News from the Network: Tackling the effects of health inequalities – commentary

Tackling the effects of health inequalities – commentary


Tracy Gibson is the Community Development Worker at the Tullibody Health Living Centre and contributed this article to the latest issue of the CHEX-Point Newsletter. Download the full edition here.

Tullibody Healthy Living Centre in Clackmannshire supports local communities to take action on issues that result from health inequalities. We systematically compile, analyse and present evidence from our interventions and are extremely interested in research and reports concerned with health inequalities. 

As a community-led health (CLH) project, demonstrating our contribution to tackling health inequalities is at the heart of what we do. So too is our role in supporting communities to respond to the issues that result from those inequalities.

I recently read with interest the ScotPHO Report, What would it take to eradicate health inequalities? which sets out the fundamental causes theory on health inequalities in Scotland. This theory compares socioeconomic gradients against health inequality gradients, and finds that:  

the current strategy to reduce health inequalities in Scotland,

which has largely focused on eradicating the proximal causes

of inequalities, such as tobacco, will be ultimately futile.”  

The report concludes that tackling the root causes of inequality is the fundamental way to create a more equal society. While agreeing with the report’s conclusions, I would suggest that addressing the structural causes of health inequalities should include, and point to the range of proven approaches and interventions that currently implement national policies and tackle health inequalities at a local level, including community-led approaches.

Supporting local people to respond to the health priorities they have identified is the unique role of community-led health organisations. We listen, build relationships and support people to find their own solutions. This often results in us acting on health issues that fall through the net of statutory provision and implement activities that address unmet need.  

CLH organisations support communities to become active in tackling their issues – making private troubles, public issues – and the impact on both communities and individuals is significant. The following case study illustrates how we identified the health issues of one individual and worked to turn this into a collective response to welfare reform.

Joan’s story

Joan had been receiving Incapacity Benefit for a number of years. Due to the welfare reforms, she was required to change from Incapacity Benefit to Employment Support Allowance. This should have been a straight forward transition for Joan and as she was being treated for physical and mental health problems and a medical review would have confirmed this.  However, Joan had heard of other people’s unfavourable experience with medical reviews and believed that she would also suffer the same fate and be deemed ‘fit for work’. She did not complete the questionnaire she was sent and therefore no medical review was arranged. Not responding resulted in her benefit being stopped. After three months, Joan eventually phoned the Department for Work and Pensions (DWP), their response, that she needed to complete a new Work Capability Assessment, further heightened her anxiety, the new name itself contributing to her fears. A neighbour urged her to come to our project for support, saying “they are part of the community, not like the bigger agencies. Why don’t you just go in for a chat?”

Identified need

A chat with Joan revealed that she had been living without any income for nearly three months. Throughout this time her health had deteriorated and she felt unable to engage with any services.  

Intervention

We were able to reassure Joan that she was unlikely to be deemed fit for work and that the medical review was a result of the Welfare Reforms. We encouraged her to contact the DWP. But she only felt able to do with advocacy support from us.  

I’d like to say it was a straight forward process for Joan, but on completing her new claim she had to await a date for her medical assessment. This proved to be the barrier to her receiving any new benefit. Throughout this time we assisted Joan in making over 20 calls to the DWP and completing three separate forms. With telephone contact only, the DWP could not have been aware of Joan’s deteriorating health. Joan’s feeling of wellbeing was paramount in our approach and this had a direct impact on her immediate health outcomes. In building a relationship with Joan, as we supported her through this process of change, we were able to encourage her to seek a health service she would not otherwise have accessed.

Outcome

Joan’s new benefit claim was reinstated, after six months without any income. Her completed questionnaire resulted in not having to attend the medical review she had first feared. Through our encouragement Joan is now engaging with mental health services and attending a weekly art class.

 Joan told us: “I don’t know what I would have done without your help. My situation would have got worse, my health would have got worse.  Thanks for everything. I feel better now than I have in years and really enjoying my wee art class, the folk there are really nice.”

Joan’s story illustrates that by addressing some of the effects of health inequalities, we help to understand and inform the bigger picture of how best to tackle the causes. The work of CLH projects in Scotland increases access and knowledge to those who need it most and, I would argue, contributes to narrowing the health inequality gap.

Supporting people to feel connected with those around them reduces isolation and encourages an uptake in services that promote positive health behaviour change.  Community fun days, walking groups, fruit barras all have a direct effect on health inequalities and people’s lives where at a local level, they vote with their feet.

The health message for a walking group is to increase physical activity. The added benefit this brings, as you make new friends, is a feeling of connection and the beginnings of building positive social capital. The report states that “socioeconomic gradients in mortality result from either a difference in knowledge on how to avoid harm or a difference in the ability to act on that knowledge”.

Community-led actions exist to change that difference.

So, what can we do to eradicate health inequalities? The research calls on a need to redistribute resources to tackle the root causes and that focussing on the individual causes “will be fruitless in reducing inequalities and may even increase them”.

Our work has shown us that enhancing relationships that result in capacity building creates a more resilient community. This increases people’s ability to access health support and knowledge they didn’t have before.

We must ensure that communities are at the heart of approaches which seek both to tackle the root causes of health inequalities in Scotland, and respond to community issues. I’d like to see research that compares different areas in Scotland, to identify if the inequalities gap, especially for avoidable mortality rates, is more favourable in areas where community-led health activity is taking place. This would help the case for sustainable funding and commitment to community-led health approaches.”

For more information on Tullibody Healthy Living Centre visit www.tullibodyhealthyliving.org.uk 

 

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