Subscribe
Share
Share
Embed
Mike Green and Anna Pearce speak to Gillian Fergie and Caroline Vaczy about Creative Insights – their participatory project to gain young people’s perspectives on health inequalities.
Podcast series from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Anna Pearce:
So welcome to our latest episode of 15 Minutes on Health Inequalities. We're going to be talking about young people's insights into health inequalities. I'm Anna Pearce with the Social and Public Health Sciences unit. And today I have with me
Mike Green:
Mike Green, I work with Anna in the Inequalities programme and we've got two of our other colleagues from the Social and Public Health Sciences unit here and I'll let them both introduce themselves.
Gillian Fergie:
Hi there, I’m Gillian Fergie. I'm a Research Associate in the same Unit as Mike and Anna and I'm really pleased to be here to talk about young people's perspectives on health inequalities.
Caroline Vaczy:
Hi. My name is Caroline Vaczy. I'm a Research Assistant on the Creative Insights Project at the University of Glasgow. Really happy to be here.
Mike Green:
So can I start by asking why you think it's important to get young people's insights on health inequalities?
Gillian Fergie:
Yeah. Thanks Mike. So yeah, we do think it's really important because despite there being decades of research and policy attention on the link between social position and health in the UK, the unfair and avoidable differences in health across the population persist. And some people suggest that policies to address the social determinants of health and those macro level influences on people's health and wellbeing are less well supported by the public. Michael Marmot's recent report from 2020 has a call for action to address the lack of public conversation around what determines people's health, sort of build support for policy action in this area. And there's been a small body of sociological research which gives us a bit of an insight into the complexities of how the public understand and discuss the determinants of health. And it tells us a bit about the UK public’s, and particularly people living in areas of deprivation or experiencing inequality, that they are really aware and articulate well the structural drivers of health and inequalities. But also that their account may be sometimes constrained because of the stigma associated with poverty and ill health. But we know much less about what young people think about this. Their perspectives are missing from the literature largely and the little bit of research that does exist suggests there might be slight differences in how they think about these issues, em, and more concerned for those issues most tangible to their life stage. And even less research goes on to explore young people's perspectives on addressing health inequalities, which also seems to us like an important gap to address.
Anna Pearce:
So can you tell us a bit more about the research approach and how you designed the project?
Gillian Fergie:
Yeah, absolutely. So, our project was developed with the aim of exploring young people's perspectives on drivers of health inequalities but, as I mentioned, importantly to fill this gap around their perceptions of opportunities for effecting change in this area. And we were particularly interested in working across the UK context. So, in Scotland and England and engage with groups of young people in cities where reducing health inequalities is a priority. So, we developed partnerships with organisations working with young people in both Glasgow and Leeds. And we were also keen to engage with them in a way that offered opportunities for them to direct the project towards those issues which mattered most to them. So, rather than use the traditional qualitative research methods, we aimed to use an art-based approach, co-producing the research process and the outputs with artist facilitators and with young people themselves. And at this point I should mention that the project was conceived pre-pandemic in a face-to-face setting. So, as we developed that, we were met with an additional challenge of trying to facilitate this sort of arts-based approach to exploring health inequalities online and then we also changed the context in terms of young people’s situations, with the disproportionate impact of the pandemic on young people, given the sort of widespread educational disruption, increased levels of unemployment amongst young people, and the surge in mental health. So, in order to make this work, and especially considering this shifting context, we have to work really closely with our key project partners and in Glasgow that was Impact Arts, a Scottish charity that works to support communities through art and creativity. And in Leeds we developed a partnership with Opera North and also Leeds Playhouses, our key delivery partner, and they have lots of experience in community engagement.
Anna Pearce:
Thanks, Gillian. It's all sounding really fascinating so far. Can you tell us how you managed to set up those collaborations in Leeds and Glasgow?
Gillian Fergie:
Yeah. So, that was a fairly lengthy process, as many of these things are, especially applying for funding or then delivering the research and creating outputs. But we wanted to engage with them as early as possible, so they were involved in the funding application developing a broad plan for the project from inception. And that meant we were able to build a shared understanding of our remits and how best to engage with young people, and we also, through the process, had to be really respectful of the different ways that research institutions and arts organisations operate, the timescales they work to and their capacity for project development. And also we have to be sensitive to the context of the pandemic because at the time arts organisations were in a pretty precarious position and they were unclear about funding and employees were furloughed. But we managed to plough through that to develop the project together and this meant that we were able to develop a project where young people were really at the forefront and we wanted to engage a broad range of young people and give them opportunities for creative capacity building, so these relationships were really important to us. And we were able to work alongside the artists to explore how the creative processes could be aligned with our research processes and also with the sharing of evidence and building ideas around health inequalities. So, key to this process was really mutual benefit, that the organisation was adequately resourced and their expertise are recognised and their contribution was well defined. That while we were delivering on research, we are also contributing to their goals for community engagement and created outputs.
Anna Pearce:
So, can you tell us a little bit more about what you did in terms of the engagement and exploring the issues with young people?
Gillian Fergie:
Yeah. So, we had a really hectic project delivery and really full and jampacked and it was actually a really wonderful experience for all the researchers involved. We engaged with six groups of young people and each spent around four days with us, I suppose two researchers and two creative facilitators, and sometimes other youth workers too. Each of the groups of young people were drawn together by a common interest or a shared experience, so they might have been a group of young people who had taken part in an employability programme together or group of young people who were part of a particular youth group in an area where they live. In total, we engaged with 39 young people aged between 14 and 18 with a couple slightly older. And in advance of the week when we were engaging with them, we sent out lots of project information, schedules, resources of public health evidence, but importantly, lots of nice art materials, things to help support them in their creative endeavours and then the workshops themselves were fully online. The facilitation was led primarily by the creative practitioners with resources and publications developed with us in advance. We did loads of online quizzes and whiteboard tasks. We also spoke a lot in large and small discussion groups. We took lots of breaks. We also took photos, played games, engaged with the evidence and also made lots of art. And each week culminated in a showcase event where we invited academics and arts practitioners and lots of people involved in the project to come and hear from the young people and see what they produced. In the Glasgow group, this was being lay with a focus on visual arts and printmaking and then in Leeds the focus was more on creative writing and performing.
Mike Green:
Sounds really great, really fascinating and interesting. I'd love to hear kind of more about what you learned about how the young people understand health inequalities.
Caroline Vaczy:
Sure. So, I should say that we're still in the process of analysing the data and writing it up, but I can give a general overview and some examples of the young people's ideas. So, across all the groups, young people suggested a wide range of factors that determine people's health, and they showed really nuanced and intuitive understandings of the fundamental causes of inequalities in health. Discussion often began with factors rooted in individual lifestyle choices or health behaviours, but then it often broadened out into animated conversations around social, economic and environmental factors that might influence or constrain these choices. In one workshop in Leeds, for example, two participants discussed this in relation to diet. One participant mentioned the importance of, quote, a healthy balanced diet and another responded with comments around peoples access to food and inability to afford to make healthy lifestyle choices, and they ended up concluding that, quote, it just depends on the circumstances that we're in. Another common theme in the data was the importance of young people's tangible lived experiences in their perceptions of inequalities. There was a strong sense that young people's concerns are based on current and near future circumstances, relationships, support networks and advocates are all really key as well as the crucial environments of home, school and social media.
Mike Green:
And I wonder how had the pandemic impacted on their understandings and experiences of inequalities.
Caroline Vaczy:
Yeah. So, of course the pandemic had an impact on their experiences and their perspectives did seem really specific to their life stage. They showed less fear of the disease itself and the consequences of contracting the virus, and much more concerned with the measures to curb spread and the impact that those had on their lives, both during the pandemic and looking ahead to implications for their future opportunities. They showed particular concern with the mental health impacts of staying home and limiting their social contact. One participant wrote a speech about what she saw as, quote, the real pandemic, based on her experience. And we can listen to a little clip of that now.
Recording of young person performing their speech:
COVID brought death, mass isolation and along with the economic downfall. Millions put on furlough, businesses going bankrupt and chaos followed. Lockdown after lockdown after lockdown caused poor mental health and suicide to become the real pandemic. To be restricted and restrained from normal routine, not in control of your own life. It threw the usual balance off. The inequality and injustice which was once unnoticed became more prevalent. Global hysteria helped to uncover the real problems. It wasn't the coronavirus, it was the human race.
Anna Pearce:
Thanks, Caroline. That’s really powerful stuff, hearing about those experiences. Have the young people also sort of given any suggestions for what could be done to help?
Caroline Vaczy:
Yes, they did. We heard lots of ideas for policy solutions to address health inequalities from the young people. For some specific suggestions we can hear again from the young people in. Their own words.
Recording of various young people talking:
There needs to be a change. Here are our demands. We need to create a system that enables direct democracy and the communities to have more say and listen to young people, more transparent decision making in the government. People in positions of power need to listen. More green spaces and focus on environmental matters, which will have an impact on mental health as more people would get the chance to go exercise or sit somewhere calming outdoors. We want a living wage for young people and to cover the cost-of-living expenses of young people. Universal basic income to ensure everyone can meet their living costs. We want affordable housing for everyone. Offering everyone a job and a first job scheme for young people. Imagine what we could achieve if everyone had access to free education. I want income equality. Why can't everyone be paid the same? I want more efficient ways to use green energy. I want an education that makes me feel confident I can get a good job in life. I want free access to more culture and creativity. It's not…[cut off]
Mike Green:
Thanks. That's really fascinating. Did the young people raise issues or solutions that kind of surprised you or were things that you hadn't kind of thought of or that had occurred to you before?
Caroline Vaczy:
Yeah, they absolutely did. The young people had really wide-ranging ideas and many of them were surprising. A lot of the proposed solutions were creative, and I think that speaks to how useful the arts-based methods were in this context. They helped support people to be brave and innovative in suggesting solutions to really complex problems. The close group working also allowed for conversations of potentially controversial or divisive policy proposals. For example, one participant suggested that everyone should receive the same pay regardless of what job they perform, and another participant assumed that she meant to suggest equal pay for equal work. But she actually meant that everyone should be paid the same no matter what their job is and this comment opened up a really dynamic discussion. So, not only were we hearing lots of ideas from the young people, we were also able to get a picture of the complexities around the acceptability of proposals, the ethical dimensions and how young people's perceptions of equity and fairness differed and shaped their ideas.
Mike Green:
So, what's next for you? And for this research?
Gillian Fergie:
Well, as you've heard from Caroline and from the young people themselves, we've got a real diversity of data and they were so generous in their time and their thoughts. So, we're spending a bit of time trying to analyse and write up our analysis of the, yeah, this really vast data set. And we're continuing to engage with arts organisations and the young people and to this end we recently published a zine and a short film, which you've heard some clips from, online on our website.
Anna Pearce:
Really looking forward to seeing more on that, Gillian and how things develop. So, as always, we like to finish these podcasts with one final question and that is what are the implications of this work for health inequalities?
Gillian Fergie:
Yeah. So, I think we would like to continue to think really carefully about how young people's perspectives are able to be more adequately considered in relation to policy development and address unfair differences in health across the population. And I think our work with these groups has helped us to consider language and the processes through which we, as researchers, engage with citizens and the importance of these ongoing discussions which support sharing of ideas and work to negate stigma around health inequalities with public groups, including young people. But also I think, perhaps, researchers working in population health can do more to support citizens and communities and governments to envision a more equitable society and work towards achieving this. And with this in mind, we can perhaps give the last word to the young people in Leeds if that's OK.
Recording of various young people talking:
It's not too late. We are the future. We are the next generation. Let's make it count. Let's make it better. This isn't going to last forever, but these are the things we ask for. For a better future. We need to take action to make sure the problems of the day don't affect the generations to come. When everyone to be truly and finally equal. My generation has realised we are going into uncharted territory. Lost generation. Or hurtful generation. Or inspired generation. Or leading generation. Or passionate generation. Or accomplished generation. Or catalyst generation.
Anna Pearce:
That really is a call to action and really, really inspiring thoughts to finish on. So, thank you. So, I think our time is up. So, all that remains is to say again, thank you to Gillian and Caroline for chatting to us today about this really important and interesting work. Thanks to everybody listening. And finally, just say the links to the film that we've been hearing clips from today and the other resources, including the zine, can be found in the podcast notes, along with all our contact details. Thank you.