Review

Mind about the gaps

WORKING FOR EQUALITY IN HEALTH
Paul Bywaters and Eileen McLeod (Eds)
Routledge, 1996, £13.99

A book about action to reduce inequalities in health is timely given the interest being shown in this by the new government.

The contributors address a broad range of barriers to equality; I was pleased to see a chapter about inequalities and age and several chapters which consider impairment and disability; often neglected in the inequalities debate. There are a broad range of settings and organisations and the contributions of mothers, users, carers, community and trade union activists, health care workers, epidemiologists and sociologists amongst others are considered.

Many contributors provide excellent summaries of what we know about inequalities and how to tackle them and where the gaps are.

Some contributors talk about users and lay people as providers, rather than consumers. This potentially presents a major challenge of thinking about who provides health care and how it should be resourced. For example, Hilary Graham talks about mothers living on income support as workers for health in her excellent chapter about the potential value of sociology for health policy development.

Clare Evans’ contribution on how disabled people have worked to influence services in Wiltshire is clear, dynamic and important. She obviously draws on thinking within the disability movement. There were no links between her chapter and thinking around impairment and disability in the rest of the book. I was not surprised by this as it is typical of the gap between thinking by disability activists and theorists and many other researchers, providers and policy makers. But the editors say they want to link health equalities with disability rights and so it is disappointing that, for example, there is no critique of the concept of ‘carers’ which the disability movement rejects. I was particularly uncomfortable about Jo Aldridge and Saul Becker’s chapter about child ‘carers’ adjacent to Clare Evan’s chapter especially as the editors do not point out the different analytical frameworks used in the different chapters and the implications of these.

A few contributors flag up the issues of promoting equality through employment practice. For example, Simon Sedgwick-Jell on the role of local authorities in servicing health, Hilary Graham about mothers but not researchers, her own employment arena, and Jenny Douglas in relation to health promotion. The contributions by a health visitor, medical consultants, social workers and a locality manager for example do not include this dimension perhaps because these issues feel outside their remit. I would have welcomed more general consideration of the role of organisational culture in reducing inequalities in health.

Overall I would recommend the book. My main reservation is that it raises issues which are not adequately explored in relation to one another but the positive side of that is that it provided lots of food for thought.