Health Inequalities

Members of the Townsend Centre for International Poverty Research have undertaken extensive research on the relationship between poverty and ill health. This research has been concentrated in three main areas:

The Extent of Health Inequalities: Both cross-sectionally and along the lifecourse with effective policies which can reduce these inequalities.
The Allocation of Health Resources: On the basis of need as a pre-requisite to reducing health inequalities and tackling the ‘inverse care law’.
The Measurement of Health: Using a ‘social model’ approach.

The main differences between our approach and a traditional ‘medical model’ of health are summarised below by comparing the Chief Medical Officer’s Top Ten Tips for Health and our alternative version:

	The Chief Medical Officer’s Ten Tips for Better Health	Alternative Tips
1	Don’t smoke. If you can, stop. If you can’t, cut down.	Don’t be poor. If you are poor, try not to be poor for too long.
2	Follow a balanced diet with plenty of fruit and vegetables.	Don’t live in a deprived area. If you do, move.
3	Keep physically active	Don’t be disabled or have a disabled child.
4	Manage stress by, for example, talking things through and making time to relax.	Don’t work in a stressful low-paid manual job.
5	If you drink alcohol, do so in moderation.	Don’t live in damp, low quality housing or be homeless.
6	Cover up in the sun, and protect children from sunburn.	Be able to afford to pay for social activities and annual holidays.
7	Practise safer sex.	Don’t be a lone parent.
8	Take up cancer screening opportunities.	Claim all benefits to which you are entitled.
9	Be safe on the roads: follow the Highway Code.	Be able to afford to own a car.
10	Learn the First Aid ABC: airways, breathing and circulation.	Use education as an opportunity to improve your socio-economic position.
	Source: DoH (1999) Saving Lives: Our Healthier Nation. London: The Stationery Office	Source: Townsend Centre for International Poverty Research, University of Bristol

The Extent of Health Inequalities

→ Poverty, Child Undernutrition and Morbidity: New Evidence from India, Bulletin of the World Health Organisation 2004: 83; 3: 161-240, Shailen Nandy, Michelle Irving, David Gordon, S.V. Subramanian and George Davey Smith, [PDF, 0.48MB]

→ Geographical disparities in mortality, S.V. Subramanian, Shailen Nandy, Michelle Kelly, David Gordon and George Davey Smith, In Rajan SI, James KS, eds. Demographic Change, Health Inequality and Human Development. Hyderabad: 2004: 210-227, [PDF, 0.3MB]

→ Multilevel analysis of health behaviors, S.V. Subramanian, Shailen Nandy, Michelle Kelly, David Gordon and George Davey Smith, In Rajan SI, James KS, eds. Demographic Change, Health Inequality and Human Development. Hyderabad: 2004: 249-281, [PDF, 0.56MB]

→ Patterns and distribution of tobacco consumption in India: cross-sectional multilevel evidence from the 1998-9 national family health survey. BMJ, 2004, 328: 801 - 806, SV Subramanian, Shailen Nandy, Michelle Kelly, David Gordon and George Davey Smith [PDF, 0.3MB]

→ Health behaviours in context: an exploratory multilevel analysis of smoking, drinking and tobacco chewing in four Indian states. Economic and Political Weekly, 2004, 39(7): 684-693, SV Subramanian, Shailen Nandy, Michelle Kelly, David Gordon and George Davey Smith, [PDF, 0.1MB]

→ Did things get better for Labour voters: premature death rates and voting in the 1997 election?, Mary Shaw, Danny Dorling and George Davey Smith, [PDF, 0.09MB] [DOC, 0.35MB]

→ Inequalities in health in India: the methodological construction of indices and measures, Report for the UK Department for International Development (2003), George Davey Smith , David Gordon, Michelle Kelly, Shailen Nandy and S.V. Subramanian, [DOC, 7.0MB]

In the Poverty, Inequality and Social Exclusion Series by the The Policy Press there have been several publications by Townsend Centre members on the extent and nature of health inequalities:

Health Inequalities: Lifecourse Approaches
Poverty, inequality and health in Britain: 1800-2000 - A reader
Inequalities in health: The evidence presented to the Independent Inquiry into Inequalities in Health
The Widening Gap: Health inequalities and policy in Britain

Members of the Townsend Centre have used measures of food and health deprivation to evaluate the extent of Child Poverty in the Developing World in a project funded by the UNICEF.

The Allocation of Health Resources

Read Article about the 'Inverse Care Law' by Julian Tudor Hart

→ Targeting Poor Health: Review of rural and urban factors affecting the costs of health services and other implementation issues, 2003
David Gordon, Adrian Kay, Michelle Kelly, Shailen Nandy, Martin Senior, Mary Shaw Full report in English [PDF, 1.3MB] [DOC, 1.7MB]
Full report in Welsh [PDF, 1.4MB] [DOC, 1.7MB]

→ Targetteting Poor Health: Wales NHS Resource Allocation Review, 2002
David Gordon, Elizabeth Lloyd, Martyn Senior, Jan Rigby, Mary Shaw, Yoav Ben Shlomo Full Report [PDF, 5.5MB] [DOC, 7.5MB]
To download individual chapters of the report click here.

The Measurement of Health

→ Jersey Health Survey
Dave Gordon, Liz Lloyd and Pauline Heslop
[PDF, .38MB] [DOC, 1.5MB]