What do we want to know?
Health inequalities are recognised as an important problem nationally and internationally. There is policy interest in improving the health of the most disadvantaged, reducing the gap between the most and least disadvantaged, and reducing gradients across the whole population. Health inequalities arise from variations in social, economic and environmental influences along the life course. Health promotion, particularly when it uses social and structural interventions developed by multi-disciplinary teams working with young people, not merely for them, has the potential to reduce health inequalities among young people immediately, and in their later lives.
This study describes how much health promotion and public health intervention research has focused on inequalities in young people’s health; and what methods have been used to define and measure inequalities.
Who wants to know?
Researchers, research commissioners, funders, journal editors, policy-makers, practitioners and the public.
What did we find?
Relatively few studies that address inequalities also evaluate interventions. Even fewer evaluate interventions particularly promising for tackling inequalities: structural and environmental interventions, or interventions working through social networks. Most frequently investigated are inequalities between genders and ethnic groups, although often with little thought as to why or how differences might be important. Many methods are used to measure socio-economic status, with little consistency across the literature. These methods include single measures such as occupational class, parental education and income, and multiple or composite measures comprising combinations of these.
Most intervention evaluations recruit young people through schools or agencies such as social services, frequently excluding the most disadvantaged and disregarding those who drop out before the study is completed. Few studies involve young people or their parents actively in developing interventions or choosing what should be evaluated or how.
Most intervention evaluations did not explicitly aim to reduce inequalities. Nor could they conclude whether inequalities were increased.
What are the implications?
There are six promising elements to be combined in an evidence-informed approach to tackling inequalities: multidisciplinary teams working in partnership with the people they aim to help, to develop structural and social support interventions that adopt inclusive approaches to delivering and evaluating their processes and impact on health and inequalities.
How did we get these results?
The research was conducted in two parts: a systematic map and a study of research methods. The systematic map described two sets of studies: health promotion and public health research included in commercial databases which clearly addressed health inequalities; and a register held by the EPPI-Centre rich in intervention evaluations. The methods study described intervention evaluations included in previous EPPI-Centre systematic reviews in areas where young people experience health inequalities (healthy eating, mental health, physical health, teenage pregnancy and teenage parent support).
This summary was prepared by the EPPI-Centre
This report should be cited as:
Oliver S, Kavanagh J, Caird J, Lorenc T, Oliver K, Harden A, Thomas J, Greaves A and Oakley A (2008) Health promotion, inequalities and young people’s health: a systematic review of research. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.