Pathology of poverty: the need for quality improvement efforts to address social determinants of health

Boozary, Andrew; Shojania, Kaveh G

doi:10.1136/bmjqs-2017-007552

Cited by 20 publications

(22 citation statements)

References 36 publications

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“…Fundamentally there is an urgent need to rethink public policies that are driving up the numbers of people affected by poverty and food insecurity in the UK [27,[98][99][100]. Healthcare professionals can also play a role by recognising and supporting patients with chronic health problems, and resource needs, such as poverty and food insecurity [59,101,102].…”

Section: Discussionmentioning

confidence: 99%

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

Douglas

MacIver

Yuill

2020

Preprint

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Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Methods : Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.Results : Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions : This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

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Section: Discussionmentioning

confidence: 99%

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

Douglas

MacIver

Yuill

2020

Preprint

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“…This work is challenging enough for people who are food secure, never mind for people who are also preoccupied and physiologically challenged by a lack of access to a stable and appropriate food supply. Indeed, it has also been found that the experience of coping with the resource constraints of poverty itself diverts mental energy to those concerns, thereby reducing an individual's available cognitive capacity to deal with other necessary day-to-day tasks and decision-making (51,52).…”

Section: Discussionmentioning

confidence: 99%

“…Fundamentally there is a crucial and urgent need to rethink public policies that are driving up the numbers of people living with household food insecurity in the UK. Notwithstanding this issue, there is also a need to identify how healthcare professionals can help identify and support patients with chronic health problems, and resource needs, such as poverty and food insecurity (51,86,87).…”

Section: Discussionmentioning

confidence: 99%

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A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

Douglas

MacIver

Yuill

2020

Preprint

View full text Add to dashboard Cite

Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. However, while international evidence outside of the UK indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this high-income country context. Methods :A qualitative investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Interview audio recordings were fully transcribed and thematically analysed.Results : Twenty individuals living with a wide range of self-reported health conditions, and being supported by a local poverty alleviation social enterprise took part. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions :This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

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“…The challenge is also broader than the issue of how attentional resources get distributed to particular clinical areas, and extends to why, for example, the topic of social inequities in healthcare improvement has remained so muted. 61 Once we think about improvement in this way, many aspects of improvement can be recognised as having a technical character, but also a normative character -as was beautifully explained in a recent special issue of Health Care Analysis edited by Alan Cribb. 62 For instance, standards are generally very important for quality and safety, but are prone to a number of technical problems, for example relating to the rapidly evolving and often uncertain nature of clinical evidence base -something William Harvey himself experienced.…”

Section: Think Beyond Effectivenessmentioning

confidence: 99%

Harveian Oration 2018: Improving quality and safety in healthcare

Dixon‐Woods

2019

Clinical Medicine

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Pathology of poverty: the need for quality improvement efforts to address social determinants of health

Cited by 20 publications

References 36 publications

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

Harveian Oration 2018: Improving quality and safety in healthcare

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