Revitalising the Health Equity Agenda

Lead Research Organisation: Durham University
Department Name: School of Applied Social Sciences

Abstract

The potential to enjoy a healthy and secure life is core to human flourishing. Health services, health status and the future for health and social care continue to be a top priority for the public and political parties. Differences in health experiences and outcomes are well documented, whilst debates continue as to how best to address these. Given that recent evidence suggests that both economic inequalities and inequalities in health are widening, this series is a timely opportunity to bring together research and action.

Our health status is based upon a range of biological, social, economic and geographical factors. Where we are born and the health status of our parents matters a lot. For most of the population household incomes, education and employment opportunities, along with any inheritance, dictate our social class and life chances. These opportunities differ across regions and localities too. Such is the concern of the public and the importance of health to our everyday lives that there are daily reports in the media on people's experiences of using health services and the implications of age, gender, social class and location on health outcomes.

The aim of this seminar series is to reinvigorate debates along with potential actions to address inequalities in health. We will work towards these goals through bringing together researchers, practitioners and policy makers from early to later career, to share and gain knowledge and insights. Debates will encourage wider thinking and ideas on how to best address the many factors which promote health and wellbeing.

The series comprises three one day conferences bringing together a wide audience and six seminars for focused discussion on specific case studies and policies.

We will use the framework provided by the World Health Organisation's Commission on Social Determinants of Health to organise the content of the series programme and bring debates alive through a case study of the North East of England, where health is generally worse in the North East than other regions in the UK and there are major disparities in health even within local boundaries. The series will produce a number of outputs for a range of audiences. There will be short briefing papers for the public and service providers; longer pieces for research and policy audiences; and social media and web based materials and debates. After 36 months of activity we will have established a strong network that will sustain long-term research programmes and engagement with public policy.

Planned Impact

Who will benefit?
The seminar series will appeal to a wide range of disciplines, NGOs and public sector organisations. The topics under investigation and discussion are at the heart of intellectual and political debates on health and inequalities in health. Health, health studies and the related subjects of economics, social policy, geography and politics underpin the study of health and remain popular with PGRs and early career researchers in academe and other sectors. The need to critically examine, monitor/evaluate and design policies and projects is imperative at a time of widening inequalities.

The main non-academic beneficiaries of knowledge arising from this seminar series are anticipated to be policy makers and advisers in government in England, Scotland, Northern Ireland and Wales) and practitioners (those working as managers and practitioners in local authority (LA) education, health and social service departments and third sector agencies - voluntary organisations, charities and social enterprise organisations operating in the field of health and social welfare. The series will also be of interest to journalists and to service users and members of the public as well as to the various pressure groups which campaign for and against some of the issues identified in the series.

How will they benefit?
Policy beneficiaries: The current policy context demonstrates the need to reinvigorate debates and action on inequalities in health; what works? what might be adopted and adapted? How might be share what has not worked so well and what is working? In short, the lessons learned and potential for lateral thinking about evidence will be promoted by the series. It is anticipated that presentations (papers and posters), outputs (briefing papers, articles and an edited book), along with social and web based materials will offer a bank of ideas and potential ways forward.

Practice beneficiaries: The series will offer opportunities to enhance critical awareness of the social determinants of health, the impact of inequalities and the challenges to action. Outputs will inform training and education, with, for example, the case study of the North East and the exploration of European and global contexts. We anticipate that involvement in the series will contribute to improved practice and professional reflection.

Society as a whole: The series is not an end in itself, albeit that events and outputs will offer tangible gains for user groups and the public in general. It is likely that the public will engage through social and web based media as these can act as springboards for debate and action. Thus we will ensure that communication in accessible and open formats is prioritised.

Publications

10 25 50

Related Projects

Project Reference Relationship Related To Start End Award Value
ES/M003027/1 01/12/2014 20/08/2017 £27,698
ES/M003027/2 Transfer ES/M003027/1 01/10/2017 30/11/2018 £13,203
 
Description The potential to enjoy a healthy and secure life is core to human flourishing. Health services, health status and the future for health and social care continue to be a top priority for the public and political parties. Differences in health experiences and outcomes are well documented, whilst debates continue as to how best to address these. Given that recent evidence suggests that both economic inequalities and inequalities in health are widening, this series was a timely opportunity to bring together research and action.

Our health status is based upon a range of biological, social, economic and geographical factors. Where we are born and the health status of our parents matters a lot. For most of the population household incomes, education and employment opportunities, along with any inheritance, dictate our social class and life chances. These opportunities differ across regions and localities too. Such is the concern of the public and the importance of health to our everyday lives that there are daily reports in the media on people's experiences of using health services and the implications of age, gender, social class and location on health outcomes.

The aim of this seminar series was to reinvigorate debates along with potential actions to address inequalities in health. We worked towards these goals by bringing together researchers, practitioners and policy makers across the regions, from early to later career, to share and gain knowledge and insights. Debates encouraged wider thinking and ideas on how to best address the many factors which promote health and wellbeing. The series comprised three one day conferences, six seminars and a final workshop to draw together ideas and consider future agendas. Over 200 participants engaged in various activities as part of the series.

Across activities we discussed a range of case studies and policies. The organisers adopted the framework provided by the World Health Organisation's Commission on Social Determinants of Health to organise the content of the series programme. Emerging from the series is a deeper concern for the conceptual breadth of health, care, resource inequalities and ageing. Priority setting in health and related policy and practice agendas remains a major concern and we reflected on the potential to 'interrogate scarcity' (Schrecker, T. (2018) Priority Setting: Right Answer to a Far too Narrow Question?, Int Jnl of Health Policy and Management, 7 (1), 86-88).

Lastly, to revitalise debates which have become mired in party political vested interests and electoral politics we would strongly recommend co-production of evidence, policies and resultant services changes. All too often research and policy developments are done on and not with service users and communities. Examples of co-production offer local ways forward might be replicated more widely to forge regional approaches to addressing inequalities.
Exploitation Route Much of what we have produced is about ways of working and engaging to enhance the potential for critical reflection.

In summary, we would encourage colleagues to locate current and future work with: -

1. reflections on existing and prior work; avoid replication and draw upon relevant experiences and developments
2. a range of groups and organisations to ensure diversity of experiences and ideas
3. dissemination of ideas and outputs across communities and academic networks

Current work on co-production offers opportunities for locally based and relevant ways to address inequity in health.
Sectors Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice

URL https://www.dur.ac.uk/research/directory/view/?mode=project&id=748
 
Description By NGOs and policy makers in debates to consider how health policy might be developed.
First Year Of Impact 2016
Sector Communities and Social Services/Policy,Education,Healthcare
Impact Types Policy & public services

 
Description 'Neoliberal epidemics,' Public Health and Policy seminar series on Health Systems and Policy, London School of Hygiene and Tropical Medicine, 1 December 2016. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Address based on book by co-investigators Schrecker and Bambra, How Politics Makes Us Sick: Neoliberal Epidemics (Palgrave Macmillan, 2015), with emphasis on the global context and the previous 15 years of research by Schrecker.
Year(s) Of Engagement Activity 2016
 
Description A mini-conference on 'Have we become acclimatised to greater inequality?' 11 January 2016, University of York 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Workshops
Have we become acclimatised to greater inequality?
11th January 2016, 09:30 to 16:45, National Science Learning Centre University of York, Heslington, York, YO10 5DD

Plennary: Have we become acclimatised to greater inequality? - Dorling Notes - Pickett Notes
Danny Dorling, Halford Mackinder Professor of Geography, University of Oxford &
Kate Pickett, Professor of Epidemiology, University of York
Workshop leaders:
Stephen Crossley (Durham): More of a shove than a nudge? "Troubled families", health and the 'remasculinisation of the state
Rob McDonald (Teesside): The Dog that Didn't Bark: Policy Ignorance and the Low-Pay, No-Pay Cycle
Jonathan Bradshaw (York): Child poverty and child health
Ruth Patrick (Leeds): Living with inequality: contrasting policy narratives with the lived experiences of welfare reform
Year(s) Of Engagement Activity 2016
URL http://www.dur.ac.uk/sass/research/healthequity/workshop/
 
Description First, do no harm: Neoliberal epidemics and the case against social policy malpractice,' North East Medical Sociology Group, British Sociological Association, Sunderland 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Workshop for practitioners and postgrduate students.
Year(s) Of Engagement Activity 2015
 
Description First, do no harm: Principles for fighting neoliberal epidemics,' British Sociological Association regional study day on neoliberalism and public health, School of Health and Related Research, University of Sheffield 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Workshop for practitioners researchers and postgraduate students.
Year(s) Of Engagement Activity 2016
 
Description First, do no harm: The case against social policy malpractice,' Walker Welfare Reform pilot research launch, Newcastle City Council and Newcastle University, Newcastle 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Launch of findings from pilot project on welfare reform.
Year(s) Of Engagement Activity 2015
 
Description First, do no harm: The public health evidence against social policy malpractice,' Institute for Advanced Study workshop on Spaces of Evidence, Durham University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Multidisciplinary academic seminar with academics from different backgrounds of Durham University and international fellows.
Year(s) Of Engagement Activity 2015
 
Description Health equity and neoliberal epidemics,' seminar on Understanding Health Inequalities: Local and Macro Approaches, School of Applied Social Science, Durham University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Internal seminar for social policy specialists.
Year(s) Of Engagement Activity 2015
 
Description International health forum 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Neoliberal epidemics: history, etiology, and a view from Ground Zero,' Symposium on Exploring Global Health in the Arctic, Centre for Arctic and Global Health and Norwegian Forum for Global Health Research, University of Tromsø, 22-23 January 2018.
Year(s) Of Engagement Activity 2018
 
Description Keynote address at international conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Ted Schrecker Neoliberal epidemics: history, etiology, and a view from Ground Zero Keynote address, mid-term conference, Research Network 16 (Sociology of Health and Illness), European Sociological Association, Turin, 19-21 April 2018.
Year(s) Of Engagement Activity 2018
 
Description Lifestyle Drift and the Politics of Stress', Centre for Public Policy and Health Guest Lecture, Wolfson Research Institute for Health and Wellbeing, 24 November 2016. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other audiences
Results and Impact Critique of 'lifestyle drift' in health promotion policy in Canada and the United Kingdom; explication of the relevance of the concept to the challenge of revitalising the health equity agenda.
Year(s) Of Engagement Activity 2016
 
Description Memorial Lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Ted Schrecker 'Neoliberal epidemics and the case against social policy malpractice,' Phil Hanns Memorial Lecture, National Association of Welfare Rights Advisers annual meeting, Sunderland, 11 December 2015.
Year(s) Of Engagement Activity 2015
 
Description Neoliberal epidemics and health politics for a new Gilded Age,' annual Cost of Living Symposium address, British Sociological Association Medical Sociology Conference, Birmingham, 8 September 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Address based upon and updating the book by co-investigators Schrecker and Bambra (2015)
Year(s) Of Engagement Activity 2016
 
Description Neoliberal epidemics and the case against social policy malpractice,' Phil Hanns Memorial Lecture, National Association of Welfare Rights Advisers annual meeting, Sunderland 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact National annual meeting for practitioners.
Year(s) Of Engagement Activity 2015
 
Description Neoliberal epidemics and the politics of evidence' at the third Fuse international conference on knowledge exchange, Gateshead, 27-28 April 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The recent book How Politics Makes Us Sick introduced the concept of neoliberal epidemics. The symposium explored the politics of evidence in the context of such epidemics.
Ted Schrecker (Durham University; co-author of the book and moderator of the workshop) argued that instead of the conventional wisdom that 'more evidence' is needed to demonstrate the effectiveness of population-level interventions to address social determinants of health, the guiding principle in this age of endemic insecurity and selective austerity should be 'first, do no harm'.
Privatisation, a key element in the neoliberal agenda, has been justified by claims about both efficiency and quality. David Byrne (Durham University) argued that the supporting evidence is weak, often non-existent. Claims about markets as promoters of efficiency ignore both transaction costs and imperfect competition. Claims that bigger means better, with restructuring often involving service reduction and shifts to the private sector, are specious.
What happens to children in their earliest years determines the distribution of key outcomes in adult life. David Taylor-Robinson (University of Liverpool) argued that the benefits of investing in the early years are well demonstrated, yet changes to the welfare system in the UK have disproportionately reduced the income of the most disadvantaged families. His explanation of the threat to public health drew on research for Due North: The report of the Inquiry on Health Equity for the North, with which co-investigator Bambra was also actively involved. Finally,
Kate Pickett (University of York and Equality Trust) addressed the failure of neoliberal economic ideology and policy to deliver wellbeing in a global frame of reference, using the framework of the Sustainable Development Goals agreed in September 2015 to present the evidence base for a new paradigm for economic and development policy.
Year(s) Of Engagement Activity 2008
URL http://www.fuse.ac.uk/events/3rdfuseinternationalkeconference/#d.en.259641
 
Description Panel at international conference 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Ted Schrecker Panelist, What can we do to reduce health inequalities? Special session on The Politics and Sociology of Health Inequities, 24th International Conference of Europeanists, Glasgow, 14 July 2017.
Year(s) Of Engagement Activity 2017
 
Description Talk at international conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Ted Schrecker '"Stop, you're killing us!" Neoliberal epidemics and prospects for resistance', Special Social and Behavioural Sciences Divisional Seminar, Dalla Lana School of Public Health, University of Toronto, 22 March 2017.
Year(s) Of Engagement Activity 2017
 
Description Talk at international conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Ted Schrecker Neoliberal epidemics: history, etiology, and a view from Ground Zero,' Social and Behavioural Sciences Divisional Seminar, Dalla Lana School of Public Health, University of Toronto, 5 April 2018.
Year(s) Of Engagement Activity 2018
 
Description Was Mackenbach right? Neoliberal epidemics, the new Gilded Age, and the politics of health inequality,' Social and Behavioural Sciences seminar series, Dalla Lana School of Public Health, University of Toronto, 21 March 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Lecture based on and updating the book by co-investigators Schrecker and Bambra (2015) and identifying broader questions for building coalitions to revitalise the health equity agenda
Year(s) Of Engagement Activity 2016
 
Description Workshop 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Ted Schrecker 'First, do no harm: The case against social policy malpractice,' Walker Welfare Reform pilot research launch, Newcastle City Council and Newcastle University, Newcastle, 5 February 2015.
Year(s) Of Engagement Activity 2015
 
Description on 'Neoliberal epidemics: Understanding how neoliberalism threatens health, and how to fight back,' International Society on Priorities in Healthcare conference, University of Birmingham, 7-9 September, 2016. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact This panel built on the concept of neoliberal epidemics and demonstrated its usefulness by considering case studies; seeking to explain the penetration of neoliberal ideas into the policy process; and proposing directions for change. Kate Pickett summarised recent evidence for a causal relation between the inequalities that are magnified by neoliberal policies and a range of adverse health outcomes, and describes the Equality Trust's innovative efforts to place inequality higher on the political agenda. Based on extensive ethnographic study, Lisa Garnham explored how the erosion of welfare state policies in the areas of housing, subsistence, social services and healthcare, along with labour market policies that tolerate and even encourage the spread of precarious employment, have played out in practice and impressed themselves upon the lived experience in a formerly industrial part of west central Scotland since the 1970s. In particular, she focusses on how these impacts have accumulated across the life course, by considering the impacts upon three birth cohorts: those born around 1930; those born around 1950; and those born around 1980. Katherine Smith used interview data and an analysis of two large policy consultations to identify the types of organisations that are trying to influence contemporary policy responses to health inequalities in the UK and European Union, examining both the ideas about health inequalities that each type of actor seems to be promoting and the ways in which they are interpreting and employing available evidence. This analysis demonstrated that a wide range of actors, beyond researchers, are trying to influence policy responses to health inequalities, supporting calls for researchers to take the politics of health policy more seriously and highlighting the lack of any clear advocacy coalitions within health inequalities policy debates. Finally, Ted Schrecker set out seven principles for fighting neoliberal epidemics: 'First, do no harm'; treat public finance as a public health issue; think critically about standards of proof with respect to the use of research evidence, working towards a precautionary principle in public health; understand the depth of disparities in the 'epidemiological worlds' that people inhabit; beware 'lifestyle drift'; interrogate assertions of resource scarcity; and speak truth about power. Based on enthusiastic audience reaction, we will be re-running a version of this symposium at a major event on health equity in July organised in collaboration with the 24th International Conference of Europeanists.
Year(s) Of Engagement Activity 2016
URL http://www.birmingham.ac.uk/generic/priorities-conference-2016/index.aspx