Abstract
IntroductionSocio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies.MethodsA qualitative research study describing policymakers’ beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out.ResultsPoliticians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city’s government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities’ limited authority.ConclusionsOfficers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector.
Highlights
Socio-economic inequalities in health are large in urban areas; local municipal governments may plan, manage and provide services and policies which can reduce these
It uses qualitative methodology to explore in-depth the following research questions: What perceptions and beliefs do policymakers have regarding health inequalities and their causes, which are political institutions’ priorities regarding inequalities in health and sectors involved? do social actors participate in policy making processes and which barriers and opportunities have policymakers encountered, in addition to what kind of information is available on health inequalities? The objective of this study was to describe the perceptions and beliefs of public policymakers regarding social inequalities in health and policies to reduce these in Barcelona
This study has relevant methodological strengths, namely triangulation of analysts-different researchers analysed the same data-and verification of results by participants. To our knowledge, this is among the few studies performed in Europe which reflect city government policymakers’ beliefs on health inequalities and policies to reduce them
Summary
Socio-economic inequalities in health are large in urban areas; local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies. Most studies compare social inequalities in health within or among countries-usually with a quantitative approach-but do not focus on cities or urban populations [9]. Morrison et al International Journal for Equity in Health (2015) 14:18 from local levels of government perceive the subject is still scarce [10,11] and the few relevant studies in this field have been carried out outside Europe [12,13,14]. This research may provide a deeper understanding on how priorities are set in the agenda in cities’ governments [16]
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