Introduction This paper presents ‘best practice’ guidelines for population monitoring of health status by socio-economic position (SEP), using routinely collected data.
Methods We reviewed published sources to identify best practices in analytic methods and reporting of population health inequalities by SEP. We selected as our case-study three recent “cutting-edge” reports on health inequalities from the Scottish Government, analysing the following categories of routinely collected outcomes: natality (low birth weight rate—LBW); adult mortality (all-cause, coronary heart disease (CHD), alcohol-related, cancer); cancer incidence; healthy life expectancy at birth; and “mental health & well-being score”.
Results The most commonly unmet criterion, across these routinely collected outcomes, was ‘prompt reversibility/sensitivity to change.’ This is because most mortality events occur in later life, and LBW rate has now become obsolete as a sole indicator of perinatal health. Other outcomes were judged to fail other criteria: alcohol-related mortality after mid-life (probable ‘reverse causation’); all cancer sites’ incidence and mortality (heterogeneity of SEP gradients across sites, as well as long latency); and mental health & well-being (uncertain responsiveness to feasible interventions).
Conclusions Even state-of-the-art reports on health inequalities by SEP are losing their relevance for most policy-makers, because they focus on routinely collected outcomes that are not very sensitive to change. We argue that more ‘upstream’ outcomes are required, which: occur earlier in the life course; can be changed within a half-decade by feasible programmes and policies of proven effectiveness; accurately reflect individuals’ future life-course chances and health status; and are strongly patterned by SEP.
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