Understanding health inequality in older people

Health inequalities result in poor accessibility to primary, secondary, community and preventative care. Additionally, they are associated with poor access to food sources and other health practices such as physical activity and exercise, across a person’s lifespan.

Older people living in deprived communities have reduced access to a range of services, which compromise their health and social care. These issues are often further exacerbated in areas of conflict, political and social unrest. Globally, we have an increasingly ageing population, and the importance of addressing issues related to deprivation in this vulnerable group is crucial.

Listening to the community

Community development approaches to improving health have been evidenced as more effective than top down approaches, yet, they are not always deployed when addressing health inequalities in this population. Community development approaches involve listening to people’s experiences, supporting communities to identify their own barriers to health and wellbeing, and incorporating their voices into the design, development, implementation and reporting of research.

Our research aimed to identify new approaches to address inequalities in health among older people living in low income and economically disadvantaged communities. Working alongside GW4 - a collaborative network of four universities based in South West England - we designed and delivered a two day, international residential workshop, known as a 'sandpit'. The Sandpit was held in Bristol in March 2018.

Finding new approaches

During our sandpit event, we aimed to:

• create a network and data base of academics, professionals and local community members, with expertise in the inequalities of older people (participants were from across the GW4 locality in the South West of England, as well as researchers from two Development Assistance Countries (DAC), Colombia and Namibia)
• form a platform to develop community lead public health education health initiatives, identified by the local communities
• develop one-two potential research projects in readiness for any future, related calls

The event saw researchers hold a number of activities, including developing connections between professional and academic groups, presenting emerging key themes to community leads, service uses and charities, and running a Dragons Den type session to establish the most appropriate ideas to move forward.

Outcomes and next steps

A number of key themes and ideas were generated initially on the first day of the event. These themes were further discussed, refined and prioritised with the delegates who joined us for day two, using a world café style approach.

The resulting projects were selected for further development:

• empowering communities through inter-generational activities
• understanding enablers and barriers to accessing activities
• evaluating existing models: impact on social isolation and health
• professional versus community lead activities: impact and engagement and models of good practice

The two-day residential sandpit was a success. Those who attended were enthusiastic and willing to engage further to discuss and develop the ideas identified, in readiness for a grant application. The group identified that a larger group of academics may have increased focus and productivity, and the presence of a public health colleague would have also enhanced the knowledge base.

Phase two

The research team is now in phase two of the project, working on developing a funding application to address one or two of the themes identified in phase one. A collaborative team from Bath, University of Bristol, University of Cardiff and the University of Exeter are working on the project.

Aims of phase two

• Refine objectives based on the four themes identified in phase one
• Identify a community champion coordinator to work as part of the steering group
• Identify a community champion in each of the four GW4 localities
• Test the acceptability of the suggested projects identified from the international sandpit event, with communities of older people in areas of deprivation in the locations of Exeter, Bristol, Bath and Cardiff

Project team

• Dr Nikki Coghill, University of Bath
• Dr Jessica Francombe-Webb, University of Bath
• Dr Melanie Chalder, University of Bristol
• Dr Martin O’Neill, University of Cardiff
• Dr Katrina Wyatt, University of Exeter
• Dr Lindsey Anderson, University of Exeter

Funder

This project is funded by a GW4 Initiator Grant.