Although health inequalities in England reflect underlying deprivation, there is considerable variation among deprived areas in the extent to which these inequalities are narrowing. Using survey data from 15 local authority areas in North West England, and Ragin's technique of Qualitative Comparative Analysis, contextual features and ways of working in these areas are shown to combine in systematic ways with recent trends in inequalities as measured by premature mortality. For circulatory diseases, a narrowing mortality gap showed a clear association with smoking cessation services that accorded with a best practice description, combined with a local population with relatively more people aged 65 or older. For cancers, a narrowing mortality gap was associated with areas that combined relatively low population mobility with a professional working culture described as one of individual commitment and championing. These findings reveal the complexity of meeting health inequality targets and applying evidence to this endeavour, since both ways of working and context appear to be important to making progress. Both need to be understood case by case if targets are to be locally realistic and evidence applied where local practice is known to matter to the outcome.
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