Growing role of reliable health inequalities data in public health service delivery
Equitable public health activity requires reliable information. The Marmot Review (2010) pointed out that health inequalities can be viewed as a gradient across society, indicating that more action needs to be taken for the most disadvantaged. Knowing about variations across this gradient and formulating policy for action is crucially dependent on comprehensive data and intelligence.
Population-based data has had a longstanding key role in public health and the development of modern healthcare. The structure of healthcare (the NHS, for example) in England is currently based on defined geographical areas. This has implications, nationally, regionally and locally, for decisions about service delivery, interventions, as well as the types of skills and sustainable workforce competences required (at all levels) and their deployment.
The abolition of area-based structures and the transfer of most responsibilities to non-geographically based clinical commissioning groups (CCGs), in addition to some responsibilities to local authorities, may undermine the availability of information required to monitor the comprehensiveness of the health service, inequalities in access, resourcing of services, and outcomes of care. Under the new healthcare legislation encompassing the public sector, most services will transfer to non-geographically based CCGs that will be able to recruit patients living anywhere in England. This may lead to erosion of data quality, accuracy and completeness (Pollock et al, 2012). For example, responsibility for services covering public health such as childhood immunisation, HIV and sexual health, and mental health will be located in local authorities. Since local authority residents may be registered with any one of a number of different CCGs, the local authority will have to subcontract these services to a CCG, which may outsource them to several providers, leading to difficulties in data comparison and interpretation.
Sources or references
- Marmot Review (2010)
- Healthy Lives, Healthy People, White Paper, DoH 2010
- Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012. Allyson M Pollock, Alison Macfarlane, Sylvia Godden. British Medical Journal 2012; 344:e2364 (Published 26 April 2012)
Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.
