Abstract
Background: Access to healthcare services is experienced unequally throughout Birmingham – one of the most deprived and diverse cities in the UK. Following the principles of the ‘inverse care’ law, many Birmingham residents have the least healthcare services available to them, precluding them from living as healthily as possible. In this paper, we discuss some of the health inequalities in West Birmingham – a locality characterised by some of the highest levels of deprivation in the UK, and a ‘superdiverse’ population. The paper provides a better understanding of how ‘under-resourced superdiverse’ communities deal with existing barriers and healthcare services shortages in their locality, and sheds light on the role of ‘bricolage’, (hyper)local voluntary, community, faith, and social enterprise (VCFSE) organisations, and the importance of co-production.
Approach: This a collaboration between Universities, the NHS, Citizens UK, and VCFSEs who teamed up to better understand the lived experience of West Birmingham residents trying to access their healthcare services.
The team co-designed innovative methodologies of health listening and co-produced initiatives, funded by the project partners, to help tackle some of the barriers that lead to poor health outcomes in West Birmingham.
Together, the team held five listening events with residents from ‘under-resourced and superdiverse’ communities to understand local challenges to accessing health services. Local VCFSEs facilitated residents to attend, providing space, refreshments and space for children to play. At these events 80 participants from minoritised backgrounds outlined their issues accessing healthcare, the impact on their health and wellbeing, and how they coped when facing challenges.
Results:
The biggest barriers to healthy living and accessing health services residents identified included:
-GP accessibility
-Language barriers and lack of suitable translation/interpretation services available
-Lack of continuity of care
-Inadequate support and provision for children and young people services
Other barriers to health services were related to wider social and structural determinants that affected general health and wellbeing because these are areas of deprivation. Including:
-Local Authority closing down local sports centres and swimming pools in underserved areas
-Lack of investment to support voluntary, community, faith and social enterprise
-Poverty and cost of living concerns
-Digital exclusion
Implications: Using the findings, the project team then hosted a ‘community sandpit’ event to co-produce solutions to respond to these challenges. As a result of this initiative, five follow-up projects were funded to support health and wellbeing among local residents. We end this presentation with a discussion of these projects, reflecting on how West Birmingham residents are far from passive social agents waiting to be served by the NHS, who resort to ‘bricolage’ and/or turn to VCFSEs for support. As such we argue that a shift in language is needed to acknowledge this (i.e., moving away from ‘deprived’ or ‘under-served’ to ‘under-resourced’). We also conclude that the impact of superdiversity should not be trivialised when tackling health inequalities, and how a place-based approach is often better suited than scalable one-size-fits-all approaches often favoured by policymakers and funders.