A lot of my work at the Institute of Health Equity in different Marmot Places across the UK and Republic of Ireland involves numbers, specifically quantitative data. Deprivation indices, healthy life expectancy gaps between the richest and poorest areas of a town, differences in exclusion rates between those on free school meals and those not, large variations in breastfeeding rates between bordering neighbourhoods, the list could go on and on. These numbers are vital to our work and matter enormously. They tell us where inequalities exist and how wide they are. But they can't always tell us why, and crucially, they can't capture the lived experience of people whose lives sit behind the statistics.
That's what makes qualitative evidence so important. And it's one of the reasons why, working as part of King's Lynn and West Norfolk's Marmot programme, we spent significant time engaging with community members, stakeholders, and professionals, at community engagement events across the Borough, and why their voices are woven throughout our report - Starting Well: King's Lynn and West Norfolk.
What we were told adds depth, urgency and nuance to what the data shows. Particularly when it comes to the lives of children and young people in the borough and the support and opportunities, they have available to them.
The picture for children and young people in King’s Lynn and West Norfolk
King's Lynn and West Norfolk is a predominantly rural area, and that rurality plays a massive role in children's opportunities and livelihoods. In some wards, more than a third of children are growing up in relative poverty. Mental health difficulties among young people have risen sharply since the pandemic and the attainment gap between children eligible for free school meals and those that are not eligible is the largest of any Norfolk local authority, a gap that research shows follow children into adulthood.
Rural poverty: hidden, but no less real
One of the things that struck me most in this work is how rural poverty can slip through the cracks. Deprivation indices are often calculated at a scale too large to pick up small pockets of deprivation within otherwise relatively affluent areas. So, King's Lynn and West Norfolk can look, in aggregate, broadly in line with England averages, while children in Brancaster, or parts of St Margaret's with St Nicholas, are living in relative poverty rates three times higher than in the Borough's wealthiest wards.
Rural deprivation has a different character to urban deprivation. There's no bus; there's no children's play centre round the corner; there's no foodbank within walking distance. Access to most basic services requires a car or a long wait for a bus which we frequently heard was unreliable. For families already stretched thin, those barriers are not minor inconveniences, they're the difference between getting support and not getting it. As one community member put it to us, young people can feel isolated and stigmatised in rural areas, particularly in places with older populations, cut off not just from services but from peers and community.
What data can't capture: stigma and shame
This is where qualitative evidence really earns its place. No survey captures the feeling of being the only child in your class on free school meals, or the disappointment of a parent not having the time or capacity to take their child to an extracurricular activity club. No deprivation index tells you about the parent who told their child not to bother applying to university, as "it costs too much" and how that single conversation shapes a young person's sense of what's possible for them.
Stakeholders repeatedly described the shame and stigma attached to poverty and to accessing support as a significant barrier to families getting the help they need. In wealthier areas, children living in poverty often face worse outcomes than children in poverty in more deprived areas, and a plausible part of that story is the social visibility of their disadvantage, the sense of not belonging, the bullying and disengagement that follow.
Stigma also attaches itself to services. Strict eligibility criteria, designed to target support at those who need it most, can inadvertently signal to families that to receive help is to be labelled as failing. We heard from stakeholders that those who qualify for schemes like holiday food programmes feel marked out, and some therefore choose not to take up entitlements as a result. This ‘cliff-edge’ criteria can also lead to resentment from those who just don’t qualify for the extra support but would still greatly benefit from the various schemes.
The absence of opportunities, aspiration, hope
Low aspirations came up often in our conversations, and it's important to be clear that this is not a personal failing or a cultural deficit, but a largely predictable response to constrained circumstances. Where local employment opportunities can be limited and where intergenerational worklessness is common, young people's expectations of what is possible for them are shaped accordingly. One education stakeholder put it starkly "Some young people seem devoid of any hope for the future. This is reinforced by a lack of opportunities and intergenerational poverty. We need practical positive examples of people from the local area showing what can be done."
This is intergenerational inequality operating in real time. Even high-achieving students frequently follow the career paths of their parents not because they lack talent, but because they lack exposure to what else might be possible. It's exactly the kind of dynamic that a social determinants lens helps us see clearly: poverty doesn't just affect children's health and development in the here and now, it shapes their sense of what their future could look like.
Why this matters for how we respond
The case for qualitative evidence alongside quantitative data is both methodological and practical. Programmes designed solely on the basis of what is measurable, risk failing to reach those with the greatest need, especially where barriers to access are rooted in stigma, shame, or distrust. Knowing that these dynamics exist is a precondition for designing responses that actually work.
King's Lynn and West Norfolk has plenty of strengths to build on: committed communities, a strong voluntary and community sector, and a growing local infrastructure around the Marmot programme. But community assets are not a substitute for addressing the structural conditions that shape children's life chances. Reducing health inequalities for children and young people in the Borough requires action on the social determinants and that, in turn, requires taking seriously both what the data shows and what local people tell us about their lives.
This blog draws on the report Starting Well: King's Lynn and West Norfolk, produced as part of the King's Lynn and West Norfolk Marmot programme.