The paper by Szilagyi et al makes for heartening reading,
particularly as a similar study conducted in the north of England over ten
years ago by myself and colleagues, came to the opposite conclusions,
namely that an intervention to improve immunisation uptake over the whole
population tended to widen social inequalities in uptake within the
population rather than narrow them. It is interesting and instructive to
speculate why.
First, the intervention by Szilagyi et al was designed and targetted
in order to reduce inequalities in uptake, whereas our intervention was
directed at the population as a whole with the primary objective of
raising overall population immunisation rates. Perhaps the lesson here is
that an explicit attempt has to be made to focus on inequalities rather
than to hope that the health promotion equivalent of the "trickle down
effect" will apply.
Second, our study covered the period 1981-1992. At that time in the
UK there was a consistent trend for poorer children to be less well
immunised than children from more affluent backgrounds. That is not the
case now, presumably as a result of the MMR scare, where more affluent
parents are less likely to complete their child's immunisations. In other
words there may be a temporal effect. I am not sure whether the same
effects have been observed in the US.
There are also some methodological differences to our respective
analyses which might result in slightly different findings, however the
overall message seems to be that social inequalities in immunisation
uptake are not inevitable.
(Reference) Reading R, Colver A, Openshaw S, Jarvis S. Do
interventions which improve immunisation uptake also reduce social
inequalities in uptake? BMJ. 1994;308:1142-4
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