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”被打破，但是这是什么意思？如何改变我们的思考方式，定义，研究，证据，监控，评估和资源“系统”对贫困社区的有意义变化？这种变化将如何受益那些拥有创伤，无家可归，贫困，失业，流离失所，精神健康或监禁的人？现实采取人类系统的方法，指出“健康和社会护理系统”（HSC）是在世界上建立的关系的精神表达，以促进人们的健康。罗斯，爱丁堡和北拉纳克郡与牢固的关系结合了矛盾的观察方式。通过第2阶段，我们共同制作了一个系统级模型，该模型与贫困的社区，政策制定者，实践者和研究人员收集和尊重不同类型的知识和替代循证基础（从艺术表演到自然步行；统计数据；统计学）对于不公平的复杂性和可避免的健康差异的复杂性同样重要。对现实的挑战，可以挑战现实的挑战。疾病塑造的医学模型是谁和被认为是“卫生系统”的一部分的医学模型为人类的生存带来了好处，尽管这些基于地方的HSCS系统中的关键参与者了解了这种系统框架对人类蓬勃发展的局限性。目前，他们没有一种方法来帮助重新构想它们。现实为这种重新构想提供了探索和方法。代表集体途径的模型，通过与他们共同研究并与他们共同创建“什么，谁，谁，如何和为什么”通过共同研究并共同创建他们所需的医疗保健，从而导致健康和社会需求的个人在健康和社区基于健康和福祉的机会之间取得成功的联系。地方当局；慈善机构；艺术家；环保主义者和政策研究人员；健康人文科学；艺术；心理学;人地理；环境社会学；牙科；药品;统计数据;经济学;咨询；心理治疗；管理;医学人类学；设计和创新。我们将：了解需要什么工作来使场所重新构想和建立“建立公平的健康和福祉”，从而探索和解释创造力，人际关系和自然之间的联系如何创造更健康，更健康的社区和更富有弹性的社区和更富有的社区，并为贫穷领域的人们提供贫困领域的人们。Suppport创造性，参与性过程，实现了共享的精神上的模型（实现了不同的方式）（ePESSERM）（epsist）（ePesist）（埃德斯）（EPSIST）（）（埃德斯）（）（） 。社会投资回报，与社区合作以重新概念化并重新定义与人类经验有关的“价值”和“生活质量”的衡量标准。