Individuals and Institutions
: Structural Adversity and Health in South East London

    Student thesis: Doctoral ThesisDoctor of Philosophy


    The UK has a long history of documenting health inequalities by SES. However, research that investigates differences in health by intersectional social identities is limited. Structural adversity represents an important risk factor for poor health outcomes and its distribution varies by social identity. Whilst much research has investigating the effects of structural adversity within a single life domain, the effects of multiple types of adversity, such as life events and discrimination across multiple life domains is under-researched. Furthermore, few studies on structural adversity use a mixed methods design to provide possible explanations for observed associations. This project therefore aims to:

    1. Perform a review of the literature related to structural adversity and health inequalities
    2. Estimate the prevalence and distribution of structural adversity across the domains of employment, housing and healthcare and to examine relationships between structural adversity and health and wellbeing
    3. Explore the everyday experiences of individuals within employment, housing and healthcare institutions and the nature, effects of and responses to structural adversity

    These aims are examined using mixed methods. Quantitative analysis makes use of survey data from the South East London Community Health Survey (SELCoH) phase 1 (N=1698) and phase 2 (N=1052). Statistical methods used include latent class analysis and weighted regression analyses. Thematic analysis of triangulated qualitative data was based on ethnographic observation and in-depth interviews with service providers, community organisations and SELCoH participants. Unique differences in the distribution of structural adversity by social identity emerged from using an intersectional approach and associations between structural adversity and health were identified. Results from qualitative data suggested a range of structural mechanisms for these associations that included negative societal attitudes and government policy. Structural adversity in employment and housing contributed to health inequalities, which has important implications for health inequalities research and policy.
    Date of Award2016
    Original languageEnglish
    Awarding Institution
    • King's College London
    SupervisorMatthew Hotopf (Supervisor) & Stephani Hatch (Supervisor)

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