In the UK today, there are sizeable inequalities in health. In Stockton-on-Tees in the north-east of England, for example, there’s a 15-year gap in life expectancy between the least and most deprived areas - the second biggest life expectancy gap in the country. The current political and economic situation in the UK means that understanding how the local context shapes health inequalities is of increasing importance and there is a clear need to expand our knowledge of the complex factors involved. This researech will engage with, advance and influence several key debates around the causes, development and localised experience of health inequalities in an age of austerity.
The overacrching objective of the study is to examine localised paterns of health ineqaulity in an age of austerity.
This research aims to provide a contemporary and innovative study of the causes and experience of health inequalities in England at a local level. And to examine whether these health inequalities and their causes change during the current period of economic downturn.
This research will address the following questions;
These questions can only be achieved by working in an interdisciplinary way, combining the insights and methods from different disciplines into a single intensive case study of health inequalities in Stockton-on-Tees. The project will therefore combine methods and concepts drawn from human geography, social epidemiology, psychology, sociology and anthropology, history, as well as social policy.
Project started in December 2012. No findings available yet.
£999,597.00 over five years.
The Leverhulme Trust
From 1 December 2012 to 1 December 2017.
The outcomes of the project will be of great interest to local authorities (given their new roles in public health policy), the media (particularly locally), policymakers and practitioners in the NHS and third sector organisations.
Principal Investigator: Professor Clare Bambra
Older people in poor health are more likely to need extra money, aids and adaptations to allow them to stay in their homes and remain in good health, yet many do not claim the benefits to which they are entitled.
This study will evaluate the effects on health and wellbeing of a welfare rights advice service provided by social services departments in north-east England for low income older people, who we will identify from general practices.
Seven-hundred-and-fifty-five (755) older people have volunteered to take part and have been assigned, by chance, to one of two groups. Half of the volunteers have been given an appointment with a welfare rights advisor in their own home, during which they received a full benefit assessment and help with claiming benefits and other entitlements. Advisors kept in touch with them until they no longer needed help. The remaining older people will receive exactly the same help and advice 24 months later and usual care in the meantime. Older people in both groups were interviewed at the outset and will be interviewed again after 24 months to find out whether the service has had beneficial or other effects and whether it is acceptable. We will also assess whether the service offers good value for money and is acceptable to professionals. Older people in both groups will be free to seek advice independently or to leave the study at any time.
Study recruitment started in May 2012 and the study is expected to report in late 2015. Seven-hundred-and-fifty-five (755) participants have been recruited and, so far, 85% of them have responded to a brief follow-up questionnaire 12 months after recruitment to the study. Final follow-up will commence in May 2014.
From 1 December 2011 to 1 December 2015
The study will have implications for fundamental understanding of social inequalities and how to tackle them, and provides a model for similar evaluations of health-orientated social interventions. If the health benefits of this intervention are proven, targeted welfare rights advice services should be extended to ensure widespread provision for older people and other vulnerable groups.
Principal Investigator: Professor Martin White
Please direct all queries to Lavinia Micelli, project secretary, Newcastle University, email: email@example.com
Related project pages:
NIHR PHR project portfolio
As with many other cancers, socioeconomic (a person’s social and economic position in relation to others, based on income, education and occupation) inequalities have been reported for both the incidence of and the survival from lung cancer in several countries. It is thought that the incidence of lung cancer is higher among people of lower socioeconomic position than among wealthier people, in part because smoking rates are higher in poorer populations. Similarly, it has been suggested that survival is worse among poorer people because they tend to be diagnosed with more advanced disease, which has a worse prognosis (predicted outcome) than early disease. But do socioeconomic inequalities in treatment exist for lung cancer and, if they do, could these inequalities contribute to the poor survival rates among populations of lower socioeconomic position?
In this project, we investigated these questions in both a systematic review and analysis of data from Northern England. A systematic review uses predefined criteria to identify all the research on a given topic; a meta-analysis is a statistical approach that combines the results of several studies.
Design/Approach & findings:
We identified 46 published papers that studied people with lung cancer in whom receipt of treatment was reported in terms of an indicator of socioeconomic position, such as a measure of income or deprivation. Twenty-three of these papers were suitable for inclusion in a meta-analysis. Lower socioeconomic position was associated with a reduced likelihood of receiving any treatment. Specifically, in our analysis, we found that patients with lung cancer who were from the lowest socioeconomic groups were 21% less likely to receive any treatment than patients from the highest socioeconomic groups. Lower socioeconomic position was also linked with a lower chance of receiving surgery (32% less likely) and chemotherapy (18% less likely), but not radiotherapy. The association between socioeconomic position and surgery remained after taking cancer stage into account. That is, when receipt of surgery was examined in early-stage patients only, low socioeconomic position remained associated with reduced likelihood of surgery. Notably, the association between socioeconomic position and receipt of treatment was similar in studies undertaken in countries where health care is free at the point of service for everyone (for example, the UK) and in countries with primarily private insurance health care systems (for example, the US). When we explored data on people with lung cancer from Northern England we found similar differences in receipt of treatment. We were able to take account of how unwell a patient was and how many other illnesses they suffered from, factors which may influence the likelihood of treatment and which vary by socioeconomic position. However, more deprived patients were still less likely to get surgery. Socio-economic differences in receipt of treatment contributed to overall differences in lung cancer survival.
UKCRC via ESRC (+3)
From 1 October 2010 to 30 September 2013
Further research is needed to determine the system and patient factors that contribute to socioeconomic inequalities in lung cancer treatment before clear recommendations for changes to policy and practice can be made. Interventions to reduce inequalities in treatment may help to improve survival in more deprived patient groups.