Purpose of this section
This section is designed to help you:
- (a) clarify how health inequalities influence the problem you want to tackle; and
- (b) identify the socio-economic causes of these inequalities.
If you are using the toolkit to prepare an application for support from us, you can consider health inequalities associated with gender, ethnic background, age, disability and so on. However, we give priority to applications that show the potential to reduce inequalities in health resulting from socio-economic inequalities.
So whatever the specific focus of your application, you should explain how the problem is influenced by inequalities in people’s social circumstances. Your application should also highlight plans to address some of these socio-economic causes of health inequalities. For example, if the problem relates to uptake of services or outcomes of treatment for a particular group (for example, women, people with disabilities, or a minority ethnic group) you will need to consider:
- • whether the problem is unequally distributed within the socio-economic group you are focusing on, and if so how; and
- • what particular socio-economic factors may contribute to these inequalities in the problem you want to focus on (for example, low income or poor-quality housing).
If you are proposing an evidence review or a capacity-building initiative, it will also need to focus on the socio-economic causes of health inequalities. Capacity-building activities might focus, fully or partly, on increasing understanding about health inequalities and their socio-economic causes among those taking part. Also, all applications submitted to us should consider more involvement from public advisers from underrepresented social groups.
The questions below will help you think about these issues and explain in your proposal how the work you want to do will tackle them. It is difficult to frame questions in language that applies to the broad range of activities we are involved in. If a particular question does not seem relevant to your activity, adapt it to suit the purpose of the exercise.
As you work through the questions, it might be helpful to look at the hypothetical example provided. This shows how you can use the toolkit to evaluate an activity aimed at increasing the uptake of health checks. This example is designed to help you see how considering the questions below can strengthen the focus on socio-economic causes of health inequalities in your proposed work.
Mol, Annemarie (2008): The Logic of Care: Health and the Problem of Patient Choice. London: Routledge (Chapter 5)
Annandale, E. and K. Hunt, (Eds). Gender inequalities in health. 2000: Open University Press.
Krieger, N. (2006). Researching critical questions on social justice and public health: an ecosocial perspective. Social injustice and public health, 11, 460.
Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of health and social behavior, 80-94.
Popay, J., et al., Beyond ‘beer, fags, egg and chips’? Exploring lay understandings of social inequalities in health. Sociology of health & illness, 2003. 25(1): p. 1-23.
Braveman, P., and Gruskin, S. (2003). Defining equity in health. Journal of epidemiology and community health, 57(4), 254-258.
Sara Arber’s latest study on inequalities in ageing in England.
Public Health England handy resource list on Health Inequalities
The roots of health inequalities - web based course funded by the National Center for Minority Health and Health Disparities, National Institutes of Health (USA).
Unnatural causes- documentary series produced by California Newsreel and Vital Pictures, Inc. (USA).
The Last Straw! A Board Game on the Social Determinants of Health - developed by Kate Rossiter and Kate Reeve (Canada)
Gender equality and health – video for the SOPHIE project (Spain/EU).
What is health equity? - short film by the Health Equity Institute (USA)
How wealth is distributed in the UK - short film by Inequality Briefing (UK).
Income inequality - short film by Inequality Briefing (UK).
Why equality is better for everyone - talk by Richard Wilkinson (UK).
The great leveller –documentary produced by the Channel 4 Equinox series.
Community factors & how they influence health equity, resources by the Prevention Institute (USA).
Listen to Professor Jennie Popay talk through the development of the HIAT - NIHR CLAHRC NWC’s website (UK).
Public Involvement resources
The Public Involvement Impact Assessment Framework (PiiAF) website provides a wide range of resources to start thinking about what public involvement (PI) involves, and possibilities for research and implementation. It also provides a comprehensive list of resources and published cases of methods and tools that have been used to assess PI. These resources can inspire you to adapt them to involve the public in the context of your intervention.
The Service User Involvement Best Practice Guide provides a series of short videos to illustrate key issues around user involvement: what it is; why it is important; different methods for different contexts and users; barriers and how to overcome them. Remember that even if you intervention/action doesn’t involve service users you can still use and adapt some of these ideas to develop your own work!
Involve, an NHS-funded organisation, and the UK National Coordinating Centre for Public Engagement offer great examples of different ways in which you can involve the public in research and funding applications.
Powercube.net provides a compilation of conceptual and practical resources, including methods and case studies, to understand power relations in participatory projects. Be inspired by this case study involving UK citizens as activists and health officials to avoid the closure of a health centre.
Mind the gap website: Listen To Your Patient And They Will Tell You The Problem – A True Story.
Real-world HIAT Assessment Examples
STEP Service Evaluation – the service aims to reduce avoidable A&E attendances. Blackburn with Darwen Borough Council
Community Connectors. Sefton CVS
Evaluating the impact of Liverpool Community Care Teams. Liverpool CCG