Tag: Health inequalities

Using sociotechnical theory to understand routine data use in a local authority setting

Author Centre for Public Health and Wellbeing | Posted on

By Abdinasir Kowdan

Background

Local authorities routinely collect vast amounts of data: council tax records, education and social care files, housing datasets and service logs. This data is generated simply by councils doing their daily work; it was not designed to be used for research or evaluation. My research starts from the premise that unlocking its wider value is not just a technical question. It is a question about how people, systems, and the regulation around them either enable or constrain the effective use of routine data beyond its original operational purpose.

That premise has empirical backing. A rapid systematic review of 28 UK studies by Moorthie and colleagues (2022) found that the most frequently cited barriers to accessing, linking and using local authority data were technical capability and data quality, followed closely by legal and ethical frameworks, funding and capacity, cultural factors, data fragmentation, and public trust. What is striking about that list is how few of the barriers are purely technical. Most sit at the intersection of technology, organisation, and culture, which is exactly what sociotechnical theory was built for.

Why sociotechnical theory

Sociotechnical theory traces back to 1949, when the British National Coal Board engaged the Tavistock Institute to investigate why some UK coal mines achieved high productivity and morale while others using similar machinery did not. Eric Trist examined the relationships between the social and technical components of mining work (Trist, 1981). The answer to the productivity puzzle was not the technology itself but how well it fitted the workforce: teams that were upskilled, given choice, and treated as complementary to their tools consistently outperformed those where technology was imposed.

At the heart of the theory is the idea that social factors such as leadership and culture, and technical factors such as systems and infrastructure should be jointly optimised, with a core principle that the two are equally important (Cherns, 1976; Whetton, 2005). Improving one subsystem while neglecting the other achieves little. A council can install the best software available, but if staff lack the capacity, training, or confidence to use it, the investment is wasted. Similarly, skilled and motivated staff working within siloed arrangements and risk-averse cultures will struggle to fully leverage the potential of routine data. Therefore, I will employ this theory to examine routine data use in Somerset Council for operations, evaluation and research.

Where the theory does its work

Clegg et al.’s hexagon model separates the social side into people, culture, and goals, and the technical side into technology, infrastructure, and processes, all sitting within a wider frame of stakeholders, regulation, and financial circumstance (Clegg et al., 1979).

Figure 1: Hexagon model for Sociotechnical System (Clegg et al., 1979)

Clegg and colleagues used the hexagon model to trace how the Mid-Staffordshire NHS failures emerged from interacting elements: a culture tolerating poor standards fed into an absence of quality goals, inadequate nursing capacity, no processes or technology for monitoring care quality (Clegg et al., 2017). Challenger and Clegg (2011) performed a similar analysis of the Hillsborough disaster, finding failures in every one of the six elements, from an official mindset fixated on hooliganism to radio failures and poorly laid out grounds. Neither case can be explained by a single broken component; both were failures of joint optimisation.

Applying this concept to local authorities’ routine data use reveals insights that a purely technical inquiry would miss. Legal ambiguity around data sharing is often treated as a compliance issue. But Moorthie and colleagues (2022) found that lack of familiarity with the legal frameworks governing inter-agency sharing contributes to a risk-averse approach; institutional caution, shaped by culture and incentive structures as much as by law, is what actually determines whether staff feel able to share data at all. Fragmented IT systems look like a technical problem on the surface: legacy systems, bespoke formats, and coding practices unique to individual teams mean data cannot easily move even between teams within a single council (Moorthie et al., 2022). The reasons the fragmentation persists are frequently organisational. The same review found no example in the literature of a designated senior officer for data within any local authority.

Councils are estimated to spend around 3% to 6% of budgets on IT, yet much social care data is unstructured and by one estimate up to 90 per cent of unstructured data is never analysed (Moorthie et al., 2022). Spending on technology is evidently not the main constraint.

Councils that succeed in unlocking routine data, for research and evaluation as well as operations, tend to be the ones where technical investment, governance clarity, and cultural buy-in move in step with one another. The cross-cutting factors Moorthie et al.  identify are trust between stakeholders, leadership, and capacity, none of which can be bought as software.

Testing the theory in practice: Somerset Council

My PhD applies this framework as a single-case study. Using a mixed-methods design grounded in critical realism, I am combining semi-structured interviews across the council and the Integrated Care Board, document analysis of existing data strategies and governance frameworks, and a quantitative assessment of routine data for quality profiling. The findings will feed directly into practical recommendations for how Somerset Council and by extension other local authorities with similar context can better integrate, govern, and use the data they already hold.

A broader lesson

The potential of routine data for local authorities does not lie in better software nor in skilling up staff without securing the space to exercise the knowledge they acquired. It lies in recognising data use as a sociotechnical system where people, technology, and environment must evolve together. As local authorities attempt to do more with less, understanding how to achieve that joint optimisation may be one of the most valuable contributions this research could offer.

References

  1. Challenger, R. and Clegg, C.W., 2011. Crowd disasters: A socio-technical systems perspective. Contemporary social science, 6(3), pp.343-360.
  2. Cherns, A., 1976. The principles of sociotechnical design. Human relations, 29(8), pp.783-792.
  3. Clegg, C.W., 1979. The process of job redesign: signposts from a theoretical orphanage?. Human Relations, 32(12), pp.999-1022.
  4. Clegg, C.W., Robinson, M.A., Davis, M.C., Bolton, L.E., Pieniazek, R.L. and McKay, A., 2017. Applying organizational psychology as a design science: A method for predicting malfunctions in socio-technical systems (PreMiSTS). Design Science, 3, p.e6.
  5. Moorthie, S., Hayat, S., Zhang, Y., Parkin, K., Philips, V., Bale, A., Duschinsky, R., Ford, T. and Moore, A., 2022. Rapid systematic review to identify key barriers to access, linkage, and use of local authority administrative data for population health research, practice, and policy in the United Kingdom. BMC Public Health, 22(1), p.1263.
  6. Trist, E.L., 1981. The evolution of socio-technical systems (Vol. 2, p. 1981). Toronto: Ontario Quality of Working Life Centre.
  7. Whetton, S. 2005. Health Informatics: A social-technical perspective. South Melbourne: Oxford University Press.

How politics shapes migrant health and integration in the UK: Beyond the ‘hostile environment’

Author Centre for Public Health and Wellbeing | Posted on

By Dr Erdem Dikici

Introduction: migration as a public health issue

Migration is often discussed through the lenses of borders, economics, welfare state, or policy. But it is also a public health issue. Migrants, including refugees and asylum seekers, face multiple and overlapping health challenges – from trauma, PTSD and other mental health issues to structural and institutional barriers in accessing healthcare and secure housing. While these are well recognized, they do not fully capture the key determinants of the health and wellbeing of migrant populations.

In my research on “Migrant Health and Integration in the UK”, I argue that we need to look beyond traditional social determinants (e.g. poverty, housing, employment) and consider something broader: the emergence of a “hostile ecosystem”. This is not simply confined to the UK’s well-known “hostile environment” policy – a policy approach designed to deliberately make life harder for illegal migrants which has had substantially negative implications on the wider minoritized communities (e.g. the Windrush scandal). The hostile ecosystem that is coined in this study refers to a multi-layered system shaped by anti-migrant political rhetoric, policy decisions, and public attitudes, operating at transnational, national, and local levels – and profoundly shaping the health, wellbeing, and integration processes of migrants.

Introduction: migration as a public health issue

Migrants’ health is usually framed in relation to pre-migration conditions in the origin country, journey-related risk factors, and conditions in the settled country. The latter, again, is often framed in terms of vulnerability: limited access to services, re-traumatization, and poor living and/or working conditions. There is no doubt that all these factors can be key determinants of health and wellbeing. Many migrants experience significant stress during their journey, unsafe or overcrowded accommodation, and prolonged waiting times in the immigration processes. Mental health conditions such as stress, anxiety, depression, and PTSD are common, often compounded by uncertainty and separation from family. There is, however, another key determinant of migrant health and integration, namely far-right anti-migrant politics that manifest itself through hostile language, policies, and attitudes. This is arguably one of the most consequential determinants of migrant health and integration in the contemporary UK, Europe and beyond.

To capture this political determinant, I propose the framework of “transnational hostile ecosystem”.

The rise of anti-migrant politics and policy

In recent decades, we have seen the global rise of anti-migrant and far-right politics, from the US to Europe and beyond. Across countries, migrants are increasingly framed through an “us vs them” narrative – often as “threats” to security, culture, identity or “burdens” on the economy, welfare state, or the society. Crucially, these once marginal narratives are no longer confined to fringe groups or political parties. Instead, these anti-migrant, xenophobic narratives have become mainstream across liberal democracies such as the UK not just shaping public opinion and attitudes but also influencing policy landscape. We now have ever more restrictive and hostile immigration regimes underpinned by hostile legislations (e.g. 2014 Immigration Act) and policies (e.g. the hostile environment policy).

The UK’s hostile environment policy, introduced in 2012 by Theresa May, extended immigration control into daily lives of not just immigrants but also the wider society. This policy involves immigration status checking in order to access housing, employment, banking, and even healthcare. That is, employers, landlords/landladies, banks, etc. are legally required to check people’s immigration status, monitoring whether they have “right to rent”, “right to work”, and so forth. Policies such as “No Recourse for Public Funds”, prolonged asylum decision-making, and restrictive accommodation arrangements have created structural insecurity, leaving many migrants in situations of substantial financial precarity, legal uncertainties, and dependency. Importantly, such policies are not simply experienced as bureaucratic changes, but lived as chronic stressors – as frequently stressed by the participants of this research.

Public attitudes toward migrants are not uniform, alongside exclusionary rhetoric, grassroots movements continue to advocate for inclusion and solidarity

Everyday experiences and their impact on health

These hostile discourses and policies have also shaped everyday life of migrants, including their interactions with the wider society in public spaces – on buses, in neighbourhood parks, in GP reception areas and so on. Migrants report experiences of racism, microaggressions, hate crimes, or being treated with suspicion. Many have reported that they have been told to “go back to your country” by a member of public on a bus or in other public spaces. Thus, some have said that they avoid public spaces due to fear. This results in less engagement with the wider society, which hinders the process of integration.

While some may see these experiences as trivial, they are most certainly consequential for health, wellbeing, and integration of migrants. They accumulate, generating chronic stress, anxiety, and social withdrawal.

Hostile language and everyday racism permeate public spaces, contributing to chronic stress and social withdrawal among migrants

Towards a more welcoming ecosystem

If a hostile ecosystem can harm health, the reverse can also be true: a welcoming ecosystem can improve it.

We need to recognize that political choices shape health outcomes, which means that addressing migrant health inequalities requires more than service-level interventions. It requires challenging the narratives, policies, and attitudes that produce hostility in the first place.

Our language, policies, and attitudes towards migrants should be welcoming, inclusive, and anti-racist, not stereotyping, marginalizing, scapegoating, not to mention dehumanizing. Reframing migrant health through the lens of a hostile ecosystem allows us to see the wider political determinants of health and wellbeing – and importantly, to imagine alternatives. We can create more welcoming and inclusive systems, structures, institutions, and communities.

A different ecosystem is possible.

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