Exploring the causes of health inequalities in disadvantaged areas of Sunderland: A grounded theory approach

OBJECTIVES: This study explores how residents in disadvantaged areas of the City of Sunderland understand, construct, and navigate the drivers of poor health and health inequalities, with particular focus on lived experience and on how social, structural, and relational forces shape everyday experiences and health outcomes. STUDY DESIGN: Interpretivist study via the adoption of qualitative methodology. METHODS: Fifty-two participants from the City of Sunderland's most demographically disadvantaged wards were recruited using purposive, snowballing and theoretical sampling mechanisms. Data were collected through semi-structured interviews and focus groups (September 2024-January 2025). Transcripts were analysed iteratively using Situational Analysis map-making and Straussian coding techniques, supported by processes of constant comparative analysis and memo writing. Analytical rigour was enhanced through reflexivity, peer debriefing, and the integration of recognised approaches to the establishment of data which is authentic and trustworthy. RESULTS: Instability emerged as a central unifying mechanism influencing health experiences. Both objective (e.g. housing, income, access to services) and subjective (e.g. stress, uncertainty, loss of control) forms of instability were identified, often interacting and consolidating the negative impact of one another. Four interrelated categories were developed: (1) housing and neighbourhood conditions as foundations of stability; (2) income insecurity and precarious employment as ongoing stressors; (3) systemic instability across health, welfare, and digital systems undermining trust and access; and (4) social isolation, harmful networks, and stigma shaping wellbeing and help-seeking. CONCLUSIONS: Health inequalities in the City of Sunderland's demographically disadvantaged wards appear to be shaped by interconnected experiences of instability across multiple life domains. Addressing both material conditions and subjective experiences of instability may be critical for reducing inequalities. Findings highlight the importance of trust, system reliability, and community-informed approaches in the context of applied public health policy and practice.