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Background The role of housing as a social determinant of health is well-established, but the causal pathways are poorly understood beyond the direct effects of physical housing defects. For low-income, vulnerable households there are particular challenges in creating a sense of home in a new tenancy which may have substantial effects on health and wellbeing. This study examines the role of these less tangible aspects of the housing experience for tenants in the social and private rented sectors in west central Scotland. Methods The paper analyses quantitative data from a mixed methods, longitudinal study of tenants from three housing organisations, collected across the first year of their tenancy. The paper postulates causal hypotheses on the basis of staff interviews and then uses a Realist Research approach to test and refine these into a theoretical framework for the connections between tenants’ broader experience of housing and their health and wellbeing. Results Housing service provision, tenants’ experience of property quality and aspects of neighbourhood are all demonstrated to be significantly correlated with measures of of health and wellbeing. Analysis of contextual factors provides additional detail within the theoretical framework, offering a basis for further empirical work. Conclusions The findings provide an empirically-informed realist theoretical framework for causal pathways connecting less tangible aspects of the housing experience to health and wellbeing. Applying this within housing policy and practice would facilitate a focus on housing as a public health intervention, with potential for significant impacts on the lives of low-income and vulnerable tenants. The framework also offers a basis for further research to refine our understanding of housing as a social determinant of health.

People on low-incomes in the UK develop multiple long-term health conditions over 10 years earlier than affluent individuals. Financial diaries -new to public health- are used to explore the lived experiences of financially-vulnerable individuals, diagnosed with at least one long-term condition, living in two inner-city London Boroughs. Findings show that the health status of these individuals is a key barrier to work opportunities, undermining their income. Their precarious and uncertain financial situation, sometimes combined with housing issues, increased stress and anxiety which, in turn, contributed to further deteriorate participants’ health. Long-term health conditions limited the strategies to overcome moments of financial crisis and diarists frequently used credit to cope. Restrictions to access reliable services and timely support were connected to the progression of multiple long-term conditions. Models that integrate healthcare, public health, welfare and financial support are needed to slow down the progression from one to many long-term health conditions.

Background Engaging with the public can influence policy decisions, particularly towards more radical policy change. While established research exists exploring public perceptions on causes of health inequalities, much less exists on how to tackle health inequalities in the UK. Despite an emphasis on ‘lived experience’, currently no study has focused on how individuals with very poor health conceive of both causes of, and solutions to, health inequalities. Methods Q methodology was used to identify and describe the shared perspectives that exist on causes of, and solutions to, health inequalities experienced in low‐income communities. Community participants living with low‐incomes and poor health (n = 20) and professional stakeholders (n = 20) from London rank ordered 34 ‘Causes’ and 39 ‘Solutions’ statements onto quasi‐normal shaped grids according to their point of view. Factor analysis defined factors for both ‘Causes’ and ‘Solutions’. Results Analysis produced three‐factor solutions for both the ‘Causes’ and ‘Solutions’. ‘Causes’ are (i) ‘Systemic inequality and poverty’, (ii) ‘Ignored and marginalised communities’, (iii) ‘Precariousness, chronic stress and hopelessness’. ‘Solutions’ are (i) ‘Meeting basic needs and providing opportunities to thrive’, (ii) ‘Empowering individuals to take control’, (iii) ‘Supporting healthy choices’. No professional stakeholders aligned with ‘Ignored and marginalised communities’ while at least one community participant or professional stakeholder aligned with all other factors. Conclusion Results support the view that the public has a relatively sophisticated understanding of causes of health inequalities and help challenge assumptions held by policy actors that lay members of the public do not recognise and understand more upstream ways to respond to health inequalities. Patient or Public Contribution The public contributed to the design of the Q study. Surveys and interviews with community participants informed the development of the statement set and the statement set was also piloted with community participants and finalised based on feedback.

The most obvious thing is preparation. Better prepared countries tend to be high spenders on publicly funded health systems, with a significant proportion of that spending allocated to public health. Such systems have the capacity to fight pandemics on multiple, integrated fronts. Successive UK governments have been responsible for eroding total healthcare spending, particularly expenditure on public health, with administrations over the past 12 years being more culpable.

Background Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While there is growing understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these groups. Methods Q methodology was used to identify and describe the shared perspectives (‘subjectivities’) that exist on i) why health is worse in low-income communities (‘Causes’) and ii) the ways that health could be improved in these same communities (‘Solutions’). Purposively selected individuals ( n  = 53) from low-income communities ( n  = 25) and professional stakeholder groups ( n  = 28) ranked ordered sets of statements – 34 ‘Causes’ and 39 ‘Solutions’ – onto quasi-normal shaped grids according to their point of view. Factor analysis was used to identify shared points of view. ‘Causes’ and ‘Solutions’ were analysed independently, before examining correlations between perspectives on causes and perspectives on solutions. Results Analysis produced three factor solutions for both the ‘Causes’ and ‘Solutions’. Broadly summarised these accounts for ‘Causes’ are: i) ‘Unfair Society’, ii) ‘Dependent, workless and lazy’, iii) ‘Intergenerational hardships’ and for ‘Solutions’: i) ‘Empower communities’, ii) ‘Paternalism’, iii) ‘Redistribution’. No professionals defined (i.e. had a significant association with one factor only) the ‘Causes’ factor ‘Dependent, workless and lazy’ and the ‘Solutions’ factor ‘Paternalism’. No community participants defined the ‘Solutions’ factor ‘Redistribution’. The direction of correlations between the two sets of factor solutions – ‘Causes’ and ‘Solutions’ – appear to be intuitive, given the accounts identified. Conclusions Despite the plurality of views there was broad agreement across accounts about issues relating to money. This is important as it points a way forward for tackling health inequalities, highlighting areas for policy and future research to focus on.

As the coronavirus disease 2019 (COVID-19) pandemic continues to unfold there is an untold number of trade-offs being made in every country around the globe. The experience in the United Kingdom and Canada to date has not seen much uptake of health economics methods. We provide some thoughts on how this could take place, specifically in three areas. Firstly, this can involve understanding the impact of lockdown policies on national productivity. Secondly, there is great importance in studying trade-offs with respect to enhancing health system capacity and the impact of the mix of private-public financing. Finally, there are key trade-offs that will continue to be made both in terms of access to testing and ventilators which would benefit greatly from economic appraisal. In short, health economics could – and we would argue most certainly should – play a much more prominent role in policy-making as it relates to the current as well as future pandemics.

Background There is an international move towards greater integration of health and social care to cope with the increasing demand on services.. In Scotland, legislation was passed in 2014 to integrate adult health and social care services resulting in the formation of 31 Health and Social Care Partnerships (HSCPs). Greater integration does not eliminate resource scarcity and the requirement to make (resource) allocation decisions to meet the needs of local populations. There are different perspectives on how to facilitate and improve priority setting in health and social care organisations with limited resources, but structured processes at the local level are still not widely implemented. This paper reports on work with new HSCPs in Scotland to develop a combined multi-disciplinary priority setting and resource allocation framework. Methods To develop the combined framework, a scoping review of the literature was conducted to determine the key principles and approaches to priority setting from economics, decision-analysis, ethics and law, and attempts to combine such approaches. Co-production of the combined framework involved a multi-disciplinary workshop including local, and national-level stakeholders and academics to discuss and gather their views. Results The key findings from the literature review and the stakeholder workshop were taken to produce a final combined framework for priority setting and resource allocation. This is underpinned by principles from economics (opportunity cost), decision science (good decisions), ethics (justice) and law (fair procedures). It outlines key stages in the priority setting process, including: framing the question, looking at current use of resources, defining options and criteria, evaluating options and criteria, and reviewing each stage. Each of these has further sub-stages and includes a focus on how the combined framework interacts with the consultation and involvement of patients, public and the wider staff. Conclusions The integration agenda for health and social care is an opportunity to develop and implement a combined framework for setting priorities and allocating resources fairly to meet the needs of the population. A key aim of both integration and the combined framework is to facilitate the shifting of resources from acute services to the community.

Background Research has been criticised for its extractive nature, often neglecting to reciprocate benefits to the communities involved. Addressing this, Patient and Public Involvement and Engagement (PPIE) has emerged as a crucial approach, engaging community members as research partners rather than subjects of research. However, it is important that PPIE is carried out in a meaningful way to avoid tokenism and extraction from communities. This paper reflects on the learning from the PPIE approach of the CommonHealth Assets (CHA) project, which partnered with 14 community-led organisations (CLOs) across the UK to evaluate their impact on health and wellbeing in their communities. Main body The CHA Lived Experience Panel (LEP), comprised of around 13 individuals from the project-partnered CLOs, played a pivotal role in informing and influencing the research process to enhance the relevance and impact of the CHA project. Following community engagement resources, we aimed to create a supportive and inclusive environment for meaningful PPIE. Through the evaluation of the CHA LEP, this paper reports on its successes and limitations to offer recommendations on creating the conditions for meaningful and effective PPIE in community-based public health research. From our evaluation, we found that adequately resourcing PPIE is crucial to its success. PPIE activities require a dedicated facilitator with expertise in working with diverse stakeholders to advocate for the sustained integration of PPIE into the research team, and to support contributors in their engagement. Being adaptive and responsive in your approach, utilising continuous evaluation and accountability in the process is also key. For contributors to have a meaningful impact, they must be engaged from the funding application stage and throughout the early stages of the project. Contributors must work closely with members of the research team at all levels, with researchers committing to facilitating authentic involvement of contributors, accessing training to work with diverse communication needs where required. Conclusion Our findings demonstrate that meaningful and effective PPIE requires a strong, sustained commitment to valuing and integrating patient/public perspectives in research. We add to the knowledge base in this area by offering a practical example of implementing PPIE in community-based research settings. Plain English summary This paper sets out ways to achieve meaningful Patient and Public Involvement and Engagement (PPIE) in community-based research. PPIE is a way for communities to influence the design, delivery and outputs of research. PPIE improves research by making sure it is relevant and impactful. It is a way to ensure that research takes account of community expertise. To work well, PPIE must be a genuine collaboration that values lived experience alongside academic knowledge. Based on learning from the CommonHealth Assets (CHA) project, we make recommendations about the conditions needed for meaningful and effective participation. Building trust and balancing power dynamics between the research team and the PPIE panel are key. We recommend a dedicated, skilled PPIE facilitator to support the panel. In our project there were limited opportunities for PPIE at the funding application stages, which meant limited impact on the study design. More time for the senior team and researchers to work with the LEP would have strengthened our approach.