Health inequalities in England, Scotland and Wales: stakeholders' accounts and policy compared

OBJECTIVES

The election of a Labour government in 1997 brought the issue of health inequalities firmly back on to the policy agenda across the UK. Since then, in the wake of devolution, the need to tackle health inequalities has been highlighted as a policy priority in all three mainland UK countries, albeit with varying degrees of emphasis. This paper reports on a major cross-national study, funded by the Economic and Social Research Council, investigating how National Health Service bodies, local councils and partnerships make sense of their work on health inequalities, and examining the difference made by the contrasting approaches that have been taken to performance assessment in England, Wales and Scotland.

STUDY DESIGN

Case studies, semi-structured interviews and analysis of key policy statements.

METHODS

In order to explore how health inequalities have been approached by the three governments (noting that there was a change in governments in Wales and Scotland during this time), key policy statements published between May 1997 and May 2007 were analysed. Concurrently, data from stakeholder interviews carried out in 2006 in case study areas in each country were analysed to determine the extent of alignment between policy and practice at local level.

RESULTS

This paper suggests that claims about the extent of health policy divergence in post-devolution Britain may have been exaggerated. It finds that, whilst the three countries have taken differing approaches to performance assessment and the setting of targets, policy approaches to health inequalities up until 2007 appear to have been remarkably similar. Furthermore, the first round of interview data suggest that variations in local understandings of, and responses to, health inequalities cannot always be clearly distinguished along national lines.

CONCLUSIONS

Based on the policy analysis, devolution in the UK does not appear to have resulted in substantively different national policy approaches to health inequalities. Indeed, the overall analysis suggests that (prior to the 2007 elections in Scotland and Wales) the differences between local areas within countries may be of as much interest as those between countries.

A comparative study of the physiological costs of walking in ten bilateral amputees

The physiological cost of walking is greater in bilateral amputees (BA) than in both unilateral amputee and non-pathological gait. The aim of this study was to describe the physiological costs and other standard gait characteristics in a sample population of BA, walking at self-selected (comfortable) speeds. Amputees had bilateral trans-tibial, bilateral trans-femoral or trans-tibial/trans-femoral amputations as a result of trauma or congenital defects. All amputees wore their own prosthetic limbs which were either full-length prostheses or short non-articulating pylon prostheses (SNAPPs). The results were compared with a base line data set collected from a non-pathological control group. It was anticipated that amputees with high-level amputations would walk at the slowest speeds, have the highest physiological costs and lowest perception of walking ability. However, varying walking speeds resulted in varying exercise intensities, exercise heart rates and perceptions of walking that could not be directly related to amputation levels. It is therefore concluded that bilateral amputee gait is complex, varied and not easily categorized.