A number of studies highlight the growing problem of health disparities in the UK and other developed countries. Addressing health inequalities, either through examining disparities in healthcare provision, tackling the wider determinants of ill health in the population, or through focused studies on marginalised groups, is a key focus for much of PIHR’s research.
Alcohol and substance abuse
Mental health problems often include and/or are exacerbated by problems of substance use. Work in this area includes
PHASED, a study examining research on physical activity in relation to alcohol and substance use disorders ( Thompson) and Flourish in Nature, a project supporting alcohol and drug use recovery through volunteer opportunities in natural environments ( Thompson).
Centre for Health Technology pop-up
As part of a number of projects funded by the UKRI place-based partnerships for public engagement worth £1.4million, a Centre for Health Technology pop-up was created in Stonehouse, Plymouth; one of the most deprived areas in the UK. The aim of the pop-up centre was to address health inequalities and social deprivation introducing local residents to digital technology and eHealth solutions (e.g. companion robots, apps, VR and internet-based health and welfare resources) in a building in the heart of the community.
Coastal Health Inequalities
The Chief Medical Officer's Report for 2021 (which included a chapter written by former PIHR Director Professor Sheena Asthana and PIHR member Dr Alex Gibson) highlighted the major health disparities between coastal and non-coastal communities. Coastal areas face a higher burden of heart disease, diabetes, cancer mental health and chronic obstructive pulmonary disease (COPD), as well as significantly lower life expectancy. In order to address these issues PIHR, working with the other strategic research institutes, helped found the Centre for Coastal Communities, which brings together researchers from different disciplines looking to address issues for coastal communities, including health inequalities.
A recent success of the Centre included a successful bid to UK Research and Innovation (UKRI) for a South West Coastal Local Policy Innovation Partnership (SW LPIP) which will work with coastal communities to co-design solutions to some of the problems they face.
Plymouth Health Determinants Research Collaboration
We have been working with our partners in Plymouth City Council (PCC) and the voluntary and community sector, as well as the Faculty of Arts, Humanities and Business to research the wider societal causes of health inequalities.
In Autumn 2022, the University, through PIHR, and PCC secured £4.7 million from the National Institute for Health and Care Research (NIHR) for the first, and so far, only Health Determinants Research Collaboration in the South West. We will be utilising our share of the funding to adapt our successful embedded research model involving. This will involve researchers-in-residence working with Plymouth City Council staff and community partners to carry out research and evaluation projects to address the determinants of health inequalities in the city.
Inequalities in healthcare
There is debate regarding the role that inequalities in health care make to overall health inequalities, compared to disparities in sectors such as education, housing and income support. However, inequalities in the use of health care threaten the core NHS principle of health care equity (equal opportunity of access to health care for people with equal needs) and tend to conflict with the public’s understanding of what is ‘fair’. Our research looks at the role that health care inequalities plays in health inequalities, compared to sectors such as education, housing and income support.
Inequalities in the utilisation of cardiovascular care and mental health services have been an important focus of
Asthana and Gibson's research, in part through the use of the use of synthetic estimation techniques (within a Bayesian analytical framework) to develop prevalence estimates. This work has informed their research on formula funding for public services and a growing concern about the interlinked and complex problems driving service need in coastal areas.
In addition to the above some of our members are undertaking research on inequalities faced by specific communities.
Dr Andy Jolly, Lecturer in Social Work, has been undertaking a number of studies on inequalities and disadvantages faced by migrant households, such as the risks of food security amongst undocumented migrants and the implications of social workers of families having no recourse to public funds.
Inequalities faced by migrants
Some of our members are also undertaking research on inequalities faced by specific communities.
The Digital Revolution
Supported by Health Data Research UK and an international partner,
Professor Shang-Ming Zhou and his team are also developing data-driven solutions to identify the complex interactions between the socioeconomic, cultural and environmental factors that contribute to individual- and population-level health outcomes. In particular, the team advances local modelling technology to explore interactions of these factors at a micro-level across different sub-regions of data space so that they can effectively identify those sub-populations. They hope this will provide important insights into targeted policy development and intervention.
Mental health and wellbeing
Recent projects include
Partners 2, an NIHR funded Programme aiming to help primary care and community based mental health services work more closely together by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder; and Engager which developed ways of organising care for men with common mental health problems as they approached being released from prison ( Byng, Callaghan, Quinn, Rybczynska-Bunt).
The group has been working alongside key stakeholders to shape and define services to better fit the needs of ex-offenders, such as
Street Triage and the Neighbourhood Liaison and Diversion intervention, services that aim to divert people away from the Criminal Justice System ( Callaghan, Hazeldine).
Researchers in the
Community and Primary Care Research Group (CPCRG) have been undertaking a range of studies examining community extension of primary and secondary health care services with a view to improving public health.
One strand of this focuses on
health and behaviour change (led by Professor Adrian Taylor) and includes NIHR-funded trials such as e-coachER, a web-based coaching/exercise referral scheme for patients with chronic physical and mental health conditions; TARS, a trial to assess the effectiveness of new physical activity support to help smokers who want to reduce but not quit; and STRENGTHEN which aims to improve health for those under community supervision, with the support of a Health Trainer. Taylor co-founded and is Editor in Chief of Mental Health & Physical Activity, an international and multi-disciplinary journal in this field.