19 July 2017
Oli Williams has published his first two papers from his CLAHRC West work. Both papers look at how promoting healthy behaviours can negatively impact on people in lower socioeconomic groups and widen the health gap between them and those of higher socioeconomic status. Oli held the Dan Hill Fellowship in Health Equity at CLAHRC West and explains in his publications that when it comes to promoting healthy lifestyles, equity is the answer.
He completed a four-year project working with people living in a deprived neighbourhood in the Midlands, where an intervention attempted to increase local levels of physical activity. He found that the intervention had achieved some useful outcomes such as building a new local leisure centre and setting up free and subsidised local activity groups. However, once the intervention had finished much of the progress that had been made was lost. Without funding the leisure centre became less accessible to residents and local groups disbanded.
Health interventions often have adverse effects. In the first of Oli’s two papers he identifies the adverse effects that had occurred as a result of this local physical activity promotion. His findings show that barriers that had previously been broken down, such as childcare, were resurrected when cuts were made after the intervention. For example, the drop-in crèche at the leisure centre was closed.
The resurrection of these barriers meant that the leisure centre became less accessible to the previously targeted local residents but people from higher socioeconomic groups were still able to take advantage of what was on offer there. In short, the intervention did not support everybody to live active lifestyles in the long-term.
Unfortunately, local service providers often framed non-participation as a result of local residents making bad choices, instead of recognising the significant and detrimental impact of social inequality and cuts to local services. These views further stigmatised an already marginalised community.
Addressing adverse effects like these could significantly improve health outcomes. Oli’s paper highlights how and why interventions designed to encourage people to eat well and move more in order to live longer will often increase health inequalities rather than reduce them and blame the victim.
A big step towards avoiding these unfair and ineffective outcomes would be for those promoting behaviour change to ensure that all interventions offer equitable opportunities in both the short and long term. If interventions are equitable it means that everyone receives fair support to benefit from them and improve their health rather than benefitting some people more than others and, as a result, increasing health inequalities. Oli picked up on this point again in his second publication which he wrote with Kass Gibson, a researcher at Plymouth Marjon University.
Kass completed a research project observing the working practices of exercise scientists. His work highlights how and why evidence created in the lab often fails to be applicable to real world settings and so does not significantly reduce inactivity. For instance, the assumptions that ‘exercise is medicine’ and if more people knew just how good it was for them they would become more active created blind spots in the work of exercise scientists. The most significant being that it’s inequality, rather than ignorance and bad choices, that inhibits people living active lifestyles. As Oli’s research showed, the problem is rarely a lack of knowledge but rather that social inequality inhibits people in lower socioeconomic groups from being more active.
Oli and Kass decided to combine their research findings to write stories (fictional in form yet factual in context) to show readers why – when attempting to promote physical activity in a vastly unequal society – framing exercise as medicine is part of the problem.
They argue that the most effective strategy is also the fairest strategy: reducing social inequality and promoting activity with equitable interventions that offer people support relative to their needs. In order to achieve this they say that there is a need for more collaboration between lab-based scientists, social scientists, policy makers and those designing health interventions. Equitable interventions are more effective interventions, and in the case of physical activity, interventions need to address inequality and inactivity as joint issues.