Fundamental causation and candidacy: Harnessing explanatory frames to better understand how structural determinants of health inequalities shape disengagement from primary healthcare

Mhairi Mackenzie, David Baruffati, Calum Lindsay, Kate O'Donnell, David Ellis, Sharon Simpson, Geoffrey Wong, Michelle Major and Andrea Williamson

Social Science & Medicine, 2025, vol. 374, issue C

Abstract: This paper aims to better understand how structural determinants of health inequalities shape disengagement from healthcare for vulnerable groups across a range of social conditions. Using a sub-sample (N = 20) from a qualitative interview UK study of those missing from primary-care, it illuminates how structural drivers of health inequalities operate at organisational and practice levels to weaken engagement with primary-care. Finding ways of better analysing and demonstrating the causal chains between structural determinants and patterns of disengagement is important because previous research has shown that practitioner and policy understanding of structural determination, an important precursor for mitigatory action, is not always sufficient, and research on healthcare utilisation can itself be weak in investigating structures of inequality.

Date: 2025
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DOI: 10.1016/j.socscimed.2025.118043

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