Abstract

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 semistructured
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.