Mixed methods investigation of the meanings of one inequality indicator (the Japanese Small Area Deprivation Index) for researching social inequalities in health in the Soma Region of Fukushima, Japan
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Date
30/11/2020Item status
Restricted AccessEmbargo end date
30/11/2026Author
Leppold, Claire Marie
Metadata
Abstract
In the process of researching social inequalities in health, certain indicators
(e.g. socioeconomic position; small area deprivation) are now widely used
across many countries. However, there has been limited research on how
these indicators may have different meanings in different contexts, to both
researchers and to lay actors, and how potential differences in meaning may
impact the representation of social inequalities in health in research findings.
Drawing on a critical realist perspective, this thesis explores the extent to
which the use of one indicator —the Japanese Small Area Deprivation Index
(JSADI)— is meaningful to different stakeholders in the assessment of social
inequalities in health in the Soma Region of Fukushima, Japan following the
3.11 triple disaster. This includes exploration of the meaning of the JSADI to
researchers who use it in attempts to measure social inequalities in health in
Japan; the extent to which its use produces meaningful statistical results on
social inequalities in health in the Soma Region; and the ways in which the
findings produced through its use are meaningful to lay actors in the Soma
Region. A mixed methods approach is taken. Multi-level models are
constructed to quantitatively determine whether social inequalities in one
health outcome (diabetes) are evident in the Soma Region in relation to small
area deprivation as defined by the JSADI, drawing on public health check
data (a cohort of 6,093 individuals, 2008 to 2014). Qualitative interviews are
undertaken with 16 researchers and 47 lay actors from the researched
communities, and thematically analyzed. The thesis finds that use of the
JSADI presents diverging lines of meaning to each stakeholder group.
Researchers experienced use of the JSADI as meaningful and necessary in
light of broader research traditions and politics around the contestation of
inequality in Japan, yet expressed uncertainties about what specifically was
being measured through its use. In the Soma Region, no statistically
significant associations were found between JSADI-defined deprivation and
the likelihood of having diabetes, with quantitative results failing to
demonstrate a gradient across deprivation quartiles. Classifications of area-level inequality produced through use of the JSADI did not resonate with local understandings and experiences, with lay actors giving accounts of
aspects of social inequalities that were meaningful to them but not reflected
in the products of the JSADI. This thesis brings these threads together to
argue that use of the JSADI has unclear meaning for assessing social
inequalities in health in the Soma Region. In identifying how the meaning
attached to one indicator can differ for different groups of stakeholders in the
research process, this thesis makes the case for a more critical examination
of the indicators used in health inequalities research and their application in
different contexts and fields.