On Wednesday, 19th September we discussed this paper:
Lorant, V. and Bhopal, R. (2010). Comparing policies to tackle ethnic inequalities in health: Belgium 1, Scotland 4. European Journal of Public Health, 21, 2, 235-40. doi:10.1093/eurpub/ckq061 Journal link. Open access link
1. Were the aims of the study clear?
The aims of the study seemed clear:
“in the contest to reduce ethnic disparity in health and health care, which is doing better, Scotland or Belgium?” (Lorant & Bhopal 2010: introduction)
Participants had mixed feelings about the use of ‘scoring’. On the one hand, this is a potentially engaging strategy for readers – use of a sporting analogy adds a competitive element: which country is the ‘winner’ in terms of tackling ethnic health inequalities. On the other, it was felt that the scoring criteria were not made sufficiently clear.
— Jackie Kirkham (@JackieKirkham) September 19, 2012
2. Was the selection of data for comparison clear and appropriate?
It was noted that not all of the data were from equivalent periods, and that the Belgian mortality data were quite old (1991-96). 2001 census data were used to assess self-rated health in both countries, so comparison was better. However, the timing meant that the impact of policies introduced after 2001 could not be assessed. It was acknowledged that data used may have been the ‘best available’, and that assessing policy impact at a population level is always going to be subject to time-lag.
3. Were the methods of analysing and comparing clear and appropriate?
Comparisons and analysis seemed appropriate, although as with any comparative study, the data and ideas being compared were qualitatively different. Participants felt that some of these differences were particularly interesting:
This was explored in the introductory section of the article. Another area of contrast that was of interest was the institutional context of health care/ public health delivery in the two countries:
Certain phenomena, e.g. the finding that minority ethnic populations overall had better self-rated health and health outcomes, were not explained in the paper (although there is a literature on this issue). We acknowledged that there were likely many findings and discussions that would not fit into the published paper.
4 . Are the authors’ conclusions justified by the findings presented?
Conclusions seemed justified.
5. What implications are there for policy on this issue?
Scotland comes out of the paper as the ‘winner’ in having the most effective policies to tackle ethnic health inequalities. The paper recognises that this is in part a product of institutional and political frameworks – the more centralised health system with clear policy edicts; a history of collecting data on ethnicity which allows for easier measurement.
Overall, participants found this an interesting and comprehensive paper in terms of close analysis of the two countries, but questioned the wider applicability of lessons based on a two-country comparison: