About the research

Inclusion Health Groups (IHGs) are groups of people that experience very high levels of social exclusion and health inequalities. This study is about ‘Street Inclusion Health Groups’ (SIHGs), that is, people who engage in ‘street activities’ - raising funds (‘begging’), street drinking/public injecting, street sex work and rough sleeping. There is a considerable intersection between these groups as well as common life experiences and risk factors such as addictions, extreme poverty, complex trauma, violence, mental health conditions, criminal justice involvement, chaotic lifestyles and risky behaviours. SIHGs experience profound health inequalities and are high users of healthcare (particularly emergency healthcare), social care and other public services. Very little is known about the determinants of health inequalities in SIHGs, therefore it is not clear how inequalities can be reduced. A small study we conducted in Luton indicated that while fragmented services and difficulty accessing services are likely to contribute to health inequalities, inequalities are driven by an interconnected web of many causal factors. This includes, but goes well beyond, the health and care system and will require working in partnership across services, sectors and communities.

In this project, we are using systems thinking to develop a way of representing an issue which recognises that there are multiple causal pathways leading to potentially complex interactions and feedback loops. Intersectionality will be used as a framework for conceptualising how SIHGs may be affected by a number of discriminations and disadvantages.

Research questions

1. Who are the stakeholders who share responsibility for this issue?
2. What factors contribute to health inequalities in SIHGs at all levels of the system and how do they interact?
3. What system-wide actions might be taken to reduce health inequalities in SIHGs?

This project is due for completion in December 2024.

Project staff

Dr Sarah Wadd, University of Bedfordshire
Maureen Dutton, University of Bedfordshire
Mike Fisher, University of Bedfordshire
David Solomon, University of Bedfordshire