Understanding Public Perspectives on Health Inequalities

Amidst the mass of scholarship examining the UK’s persistent health inequalities, very little research considers public understandings of these inequalities. The literature that does exist is dominated by small-scale qualitative studies exploring how health inequalities are experienced by specific communities. As a result, we know very little about what members of the public, more broadly, think about the country’s long-standing health inequalities. We know even less about public views on potential policy responses to these inequalities. This is an important gap, given research has previously found that many researchers and policymakers working on health inequalities in the UK do not believe ‘upstream’ evidence-informed proposals would attract sufficient public support to be viable. This study employed a mixed methods approach, combining a nationally representative survey with three two-day citizens’ juries to explore public views of health inequalities and potential policy responses. This seminar will discuss our results, starting by demonstrating that members of the public generally have a good understanding of the social determinants of health but that this does not translate into an awareness of health inequalities. Next, we argue our results challenge perceptions that there is a lack of public support for the kinds of upstream policy proposals favoured by many researchers. However, we go on to show that, despite evident support for upstream policy responses, some of these proposals (notably tax increases to redistribute wealth) also generated substantial controversy within jury discussions. Our analysis suggests this occurred as a result of three, intersecting factors: a resistance to ideas experienced by participants as disempowering; the existence of discourses that run counter to ideas about health inequalities; and a lack of trust in local and national government. This has important implications for those seeking to promote evidence-informed policy responses to health inequalities since it suggests that efforts to better communicate patterns and causes of health inequalities, or even evidence to support particular interventions, may make little difference to public support without additional work to address these broader challenges. The seminar will conclude by reflecting on our findings in the context of the COVID-19 pandemic, considering whether and how this might be changing public views.