Working ‘upstream’ to reduce social inequalities in health:a qualitative study of how partners in an applied health research collaboration interpret the metaphor

McMahon, Naoimh (2021) Working ‘upstream’ to reduce social inequalities in health:a qualitative study of how partners in an applied health research collaboration interpret the metaphor. Critical Public Health. ISSN 0958-1596

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Abstract

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular ‘upstream-downstream’ story, and what it means to work ‘upstream’ to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants’ research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences.

Item Type:
Journal Article
Journal or Publication Title:
Critical Public Health
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2739
Subjects:
ID Code:
155554
Deposited By:
Deposited On:
01 Jun 2021 10:10
Refereed?:
Yes
Published?:
Published
Last Modified:
02 Jun 2021 02:35