Mapping the child health system at a local level to reduce health inequalities
Mapping the child health system at a local level to reduce health inequalities (WP3)
Research Team: Dr Ruth Kipping, Dr Katie Powell, Dr Hannah Fairbrother, Dr Jo Williams & Tricia Jessiman
Who's involved: University of Sheffield, University of Bristol, University of Cambridge, Fuse, LSHTM & LiLaC
April 2019 - March 2020
Project summary
Systems thinking addresses poor health outcomes as the result of a complex web of interdependent factors that work together as a system. For children, the focus of systems approaches has been on single outcomes e.g. obesity, rather than addressing the broad range of inequalities in health outcomes.
This study developed a visualisation of factors that underpin child health inequalities at the local area level. Initial fieldwork was undertaken in two contrasting local areas. Senior decision makers with responsibility for child health from the Local Authority, NHS Clinical Commissioning Group, and third sector organisations were involved in developing a local map. In addition, children, young people, and carers contributed. These two local maps were combined by the research team to develop a single generic version that was reviewed and amended through online consultation with policy and practice experts.
The system map developed as a result is a visual representation of the determinants of child health inequalities at the local area level. It has 125 factors arranged across the following six domains: physical, economic, social, governance, services, and personal.
What does this mean for public health professionals?
Interviews with public health policy makers, practitioners and academics suggest that the systems map has potential in demonstrating the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health. Those responsible for addressing child health outcomes may use the map to understand how the local system operates to produce inequalities and make best use of limited local resources. Intervening in the system may be in the form of a policy or intervention, but mapping the system also demonstrates how single programmes, policies or interventions are unlikely to impact on the complex and dynamic issue of child health inequalities.
Giving every child the best start in life is a policy priority in England, yet we currently lack understanding of how to support children at a local level. To address this, we are undertaking a programme of research to better understand child health systems at a local level in order to identify opportunities for intervention. A systems model of public health “conceptualises poor health and health inequalities as outcomes of a multitude of interdependent elements within a connected whole”. It places emphasis on understanding the whole system of influences on child health, rather than individual factors. Currently we have a limited understanding of how local child health systems operate and are changing over time. In this work package, we will use a systems ‘lens’ to map the components of local systems that influence child health and inform systems-based approaches to improving CYP outcomes. By ‘local’ we mean the geographical boundaries of the local authority but recognise that components of the system will not be organisationally-bounded to local government but will include other public bodies (e.g. the NHS), third and private sector actors. We will use the system map to identify potential cost-effective, equitable local policies/practices/interventions that seek to change the system to work towards better child health outcomes within current resources available; and develop principles of good practice for the development of a protective system to reduce child health inequalities.
The overall aim of this work is to scope and create a child health system map for use at a local level in order to inform opportunities for effective interventions at a systems level to reduce child health inequalities.
Publications
Jessiman PE, Powell K, Williams P, Fairbrother H, Crowder M, Williams JG, Kipping R. (2021) A systems map of the determinants of child health inequalities in England at the local level. PLoS ONE 16(2): e0245577. https://doi.org/10.1371/journal.pone.0245577
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