{"title":"What shapes local health system actors' thinking and action on social inequalities in health? A meta-ethnography.","authors":"Naoimh E McMahon","doi":"10.1057/s41285-022-00176-6","DOIUrl":null,"url":null,"abstract":"<p><p>Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1057/s41285-022-00176-6.</p>","PeriodicalId":46551,"journal":{"name":"Social Theory & Health","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8801929/pdf/","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Social Theory & Health","FirstCategoryId":"90","ListUrlMain":"https://doi.org/10.1057/s41285-022-00176-6","RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/31 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"SOCIAL SCIENCES, BIOMEDICAL","Score":null,"Total":0}
引用次数: 4
Abstract
Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health.
Supplementary information: The online version contains supplementary material available at 10.1057/s41285-022-00176-6.
期刊介绍:
Social Theory & Health provides an international scholarly forum for theoretical reflection and debate on contemporary health issues, many of which bear directly on the planning and delivery of services. The journal aims to consolidate, refine and extend theoretically informed work on the role of health in modern societies. Interest in issues of theory and health now informs many academic and practice-oriented disciplines and crosses discipline boundaries. The Editors encourage contributions from all relevant disciplines, as well as from those involved directly in front-line treatment and care. Contributions from the developing world are particularly welcome. The journal aims to include contributions from all theoretical perspectives.