Meaningful inclusion of young people’s perceptions and experiences of inequalities is argued to be critical in the development of pro-equity policies. Our study explored young people’s perceptions of what influences their opportunities to be healthy within their local area and their understandings of health inequalities. Three interlinked qualitative focus group discussions, each lasting 90 to 100 minutes, with the same six groups of young people (n = 42) aged 13–21, were conducted between February and June 2021. Participants were recruited from six youth groups in areas of high deprivation across three geographical locations in England (South Yorkshire, the North East and London). Our study demonstrates that young people understand that health inequalities are generated by social determinants of health, which in turn influence behaviours. They highlight a complex interweaving of pathways between social determinants and health outcomes. However, they do not tend to think in terms of the social determinants and their distribution as resulting from the power and influence of those who create and benefit from health and social inequalities. An informed understanding of the causes of health inequalities, influenced by their own unique generational experiences, is important to help young people contribute to the development of pro-equity policies of the future.

Background Across England, inequalities in health are worsening. They have been exacerbated by the COVID-19 pandemic and are particularly acute for some ethnic and socioeconomic groups, and some regions. Exploration of the public's understanding of health inequalities has increased, but few studies have looked at the views of young people. Our study seeks to redress this gap by exploring young people's perspectives of inequalities in health. MethodsWe did a qualitative study consisting of three interlinked focus groups (online and face-to-face) with young people from six youth organisations. Focus groups took place from Feb 10 to June 28, 2021. They were co-delivered with partnering youth organisations and involved participatory concept mapping activities and the discussion of health-related news articles. Working with youth organisations, we recruited young people (aged 13-21 years) from six youth groups in areas of high and mixed deprivation across three geographical locations in England (the North East, South Yorkshire, and London). Data were analysed using thematic analysis. The data management software NVivo 12 was used to facilitate coding. All participants provided written informed consent, following acquisition of verbal informed consent from parents or guardians. Ethical approval for the study was granted by the University of Sheffield, Durham University, and London School of Hygiene & Tropical Medicine ethics committees. Findings We ran 15 focus groups online and three face-to-face with 42 young people (19 male, 18 female, two nonbinary, and three trans-male). Numbers ranged from two to ten participants in each group. Young people described a variety of different factors that shaped their health, including individual behaviours, personal or household resources, relationships and community, local services, the physical environment (particularly reputation and safety), psychosocial factors (including sense of belonging), and the socioeconomic context of the area (eg, quality and quantity of local jobs). However, throughout their discussions they foregrounded the importance of interrelationships between factors. Young people's understanding of inequalities in health were often rooted in their own experience and focused on an awareness of advantage and disadvantage. Young people articulated several different pathways through which they perceived health inequalities to be created, and consistently emphasised the importance of poverty as a root cause of inequality. Priorities for change included improving mental health support, access to safe and healthy local spaces, affordability of activities, healthy food availability, and youth group funding. Interpretation Our study highlights that young people have nuanced, experiential understandings of factors influencing their and other people's health within their local areas. Exploring young people's perspectives of inequalities is crucial in designing policies that are relevant to, and informed by, the people and places they affect.

Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0–25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0–25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.

Background The rising prevalence of mental health problems is a growing public health issue. Poor mental health is not equally distributed across social groups and is associated with poverty and insecure housing. An evaluation of a social housing intervention provided an opportunity to explore the connections between housing and wider determinants of health and wellbeing. Methods We undertook 44 interviews with social housing tenants over a two-year period to explore their views on housing, health and wellbeing. Results Poor mental health was common. The results suggest that perceptions of housing quality, service responsiveness, community safety, benefit changes and low income all have a detrimental effect on tenants’ mental health. Conclusions Social housing providers who wish to have a positive impact on the mental health of their tenants need to consider how to best support or mitigate the impact of these stresses. Addressing traditional housing officer functions such as reporting or monitoring home repairs alongside holistic support remains an important area where social housing departments can have substantial health impact. Tackling the complex nature of mental health requires a joined up approach between housing and a number of services.

PurposeThe use of online focus groups to explore children and young people's (CYP) perspectives of inequalities in health and associated “sensitive” topics raises important ethical and methodological issues to consider. The purpose of the paper is to discuss lessons learnt from navigating the authors' way through some of the key challenges the authors encountered when researching inequalities in health with CYP through online focus groups.Design/methodology/approachIn the paper, the authors draw on reflections and notes from the fieldwork design, public involvement and engagement (PIE) activities and data collection for their research project.FindingsCollecting data online influenced the authors' ability to develop rapport and relationships with CYP and to provide effective support when discussing sensitive topics. The authors note that building activities to develop rapport with participants during recruitment and data collection and establishing clear support and safeguarding protocols helped navigate challenges of online approaches around effective and supportive participant engagement.Originality/valueThe paper highlights that despite ethical and methodological challenges of conducting online focus groups with CYP on potentially sensitive topics, the adoption of practical steps and strategies before, during and following data collection can facilitate the safe participation of CYP and generate useful and valid data in meaningful and appropriate ways.