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Bernard K, McGowan VJ, Bambra C. "Power, control, strain": Lay perceptions of health inequalities across England's 'North South divide'. Soc Sci Med 2024; 355:117089. [PMID: 39024711 DOI: 10.1016/j.socscimed.2024.117089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
People in the North of England live shorter, less healthy lives than those in the South. Despite the significance of this 'North South health divide', regional health inequalities in England are under-researched qualitatively. Existing literature on geographical inequalities in health is largely confined to the neighbourhood level, is quantitative, and consists of very little lay knowledge. The current study is the first to examine lay perspectives of health inequalities on a regional level: exploring how people living in two urban areas of the North and South of England experience and perceive the North South health divide - including its causes and solutions. Using three focus group discussions with a total of 34 participants, and conducting participatory analysis, we identified three key themes: 'inequalities of power', 'lack of control over lived environment' and 'communities under strain'. Findings align with existing research on lay perspectives of health inequalities at the neighbourhood level - identifying a network of material-structural and psychosocial factors. Participants across both regions discussed political and economic structures as central to understanding regional health inequalities, supporting calls to adopt a political economy approach in understanding health and place. Deindustrialisation, unemployment, loss of community facilities, and disengagement from politics were more present in Northern narratives than Southern. Findings add important 'social meaning' to emerging research on the North South health divide, reinforcing the urgency of public health professionals' recommendations for fair redistribution of power, wealth and resources to reduce regional health inequalities. In the context of government policy which diverges from public health evidence, this study sparks questions of how health inequalities research can intersect with wider social and political movements organising for systemic change.
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Affiliation(s)
- Kate Bernard
- Population Health Sciences Institute, Newcastle University, Ridley 1 Building, Newcastle-upon-Tyne, NE1 7RU, UK.
| | - Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Ridley 1 Building, Newcastle-upon-Tyne, NE1 7RU, UK.
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Ridley 1 Building, Newcastle-upon-Tyne, NE1 7RU, UK.
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Fairbrother H, Woodrow N, Holding E, Crowder M, Griffin N, Er V, Dodd-Reynolds C, Egan M, Scott S, Summerbell C, Rigby E, Kyle P, Knights N, Quirk H, Goyder E. 'It depends on where you were born…here in the North East, there's not really many job opportunities compared to in the South': young people's perspectives on a North-South health divide and its drivers in England, UK. BMC Public Health 2024; 24:2018. [PMID: 39075449 PMCID: PMC11285465 DOI: 10.1186/s12889-024-19537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Improving the public's understanding of how regional and socioeconomic inequalities create and perpetuate inequalities in health, is argued to be necessary for building support for policies geared towards creating a more equal society. However, research exploring public perceptions of health inequalities, and how they are generated, is limited. This is particularly so for young people. Our study sought to explore young people's lived experiences and understandings of health inequalities. METHODS We carried out focus group discussions (n = 18) with 42 young people, aged 13-21, recruited from six youth organisations in England in 2021. The organisations were located in areas of high deprivation in South Yorkshire, the North East and London. Young people from each organisation took part in three interlinked focus group discussions designed to explore their (i) perceptions of factors impacting their health in their local area, (ii) understandings of health inequalities and (iii) priorities for change. Due to the Covid-19 pandemic, most discussions took place online (n = 15). However, with one group in the North East, we carried out discussions face-to-face (n = 3). Data were analysed thematically and we used NVivo-12 software to facilitate data management. RESULTS Young people from all groups demonstrated an awareness of a North-South divide in England, UK. They described how disparities in local economies and employment landscapes between the North and the South led to tangible differences in everyday living and working conditions. They clearly articulated how these differences ultimately led to inequalities in people's health and wellbeing, such as linking poverty and employment precarity to chronic stress. Young people did not believe these inequalities were inevitable. They described the Conservative government as prioritising the South and thus perpetuating inequalities through uneven investment. CONCLUSIONS Our study affords important insights into young people's perceptions of how wider determinants can help explain the North-South health divide in England. It demonstrates young people's contextualised understandings of the interplay between spatial, social and health inequalities. Our findings support calls for pro-equity policies to address the structural causes of regional divides in health. Further research, engaging young people in deliberative policy analysis, could build on this work.
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Affiliation(s)
| | | | | | - Mary Crowder
- SCHARR, University of Sheffield, Sheffield, S1 4DA, UK
| | - Naomi Griffin
- Population Health Sciences Institute, Faculty of Medical Sciences, Fuse, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Vanessa Er
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Steph Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Fuse, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Fuse, Durham University, Durham, DH1 3LA, UK
| | - Emma Rigby
- Association for Young People's Health, London, SE1 4YR, UK
| | - Philippa Kyle
- Population Health Sciences Institute, Faculty of Medical Sciences, Fuse, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Nicky Knights
- Nicky Knights, Social Sciences, University of Westminster, London, W1W 6UW, UK
| | - Helen Quirk
- SCHARR, University of Sheffield, Sheffield, S1 4DA, UK
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Verra SE, Poelman MP, de Wit J, Kamphuis CBM. An unequal health policy landscape? Examining socioeconomic differences in acceptability and preferences for policies that aim to reduce socioeconomic inequalities in health. J Epidemiol Community Health 2024:jech-2024-222449. [PMID: 39048293 DOI: 10.1136/jech-2024-222449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND This study explores socioeconomic differences in acceptability and preferences for policies that aim to reduce socioeconomic health inequalities. The investigated policies range from structural policies, requiring no individual agency, to agentic policies, which depend on the individual agency for behaviour change. METHODS An online, cross-sectional survey was conducted among 1182 participants, stratified by education and representative of Dutch adults (aged 25-65) for age and gender. Across 31 policies, including structural socioeconomic policies, structural housing and neighbourhood policies, structural and agento-structural behavioural policies (facilitating behaviour) and agentic policies (focusing on information provision for behaviour change), acceptability was measured on a 7-point scale, preferences were measured using participants' top-5 policy choices. Regression analyses examined socioeconomic differences in acceptability and preferences based on education and income, controlling for age, gender, receiving welfare, and employment. RESULTS People in lower socioeconomic positions were more likely to accept and favour structural socioeconomic policies, whereas those in higher socioeconomic positions were more likely to accept and favour structural housing and neighbourhood, structural and agento-structural behavioural, and agentic policies. Socioeconomic differences were the largest for agentic policies. Overall, 83.3% preferred at least one structural socioeconomic policy, while only 32% preferred an agentic policy. Most preferred was eliminating taxes on fruits and vegetables, (preferred by 41.4%), and least preferred was a campaign promoting healthy nutrition (preferred by 3.9%). CONCLUSIONS These socioeconomic differences in policy support underscore the need for inclusive policymaking processes. Including the perspectives of people in lower socioeconomic positions helps to ensure that their needs are met.
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Affiliation(s)
- Sanne E Verra
- Faculty of Social and Behavioural Sciences, Universiteit Utrecht, Utrecht, Utrecht, Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Gelderland, Netherlands
| | - John de Wit
- Faculty of Social and Behavioural Sciences, Universiteit Utrecht, Utrecht, Utrecht, Netherlands
| | - Carlijn B M Kamphuis
- Faculty of Social and Behavioural Sciences, Universiteit Utrecht, Utrecht, Utrecht, Netherlands
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Kock L, Shahab L, Moore G, Shortt NK, Pearce J, Brown J. Assessing the profile of support for potential tobacco control policies targeting availability in Great Britain: a cross-sectional population survey. Tob Control 2024; 33:221-231. [PMID: 36008128 DOI: 10.1136/tc-2022-057508] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
AIM To examine the level of support for tobacco availability policies across Great Britain (GB) and associations between support for policy and sociodemographic, smoking and quitting characteristics. METHODS A cross-sectional representative survey (the Smoking Toolkit Study) of adults in GB (n=2197) during September 2021. Logistic regressions estimated the associations between support for each policy and sociodemographic and smoking characteristics. FINDINGS There was majority support for requiring retailers to have a license which can be removed if they sell to those under-age (89.6%) and for restrictions on the sale of cigarettes and tobacco near schools (69.9%). More supported than opposed raising the legal age of sale of cigarettes and tobacco to 21 (49.2% supported; 30.7% opposed; 20.1% unsure) and reducing the number of retailers selling tobacco in neighbourhoods with a high density of tobacco retailers (46.5% supported; 23.3% opposed; 30.2% unsure). More opposed than supported a ban on the sale of cigarettes and tobacco to everyone born after a certain year from 2030 onward (a 'tobacco-free generation') (41.3% opposed; 34.5% supported; 24.2% unsure). Age was positively associated with support for raising the age of sale and inversely associated with requiring tobacco retailer licenses. Women were more likely to support raising the age of sale and reducing the number of retailers. CONCLUSIONS Requiring tobacco retailer licensing and restrictions on sales near schools received majority support. Other tobacco availability policies received substantial support despite considerable opposition.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Niamh K Shortt
- School of Geosciences, Univerity of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- School of Geosciences, Univerity of Edinburgh, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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Kolade OR, Porat-Dahlerbruch J, Makhmutov R, van Achterberg T, Ellen ME. Strategies for engaging older adults and informal caregivers in health policy development: A scoping review. Health Res Policy Syst 2024; 22:26. [PMID: 38374133 PMCID: PMC10875823 DOI: 10.1186/s12961-024-01107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost-effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+ years) and informal caregivers' involvement in health policy development. METHOD As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute's methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. RESULTS A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as "traditional", "deliberative" and "others", adopting the World Bank's categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. CONCLUSION Although approaches for involving older adults and their informal caregivers' involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.
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Affiliation(s)
- Opeyemi Rashidat Kolade
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, KU Leuven, Kapucijnenvoer 35, 3000, Louvain, Belgium
| | - Joshua Porat-Dahlerbruch
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Rustem Makhmutov
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Theo van Achterberg
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, KU Leuven, Kapucijnenvoer 35, 3000, Louvain, Belgium
| | - Moriah Esther Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Macintyre AK, Shipton D, Sarica S, Scobie G, Craig N, McCartney G. Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews. Syst Rev 2024; 13:58. [PMID: 38331910 PMCID: PMC10851517 DOI: 10.1186/s13643-023-02429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown. OBJECTIVE Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence. METHODS We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles. RESULTS We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts. CONCLUSIONS Review-level evidence is sparse and focuses on 'corrective' approaches. Future reviews should examine a diverse set of 'upstream' actions intended to be inclusive 'by design' and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.
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Affiliation(s)
- Anna K Macintyre
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK.
| | - Deborah Shipton
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Shifa Sarica
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Graeme Scobie
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Neil Craig
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Gerry McCartney
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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Fergie G, Vaczy C, Smith K, Mackenzie M, Phan TT, Hilton S. Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action. Health Expect 2023; 26:2264-2277. [PMID: 37427532 PMCID: PMC10632646 DOI: 10.1111/hex.13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing. METHODS Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist-facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy. FINDINGS Proposals ranged from radical, whole-systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual-level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate. CONCLUSION Young people contributed wide-ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for 'upstream' systemic change to achieve reductions in social inequalities and the health differences that flow from these. PUBLIC CONTRIBUTION An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers.
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Affiliation(s)
- Gillian Fergie
- MRC/CSO Social and Public Health Sciences UnitSchool of Health and Wellbeing, University of GlasgowGlasgowUK
| | - Caroline Vaczy
- MRC/CSO Social and Public Health Sciences UnitSchool of Health and Wellbeing, University of GlasgowGlasgowUK
| | - Katherine Smith
- Centre for Health PolicySchool of Social Work and Social Policy, University of StrathclydeGlasgowUK
- School of Social and Political ScienceUniversity of EdinburghEdinburghUK
| | - Mhairi Mackenzie
- Urban StudiesSchool of Social and Political Sciences, University of GlasgowGlasgowUK
| | - Thu Thuy Phan
- MRC/CSO Social and Public Health Sciences UnitSchool of Health and Wellbeing, University of GlasgowGlasgowUK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences UnitSchool of Health and Wellbeing, University of GlasgowGlasgowUK
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Bridger EK. Subjective socioeconomic status and agreement that health is determined by distal and proximal factors. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:536-544. [PMID: 37337347 DOI: 10.1002/ijop.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
This report examines whether a person's subjective view of their rank relative to others in society-subjective socioeconomic status (SES)-is systematically related to views on distal and proximal determinants of ill-health. This was tested using cross-sectional data from 28,718 respondents from 27 countries who took part in the International Social Survey Programme (ISSP) in 2011. Adjusting for age and gender as well as income and education, mixed logistic regression models showed that subjective SES was negatively associated with the likelihood of agreeing with distal explanations for poor health (being poor or because of work/life environment) and positively associated with the likelihood of agreeing with health-related behaviours as a cause for poor health. Subjective SES was not related to agreement that genes influence health. These analyses introduce a social psychological factor into the lay understanding of health determinants and extend models of subjective status and attributional style to health explanations.
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Affiliation(s)
- Emma K Bridger
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
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Bridger EK, Tufte-Hewett A, Comerford DA. Perceived health inequalities: are the UK and US public aware of occupation-related health inequality, and do they wish to see it reduced? BMC Public Health 2023; 23:2326. [PMID: 38001407 PMCID: PMC10668500 DOI: 10.1186/s12889-023-17120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND One underexamined factor in the study of lay views of socioeconomic health inequalities is occupation-related health. Examining health by occupational social class has a long history in the UK but has been comparatively overlooked in US public health literatures, where the relationship between health and work has attended more to hazard exposure. METHODS Representative samples of the UK and US indicated the perceived and ideal lifespan of people working in "higher managerial/professional" and "routine" occupations. We examine perceptions of inequality and desires for equality across occupation groups as a function of country and key socio-demographic variables. RESULTS 67.8% of UK and 53.7% of US participants identified that professionals live longer than routine workers. Multivariate models indicated that US participants were markedly less likely to be aware of occupation-related inequalities after controlling for age, gender, and education. Awareness was negatively related to age (in the US) and recent voting behaviours (both samples). Desiring equal life expectancy was less likely in the US sample, and less likely across both samples among older participants and those with lower levels of education. CONCLUSION Employing a novel approach to measuring perceived and ideal life expectancy inequality, this is the first study to examine perceptions of lifespan inequality by occupational groups. It reports widespread understanding of the occupation-related gradient in lifespan and a desire that these inequalities be eliminated in the UK, but considerably less awareness and desire for equality in the US. Greater tolerance for social status inequalities in the US than other similar countries appear to also extend to differences in life expectancy.
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Affiliation(s)
- Emma K Bridger
- School of Psychology and Vision Sciences, University of Leicester, Leicester, England
| | | | - David A Comerford
- Behavioural Science Centre, University of Stirling, Stirling, Scotland.
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Xu J, Xia C, Ding X. Does health literacy affect older people's avoidance of medical care? The sense of medical care policy alienation and perceptions of control. Geriatr Nurs 2023; 51:202-208. [PMID: 37011492 DOI: 10.1016/j.gerinurse.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
We aimed to clarify whether health literacy (HL) impacts medical care avoidance through an underexplored mediator: a sense of policy alienation towards medical care policy for residents (SPA-M). A moderated mediation model with control perception as a moderator was used to analyze the inner relationship between HL and SPA-M. A cross-sectional survey of 470 people ≥ 60 years old, revealed a significant negative association between HL and medical care avoidance intention, which bootstrapped moderated mediation analysis confirmed is partially mediated by SPA-M. When older people's control perception was high, HL had a significant negative impact on medical care avoidance intention through SPA-M; for low control perception, the effect was insignificant. This study elucidates HL's impact of HL on medical care avoidance, highlighting control perception's relevance to medical care policymaking for older people.
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McHugh N, Baker R, Bambra C. Policy actors' perceptions of public participation to tackle health inequalities in Scotland: a paradox? Int J Equity Health 2023; 22:57. [PMID: 36997962 PMCID: PMC10062251 DOI: 10.1186/s12939-023-01869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Health inequalities are persistent and widening with transformative policy change needed. Radically shifting policy to tackle upstream causes of inequalities is likely to require public participation to provide a mandate, evidence and to address questions of co-design, implementation and acceptability. The aim of this paper is to explore perceptions among policy actors on why and how the public should be involved in policymaking for health inequalities. METHODS In 2019-2020, we conducted exploratory, in-depth, semi-structured interviews with 21 Scottish policy actors from a range of public sector bodies and agencies and third sector organisations that work in, or across, health and non-health sectors. Data were analysed thematically and used to examine implications for the development of participatory policymaking. RESULTS Policy actors viewed public participation in policymaking as intrinsically valuable for democratic reasons, but the main, and more challenging, concern was with how it could affect positive policy change. Participation was seen as instrumental in two overlapping ways: as evidence to improve policies to tackle health inequalities and to achieve public acceptance for implementing more transformative policies. However, our analysis suggests a paradox: whilst policy actors place importance on the instrumental value of public participation, they simultaneously believe the public hold views about health inequalities that would prevent transformative change. Finally, despite broad agreement on the need to improve public participation in policy development, policy actors were uncertain about how to make the necessary changes due to conceptual, methodological and practical challenges. CONCLUSIONS Policy actors believe in the importance of public participation in policy to address health inequalities for intrinsic and instrumental reasons. Yet, there is an evident tension between seeing public participation as a route to upstream policies and a belief that public views might be misinformed, individualistic, short-term or self-interested and doubts about how to make public participation meaningful. We lack good insight into what the public think about policy solutions to health inequalities. We propose that research needs to shift from describing the problem to focusing more on potential solutions and outline a potential way forward to undertake effective public participation to tackle health inequalities.
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Affiliation(s)
- Neil McHugh
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, England, UK
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Bridger EK, Tufte‐Hewett A, Comerford DA. Dispositional and situational attributions for why the rich live longer than the poor. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2023. [DOI: 10.1111/jasp.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Emma K. Bridger
- Department of Psychology, Faculty of Business, Law and Social Sciences Birmingham City University Birmingham UK
| | - Angela Tufte‐Hewett
- Department of Psychology, Faculty of Business, Law and Social Sciences Birmingham City University Birmingham UK
| | - David A. Comerford
- Stirling Management School, Economics Division University of Stirling Stirling UK
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Dove ES, Reed-Berendt R, Pareek M. "Data makes the story come to life:" understanding the ethical and legal implications of Big Data research involving ethnic minority healthcare workers in the United Kingdom-a qualitative study. BMC Med Ethics 2022; 23:136. [PMID: 36527096 PMCID: PMC9756740 DOI: 10.1186/s12910-022-00875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of UK-REACH ("The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers") is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information governance associated with the linkage of HCWs' registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust-of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a "Big Data Ethics by Design" approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research.
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Affiliation(s)
- Edward S. Dove
- grid.4305.20000 0004 1936 7988Edinburgh Law School, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL UK
| | - Ruby Reed-Berendt
- grid.4305.20000 0004 1936 7988Edinburgh Law School, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL UK
| | - Manish Pareek
- grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK ,grid.269014.80000 0001 0435 9078Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Xu P, Ye P. The Impact of Foreign Trade on Health Inequality in China: Evidence From China Family Panel Studies (CFPS). Int J Public Health 2022; 67:1605117. [PMID: 36188752 PMCID: PMC9515319 DOI: 10.3389/ijph.2022.1605117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: To assess the health inequality caused by foreign trade in China using individual self-rated health data from China Family Panel Studies (CFPS). Methods: The GMM model was used to explore the direct and indirect effects of foreign trade on health level, and the concentration index method was then used to decompose the contribution of foreign trade to health inequality. Results: The direct effect of foreign trade does not contribute to the current health inequality, although the indirect effects of trade contribute to health inequality through inequalities in income and healthcare utilization. The indirect pollution effect of trade does not cause health inequality. Subsequently, the direct effect of trade aggravates the dynamic expansion trend of health inequality, whereas the indirect effects of trade alleviate the increasing trend of health inequality. Conclusion: Although foreign trade improves the overall health level in China, it contributes to health inequality. Optimizing product structure of trade, adjusting income distribution, and enhancing medical securities for low-income groups are necessary to alleviate the health inequality caused by foreign trade.
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Affiliation(s)
- Pei Xu
- Business School, Yangzhou University, Yangzhou, China
| | - Penghao Ye
- School of Economics, Hainan Open Economy Research Institute, Hainan University, Haikou, China
- *Correspondence: Penghao Ye,
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15
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Ralston R, Smith K, O'Connor CH, Brown A. Levelling up the UK: is the government serious about reducing regional inequalities in health? BMJ 2022; 377:e070589. [PMID: 35649577 DOI: 10.1136/bmj-2022-070589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Katherine Smith
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh
- SIPHER (System-science Informed Public Health and Health Economic Research), Glasgow
| | - Clementine Hill O'Connor
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
- SIPHER (System-science Informed Public Health and Health Economic Research), Glasgow
| | - Ally Brown
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
- SIPHER (System-science Informed Public Health and Health Economic Research), Glasgow
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16
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Fairbrother H, Woodrow N, Crowder M, Holding E, Griffin N, Er V, Dodd-Reynolds C, Egan M, Lock K, Scott S, Summerbell C, McKeown R, Rigby E, Kyle P, Goyder E. ‘It All Kind of Links Really’: Young People’s Perspectives on the Relationship between Socioeconomic Circumstances and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063679. [PMID: 35329365 PMCID: PMC8950291 DOI: 10.3390/ijerph19063679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023]
Abstract
Meaningful inclusion of young people’s perceptions and experiences of inequalities is argued to be critical in the development of pro-equity policies. Our study explored young people’s perceptions of what influences their opportunities to be healthy within their local area and their understandings of health inequalities. Three interlinked qualitative focus group discussions, each lasting 90 to 100 min, with the same six groups of young people (n = 42) aged 13–21, were conducted between February and June 2021. Participants were recruited from six youth groups in areas of high deprivation across three geographical locations in England (South Yorkshire, the North East and London). Our study demonstrates that young people understand that health inequalities are generated by social determinants of health, which in turn influence behaviours. They highlight a complex interweaving of pathways between social determinants and health outcomes. However, they do not tend to think in terms of the social determinants and their distribution as resulting from the power and influence of those who create and benefit from health and social inequalities. An informed understanding of the causes of health inequalities, influenced by their own unique generational experiences, is important to help young people contribute to the development of pro-equity policies of the future.
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Affiliation(s)
- Hannah Fairbrother
- Health Sciences School, University of Sheffield, Sheffield S10 2LA, UK
- Correspondence:
| | - Nicholas Woodrow
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| | - Mary Crowder
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| | - Eleanor Holding
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| | - Naomi Griffin
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Vanessa Er
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (V.E.); (M.E.); (K.L.)
| | - Caroline Dodd-Reynolds
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (V.E.); (M.E.); (K.L.)
| | - Karen Lock
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (V.E.); (M.E.); (K.L.)
| | - Steph Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 4LP, UK;
| | - Carolyn Summerbell
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Rachael McKeown
- Association for Young People’s Health, London SE1 4YR, UK; (R.M.); (E.R.)
| | - Emma Rigby
- Association for Young People’s Health, London SE1 4YR, UK; (R.M.); (E.R.)
| | - Phillippa Kyle
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Elizabeth Goyder
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
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Abstract
WHO has a pivotal role in reducing health inequities but faces five fundamental constraints to progress, argue Unni Gopinathan and Kent Buse
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Affiliation(s)
- Unni Gopinathan
- Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kent Buse
- Healthier Societies Programme, George Institute for Global Health, Imperial College London, London, UK
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Kelly-Irving M, Ball WP, Bambra C, Delpierre C, Dundas R, Lynch J, McCartney G, Smith K. Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2036701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Michelle Kelly-Irving
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Institut fédératif de recherche et d’études interdisciplinaire santé société, Université de Toulouse, Toulouse, France
| | | | - Clare Bambra
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, UK
| | - Cyrille Delpierre
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Julia Lynch
- Department of Political Science and Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, U S.A
| | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Katherine Smith
- School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
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McMahon NE. What shapes local health system actors' thinking and action on social inequalities in health? A meta-ethnography. SOCIAL THEORY & HEALTH 2022; 21:119-139. [PMID: 35125968 PMCID: PMC8801929 DOI: 10.1057/s41285-022-00176-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health. Supplementary Information The online version contains supplementary material available at 10.1057/s41285-022-00176-6.
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Affiliation(s)
- Naoimh E. McMahon
- Division of Health Research, National Institute for Health Research School for Public Health Research (NIHR SPHR), Lancaster University, Lancaster, LA1 4YW UK
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