From causes to solutions - insights from lay knowledge about health inequalities

Abstract

BackgroundThis paper reports on a qualitative study of lay knowledge about health inequalities and solutions to address them. Social determinants of health are responsible for a large proportion of health inequalities (unequal levels of health status) and inequities (unfair access to health services and resources) within and between countries. Despite an expanding evidence base supporting action on social determinants, understanding of the impact of these determinants is not widespread and political will appears to be lacking. A small but growing body of research has explored how ordinary people theorise health inequalities and the implications for taking action. The findings are variable, however, in terms of an emphasis on structure versus individual agency and the relationship between being 'at risk' and acceptance of social/structural explanations.MethodsThis paper draws on findings from a qualitative study conducted in Adelaide, South Australia, to examine these questions. The study was an integral part of mixed-methods research on the links between urban location, social capital and health. It comprised 80 in-depth interviews with residents in four locations with contrasting socio-economic status. The respondents were asked about the cause of inequalities and actions that could be taken by governments to address them.ResultsAlthough generally willing to discuss health inequalities, many study participants tended to explain the latter in terms of individual behaviours and attitudes rather than social/structural conditions. Moreover, those who identified social/structural causes tended to emphasise individualized factors when describing typical pathways to health outcomes. This pattern appeared largely independent of participants' own experience of advantage or disadvantage, and was reinforced in discussion of strategies to address health inequalities.ConclusionsDespite the explicit emphasis on social/structural issues expressed in the study focus and framing of the research questions, participants did not display a high level of knowledge about the nature and causes of place-based health inequalities. By extending the scope of lay theorizing to include a focus on solutions, this study offers additional insights for public health. Specifically it suggests that a popular constituency for action on the social determinants of health is unlikely to eventuate from the current popular understandings of possible policy levers.

Addressing health inequities in Ontario, Canada: what solutions do the public support?

“…Our study findings underscore the need to raise greater awareness of health inequities, and develop appropriate messages to promote public support for health equity interventions [25], in so far as public opinion is influential for policy-making. In this regard, more messaging that frames health inequities as due to the plight of the poor or the privilege of the rich could translate into support for the comprehensive range of targeted and broader health equity interventions that are needed to tackle this issue.…”

“…As per this research, attributions of social conditions to internal or external factors are influenced by personal experience and socialization to norms and values from the groups with which individuals identify (e.g., socio-economic status, political affiliation) and related perceptions of deservingness [23–25]. Thus, the observed patterns with respect to attributions and intervention support may be due to respondents’ personal experience with the social determinants of health, and/or the societal values that they hold related to political affiliation [25]. …”

‘I Sat Filling in This Form While Smoking and It Was Divine’. An Analysis of Free-Text Comments from Smokers Who Report They Have No Intention of Quitting in the Next Six Months

“…An example of this was participants who were particularly unhappy with questions which focused on socio-economic status. This may be reflective of the reluctance of people to acknowledge a causal link between socio-economic status and health behaviours (Blaxter, 1997;Putland, Baum, & Ziersch, 2011). It may also be linked to the previously mentioned stigma some smokers experience and the complex relationship between smoking and socioeconomic status (Putland, et al, 2011).…”

“…This may be reflective of the reluctance of people to acknowledge a causal link between socio-economic status and health behaviours (Blaxter, 1997;Putland, Baum, & Ziersch, 2011). It may also be linked to the previously mentioned stigma some smokers experience and the complex relationship between smoking and socioeconomic status (Putland, et al, 2011). Perhaps a brief explanation of the necessity of these types of items in health surveys could both improve responses to these questions and the questionnaire in general.…”

A Sophisticated Architecture Is Indeed Necessary for the Implementation of Health in All Policies but not Enough Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities"

“…First is the enduring constricted view of the determinants of population health. [7][8][9][10][11] Scientific evidence (and anecdotal evidence from my discussions with members of the health policy elite here in France), points to the dominant view that population health is a function of the accessibility and quality of healthcare services. Such a reductionist perspective makes health professionals unlikely partners for actors in transportation, employment or housing (excepted for environmental exposures such as lead, moulds, asbestos and carbon monoxide).…”