Health inequalities

This page contains the findings of systematic reviews undertaken by the EPPI Centre Health Promotion and Public Health Reviews Reviews Facility

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

One systematic review [1] found that 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.

Mental health [2]

It was found that cognitive-behavioural therapy delivered to young people in secondary schools can reduce the symptoms of depression and anxiety. No evidence was found to assess the impact of CBT on suicidal thinking or behaviour.

Few studies provided any useful data that might be used to examine the impact of CBT-based interventions on inequalities in mental health. Although conclusions about impact of CBT on inequalities are therefore tentative, there are suggestions that it might be less effective for people who are more socio-economically disadvantaged.

1. Health promotion, inequalities and young people's health: a systematic review of research (2008)

2. Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions (2009)