A Qualitative Comparative Analysis of factors associated with trends in narrowing health inequalities in England
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.
Volume (Year): 72 (2011)
Issue (Month): 12 (June)
|Contact details of provider:|| Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description|
|Order Information:|| Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional|
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Vie, Ola Edvin, 2010. "Have post-bureaucratic changes occurred in managerial work?," European Management Journal, Elsevier, vol. 28(3), pages 182-194, June.
- Gatrell, Anthony C., 2005. "Complexity theory and geographies of health: a critical assessment," Social Science & Medicine, Elsevier, vol. 60(12), pages 2661-2671, June.
- Ragin, Charles C., 2000. "Fuzzy-Set Social Science," University of Chicago Press Economics Books, University of Chicago Press, edition 1, number 9780226702773, December.
- 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.
- 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, 02.
- 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.
- 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.
- 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.
- repec:ucp:bkecon:9780226702766 is not listed on IDEAS
When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:72:y:2011:i:12:p:1965-1974. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu)
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.