Framing the wider determinants of health and health inequalities: local stakeholder views in England

Abstract

Background:Despite decades of concern, health inequalities persist and collaborations to address them at a local level are yet to prove effective. One potential way of improving actions to address health inequalities is to pay greater attention to the way the problems and solutions are framed. Aims and objectives:The aims of the study were to: 1) review existing advice and guidance on how to frame the wider determinants of health, health inequalities and how to address them in policy; 2) critically appraise this guidance with reference to a study of local action to address the wider determinants of health and health inequalities in England; and 3) offer insight into the future of framing these issues at the local level. Methods:An exploratory qualitative study of local actors’ activities and experiences that relate to framing health inequalities. Analysis is drawn from 14 in-depth, qualitative interviews with people working in health- and other-sector partnerships. Findings:Local actors engaged in systemic framing of the wider determinants, health inequalities and what to do about them across localities, albeit in a non-routinised or uniform way. Evidence and data were a key part of telling the story. Owing in part to resource constraint, local practitioners tended to work with people who quickly ‘got it’ (the structural, systemic nature of health inequalities) and focused their efforts on working in these partnerships; this was a reflection of the relational process of ‘co-framing’. Other tactics were used to try and persuade unconvinced colleagues or elected members. There were multiple challenges, however, to framing consistency, coherency and comprehensiveness of coverage, and using a systemic frame was no guarantee of cross-sectoral collaborative working. Discussion and conclusion:Re-framing health inequalities is challenging and relational for local practitioners. Local tactics that include tailoring, co-framing and building strong local examples offer promise.