Causes, Solutions and Health Inequalities: Comparing Perspectives of Professional Stakeholders and Community Participants Experiencing Low Income and Poor Health in London

Background: Engaging with the public can influence policy decisions, particularly towards more radical policy change. While established research exists exploring public perceptions on causes of health inequalities, much less exists on how to tackle health inequalities in the UK. Despite an emphasis on 'lived experience', currently no study has focused on how individuals with very poor health conceive of both causes of, and solutions to, health inequalities.

Methods: Q methodology was used to identify and describe the shared perspectives that exist on causes of, and solutions to, health inequalities experienced in low-income communities. Community participants living with low-incomes and poor health (n = 20) and professional stakeholders (n = 20) from London rank ordered 34 'Causes' and 39 'Solutions' statements onto quasi-normal shaped grids according to their point of view. Factor analysis defined factors for both 'Causes' and 'Solutions'.

Results: Analysis produced three-factor solutions for both the 'Causes' and 'Solutions'. 'Causes' are (i) 'Systemic inequality and poverty', (ii) 'Ignored and marginalised communities', (iii) 'Precariousness, chronic stress and hopelessness'. 'Solutions' are (i) 'Meeting basic needs and providing opportunities to thrive', (ii) 'Empowering individuals to take control', (iii) 'Supporting healthy choices'. No professional stakeholders aligned with 'Ignored and marginalised communities' while at least one community participant or professional stakeholder aligned with all other factors.

Conclusion: Results support the view that the public has a relatively sophisticated understanding of causes of health inequalities and help challenge assumptions held by policy actors that lay members of the public do not recognise and understand more upstream ways to respond to health inequalities.

Patient or public contribution: The public contributed to the design of the Q study. Surveys and interviews with community participants informed the development of the statement set and the statement set was also piloted with community participants and finalised based on feedback.