Health providers as bricoleurs: An examination of the adaption of health ecosystems to superdiversity in Europe

Abstract

This paper examines the ways in which healthcare providers from a mixed economy of welfare operating in superdiverse neighbourhoods connect and innovate across the healthcare ecosystem to meet diverse and complex needs. Moving beyond a health systems approach which siloes different types of provision we use the concept of bricolage to make visible the work undertaken by providers across the ecosystem. While we show that public, private and civil society provision all adapt to meet complex and diverse needs to some degree, we highlight the importance of inter-connectedness between providers and note the role of civil society in addressing gaps and cracks in provision. The importance of adopting a whole ecosystem approach and focusing on the actions and interactions which enable the ecosystem to function in complex demographic environments is highlighted before we stress the dangers of over-reliance on civil society.

Healthcare bricolage in Europe’s superdiverse neighbourhoods: a mixed methods study

“…We did not seek to identify if, and when, bricolage is effective in addressing individuals’ health concerns or the relative effectiveness of some kinds of bricolage over others. We examine in a separate paper the bricolage tactics adopted by healthcare providers in order to reduce the pressure of demand in superdiverse neighbourhoods [12]. Having demonstrated the presence of variable tactics of healthcare bricolage in both patients and healthcare providers, we argue that the concept can be further utilized to highlight that the functioning of biomedical systems frequently depends on actors’ usage of multiple unacknowledged social, economic and cultural resources.…”

“…Further it is necessary to shift beyond research that focuses on access to service provision by sector, examining the role of the state [6], the voluntary [7] and private sectors [8] separately, and to include informal provision [9], internet provision [10] and transnational strategies [11]. Elsewhere we introduce the concept of healthcare bricolage to move beyond existing approaches to researching access to healthcare in diverse communities that silo provision, failing to consider healthcare systems as ecosystems comprising multiple providers [12] and how individuals may access different sectors or adopt multiple approaches either simultaneously or consecutively.…”

Superdiversity, population health and health care: opportunities and challenges in a changing world

“…Fundamentally the existing categorisations used in Europe, whether they are ethnicity, country of origin, or migration background fail to capture the "diversification of diversity". Such categories omit the influence of structure, a factor of increased importance as access to healthcare becomes more and more restricted for some categories of migrant (Phillimore et al 2018). They also overlook the importance of intersectionality and complexity in shaping access and outcomes and encourage rarefication and essentialisation of culture as causal factors in diverse populations' low levels of access to care and poor outcomes.…”

‘If there were doctors who could understand our problems, I would already be better’: dissatisfactory health care and marginalisation in superdiverse neighbourhoods.

“…This article offers an analysis of semi‐structured interview data with service users residing in neighbourhoods characterised by migration‐driven diversity, collected as part of a broader study of welfare bricolage (Phillimore et al . , 2019a). The article offers a new perspective on the role of healthcare users’ accounts of disappointment and dissatisfaction in improving service provision.…”

“…Professionals and civil society organisations re‐purpose existing resources to address gaps in public health provision (Phillimore et al . 2019a) with healthcare users also mediating with and supplementing available services for themselves and others (Phillimore et al . 2019b).…”