Centre for Health Inequalities Research
The Centre for Health Inequalities Research aims to contribute to greater health equity for communities locally, nationally and internationally by producing high quality applied research to inform action to reduce avoidable upstream social and economic inequalities that drive health inequalities.
Our context
The Centre is based in the Division of Health Research at Lancaster University in North West England: a region with relatively poor health compared with the south of England and with significant inequalities in health between more and less advantaged groups and neighbourhoods. These inequalities have a long history but they have continued to widen over recent decades driven by increasing social and economic inequalities which in turn limit the control people have over their lives, helping to shape behaviours that are potentially health damaging.
How we work
To achieve its aim the Centre brings together academics from across disciplines with policy makers and practitioners from across sectors and members of the public experiencing social and economic disadvantage to:
- Better understand the social and economic drivers of health inequalities;
- Develop and evaluate innovative approaches to address these inequalities locally, nationally and globally; and
- Disseminate existing and new knowledge in innovative and accessible ways to diverse audiences to inform action for greater health equity.
Our research
Our research is concerned with applied, empirical research that addresses the social determinants of health inequalities. Health inequalities research activity shares a common concern to illuminate the social determinants of inequalities in health and to produce and exchange evidence to reduce these inequalities. At a Faculty level Social and Economic Inequality in Health is identified as a key theme which fosters interdisciplinary research across sociology, economics, geography, feminism, sexualities and gender studies, history, psychology, medicine, psychiatry and statistics within the Faculty as well as across other Faculties at Lancaster. DHR has a wide range of people engaged in health inequalities research across a number of groupings, all affiliated to the Centre for Health Inequalities Research (CHIR) which helps to connect health inequalities research activities across the Division.
As part of LiLaC (Liverpool and Lancaster Universities Collaboration for Public Health Research), Lancaster is one of eight core academic centres within the NIHR School for Public Health Research (SPHR). SPHR is a partnership between eight leading academic centres with excellence in applied public health research and evaluative practice in England. The School brings together its members’ expertise in a collaborative working relationship – to ensure emphasis on what works practically, can be applied across the whole country and better meets the needs of policy makers, practitioners and the public. Following an open competition, LiLaC’s membership of SPHR was renewed for a further 5 years until March 2022.
See: http://www.lilac-healthequity.org.uk/index.php/sphr-research
Also as part of LiLaC, Lancaster is a core part of the North West Coast NIHR Collaboration for Leadership in Applied Health, Research and Care (CLAHRC), which has a major focus on tackling health inequalities. CLAHRC NWC's public health thematic programme is led by Jennie Popay at Lancaster University and Ben Barr, senior lecturer in public health at Liverpool University. It is managed by a group comprising representatives from the nine partner local authorities involved in the programme, and aims to support local authorities to implement and evaluate evidence-based policies/practices to reduce health inequalities by promoting and supporting systems resilience in relatively disadvantaged areas.
See: http://www.lilac-healthequity.org.uk/index.php/17-nwc-clahrc/21-nwc-clahrc-lilac
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Mental health inequalities
Public mental health is a key priority within CHIR and reflects the global and national concern regarding the deteriorating mental health of the population. At CHIR research is being conducted that focuses on those population groups who are most likely to develop poor mental health. These include, for example, those living in impoverished conditions, those at the bottom of the social and economic hierarchy, LGBTQ populations, people with learning/intellectual disabilities and young people. Our approach is to conduct research (empirical and theoretical) that aims to understand the social determinants of this mental health inequality, particularly the mechanisms and processes by which inequality is translated into poor mental health. We also have a strong commitment to applied research that examines the ways we can tackle mental health inequality and intervene to prevent poor mental health
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Inequalities relating to young people
The research carried out within CHIR recognises the relatively powerless and marginalised position of young people and how this intersects with other social determinants of health and wellbeing, particularly in relation to gender, sexuality and socio-economic status. We are particularly concerned to explore the structures that prevent the active and equitable participation of young people in the decisions that affect their lives and how this lack of control contributes directly and indirectly to health and social outcomes. Our research includes work with particular groups of young people, including young men and LGBTQ youth, and is focused on exploring particular contexts including educational settings, health services and informal youth provision. The importance and value of participation is extended to the conduct of our research which seeks to be actively participatory and co-produced with young people. Our work covers a wide range of health and social issues but with a particular focus on sex, alcohol and mental health. As with other areas of research within CHIR our research is explicitly theory-driven and applied.
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The role of communities in tackling inequalities
There is a growing body of evidence that low control may be a fundamental cause of inequalities in health. However, there is little evidence about effective approaches to support greater control of communities at the collective level, and that contribute to reducing health inequalities. CHIR research and engagement activities build knowledge about approaches that empower communities of place and/or interest to have greater control over decisions affecting their lives. We have undertaken several reviews of community engagement and evaluations of regeneration and place-based initiatives that aim to involve communities in decision-making within geographical areas. Lancaster currently leads a major NIHR study (the Communities in Control study), now in its third phase, to evaluate the health inequalities impact of the Lottery’s place-based programme, Big Local. The research is investigating longer-term impacts for the health and wellbeing of residents who are most actively involved in delivering Big Local, as well as health and social impacts for local populations in Big Local areas.
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Inequalities experienced by people with disabilities or long-term health conditions
People with disabilities or long-term conditions experience considerable inequalities in employment rates, income, education and standards of living. International data show that the magnitude of these inequalities varies significantly across different welfare regimes and are amenable to policy interventions. Our research utilises quantitative and qualitative approaches to investigate the social inequalities experienced by people with disabilities and/or long-term conditions and identify ways to address them. Prominent themes include: experiences of working with a disability/long-term condition; government and organisational interventions to support work retention and return-to-work for people with disabilities and/or long-term conditions; and the health inequalities experienced by people with learning/intellectual disabilities. Lancaster University is a member of the Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, which aims to find ways to support work retention and return-to-work for individuals with musculoskeletal disorders. Lancaster University is also a core part of the Public Health England Learning Disabilities Observatory. This was established in 2010 and aims to generate evidence concerning the health inequalities faced by people with learning/intellectual disabilities, understand these health inequalities, and facilitate policy and practice action to tackle these inequalities.
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Modelling health inequalities
Health Economics at Lancaster, (HEAL), has the primary objectives of developing and applying quantitative research methods capable of informing health policy-making through empirical evidence and contributing to the academic and policy debate, including a substantial body of work on inequalities. The work undertaken by HEAL aims at having an impact on people's wellbeing and society as a whole.
Narrative Synthesis in Systematic Reviews
Statistical approaches to combining quantitative findings from different studies in systematic reviews of evidence are well developed. However, these techniques are not always appropriate, either because the quantitative data are not adequate or because the findings to be synthesised are both quantitative and qualitative. Narrative approaches to evidence synthesis are therefore being developed but these do not rest on an authoritative body of knowledge.
Study Objectives
The study objectives were:
- To review the methodological literature on narrative approaches to evidence synthesis;
- To assess existing approaches to narrative synthesis in systematic reviews;
- To produce draft guidance on best practice for the narrative synthesis of quantitative and qualitative data;
- To test the use of this guidance;
- To disseminate validated good practice guidance on the conduct of narrative synthesis.
The guidance document, produced in April 2006, provides practical examples of the application of the guidance in two 'demonstration narrative syntheses', which have now been published and provide important insights into the potential benefits of narrative approaches to the synthesis of findings from multiple studies. These can be found under the NS Publications tab above as downloadable PDFs.
Impact on Policy and Practice
The availability of high quality research syntheses, addressing questions important to policymakers, implementers and service users is key to the policy agenda on user involvement. Producing these syntheses in ways that are accessible is a challenge for the academic community. Narrative approaches to evidence synthesis are widespread but they currently do not rest on an extensive body of methodological work and often lack transparency. Our guidance has already been welcomed by some of the leading figures in the world of evidence synthesis and we are confident that it will contribute to increasing the quality of the evidence available to policy makers and practitioners in this country and elsewhere.
NS Publications
The Narrative Synthesis guidance is provided free and you are asked not to distribute the guidance document to anyone else, but that we ask them to download their own copy.
If the guidance or any part of it is used in evidence synthesis we ask that people:
- Acknowledge the authorship team;
- Send copies of any reports/papers that are produced to h.chadburn@lancaster.ac.uk, for the attention of Professor Jennie Popay;
- Let us have any comments/suggestions for how the guidance could be improved so that people's experience can be incorporated into subsequent updates.
Guidance document
NS Synthesis Guidance Version 1 - April 2006
Demonstration review documents
People
Dr Susannah Baines
Research Associate
s.baines1@lancaster.ac.uk
Hannah Chadburn
Programme Administrator
h.chadburn@lancaster.ac.uk
Dr Michelle Collins
Senior Research Associate
michelle.collins@lancaster.ac.uk
Dr Rachael Eastham
Senior Research Associate
r.eastham1@lancaster.ac.uk
Professor Eric Emerson
Emeritus Professor
eric.emerson@lancaster.ac.uk
Dr Emma Halliday
Senior Research Fellow
e.halliday@lancaster.ac.uk
Professor Chris Hatton
Professor of Public Health and Disability
chris.hatton@lancaster.ac.uk
Dr Paula Holland
Lecturer
p.j.holland@lancaster.ac.uk
Professor Bruce Hollingsworth
Professor
b.hollingsworth@lancaster.ac.uk
Dr Vivien Holt
Senior Research Associate
v.l.holt@lancaster.ac.uk
Jenny Irvine
Public Engagement Facilitator
j.irvine@lancaster.ac.uk
Dr Katharina Janke
Lecturer in Health Economics Modelling
k.jankemarie@lancaster.ac.uk
Koser Khan
Senior Research Associate
k.khan4@lancaster.ac.uk
Dr Mark Limmer
Lecturer
m.limmer@lancaster.ac.uk
Dr Ceu Mateus SFHEA
Senior Lecturer in Health Economics
c.mateus@lancaster.ac.uk
Professor Elizabeth McDermott
Professor of Health Inequality
e.mcdermott@lancaster.ac.uk
Professor Jennie Popay
Professor
j.popay@lancaster.ac.uk
Dr Ana Porroche-Escudero
Senior Research Associate
a.porroche-escudero@lancaster.ac.uk
Dr Siobhan Reilly
Senior Lecturer
s.reilly@lancaster.ac.uk
Dr Janet Robertson
Research Fellow
j.m.robertson@lancaster.ac.uk
Gill Sadler
Senior Manager CLAHRC
g.sadler1@lancaster.ac.uk
Fiona Ward
Senior Research Associate
f.j.ward@lancaster.ac.uk
Paula Wheeler
Honorary/Visiting
p.wheeler1@lancaster.ac.uk
Dr Eugenio Zucchelli
Senior Lecturer
e.zucchelli@lancaster.ac.uk