Abstract Background Industrial countries are undergoing a prolonged period of deindustrialisation, characterised by declining labour in manufacturing and extractive industries. Considering the urgent need to decrease humanity's overall environmental footprint, industrial transformation is imperative. Research showed that deindustrialisation correlates with worsening ill health; yet, little attention has been paid to mapping the complexity of the mechanism of impact. Methods Hungary experienced significant deindustrialisation in the 1990s and a parallel decline in life expectancy. Four medium-sized towns were identified in the Hungarian rustbelt: two moderately (25-50%), and two severely (>50%) deindustrialised. Between September 2016 and January 2017, 82 semi-structured interviews were conducted in these towns with subjects who were working-age adults in 1989 and who lived and worked in the interview towns in the following decades. The 816,118 words-long interview-corpus was analysed with qualitative thematic analysis using NVivo. Findings The interviews revealed that deindustrialisation affects health through multiple channels. Short-term mechanisms impact individuals directly, such as unemployment, deprivation and increased work-related stress. Medium-term mechanisms impact health through disrupting social hierarchies, social capital, local services, and workplace identities. Long-term impacts are latent, and influence health through territorial stigma, loss of working-class culture, and accumulated perceptions of injustice. Conclusions Deindustrialisation is a crucial contextual factor affecting ill health over the short, medium and long term. Going beyond the direct individual channel, involving communities and localities, the health effect of deindustrialisation represents a complex and layered mechanism with multiple explicit and latent components. Complex research approaches and policy responses are needed to address explicit and latent structural mechanisms alike. Key messages The study maps the mechanism of impact that links deindustrialisation and ill health in four Hungarian towns using thematic analysis of 82 qualitative interviews. Deindustrialisation affects health over the short, medium and long term going beyond the direct individual channel, necessitating complex research approaches and policy responses.
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