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This paper draws on the experience of two Romani and three non-Romani scholars in knowledge production on the health and social inequalities experienced by European Roma populations. Together, we explore how we might better account for, and work against, the complex web of dynamic oppressions embedded within processes of academic knowledge production. Our aim is to encourage careful scrutiny through which sociologists of health and illness might better recognise our own complicity with oppression and identify concrete actions towards transforming our research practices. Drawing on a well-known domains of racism typology (Annual Review of Public Health, 40, 2019, 105), we use examples from our own work to illustrate three interconnected domains of oppression in which we have found ourselves entangled (structural, cultural and interpersonal). A new conceptual framework is proposed as an aid to understanding the spectrum of different “types” of complicity (voluntary–involuntary, conscious–unconscious) that one might reproduce across all three domains. We conclude by exploring how sociologists of health and illness might promote a more actively anti-racist research agenda, identifying and challenging subtle, hidden and embedded negative ideologies and practices as well as more obviously oppressive ones. We hope these reflections will help revitalise important conversations.

While social and spatial determinants of biomarkers have been reported, no previous study has examined both together within an intersectional perspective. We present a novel extension of quantitative intersectional analyses using cross-classified multilevel models to explore how intersectional positions and neighbourhood deprivation are associated with biomarkers, using baseline UK Biobank data (collected from 2006 to 2010). Our results suggest intersectional inequalities in biomarkers of healthy ageing are mostly established by age 40–49, but different intersections show different relationships with deprivation. Our study suggests that certain biosocial pathways are more strongly implicated in how neighbourhoods and intersectional positions affect healthy ageing than others.

This article—third in a series of three—uses theoretical frameworks described in Part 1, and empirical markers reported in Part 2, to present evidence on how power dynamics shifted during the early years of a major English community empowerment initiative. We demonstrate how the capabilities disadvantaged communities require to exercise collective control over decisions/actions impacting on their lives and health (conceptualized as emancipatory power) and the exercise of power over these communities (conceptualized as limiting power) were shaped by the characteristics of participatory spaces created by and/or associated with this initiative. Two main types of participatory spaces were identified: governance and sense-making. Though all forms of emancipatory power emerged in all spaces, some were more evident in particular spaces. In governance spaces, the development and enactment of ‘power to’ emerged as residents made formal decisions on action, allocated resources and managed accountability. Capabilities for alliance building—power with—were more likely to emerge in these spaces, as was residents’ resistance to the exercise of institutional power over them. In contrast, in sense-making spaces residents met informally and ‘made sense’ of local issues and their ability to influence these. These processes led to the development of power within capabilities and power to resist stigmatizing forms of productive power. The findings highlight the importance of designing community initiatives that: nurture diverse participatory spaces; attend to connectivity between spaces; and identify and act on existing power dynamics undermining capabilities for collective control in disadvantaged communities.

Purpose: The purpose of this paper is to explore the perceived usefulness of a diabetes economic model as a potential tool for aiding evidence-based decision-making in public health practice. Methods: Fifteen semi-structured interviews and two focus groups with four participants each were conducted with health and management professionals working in one public health department in a local council. Data were analysed using inductive thematic analysis to generate four themes. Findings: Findings reflect the attitudes and beliefs of a diverse staff group situated in public health services. They demonstrate that the economic model had perceived usefulness, and participants reported positive views regarding the principles of economic modelling for decision-making. The model was perceived as useful but potentially problematic in practice due to organisational constraints linked to limited organisational resources, restricted budgets and local priorities. Differences in the institutional logics of staff working in public health and stakeholders from local government were identified as a potential barrier to the use of the diabetes model in practice. Discussion: The findings highlight anticipated challenges that individuals tasking with making decisions for public health practice and policy could face if they selected to implement an economic modelling approach to fulfill the evidence needs of decision-makers. Previous studies have revealed that healthcare decision-makers would find evidence around the economic impacts of public health interventions useful, but this information was not always available in the context or format required. This paper provides insights into how staff working in public health perceive economic modelling and explores how they consider evidence from a diabetes model when making public health practice and policy decisions.

Over the past decade, the need for greater diversity and inclusion across research systems has received greater emphasis from policymakers, funders, universities and stakeholders. Strategies in support of diversity and inclusion need to be underpinned by the best available evidence. This short briefing paper is a summary of a larger review carried out by a multidisciplinary team from University of Sheffield of the relationship between a diverse and inclusive biomedical and health research community, and the qualities and impacts of its research.

$\textbf{BACKGROUND}$: older people may be less likely to receive interventions than younger people. Age bias in national guidance may influence entire public health and health care systems. We examined how English National Institute for Health & Care Excellence (NICE) guidance and guidelines consider age. $\textbf{METHODS}$: we undertook a documentary analysis of NICE public health ($\textit{n}$ = 33) and clinical ($\textit{n}$ = 114) guidelines and technology appraisals ($\textit{n}$ = 212). We systematically searched for age-related terms, and conducted thematic analysis of the paragraphs in which these occurred ('age-extracts'). Quantitative analysis explored frequency of age-extracts between and within document types. Illustrative quotes were used to elaborate and explain quantitative findings. $\textbf{RESULTS}$: 2,314 age-extracts were identified within three themes: age documented as an $\textit{a-priori}$ consideration at scope-setting (518 age-extracts, 22.4%); documentation of differential effectiveness, cost-effectiveness or other outcomes by age (937 age-extracts, 40.5%); and documentation of age-specific recommendations (859 age-extracts, 37.1%). Public health guidelines considered age most comprehensively. There were clear examples of older-age being considered in both evidence searching and in making recommendations, suggesting that this can be achieved within current processes. $\textbf{CONCLUSIONS}$: we found inconsistencies in how age is considered in NICE guidance and guidelines. More effort may be required to ensure age is consistently considered. Future NICE committees should search for and document evidence of age-related differences in receipt of interventions. Where evidence relating to effectiveness and cost-effectiveness in older populations is available, more explicit age-related recommendations should be made. Where there is a lack of evidence, it should be stated what new research is needed.

The whole study aims to develop support for local authority-based public health commissioners and other stakeholders in prioritising investment in health and addressing health inequalities, and in deciding on disinvestment. In addition, it seeks to understand the issues surrounding the decision-making process. The specific research questions addressed in the overall study are: 1. Which prioritisation tools do commissioners find useful for prioritising public health investment and why? 2. What are the enablers and barriers for decision-making related to prioritising investment in public health? 3. What difference does the use of specific decision-making support exert on spending within and across programmes with reference to improving health and addressing health inequalities?

High rates of immigration in recent years in the United Kingdom presents service design and delivery challenges to primary care. At a time when resources are stretched, services must be both efficient and equitable for patients. Migrants are often healthy on arrival but some groups, such as refugees and asylum seekers, may have many healthcare needs. This study sought to explore how primary care is managing demand on its services by new migrants and how it addresses need in provision.APPROACHThe research was exploratory and formative. It looked at the services delivered in primary care organisations. The study took place between November 2015 and March 2016. Its methods were:Survey and contact form: Non-probability sampleof GPs, other health professionals, practice managers and third sector providers who hadserved new migrant populations in the last fiveyears (n=70); Responses were sifted for contact details and selected for case studies.In-depth case studies: Documentary analysis andin-depth interviews and focus groups with eightcase study primary care organisations.University of Sheffield’s School of Health and Related Research ethics committee (ref no 006009)The report was produced by the School of Health and Related Research (ScHARR) and the Academic Unit of Primary Medical Care (AUMPC), University of Sheffield. ISBN 978-0-9571207-3-0

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods.

Poverty, stress, low level anxiety and depression are associated in some way, but the exact nature of these relationships has not been clearly articulated. \ud This report aims to provide further understanding of these relationships, and the influences which mediate and moderate these.\ud Key points:\ud - The relationships between poverty, stress, low level anxiety and depression are highly complex.\ud - There is very little direct evidence of causal relationships between the factors; with the exception of data showing that poverty causes stress. \ud - The relationship between poverty and anxiety/depression is largely mediated by stress.\ud - A large number of moderating factors act on this relationship at individual, \ud relationship and community levels. \ud - A feedback loop reinforces the relationships linking anxiety and depression back to poverty.\ud - Interventions targeted at the individual level aimed to improve coping with living in poverty, and at the family level to promote positive parenting and family \ud functioning.

Background:\ud The Government of Malawi is seeking\ud evidence to improve implementation of its flagship\ud quality of care improvement initiative\ud —\ud the Standards\ud Based Management-Recognition for Reproductive\ud Health (SBM-R(RH)).\ud Objective:\ud This implementation study will assess the\ud quality of maternal healthcare in facilities where the\ud SBM-R(RH) initiative has been employed, identify\ud factors that support or undermine effectiveness of the\ud initiative and develop strategies to further enhance its\ud operation.\ud Methods:\ud Data will be collected in 4 interlinked\ud modules using quantitative and qualitative research\ud methods. Module 1 will develop the programme theory\ud underlying the SBM-R(RH) initiative, using document\ud review and in-depth interviews with policymakers and\ud programme managers. Module 2 will quantitatively\ud assess the quality and equity of maternal healthcare\ud provided in facilities where the SBM-R(RH) initiative\ud has been implemented, using the Malawi Integrated\ud Performance Standards for Reproductive Health.\ud Module 3 will conduct an organisational ethnography\ud to explore the structures and processes through which\ud SBM-R(RH) is currently operationalised. Barriers and\ud facilitators will be identified. Module 4 will involve\ud coordinated co-production of knowledge by\ud researchers, policymakers and the public, to identify\ud and test strategies to improve implementation of the\ud initiative.\ud Potential impact:\ud The research outcomes will\ud provide empirical evidence of strategies that will\ud enhance the facilitators and address the barriers to\ud effective implementation of the initiative. It will also\ud contribute to the theoretical advances in the emerging\ud science of implementation research.

A national survey was carried out in autumn 2014, using Bristol Online Surveys , to collect the views of selected core members of Health and Wellbeing Boards (HWBs) across England. Invitations to complete the survey were sent to 610 members of HWBs. Overall, after repeated follow-ups, there were 47 responses received between 30th September 2014 and 1st December 2014 (a 7.7% response rate). Of the 47 respondents, 28 (58%) were senior public health professionals, eight (14%) were councillors or executive/cabinet members and six (13%) were senior CCG professionals. Given the low response rate, the results of this survey do not allow for generalisation.

This first briefing paper is an account of why health inequality matters and why health inequalities deserve consideration across all areas of CLAHRC (SY) activity. We begin by briefly reviewing the policy landscape and the prominence of 'inequality' as a growing focus of concern over the past 30 years. We then set out the type of philosophical and political considerations that may underpin the view that health inequality is a problem. Next we identify the main axes of inequality with which we suggest CLAHRC (SY) should concern itself. In the next section of the paper we set out the extent of health inequality in South Yorkshire, as far as available data allow. Finally, we show the relevance of health inequality across the CLAHRC (SY) themes and raise for discussion the implications for CLAHRC (SY) activity.