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Background Systems thinking has emerged as a promising approach to addressing complex public health issues. For children, the focus of the approach has been on single outcomes e.g. obesity, rather than addressing the broad range of inequalities in health outcomes. We report on an approach to developing a system-oriented perspective on the determinants of inequalities in child health and wellbeing in English local authorities. Methods Qualitative group concept mapping workshops (a 'soft' system science approach) were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were refined using data from qualitative interviews with professionals (N = 16) and resulting maps reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online consultation (N = 21; N = 8) and qualitative interviews (N = 12) with experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities, and give insight into its potential utilisation. Results The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. Conclusions To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. Group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities and is a useful tool for strategy development, action prioritisation and systems evaluation planning. Key messages Group concept mapping can be successfully applied to facilitate a systems approach to child health inequalities at the local area level. Mapping the local child health system highlights complex relationships between physical, social, personal, service, governance and economic factors which influence inequalities and health outcomes.

Background Many health outcomes for children and young people in England, UK remain poor compared to international peers, with persistent inequalities across the country. Our study sought to understand, from the perspectives of local stakeholders, the key factors affecting the development and implementation of policy to improve child health and reduce inequalities. Methods We carried out a detailed case study in an English local authority area. Our fieldwork comprised: documentary review of local policies, observation of key strategic and operational meetings and semi-structured interviews with local stakeholders. We followed Jessop's (2016) approach in using specific policy areas and policies (mental health, obesity and the early years) as 'entry points' to understand the local context. Results First, and most importantly, there was an overriding consensus that local action to reduce inequalities in child health is hampered by a persistent unequal distribution of the social determinants of health. Second, local stakeholders highlighted the damaging impact of austerity measures and poverty in the UK, which, they argued, had impacted most upon the most vulnerable. Third, while national policies often provided a framework and incentive for local action, there was an emphasis on the importance of local knowledge and place-based approaches, developed through close work with communities. Conclusions Our study highlights the need for progressive policies to begin to reduce the uneven distribution of the social determinants of health to enable local stakeholders to make progress in tackling inequalities in child health. It emphasises the futility of funding national policies to improve child health and reduce inequalities in the context of greatly reduced budgets for local authorities. National policy should also facilitate the mobilisation of context specific knowledge, produced in conjunction with community members. Key messages Our work evidences the pressing need to address structural inequalities and adequately resource and facilitate work to reduce inequalities at a local level. National policy should facilitate the mobilisation of context specific knowledge, produced in conjunction with community members.

Background In recent years, asset-based approaches (ABAs) to promote health have increasingly been adopted as a strategy to reduce health inequalities between neighbourhoods. However, evidence of impact is still limited due to their complexity. This research aimed to explore what changes ABAs generate, studying two asset-based initiatives that train local lay people to become peer health promoters, implemented in two different settings (Spain and UK). Methods A five months ethnography was conducted in each setting between March 2018 and March 2019. Data were collected through 127 hours of observations and interviews with 44 participants (learners, community workers and health professionals). Thematic analysis was performed to explore the impacts of the interventions and their interactions with local contexts. Results Preliminary findings indicate that learners' self-confidence, knowledge and skills for addressing local health determinants increased in both settings. However, contextual factors played an important role in supporting or hindering wider impacts in the communities where the initiatives were implemented. Opportunities for working together across sectors and being supported by local institutions were key elements supporting learners to transfer the acquired confidence, skills and knowledge to other settings beyond the time and space of the initiatives. These learners reported volunteering more in their communities, developing new activities, or transferring skills in their workplace to change practice and attitudes. Conclusions This study found that ABAs initiatives implemented in communities have the potential to support reduction of inequalities through increasing people's skills, knowledge and self-confidence. However, it is key to work intersectorally to create enabling environments where these acquired capacities can be mobilised, as the context can support or hinder wider changes to occur. Key messages Asset-based interventions to promote health increase people knowledge, skills and self-confidence, but it is key to consider how contextual factors can favour or hinder the potential for wider impacts. Community structures and institutional support for joint working influence mobilisation of learners’ acquired confidence, skills and knowledge beyond the formal spaces of asset-based interventions.

The number of older adults living in Europe is expected to grow rapidly over the next 15 years, raising a number of new public health challenges. Inequalities in health are evident within all European countries, the most prominent of which relate to socio-economic differences. In the current European context of economic difficulties and austerity, fundamental aspects of welfare provision through the state have been challenged. In the UK, there have been calls to reconsider the viability and fairness of …