International Festival of Public Health

LT 2 - Health Services Research and Health Economics

HIAT toolkit for incorporating a health inequalities dimension into the design and implementation of clinical and applied health research

Presenter: Ana Porroche-Escudero (NIHR CLAHRC NWC / Lancaster University)

Other Author(s): Jennie Popay

Abstract Text:

Despite increasingly insistent calls for health inequalities research to inform health and social care policy and practice, examples of clinical and applied health research describing interventions that tackle the social determinants of health, and explaining whether these have differential impacts by socio-economic groups, are rare. This is the result of several factors including diverging views about health inequalities; methods of data collection; notions of responsibility for health inequalities; perceptions about practice professionals that inequalities can only be tackled with political action; and a lack of support for professionals to equip them with the knowledge and skills to act on the social and economic causes of health inequalities. Recognising this problem the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Research and Care in the North West Coast of England (CLAHRC NWC) developed the Health Inequalities Assessment Toolkit (HIAT) in 2015. HIAT was designed to support professionals to integrate a routine health inequalities focus in a variety of activities in clinical, applied health research and implementation, including controlled trials, commissioning, capacity building, knowledge mobilisation and evidence synthesis. The tool includes guidance on how to use it and links to resources that can help you assess whether your work considers the causes of health inequalities and has the maximum possible effect on reducing these. This presentation introduces the HIAT and outlines the benefits of the toolkit, drawing on CLAHRC NWC mixed methods evaluation. Findings conclude that HIAT contributed to; an increased understanding of the socio-economic drivers of health inequalities; enhanced skills to integrate health inequalities concerns in the design and analysis of activities; built confidence enabling the collection of better data on the upstream processes that generate inequalities and enhanced capacity to address the socio-economic determinants of these inequalities in health. Public health and clinical medicine practitioners, as well as their organisations, are encouraged to use the HIAT in their day-to-day practice to support action that positively influences health inequalities.

A systematic review of economic evidence of not accessing oral healthcare services in the over 65-year-old population.

Presenter: Mohammed Azhar Khan (Bangor University)

Other Author(s): -

Abstract Text:

Introduction: The elderly population, or those over 65 years old, is growing globally. This demographic shift is unprecedented in the history of the world, with this cohort of the population set to become the largest portion of the global population by 2050. The biological changes that occur over the life course, in addition to socioeconomic pressures, predisposes this population to unique oral and general health challenges which necessitate access to oral healthcare services. These unique challenges will impact government budgets for health and social support due to increasing reliance on state resources. Numerous Government and international policies espouse the importance of providing access to healthcare for this group; however, oral healthcare benefits for the elderly increasingly face cuts and the financial stability of this population is more uncertain. A better understanding of the economic impact that not accessing services has on this population, healthcare services and Government budgets are necessary. Methods: The inclusion criteria stipulated only English language studies printed in peer-review journals that were accessible in full would be selected for the study. An electronic database search was conducted of PubMed, Ovid Medline, Web of Science and CINAHL using key search terms related to the research question; which in turn was developed by using a population, intervention, comparator and outcome (PICO) approach. Two researchers (MAK and ML) working independently screened the results for inclusion in the study based on title and abstract and a review of these separate processes was conducted jointly to decide on the final number of studies included. Results: This study is ongoing, and the results should be finalised by mid-June. Results will include information on the number of studies included, details of the participants and characteristics of the study. A synthesis of the included studies will be included using a thematic narrative.

‘We Treat Them All the Same’: what Care Home Staff Know and Reported Practices Concerning Old/er Lesbian, Gay, Bisexual and Trans Residents

Presenter: Paul Simpson (Edge Hill University)

Other Author(s): K. Almack, P. Walthery

Abstract Text:

The needs of older LGB&T care home residents have been neglected in scholarship and they face restrictions on privacy, autonomy and (self-)value. On the basis of a survey of 187 care home staff (which include direct carers and home managers), we propose three related arguments. First, whilst employees’ attitudes generally indicate a positive disposition towards LGB&T residents, this appears unmatched by ability to recognize such individuals and knowledge of the issues and policies affecting LGB&T people. Statements such as, ‘We don’t have any at the moment,’ and ‘I/we treat them all the same’ were common in responses to open-ended questions. They suggest the working of heteronormativity which denies sexual and identity difference. Second, failure to recognize the distinct health and social care needs of LGB&T residents means that they could be subject to a uniform service, which presumes a heterosexual past and cisgender status (compliance with ascribed gender). This risks reinforcing inequality and invisibility. Third, LGB&T residents are obliged to depend largely on the goodwill, knowledge and reflexivity of individual staff (including people of faith) to meet care and personal needs. Such qualities were necessary but not sufficient conditions for inclusion and no substitute for collective practices (involving a commitment to learn about LGB&T issues) that become integral to care homes’ everyday functioning. A collective approach is key to advancing inclusion, implementation of legal rights to self-expression and securing equality through differentiated provision.

How does the UK primary healthcare system meet the needs of asylum seekers in the North West? A Qualitative Study

Presenter: Samihah Moazam (Health Education North West / University of Liverpool)

Other Author(s): -

Abstract Text:

Background: The unprecedented global migration crisis has resulted in an increasing number of asylum seekers entering the UK annually. Asylum seekers are at risk of multiple physical and mental health conditions, which can be exacerbated during the asylum process. Despite free access to primary care, asylum seekers have a poor uptake of GP registration. Previous research has suggested there are multiple barriers to accessing appropriate primary care, both for asylum seekers and healthcare professionals. The North West receives more asylum seekers than any other region in England and primary care services for this group are being reviewed by local authorities. Research in this region, however, is lacking.

Aim: This research aimed to understand how the current primary healthcare system is trying to meet the needs of asylum seekers in the North West, and what improvements are recommended by those working in this field.

Methods: Eight semi-structured interviews were conducted. A purposive and snowball sampling strategy was used. Participants were experienced professionals in planning or providing primary care services for asylum seekers in the North West. Themes were identified from interview transcripts using thematic framework analysis.

Findings: Six themes were identified; challenges in gaining access to primary care, difficulties in communicating the problem, understanding and managing complex mental health, working against the asylum process, the training gap and the need for tailored, holistic care. Participants spoke of how GP practices could be unaware of asylum seekers’ rights to access free primary care, affecting their ability to register with a practice. Language and interpretation affected every level of care, from appointment bookings to referrals to secondary services. Complex mental health was identified as the main health need with challenges in both presentation and management. Health could be both directly and indirectly worsened by the asylum process. There was a lack of training provision and awareness of training among healthcare professionals and planners. Participants discussed the need for tailored care for asylum seekers in order to adequately meet their health needs, that may be best provided within a specialised service.

Conclusion: The findings support the need for changes to the primary care provision for asylum seekers. Recommendations for primary care services and policy makers are suggested, including provision of training for healthcare workers, quality assured interpretation services, and co-designing a specialised service.