Social policy and health inequalities : the relevance of faith to chronic illness management in the Pakistani community

Two historical frameworks dominate European discourse about Muslim identity. First, the Enlightenment notion that religion is a private matter to be disassociated from public life, particularly from the scientific enterprise. Secondly, the Orientalist tradition of portraying Islam as inferior to Western culture and Muslims as people to be feared and controlled. These discursive practices have consequences for the everyday lives of Pakistani Muslims in the UK and for their healthcare and health. This thesis aims to assess the influence of Muslim identity on healthcare and health through a multifaceted methodology, which takes account of context and of other aspects of identity such as social class, ethnicity, gender and age. Findings show that dominant conceptualisations of Islam and Muslims corrupt the communication process between Pakistani people and health practitioners and expose Pakistani people to stereotypical ideas about their beliefs and practices. Furthermore, discussion of religious influences on selfcare is avoided by patients and practitioners alike. Consequently, Pakistani people receive inadequate support in decision-making about chronic illness management and are more likely to develop complications. This disadvantage is exacerbated by ethnicity and gender. These dynamics of healthcare reflect discrimination that is mirrored in almost all contexts in the wider UK society, affecting education, employment and civic participation. These areas affect health status, as does self-perception of social position and social relations. The disadvantage to which Muslim identity appears to expose individuals and groups suggests a possible explanation for higher levels of mortality and morbidity within this community compared to other minority ethnic communities. This thesis explores the implications of these findings for practice, policy, research and activism. It concludes that developing shared understanding and common ground needs to be a focus for policy and practice development. Policy support for Muslims to organise on the basis of faith identity is also needed if health inequalities within the Pakistani Muslim community arc to be effectively addressed

Impact of Long COVID on productivity and informal caregiving

BackgroundAround 2 million people in the UK suffer from Long COVID (LC). Of concern is the disease impact on productivity and informal care burden. This study aimed to quantify and value productivity losses and informal care receipt in a sample of LC patients in the UK.MethodsThe target population comprised LC patients referred to LC specialist clinics. The questionnaires included a health economics questionnaire (HEQ) measuring productivity impacts, informal care receipt and service utilisation, EQ-5D-5L, C19-YRS LC condition-specific measure, and sociodemographic and COVID-19 history variables. Outcomes were changes from the incident infection resulting in LC to the month preceding the survey in paid work status/h, work income, work performance and informal care receipt. The human capital approach valued productivity losses; the proxy goods method valued caregiving hours. The values were extrapolated nationally using published prevalence data. Multilevel regressions, nested by region, estimated associations between the outcomes and patient characteristics.Results366 patients responded to HEQ (mean LC duration 449.9 days). 51.7% reduced paid work hours relative to the pre-infection period. Mean monthly work income declined by 24.5%. The average aggregate value of productivity loss since incident infection was £10,929 (95% bootstrap confidence interval £8,844-£13,014) and £5.7 billion (£3.8-£7.6 billion) extrapolated nationally. The corresponding values for informal caregiving were £8,726 (£6,247-£11,204) and £4.8 billion (£2.6-£7.0 billion). Multivariate analyses found significant associations between each outcome and health utility and C19-YRS subscale scores.ConclusionLC significantly impacts productivity losses and provision of informal care, exacerbated by high national prevalence of LC

The effectiveness of anti-stigma interventions for reducing mental health stigma in young people: A systematic review and meta-analysis

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people’s help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10–19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions

Systematic review of the role of social inclusion within sustainable urban developments

Rapid urbanisation presents multiple opportunities, but also poses challenges for equitable distribution of gains from socio-economic developments. This systematic review explored the role of social inclusion within the urban sustainability agenda. Sustainable urban developments were conceptualised as comprising environmental, spatial, social and economic perspectives; and social inclusion as entailing access to core services (healthcare) and resources (food). A search of five databases and grey literature returned 1,015 articles; 26 papers were included following screening using pre-determined criteria. Data was analysed thematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Most included studies were from North America and few were from Africa and Asia. More empirical than conceptual studies were found, and more focused on food than healthcare. Social inclusion was generally included within the urban sustainability but was often an autonomous component, rather than mainstreamed, within urban sustainability. Social inclusion was mostly related to multiple elements of sustainability, with the greatest focus on combinations of environmental, social and economic opportunities for under privileged groups. However, less consideration was given to gender, ethnicity and other aspects of intersectionality. Multiple theories contributed to transferability of lessons. Key policy implications include prioritising the most vulnerable socially excluded populations, ensuring equal representation in urban planning, designing people-centred systems, building partnerships with communities, considering socio-cultural-political-economic contexts, and recognising both intended and unintended effects. More research is needed in low and middle-income countries (LMICs) on the role of social inclusion in achieving sustainable development, using cross-disciplinary approaches

Intersectional impact of multiple identities on social work education in the UK

This document is the Accepted Manuscript version of the following article: Ben Chi-pun Liu, ‘Intersectional impact of multiple identities on social work education in the UK’, Journal of Social Work, Vol 17(2): 226-242, March 2017. © 2016 The Author(s). DOI to the published version: 10.1177/1468017316637220. Reprinted by permission of SAGE Publications.Summary: The study reviews the records of 671 social work students and graduates including the seven intakes from the first cohort in 2003/2004 to the intake in 2010/2011 to examine the interacting effect of learning difficulties, ethnicity and gender on the completion of social work training at a university in the South East of England. Findings: Among the students, 79.9% of them were female, 50.1% were black, 27.9% white, 10.7% Asian and 11.3% other ethnicities. A majority of students did not report any disability. Among those who did (n ¼ 84), 52.3% (n ¼ 44) reported a learning difficulty.The percentage of students who have successfully completed the training is 76.4%, a completion rate that is comparable to the UK’s national figure. Having controlled the confounding variables, hierarchical logistic regression identified the risk factor for dropoutfrom undergraduate social work programme as black female students with learning difficulties (odds ratio ¼ 0.100, 95% confidence interval ¼ 0.012–0.862, p < 0.05). Findings suggested that students with multiplicity of identities, i.e. being black and female and with a learning difficulty, have a lower probability to complete the programme successfully. Applications: Strategies for tackling the intersecting disadvantages of race, gender and disabilities in social work training should embrace three principles: providing continuous support, focusing on how the support is provided and addressing contextual and structural barriers.Peer reviewedFinal Accepted Versio

Adapted behavioural activation for the treatment of depression in Muslims

Background Incorporating religious beliefs into mental health therapy is associated with positive treatment outcomes. However, evidence about faith-sensitive therapies for minority religious groups is limited. Methods Behavioural Activation (BA), an effective psychological therapy for depression emphasising client values, was adapted for Muslim patients using a robust process that retained core effective elements of BA. The adapted intervention built on evidence synthesised from a systematic review of the literature, qualitative interviews with 29 key informants and findings from a feasibility study involving 19 patients and 13 mental health practitioners. Results Core elements of the BA model were acceptable to Muslim patients. Religious teachings could potentially reinforce and enhance BA strategies and concepts were more familiar to patients and more valued than the standard approaches. Patients appreciated therapist professionalism and empathy more than shared religious identity but did expect therapist acceptance that Islamic teachings could be helpful. Patients were generally enthusiastic about the approach, which proved acceptable and feasible to most participants; however, therapists needed more support than anticipated to implement the intervention. Limitations The study did not re-explore effectiveness of the intervention within this specific population. Strategies to address implementation issues highlighted require further research. Conclusions The adapted intervention may be more appropriate for Muslim patients than standard therapies and is feasible in practice. Therapist comfort is an important issue for services wishing to introduce the adapted therapy. The fusion of conceptual frameworks within this approach provides increased choice to Muslim patients, in line with policy and research recommendations

Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p