Practitioner perspectives on tackling health inequalities: Findings from an evaluation of healthy living centres in Scotland

• Published in: Social science & medicine (1982) 2009-03, Vol.68 (5), p.925-932
• Main Authors: Rankin, David, Backett-Milburn, Kathryn, Platt, Stephen
• Format: Article
• Language: English
• Subjects: Anthropology, Cultural; Attitude of Health Personnel; Class Differences; Classed Practices; Community Health Services - methods; Delivery Systems; Disadvantaged; Evaluation; Family physicians; Health Care Services; Health inequalities; Health inequalities Practitioner accounts Classed Practices Social Class Evaluation Scotland UK; Health inequality; Health Promotion - methods; Health Status Disparities; Holistic Health; Humans; Interviews as Topic; Low income groups; Medical personnel; Medical research; Perception; Personal Autonomy; Physician-Patient Relations; Poverty; Power (Psychology); Practice Patterns, Physicians; Practitioner accounts; Public Health; Scotland; Social Class; Social classes; Social Inequality; State Medicine; Studies; United Kingdom
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2008.12.013

Little is known about how health practitioners tasked with tackling health inequalities account for their own programmes and actions. This paper attempts to address this gap by drawing on data collected in the course of an evaluation of the Healthy Living Centre (HLC) programme, which was designed to address the wider determinants of health, in particular social exclusion and socioeconomic disadvantage, through targeting services at the most deprived local communities. Six Scottish HLC case studies explored in depth how HLC practitioners conceptualised ‘health inequalities’ and applied the construct to legitimate their public health and health improvement work. Practitioners drew on multiple explanations of health inequalities, sought to apply holistic approaches to service provision, and developed activities that took account of classed practices intended to overcome class-related disempowerment and stigma. They discussed the challenges of positioning services to appeal to and reach target groups and the difficulties in assessing the impact of their work on reducing health inequalities. Responses to tackling inequalities were variable across time and between HLCs, resulting from uneven learning about target groups and their changing needs, an evolving policy agenda and consideration given to the longer-term sustainability of HLC sites. Although practitioners' work to address health inequalities was limited by the programme's focus on working with disadvantaged groups, findings illustrate how classed practices are linked to the challenges of attracting and successfully engaging with such groups. Practitioner accounts highlighted the importance of gaining acceptance to overcome barriers to engagement with disadvantaged communities, the time required to achieve a satisfactory level of engagement, the proximity of service providers to clients and the adaptability of services necessary to address evolving needs.