Any views expressed within media held on this service are those of the contributors, should not be taken as approved or endorsed by the University, and do not necessarily reflect the views of the University in respect of any particular issue.
Best practice guidelines for monitoring socioeconomic inequalities in health status: lessons from Scotland.

Best practice guidelines for monitoring socioeconomic inequalities in health status: lessons from Scotland.


In this article we present “best practice” guidelines for monitoring socioeconomic inequalities in health status in the general population, using routinely collected data.


First, we constructed a set of critical appraisal criteria to assess the utility of routinely collected outcomes for monitoring socioeconomic inequalities in population health status, using epidemiological principles to measure health status and quantify health inequalities. We then selected as case studies three recent “cutting-edge” reports on health inequalities from the Scottish government and assessed the extent to which each of the following outcomes met our critical appraisal criteria: natality (low birth weight rate, LBW), adult mortality (all-cause, coronary heart disease [CHD], alcohol-related, cancer, and healthy life expectancy at birth), cancer incidence, and mental health and well-being.


The critical appraisal criteria we derived were “completeness and accuracy of reporting”; “reversibility and sensitivity to intervention”; “avoidance of reverse causation”; and “statistical appropriateness.” Of these, the most commonly unmet criterion across the routinely collected outcomes was “reversibility and sensitivity to intervention.” The reasons were that most mortality events occur in later life and that the LBW rate has now become obsolete as a sole indicator of perinatal health. Other outcomes were also judged to fail other criteria, notably alcohol-related mortality after midlife (“avoidance of reverse causation”); all cancer sites’ incidence and mortality (statistical appropriateness due largely to heterogeneity of SEP gradients across different cancer sites, as well as long latency); and mental health and well-being (“uncertain reversibility and sensitivity to intervention”).


We conclude that even state-of-the-art data reports on health inequalities by SEP have only limited usefulness for most health and social policymakers because they focus on routinely collected outcomes that are not very sensitive to intervention. We argue that more “upstream” outcome measures are required, which occur earlier in the life course, can be changed within a half decade by feasible programs and policies of proven effectiveness, accurately reflect individuals’ future life-course chances and health status, and are strongly patterned by SEP.



Report this page

To report inappropriate content on this page, please use the form below. Upon receiving your report, we will be in touch as per the Take Down Policy of the service.

Please note that personal data collected through this form is used and stored for the purposes of processing this report and communication with you.

If you are unable to report a concern about content via this form please contact the Service Owner.

Please enter an email address you wish to be contacted on. Please describe the unacceptable content in sufficient detail to allow us to locate it, and why you consider it to be unacceptable.
By submitting this report, you accept that it is accurate and that fraudulent or nuisance complaints may result in action by the University.