Abstract
The links between socioeconomic circumstances and health have been extensively studied in Britain but surprisingly few studies consider lay perspectives. This is problematic given popular efforts to reduce health inequalities appear to be based on assumption that public understanding is limited (this is evident in efforts to raise awareness of both 'upstream' causes of health inequalities and health-damaging behaviours). The results of this meta-ethnography, involving 17 qualitative studies, fundamentally challenge this assumption. We show, first, that people who are living with socioeconomic disadvantage already have a good understanding of the links between socioeconomic hardship and ill-health. Indeed, participants' accounts closely mirror the research consensus that material-structural factors represent 'upstream' determinants of health, while 'psychosocial' factors provide important explanatory pathways connecting material circumstances to health outcomes. Despite this, people living in disadvantaged circumstances are often reluctant to explicitly acknowledge health inequalities, a finding that we suggest can be understood as an attempt to resist the stigma and shame of poverty and poor health and to (re)assert individual agency and control. This suggests that work to increase public awareness of health inequalities may unintentionally exacerbate experiences of stigma and shame, meaning alternative approaches to engaging communities in health inequalities discussions are required.
Highlights
A large, cross-disciplinary body of research demonstrates the significant association between socioeconomic disadvantage and poor health experiences in Britain (Marmot 2010, Smith et al 2016)
The limited survey based-research provides support for such efforts, finding that the British public tend to under-estimate the extent of health inequalities (Macintyre et al 2005) and downplay material, structural and environmental causes of poor health (Blaxter 1997, Popay et al 2003a, 2003b)
The first two questions were our guiding analytical questions, which we asked of each study included in the meta-ethnography: (i) how do people living in Britain understand the links between socioeconomic circumstances and health?; and (ii) to what extent do people acknowledge the existence of health inequalities in Britain? The third question, which we explore towards the end of the paper, emerges out of the analysis we present and this is to ask what the implications of these findings are for health inequalities research and public engagement
Summary
A large, cross-disciplinary body of research demonstrates the significant association between socioeconomic disadvantage and poor health experiences in Britain (Marmot 2010, Smith et al 2016). The limited survey based-research (which is only included in our meta-ethnography where it was accompanied by more in-depth, qualitative data) provides support for such efforts, finding that the British public tend to under-estimate the extent of health inequalities (Macintyre et al 2005) and downplay material, structural and environmental causes of poor health (Blaxter 1997, Popay et al 2003a, 2003b). As this meta-ethnography demonstrates, sociological studies provide a rather different perspective on public understandings of health inequalities
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