EQUIPOL (The Equity in Health Policy Research Group) is an inter-disciplinary group of researchers based at the University of York, with collaborators around the world.  We develop and apply methods for analysing policy impacts on the health of different population groups, with the aim of helping policy makers use evidence to reduce unfair health inequalities.

Core team

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Tim Doran
Professor of Health Policy
Department of Health Sciences

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Richard Cookson
Professor of Health Economics
Centre for Health Economics

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Helen Cohen
Equipol Research Coordinator
Department of Health Sciences

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Matthew Robson
Research Fellow
Department of Health Sciences

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Lu Han
Research Fellow
Department of Health Sciences

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Ieva Skarda
Research Fellow
Centre for Health Economics

Maria Josefina Valenzuela
PhD Student
Department of Health Sciences

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Christopher Lübker

PhD Student
Department of Health Sciences

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Ana Castro 
Research Fellow
Department of Health Sciences

Collaborators

David Ashe is Professor of Medical Ethics and Health Policy at the University of Pennsylvania.

Mark Ashworth is Clinical Senior Lecturer in General Practice at King’s College London.

Iain Buchan is Professor of Public Health and Clinical Informatics at the University of Liverpool.

Stephen Holland is Reader in Philosophy at the University of York.

Evangelos Kontopantelis is Reader in Biostatistics at the University of Manchester.

Martin O’Flaherty is Professor of Epidemiology and Health Services Research at the University of Liverpool.

Rosalind Raine is Professor of Health Care Evaluation at University College London.

Andrew Ryan is Associate Professor of Health Management and Policy at the University of Michigan.

Unfair health equalities

Health inequalities (also known as “health inequities” or “health disparities”) are differences in health between people that raise serious concerns about fairness or justice. In most societies there is a strong social gradient in health: the lower someone’s position within society – for example, the more deprived their neighbourhood – the worse their health is likely to be. This not only damages individuals, it affects their families and wider social networks, and creates enormous pressure on public services. In England, people living in the most deprived neighbourhoods can expect to live 7 years fewer overall – and 17 years fewer free of disability – than people living in the most affluent neighbourhoods (FIGURE 1). Hospital admissions resulting from these health inequalities cost the NHS almost £5 billion every year.

Figure 1: Male life expectancy and healthy life expectancy at birth for neighbourhoods (LSOAs) by the Index of Multiple Deprivation (IMD) 2015: England 2009 to 2013

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Tackling health inequalities

Health inequality results from structural imbalances in wealth and political power, social differences in health-related behaviours, and variations in access to material resources and public services such as healthcare and education. These factors persist over time, damaging successive generations.

Although patterns of health inequality and their causes are now well understood, limited progress has been made in tackling them. Many healthcare, public health and social policy interventions unintentionally worsen health inequalities because they have greater health benefits for more affluent groups. This is a policy failure, but it is also a scientific failure. The methods commonly used by researchers to assess the effects of health policies measure the average impact across whole populations but overlook the specific impacts on different social groups. This can lead to the adoption of policies that benefit some groups at the expense of others, thereby widening inequalities.

“One of the major difficulties holding back all those involved in trying to tackle health inequalities is that it is nearly impossible to know what to do given the scarcity of good evidence and good evaluation of current policy.”
House of Commons Health Committee. (2009). Health Inequalities - Third Report of Session 2008-2009. London, The Stationery Office Limited.

The EQUIPOL project aims to address this scientific failure by developing new methods for health policy research.

Fairer decisions, better health

In recent years the research community has developed robust ways of measuring the overall cost-effectiveness of health policies, and these methods can be used to inform policy decisions. For example, in the UK the National Institute for Health and Care Excellence (NICE) will recommend funding an intervention if it exceeds a set cost-effectiveness threshold. However, these decisions do not fully account for equity. An intervention may be beneficial for the population on average but may have less benefit – or may even be harmful – for some groups within the population.

Our methods add an equity dimension to policy evaluation, so we can assess whether an apparently effective intervention is harmful from an equity perspective, or whether an apparently ineffective intervention improves equity (FIGURE 2). These methods equip researchers with robust tools for measuring equity impacts, and provide policy makers with vital information on who gains and who loses as a result of their decisions.

Figure 2: The Equity Impact Plane – assessing the cost-effectiveness and equity impact of policies and interventions

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Funding

EQUIPOL is supported by the University of York, the Wellcome Trust (Grant No. 205427/Z/16/Z) and the NIHR (SRF-2013-06-015).

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