Beyond ‘beer, fags, egg and chips’? Exploring lay understandings of social inequalities in health

Abstract

This paper seeks to contribute to the limited body of work that has directly explored lay understandings of the causes of health inequalities. Using both quantitative and qualitative methodology, the views of people living in contrasting socio-economic neighbourhoods are compared. The findings support previous research in suggesting that lay theories about causality in relation to health inequalities, like lay concepts of health and illness in general, are multi-factorial. The findings, however, also illustrate how the ways in which questions about health and illness are asked shape people's responses. In the survey reported on here people had no problem offering explanations for health inequalities and, in response to a question asking specifically about area differences in health experience, people living in disadvantaged areas 'constructed' explanations which included, but went beyond, individualistic factors to encompass structural explanations that gave prominence to aspects of 'place'. In contrast, within the context of in-depth interviews, people living in disadvantaged areas were reluctant to accept the existence of health inequalities highlighting the moral dilemmas such questions pose for people living in poor material circumstances. While resisting the notion of health inequalities, however, in in-depth interviews the same people provided vivid accounts of the way in which inequalities in material circumstances have an adverse impact upon health. The paper highlights ways in which different methodologies provide different and not necessarily complementary understandings of lay perspectives on the causes of inequalities in health.2 Jennie Popay, Sharon Bennett, Carol Williams et al.

The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation

“…Qualitative research suggests that some of the strategies that people develop to manage their lives in difficult places, for example distancing themselves from others living in the same neighbourhood, can undermine the development of shared narratives and respect based on mutual understanding, which are prerequisites for collective action for change. 26,27 Research suggests that initiatives aiming to engage people in policy-making and implementation may help counter these processes and may have positive health and social outcomes for the people who get engaged. However, there is also a significant body of research highlighting the barriers to effective engagement of communities in policy and practice decision-making.…”

The public health system in England

“…For example, the limited research that has been undertaken in relation to public perceptions of health inequalities found that, overall, the public do not tend to be overly concerned about health inequalities (Blaxter 1997) and, furthermore, that the individuals who are most likely to experience the negative effects of health inequality (i.e. those living in difficult social or economic circumstances) tend to be more reluctant than others to accept the existence of health inequalities (Popay et al 2003), possibly due to the stigmatising effect that accepting the existence of health inequalities can have on communities and individuals.…”

Theorising participatory practice and alienation in health research: A materialist approach

“…The aim of such research is to draw public attention to the impact of structural and material inequalities on people's health, an aim that appears to be underpinned by an assumption that, if decision makers and the public only knew more about the structural and material inequalities underlying health inequalities, they would do more to address them. Such an assumption belies the small number of in-depth, qualitative studies of public understandings of health inequalities, which demonstrate that many of the communities most negatively affected by health inequalities already have a good understanding of the factors and processes that contribute to their communities poor health (for example, Popay et al, 2003;Davidson et al, 2006) To quote George (1976, p. 289), those living in poverty already 'know what is wrong with their lives'. The issue, then, is what we, collectively, might do about this.…”