title: Addressing inequalities in health--what is the contribution of health trainers?
abstract: OBJECTIVE
  The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England.
  
  
  METHODS
  Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers' background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture.
  
  
  RESULTS
  Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level.
  
  
  CONCLUSIONS
  Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.
authors.affiliation: Institute for Health and Wellbeing, Leeds Metropolitan University, Leeds LS2 4NU, UK. j.white@leedsmet.ac.uk
authors.forename: Judy
authors.initials: J
authors.lastname: White
authors.forename: Jenny
authors.initials: J
authors.lastname: Woodward
authors.forename: Jane
authors.initials: J
authors.lastname: South
mesh_terms: D000367:Age Factors; D003150:Community Health Workers / Q000458:organization & administration*; D004739:England; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D006302:Health Services Research; D054624:Health Status Disparities; D006801:Humans; D008019:Life Style; D008913:Minority Groups; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: community engagement; evaluation; health inequalities; health trainers; peer support