Suchergebnisse

Clare Bambra examines the social, environmental, economic and political causes of health inequalities, how they have evolved over time and what they are like today. Revealing gaps in life expectancy of up to 25 years between places just a few miles apart, this important book demonstrates that where you live can kill you.

Since the early 1980s, neoliberalism or 'market fundamentalism' has dominated politics and economics across the globe. In this important book, Ted Schrecker and Clare Bambra consider the effects of over three decades of these policies with particular reference to the US and the UK. They focus on obesity, insecurity, austerity, and inequality, arguing that each represents a 'neoliberal epidemic' - neoliberal because they are implicated in the rise of neoliberal politics; and epidemics because they have been rapidly transmitted across international populations at a rate seen in epidemics of biological contagions. Crucially, the authors argue that neoliberal epidemics require a political cure in the form of a revitalised and social democratic welfare state.

The United States has a mortality disadvantage relative to its political and economic peer group of other "rich democracies". Recently it has been suggested that there could be a role for social policy in explaining this disadvantage. In this paper, we test this 'social policy' hypothesis by presenting a time trend analysis from 1970 to 2011 of the association between welfare state generosity (for unemployment insurance, sickness benefits, and pensions) and life expectancy, for the US and 17 other high-income countries. Fixed-effects estimation with autocorrelation-corrected standard errors (robust to unmeasured between-country differences and serial autocorrelation of repeated measures) found strong associations between welfare generosity and life expectancy. A unit increase in overall welfare generosity yields a 0.17 year increase in life expectancy at birth (p < 0.001), and a 0.07 year increase in life expectancy at age 65 (p < 0.001). The strongest effects of the welfare state are in the domain of pension benefits (b = 0.439 for life expectancy at birth, p < 0.001; b = 0.199 for life expectancy at age 65, p < 0.001). Models that lag the measures of social policy by ten years produce similar results, suggesting that the results are not driven by endogeneity bias. There is evidence that the US mortality disadvantage is, in part, a welfare-state disadvantage. We estimate that life expectancy in the US would be approximately 3.77 years longer, if it had just the average social policy generosity of the other 17 OECD nations.

This glossary reflects a (re‐)emerging awareness within public health of the political dimension of health and health inequalities, and it also attempts to define some of the key concepts from the political science literature in a way that will be of use in future public health analyses. Examples from different domains (healthcare and population health) are provided to highlight how political concepts pervade health.

There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.

Following government commitments to reducing health inequalities from 1997 onwards, the UK has been recognised as a global leader in health inequalities research and policy. Yet health inequalities have continued to widen by most measures, prompting calls for new research agendas and advocacy to facilitate greater public support for the upstream policies that evidence suggests are required. However, there is currently no agreement as to what new research might involve or precisely what public health egalitarians ought to be advocating. This article presents an analysis of discussions among 52 researchers to consider the feasibility that research-informed advocacy around particular solutions to health inequalities may emerge in the UK. The data indicate there is a consensus that more should be been done to learn from post-1997 efforts to reduce health inequalities, and an obvious desire to provide clearer policy guidance in future. However, discussions as to where researchers should now focus their efforts and with whom researchers ought to be engaging reveal three distinct ways of approaching health inequalities, each of which has its own epistemological foundations. Such differences imply that a consensus on reducing health inequalities is unlikely to materialise. Instead, progress seems most likely if all three approaches are simultaneously enabled.

In response to the 2007/8 financial crisis and the subsequent 'Great Recession', the UK government pursued a policy of austerity, characterised by public spending cuts and reductions in working-age welfare benefits. This paper reports on a case study of the effects of this policy on local inequalities in mental health and wellbeing in the local authority of Stockton-on-Tees in the North East of England, an area with very high spatial and socio-economic inequalities. Follow-up findings from a prospective cohort study of the gap in mental health and wellbeing between the most and least deprived neighbourhoods of Stockton-on-Tees is presented. It is the first quantitative study to use primary data to intensively and longitudinally explore local inequalities in mental health and wellbeing during austerity and it also examines any changes in the underpinning social and behavioural determinants of health. Using a stratified random sampling technique, the data was analysed using linear mixed effects model (LMM) that explored any changes in the gap in mental health and wellbeing between people from the most and least deprived areas, alongside any changes in the material, psychosocial and behavioural determinants. The main findings are that the significant gap in mental health between the two areas remained constant over the 18-month study period, whilst there were no changes in the underlying determinants. These results may reflect our relatively short follow-up period or the fact that the cohort sample were older than the general population and pensioners in the UK have largely been protected from austerity. The study therefore potentially provides further empirical evidence to support assertions that social safety nets matter - particularly in times of economic upheaval.

In response to the 2007/8 financial crisis and the subsequent 'Great Recession', the UK government pursued a policy of austerity, characterised by public spending cuts and reductions in working-age welfare benefits. This paper reports on a case study of the effects of this policy on local inequalities in mental health and wellbeing in the local authority of Stockton-on-Tees in the North East of England, an area with very high spatial and socio-economic inequalities. Follow-up findings from a prospective cohort study of the gap in mental health and wellbeing between the most and least deprived neighbourhoods of Stockton-on-Tees is presented. It is the first quantitative study to use primary data to intensively and longitudinally explore local inequalities in mental health and wellbeing during austerity and it also examines any changes in the underpinning social and behavioural determinants of health. Using a stratified random sampling technique, the data was analysed using linear mixed effects model (LMM) that explored any changes in the gap in mental health and wellbeing between people from the most and least deprived areas, alongside any changes in the material, psychosocial and behavioural determinants. The main findings are that the significant gap in mental health between the two areas remained constant over the 18-month study period, whilst there were no changes in the underlying determinants. These results may reflect our relatively short follow-up period or the fact that the cohort sample were older than the general population and pensioners in the UK have largely been protected from austerity. The study therefore potentially provides further empirical evidence to support assertions that social safety nets matter - particularly in times of economic upheaval.

Employability initiatives are becoming increasingly popular in government discourse as a means of tackling worklessness. Here we discuss the findings of a small-scale, qualitative study which mapped the impacts of a multi-intervention programme on participants' health, wellbeing and employability. Each of the 13 interventions was independently appraised through focus groups or semi-structured interviews. Thematic analyses revealed that participants from all interventions reported increased self-confidence, with several individuals suggesting that project involvement had facilitated their movement into the labour market. While the findings illustrate some positive outcomes, we argue that government policy needs to consider more carefully strategies that also address the demand side of the labour market.

Employability initiatives are becoming increasingly popular in government discourse as a means of tackling worklessness. Here we discuss the findings of a small-scale, qualitative study which mapped the impacts of a multi-intervention programme on participants' health, wellbeing and employability. Each of the 13 interventions was independently appraised through focus groups or semi-structured interviews. Thematic analyses revealed that participants from all interventions reported increased self-confidence, with several individuals suggesting that project involvement had facilitated their movement into the labour market. While the findings illustrate some positive outcomes, we argue that government policy needs to consider more carefully strategies that also address the demand side of the labour market.

Objectives: To explore similarities and differences in policy content and the political context of the three main English government reports on health inequalities: the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010). Methods: Thematic policy and context analysis of the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010) in terms of: (i) underpinning theoretical principles; (ii) policy recommendations; (iii) the political contexts in which each was released; and (iv) their actual or potential influence on research and policy. Results: There were great similarities and very few differences in terms of both the theoretical principles guiding the recommendations of these reports and the focus of the recommendations themselves. However, there were clear differences in terms of the political contexts of each report, as well as their subsequent impacts on research and policy. Conclusion: The paper calls into question the progress of health inequalities research, the use of evidence and of the links between research, politics and policy.