Understanding place-based public health to reduce inequalities in the context of austerity

Abstract

Abstract Background Ageing populations and increased prevalence of long-term conditions, combined with reduced public funding following the financial crisis mean health needs often outstrip provision. Furthermore, austerity policies across Europe have been associated with a steep rise in health inequalities. Methods A comparative case study design, drawing on realist evaluation, examines the place-based strategies used by five UK Local Authorities (LAs) to maximise resources and reduce health inequalities. LAs were selected based on their implementation of innovative interventions and/or their experience of better or worse than expected trends in reducing health inequalities. Initial programme theories (IPTs) were developed through stakeholder consultation and literature searches, which will be tested and refined using case study data. Data collection methods are tailored to each case study context, but include: documentary analysis; system mapping exercises; and interviews with stakeholders and community members. Preliminary Results Initial programme theories were developed detailing the place-based strategies that are most effective in maximising resources and improving health outcomes, depending on contextual conditions. These theories cover strategies such as income generation schemes to supplement taxation; the introduction of ’disruptive’ voices into decision processes; outsourcing and widening skill-sets; reviewing and streamlining resources; and the development of tightly defined targets. Conclusions There is currently a lack of guidance on the optimal allocation of limited resources and effective delivery of services and interventions in contexts of reduced spending. Employing a realist approach has enabled us to move beyond the particularities of local contexts and strategies to produce pragmatic and transferable solutions which can inform the funding decisions of local government. Key messages LAs have to innovate to balance growing needs with shrinking resources. Pragmatic lessons are drawn to inform decision making applicable beyond local contextual specificities.