Genetics, Evolution and Environment, UCL Division of Biosciences, University College London, London, UK.
Kings Culture, Kings College London, London, UK.
Int J Equity Health. 2021 Nov 24;20(1):249. doi: 10.1186/s12939-021-01590-4.
Reducing health inequalities in the UK has been a policy priority for over 20 years, yet, despite efforts to create a more equal society, progress has been limited. Furthermore, some inequalities have widened and become more apparent, particularly during the Covid-19 pandemic. With growing recognition of the uneven distribution of life expectancy and of mental and physical health, the current research was commissioned to identify future research priorities to address UK societal and structural health inequalities.
An expert opinion consultancy process comprising an anonymous online survey and a consultation workshop were conducted to investigate priority areas for future research into UK inequalities. The seven-question survey asked respondents (n = 170) to indicate their current role, identify and prioritise areas of inequality, approaches and evaluation methods, and comment on future research priorities. The workshop was held to determine areas of research priority and attended by a closed list of delegates (n = 30) representing a range of academic disciplines and end-users of research from policy and practice. Delegates self-selected one of four breakout groups to determine research priority areas in four categories of inequality (health, social, economic, and other) and to allocate hypothetical sums of funding (half, one, five, and ten million pounds) to chosen priorities. Responses were analysed using mixed methods.
Survey respondents were mainly 'academics' (33%), 'voluntary/third sector professionals' (17%), and 'creative/cultural professionals'(16%). Survey questions identified the main areas of inequality as 'health' (58%), 'social care' (54%), and 'living standards' (47%). The first research priority was 'access to creative and cultural opportunities' (37%), second, 'sense of place' (23%), and third, 'community' (17%). Approaches seen to benefit from more research in relation to addressing inequalities were 'health/social care' (55%), 'advice services' (34%), and 'adult education/training' (26%). Preferred evaluation methods were 'community/participatory' (76%), 'action research' (62%), and 'questionnaires/focus groups' (53%). Survey respondents (25%) commented on interactions between inequalities and issues such as political and economic decisions, and climate. The key workshop finding from determining research priorities in areas of inequality was that health equity could only be achieved by tackling societal and structural inequalities, environmental conditions and housing, and having an active prevention programme.
Research demonstrates a clear need to assess the impact of cultural and natural assets in reducing inequality. Collaborations between community groups, service providers, local authorities, health commissioners, GPs, and researchers using longitudinal methods are needed within a multi-disciplinary approach to address societal and structural health inequalities.
减少英国的健康不平等问题是 20 多年来的政策重点，但尽管为创建一个更加公平的社会做出了努力，进展却有限。此外，一些不平等现象已经扩大并变得更加明显，特别是在新冠疫情期间。随着人们越来越认识到预期寿命和身心健康的分布不均，当前的研究受委托确定解决英国社会和结构性健康不平等问题的未来研究重点。
进行了一项专家意见咨询过程，包括匿名在线调查和协商研讨会，以调查英国不平等问题未来研究的优先领域。七项问题的调查要求受访者（n=170）表明其当前的角色，确定和优先考虑不平等领域、方法和评估方法，并对未来的研究重点进行评论。研讨会是为了确定研究重点而举行的，由 30 名代表（代表来自政策和实践领域的各种学术学科和研究最终用户的）封闭名单的代表参加。代表们自行选择四个分组讨论之一，以确定四个不平等类别（健康、社会、经济和其他）的研究重点领域，并将假设的资金（半、一、五和 1000 万英镑）分配给选定的优先事项。使用混合方法对回复进行了分析。
调查受访者主要是“学者”（33%）、“志愿/第三部门专业人员”（17%）和“创意/文化专业人员”（16%）。调查问题确定了主要的不平等领域为“健康”（58%）、“社会关怀”（54%）和“生活水平”（47%）。第一个研究重点是“获得创意和文化机会”（37%），其次是“地方感”（23%），第三是“社区”（17%）。在解决不平等问题方面，被视为受益于更多研究的方法是“健康/社会关怀”（55%）、“咨询服务”（34%）和“成人教育/培训”（26%）。首选的评估方法是“社区/参与式”（76%）、“行动研究”（62%）和“问卷/焦点小组”（53%）。25%的调查受访者对不平等问题与政治和经济决策以及气候等问题之间的相互作用发表了评论。在确定不平等领域的研究重点方面，研讨会的主要发现是，只有通过解决社会和结构性不平等、环境条件和住房问题，并实施积极的预防计划，才能实现健康公平。
研究表明，需要评估文化和自然资产在减少不平等方面的影响。需要在多学科方法中，通过社区团体、服务提供商、地方当局、卫生专员、全科医生和研究人员之间的合作，解决社会和结构性健康不平等问题，使用纵向方法。
