Abstract
A substantial body of research describes the distribution, causes and potential reduction of health inequalities, yet little scholarship examines public understandings of these inequalities. Existing work is dominated by small-scale, qualitative studies of the experiences of specific communities. As a result, we know very little about what broader publics think about health inequalities; and even less about public views of potential policy responses. This is an important gap since previous research shows many researchers and policymakers believe proposals for ‘upstream’ policies are unlikely to attract sufficient public support to be viable. This mixed methods study combined a nationally representative survey with three two-day citizens' juries exploring public views of health inequalities and potential policy responses in three UK cities (Glasgow, Manchester and Liverpool) in July 2016. Comparing public opinion elicited via a survey to public reasoning generated through deliberative processes offers insight into the formation of public views. The results challenge perceptions that there is a lack of public support for upstream, macro-level policy proposals and instead demonstrate support for proposals aiming to tackle health inequalities via improvements to living and working conditions, with more limited support for proposals targeting individual behavioural change. At the same time, some macro-economic proposals, notably those involving tax increases, proved controversial among study participants and results varied markedly by data source. Our analysis suggests that this results from three intersecting factors: a resistance to ideas viewed as disempowering (which include, fundamentally, the idea that health inequalities exist); the prevalence of individualising and fatalistic discourses, which inform resistance to diverse policy proposals (but especially those that are more ‘upstream’, macro-level proposals); and a lack of trust in (local and national) government. This suggests that efforts to enhance public support for evidence-informed policy responses to health inequalities may struggle unless these broader challenges are also addressed.
Highlights
Research on health inequalities abounds, in the UK, but rarely focuses on public perceptions (McHugh, 2021; Smith and Anderson, 2018), despite repeated articulations of the importance of such work (e.g. Popay et al, 2003; Popay et al, 1998)
We look across data sources to consider public support for specific policy proposals to tackle health inequalities
This section is divided according to Whitehead (2007) typology, highlighting how distinct data sources provide varying answers about the extent to which citizens support the macro-level policies favoured by many researchers (Smith and Kandlik Eltanani, 2014)
Summary
Research on health inequalities abounds, in the UK, but rarely focuses on public (or ‘lay’) perceptions (McHugh, 2021; Smith and Anderson, 2018), despite repeated articulations of the importance of such work (e.g. Popay et al, 2003; Popay et al, 1998). Research on health inequalities abounds, in the UK, but rarely focuses on public (or ‘lay’) perceptions (McHugh, 2021; Smith and Anderson, 2018), despite repeated articulations of the importance of such work Un derstandings of population health among disadvantaged groups are often thought to be out of synch with prevailing public health perspectives (Subica and Brown, 2020), a recent meta-ethnography suggests lay accounts from these communities align closely with aca demic understandings of the social determinants of health (Smith and Anderson, 2018). Very little research has examined public perspectives on health inequalities across social groups or potential policy responses (the few exceptions include Lundell et al, 2013; McHugh et al, 2019; Popay et al, 2003; Putland et al, 2011).
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