The limitations of targeting to address inequalities in health: a case study of road traffic injury prevention from the UK

Abstract

So-called ‘Third Way’ responses to inequalities in health have encouraged the ‘targeting’ of evidence-based interventions at those communities at high risk in order to improve health outcomes. In the UK, one area of persisting inequalities in mortality and morbidity risk is from injury, and there have been recent national and local incentives for relevant agencies to ‘address deprivation’ in delivering reductions in injury through ‘targeting’ particular communities in the context of an evidence-based approach to policy making. This case study draws on interviews with those responsible for implementing policy in London in order to explore the tensions inherent in such approaches. We suggest that ‘taking deprivation into account’ by targeting is unlikely to be a fruitful route for addressing inequalities in health, as it devolves responsibility to a level which has no power to address the determinants of inequality.

Keywords:

• inequalities
• public policy
• injury

Acknowledgements

This paper draws on data from a study funded by Transport for London (Deprivation and Road Safety in London). The views expressed here are those of the authors, and not necessarily Transport for London. We would like to thank Rosie Meade, Nicki Thorogood and Pam Laidman for contributions to the project, Ian Roberts for comments, and all those participating road safety professionals, who were generous with their time and knowledge.