Geopolitical aspects of health: austerity and health inequalities

This chapter examines the effects of austerity on geographical health inequalities by focusing on the North–South health divide in England and health inequalities between local neighbourhoods. It first explains the importance of geography for health by presenting the two case studies involving the North–South divide and local inequalities. It then considers the austerity and welfare reforms that have been introduced in England since 2010 and how these policies are affecting these spatial health divides. It also reviews evidence from previous international research into welfare retrenchment, as well as qualitative data about the lived experiences of people at the sharp end of austerity. The chapter concludes by highlighting the uneven consequences of austerity measures for health across localities and across different sociodemographic groups, thus exacerbating existing health inequalities.

What works to improve the health of the multiply excluded?

This chapter considers what is needed to improve the health of people affected by multiple exclusions, focusing on the homeless as exemplars for the research, service and policy agenda known as Inclusion Health (IH). The aim of IH is to prevent and redress health and social inequities among the most vulnerable and marginalised in a community, such as those with experiences of homelessness and drug use. The chapter first explains why special effort is required to improve health care services for multiply excluded groups and argues that neither a right of access to health care nor a right of access to housing is sufficient to address health inequalities. It then discusses what works by emphasising prevention, pharmacological interventions and service organisation before concluding with an overview of models of service delivery and social determinants of health.

Brain injury and social exclusion

This chapter examines the link between brain injury and social exclusion. Evidence suggests that people belonging to socially peripheral and disadvantaged groups are more likely to have suffered an acquired brain injury (ABI), particularly a traumatic brain injury (TBI). However, it is not clear whether this association is due to common risk factors for social exclusion and for brain injury, or whether each increases the risk of the other. The chapter first considers screening for brain injury, with particular emphasis on the Brain Injury Screening Index (BISI), before discussing a number of potential risk factors for brain injury such as homelessness and offending. It then describes a low-cost, low-intensity intervention known as the Linkworker system developed by The Disabilities Trust Foundation (TDTF) and concludes that self-reports of brain injury are an important source of evidence that TBI is prevalent in socially marginalised groups such as offenders and homeless people.

Towards an integrative theory of homelessness and rough sleeping

This chapter considers some of the main psychological factors theorised to cause and maintain homelessness, with an eye towards developing an integrative theory of homelessness and rough sleeping. It first describes what a good theory or model may do in terms of identifying the psychological factors and concomitant interventions that may be useful in helping people to break out of behavioural patterns that maintain a cycle of rough sleeping and homelessness. It then examines factors that affect the likelihood of people becoming and staying homeless on a number of levels by making use of a framework increasing in ‘reductionism’. It also discusses a psychological approach to homelessness, the psychology of environment–individual interaction, and the detrimental effects of attachment and interpersonal issues, cognitive functioning, and negative beliefs on homelessness. Finally, it introduces a model of repeat homelessness that takes into account the factors mentioned above, along with psychological interventions.

Social enterprise and the well-being of young people not in education, employment or training

This chapter examines how social enterprises can improve the well-being of young people who are not in education, employment or training (NEET). NEET or NEETs refer to young people aged 16–24 who are not in education, employment or training. There are two subcategories of NEETs: unemployed young people (those who are actively seeking work) and economically inactive young people (those who have not actively sought work recently and/or are unable to start work imminently). The chapter first explains what we mean by ‘NEET’, ‘well-being’ and ‘social enterprise’ before providing an overview of the prevalence and make-up of the NEET population. It then considers the risk factors of becoming NEET and the consequences of NEET status, along with the social impact of social enterprises. It also uses the case of the Cambridgeshire County Council in Scotland to show how budget cuts adversely affect NEETs and concludes by emphasising the importance of entrepreneurship for NEETs.

Health and well-being in the digital society

This chapter examines the negative effects of increased use of technology on health and well-being using two case studies that illustrate the influence of alcohol use on young people. It first provides an overview of the digital society and Internet use before discussing the ways in which growing engagement with technology has affected sedentary behaviour and how it can also influence mental health. It then considers how the content created by other Internet users may encourage or reinforce health risk behaviours and how digital marketing can affect behaviour. The two case studies show that extensive Internet use, particularly among the youth, emphasises the importance of identifying and addressing determinants of health and well-being in a digital society, and that it is increasing sedentary behaviour that leads to a range of adverse physical and mental outcomes.

Conclusion

This book has examined the social determinants of health using an interdisciplinary approach, showing that relative poverty and social capital will provide the resilience for an individual to experience a sense of well-being and lead to successful ageing, while lifestyle choices and the support of a healthy community will reduce vulnerability to negative health behaviours. It has also explained how personal well-being is related to the availability of personal, family and community resources. This conclusion considers the austerity policies and other highly contentious policy intentions in the Conservative Party's manifesto and highlights their implications for health and well-being, particularly the policy on social care known as the ‘dementia tax’. It argues that these regressive policies are being reinforced by a major economic impact on the UK economy from policies related to Brexit and concludes by emphasising the importance of a wholistic approach to inequality and well-being.

Addiction, inequality and recovery

This chapter examines the impact of health inequalities on addiction and how the recommendations of the Marmot Review could influence recovery from addiction. The Marmot Review was tasked with devising strategies to reduce health inequalities in England, and rightly recognised that health equality requires a debate about what kind of society we want to live in. When considering societies as a whole, there is a clearer relationship between poor health outcomes and societal inequality; rich countries with a steep social gradient do worse than poorer, but more equal, countries. The chapter first provides an overview of factors that cause substance use and addiction before discussing the role of early life adversity in addiction and the link between inequality and addiction. More specifically, it explains how unequal societies lead to addiction and goes on to consider how society can support recovery from addiction.

Nutrition in marginalised groups

This chapter examines key nutritional issues and contemporary advances in human nutrition in marginalised groups. Evidence suggests that the dietary choices of communities on low income, including the homeless and families residing in temporary accommodation, are compromised. Homelessness in particular is associated with increased physical and mental health needs. The chapter reviews the evidence for the nutritional requirements, dietary intake and associated health and lifestyle factors in homeless individuals. It considers the unique challenges faced by single homeless adults and homeless families (residing in temporary or bed-and-breakfast accommodation), along with possible interventions to overcome these. It also discusses the potential benefit and community responses to dietary intervention, food banks and voucher systems within the context of complex nutritional needs, food insecurity and marginalised housing scenarios. UK policies and guidelines, including the National Institute of Clinical Excellence (NICE) and specialist groups, are analysed as well.

Addressing inequalities in education: parallels with health

This chapter examines similarities in patterns of inequality in education and in health. Using England as a case study, it considers broad patterns of educational inequality and recent policy responses to these, emphasising the need for greater understanding of, and engagement with, the underlying causes of educational inequalities. The chapter first provides an overview of patterns of inequality in educational outcomes before discussing policy responses to educational inequalities in England. It argues that a central part of efforts to address educational inequalities must be for education, as a field, to think and act more comprehensively in ways that parallel thinking about the social determinants of health. It also highlights the important role of schools in leading the development of innovative responses to educational inequalities at a local level and concludes with an analysis of overlaps between educational and health inequalities and the responses needed to address these.