At Uscreates, we know that health inequalities result from social inequalities. Two individuals could be living around the corner from one another, but one could be expected to live 20 years longer than the other, simply because of how much money they have, their education, where they work, and how many people they can rely on for help. Action on health inequalities requires action across all the social determinants of health – education, employment, finances, housing, social networks and the physical environment. For example, we have helped design a home swapping app to improve health through more adequate housing, an in-school game to improve young people’s wellbeing through education, and a social enterprise that builds on the power of parent networks to address childhood obesity. You can find out more about these projects here.
On the 6th of February 2018, Uscreates were part of the HiAP GovConnect Conference. The conference was organised to galvanise thinking and action following the release of Health in All Policies (HiAP), an approach that supports local government to take account of health implications of decisions made, across all the social determinants, in order to reduce health inequity. We had the opportunity to speak with over 300 professionals who work across the public sector and who are committed to addressing health inequalities; from local government directors, commissioners and service managers, to academics, clinicians, and service providers
On the day, we invited all attendees to contribute to a live and collaborative systems mapping activity, identifying all the problems that were affecting health inequalities across the social determinants. It was a busy day, with lots of thought provoking conversations, and a number of heated discussions and disagreement about cause and effect which meant removing, re-adding and re-positioning things on the systems map multiple times! But by the end of the day, we had received over 200 contributions that we have now visualised in the Health Inequalities Systems Map below. It was fascinating to follow connections on the map across the social determinants and to see for example how environmental challenges that start with lack of green spaces and affordable activities could lead to a reluctance to go outside, which could then lead to social challenges such as isolation and loneliness, that are then connected to health challenges such as alcohol, drug abuse and increasing risk of long-term conditions. Similarly, an educational challenge that starts with the inability to afford to live near a good school leads to low educational attainment and lack of support to reach full potential, which then links to employment challenges such as low pay and unstable work, which in turn has a knock-on effect on the inability to afford to pay for rent or to get a mortgage, and possibly homelessness (considering the current challenges around lack of availability of affordable housing).
Through this exercise we hope to gather a better understanding of what is driving health inequalities, the key causes where intervention would be most beneficial, and how that could ripple across other social determinants. All of these insights can help everyone working and thinking in this space to make better decisions and to forge systems-wide collaborations in our collective mission to reduce health inequalities. We’re certain that this is in no way a comprehensive systems map at this point, and there is a lot more to capture and to reflect on, so please do get in touch with firstname.lastname@example.org with anything you would like to add, or if you would like support or advice with systems mapping more broadly.
Design Director Joanna Choukeir sums up the day at HiAP GovConnect in this short video.
Note: We used Kumu to visualise the systems map and would definitely recommend it. It takes a little getting used to, but it got us there in the end!