Inequalities in health: approaches by health authorities in an English health region.
BACKGROUND
In 1995 the Department of Health published Variations in health: what can the Department of Health do? This recommended that health authorities should have a comprehensive plan for identifying and tackling variations in health. We investigated how health authorities in the South and West Region were taking forward this work.


METHODS
Semi-structured interviews and reviews of documentation were conducted in all health authorities in the South and West Region of England.


RESULTS
All health authorities viewed tackling inequalities in health as important; however, explicit strategies did not exist and Health of the Nation targets were a vehicle for determining priorities of inequalities. Explicit corporate commitment was often weak. Analyses were being conducted to determine the magnitude of local health inequalities and to assist in designing appropriate interventions. The importance of alliance working was highlighted; much work was being done although success was variable.


CONCLUSIONS
Efforts are being made throughout the South and West region to tackle inequalities in health. Although strategic vision at the corporate level was often lacking, there was evidence of commitment to taking the inequalities agenda forward within public health directorates. Strengthening of primary care and alliance working roles is essential. Recent national strategy documents, forthcoming legislation, and a review of health inequalities recognize the health effects of inequalities and require health authorities to collaborate with local partners to tackle these, and will offer opportunities to improve corporate commitment and alliance working. Uptake and success of these opportunities will have a major influence on progress in tackling health inequalities.
Department of Social Medicine, University of Bristol.
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McCarron
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Yates
D018672:Community Health Planning; D019058:Community Networks / Q000458:organization & administration; D003256:Community Participation; D004739:England; D006292:Health Priorities / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D015274:Interdepartmental Relations; D020380:Needs Assessment / Q000458:organization & administration; D015279:Organizational Culture; D009937:Organizational Objectives; D011159:Population Surveillance; D011320:Primary Health Care / Q000458:organization & administration; D012040:Regional Health Planning / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires