The following sets out the definition of health inequalities and the new strategic focus on health inequalities within NIHR Policy Research Programme.
How do we define health inequalities and what is the problem?
Health inequalities are avoidable and unfair differences in health status between groups of people or communities. Our health is determined by our genetics, lifestyle, the health care we receive, and the impact of wider determinants, such as our physical, social and economic environments, education and employment1. Health inequalities are a major government and research priority, but although we are seeing advances in health and care, health inequalities persist2.
What is PRP’s ambition?
In 2021, the publication 'Best Research for Best Health: The Next Chapter' reaffirmed NIHR's commitment to tackling health inequalities and their wider determinants. The NIHR Policy Research Programme (PRP) will now ask all applicants to consider whether, and how, their research can contribute to this commitment. This will include identifying opportunities to incorporate health inequalities elements or themes, as well as considering how the research findings could impact health inequalities. Where appropriate for the research design, it will also include collecting data related to the equity-relevant variables detailed below. Through these means, we hope to achieve our goal of collecting specific information about proposals submitted to the programme that will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research, and enable policymakers to better understand the implications of health inequalities within their policy areas.
A majority of the research funded by the NIHR PRP contains elements of health inequalities, but this is often not explicitly acknowledged and the research findings aren’t assessed through a health inequalities lens. Although we are not asking applicants to change the focus of all research to health inequalities, we are asking for an acknowledgement that health inequalities may play a role, and consideration of this when assessing the findings. Full details on this request are included in each of the research specifications and the guidance for applicants for the current PRP funding round.
The Request
We are asking researchers to clearly identify in the research design section of all NIHR PRP applications whether or not your application has a health inequalities component or relevance to health inequalities, and to detail the core set of health inequalities breakdowns that will be reported. We understand that research projects have different methodologies and focus on different populations, so we will ask researchers to explain what data will be collected and reported for the methodology they plan to use. If a health inequalities component is not included, we ask that researchers explain why this does not fit within their proposed research. This should only take a few sentences.
For quantitative research we would ideally like researchers to provide one-way breakdowns of their main outcome(s) by the following equity-relevant variables: age, sex, gender, disability, region, 5 ONS Ethnic groups, and the 5 IMD quintile groups. If more detailed cross tabulations are appropriate, please include these. This table should be submitted to NIHR PRP at the end of the project. Due to data limitations, judgement may be necessary about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgements yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. More details and an example table can be found in Appendix A of the relevant research specification.
For qualitative research projects, this can be simply giving the number of observations against the various variables.
This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk.
Health Inequalities in NIHR PRP Research Virtual Q&A Webinar
We hosted a webinar event on Monday, 26 September from 11am - 12pm to explain this request and to answer questions from potential applicants. Please find a recording of the webinar.
1. Public Health England: Reducing Health Inequalities: System, Scale and Sustainability
2. Public Health England: Health Profile for England 2010 - inequalities in health