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.
- The impact of this study on the style of performance assessment in the delivery of health and welfare services is potentially enormous, not only in the UK, but across the world, in any country seeking to tackle these ‘wicked issues’.
- The research will use cross-national, cross-locality and cross-stakeholder comparisons to find out how performance assessment engages with a wicked issue and in what contexts health inequalities become a central issue in local health discourses.
- The adoption of a complexity theory methodology and the use on non-linear perspectives could provide important insights into more holistic performance assessment approaches than those commonly seen as restrictive, vertically driven and oblivious to unintended consequences.
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.