Uncovering Root Causes: A life-course study to explore health disparities among single parents. A community-centered approach.

Background: Achieving health equality requires a deep understanding of the root causes of health inequalities. In a specific deprived neighborhood in The Netherlands, our research found that single parents -in particular- face complex and intersecting health- and social challenges across their life course, increasing the likelihood of health disparities for them and their children. This study explores how social- and structural stressors shape the way these single parents approach life and how this approach impact the way health and social outcomes are intertwined and embodied (syndemic suffering). Approach: Using a participatory action research approach involving 7 single parents as co-researchers, we sought to incorporate diverse perspectives. We conducted 10 life-course interviews with other single parents in this deprived neighborhood, which were analyzed and elucidated in close collaboration with the co-researchers during 8 group sessions. Results: The interviews demonstrate that life-course challenges and events -such as financial insecurity, housing instability, (domestic) violence and institutional distrust- form the root causes of health disparities for these single parents. Single parents describe how they understand and approach life because of the ongoing challenges and events during their life-course. Although there are slight differences in the life-courses of this single parents, they all share a history of instability and violence before and during they came to live in this deprived neighborhood The most common health complaints of this single parents (chronic stress, musculoskeletal pain and signs of depression) seem both related to the ongoing life-course events and the way the participants and co-researchers explain their responses used to cope with these challenges. This single parents in this deprived neighborhood developed a structured way of navigating life because of the challenges and events they face. They seem to navigate life with the notion of ‘being on guard’. This way of navigating life has become a way of understanding life; a structured way of responding. This structured response helps us to underscore the complexity of syndemic suffering: while this automatic responses are essential for short-term survival, they may, paradoxically, entrench this single parents into cycles of chronic stress, musculoskeletal pain and depression by not seeking support and therefor reinforcing their health and social vulnerability. Implications: This research underscores the importance of understanding health disparities through a life-course lens. Recognizing how structural and social factors shape life, health and the way single parents cope with life-course challenges -by being on guard- provides a foundation for developing more community-centered solutions. This means shifting the focus from interventions from merely treating health symptoms towards a focus on understanding the structural conditions that lead to single parents’ structured responses. In collaboration with the co-researchers, we now translate a Theory-of-Change into a community-centered approach in which health and support services offer relational, stable, long-term support, carefully building on confidence and health for these single parents with an increased vulnerability for syndemic suffering.