br Explaining health inequalities Three main theories have
Explaining health inequalities Three main theories have been documented to account for health inequalities: materialist, psychosocial, and behavioural/cultural (Bartley, 2008).
Methods The ‘Local Health Inequalities in an Age of Austerity: The Stockton-on-Tees Study’ is a mixed method, interdisciplinary case study that aims to explore key debates around localised health inequalities in an age of austerity. Using a case study approach provides the opportunity to advance research into health inequalities by combining the methods and insights of different disciplines to study the localised effects of the social and spatial determinants of health. This paper presents the baseline findings from a prospective cohort survey comparing the health gap in Stockton-on-Tees. The gap is examined using a random baseline sample of adults aged over 18, split between participants from the 20 most to 20 least deprived lower super output areas (Fig. 1). LSOAs are small areas of relatively even size, with around 1500 people in each area; there are 32,484 LSOAs in England (Dept for Communities and Local Government, 2011). The aim of the project is to analyse health inequalities between the most and least deprived areas of the local authority during austerity, and how any changes in the underpinning social determinants (material, behavioural, and psychosocial) might explain any such changes. This paper focuses on inequalities in mental health and mental wellbeing. Stockton-on-Tees was chosen as the site for analysis because it has the highest spatial health inequalities in England both for men (at a 17.3 year difference in life expectancy at birth) and for women (11.4 year gap in life expectancy) (Public Health England, 2015). This makes it a particularly important site to analyse health inequalities during austerity. Stockton-on-Tees has a jak inhibitor of 191,600 residents (Census, 2011). The population is overwhelmingly white (93.4%) although there is a small Asian/Asian British population (Indian 0.8%, Pakistani 1.6%, Bangladeshi 0.1%, Chinese 0.5%) (Census, 2011). Stockton has high levels of social inequality, with some areas of the local authority with very low levels of deprivation (e.g. Ingleby Barwick) and others with high levels of deprivation (e.g. Hardwick). These areas are often in close proximity to one another (as shown in Fig. 1). Deprivation overall is higher than the national average e.g. 21.9% of children live in poverty compared to 19.2% nationally (Public Health England, 2015).
Discussion This is consistent with the substantial research base evidencing inequalities in mental health (Marmot, 2010). Consistent associations have been found between mental ill health and low income, low education; low social status; unemployment; and poorer material circumstances (Melzer, Fryers & Jenkins, 2004). The literature suggests that it is not only individual factors (such as having a higher income or better housing) that impacts on the relationship between living in a more affluent area and better mental health, but also the context of the area itself which could be protective including such things as the physical environment (e.g. there is better access to green space in more affluent areas), opportunity structures (e.g. better access to healthcare services or education or childcare), or the economic environment (e.g. availability of better jobs) (Bambra, 2016). Our research has also shown that material and psychosocial factors are the most important determinants of the divide in mental health and wellbeing in Stockton on Tees. However, there was a difference between the two mental health measures in terms of which category had the biggest direct effect on the outcome. With the SF8 score, psychosocial factors contributed most to the gap (54%), whereas in the WEMWBS it was material factors that took precedence (37%). Psychosocial variables such as social isolation were particularly important in the SF8. Participants in the most deprived areas, who tended to be slightly younger, seemed more isolated and lacking in companionship than those in the least deprived areas. These are social problems that are often associated with the mental health of older people (Cattan, White, Bond & Learmouth, 2005). As such, our findings suggest that either deprivation is strongly associated with social isolation in addition to age, or that the older participants in the most deprived areas were feeling so much more isolated than their counterparts in the least deprived.