Parity of esteem and systems thinking: a theory informed qualitative inductive thematic analysis

Abstract

Background Parity of Esteem (PoE) is about equality between mental and physical health but is a term lacking definition and clarity. The complexity of the field of mental health and the conversations around PoE add to its opacity. Therefore, the aim of this study is to use systems thinking to explore the strengths and challenges of using PoE. Methods This is a secondary analysis of descriptive qualitative data, from 27 qualitative interviews, utilising the World Health Organisation (WHO) system domains as a framework for the inductive thematic analysis. Results Examining the current strengths and challenges of systems in mental and physical healthcare using the WHO domains and macro, meso and micro levels, identifies specific actions to redress inequity between mental and physical health provision. Conclusion The evidence suggests that moving PoE from rhetoric towards reality requires new configurations with a systems orientation, which uses macro, meso and micro levels to analyse and understand the complexity of relations within and between domain levels and reorienting funding, training and measurement. This requires embedding new competencies, infrastructures and practices within an effective learning healthcare system.

Trends in weight gain recorded in English primary care before and during the Coronavirus-19 pandemic: an observational cohort study using the OpenSAFELY platform

“…These differences may reflect associations between disordered eating, reduced physical activity and poor mental health exacerbated by the pandemic. 20,21 Our finding highlights the need for health services to ensure parity of esteem 22 between physical and mental health conditions when prioritising groups to be supported by weight loss interventions.…”

Trends in weight gain recorded in English primary care before and during the Coronavirus-19 pandemic: An observational cohort study using the OpenSAFELY platform

“…As a descriptive study we cannot assign a causal relationship between mental health conditions and unhealthy patterns of weight gain, nor comment on pathways that may mediate apparent associations. However, our findings highlight the need for parity of esteem [ 27 ] between physical and mental health conditions in research and when prioritising groups to be supported by weight loss interventions.…”

“…An increase in median BMI was seen in all subgroups, except the oldest age group (aged 80 to 90), people with dementia, and people with T2D. Although for some groups, such as individuals living in the least deprived IMD quintile, this increase was quite modest (IMD 5: 27.0 kg/m 2 , IQR [23.9, 30.9] in 2019 to 27…”