
Margaret WhiteheadUniversity of Liverpool | UoL · Department of Public Health and Policy
Margaret Whitehead
PhD
About
360
Publications
187,212
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
24,554
Citations
Publications
Publications (360)
Background
Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap.
Intervention
Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities...
Amartya Sen first used the phrase ‘missing women’ to describe a survival disadvantage for women exposed to extreme gender discrimination in son-preference countries. In 1989 he estimated that, despite a biological survival advantage for females, there were 100 million fewer women in Asia and north Africa than expected. He blamed corrosive gender di...
Background
Inequalities in gastrointestinal infections exert a significant public health burden on UK healthcare services and the community. Studies on gastrointestinal infections have suggested conflicting findings on where ethnic inequalities are likely to persist. This systematic review was warranted to assess, systematise and interpret the conf...
The persistence of health inequalities means that many public health professionals face an ongoing task to develop and update policies to tackle them. However, although the inequalities might be unchanged, the political priorities in the many policy areas involved are changing and the ambition to reduce the health divide is constantly facing strong...
This ethnographic study in two socio-economically contrasting areas employed geo-ethnography, underpinned by a relational approach, to understand inequalities in gastrointestinal infections in families with young children. In our ‘relatively disadvantaged’ area, gastrointestinal infections spread to multiple households within a small radius, wherea...
Background
Government nutritional welfare support from the English ‘Healthy Start’ scheme is targeted at low-income pregnant women and preschool children, but take-up of its free food vouchers is much better than its free vitamin vouchers. While universal implementation probably requires a more extensive scheme to be cost-effective, the everyday ex...
Background: Insufficient progress has been made towards reducing health inequities, due in part to a lack of action on the root causes of health inequities. At present, there is a limited evidence base to guide policy decision making in this space. Key points for discussion: This paper proposes new principles for researchers to conduct health equit...
High prevalence of risk behaviours may exacerbate existing poor health in disadvantaged groups. We aimed to identify and bring together systematic reviews with a focus on reducing risk behaviours in disadvantaged groups and highlight where evidence is lacking. We searched MEDLINE and Embase up to October 2020, with supplementary searching in Episte...
Background
Lifestyle risk behaviours are key risk factors for non-communicable diseases. Some disadvantaged groups face particularly poor health outcomes, which may be exacerbated by high prevalence of risk behaviours. The aim of this scoping review was to identify and bring together evidence from systematic reviews on reducing risk behaviours in t...
Background
Government nutritional welfare support from the English ‘Healthy Start’ scheme is targeted at low income pregnant women and preschool children, but take-up of its free food vouchers is much better than its free vitamin vouchers. While universal implementation probably requires a more extensive scheme to be cost-effective, the everyday ex...
This year marks the 30th anniversary of the Dahlgren and Whitehead model of the main determinants of health, sometimes known as ‘The Rainbow Model’. In this article, we reflect on developments over those thirty years before going on to look to the future. We start by telling the story of our model’s idiosyncratic journey from initial rejection to w...
Background
Lifestyle risk behaviours are associated with an increased risk of non-communicable disease and mortality. There are socio-economic inequalities in these behaviours, with some behaviours being more prevalent in particular groups, such as prisoners, homeless people and Gyspies, Travellers and Roma. The aim of this scoping review was to id...
Gastrointestinal infections are an important global public health issue. In the UK, one in four people experience a gastrointestinal infection each year and epidemiological research highlights inequalities in the burden of disease. Specifically, poorer children are at greater risk of infection and the consequences of illness, such as symptom severi...
Background
Previous studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility.
Methods
25 310 men and 26 018 women aged 35–74 and CHD free at baselin...
The debate about extending working lives in response to population ageing often overlooks the lack of employment opportunity for older adults with disabilities. Without work, their living standards depend heavily on government transfers. This study contributes to the literature on health inequalities by analysing the sources of income and poverty o...
Both environmental improvement and collective agency over local decisions are recognised strategies for promoting health and health equity. However, both strategies have been critiqued for their association with policies that emphasise local resources and decision-making while the state disinvests in social and environmental determinants of health....
Introduction
Applying a complex systems perspective to public health evaluation may increase the relevance and strength of evidence to improve health and reduce health inequalities. In this review of methods, we aimed to: (i) classify and describe different complex systems methods in evaluation applied to public health; and (ii) examine the kinds o...
Background
Restrictions in the eligibility requirements for disability benefits have been introduced in many countries, on the assumption that this will increase work incentives for people with chronic illness and disabilities. Evidence to support this assumption is unclear, but there is a danger that removal of social protection without increased...
Both environmental improvement and collective agency over local decisions are recognised strategies for promoting health and health equity. However, both strategies have been critiqued for their association with policies that emphasise local resources and decision-making while the state disinvests in social and environmental determinants of health....
Background
Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to...
Background
Both adverse childhood experiences (ACEs) and adverse childhood socioeconomic conditions (SECs) in early life are associated with poor outcomes across the life course. However, the complex interrelationships between childhood SECs and ACEs are unclear, as are the consequences for health outcomes beyond childhood. We therefore assessed th...
Background
Keeping older workers in employment is critical for societies facing the challenge of an ageing population. This study examined the association between types of health conditions and differentials in the probability of employment by level of education among men and women between 60–69 years of age in Canada, Denmark, Sweden and England....
Gastrointestinal (GI) infections exert a significant public health burden in the United Kingdom and the numbers of episodes are increasing. Younger children are considered particularly vulnerable to infection, and can experience 2–3 GI infections episodes per year, with consequences being more severe for more disadvantaged children, who are much mo...
Community initiatives aiming to reduce health inequalities are increasingly common in health policy. Though diverse many such initiatives aim to support residents of disadvantaged places to exercise greater collective control over decisions/actions that affect their lives - which research suggests is an important determinant of health – and some se...
This paper – third in a series of three – uses theoretical frameworks described in Part 1, and empirical markers reported in Part 2, to present evidence on how power dynamics shifted during the early years of a major English community empowerment initiative. We demonstrate how the capabilities disadvantaged communities require to exercise collectiv...
Background:
The randomized controlled trial (RCT) is considered the gold standard study design to inform decisions about the effectiveness of interventions. However, a common limitation is inadequate reporting of the applicability of the intervention and trial results for people who are "socially disadvantaged" and this can affect policy-makers' d...
Background
Universal Credit, a welfare benefit reform in the UK, began to replace six existing benefit schemes in April, 2013, starting with the income-based Job Seekers Allowance. We aimed to determine the effects on mental health of the introduction of Universal Credit.
Methods
In this longitudinal controlled study, we linked 197 111 observation...
In the health field there is great interest in the role empowerment might play in reducing social inequalities in health. Empowerment is understood here as the processes of developing capabilities that individuals and/or communities need to exercise control over decisions and actions impacting on their lives and health. There is a fundamental probl...
Background
Gastrointestinal (GI) infections cause a significant public health burden worldwide and in the UK with evidence pointing to socio-economic inequalities, particularly among children. Qualitative studies can help us understand why inequalities occur and contribute to developing more effective interventions. This study had two aims: 1. Cond...
Objectives
Haemolytic uraemic syndrome (HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is the the most common cause of acute renal failure among children in the UK. This study explored differential progression from STEC to HUS by social, demographic and clinical risk factors.
Methods
We undertook a retrospective cohort stud...
Objective
To determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends.
Design
This is an analysis of trends in infant mortality in local authorities grouped into five categories (quintiles) based on their level of income deprivation....
Background
Low control and high demand in the places where people work has been shown to partially explain why those in lower socioeconomic positions experience poorer health than their counterparts in higher socioeconomic positions. It would seem likely then that experiences of control in the wider living environment, beyond people’s places of wor...
Objective
To assess the prevalence of different trajectories of exposure to child poverty and their association with three indicators of adolescent physical and mental health in UK children.
Methods
We analysed data on 10 652 children from a large, prospective, nationally representative sample in the UK Millennium Cohort Study. The outcomes were m...
Background
Denmark and Sweden have implemented reforms that narrowed disability benefit eligibility criteria. Such reforms in combination with increasing work demands create a pincer movement where in particular those with moderate health problems might be unable to comply with work demands, but still not qualify for permanent disability benefits,...
Purpose
The purpose of this paper is to explore the emergence of “Roma health and wellbeing” as a focus of attention in European research and in policy and the possible detrimental consequences of action founded on a generic representation of “Roma health”
Design/methodology/approach
Based on discussions with and research conducted by scholars who...
From birth, children living in disadvantaged socioeconomic circumstances (SECs) suffer from worse health than their more advantaged peers. The pathways through which SECs influence children’s health are complex and inter-related, but in general are driven by differences in the distribution of power and resources that determine the economic, materia...
Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a data...
Janet Jull, Mark Petticrew, Elizabeth Kristjansson, Manosila Yoganathan , Jennifer Petkovic, Peter Tugwell, Vivian Welch and the CONSORT-Equity 2017 and Boston Equity Symposium participants. Engaging knowledge users in development of the CONSORT-Equity 2017 reporting guideline: a qualitative study using in-depth interviews. Research Involvement and...
Background:
The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England.
Methods:
Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consu...
Background Maltreatment in childhood is associated with
subsequent adverse health outcomes, but more recently the
concept of ‘adverse childhood experiences’ (ACEs) has gaining
increasing policy traction. Various adverse childhood
exposures and risk conditions have been termed ACEs and
have been associated with poor subsequent health outcomes,
parti...
There is a need for greater conceptual clarity in place-based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qua...
Background: Identifying children at risk of poor developmental outcomes remains a
challenge, but is important for better targeting children who may benefit from additional
support. We explored whether data routinely collected in early life predicts which
children will have language disability, overweight/obesity, or behavioural problems in
later ch...
Objectives:
Gastrointestinal (GI) infections are common and most people do not see a physician. There is conflicting evidence of the impact of socioeconomic status (SES) on risk of GI infections. We assessed the relationship between SES and GI calls to two National Health Service (NHS) telephone advice services in England.
Methods:
Over 24 milli...
This paper discusses the concepts of vulnerability and susceptibility and their relevance for understanding and tackling health inequalities. Tackling socioeconomic inequalities in health is based on an understanding of how an individual's social position influences disease risk. Conceptually, there are two possible mechanisms (not mutually exclusi...
In recent years, there has been growing emphasis on the need to develop ways of capturing ‘complexity’ in the evaluation of health initiatives in order to produce better evidence about ‘how’ and under what conditions such interventions work. Used alone, conventional methods of evaluation that attempt to reduce intervention processes and outcomes to...
There is a need for greater conceptual clarity in place-based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qua...
Editorial Comment-
If a child lives with an adult who has a mental health disorder or an alcohol-related illness, how does that affect the risk of emergency hospital admission for that child? In The Lancet Public Health, Shantini Paranjothy and colleagues1 use the excellent record linkage system established in Wales to address this question, showi...
We conducted a systematic review of observational evidence on the health impacts of women's low control/ autonomy in the living environment in societies with profound gender discrimination and gender bias. Thirty observational studies of varying methodological quality were included. Overall, the evidence suggests that women's lower control or auton...
Background
Public involvement in research is considered good practice by European funders; however, evidence of its research impact is sparse, particularly in relation to large-scale epidemiological research.
Objectives
To explore what difference public and stakeholder involvement made to the interpretation of findings from an evaluation of a natu...
We conducted a systematic review of observational evidence on the health impacts of women's low control/autonomy in the living environment in societies with profound gender discrimination and gender bias. Thirty observational studies of varying methodological quality were included. Overall, the evidence suggests that women's lower control or autono...
Background
The association between socioeconomic status (SES) and health is well-documented; however limited evidence on the relationship between SES and gastrointestinal (GI) infections exists, with published studies producing conflicting results. This systematic review aimed to assess the association between SES and GI infection risk, and explore...
Supporting information File 1.
(PDF)
Welch V, Norheim OF, Jull J, Cookson R, Sommerfelt H, Tugwell P, CONSORT-Equity and Boston Equity Symposium. CONSORT-Equity 2017 extension and elaboration for better reporting of health equity in randomised trials. BMJ 2017;359:j5085. Accessed http://www.bmj.com/content/359/bmj.j5085
http://bmjopen.bmj.com/content/7/9/e015815
Full text available in Open Access
Background Randomised controlled trials can provide evidence relevant to assessing the equity impact of an intervention, but such information is often poorly reported. We describe a conceptual framework to identify health equity-relevant randomised trials with the aim of...
Background
The public health impact of gastrointestinal (GI) infections is substantial, with around a quarter of individuals experiencing an episode of infectious gastroenteritis each year. Yet relatively little is known about the social patterning of these infections. Studies investigating the association between socioeconomic status (SES) and ris...
Background:
Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID r...
Objective
To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy.
Design
Time trend analysis.
Setting
Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England.
Interv...
Supplementary information: appendices 1-14
Background
The burden of infectious intestinal disease (IID) in the UK is substantial. Negative consequences including sickness absence are common, but little is known about the social patterning of these outcomes, or the extent to which they relate to disease severity.
Methods
We performed a cross-sectional analysis using IID cases identified fro...
Supporting info item
Background: Whether or not relative measures of income poverty effectively reflect children's life chances has been the focus of policy debates in the UK. Although poverty is associated with poor child and maternal mental health, few studies have assessed the effect of moving into poverty on mental health. To inform policy, we explore the associati...
Background
Good health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequ...
Background
Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe.
Methods
We inte...
Background:
In many countries, those with lower socioeconomic status are disproportionately affected by poor oral health. This can be attributed, at least in part, to differences in preventive dental visiting. While several theories have been applied to the area, they generally fail to capture the recursive nature of dental visiting behaviour, and...