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“The state They're in”: Unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities

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  • Mackenzie, Mhairi
  • Skivington, Kathryn
  • Fergie, Gillian

Abstract

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.

Suggested Citation

  • Mackenzie, Mhairi & Skivington, Kathryn & Fergie, Gillian, 2020. "“The state They're in”: Unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities," Social Science & Medicine, Elsevier, vol. 256(C).
  • Handle: RePEc:eee:socmed:v:256:y:2020:i:c:s0277953620302665
    DOI: 10.1016/j.socscimed.2020.113047
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    References listed on IDEAS

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    1. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    2. Annette Hastings & Nick Bailey & Maria Gannon & Kirsten Besemer & Glen Bramley, 2015. "Coping with the Cuts? The Management of the Worst Financial Settlement in Living Memory," Local Government Studies, Taylor & Francis Journals, vol. 41(4), pages 601-621, July.
    3. McCartney, Gerry & Collins, Chik & Mackenzie, Mhairi, 2013. "What (or who) causes health inequalities: Theories, evidence and implications?," Health Policy, Elsevier, vol. 113(3), pages 221-227.
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    1. Simons, Ronald L. & Lei, Man-Kit & Klopack, Eric & Beach, Steven R.H. & Gibbons, Frederick X. & Philibert, Robert A., 2021. "The effects of social adversity, discrimination, and health risk behaviors on the accelerated aging of African Americans: Further support for the weathering hypothesis," Social Science & Medicine, Elsevier, vol. 282(C).
    2. Gibson, Kate & Pollard, Tessa M. & Moffatt, Suzanne, 2021. "Social prescribing and classed inequality: A journey of upward health mobility?," Social Science & Medicine, Elsevier, vol. 280(C).

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