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Using Socioeconomic evidence in clinical practice guidelines, National Health and Medical Research Council, Canberra, 2003
Taken as a whole, the evidence on socioeconomic status and health in Australia is unequivocal: those who occupy positions at lower levels of the socioeconomic hierarchy fare significantly worse in terms of their health. Specifically, persons variously classified as ‘low’ socio-economic status have higher mortality rates for most major causes of death, their morbidity profile indicates that they experience more ill-health (both physiological and psychosocial), their illness is more likely to be chronic and treatment needs complex, and their use of health care services suggests that they are less likely to act to prevent disease or detect it at an asymptomatic stage.
In response the National Health and Medical Research Council (NHMRC) has prepared a handbook explicitly acknowledging the relationship between socioeconomic position (SEP) and health inequalities, and setting out methods to identify and incorporate socio-economic evidence into the development of Clinical Practice Guidelines (CPGs). The application of the framework will assist in the development of CPGs which:
- identify the groups within the population who are experiencing inequity in the form of health service delivery and/or outcomes
- identify interventions that ameliorate any inequalities and barriers to improved health
- provide recommendations for interventions to improve health service delivery and/or outcomes
- present recommendations within a shared, informed, decision-making framework
- frame recommendations so that all clients/patients have an equal opportunity for achieving health gains and
- conceptualise outcomes in a broad way to include clinical outcomes, quality of life and well-being, and social justice and equity.
The framework presents a logical four step process that begins with the identification of the required health decisions, leads into specific questions for the literature search and results in recommendations to incorporate evidence on SEP and health into CPGs.
- Identify the health decisions required
- Search the literature for evidence that, due to SEP, population subgroups may experience barriers to and/or have limited capacity or opportunities to achieve equal health gains
- Search the literature to identify interventions that address barriers and/or opportunities to achieving equal health gains
- Synthesise evidence from Steps 2 and 3 and current clinical best-practice evidence to develop recommendations
The framework shows that using the literature to identify and address the barriers to achieving equitable health gains is an essential step in the process of developing practice/ service/intervention guidelines. By addressing these factors at the outset, decision-making becomes a fully informed and participatory process, leading to improved health gains.
This document is available in full at http://www7.health.gov.au/nhmrc/publications/synopses/cp89syn.htm
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