-making

28. Policy entry points Place of evidence in policy making How to achieve best fit with dominant political vision and desired outcomes Importance of local infrastructure for implementation Political nature of policy making Prepared advocate need What we need to understand

29. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover

30. Research into what works Strong advocacy To maximise public involvement Intervene with children To tackle the social determinants of health inequalities Policies which have greater beneficial effects on disadvantaged groups So what is needed in Ireland?

31. To address the gradient Work on knowledge transfer Research into the effects of policies on the unequal distribution of the major factors which influence health So what is needed in Ireland?

32. Increase awareness across government and academic disciplines of the centrality of non-health policies and interventions for improving health and tackling health inequalities As a research community we need to:

33. Ensure that policy evaluations include measures of health determinants, risk factors and health status Ensure that evaluation of policies and interventions include effects on subgroups As a research community we need to:

34. Ensure that policy evaluations include measures of health determinants, risk factors and health status Ensure that evaluation of policies and interventions include effects on subgroups As a research community we need to:

35. Interdisciplinary research and a variety of methods Research designs and evaluation strategies that capture the effects of policies on health determinants and outcomes More research funding on interventions to reduce inequalities As a research community we need to:

36. Consider the relationships between the different dimensions of inequalities and how they interact Study differential responses to similar interventions between different groups Ensure an inequalities dimension included in topic based research As a research community we need to:

37. Make tackling health inequalities a priority Develop strategy Gather information Integrate action across all health programmes As a research community we need to:

38. Pursue community and public involvement work in partnership with other sectors Improve access for and differentially address the needs of disadvantaged and marginalised groups What can the health services do?

39. Inequalities in health in Ireland The policy context Research into inequalities in health in Ireland International inequalities research Getting research evidence into policy Future needs for inequalities research in Ireland and contribution of the health system What I will cover