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Home » Research Projects » Performance Assessment and Wicked Issues: the Case of Health Inequalities

Minding the gap

Does target setting reduce health inequalities?

Yes, people across Britain are living longer, but, no, the gap between life expectancies of rich and poor has not closed by one iota. In fact, it may even be widening. If you are a man living in a wealthy area, such as, for instance, Wokingham in England, you can expect to live until the age of 78; if you are a man living in Glasgow in Scotland, you can expect to die at the age of 71.

The UK government has thrown huge resources into poverty reduction and urban renewal, yet the health divide remains stubbornly intractable. There is, though, another recent government initiative which may help throw light on the best and most successful ways of tackling this most difficult of issues.

With devolution, health care is now treated quite differently in England, Scotland and Wales. These policy differences and their effects on public health provide the focus for Professor Blackman and his team in their research into performance assessment and wicked issues: the case of health inequalities.

The study, extending over three years, will track the progress made in ironing out health inequalities in England, Scotland and Wales, and will seek to establish the comparative success of different strategies. The English, for instance, put great store on target setting within the health service, pointing to the way in which it has driven down waiting lists. But will target setting prove equally successful in tackling the infinitely more complex ‘wicked issue’ of life expectancy? That is one of the questions Professor Blackman’s team will seek to answer.

What the research means for policymakers and the wider community

Research methods

Several case study localities will be selected across England, Wales and Scotland. Two waves of interviews with local stakeholders will be undertaken early in 2006 and again in 2008 to gather local accounts of how health inequalities are being tackled and the role of performance management in making progress. The project will also undertake a statistical analysis of patterns and trends in each locality studied, study local documents and draw on reviews of evidence-based practice, comparing local accounts with an evidence base for each issue in each locality. Finally, the researchers will spend time in each locality observing local decision-making and practice. Analysis of the data will look for key themes and seek to identify the factors that contribute best to making progress with tackling inequalities in health. This will be based on comparisons across countries, localities, agencies and roles.

Project Outputs and Related Webpages

Project Poster 2009

 Tim Blackman, David Hunter, Linda Marks, Barbara Harrington, Eva Elliott, Gareth Williams, Alex Greene, and Lorna Mckee (2010) Wicked Comparisons: Reflections on Cross-national Research about Health Inequalities in the UK, Evaluation,16: 43-57.

Tim Blackman, Eva Elliott, Alex Greene, Barbara Harrington, David Hunter, Linda Marks,  Lorna Mckee, Kat Smith and Gareth Williams, (2009) ‘Tackling Health Inequalities in Post-Devolution Britain: Do Targets Matter?Public Administration, Vol 87 (4): 762-778

Smith K, Hunter D., Blackman T., Elliott E., Greene A.,  Harrington B., Marks L., McKee L. and Williams G. (2009) Divergence or convergence? Health inequalities and policy in a devolved Britain,  Critical Social Policy, Vol 29 (2): 216-242

B. Harrington, K. Smith, D. Hunter, L. Marks, T. Blackman, L. McKee, A. Greene, E. Elliott, G. Williams (2009 ) Health inequalities in England, Scotland and Wales: Stakeholders’ accounts and policy compared
Public Health, Volume 123, Issue 1, Pages e24-e28
The project team’s own webpage

Summer 2006: Performance Assessment and Wicked Issues: The Case of Health Inequalities, Public Policy and Administration, Volume 21 Number 2.

Research Team

Tim Blackman

Tim Blackman

Tim Blackman is Professor of Sociology and Social Policy at Durham University, Head of the School of Applied Social Sciences and an advisor on neighbourhood renewal and health to the Office of the Deputy Prime Minister.

Tel: 01913 346 820
Email: tim.blackman@durham.ac.uk

David Hunter

David Hunter

David Hunter is a Professor of Health Policy and Management at Durham University, where he is Director of the Centre for Public Policy and Health. He is Chair of the UK Public Health Association.

Tel: 01913 340 362
Email: d.j.hunter@durham.ac.uk

Linda Marks

Linda Marks

Linda Marks is a Senior Research Fellow at the Centre for Public Policy and Health at Durham University.

Tel: 01913 340 703
Email: linda.marks@durham.ac.uk

Gareth Williams

Gareth Williams

Gareth Williams is Professor of Sociology at Cardiff University and is engaged in a number health and community regeneration projects in Wales.

Tel: 02920 875 500
Email: WilliamsGH1@cf.ac.uk

Lorna McKee

Lorna McKee

Lorna McKee is Professor of Management Studies and Director for the Delivery of Care Programme in the Health Services Research Unit at the University of Aberdeen.

Tel: 01224 272 7151
Email: l.mckee@abdn.ac.uk