Dr Kate Bernard, Dr Victoria J McGowan, Professor Clare Bambra (2024)

Social Science & Medicine 

Abstract

People in the North of England live shorter, less healthy lives than those in the South. Despite the significance of this ‘North South health divide’, regional health inequalities in England are under-researched qualitatively. Existing literature on geographical inequalities in health is largely confined to the neighbourhood level, is quantitative, and consists of very little lay knowledge. The current study is the first to examine lay perspectives of health inequalities on a regional level: exploring how people living in two urban areas of the North and South of England experience and perceive the North South health divide – including its causes and solutions. Using three focus group discussions with a total of 34 participants, and conducting participatory analysis, we identified three key themes: ‘inequalities of power’, ‘lack of control over lived environment’ and ‘communities under strain’. Findings align with existing research on lay perspectives of health inequalities at the neighbourhood level – identifying a network of material-structural and psychosocial factors. Participants across both regions discussed political and economic structures as central to understanding regional health inequalities, supporting calls to adopt a political economy approach in understanding health and place. Deindustrialisation, unemployment, loss of community facilities, and disengagement from politics were more present in Northern narratives than Southern. Findings add important ‘social meaning’ to emerging research on the North South health divide, reinforcing the urgency of public health professionals' recommendations for fair redistribution of power, wealth and resources to reduce regional health inequalities. In the context of government policy which diverges from public health evidence, this study sparks questions of how health inequalities research can intersect with wider social and political movements organising for systemic change. 

Dr Tim Price, Dr Victoria J McGowan, Dr Shelina Visram, Professor John Wildman, Professor Clare Bambra (2024)

Health & Place

Abstract

The rise in mortality in high-income countries from drug, suicide, and alcohol specific causes, referred to collectively as ‘deaths of despair’, has received growing interest from researchers. In both the US and UK, mortality rates from deaths of despair are higher in deprived, deindustrialised communities. In this qualitative study, we sought to learn how stakeholders working with vulnerable populations in Middlesbrough, a deindustrialised town in North East England with above average mortality from deaths of despair, understand and explain the prevalence of deaths from these causes in their area. Participants identified a number of structural and socio-cultural determinants that they believe drive deaths of despair in their community, including the effects of austerity, deindustrialisation, communal identity, and collective trauma; we argue that these determinants are themselves a product of structural violence.