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Health Inequalities

Health Inequalities

This enquiry examines the role of design and creative practice in giving voice to older people facing extreme poverty in Sheffield. 

Funded by: Research England

Project lead: Claire Craig, Sarah Smith (Smizz), Helen Fisher

Despite the long-term trends of improvement in life expectancy, infant mortality and rates of premature deaths from cancer and cardiovascular disease in England as a whole, stark inequalities in health remain (Public Health England, 2019). 

According to research undertaken by the Kings Fund ‘long term conditions are 60% higher in people experiencing poverty (DH, 2012). Studies have suggested that the severity of the disease is 30% greater for this population and that multi-morbidity is more prevalent particularly in relation to individuals living with mental health problems. For premature cardiovascular disease mortality considerable inequality by deprivation exists with mortality rates in the most deprived tenth of areas of the UK almost 3.5 times higher than those in the least deprived tenth of areas.

Design has an important role to play in challenging and addressing these inequalities. In 1972 Papanek and Fuller argued that design is imperative to satisfy unmet or underserved needs of marginalised people living in resource limited societies. More recently there has been a diversification of how and where designers are working with greater emphasis on civic responsibility and the value of social design. 

Researchers in Lab4Living engage in a wide-ranging programme of work addressing health inequalities. This current study utilizes a design-led approach to make visible some of the challenges older people living in poverty in Sheffield face. This two year project was undertaken in partnership with REACH as part of the national AgeBetter programme. Inspired by the Life Café (a curated set of materials to enable individuals to have challenging conversations about sensitive topics of end of life), the project lead commissioned the development of a toolkit to support conversations about finances. This was found to be successful and has now been adopted by Age Better in a national roll out of the work.The research culminated in an interactive exhibition where participants were able to share their experiences of social isolation, loneliness and financial hardship. The work has contributed to broader debates regarding he need to create services that are more in-tune with the complex and multiple barriers people living in poverty face.

The 100-year Life: End of Life, Death and Bereavement

An enquiry building on previous work funded by Marie Curie exploring the role of design in rethinking how we experience end of life, death and bereavement.

Funded by: Research England

Project lead: Helen Fisher, Claire Craig

The UK is undergoing a huge demographic shift. On average people are now living much longer and this trend is set to continue: by 2037 the number of people aged 65 and over will rise from 11.6 million today to 17.8 million. While this is a triumph of modern medicine and living standards, it will actually translate into more, increasingly frail, older people, with multiple health issues, who will need more care towards the end of their lives. More people will need personalised and tailored care in the future and most of this care will take place in the community, in people’s own homes and care homes, rather than in hospitals. Within the context of the 100 year life, a consideration of the role of design at end of life is important. Death is a key part of life and of the 100 year life.

This enquiry builds on the 2 year Marie Curie funded research project Design to Care. Claire Craig is working with the Michele Angelo Petrone to explore ways of supporting individuals diagnosed with life-limiting and terminal illness. Helen Fisher is working with the FLOW Academy (led by Sheffield Teaching Hospitals with representation from key organisations across the city including the Carers Centre, Age UK, Sheffield Alliance, MIND and other 3rd sector orgnisations) to explore the potential of design-led interventions in the context of carers and family members.

Re-imagining ageing

This design-led research study seeks to understand, higlight and challenge many of the existing negative conceptualisations of ageing to re-imagine the 100 year life. 

Funded by: Research England

Project lead: Claire Craig, Helen Fisher, Alison Mayne, Fanke Peng

Patricia Moore, in the 1970s identified stigmatising nature of ageing and importance of design and the role it has to play. Yet 50 years after this study little has changed, we still see the design of products and environments that reinforce existing stereotypes of ageing. If the ambitions of the Industrial Strategy are to be realised, we need to find ways of understanding how deeper and hidden conceptualisations of ageing shape the design process. Without this understanding poorly designed products will continue to perpetuate societal assumptions about what ageing means. This research seeks to understand these deeper preconceptions and build insights in relation to how they have evolved. 

This research comprises of 3 inter-related studies:

  • Dr. Claire Craig and Edinburgh based researcher Dr. Alison Mayne have undertaken a systematic review of the ageing and design literature.
  • Dr. Fanke Peng (University of Canberra and co-founder of the cross cultural design lab) is working with older artists in Canberra who are exploring ‘ageing from the inside’ by creating self-portraits through a range of media including sculpture, textiles and painting
  • Dr. Joan Healey on secondment with Lab4Living is exploring this theme using poetry, prose and other forms of writing 

This phase of the work will culminate in an exhibition to share the findings to date and to act as a stimulus for further discourse.

Ageing populations will create new demands for technologies, products and services, including new care technologies, new housing models and innovative savings products for retirement. We have an obligation to help our independent, older citizens lead fulfilled lives, continuing to contribute to society. 

Industrial Strategy

Playponics

Combining the benefits of physical play through developing a low-cost system that facilitates environmental education.

Project lead: Heath Reed, Andy Stanton

Project funding: Global Challenge Research Fund, E3

Partners: ATIVA Design Consultancy, Delhi, Vahani Scholarship Trust

Playponics provides kinaesthetic learning opportunities across STEM subjects, with environmental education and sustainable practices at their core. Through this, the project aims to instil better understandings in current and future populations of our relationship with the natural world. 

The teams has developed play and exercise equipment enhanced with systems that harnesses users physical activity energy, and use that power to sustain a variety of hydroponic and conventionally grown crops. The playground gardens are being researched and designed for schools and communities in India to impart and instil in participants, older and younger,  privileged and underprivileged, knowledge and understanding about STEM and STEAM infused  environmental education and sustainability practices in fun and interactive ways.

Playponics website

Making Sense Together

A space where people with dementia, family members and supporters can come together and explore ways of living well with dementia.  

Project lead: Claire Craig, Helen Fisher

Funded by: Research England

Partners: Scottish Dementia Working Group / Alzheimer Scotland / DEEP Network

Traditionally patient information for people living with dementia is written separately from that aimed at their family members and carers. This research enquiry challenges this genre and through a participatory design research process has developed a resource to enable people with dementia and their family members to make sense of the condition and develop supportive strategies together.

This resource has transformed how we relate to each other. We have completely re-designed our routine, the environment and this has made all the difference in adapting to and managing the challenge that dementia brings.

Support of Person with Dementia

Compassionate Sheffield

​A project exploring what makes Sheffield ‘compassionate’ when it comes to end of life care.

Project lead: Claire Craig, Helen Fisher

Funded by: Research England

Partners: Sheffield City Council

Compassionate Communities are networks of support comprising of family, friends, neighbours and community members; they are the foundation of what matters most to those undergoing experiences of death, dying, loss and care giving. A Compassionate City builds on this, covering the civic aspect of our lives; how we can become engaged in compassionate activities in the workplace, churches and temples, our educational institutions etc. Lab4Living are working with the council and organisations across the city to achieve a Compassionate City status in line with the Compassionate City Charter.

Compassionate Communities – Network Mapping

The development of resources for network enhancement activities, part of the mechanism to establishing Compassionate Communities when it comes to end of life care.

Project lead: Claire Craig, Helen Fisher

Funded by: Marie Curie

Partners: Compassionate Communities UK

Compassionate Communities are networks of support comprising of family, friends, neighbours and community members; they are the foundation of what matters most to those undergoing experiences of death, dying, loss and care giving. The Network Mapping Kit was funded by Marie Curie as an extension to the Life Cafe and is used by Community Connectors to establish and build supportive networks within communities.

For more information about Compassionate Communities please visit the CCUK website.

Patient Experience Toolkit

Patient experience is a highly contested concept. However there is emerging evidence and near universal agreement that Patient Experience (PE) feedback is necessary in order to deliver high quality care. In the UK, there is a mandatory requirement to capture patient experience data. This project aimed to explore staff attitudes towards and understanding of patient experience data, and what (if anything) they did with it.

Funded by NIHR HS&DR

Partners:
Bradford Institute of Health Research
NIHR CLAHRC YH

Project Team:
Design Lead – Joe Langley
Rebecca Partridge, Ian Gwilt, Rebecca Lawton, Laura Sheard, Claire Marsh

An initial scoping review was conducted in stage 1 to understand what Patient Experience (PE) measures are currently collected, collated, and used to inform service improvement and care delivery.

Stage 2 was a phase of action research and co-design iteratively combined. This was followed by an evaluation and a refinement of the intervention developed in stage 2 for scale up to the wider NHS context.

Our specific contribution focused on the co-design in stage 2.

A patient experience improvement toolkit was developed through three workshops using participative co-design methods.  Representatives from six wards from three NHS Trusts and a group of six patient/public representatives volunteered to take part in the three workshops. Members of the research team (who did the initial scoping research) also participated in the co-design.

The initial prototype was piloted for a 12 month period through an embedded action researcher process. The action researchers then engaged in a subsequent design consultancy process to refine and modify the toolkit.

A toolkit was developed to support frontline staff to access, collect, analyse, interpret and use patient experience data to identify ward level changes prototypes and sustain them.

It was identified that the data interpretation skills did not typically exist in the ward and so the toolkit was modified to accommodate a data skilled person as a toolkit facilitator. This individual took on many of the characteristics of the action researchers – primarily because the action researchers took up this role in order to keep the project moving forwards.

What was interesting from a co-design and design research perspective was the presence of the action researchers in the extended prototype testing phase and the mediating role that the action researchers took on after this, acting as an intermediary and gatekeeper between the design team and the frontline staff who had tested the toolkit.

This raised interesting questions for us about how to access the right knowledge (from the frontline staff) ‘remotely’ and how to design ‘around’ the action researchers – in our minds was a constant query about the influence the action researchers played in the process and became part of the intervention itself.

Higher order reflections about design researchers working with health sciences researchers and the integration of methods from design research and health sciences were also raised.

The toolkit has since been further refined into the Yorkshire Patient Experience Toolkit (YPET). A coaches network has been established to support ward staff to use the toolkit, and is available as a free resource.

Portraits of Care

This transnational enquiry uses the media of illustration, photography and textiles to explore narratives of ageing in the United Kingdom and Australia. Two parallel lines of enquiry have been developed.

Project team: Claire Craig, Helen Fisher, Fanke Peng

Funded by: Research England / Canberra University

One strand explores the use of self-portraiture as a mechanism through which older people can explore and express a view of ageing from the inside. The second strand presents a view of ageing from ‘the outside’, exploring what can be learned of the experience of ageing when drawing is used as phenomenology.  

This study offers an opportunity to interrogate drawing as a method in understanding the 100 year life. 

‘The act of drawing makes you look more carefully; the more closely you look, the more you see, and the more you see, the more you can draw and the more you come to understand’  

Lucy Lyons

Occupation Based Social Transformation

The term ‘social transformation through occupation’ is used broadly to refer to various approaches that focus on using occupation as a means to restructure practices, systems and structures, so as to ameliorate occupational and social inequities. 

Project team: Claire Craig / Nicholas Pollard

Funded by: European Network of Occupational Therapists in Higher Education

The social transformation through occupation think-tank has brought together a global multi-sectorial group, which includes professionals, service users, researchers, politicians, members of the public, students and teachers. The enquiry explores how communities draw on collective creativity to come together and build assets to support quality of life.  

Members of the think-tank and its associated network which spans over 30 countries, have been gathering information and creating pathways towards actions to tackle health inequalities through an occupation based perspective. The research team focuses on ways to bring together diverse theoretical perspectives and practices to move social transformation through occupation forward. 

Early research has been manifested in an e-book of Case Studies for Social Transformation through Occupation. The e-book shares exemplar case studies generated throughout the research, providing ideas for how such case studies can be used in education and practice.

Analysis of these case studies identified that participants were drawing upon key principles and practices associated with broader models of social transformations, particularly those associated with participatory, emancipatory and community development approaches. Aligned with these types of approaches, participants emphasized the need to:

  • Span a continuum from individual lives to political systems 
  • Incorporate critical examination of power and positionality 
  • Engage critical theoretical frameworks 
  • Build collaborative partnerships across diverse groups 

Thank you for your work and inspiration on this important topic. Congratulations for this fantastic product. I could see this resource being useful for introducing occupation to students in other disciplines. I would like to use the cases as exemplars for my students’ projects in health entrepreneurship. 

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