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Parbery-Clark C, McSweeney L, Lally J, Sowden S. How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK. BMC Public Health 2024; 24:2168. [PMID: 39127652 DOI: 10.1186/s12889-024-19531-5] [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: 10/20/2023] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system's level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions. METHODS In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach. RESULTS Interviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system's approach to reducing health inequalities was evident as was collective action and involving people, with links to a "strong third sector". Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system. CONCLUSION We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system's working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.
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Affiliation(s)
- Charlotte Parbery-Clark
- Faculty of Medical Sciences, Public Health Registrar, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Lorraine McSweeney
- Post-Doctoral Research Associate, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Joanne Lally
- Senior Research Methodologist & Public Involvement Lead, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Sowden
- Senior Clinical Lecturer &, Faculty of Medical Sciences, Honorary Consultant in Public Health, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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Er V, Crowder M, Holding E, Woodrow N, Griffin N, Summerbell C, Egan M, Fairbrother H. Young people's views and experience of diet-related inequalities in England (UK): a qualitative study. Health Promot Int 2024; 39:daae107. [PMID: 39175414 PMCID: PMC11341847 DOI: 10.1093/heapro/daae107] [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] [Indexed: 08/24/2024] Open
Abstract
Inequalities in diets contribute to overall inequalities in health. Economic inequality and inequalities in access to healthy food are key drivers of poor diet and ill health among young people (YP). Despite mounting evidence of structural barriers to healthy eating, less is known about how YP view and experience these inequalities where they live, and how to address them. To explore YP's perspectives on the drivers of diet-related health inequalities, we conducted three interlinked focus groups with YP aged 13-21 years from six youth groups across three geographical areas in England. We analysed the data inductively and deductively using reflexive thematic analysis and generated themes by examining how social structure, context and agency interact and impact YP's diet. YP were aware of how inequalities in employment conditions impact their families' income and ability to eat a healthy diet. They cited the high availability of hot food takeaways in their local areas as a significant barrier to healthy eating but did not support closing or restricting these outlets. They held strong views on policies to tackle diet inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Our study showed that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities. However, further efforts are needed to shape and promote policies that resonate with YP and address both their health and wider social concerns.
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Affiliation(s)
- Vanessa Er
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mary Crowder
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Eleanor Holding
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Nicholas Woodrow
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Naomi Griffin
- Population Health Sciences Institute, Fuse, Newcastle University, Ridley Building 1, Queen Victoria Road, Newcastle Upon Tyne, NE1 7RU, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Fuse, Durham University, Green Lane, Durham, DH1 3LA, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Hannah Fairbrother
- Faculty of Health, University of Sheffield, Barber House Annexe, 3 Clarkehouse Road, Sheffield, S10 2HQ, 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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Stevely AK, Gray LA, Fairbrother H, Fenton L, Henney M, Kersbergen I, Holmes J. A latent class analysis of international change and continuity in adolescent health and wellbeing: A repeat cross-sectional study. PLoS One 2024; 19:e0305124. [PMID: 38861509 PMCID: PMC11166295 DOI: 10.1371/journal.pone.0305124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Since the early 2000s, there have been marked trends in adolescent health and wellbeing indicators across Europe, North America and Australia. In particular, there have been substantial declines in youth drinking. We know little about how these trends are underpinned by co-occurring indicators within individuals. This paper aims to analyse change over time in how indicators cluster within individuals and differences in these patterns between five countries with different trends in youth drinking. METHODS We analysed four waves of repeat cross-sectional survey data from 15-year-olds in England (n = 5942), Italy (n = 5234), the Netherlands (n = 5408), Hungary (n = 5274), and Finland (n = 7446), which were included in the Health Behaviours in School-aged Children (HBSC) study between 2001/02 and 2013/14. We defined clusters of individuals using multigroup latent class analyses which accounts for change over time. The class indicators included health behaviours, attitudes, wellbeing and relationships. We modelled associations between class membership, sex, and family affluence over time. RESULTS We identified four classes in all countries: Overall unhealthy, Overall healthy, Moderately healthy and Substance abstainers with behaviour risk indicators. The proportion of adolescents in the Overall unhealthy class declined between 2001/02 and 2013/14 by between 22.8 percentage points (pp) in England and 3.2pp in Italy. The extent to which indicators of health and wellbeing changed as linked clusters differed across countries, but changes in alcohol consumption, smoking, drug use and sexual activity were typically concurrent. Adolescents with low family affluence were more likely to be in the Overall unhealthy class in all years. CONCLUSIONS Improvements in indicators of adolescent health and well-being are due mainly to concurrent declines in drinking, smoking, sexual activity, and cannabis use, but these declines are not consistently associated with improvements in other domains. They have also not led to reductions in inequalities in indicators of health and well-being.
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Affiliation(s)
- Abigail K. Stevely
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - Laura A. Gray
- Health Economics and Decision Science, Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
- Healthy Lifespan Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Laura Fenton
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - Madeleine Henney
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - Inge Kersbergen
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - John Holmes
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
- Healthy Lifespan Institute, University of Sheffield, Sheffield, United Kingdom
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Martínez-Jiménez M, Hollingsworth B, Zucchelli E. Socioeconomic deprivation, health and healthcare utilisation among millennials. Soc Sci Med 2024; 351:116961. [PMID: 38761457 DOI: 10.1016/j.socscimed.2024.116961] [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: 11/07/2023] [Revised: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
This study estimates and decomposes components of different measures of inequality in health and healthcare use among millennial adolescents, a sizeable cohort of individuals at a critical stage of life. Administrative data from the UK Hospital Episode Statistics are linked to Next Steps, a survey collecting information about millennials born between 1989 and 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Socioeconomic inequalities in psychological distress, long-term illness and the use of emergency and outpatient hospital care are measured using a corrected concentration index. Shapley-Shorrocks decomposition techniques are employed to measure the relative contributions of childhood socioeconomic circumstances to adolescents' health and healthcare inequality of opportunity. Results show that income-related deprivation contributes to significant inequalities in mental and physical health among adolescents aged between 15 and 17 years old. There are also pro-rich inequalities in the use of specific outpatient hospital services (e.g., orthodontic and mental healthcare), while pro-poor disparities are found in the use of emergency care services. Regional and parental circumstances are leading factors in influencing inequality of opportunity in the use of hospital care among adolescents. These findings shed light on the main drivers of health inequalities during an important stage of human development and have potentially important implications on human capital formation across the life-cycle.
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Affiliation(s)
- Mario Martínez-Jiménez
- Department of Economics and Public Policy, Imperial College Business School, Imperial College London, London, UK; Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK.
| | | | - Eugenio Zucchelli
- Division of Health Research, Lancaster University, Lancaster, UK; Madrid Institute for Advanced Study (MIAS) and Department of Economic Analysis, Universidad Autónoma de Madrid (UAM), Madrid, Spain; IZA, Bonn, Germany
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Dodd-Reynolds C, Griffin N, Kyle P, Scott S, Fairbrother H, Holding E, Crowder M, Woodrow N, Summerbell C. Young people's experiences of physical activity insecurity: a qualitative study highlighting intersectional disadvantage in the UK. BMC Public Health 2024; 24:813. [PMID: 38491419 PMCID: PMC10941463 DOI: 10.1186/s12889-024-18078-9] [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: 05/31/2023] [Accepted: 02/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Intersecting socioeconomic and demographic reasons for physical activity (PA) inequalities are not well understood for young people at risk of experiencing marginalisation and living with disadvantage. This study explored young people's experiences of PA in their local area, and the associated impacts on opportunities for good physical and emotional health and wellbeing. METHODS Seven local youth groups were purposefully sampled from disadvantaged areas across urban, rural and coastal areas of England, including two that were specifically for LGBTQ + young people. Each group engaged in three interlinked focus groups which explored young people's perceptions and lived experience of PA inequalities. Data were analysed using an inductive, reflexive thematic approach to allow for flexibility in coding. RESULTS Fifty five young people aged 12-21 years of different sexualities, gender and ethnicity took part. Analysis yielded four themes: PA experiences across spaces; resigned to a lack of inclusivity and 'belonging'; safety first; complexities in access and accessibility. Young people felt more comfortable to be active in spaces that were simpler to navigate, particularly outdoor locations largely based in nature. In contrast, local gyms and sports clubs, and the school environment in general, were spoken about often in negative terms and as spaces where they experienced insecurity, unsafety or discomfort. It was common for these young people to feel excluded from PA, often linked to their gender and sexuality. Lived experiences or fears of being bullied and harassed in many activity spaces was a powerful message, but in contrast, young people perceived their local youth club as a safe space. Intersecting barriers related to deprivation, gender and sexuality, accessibility, disability, Covid-19, affordability, ethnicity, and proximity of social networks. A need emerged for safe spaces in which young people can come together, within the local community and choose to be active. CONCLUSIONS The overarching concept of 'physical activity insecurity' emerged as a significant concern for the young people in this study. We posit that PA insecurity in this context can be described as a limited or restricted ability to be active, reinforced by worries and lived experiences of feeling uncomfortable, insecure, or unsafe.
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Affiliation(s)
- Caroline Dodd-Reynolds
- Department of Sport and Exercise Sciences, Fuse, Durham University, Durham, DH1 3LA, UK.
| | - Naomi Griffin
- Population Health Sciences Institute, Fuse, Newcastle University, Newcastle, NE1 4LP, UK
| | - Phillippa Kyle
- Newcastle University Business School, Fuse, Newcastle University, Newcastle, NE1 4SE, UK
| | - Steph Scott
- Population Health Sciences Institute, Fuse, Newcastle University, Newcastle, NE1 4LP, UK
| | | | | | - Mary Crowder
- ScHARR, University of Sheffield, Sheffield, S1 4DA, UK
| | | | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Fuse, Durham University, Durham, DH1 3LA, UK
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Parbery‐Clark C, Nicholls R, McSweeney L, Sowden S, Lally J. Coproduction of a resource sharing public views of health inequalities: An example of inclusive public and patient involvement and engagement. Health Expect 2024; 27:e13860. [PMID: 37705302 PMCID: PMC10726063 DOI: 10.1111/hex.13860] [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: 05/16/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND UNderstanding Factors that explain Avoidable hospital admission Inequalities-Research study (UNFAIR) addresses how to reduce health inequalities, particularly for avoidable hospital admissions. Our Patient and Public Involvement and Engagement (PPIE) members broached that health inequalities are complex, challenging to understand and communicate. They identified a need to explore diverse views, including people who have a higher risk of health inequalities. With limited public-facing resources relating to the public's understanding or emotions around health inequalities, this project aimed to fill this gap using co-leadership and co-production. METHODS Members of the public worked with researchers to co-produce and run PPIE workshops. This project was co-led by a member of the public and a researcher. One online workshop open to anyone in England accompanied by three face-to-face workshops were held. Public contributors, including people living in diverse communities, were invited. Inclusive involvement opportunities were offered including flexible ways of involvement and remuneration. To strengthen the key messages' rigour, transcriptions of the audio-recordings from each workshop, with facilitator notes, were analysed using thematic analysis. From the key messages, an animation was co-produced with public contributors with the public's voice being integral throughout. KEY MESSAGES A total of 58 people took part capturing intersecting and multiple dimensions of marginalisation including people with a range of ages, genders, ethnicities, socioeconomic backgrounds, and members of communities who face exclusion (including people with learning difficulties and experiencing ill-health). The animation highlighted powerful lived experience, for example, some people are dying earlier than expected. Health inequalities conjured up powerful emotions, such as anger and hopelessness. Public views of how to address health inequalities included respecting, accepting and valuing everyone, regardless of, for example, where people live. The animation is publicly available for use by anyone, including decision makers across the health and care system. CONCLUSIONS Through co-leadership and co-production, this project is an example of inclusive PPIE. This project provided a way for the public's voice to influence policy and practice to inform understanding and action to address health inequalities. The animation provides powerful insights into what health inequalities mean to people with examples of lived experience and corroborates the moral argument for action by decision makers. PATIENT AND PUBLIC CONTRIBUTION Members of the public, including people who were affected or at higher risk of health inequalities, co-led this project and were involved as co-creators and developers from the inception of the project to completion. Their involvement was integral and documented in full throughout the project.
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Affiliation(s)
- Charlotte Parbery‐Clark
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Rosemary Nicholls
- Patient and Public Involvement Representative and Consumer Panel MemberNIHR Research Design Service (RDS) North East North Cumbria (NENC)Newcastle upon TyneUK
| | - Lorraine McSweeney
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Sowden
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Joanne Lally
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
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Stevely AK, Gray LA, Fairbrother H, Fenton L, Henney M, Holmes J. A latent class analysis of change and continuity in adolescent health and wellbeing in England during the decline in youth alcohol consumption: A repeat cross-sectional study. Prev Med Rep 2023; 36:102481. [PMID: 37881177 PMCID: PMC10594568 DOI: 10.1016/j.pmedr.2023.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
In England, the proportion of 13-15 year-olds who have ever drunk alcohol fell from 71% in 1999 to 35% in 2019. Despite substantial research literature studying this decline, we know little about connections with concurrent shifts in wider aspects of health and wellbeing. This paper aims to identify how indicators of health and wellbeing cluster within 15-year-olds in England, identify changes in clustering over time, and explore associations with sex and family affluence. We used latent class analysis of cross-sectional data from the Health Behaviours in School-aged Children study (n = 5,942; four waves 2001/02-2013/14). Classes were defined by indicators of substance use, sexual activity, diet, exercise, school-related measures, e-media use, parental relationships, and wellbeing. We identified three classes, which we labelled Overall unhealthy, Substance abstainers with behavioural risk indicators, and Overall healthy. The probability of being in the Overall unhealthy class fell (2001/02: 0.39; 2013/14: 0.18) while the probability of being in the Overall healthy class increased (0.21 to 0.41). The probability of weekly alcohol use fell in all classes (e.g. Overall unhealthy: 0.71 to 0.28). Females (female vs male OR: 1.74 95%CI: 1.30 - 2.34) and those with low family affluence (high vs low family affluence OR: 0.18 95%CI: 0.08 - 0.44) had significantly higher odds of being in the Overall unhealthy class. Overall, adolescents became more likely to have co-occurring indicators of good health and wellbeing, including reduced alcohol consumption, sexual activity and cigarette smoking. However, girls and those from poorer families remained more likely to have poor health and wellbeing.
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Affiliation(s)
- Abigail Kate Stevely
- Sheffield Alcohol Research Group, Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, UK
| | - Laura A Gray
- Health Economics and Decision Science, Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, UK
- Healthy Lifespan Institute, University of Sheffield, UK
| | | | - Laura Fenton
- Sheffield Alcohol Research Group, Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, UK
| | - Madeleine Henney
- Sheffield Alcohol Research Group, Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, UK
| | - John Holmes
- Sheffield Alcohol Research Group, Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, UK
- Healthy Lifespan Institute, University of Sheffield, UK
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van den Akker A, Fabbri A, Alardah DI, Gilmore AB, Rutter H. The use of participatory systems mapping as a research method in the context of non-communicable diseases and risk factors: a scoping review. Health Res Policy Syst 2023; 21:69. [PMID: 37415182 DOI: 10.1186/s12961-023-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
CONTEXT Participatory systems mapping is increasingly used to gain insight into the complex systems surrounding non-communicable diseases (NCDs) and their risk factors. OBJECTIVES To identify and synthesize studies that used participatory systems mapping in the context of non-communicable diseases. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed studies published between 2000 and 2022. STUDY SELECTION Studies that focused on NCDs and/or related risk factors, and included participants at any stage of their system's mapping process, were included. CATEGORIES FOR ANALYSIS The main categories for analysis were: (1) problem definition and goal-setting, (2) participant involvement, (3) structure of the mapping process, (4) validation of the systems map, and (5) evaluation of the mapping process. RESULTS We identified 57 studies that used participatory systems mapping for a variety of purposes, including to inform or evaluate policies or interventions and to identify potential leverage points within a system. The number of participants ranged from 6 to 590. While policymakers and professionals were the stakeholder groups most often included, some studies described significant added value from including marginalized communities. There was a general lack of formal evaluation in most studies. However, reported benefits related mostly to individual and group learning, whereas limitations described included a lack of concrete actions following from systems mapping exercises. CONCLUSIONS Based on the findings of this review, we argue that research using participatory systems mapping would benefit from considering three different but intertwined actions: explicitly considering how different participants and the power imbalances between them may influence the participatory process, considering how the results from a systems mapping exercise may effectively inform policy or translate into action, and including and reporting on evaluation and outcomes of the process, wherever possible.
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Mansukoski L, Lockyer B, Creaser A, Sheringham J, Sheard L, Garnett P, Yang T, Cookson R, Albert A, Islam S, Shore R, Khan A, Twite S, Dawson T, Iqbal H, Skarda I, Villadsen A, Asaria M, West J, Sheldon T, Wright J, Bryant M. Meta-evaluation of a whole systems programme, ActEarly: A study protocol. PLoS One 2023; 18:e0280696. [PMID: 37262082 PMCID: PMC10234514 DOI: 10.1371/journal.pone.0280696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme's impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. METHODS The ActEarly meta-evaluation will follow and adapt the five iterative stages of the 'Evaluation of Programmes in Complex Adaptive Systems' (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model ("LifeSim") will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly's dynamic programme outputs at different system levels and measure the programme's system changes on early life health and well-being. DISCUSSION This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose.
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Affiliation(s)
- Liina Mansukoski
- Department of Health Sciences, University of York, York, United Kingdom
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Bridget Lockyer
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Amy Creaser
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Laura Sheard
- Department of Health Sciences, University of York, York, United Kingdom
| | - Philip Garnett
- The School for Business and Society, University of York, York, United Kingdom
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Richard Cookson
- Centre for Health Economics, University of York, York, United Kingdom
| | | | - Shahid Islam
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Robert Shore
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Aiysha Khan
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Simon Twite
- Public Health Division, London Borough of Tower Hamlets, London, United Kingdom
| | - Tania Dawson
- The School for Business and Society, University of York, York, United Kingdom
| | - Halima Iqbal
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
| | - Ieva Skarda
- Centre for Health Economics, University of York, York, United Kingdom
| | - Aase Villadsen
- Centre for Longitudinal Studies, University College London, London, United Kingdom
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jane West
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Trevor Sheldon
- Centre for Public Health & Policy, Queen Mary University of London, London, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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11
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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12
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Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DS. Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study. BMJ Open 2022; 12:e060961. [PMID: 35940830 PMCID: PMC9364042 DOI: 10.1136/bmjopen-2022-060961] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING All National Health Service (public) hospitals in England. PARTICIPANTS All people in England aged <25 years. OUTCOME MEASURES Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kimberley A Foley
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Simon Kenny
- National Clinical Director, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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13
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Bates G, Ralphs R, Bond VW, Boardley I, Hope V, Van Hout MC, McVeigh J. Systems mapping to understand complexity in the association between image and performance enhancing drugs (IPEDs) and harm. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103801. [PMID: 35858502 DOI: 10.1016/j.drugpo.2022.103801] [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: 02/28/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Effective harm reduction work is needed to prevent and respond to the harms associated with image and performance enhancing drug (IPED) use and the diverse needs of IPED communities. Methods based around understanding and mapping complex systems have previously been applied to advance thinking on a range of complex health issues. We applied a systems perspective to explore factors that contribute to IPED-related harms in the UK and to identify harm reduction priorities. METHODS An illustrative systems map was developed based on methods for mapping complex systems with expert stakeholders. Participants in two online workshops debated the important factors contributing to harm amongst people who use IPEDs and helped to refine and clarify the map. Discussions using the map reflected on where in the system intervention is needed and the policy implications. RESULTS Stakeholders (n=18) identified 51 distinct factors as being important determinants of IPEDs-related harms, and the connections between them. These were grouped under nine domains that formed this system: identity, cognitive processes, beliefs about risk and harm, health and wellbeing, social environment, beliefs about healthcare, healthcare providers, interventions, and IPED markets. Four harm reduction priorities identified through reflexive discussion included providing a wider range of interventions, improving engagement between the IPED communities and healthcare professionals, new approaches to disseminating information in the community, and early intervention. CONCLUSION Systems mapping methods are a useful approach to engage stakeholders to discuss drug use issues. A comprehensive policy response is required to this complex issue that recognises diversity in IPEDs communities, their decision-making, and their intervention and service needs, as current approaches are failing to adequately address important areas of harm. Engaging with a wide range of stakeholders is critical to generate new insights that can help respond effectively to reduce the risk of health harms.
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Affiliation(s)
- Geoff Bates
- Institute for Policy Research, University of Bath, 10 West, Claverton Down, Bath, BA2 7AY, UK.
| | - Rob Ralphs
- Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, 4 Rosamond Street West, Manchester, M15 6LL, UK
| | - Vincent Walker Bond
- Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, 4 Rosamond Street West, Manchester, M15 6LL, UK
| | - Ian Boardley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Viv Hope
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Stations, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Marie-Claire Van Hout
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Stations, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Jim McVeigh
- Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, 4 Rosamond Street West, Manchester, M15 6LL, UK
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14
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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; 19:3679. [PMID: 35329365 PMCID: PMC8950291 DOI: 10.3390/ijerph19063679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [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)
| | - 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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15
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Satherley RM, Wolfe I, Lingam R. Experiences of healthcare for mothers of children with ongoing illness, living in deprived neighbourhoods health and place. Health Place 2021; 71:102661. [PMID: 34492455 DOI: 10.1016/j.healthplace.2021.102661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE While the association between socioeconomic deprivation and children's poor health is clear, the complex pathways linking socioeconomic deprivation with access to care and health inequalities are less well understood. This analysis sought to understand the root cause of these inequalities by exploring how mothers living in deprived neighborhoods support their sick children, and their experiences with primary care. METHODS Interview transcripts from eight mothers, living in socioeconomically deprived neighborhoods, were analyzed using interpretative phenomenological analysis. RESULTS Participants described their experiences in three distinct themes. Each theme highlights the importance of the mother's agency, voice, and power in supporting their child's health, and the crucial role played by the health system in addressing, maintaining, or reinforcing health inequalities. Participants used several strategies to address these health inequalities, which included fighting against the health system, using past experiences to explain health needs, and support from friends and family. CONCLUSION Although the health system is an essential resource to support families, encounters with primary care may fail to address health inequalities and may therefore exacerbate existing health inequalities for families living in deprived neighborhoods, irrespective of health system financing and ability to pay.
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Affiliation(s)
- Rose-Marie Satherley
- Department of Psychological Interventions, University of Surrey, Guilford, England, UK.
| | - Ingrid Wolfe
- Department of Women's and Children's Health, King's College London, London, England, UK.
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women & Children's Health, University of New South Wales, Sydney, Australia.
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