Qualitative Comparative Analysis and Health Inequalities: Investigating Reasons for Differential Progress with Narrowing Local Gaps in Mortality

Blackman, Tim; Dunstan, Katie

doi:10.1017/s0047279409990675

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…4 Unexplained variation in years of potential life lost suggests that significant reductions in disparities across districts and cities cannot be achieved by targeted public health interventions alone. True, best practice smoking cessation services can result in a small reduction in lung cancer (Blackman and Dunstan 2010), and increasing the density and accessibility of physicians can result in a small reduction in overall mortality (Chen et al 2010), particularly with respect to avoidable cancer such as breast cancer, colon, rectum and anus cancer (Sundmacher and Busse 2011). Yet, unless governments tackle and reduce inequalities in the socioeconomic determinants of premature mortality with a comprehensive set of economic, social and education policies, very large disparities will persist.…”

Section: Resultsmentioning

confidence: 99%

“…Others before us have analysed sub-national variation in premature mortality (e.g., Langford and Bentham 1996;Blackman and Dunstan 2010;Chen et al 2010;Schofield et al 2016), including in Germany (e.g., Wiesner andBittner 2004, Sundmacher et al 2012). Our main contribution is to demonstrate that the systematic spatial patterns in premature mortality found across Germany essentially disappear after socioeconomic factors that determine premature mortality have been taken into account.…”

Section: Introductionmentioning

confidence: 99%

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The Limits to Equivalent Living Conditions: Regional Disparities in Premature Mortality in Germany

2018

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Aim Despite the country's explicit political goal to establish equivalent living conditions across Germany, significant inequality continues to exist. We argue that premature mortality is an excellent proxy variable for testing the claim of equivalent living conditions since the root causes of premature death are socioeconomic. Subject and methods We analyse variation in premature mortality across Germany's 402 districts and cities in 2014. Results Premature mortality spatially clusters among geographically contiguous and proximate districts/cities and is higher in more urban places as well as in districts/cities located further north and in former East Germany. We demonstrate that, first, socioeconomic factors account for 62% of the cross-sectional variation in years of potential life lost and 70% of the variation in the premature mortality rate. Second, we show that these socioeconomic factors either entirely or almost fully eliminate the systematic spatial patterns that exist in premature mortality. Conclusion On its own, fiscal redistribution, the centrepiece of how Germany aspires to establish its political goal, cannot generate equivalent living conditions in the absence of a comprehensive set of economic and social policies at all levels of political administration, tackling the disparities in socioeconomic factors that collectively result in highly unequal living conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Limits to Equivalent Living Conditions: Regional Disparities in Premature Mortality in Germany

2018

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“…Regarding premature mortality in particular, it also suggests that significant reductions in disparities across districts and cities cannot be achieved by targeted public health interventions alone. True, best practice smoking cessation services can result in a small reduction in lung cancer (Blackman and Dunstan 2010 ), and increasing the density and accessibility of physicians can result in a small reduction in overall mortality (Chen et al 2010 ), particularly with respect to avoidable cancer such as breast cancer, colon, rectum and anus cancer (Sundmacher and Busse 2011 ). Yet, unless governments tackle and reduce inequalities in the socioeconomic determinants of premature mortality with a comprehensive set of economic, social and education policies, very large disparities will persist.…”

Section: Discussionmentioning

confidence: 99%

“…Others before us have analysed sub-national variation in premature mortality (e.g., Langford and Bentham 1996 ; Blackman and Dunstan 2010 ; Chen et al 2010 ; Schofield et al 2016 ), including in Germany (e.g., Wiesner and Bittner 2004 , Sundmacher et al 2012 ). Our main contribution is to demonstrate that the systematic spatial patterns in premature mortality found across Germany essentially disappear after socioeconomic factors that determine premature mortality have been taken into account.…”

Section: Introductionmentioning

confidence: 99%

The limits to equivalent living conditions: regional disparities in premature mortality in Germany

2017

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AimDespite the country’s explicit political goal to establish equivalent living conditions across Germany, significant inequality continues to exist. We argue that premature mortality is an excellent proxy variable for testing the claim of equivalent living conditions since the root causes of premature death are socioeconomic.Subject and methodsWe analyse variation in premature mortality across Germany’s 402 districts and cities in 2014.ResultsPremature mortality spatially clusters among geographically contiguous and proximate districts/cities and is higher in more urban places as well as in districts/cities located further north and in former East Germany. We demonstrate that, first, socioeconomic factors account for 62% of the cross-sectional variation in years of potential life lost and 70% of the variation in the premature mortality rate. Second, we show that these socioeconomic factors either entirely or almost fully eliminate the systematic spatial patterns that exist in premature mortality.ConclusionOn its own, fiscal redistribution, the centrepiece of how Germany aspires to establish its political goal, cannot generate equivalent living conditions in the absence of a comprehensive set of economic and social policies at all levels of political administration, tackling the disparities in socioeconomic factors that collectively result in highly unequal living conditions.

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“…These largely reflected the first author's country affiliations in the UK (n = 13); USA (n = 9); and one each from South Africa, Austria, Belgium, and the Netherlands. All three studies primarily addressing health inequalities [35][36][37]…”

Section: Overview Of Scope Of Qca Research In Public Healthmentioning

confidence: 99%

The use of Qualitative Comparative Analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions

et al. 2021

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Background Qualitative Comparative Analysis (QCA) is a method for identifying the configurations of conditions that lead to specific outcomes. Given its potential for providing evidence of causality in complex systems, QCA is increasingly used in evaluative research to examine the uptake or impacts of public health interventions. We map this emerging field, assessing the strengths and weaknesses of QCA approaches identified in published studies, and identify implications for future research and reporting. Methods PubMed, Scopus and Web of Science were systematically searched for peer-reviewed studies published in English up to December 2019 that had used QCA methods to identify the conditions associated with the uptake and/or effectiveness of interventions for public health. Data relating to the interventions studied (settings/level of intervention/populations), methods (type of QCA, case level, source of data, other methods used) and reported strengths and weaknesses of QCA were extracted and synthesised narratively. Results The search identified 1384 papers, of which 27 (describing 26 studies) met the inclusion criteria. Interventions evaluated ranged across: nutrition/obesity (n = 8); physical activity (n = 4); health inequalities (n = 3); mental health (n = 2); community engagement (n = 3); chronic condition management (n = 3); vaccine adoption or implementation (n = 2); programme implementation (n = 3); breastfeeding (n = 2), and general population health (n = 1). The majority of studies (n = 24) were of interventions solely or predominantly in high income countries. Key strengths reported were that QCA provides a method for addressing causal complexity; and that it provides a systematic approach for understanding the mechanisms at work in implementation across contexts. Weaknesses reported related to data availability limitations, especially on ineffective interventions. The majority of papers demonstrated good knowledge of cases, and justification of case selection, but other criteria of methodological quality were less comprehensively met. Conclusion QCA is a promising approach for addressing the role of context in complex interventions, and for identifying causal configurations of conditions that predict implementation and/or outcomes when there is sufficiently detailed understanding of a series of comparable cases. As the use of QCA in evaluative health research increases, there may be a need to develop advice for public health researchers and journals on minimum criteria for quality and reporting.

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Qualitative Comparative Analysis and Health Inequalities: Investigating Reasons for Differential Progress with Narrowing Local Gaps in Mortality

Cited by 6 publications

References 18 publications

The Limits to Equivalent Living Conditions: Regional Disparities in Premature Mortality in Germany

The Limits to Equivalent Living Conditions: Regional Disparities in Premature Mortality in Germany

The limits to equivalent living conditions: regional disparities in premature mortality in Germany

The use of Qualitative Comparative Analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions

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