Journal
SOCIAL SCIENCE & MEDICINE
Volume 256, Issue -, Pages -Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.socscimed.2020.113047
Keywords
UK; Social determinants of health; Health inequalities; Social prescribing; Structural competency; Primary care; Qualitative research
Funding
- NHS Health Scotland
- Medical Research Council [MC_UU_12017/15]
- Scottish Government Chief Scientist Office [SPHSU15]
- MRC [MC_UU_12017/11]
- Chief Scientist Office of the Scottish Government Health Directorates Grants [SPHSU11]
- Medical Research Council Strategic Award [MC_PC_13027]
- MRC [MC_UU_12017/15, MC_UU_12017/11, MC_PC_13027, MC_UU_00022/3] Funding Source: UKRI
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Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent 'Fantasy Paradigms'. This paper explores one example of such 'Fantasy' intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services.
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