The aim of this project was to scope and create a child health system map for use at a local level in order to inform opportunities for effective interventions at a systems level to reduce child health inequalities. Child health inequalities in the UK are persistent and increasing, and health outcomes for children and young people are worse than in many other western countries. However, we currently lack understanding of how to support children at a local level. A systems approach to public health views poor health and health inequalities as outcomes of a complex web of interdependent elements that work together as a system. It places emphasis on understanding the whole system of influences on child health, rather than individual factors. In this project, we use a systems ‘lens’ to map the components of local systems that influence child health to develop a tool (a system map) to support local planning and implementation of actions to improve child health and reduce inequalities. Face to face, in depth qualitative interviews were held in each case study area with senior decision makers who held responsibility for child health. A topic guide was developed for the interviews that covered the local context and key child health challenges, local priorities for child health, key initiatives developed in recent years to improve child health outcomes and reduce child health inequalities, and experience of whole-system approaches to child health (generally, and specific to the local area). The interviews were also used to identify key local documentation (policy and strategy documents), and further participants for both qualitative interviews, and involvement in group mapping workshops.

Qualitative, face-to-face interviews were conducted with senior decision-makers with responsibility for child health. Interview samples were drawn from two local authority sites that formed our case study areas. These areas were selected on the following criteria i) proximity to the research team for ease of access and cost-effectiveness, ii) variation in terms of urban and rural location, iii) variation regarding authority type - one unitary authority and one two-tier, iv) geographical distance - one in the North and one in the South of England and v) contrast in terms of area level index of multiple deprivation scores. In each case study we worked with our lead contacts in the local authority and local Clinical Commissioning Group site to identify and recruit interview participants. Interviews lasted between 30-60 minutes.