Examining Intersectional Inequalities in Access to Health (Enabling Resources) in Scotland: Advancing the Participatory Paradigm

This photovoice project (funded by the British Academy and Leverhulme Trust) contributed to wider participatory ation research to deepen understanding of how multiple factors intersect to determine access to resources affecting health, and to understand how policy-making processes can be made responsive to community voices. The study was carried out between Jan’17-May’18 in two deprived areas of Scotland- Leith and Craigmillar.

Photovoice was used to record resources and environments that enable health, facilitate collective reflection and critical dialogue on their distribution, determine contexts that impede access to health resources and changes necessary at policy level. Recruitment was in 2 phases. First, resident community workers in the two sites. Second, residents through multiple entry points including pre-defined specific identity or axes of marginalisation (young ethnic minority, breakfast clubs &walking group of homeless men). In total, 4 groups of 4-6 members each participated.

Participants revealed a combination of material, environmental, socio-cultural and affective resources as enabling health. Value was placed on strong community oriented primary healthcare as well as wider determinants such as safe/secure housing and healthy foods. In addition, social and affective resources such as self-esteem were stressed.

Submitted by:
Anuj Kapilashrami and Sara Marsden

Community-oriented and compassionate health care

Strong community-oriented healthcare is critical. The centre does great things. People that work here are very community orientated and kind in how they treat you. You don't get that treatment in certain places because they're under that much pressure. The community here starts from hospital and they are with the community.

Photographer: Anonymous, Men’s Activity Group Photovoice Walk participant

Social housing and exclusion: securitising the iconic banana flats

The iconic banana flats reflect the changing nature of social housing and loss of community. “I don't like the use of it now…Down and outs, alcoholics, all trying to rehab. They're all put together, in what’s now a highly securitised complex to keep them away.”

Photographer: Anonymous, Men’s Activity Group Photovoice Walk participant

Inequities in housing resulting in isolation and exclusion

“You see two types of windows. Some are well kept with flowers, smart curtains. Others are boarded up, derelict but with signs of life. I’ve been there and know that the person living there is dealing with addictions, isolation. […] We need affordable housing but the planning system favours developers redeveloping community spaces (social housing, cinema, café) into more luxury flats”.

Photographer: Community Workers group participant

Insecurity of job and decent income: job centre as a source of mental distress

There are big health impacts of benefit reforms; stress from changes, being without money, having to learn new skills etc. Even professionals who have lost jobs find applying for benefits appalling. So, imagine if you're vulnerable or homeless, have problems with addiction or never had education, it's horrendous.

Photographer: Community Worker Participant

Loss of common public goods

This is one of the few public toilets remaining. City is undergoing major changes. The council has been selling toilets. That’s a bad thing, especially for those who need to move about the urban space (because of homelessness, unemployment, to get exercise, or feeling unsafe at home) and who have little or no disposable income.
Photographer: Men’s Activity Group participant

Tackling Social isolation and bringing communities together

Producing things that are helping other people keeps you active, rekindling and sharing skills, but also helps self-esteem. It's that whole thing about being needed again, as opposed to being a burden on society because you're elderly and it's all draining the services of doctors and hospitals. We're actually contributing again.

Photographer: Elderly Scottish women’s craft group