Dear Colleagues

I have attached below some information on some papers from the latest issue of the Journal of Public Health Medicine which may be of interest to some of you.

These include

1. Addressing health inequalities in the United Kingdom: a case study. Adam Oliver and Don Nutbeam
2. Socio-economic position and health: what you observe depends on how you measure it. Sally Macintyre, Laura McKay, Geoff Der, and Rosemary Hiscock
3. Caring-related inequalities in psychological distress in Britain during the 1990s. Michael Hirst
4. Equity of access to tertiary hospitals in Wales: a travel time analysis. Stephen Christie and David Fone

More info below

Best wishes

David McDaid
LSE health and social care


Addressing health inequalities in the United Kingdom: a case study

Adam Oliver and Don Nutbeam
J Public Health Med 2003 25: 281-287.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/281?etoc

Health inequalities research has a long history in the United Kingdom, and the development of government policies that are intended to explicitly address the existing health inequalities has been gathering pace since the Labour Party returned to power in 1997. In this paper, using the influential Acheson Report as a reference point, one of us (D.N.) describes how health inequalities policies have been developed, and the other (A.O.) assesses how, ideally, such policies ought to be developed. Although progress in the development of health inequalities policies has been made, the policies, and the evidence that has informed them, have been less than ideal. 
Key Words: United Kingdom * health inequalities policy * equity * Acheson Report


Socio-economic position and health: what you observe depends on how you measure it

Sally Macintyre, Laura McKay, Geoff Der, and Rosemary Hiscock
J Public Health Med 2003 25: 288-294.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/288?etoc


Background A number of different socio-economic classifications have been used in relation to health in the United Kingdom. The aim of this study was to compare the predictive power of different socio-economic classifications in relation to a range of health measures. 
Methods A postal questionnaire was sent to a random sample of adults in the West of Scotland (sampling from 1997 electoral roll, response rate 50 per cent achieved sample 2,867) 
Results Associations between social position and health vary by socio-economic classification, health measure and gender. Limiting long-standing illness is more socially patterned than recent illness; income, Registrar General Social Class, housing tenure and car access are more predictive of health than the new National Statistics Socio Economic Classification; and men show steeper socio-economic gradients than women. 
Conclusion Although there is a consistent picture of poorer health among more disadvantaged groups, however measured, in seeking to explain and reduce social inequalities in health we need to take a more differentiated approach that does not assume equivalence among social classifications and health measures. 
Key Words: social classifications * inequalities in health * self-reported health * gender


Caring-related inequalities in psychological distress in Britain during the 1990s
Michael Hirst
J Public Health Med 2003 25: 336-343.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/336?etoc

Background This paper examines recent trends in inequalities in psychological distress associated with the provision of unpaid care by those who look after frail older people and younger disabled adults and children. Caring activities intensified during the 1990s, associated with increasing amounts of time devoted to the more demanding types of care and to those relationships that typically make heavy demands on the carer. Heavy involvement in caregiving is often associated with symptoms of anxiety and distress, and the intensification of care may increase rates of distress in carers relative to that in non-carers. 
Methods A secondary analysis was carried out of data drawn from the first 10 waves of the British Household Panel Survey covering 1991-2000, based on around 9000 adults interviewed personally in successive waves. Symptoms of psychological distress, including anxiety and depression, were assessed using the 12-item General Health Questionnaire. 
Results Carers present higher rates of distress than noncarers and the health gap widens as the definition of caregiving focuses on those living with the person they care for, and those devoting 20 h or more per week to their caring activities. Differences in distress rates between carers and non-carers are greater for women than for men. There is no support for the hypothesis that inequalities in distress associated with caregiving have increased over time. 
Conclusion There was no change during the 1990s in the extent of inequalities in psychological distress associated with caregiving in Britain. The need to maintain carers' emotional and mental health is as compelling as ever it was. 


Equity of access to tertiary hospitals in Wales: a travel time analysis

Stephen Christie and David Fone
J Public Health Med 2003 25: 344-350.
http://jpubhealth.oupjournals.org/cgi/content/abstract/25/4/344?etoc

Background The objective of the study was to investigate the implications for equity of geographical access for population subgroups arising from hypothetical scenarios of change in configuration of National Health Service tertiary hospital service provision located in Wales. 
Methods For each of three scenarios, the status quo and centralization of services to one of two locations, we used a travel time road length matrix in geographical information software to calculate the proportion of the population living within 30, 60, 90 and 120 min travel of each hospital site and the associated mean, median and 90th percentile travel times. We analysed data for the total resident population of Wales, for residents aged 75 or more years, for residents of the most deprived 10 per cent of enumeration districts, and for residents of rural areas. 
Results Centralization of services reduces geographical access for all population subgroups. Access varies between population subgroups, both between and within different scenarios of service configuration. A change in service configuration may improve access for one subgroup but reduce access for another. The interpretation may also vary according to whether the defined cut point for comparing access is based on short or long travel times. Measurements of absolute and relative access are sensitive to the assumed travel speeds. 
Conclusion Access for the total population does not imply equity of access for subgroups of the population. Comparisons of access between scenarios are dependent on which measure of access is the indicator of choice. Results are sensitive to the road network travel speeds and further local validation may be necessary. This method can provide explicit information to health service planners on the effects on equity of access from a change in service configuration. 
Key Words: geographical access * travel time * equity