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Qualitative Comparative Analysis and Health Inequalities: Investigating Reasons for Differential Progress with Narrowing Local Gaps in Mortality

Published online by Cambridge University Press:  23 February 2010

TIM BLACKMAN  and
KATIE DUNSTAN
TIM BLACKMAN
Affiliation:
Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH email: tim.blackman@durham.ac.uk
KATIE DUNSTAN
Affiliation:
Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH email: tim.blackman@durham.ac.uk
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Abstract

Although health inequalities in England reflect underlying deprivation, there is considerable variation among deprived areas in the extent to which these inequalities are narrowing. Using survey data from 15 local authority areas in North West England, and Ragin's technique of Qualitative Comparative Analysis, contextual features and ways of working in these areas are shown to combine in systematic ways with recent trends in inequalities as measured by premature mortality. For circulatory diseases, a narrowing mortality gap showed a clear association with smoking cessation services that accorded with a best practice description, combined with a local population with relatively more people aged 65 or older. For cancers, a narrowing mortality gap was associated with areas that combined relatively low population mobility with a professional working culture described as one of individual commitment and championing. These findings reveal the complexity of meeting health inequality targets and applying evidence to this endeavour, since both ways of working and context appear to be important to making progress. Both need to be understood case by case if targets are to be locally realistic and evidence applied where local practice is known to matter to the outcome.

Type
Articles
Information
Journal of Social Policy , Volume 39 , Issue 3 , July 2010 , pp. 359 - 373
Copyright
Copyright © Cambridge University Press 2010

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References

Abbott, A. (2001), Chaos of Disciplines, Chicago: University of Chicago Press.Google Scholar
Asthana, S. and Halliday, J. (2006), What Works in Tackling Health Inequalities?, Bristol: Policy Press.Google Scholar
Bambra, C. and Eikemo, T. A. (2009), ‘Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries’, Journal of Epidemiology and Community Health, 63: 92–8.CrossRefGoogle Scholar
Barnes, M., Bauld, L., Benzeval, M., Judge, K., Mackenzie, M. and Sullivan, H. (2005), Health Action Zones: Partnerships for Health Equity, London: Routledge.Google Scholar
Bauld, L., Judge, K., Barnes, M., Benzeval, M., MacKenzie, M. and Sullivan, H. (2005), ‘Promoting social change: the experience of Health Action Zones in England’, Journal of Social Policy, 34: 427–45.CrossRefGoogle Scholar
Bevan, G. and Hood, C. (2006), ‘Have targets improved performance in the English NHS?’, British Medical Journal, 332: 419–22.CrossRefGoogle ScholarPubMed
Blackman, T. (2006), Placing Health: Neighbourhood Renewal, Health Improvement and Complexity, Bristol: Policy Press.Google Scholar
Blackman, T. (2008), ‘Can smoking cessation services be better targeted to tackle health inequalities? Evidence from a cross-sectional study’, Health Education Journal, 67: 91–101.CrossRefGoogle Scholar
Bundred, S. (2006), ‘The future of regulation in the public sector’, Public Money and Management, 26: 3, 181–8.CrossRefGoogle Scholar
Byrne, D. (2009), ‘Using cluster analysis, qualitative comparative analysis and NVivo in relation to the establishment of causal configurations with pre-existing large N datasets: machining hermeneutics’, in Byrne, D. and Ragin, C. C. (eds.), The SAGE Handbook of Case-Based Methods, London: Sage.CrossRefGoogle Scholar
Commission on Social Determinants of Health (2008), Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, Geneva: World Health Organisation.Google Scholar
Department of Health (2008), Tackling Health Inequalities: 2005–07 Policy and Data Update for the 2010 National Target, London: Department of Health.Google Scholar
Drass, K. A. and Miethe, T. D. (2001), ‘Qualitative comparative analysis and the study of crime’, in Meier, R. F., Kennedy, L. W. and Sacco, V. (eds.), The Process and Structure of Crime, London: Transaction Publishers.Google Scholar
GFA Consulting (2005), Improving Floor Target Performance: What Works? London: Office of the Deputy Prime Minister.Google Scholar
Graham, H. (2004), ‘Tackling inequalities in health in England: remedying health disadvantages, narrowing health gaps or reducing health gradients?’, Journal of Social Policy, 33: 115–31.CrossRefGoogle Scholar
HM Treasury (2000), New Public Spending Plans for 2001–2004: Prudent for a Purpose: Building Opportunity and Security for All, London: The Stationery Office.Google Scholar
Hunter, D., Marks, L. and Smith, K. (2007), The Public Health System in England: A Scoping Study, Part 1: An Interim Report, Durham: Durham University Centre for Public Policy and Health.Google Scholar
Klein, R. (2005), ‘Transforming the NHS: The Story in 2004’, in Powell, M., Bauld, L. and Clarke, K. (eds.), Social Policy Review 17, Bristol: Policy Press.Google Scholar
Lodge, N. (2001), ‘The identified needs of ethnic minority groups with cancer within the community: a review of the literature’, European Journal of Cancer Care, 10: 234–44.CrossRefGoogle ScholarPubMed
Marinker, M. (ed.) (2002), Health Targets in Europe, London: BMJ Books.Google Scholar
McCormick, J. and Fulop, N. (2002), ‘For and against health targets’, in Marinker, M. (ed.), Health Targets in Europe, London: BMJ Books.Google Scholar
Nutley, S. M., Walter, I. and Davies, H. T. O. (2007), Using Evidence: How Research Can Improve Public Services, Bristol: The Policy Press.Google Scholar
Office for National Statistics (2008), ‘Results from the 2006 General Household Survey’ (www.ons.gov.uk/ghs).Google Scholar
Olsen, K. M. and Dahl, S-Å. (2007), ‘Health differences between European countries’, Social Science and Medicine, 64: 1665–78.CrossRefGoogle ScholarPubMed
Pawson, R. and Tilley, N. (1997), Realistic Evaluation, London: Sage.Google Scholar
Plsek, P. (2001), ‘Redesigning health care with insights from the science of complex adaptive systems’, in Committee on Quality Health Care in America, Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, Washington, DC: National Academy Press.Google Scholar
Ragin, C. C. (2000), Fuzzy-Set Social Science, Chicago: University of Chicago Press.Google Scholar
Social Exclusion Unit (2001), A New Commitment to Neighbourhood Renewal: National Strategy Action Plan, London: Cabinet Office.Google Scholar
Unal, B., Critchley, J. A. and Capewell, S. (2005), ‘Modelling the decline in coronary heart disease deaths in England and Wales, 1981–2000: comparing contributions from primary prevention and secondary prevention’, British Medical Journal, 331 (7517): 614.CrossRefGoogle ScholarPubMed
Wilcox, J. and de Gruchy, J. (2006), Nottingham City Health Floor Target Action Plan Baseline Assessment, Nottingham: Nottingham Primary Care Trust.Google Scholar
Wrede, S., Benoit, C., Bourgeault, I. L., van Teijlingen, E. R., Sandall, J. and De Vries, R. G. (2006), ‘Decentred comparative research: Context sensitive analysis of maternal health care’, Social Science and Medicine, 63: 2986–97.CrossRefGoogle ScholarPubMed