Reducing Health Inequalities Implementation Theme. Briefing paper 1: Why health inequalities matter

This first briefing paper is an account of why health inequality matters and why health inequalities deserve consideration across all areas of CLAHRC (SY) activity. We begin by briefly reviewing the policy landscape and the prominence of 'inequality' as a growing focus of concern over the past 30 years. We then set out the type of philosophical and political considerations that may underpin the view that health inequality is a problem. Next we identify the main axes of inequality with which we suggest CLAHRC (SY) should concern itself. In the next section of the paper we set out the extent of health inequality in South Yorkshire, as far as available data allow. Finally, we show the relevance of health inequality across the CLAHRC (SY) themes and raise for discussion the implications for CLAHRC (SY) activity

Modern slavery in the UK: how should the health sector be responding?

Modern slavery is crime of extreme exploitation. It includes the use of coercion, force, deception and abuse of vulnerability for such purposes as trafficking, labour, sexual exploitation, forced criminal activity and domestic servitude. It is a topic of growing interest in the UK and beyond as it has emerged as an issue of considerable scale and consequence. To date, debates have been dominated by a law enforcement perspective. Less apparent has been an articulation of the implications of modern slavery for the health sector. This is despite growing evidence of the dire physical and mental health consequences for survivors. This paper addresses this gap by confronting a series of issues relevant to UK health systems. After describing what is modern slavery and the nature of the problem, we identify how the health sector has responded to date. We then articulate how health services and public health can more coherently and systematically meet the challenges of modern slavery through policy and practice. Finally, we present a call for the health sector to position itself as a central to the wellbeing of survivors and as a fundamental ally in modern slavery prevention

Social research for a multiethnic population: do the research ethics and standards guidelines of UK Learned Societies address this challenge?

There is increasing recognition in the UK that social science research should generate an evidence base that reflects the ethnic diversity of the population and informs positive developments in public policy and programmes for all. However, describing and understanding ethnic diversity, and associated disadvantage, is far from straightforward. In practice, the ethical and scientific arguments around whether and how to incorporate ethnicity into policy-relevant social research are complex and contentious. In particular, untheorised or insensitive inclusion of data on ethnic 'groups' can have negative consequences. The present investigation begins to explore the extent to which social scientists have access to advice and guidance in this area of research. Specifically, the paper examines how ethnic diversity is explicitly or implicitly considered within the research ethics and scientific standard guidance provided by UK social science Learned Societies to their members. The review found little in the way of explicit attention to ethnic diversity in the guidance documents, but nevertheless identified a number of pertinent themes. The paper compiles and extrapolates these themes to present a tentative set of principles for social scientists to debate and further develop

Mapping intersectional inequalities in biomarkers of healthy ageing and chronic disease in older English adults

Chronic diseases and their inequalities amongst older adults are a significant public health challenge. Prevention and treatment of chronic diseases will benefit from insight into which population groups show greatest risk. Biomarkers are indicators of the biological mechanisms underlying health and disease. We analysed disparities in a common set of biomarkers at the population level using English national data (n = 16,437). Blood-based biomarkers were HbA1c, total cholesterol and C-reactive protein. Non-blood biomarkers were systolic blood pressure, resting heart rate and body mass index. We employed an intersectionality perspective which is concerned with how socioeconomic, gender and ethnic disparities combine to lead to varied health outcomes. We find granular intersectional disparities, which vary by biomarker, with total cholesterol and HbA1c showing the greatest intersectional variation. These disparities were additive rather than multiplicative. Each intersectional subgroup has its own profile of biomarkers. Whilst the majority of variation in biomarkers is at the individual rather than intersectional level (i.e. intersections exhibit high heterogeneity), the average differences are potentially associated with important clinical outcomes. An intersectional perspective helps to shed light on how socio-demographic factors combine to result in differential risk for disease or potential for healthy ageing

A formative review of physical activity interventions for minority ethnic populations in England

Background: Physical activity (PA) levels are lower among some UK minority ethnic groups than the majority White British population. Barriers to participation have been examined and a variety of tailored interventions have emerged. This study documents the characteristics and logic of local adaptations; a vital first step in evaluating such innovations. Methods: 58 PA interventions from an English PA dataset were examined to establish the characteristics of programmes focussed on minority ethnic populations. From these 58, three case studies were examined to reveal the nature of tailoring and the logic underpinning it; employing documentary analysis and qualitative interviews. Results: Interventions typically aimed to improve both health and social outcomes, were largely publically and charitably funded and sought to engage the most inactive groups. Tailoring was based on six principles including using community resources to promote the intervention and accommodating varying degrees of cultural identification. Additionally, tailoring interventions were intended to build capacity for sustainability. Conclusions: PA interventions tailored to the needs of minority ethnic groups reflect their largely disadvantaged position in society and focus on addressing inactivity. Tailoring PA with the six principles in mind could be used as a useful framework for developing, designing and evaluating interventions for minority ethnic populations

Adapting primary care for new migrants: a formative assessment

Background: Immigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands. Aim: To formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need. Design & setting: Online survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector. Method: Non-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care. Results: Survey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care. Conclusion: Despite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented