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A Qualitative Comparative Analysis of factors associated with trends in narrowing health inequalities in England

Listed author(s):
  • Blackman, Tim
  • Wistow, Jonathan
  • Byrne, David
Registered author(s):

    This study explores why progress with tackling health inequalities has varied among a group of local authority areas in England that were set targets to narrow important health outcomes compared to national averages. It focuses on premature deaths from cancers and cardiovascular disease (CVD) and whether the local authority gap for these outcomes narrowed. Survey and secondary data were used to create dichotomised conditions describing each area. For cancers, ten conditions were found to be associated with whether or not narrowing occurred: presence/absence of a working culture of individual commitment and champions; spending on cancer programmes; aspirational or comfortable/complacent organisational cultures; deprivation; crime; assessments of strategic partnership working, commissioning and the public health workforce; frequency of progress reviews; and performance rating of the local Primary Care Trust (PCT). For CVD, six conditions were associated with whether or not narrowing occurred: a PCT budget closer or further away from target; assessments of primary care services, smoking cessation services and local leadership; presence/absence of a few major programmes; and population turnover. The method of Qualitative Comparative Analysis was used to find configurations of these conditions with either the narrowing or not narrowing outcomes. Narrowing cancer gaps were associated with three configurations in which individual commitment and champions was a necessary condition, and not narrowing was associated with a group of conditions that had in common a high level of bureaucratic-type work. Narrowing CVD gaps were associated with three configurations in which a high assessment of either primary care or smoking cessation services was a necessary condition, and not narrowing was associated with two configurations that both included an absence of major programmes. The article considers substantive and theoretical arguments for these configurations being causal and as pointing to ways of improving progress with tackling health inequalities.

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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 72 (2011)
    Issue (Month): 12 (June)
    Pages: 1965-1974

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    Handle: RePEc:eee:socmed:v:72:y:2011:i:12:p:1965-1974
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    1. Vie, Ola Edvin, 2010. "Have post-bureaucratic changes occurred in managerial work?," European Management Journal, Elsevier, vol. 28(3), pages 182-194, June.
    2. Gatrell, Anthony C., 2005. "Complexity theory and geographies of health: a critical assessment," Social Science & Medicine, Elsevier, vol. 60(12), pages 2661-2671, June.
    3. Ragin, Charles C., 2000. "Fuzzy-Set Social Science," University of Chicago Press Economics Books, University of Chicago Press, edition 1, number 9780226702773, January.
    4. Rachel Parker & Lisa Bradley, 2004. "Bureaucracy or Post-Bureaucracy? Public Sector Organisations in a Changing Context," Asia Pacific Journal of Public Administration, Taylor & Francis Journals, vol. 26(2), pages 197-215, December.
    5. John Seddon & Carlton Brand, 2008. "Debate: Systems Thinking and Public Sector Performance," Public Money & Management, Chartered Institute of Public Finance and Accountancy, vol. 28(1), pages 7-9, February.
    6. John Seddon & Carlton Brand, 2008. "Debate: Systems Thinking and Public Sector Performance," Public Money & Management, Taylor & Francis Journals, vol. 28(1), pages 7-9, February.
    7. Wai Lam & Elinor Ostrom, 2010. "Analyzing the dynamic complexity of development interventions: lessons from an irrigation experiment in Nepal," Policy Sciences, Springer;Society of Policy Sciences, vol. 43(1), pages 1-25, March.
    8. Islam, M. Kamrul & Gerdtham, Ulf-G. & Gullberg, Bo & Lindström, Martin & Merlo, Juan, 2008. "Social capital externalities and mortality in Sweden," Economics & Human Biology, Elsevier, vol. 6(1), pages 19-42, March.
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