Inequalities in health: approaches by health authorities in an English health region

Background In 1995 the Department of Health published Variations in health: what can the Department of Health do? This recommended that health authori ties should have a comprehensive plan for identifying and tackling variatio ns in health. We investigated how health authorities in the South and West Region were taking forward this work. Methods Semi-structured interviews and reviews of documentation were conduc ted in all health authorities in the South and West Region of England. Results All health authorities viewed tackling inequalities in health as im portant; however, explicit strategies did not exist and Health of the Natio n targets were a vehicle for determining priorities of inequalities. Explic it corporate commitment was often weak, Analyses were being conducted to de termine the magnitude of local health inequalities and to assist in designi ng appropriate interventions. The importance of alliance working was highli ghted; much work was being done although success was variable. Conclusions Efforts are being made throughout the South and West region to tackle inequalities in health. Although strategic vision at the corporate l evel was often lacking, th ere was evidence of commitment to taking the ine qualities agenda forward within public health directorates. Strengthening o f primary care and alliance working roles is essential. Recent national str ategy documents, forthcoming legislation, and a review of health inequaliti es recognize the health effects of inequalities and require health authorit ies to collaborate with local partners to tackle these, and will offer oppo rtunities to improve corporate commitment and alliance working. Uptake and success of these opportunities will have a major influence on progress in t ackling health inequalities.