Tackling Health Inequalities: Turning Policy Into Practice

Health Development Agency

Tackling health inequalities: turning policy into practice?
David J. Hunter and Amanda Killoran

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Authors
Dr David J. Hunter, Professor of Health Policy and Management, School for Health, University of Durham
Dr Amanda Killoran, Public Health Specialist, Health Development Agency

Acknowledgements
We are grateful to the authors of the papers commissioned for the seminars. We also wish to thank all the seminar participants who commented on the papers and provided valuable insights from their own experiences.

Copies of this publication are available to download from the HDA website (www.hda.nhs.uk).
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The key challenge focuses on turning policy into practice at all levels of government. In 2002, the HDA organised three seminars that aimed to explore how government policy gets, or does not get, translated into practice. It aimed to identify the factors that help or hinder implementation, as well as the criteria that lead to success or failure. The seminars brought together an invited audience of policy makers, managers and practitioners from healthcare organisations, local government, central government departments and academic researchers.
Graham (2002) points out that national policy shows a range of interpretations of what is meant by tackling health inequalities. At one end of the continuum, addressing the health disadvantage of poor groups and communities is the focus. The focus widens at the mid-point to narrowing the health gap between those in the poorest groups and those who are better off. At the other end of the continuum, the focus is on reducing the health gradient across the socioeconomic hierarchy. While these definitions are complementary, each raises important implications for policy development and interventions. The seminars were primarily concerned with how to narrow the health gap,
In their exploratory study of the perspectives of various stakeholders, Killoran and
Popay (2002) were concerned to investigate the nature and dynamics of local systems within which policies aimed at reducing health inequalities are being implemented.
Stakeholders’ views are shaped by their different conceptions of the local system. For some stakeholders, the local system is geographically bounded, with particular emphasis placed on neighbourhood renewal and area-based initiatives such as the New Deal for Communities and Health Action Zones, which target the worst areas nationally and locally. The emphasis is placed on a developmental approach characterised by learning, evidence and technical support, promoting experimentation and innovation to inform and influence mainstream change. In such a context, a commandand-control approach to policy and its delivery, pursued through vertically organised performance management and inspection arrangements, may be wholly inappropriate