An evidence base for tackling inequalities in health: Distraction or necessity?

Abstract

Evidence of effectiveness is prominent as a basis for decision-making. Addressing inequalities is a key UK policy objective to be implemented through national and local strategies. Tensions that emerge in adopting an evidence-based approach for tackling inequalities in health are only partly due to limitations of the evidence base in this area. Three research and development projects on different aspects of addressing the inequalities agenda, carried out in the North East of England between 2000 and 2002, explored how local decision-makers tackled inequalities in health and how this issue was reflected in local strategies. These projects illustrate the breadth of this agenda, different ways in which it can be conceptualized and prioritized at a local level and barriers to its implementation. It is argued that evidence of effective interventions plays a relatively small part in decision-making at a local level. In order to address inequalities in health, greater attention should be directed to ways in which the inequalities agenda is embedded within local monitoring and decision-making processes.