TACKLING HEALTH INEQUALITIES IN POST-DEVOLUTION BRITAIN: DO TARGETS MATTER?
TACKLING HEALTH INEQUALITIES IN POST-DEVOLUTION BRITAIN: DO TARGETS MATTER?
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DOI：
10.1111/j.1467-9299.2009.01782.x
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发表时间：
2009-01-01
影响因子：
3.5
通讯作者：
Williams, Gareth
中科院分区：
文献类型：
--
作者：
Blackman, Tim;Elliott, Eva;Williams, Gareth
自1998年权力下放以来，英国公共政策的许多方面在英格兰、苏格兰和威尔士之间出现了分歧，包括国家医疗服务体系和地方政府如何使用目标和绩效评估。健康不平等是一个例子，这三个国家都认识到有必要采取行动，但对绩效评估的方法各不相同。基于对高级管理人员的采访，探讨和比较了健康不平等作为地方干预对象的复杂性。尽管对目标的态度截然不同，但这三个国家的地方话语有很大的相似之处。卫生不平等必须与改善获得紧急服务的普遍机会和在短期内平衡预算的当务之急竞争。所描述的干预措施偏向于以健康行为为目标，但对有效性证据的使用有限，而且有迹象表明，衡量减少健康不平等的进展正开始导致强调从药物干预中获得“速效”。
Since devolution in 1998, many aspects of public policy in Great Britain have diverged between England, Scotland and Wales, including how targets and performance assessment are used in the National Health Service and local government. Health inequality is an example where all three countries have recognized a need to act but approaches to performance assessment differ. Based on interviews with senior managers, the complexity of health inequality as an object of local intervention is explored and compared. Despite contrasting approaches to targets, local discourses in all three countries had significant similarities. Health inequality had to compete against a preoccupation with improving access to acute services generally and balancing budgets over the short term. There was a bias in the interventions described towards targeting health behaviours, but with limited use of evidence about efficacy, and indications that measuring progress with reducing health inequalities was starting to lead to an emphasis on 'quick wins' from pharmacological interventions.