Durham University, School of Applied Social Sciences, 32 Old Elvet, Durham DH1 3HN, United Kingdom.
Soc Sci Med. 2011 Jun;72(12):1965-74. doi: 10.1016/j.socscimed.2011.04.003. Epub 2011 May 13.
This study explores why progress with tackling health inequalities has varied among a group of local authority areas in England that were set targets to narrow important health outcomes compared to national averages. It focuses on premature deaths from cancers and cardiovascular disease (CVD) and whether the local authority gap for these outcomes narrowed. Survey and secondary data were used to create dichotomised conditions describing each area. For cancers, ten conditions were found to be associated with whether or not narrowing occurred: presence/absence of a working culture of individual commitment and champions; spending on cancer programmes; aspirational or comfortable/complacent organisational cultures; deprivation; crime; assessments of strategic partnership working, commissioning and the public health workforce; frequency of progress reviews; and performance rating of the local Primary Care Trust (PCT). For CVD, six conditions were associated with whether or not narrowing occurred: a PCT budget closer or further away from target; assessments of primary care services, smoking cessation services and local leadership; presence/absence of a few major programmes; and population turnover. The method of Qualitative Comparative Analysis was used to find configurations of these conditions with either the narrowing or not narrowing outcomes. Narrowing cancer gaps were associated with three configurations in which individual commitment and champions was a necessary condition, and not narrowing was associated with a group of conditions that had in common a high level of bureaucratic-type work. Narrowing CVD gaps were associated with three configurations in which a high assessment of either primary care or smoking cessation services was a necessary condition, and not narrowing was associated with two configurations that both included an absence of major programmes. The article considers substantive and theoretical arguments for these configurations being causal and as pointing to ways of improving progress with tackling health inequalities.
本研究探讨了为什么在英格兰的一组地方当局中，与全国平均水平相比，缩小重要健康结果差距的目标进展情况各不相同。它关注癌症和心血管疾病 (CVD) 的过早死亡，并关注这些结果的地方当局差距是否缩小。调查和二级数据用于创建描述每个区域的二分条件。对于癌症，发现有十个条件与缩小差距是否发生有关：是否存在个人承诺和拥护者的工作文化；癌症计划的支出；有抱负或舒适/自满的组织文化；贫困；犯罪；对战略伙伴关系工作、委托和公共卫生劳动力的评估；进展审查的频率；以及地方初级保健信托 (PCT) 的绩效评级。对于 CVD，有六个条件与缩小差距是否发生有关：PCT 预算更接近或远离目标；对初级保健服务、戒烟服务和地方领导力的评估；是否存在少数几个重大计划；以及人口流动。使用定性比较分析方法找到这些条件与缩小或不缩小结果相关的配置。缩小癌症差距与三种配置相关，其中个人承诺和拥护者是必要条件，而不缩小与一组共同具有高水平官僚型工作的条件相关。缩小 CVD 差距与三种配置相关，其中对初级保健或戒烟服务的高度评估是必要条件，而不缩小与两种都包括缺乏重大计划的配置相关。本文考虑了这些配置是因果关系的实质性和理论论点，并指出了改善解决健康不平等问题进展的方法。
