Background Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While we have an understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these different societal groups.
Methods Q methodology was used to identify and describe the shared perspectives (‘subjectivities’) that exist on i) why health is worse in low-income communities (’Causes’) and ii) the ways that health could be improved in these same communities (‘Solutions’).
53 purposively selected individuals from low-income communities (n=25) and professional stakeholder groups (n=28), for example, academics, policymakers, public health professionals, financial service practitioners, ranked ordered sets of 34 ‘Causes’ statements and 39 ‘Solutions’ statements onto quasi-normal shaped grids according to their point of view. These ‘Q’ sorts were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals’ Q sorts). ‘Causes’ and ‘Solutions’ were analysed independently.
Results Analysis produced three factor solutions for both the ‘Causes’ and ‘Solutions’. These rich, shared accounts can be broadly summarised as: ‘Causes’ i) ‘Unfair Society’, ii) ‘Individual Responsibility’, iii) ‘Hard Lives’ and for ‘Solutions’ i) ‘More than Money’, ii) ‘Guiding Choice’, iii) ‘Make Society Fair’.
No professionals were among respondents who exemplified (had a significant association with) ‘Causes – Individual Responsibility’ or ‘Solutions – Guiding Choice’ and no community participants exemplified ‘Solutions – Make Society Fair’. There was an expected correlation between the ‘Causes’ and ‘Solutions’ factor solutions given the accounts identified.
Conclusion While there was some disagreement among professional participants, there was more of a focus on material, social and environmental factors. Community participants recognised a range of causes of worse health but even among those identifying structural causes as the main problem, structural solutions were not recognised. Despite the plurality of views there was broad agreement across the accounts about issues relating to money. While no easy solutions exist, addressing basic needs and the unpredictability of finances are seen as important for good health.
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