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Journal of Public Health Advance Access originally published online on July 17, 2007
Journal of Public Health 2007 29(3):218-221; doi:10.1093/pubmed/fdm046
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© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Bridging the gap in health inequalities with the help of health trainers: a realistic task in hostile environments? A short report for debate



Tanya Trayers, Research Training Fellow1

Debbie A. Lawlor, Professor of Epidemiology2,
1 Academic Unit of Primary Health Care, Department of Community-Based Medicine, University of Bristol, Bristol BS8 2AA, UK
2 Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Rd, Bristol BS8 2PR, UK

Address correspondence to Debbie A. Lawlor, E-mail: d.a.lawlor{at}bristol.ac.uk


  Abstract

Background From a public health theoretical perspective, there is acknowledgement that synchronized policies, which address both individual and area level risks to health, are important to reduce inequalities and improve health. Despite this, much research focuses on just one of these two approaches (often pitting them against each other) and much practice tends to focus on individual level interventions. Efforts to address health inequalities between rich and poor in the UK continue to focus on individual-based interventions, with the most recent initiative being health trainers.

Methods In this debate piece, we will use health trainers as a specific example, and focusing primarily on levels of physical activity, we will argue that neither individual level interventions nor environmental change alone are likely to improve levels of activity or reduce health inequalities.

Conclusions We argue that synchronized policies that tackle both individual and neighbourhood environmental barriers to improving health behaviours are essential.

Keywords: area effects, health inequalities, individual effects, physical activity


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