11 February 2010

Marmot Review calls for Health Equity Impact Assessment: What does this mean for us?

The Strategic Review of Health Inequalities in England Post 2010, known as the Marmot Review, was published today:

It sets out several priorities for redressing health inequities in England, including:

  1. Giving every child the best start in life (highest priority recommendation) - increasing the proportion of overall expenditure allocated to the early years and ensure expenditure on early years development is focused progressively across the social gradient.
  2. Enabling all children, young people and adults to maximise their capabilities and have control over their lives - reducing social inequalities in pupils’ educational outcomes; prioritise reducing social inequalities in life skill.
  3. Creating fair employment and good work for al.
  4. Ensuring a healthy standard of living for all minimum income for healthy living
  5. Creating and developing sustainable places and communities
  6. Strengthening the role and impact of ill-health prevention - core efforts of public health departments focused on interventions related to the social determinants of health proportionately across the gradient
Of interest to HIA practitioners, the review promotes as health equity impact assessment. These sections are below and were identified by Debbie Fox from Liverpool University:
National and regional leadership should promote awareness of the underlying social causes of health inequalities and build understanding across the NHS, local government, third sector and private sector services of the need to scale up interventions and sustain intensity using mainstream funding. p34

Interventions should have an evidenced-based evaluation framework and a health equity impact assessment. p34

Research on health interventions should include health equity impact assessments. p146

There should also be an explicit requirement that all government policies and strategies be subject to a health equity impact assessment. p152

All national and local policies and strategies should be routinely scrutinised through a health equity impact assessment. p152

The policy emphasis should address how mainstream spending can best be utilised to reduce health inequalities, rather than relying on new project funding. Interventions should be implemented with an evidence-based evaluation framework, incorporating a health impact assessment. Such action would inform public debate on the effectiveness of policies and disinvestment and investment for future delivery p153
These recommendations are of course welcome. I imagine there will be some consternation about what "health equity impact assessments of research on health interventions" actually means, as it's at odds with common practitioner understanding of the purpose of HIA. HIAs are undertaken on proposals that are yet to be implemented, rather than on new research and knowledge per se.

Health equity impact assessment has previously been operationalised as equity focused health impact assessment. Anyone interested in assessing the health equity impacts should refer to the Equity Focused Health Impact Assessment Framework or completed HIAs reports with an equity focus.