TY - JOUR

T1 - Assessment and Qualitative Comparative Analysis of English Local Authority Joint Health and Wellbeing Strategies to Improve Health under Austerity Conditions, 2013–2017

AU - Tompson, Alice

AU - Egan, Matt

AU - McGill, Elizabeth

AU - Rinaldi, Chiara

AU - Mead, Rebecca

AU - Holland, Paula

AU - Alexiou, Alexandros

AU - Popay, Jennie

AU - Lhussier, Monique

PY - 2024/7/25

Y1 - 2024/7/25

N2 - Background. Local government is important for health equity because local policies often affect place-based health, health equity, andtheir wider social determinants of health. In England, local governments must produce Joint Health and Wellbeing (JH&W)Strategies, outlining local strategies for health improvement. These strategies have been produced concurrently with budget cuts tolocal governments that are associated with adverse health and mortality outcomes. Using a novel approach, we assessed whetherEnglish local governments’ strategies for place-based health and equity help explain why some disadvantaged areas have bettermortality trends than others. Methods. We sampled “Joint Health and Wellbeing” (JH&W) Strategies for 20 disadvantaged localitiescovering the years 2013–2017. We sampled areas to include some with larger and some with smaller budget cuts. We developeda qualitative appraisal process for scoring the extent to which JH&W strategies focused on (i) place-based social determinants ofhealth and (ii) health equity. Using qualitative comparative analysis, we assessed whether mortality trends might be explained byJH&W scores or wider contextual factors such as budget cuts, population age, and disadvantage. Results. JH&W strategies on place-basedsocial determinants of health and equity were often underdeveloped. Only a minority of strategies were highly rated (i.e.,scoring >2 out of 3) for addressing social inequalities of health (n . 6), and even fewer scored highly for place-based social determinantsof health (n . 3). Our qualitative comparative analysis found that external and contextual factors (e.g., budget cuts anddisadvantages) offer more plausible explanations than JH&W strategies for place variations in life expectancy trends. Conclusion.Budget cuts and other contextual factors better explain mortality trends than JH&W strategies. +is raises concerns about what suchstrategies can realistically achieve in the face of structural disadvantage and national policies that restrict local spending.

AB - Background. Local government is important for health equity because local policies often affect place-based health, health equity, andtheir wider social determinants of health. In England, local governments must produce Joint Health and Wellbeing (JH&W)Strategies, outlining local strategies for health improvement. These strategies have been produced concurrently with budget cuts tolocal governments that are associated with adverse health and mortality outcomes. Using a novel approach, we assessed whetherEnglish local governments’ strategies for place-based health and equity help explain why some disadvantaged areas have bettermortality trends than others. Methods. We sampled “Joint Health and Wellbeing” (JH&W) Strategies for 20 disadvantaged localitiescovering the years 2013–2017. We sampled areas to include some with larger and some with smaller budget cuts. We developeda qualitative appraisal process for scoring the extent to which JH&W strategies focused on (i) place-based social determinants ofhealth and (ii) health equity. Using qualitative comparative analysis, we assessed whether mortality trends might be explained byJH&W scores or wider contextual factors such as budget cuts, population age, and disadvantage. Results. JH&W strategies on place-basedsocial determinants of health and equity were often underdeveloped. Only a minority of strategies were highly rated (i.e.,scoring >2 out of 3) for addressing social inequalities of health (n . 6), and even fewer scored highly for place-based social determinantsof health (n . 3). Our qualitative comparative analysis found that external and contextual factors (e.g., budget cuts anddisadvantages) offer more plausible explanations than JH&W strategies for place variations in life expectancy trends. Conclusion.Budget cuts and other contextual factors better explain mortality trends than JH&W strategies. +is raises concerns about what suchstrategies can realistically achieve in the face of structural disadvantage and national policies that restrict local spending.

UR - https://onlinelibrary.wiley.com/doi/10.1155/2024/4764325?msockid=393cc8583dde6c063495dca13ca46d67

U2 - 10.1155/2024/4764325

DO - 10.1155/2024/4764325

M3 - Journal article

JO - Health and Social Care in the Community

JF - Health and Social Care in the Community

SN - 0966-0410

ER -