Addressing Health Inequalities

This is the fourth and final article in a series on health inequalities. Previous article: Ethnic health equalities.

Welcome to the final article in a series of articles about health inequalities. This article will look more in detail at how to address health inequalities.

Introduction

Health inequalities are systematic and avoidable differences in health outcomes. They carry heavy human and economic costs, including over £31bn in lost productivity annually. Previous articles in this series explored how factors like geography, income, and ethnicity drive these disparities. However, addressing healthcare inequalities requires a strategy accounting for these factors, as well as other wider determinants of health.

The impact of the environment

Scientists have published research which found that environmental factors, including smoking, physical activity, and socioeconomic status, have a greater impact on a person’s health and premature death compared to their genes. They analysed data from the UK Biobank, a dataset of biological, health and lifestyle information. Their analysis showed that environmental exposure explains 17% of the variation in risk of death, while genetic predisposition explains less than 2%. Of the 25 factors that were analysed, smoking was linked to 21 diseases, followed by 19 diseases for socioeconomic factors like household income, home ownership, and employment status. While genetics still dominates for specific conditions like dementia and breast cancer, these findings emphasise that the vast majority of health outcomes are determined by our environment rather than our biology. Therefore, to address health inequalities, targeted strategies and collaborative methods like co-design need to be used to ensure interventions meet the genuine needs of the most vulnerable communities.

Core20PLUS5

The NHS’s Core20PLUS5 is one of these targeted strategies, defining a target population (the “Core20PLUS”) and identifying 5 areas of healthcare that require improvement. For both groups (adults, children and young people), the target population is the same: CORE20 refers to the most deprived 20% of the population identified by the national Index of Multiple Deprivation, while the PLUS population includes those who experience health inequalities the most, such as ethnic minority groups, individuals with a learning disability, autistic individuals, and individuals with multiple long-term health conditions.

The differences between the strategy for adults and that for children and young people are in the 5 areas of healthcare requiring improvement. As seen in Figure 1, for adults, the 5 areas are continuity and improvement of maternity care (specifically for women from Black, Asian and ethnic minority groups and from the most deprived groups), improved services for individuals with severe mental illness, improved services for those with chronic respiratory disease, early cancer diagnosis, and improved management of hypertension. Smoking cessation is another area of focus that covers all the 5 priorities.

For children and young people, the 5 areas of healthcare improvement are specific to this population: asthma care, diabetes care, epilepsy care, oral health, and mental health, as seen in Figure 2.

Co-design for addressing health inequalities

Another method to address health inequalities is through co-design, which is a participatory methodology where stakeholders, including service users (e.g., patients, their carers, etc) and providers (healthcare professionals and other staff), collaborate to jointly create and refine services, products, or solutions. A diagram of three key factors needed in co-design can be seen in Figure 3. This joint approach helps to ensure that interventions align with the genuine needs and preferences of the people who will be using that service, and the findings that providers see coming up frequently from comments by service users. Co-design can be used to address health inequalities by co-producing strategies with people from those communities and backgrounds. For example, individuals from ethnic minority groups can participate, so researchers can genuinely understand and try to address racism's impact on health. This is supported by research published in the BMJ, where co-design with service users and providers from ethnic minority groups found that more culturally appropriate mental healthcare was needed, and that there needed to be more open discussions about the impacts of ethnicity, culture and racism in mental health. In the context of Figure 3, this study involved “committed” ethnic minority groups with the “capability” of sharing their lived experience with researchers. This shows how co-design can be used as a tool that allows others to share their experiences for the benefit of themselves and others.

Conclusion

There needs to be a cross-government strategy that aligns current policy, funding, and practice around health equity. Because these inequalities are systematic and avoidable failures, they require a holistic approach that moves beyond clinical care to address the PLUS populations who experience the greatest disadvantage. Trust in the healthcare system has been eroded among ethnic minority groups due to repeated negative experiences, cultural insensitivity, and discriminatory treatment. To rebuild it, lived experiences need to be accounted for, and solutions need to be co-designed. Furthermore, determinants of good health, like stable housing, fair pay, and high-quality education, must be provided to the people most affected by health inequalities. These inequalities must be addressed to ensure everyone has the ability and opportunity to have a long and healthy life.

Written by Naoshin Haque

Related article: Reflection on global health injustices