Exploring deprivation, locality and health: a qualitative study on St Ann's Nottingham

This thesis is an attempt to better understand the inter-relationship between deprivation, locality and health. This study explores the views of different residents in St Ann s, a deprived neighbourhood in Nottingham, to find out how they make sense of their health. The thesis is based on some participant observation in the area but mainly draws on qualitative interviews with diverse residents in St Ann's: (including, in particular, working-class older adults of different ethnicities; some working-class parents with children; middle-class younger adults living in the area; and activists and professionals providing services to the area, such as volunteers running the food bank, the local priest and GPs. As I asked all of my participants questions about their lives and their health, as well as their perceptions of what health was like in St Ann s generally, I realised they did not mention what talk about things that I, or public health professionals, would expect them to i.e. whether they took regular exercise or ate fruits and vegetables. Rather than individual lifestyle choices , people mostly talked about places, doing rounds and routines. They also talked about other groups, which allegedly were less healthy than them. Further, different groups of people in the area spoke about health quite differently. It is these broader discussions and concerns, and differences between groups of people, that I make sense of throughout my thesis. I argue that existing quantitative research on health, deprivation and the physical environment typically focuses on how health varies across different neighbourhoods. Some of these studies examine how factors, such as the proximity of supermarkets or leisure facilitates, produce health inequalities. However, while I found residents in St Ann s mentioned the proximity of shops, I also found that health and place had broader meanings to people in terms of gathering together and structuring routines. Additionally, I found that different people had conflicting ideas about health, place and one another. Addressing health therefore needs to take these conflicts into consideration rather than implementing public health policy that mainly articulates the views and habits of the middle-class. I use concepts from Bourdieu (1979), such as habitus , field and symbolic violence to make sense of these conflicts, arguing that the reasons why people act as they do is beyond their cognitive and rational understanding. In circumstances such as those in St Ann's, where the working-class residents were most at home in their given social space where habitus meshes with field - their apprehension of their social environment is more practical than it is theoretical and more tacit than it is explicit. In other words, I argue that residents in St Ann s are curtailed by their habitus. Additionally, I argue that there is insufficient previous work which has acknowledged and validated the experiences of residents in deprived neighbourhoods. Residents may articulate deprivation and lack of understanding of what constitutes health, but they also draw attention to important issues that, whilst often mentioned in the literature (e.g. social cohesion and health), have not been sufficiently accounted for, such as the importance of sociability, community activities, amenities and services. Finally, it should be acknowledged that these issues are not equally or similarly important for all residents, so that middle-class residents are unlikely to mix with locals at the community centre for example and that also older and younger residents considered different places important. So, instead of accepting the premise inherent in much public health research that seeks to identify the barriers to change with individuals, there first needs to be a more rigorous examination of the practices and lifestyles of the working-class residents within deprived communities such as St Ann s. We should seek to understand that their current practices are important for their well-being and sense of community. However, and, at the same time, we should seek to identify appropriate approaches that can improve their health that does not only fit the middle-class agenda. A key element of this is to take the various elements of their practical, tacit knowledge more seriously as part of these conditions of possibility. Then, it may be possible to more fruitfully identify how and why such practices are created, and what might be the conditions of possibility for change.