Health inequalities: A societal challenge that needs a cross-sector solution

COVID-19 has laid the UK’s health inequalities bare and created an imperative for the NHS to develop a step-change in how it cares for diverse and marginalised communities.

Health inequality is the “greatest societal challenge of our time”, according to a briefing document calling for a system-wide solution.

The report was published by the Association of the British Pharmaceutical Industry (ABPI) and the NHS Confederation as part of the NHS Reset project, which has been working to set a post-pandemic roadmap for health and social care.

Said the authors: “The pandemic has thrown into sharp focus the issue of health inequalities in the UK and exposed the consequences of a long-standing failure to tackle this deep-rooted and multi-faceted problem.

“The first wave had disproportionate health, economic and social impacts on people in lower socioeconomic groups and those with black, Asian and minority ethnic backgrounds.”

It highlights the need for a clear strategy, pointing to a recent survey that found nine out of ten NHS Confederation members agreed that “the time to act is now”. Just 41%, however, said they had the tools, knowledge, and support to deliver the necessary change.

Societal challenges

In November, the two organisations held a roundtable with more than 20 NHS and industry leaders, who discussed “tangible approaches” to tackling “the greatest societal challenge of our age”.

Working under Chatham House rules, they agreed that reducing avoidable and unfair differences in health outcomes would require action in four key areas: data quality, community engagement, access to services, and risk identification and stratification.

“Participants heard that the health system is capturing patient ethnicity data around 65 per cent of the time. More complete – and more comprehensive – data is needed to obtain a full picture of how ethnicity affects health outcomes,” said the report.

The meeting agreed primary care had the biggest potential to rapidly increase the volume of captured ethnicity data, using opportunities such as vaccination programmes and changes to practice registration details.

It also discussed the need to involve and listen to local communities, and the possibility of funding community champions employed through voluntary and community sector organisations.

Equitable access

Much has been published on the increase of digital health during the pandemic, but, as the report stresses, digital exclusion and digital poverty can compound health inequalities.

According to NHS England, people from excluded groups or living in deprived areas often lack the skills, ability and means to get online. This can block access to initiatives such as virtual consultations, which have been soaring in popularity.

Restoring services in the aftermath of the pandemic was also felt to pose particular challenges relating to equity of access.

“Concerns were raised that providers simply working through waiting lists using standard processes, without viewing them through the lens of inequalities, could actively exacerbate the problem.

“A possible way to resolve this unintended outcome would be to use a clinical prioritisation process to identify who will benefit most from intervention,” said the authors.

“The first wave had disproportionate health, economic and social impacts on people in lower socioeconomic groups and those with black, Asian and minority ethnic backgrounds”

Wider determinants of health

Healthcare systems need to be able to proactively identify populations at high risk by virtue of their socioeconomic status and ethnicity, as well as their clinical and co-morbidity data.

The impact of poverty in particular was discussed as a factor requiring much more consideration in terms of risk stratification.

“For example, in some areas, people continued to work during lockdown despite being in high-risk COVID-19 localities, due to intense financial pressures and economic insecurity.”

As set out in the Long-Term Plan, integrated care systems (ICS), which bring health, social care, the voluntary sector, and local authorities together, are playing an increasing role in the NHS.

“ICS and their constituent place-based partnerships were viewed as potentially playing a role by convening organisations outside healthcare, such as housing associations, to ensure they are enabled to play a role in discussions about the wider determinants of health.”

The authors agreed that this approach presented a “particular opportunity to make system-wide improvements to determinants that have traditionally been out of scope for the NHS, such as air quality”.

However, it was also felt that this should be complemented by neighbourhood-level cross-sector multidisciplinary teams, able to provide health and care interventions, as well as connecting individuals to the wider community.

Call to action

Building these recommendations into the fabric of society, even with cross-sector involvement, will certainly be a challenge.

But, said the report, the NHS Confederation and the ABPI are “committed to a long-term partnership to help build the right tools, techniques, and capabilities to meaningfully address health inequalities”.

That includes developing a suite of datasets and methodologies to improve risk stratification, as well as recommendations on how to improve diversity, inclusion, and patient experience in research.

“Both organisations are eager for as many NHS and industry colleagues as possible to become part of this process, contributing expertise to co-create solutions to the greatest societal challenge of our age,” the authors concluded.

To get involved, contact Nasima Hossain on nasima.hossain@nhsconfed.org or Su Jones at sujones@abpi.org.uk