"The state they're in": unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities

Mackenzie, M. , Skivington, K. and Fergie, G. (2020) "The state they're in": unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities. Social Science and Medicine, 256, 113047. (doi: 10.1016/j.socscimed.2020.113047) (PMID:32460096) (PMCID:PMC7306155)

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Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent ‘Fantasy Paradigms’. This paper explores one example of such ‘Fantasy’ intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Skivington, Dr Kathryn and Fergie, Dr Gillian and Mackenzie, Professor Mhairi
Authors: Mackenzie, M., Skivington, K., and Fergie, G.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Social Sciences > School of Social and Political Sciences > Urban Studies
Journal Name:Social Science and Medicine
ISSN (Online):1873-5347
Published Online:19 May 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Social Science and Medicine 256: 113047
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU15
727631SPHSU Core Renewal: Relationships & Health Improvement Research ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/11IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU11
168560MRC SPHSU/GU Transfer FellowshipsLaurence MooreMedical Research Council (MRC)MC_PC_13027HW - MRC/CSO Social and Public Health Sciences Unit