Bridging the gap : working towards equity in health and health care

Sammanfattning: The large differentials in health between socio-economic groups within European populations rank amongst the most serious of contemporary challenges to public health in these countries. A central part of that challenge is to develop effective ways of taking action to reduce health inequalities considered both avoidable and unfair. This thesis focuses on the question of what is needed to facilitate effective policy making in this area and what contribution scientific investigations could make to the process. The thesis is based on seven papers: three health policy studies and four epidemiological studies designed to inform policy-making. The first four studies focus on equity in health, carrying out a theoretical analysis of the concepts and principles of equity implicit in the World Health Organisation's Health For All Strategy; devising a conceptual framework for policy formulation; making an assessment of current policy initiatives; and carrying out empirical analyses to give a current picture of the scale of the problem in Britain, from area-based and individual social class perspectives. The second part of the thesis consists of three studies which single out one aspect of equity in health - that of equity in health care - for more in-depth investigation. An assessment is made of the principles and components of one health care system, the British national health service (NHS), which would tend to make it equitable and the potential impact of the 1990s health care reforms on the maintenance of those principles. Comparative analyses are then carried out to assess equity in healthcare utilisation in the Swedish and British NHSs, and the development of methods for one of its prerequisites - the equitable allocation of resources. The findings indicate that a consideration for equity in health could, and should, be injected into policy-making at all levels. Epidemiological and health policy research could make a valuable contribution to this goal, by helping to identify the most effective, efficient and equitable courses of action to tackle the health divide.