Monitoring health inequities by socio-economic status: Lessons from Scotland

Wednesday, May 22, 2013
Dr. John Frank
Scottish Collaboration for Public Health Research and Policy, University of Edinburgh

There is much enthusiasm globally for reducing health inequalities by socio-economic status. However, only a few jurisdictions internationally have put substantial effort into robustly monitoring such inequalities over several years. Scotland is perhaps the best example of a country that has.

In this plenary, Dr. John Frank of the Scottish Collaboration for Public Health Research and Policy presents the results of a half-decade of annual Scottish government reports on reducing health inequalities by socio-economic status (SES). These reports monitor nearly one dozen health outcomes that have been routinely collected since the late 1990s. Dr. Frank focuses on the measurement properties of these routinely collected health statistics, which are found in virtually all such reports internationally—especially their responsiveness to feasible public health policies and programs that should theoretically reduce SES inequalities.

Dr. Frank discusses the “insensitivity to prompt change” for almost all of the routinely collected population health outcomes that are in wide use. He argues for the universal use of more “upstream” indicators that are more capable of being changed by currently feasible interventions, within the usual “attention span” of democratically elected governments (typically less than five years). He uses the example of a measure of child development at school entry at the local community level: the Early Development Instrument (EDI), which was originally developed in Canada and is in wide use internationally.

Monitoring health inequities by socio-economic status, May 22, 2013