Lancaster University tackles health inequalities

The first phase of a multi-million pound research programme to discover why, in a country enjoying unparalleled levels of wealth and health, there are sharp and persisting socio-economic gradients in disease, disability and premature death has been completed

The Health Variations Programme, a programme of research involving research groups and centres across the UK and directed by Professor Hilary Graham of Lancaster University, has been collecting evidence to inform public health policy.

The research has been given essential relevance by the Government who see tackling health inequality as the key objective in improving the health of the country. Targets are even being built into the funding and practice of health care to try and reduce health inequalities.

Professor Hilary Graham explains that the Health Variations Programme is about unravelling the causes of health inequalities in light of this increased government concern with narrowing the health gap between rich and poor:

"Major themes in the programme concern the way in which our health is shaped over our lives. Previous research had suggested that 'the die is cast' by our experiences early in life. But evidence from the programme demonstrates that experiences across our lives also matter."

"This is crucial information for Government, for health professionals and for local communities. It means that we need policies which not only target children in poverty but which lift the weight of disadvantage at all stages of life. If you grow up in poor circumstances, and then enjoy a good standard of living in middle life, your chances of living a long and healthy life will improve. Conversely, if you slide into poverty in adulthood after a privileged childhood, your health prospects will worsen. As this suggests, it is never too late - or too early - to intervene and we need lifetime policies that tackle health inequalities."

A second major theme in the programme concerns the marked geographical inequalities in health: people living in the poorer industrial areas of the UK live shorter lives in poorer health than those in the prosperous suburbs. Conventional wisdom was that these area differences in health were simply the result of the fact that richer people, with their better health prospects, were concentrated in more affluent areas while poorer people, with their poorer health profiles, were confined to declining areas. However, studies in the programme have found that areas also have an effect: even the health of the rich suffers by living in a poor neighbourhood. Lack of amenities and facilities, exposure to traffic danger and the strain of living in areas where residents feel isolated and unsupported have been identified as important factors explaining these area influences.

Professor Graham says, that again, there are important policy messages: "Knowing that places make a difference provides support for policies which are improving the environment of run-down neighbourhoods - by regenerating inner city areas, investing in local services and by improving public transport in rural areas for example."

With 13 of the 26 projects in the programme now completed, the programme is also drawing conclusions about how different health risks - for example, poor living and working conditions, and health-damaging behaviours like smoking - combine and reinforce each other. Addressing a single risk is likely to be less effective than strategies which make a difference to a broad range of risk factors.

Professor Graham explains: "the findings underlie the need for a basket of policies which tackle health inequalities from the cradle to the grave, including social security and tax policies, education and employment, traffic calming and access to leisure facilities. Improving conditions in the workplace and in the community and supporting initiatives to take more exercise and to quit smoking also have a vital part to play in an effective public health policy.

The Health Variations Programme is funded by the Economic and Social Research Council (ESRC).