Addressing health disparities across the UK – what can we do to help?
What are health disparities?
Health disparities is the term used to describe the avoidable differences in health outcomes between groups of people that are considered to be unfairly unequal. These outcomes can be identified in a variety of areas including:
- Health status, such as life expectancy
- Access to care, such as availability to services
- Quality and experience of care
- Behavioural risks to health, such as rates of smoking, alcohol and drugs.
- Health disparities are influenced by individual characteristics and societal factors such as socio-economic status and deprivation including unemployment, low income, living in a deprived area, poor housing and educational achievements.
Protected characteristics as listed by the Equality Act 2010, can also impact how an individual is treated by society, as they may face discrimination which can affect the quality of care they receive and their attitude towards seeking medical treatment. Discrimination can also affect opportunities in employment and education which in turn will impact an individual’s health as well as where they live and access to services.
In England in 2021, people in the most deprived areas were over four times more likely to die from an avoidable cause than those in the least deprived areas.
Why act on health disparities?
It is important to act on health disparities primarily for the ethical and moral concerns that such inequalities possess, especially when many individuals find circumstances fall outside of their control.
Moreover, health disparities are costly for the NHS and the wider economy. One report estimated that prior to Covid-19, health disparities were costing the NHS an extra £4.8 billion a year. However, following the pandemic, health disparities are thought to have increased with lost output of labour from premature deaths, for example, showing an increase from £6.1 – £6.3 billion in 2019 to between £7.2 to £7.7 billion in 2021. Health factors such as NHS referral waiting times, a higher number of incidences of Long Covid, mental health issues (potentially increasing due to the impact of Covid), as well as rising obesity for people from deprived backgrounds contribute to this figure.
Oxera predicts that if these impacts persist over a decade this would represent a loss of the productive capacity to the economy of around £60 to £80 billion, equivalent to the cost of building around 250 and 350 new hospitals. Reducing health disparities is therefore crucial in improving the lives of individuals, economic performance and prosperity.
How do we tackle such issues?
Tackling health disparities should start with addressing its root issues and causes. Gathering accurate and comprehensive data is one way to obtain this information. After evidence is gathered, commitments to implement change through strategy, policy and initiatives are required. This can be enforced throughout multiple levels of organisations and governance, as well working alongside those affected by the disparities. Once introduced, it is necessary to maintain a sense of commitment and urgency, as well as a focus on implementation impact and evaluation. This helps to ensure steps are carried out effectively to reach maximum success.
Creating a wider system context
A guide commissioned by The Health Foundation and NHS England to tackle the disparities in healthcare access, experience and outcomes outlines aligning a vision and priority at every level. There needs to be a shared vision and ambition to reduce healthcare disparities and collaboration across organisations, partners and communities. Within governance and resourcing, implications need to be considered across policies, strategies, programmes of work and pathways with investment in services that will prevent and mitigate healthcare inequalities. Data is then required to provide accurate and comprehensive information to create a systemwide understanding of the most significant disparities and challenges for local and regional populations. Effective data sharing and analytic capabilities should then be in place to maximise effectiveness.
The guide cites many excellent projects and initiatives which have been undertaken by public health and social care to help improve inequalities. One example was improving vaccination uptake for ethnically diverse communities in socioeconomically diverse areas such as Keighley in West Yorkshire. This involved a concerted, collaborative, proactive and innovative effort to reach out to the most vulnerable in partnership with local voluntary groups, community partners as well as Voluntary and Community Sector (VCS) health coaches. This enabled the delivery of 30 pop-up vaccination clinics across a range of community and faith settings which improved vaccination take up.
Building clear and shared understanding
Acquiring good quality data is essential in providing insights that can bring about improvement and reduce disparities. By careful analysis, system inequalities that are having a major impact on communities can be exposed and worked on and reveal how needs differ in groups and populations. This data can then be tested with lived experience which will enable a better understanding on what the data shows and the reasons behind it such as societal or cultural impacts. Solutions can then be co-designed with communities that the services are intended to benefit, acknowledging the needs and that right solutions are delivered in response. By creating effective partnerships, greater agency among marginalised groups can be achieved and enable people to take steps to improve their own health and the health of their population.
The use of data is demonstrated in another project cited by The Health Foundation and NHS England: Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care System took part in the national 22-week Population Health Management Development Programme to help find and support groups at higher risk of developing heart failure and significant health inequalities. This enabled health professionals to use the data to identify those at higher risk and be able to offer them a range of interventions. These included an appointment with a social prescriber to discuss their personal needs with onward referral to other services where needed, including weight management and exercise programmes, medication reviews and annual health checks, links to peer support and a Healthy Heart Group consultation.
Maintaining a sense of urgency and commitment to act
In order to maximise success it’s vital to maintain a sense of urgency and commitment throughout the process of tackling health disparities. This can be done through raising awareness of issues at forums, boards and meetings throughout all levels. This will help maintain momentum and ensure the drive for bringing about change isn’t lost or forgotten about.
Another key aspect is the importance of engaging leadership. By identifying leaders across organisations, processes can be streamlined and organised, allowing for solutions to be carried out effectively. Furthermore, by engaging with leaders early, values and determination can be shared to encourage motivation and knowledge which will help improve the lives of those they serve.
An effort also needs to be made in terms of engaging hearts as well as minds. Tagging into people’s sense of fairness, making emotional connections and highlighting the role everyone can play will help boost people’s motivation and commitment to the cause. This will help further ensure the success of actions and interventions.
Public Health England’s Health Equity Assessment Tool (HEAT) is one example of an application that has been used to maintain urgency and commitment to act. In the northwest, areas were lacking the knowledge of health disparities to carry out meaningful action; seeing it as a simple tick box exercise or simply addressing only the inequalities easiest to deal with. However, HEAT helped address these issues by identifying targeted populations groups. This created a level playing field that ensured those in most need were included in every action taken. This tool therefore helped provide a sense of urgency and commitment to act, with the process being moved along at scale and pace.
Focussing on implementation, impact and evaluation
It is important to be able to not only implement initiatives to help address health disparities but also be able to evaluate the impact and measure progression, highlighting areas that are successful and those that aren’t. From this, crucial perspectives can be gained which can make processes more effective and demonstrate if real improvements are being achieved.
Using a logical model, connections can be made between short-term and long-term impacts helping to create more manageable steps to achieve aims. Establishing frameworks are also useful for monitoring successes of interventions against specific metrics. Trying out new initiatives with a mentality to action, test and learn can help improve progress by identifying areas of success and failure. Finally, ensuring that communication, promotion and sharing is kept up through social media, awareness campaigns and press releases, will help engage the target population; ensuring the right people are communicating the right message to the right cohort.
Conclusion
Overall, it can be seen that health disparities exist due to individual characteristics and societal factors. It is of paramount importance, however, that these disparities are addressed by health, public health and social care organisations, as well as society as a whole. Not only due to the moral implications but due to the negative impact it has on the wider economy and prosperity of the UK, as well as the impact on health and social care. Despite being a complicated and varied issue with certainly not a ‘one size fits all’ approach being sufficient, measures can be put in place to help tackle these issues and improve the health disparities that certain groups face.