Background The UNderstanding Factors that explain Avoidable hospital admission Inequalities – Research study (UNFAIR)’s Patient and Public Involvement and Engagement (PPIE) representatives raised that health inequalities (HI) are complex and can be difficult to both understand and communicate. They identified a need to seek more diverse views, including people who are at higher risk of HI. Limited public facing resources exist relating to the public’s understanding and emotions around HI. The project aimed to explore and co-produce a resource sharing public views of HI including how the public feel about HI and their views of possible solutions to reduce them.

Methods Members of the public worked with researchers to co-design and run workshops. The project was co-led by a member of the public and the UNFAIR PPIE representatives provided invaluable ideas and feedback throughout. A hub-and-spoke model was used with an online workshop open to anyone in England alongside three face-to-face workshops. Participants, including people living in under-served areas, were invited using local and national networks. Inclusive opportunities for participation were provided with flexible ways of involvement and remuneration. Transcriptions of audio-recordings from each workshop, alongside facilitator notes, were analysed using thematic analysis to identify key themes. An animation, based entirely upon these themes, was co-produced in partnership with members of the public and a local film-making company ensuring the public’s voice was integral to the final resource.

Results A diverse group of 58 members of the public took part. The published animation highlights powerful examples of lived experience, for example, some people are dying younger than they should be. Another key theme is that HI stir up powerful emotions such as worry, anger, hopelessness and alarm. Participants stressed the importance of respecting, accepting and valuing everyone regardless of, for example, their appearance or where they live. The animation has been widely promoted, for instance through NHS England, and the Association of Directors of Public Health’s network. It is free to use by decision makers across the system.

Conclusion This project is an example of innovative and inclusive PPIE achieved through co-leadership and co-production. It provides an avenue for the public’s voice to have an impact on policy and practice to both inform understanding and action taken to address health and care inequalities. The animation furthers the understanding of what HI means to people with inclusion of lived experience and substantiates the moral argument for decision makers to act.