Actions or programmes which aim to improve health across the whole population (universal provision) can risk increasing inequalities, as everyone has different access or ability to take up opportunities to improve their health. It is important to distinguish between targeting vulnerable groups and reducing inequalities.
- Targeting vulnerable or marginalised groups might improve their health but not necessarily reduce inequalities.
- Population wide approaches aimed at reducing inequalities are likely not to reach marginalised groups if buy-in is required (e.g. cost or need for proactive action can be barriers).
The Health Inequalities Action Framework offers a scheme for assessing plans against theoretical concepts that explain the link between social factors and inequalities in health outcomes, and encourages consideration of the range of actions that might be taken.
The framework should be taken into consideration at an early stage in the planning process.
The framework is most useful when used as a discussion tool for a group who want to come to a shared understanding about inequalities before starting to plan.
The framework has four stages to work through.
- Why is action being taken?
- What is the aim of the action?
- How can we act to contribute to reducing health inequalities?
- Measuring progress: how do we know we’re making a difference?
These should be thought of as the main concepts to consider rather than a list of questions to be answered, as the complexity of inequalities means that issues often overlap and each question tends to raise further questions. Every group that uses the framework will be at a different starting point and every issue will require a different approach.
We used the framework in the development of our corporate strategy, A Fairer Healthier Scotland. We worked through the four stages to plan our own contribution to reducing health inequalities in Scotland.
You can download the Action Framework for detailed information, and you can also download example questions for applying the Health Inequalities Action Framework to your own work.
Assess the potential impacts
Once a plan or policy has been developed, it is important to think about how it might affect people and population groups in different ways. This should be done once a policy is well enough developed to allow understanding of potential impacts, but while there is still scope to make changes to it as a result of the assessment.
Health Inequalities Impact Assessment (HIIA) is a structured way to think about potential impacts on health, health inequalities and human rights.