Tackling health inequalities in the United Kingdom: The progress and pitfalls of policy
Tackling health inequalities in the United Kingdom: The progress and pitfalls of policy
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DOI：
10.1111/j.1475-6773.2003.00208.x
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发表时间：
2003-12-01
影响因子：
3.4
通讯作者：
Marmot, M
中科院分区：
文献类型：
--
作者：
Exworthy, M;Blane, D;Marmot, M
目标。评估英国当前减少健康不平等政策的进展和缺陷。目标。 (1) 描述使健康不平等进入英国政策议程的背景。 (2) 对可能影响健康不平等的英国现行政策进行分类和评估。 （3）运用“政策窗口”模型，了解政策制定和实施过程中面临的问题。 (4) 检查英国和其他地方新出现的政策挑战。数据来源。官方文件、二次分析和政策制定者访谈。研究设计。定性、政策分析。数据收集。 2001-2002。该方法分为两个阶段。第一个确定了与个人调查建议相关的政策。第二个涉及三个政策领域的案例研究，这些政策领域被认为对于解决健康不平等问题至关重要。这两个阶段都涉及政策制定者访谈和文献分析。主要发现。 (1) 现任英国政府承诺减少健康不平等。 (2) 政府已开始实施解决更广泛决定因素的政策。 （3）一些进展是明显的，但许多指标仍然顽固。 （4）政府间政策协调和进展衡量仍存在困难。 (5)“政策窗口”模型解释了进展的有限程度，并强调了当前和未来可能存在的陷阱。 (6) 英国的经验对其他参与解决健康不平等问题的政府具有借鉴意义。结论。健康不平等已列入英国政府政策议程，并已采取措施解决这些问题。有一些进展迹象，但仍有许多工作要做，包括克服国家层面的一些不正当激励措施、改善联合工作、确保适当的绩效/进展衡量标准以及改进监督安排。概念性政策模型有助于理解并指出维持和扩展近期进展以及克服陷阱的方法。
Goal. Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities.Objectives. (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the "policy windows" model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere.Data Sources. Official documents, secondary analyses, and interviews with policy-makers.Study Design. Qualitative, policy analysis.Data Collection. 2001-2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case-studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policy-makers and documentary analysis.Principal Findings. (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The "policy windows" model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities.Conclusions. Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls.