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P34 Systems approaches to reducing health inequalities at place: an in-depth case study in the UK
  1. Lorraine McSweeney,
  2. Charlotte Parbery-Clark,
  3. Joanne Lally,
  4. Sarah Sowden
  1. Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK


Background Tackling complex issues such as avoidable hospital admissions and reducing socioeconomic inequalities in health and healthcare, requires integrated strategy and intervention across health systems. We aimed to explore and develop a systems’ level understanding of how local areas address health inequalities ‘at place’ with a focus on avoidable emergency admissions.

Methods In-depth case study using qualitative investigation with documentary analysis and key informant interviews. An urban local authority, in a region of the UK with high levels of socioeconomic disadvantage, was selected for in-depth study. Prior to the Covid-19 pandemic (2009–2018), this area experienced a trend towards reducing within area socioeconomic inequalities in avoidable hospital admission rates. Initially board-level committee members (including lay, managerial, and clinical members) within relevant local organisations were interviewed to gain an overview of the context. Snowball sampling followed, to identify additional informants.

Documents were retrieved via key informants and web searches of relevant organisations (Local Authority (LA), the NHS including primary care and Voluntary Community and Social Enterprise Sector (VCSE)).

Interviews and documents were coded and analysed independently using thematic analysis, ‘normalisation process theory’ lens, and referencing the ‘whole system approach to community-centred public health’ model. Interview and documentary findings were cross-referenced to provide a cohesive in-depth analysis.

Results Interviewees (n=14) included representation from LA (n=8), NHS (n=5) and VCSE (n=1) and 75 documents were reviewed. The cross-referenced themes included understanding the local context surrounding health inequalities (underpinned by local intelligence of populations at higher risk of health inequalities), facilitators of how to tackle health inequalities, and horizon scanning.

A strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident ‘at place’. For example, the case study described having health inequalities ‘at the heart of its health and wellbeing strategy’ which was echoed across the documents from multiple sectors. Evidence of collective action with whole systems working centred around the importance of place and involving people, with links to a ‘strong third sector’, was present. One area identified as requiring action, was the collection, analysis, sharing and use of data accessible by the whole system.

Conclusion This in-depth case study provides a unique perspective across the system of an approach to tackling health inequalities with reference to avoidable emergency admissions ‘at place’ relevant to those working across the health and care system to reduce health inequalities and address acute hospital pressures.

  • Health inequalities
  • Complex whole systems approach
  • Qualitative case study

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