Realities in Health Disparities: Researching Evidence-Based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems

健康差异的现实：研究生活、想象力、创伤性、综合性、具体化系统中基于证据的替代方案

• 批准号: AH/Z505456/1
• 负责人: Marisa De Andrade
• 金额: $ 274.59万
• 依托单位: University of Edinburgh
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=AH%2FZ505456%2F1
• 关键词: Realities; Health; Disparities; Researching; Evidence

We often hear 'the system' is broken, but what do we mean by this? How can changing the way we think about, define, research, evidence, monitor, evaluate and resource 'the system' lead to meaningful change for deprived communities? How will this change benefit those who have first-hand experience of trauma, homelessness, poverty, unemployment, displacement, poor mental health or imprisonment?REALITIES takes a human-systems approach noting 'health and social care systems' (HSCS) are constructed mental representations of relationships existing in the world to promote health for people.Our Scottish consortium of 57 people has five established asset hubs in Clackmannanshire, Dundee, Easter Ross, Edinburgh and North Lanarkshire with strong relationships uniting conflicting ways of seeing the world. Through phase 2, we co-produced a systems-level model with deprived communities, policymakers, practitioners and researchers collecting and respecting different types of knowledge and alternative evidence-bases (from arts performances to nature walks; words to statistics) as equally important to understand complexities of unjust and avoidable health differences.Foundational funding evidenced REALITIES is able to transcend the challenge for our currently imagined HSCS. The medical model of disease shaping who and what is considered to be part of 'the health system' has brought benefits to human existence, though key actors within these place-based HSCS systems understand the limitations of this systems-framing for human flourishing. At present, they don't have a way to help reimagine them.REALITIES provides exploration and method for this reimagining. A model representing collective pathways producing creative routes for people to get the healthcare they need at the right time of their journeys by co-researching and co-creating with them the "what, whom, how, and why" - leading to successful connections between individuals with health and social needs and community-based opportunities for health and wellbeing improvement.We are a transdisciplinary collective of individuals with lived and felt experience of inequalities working alongside policymakers; local authorities; charities; artists; environmentalists and researchers from policy; health humanities; arts; psychology; human geography; environmental sociology; dentistry; medicine; statistics; economics; counselling; psychotherapy; management; medical anthropology; design and innovation.We will:understand what work is needed to enable places to reimagine and build 'systems' that create equitable health and wellbeing.explore and explain how links between creativity, relationships and nature create healthier and more resilient communities and environments for people in deprived areas.support creative, participatory processes, enabling communities to construct shared mental models (systems) using different ways of knowing (epistemologies) and perceiving reality (ontologies).combine different ways of knowing, enabling a more complete representation of bio-psycho-social-political factors which create 'health' and ways in which these are experienced by marginalised people.support communities to construct place-based versions of systems encompassing all aspects of health and wellbeing, and make purposeful changes in the nature of their relationships with each other and their environment.explore the usefulness of 'standard' Health Economic evaluation tools to assess Social Return of Investment, working with communities to re-conceptualise and re-define measures of 'value' and 'quality of life' in relation to human experience.

我们经常听到“系统”坏了，但这是什么意思呢？改变我们思考、定义、研究、证据、监测、评估和资源“系统”的方式如何为贫困社区带来有意义的改变？这一变化将如何使那些亲身经历过创伤、无家可归、贫困、失业、流离失所、心理健康状况不佳或监禁的人受益？现实采用人类系统方法，指出“健康和社会护理系统”(HSCS) 是在心理上构建的代表世界上现有的关系，以促进人们的健康。我们的苏格兰财团由 57 人组成，在克拉克曼南郡、邓迪、复活节罗斯、爱丁堡和北拉纳克郡建立了五个资产中心，并拥有牢固的关系统一看待世界的相互冲突的方式。在第二阶段，我们与贫困社区、政策制定者、从业者和研究人员共同制作了一个系统级模型，收集和尊重不同类型的知识和替代证据基础（从艺术表演到自然漫步；文字到统计）对于了解不公正和可避免的健康差异的复杂性。基金会资金证明 REALITIES 能够超越我们当前想象的 HSCS 的挑战。尽管这些基于地方的 HSCS 系统中的关键参与者了解该系统框架对人类繁荣的局限性，但疾病医学模型塑造了被认为是“卫生系统”一部分的人员和内容，为人类的生存带来了好处。目前，他们还没有办法帮助重新想象。REALITIES为这种重新想象提供了探索和方法。代表集体路径的模型，通过与人们共同研究和共同创造“什么、谁、如何和为什么”，为人们在旅途的正确时间获得所需的医疗保健提供创造性的路线，从而在人们之间建立成功的联系具有健康和社会需求以及基于社区的健康和福祉改善机会的个人。我们是一个跨学科的集体，由拥有与决策者一起工作的不平等经验的跨学科集体组成；地方当局；慈善机构；艺术家；环保主义者和政策研究人员；健康人文；艺术；心理学;人文地理学；环境社会学；牙科；药品;统计数据;经济学;辅导；心理治疗；管理;医学人类学；设计和创新。我们将：了解需要做什么工作才能使地方能够重新构想和建立创造公平健康和福祉的“系统”。探索并解释创造力、关系和自然之间的联系如何为人们创造更健康、更有弹性的社区和环境在贫困地区。支持创造性的、参与性的过程，使社区能够使用不同的认识方式（认识论）和感知现实（本体论）构建共享的心智模型（系统）。结合不同的认识方式，使更完整地代表创造“健康”的生物-心理-社会-政治因素以及边缘化人群体验这些因素的方式。支持社区构建涵盖健康和福祉各个方面的基于地方的系统版本，并使其有目的探索“标准”健康经济评估工具评估投资社会回报的有用性，与社区合作重新概念化和重新定义“价值”和“价值”衡量标准质量生命的意义与人类的经验有关。