University of Dundee University of Dundee
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16 June 2006

More action needed to tackle health inequalities

* Professor Crombie will be available for interview after 11am on Friday June 16th 2006*

Inequalities in health are increasing and unlikely to change unless Government departments coordinate policies to tackle underlying socio-economic factors, a leading public health professor at the University of Dundee has claimed.

Professor Iain Crombie argues there is a "pressing need" for a more coordinated approach in a new book published by the World Health Organisation.

In Closing the Health Inequalities Gap: An International Perspective, Professor Crombie and colleagues Professor Lawrence Elliott, Dr Linda Irvine and Hilary Wallace examined policies of 13 developed countries including the UK countries, Scandinavia, the USA and Australia.

The work was part of a programme of research supported by funding of £1/4 million from NHS Health Scotland. The inequalities study was based on a detailed examination of over 100 policy documents from the 13 countries.

Professor Crombie and his colleagues found that all the countries acknowledged substantial and unacceptable inequalities in health between groups in society. These countries are also concerned that the health gap has widened at a time when the overall health of countries has improved.

"Inequalities in health are pervasive, increasing and morally unacceptable, "said Professor Crombie. "They are a major challenge for developed countries. This book explores how governments in 13 countries have responded to that challenge"

"Inequalities in health are mainly caused by socio-economic factors such as differences in income, quality of housing and the local physical and social environment. Governments need to ensure that everyone has equal access to education, employment, health care and recreation."

"Inequalities in health are also associated with smoking and poor diet. However these adverse health behaviours are more to do with lack of opportunity, poverty and a poor environment than with individual choice. There is no point in blaming individuals, we need to tackle the root causes."

"Policies on inequalities address the need to improve housing quality, promote education and provide opportunities for employment. They also wish to break the cycle of deprivation across generations. Some countries follow the pioneering Head Start programme of the United States. This targets children of low-income families, providing comprehensive initiatives to meet their emotional, social, health, nutritional and psychological needs."

"Of all the countries we studied, England has the most ambitious, coordinated and well-funded programme of interventions to reduce inequalities. New Zealand also stands out by making inequalities a priority for all policies."

Professor Crombie added that a weakness of policies on inequalities in health is that they commonly emanate solely from ministries of health.

"These ministries do not have direct control over many of the underlying causes of inequality. The levers of power also lie within departments of education, employment, transport and tax."

"As well as policies on inequalities in health all the countries studied have separate policies on social inclusion and social justice. These policies are driven by concerns about human rights within society, that all individuals should have the opportunity to achieve their full potential."

He also added that policies on social justice are better placed to tackle the underlying causes because they are issued jointly by all the relevant government departments, including education, employment, transport and tax.

"Unfortunately there is not always a strong link between health inequalities policy and social justice policy," he said.

"The challenges facing policymakers are to ensure that strategies to tackle the macroenvironmental factors feature in policy on inequalities in health and that health becomes a prominent issue in social inclusion/social justice policy. This may be best achieved by integrating policies in these two areas."

Dr Erio Ziglio, head of WHO’s European Office for Investment for Health and Development in Italy, described the new book as an "important work."

"Equity is closely linked to human rights and inequities in health status refer to differences that are systematic and quantifiable," he said. "Inequities thus refer to differences that are unfair and avoidable. An increasing number of countries and international organizations are acknowledging the importance of improving the health of the population and reducing health inequities."

"The work of Professor Crombie is important as it fills a knowledge gap in comparing similarities and differences in policy approaches in 13 high-income countries. It is important to monitor both policy processes and impact so that we can improve our knowledge and know-how in this very complex area."

Dr Laurence Gruer, Director of Public Health Science with Health Scotland said. "I congratulate Professor Crombie and his team for producing this report about health inequalities. The decision of the WHO to publish it shows that their work is of international importance."

"Every country has health inequalities and each is trying to tackle them in its own way. Whilst a great deal is being done in Scotland, we still can learn a lot from other countries. What’s being done in New Zealand, Norway and Sweden is impressive. England now has a very comprehensive strategy covering a wide range of initiatives".


The countries in the study are Scotland, Wales, England, Northern Ireland, Ireland, Denmark, Sweden, Norway, Finland, USA, Canada, Australia and New Zealand.

Professor Crombie is the James Mackenzie Professor of Public Health at the University of Dundee’s Medical School.

Dr Linda Irvine is a research fellow in the Public Health Section of the University of Dundee’s Medical School.

Mrs Hilary Wallace is a research assistant in the Public Health Section of the University of Dundee’s Medical School.

Professor Lawrence Elliot was Reader in the School of Nursing and Midwifery, Dundee University at the time of the research study. He is now a Professor at the Centre for Integrated Healthcare Research at Napier University.

Professor Crombie will be available for interview on Friday June 16 2006 after 11am.

For more information contact:

Hilary McNally
Press Office
University of Dundee
Nethergate Dundee, DD1 4HN
TEL: 01382 384768