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.

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.

Background A national policy for England, published in 2017, entitled ‘Transforming Children and Young People’s Mental Health Provision’ aimed to address the increasing prevalence mental health problems in children and tackle inequalities. In the context of this policy’s implementation as ongoing and the effects of the Covid-19 pandemic, the need for appropriate, timely and ongoing national government commitment is vital. Methods A narrative review using a problem representation evaluation [1], we critiqued the policy and related consultation documents using a social determinants of health perspective. We also reviewed wider policy discourses through engaging with stakeholder responses, providing an innovative methodological contribution to scholarship on public health policy and health inequalities. Results We found absences and oversights in relation to inequalities (most notably the lack of acknowledgement that mental health can cause inequalities), access, workforce capacity, and the impacts of cuts and austerity on service provision. We suggest these inadequacies may have been avoided if stakeholder responses to the consultation process had been more meaningfully addressed. We illustrate how ‘problems’ are discursively created through the process of policy development, justified using specific types of evidence, and that this process is politically motivated. Local policy makers have a critical role in translating and adapting national policy for their communities but are constrained by absences and oversights in relation to health inequalities. Conclusions This narrative review illustrates how policy discourse frames and produces ‘problems’, and how the evidence used is selected and justified politically. This review contributes to the existing transdisciplinary field of knowledge about how using methods from political and social science disciplines can reveal new insights when critiquing and influencing policy approaches to health inequalities.