Certain individuals and groups are more likely to experience inequalities, both in health outcomes and access to health services. This is particularly apparent for ethnic minority groups and those living in deprivation, for which there is also an overlap, as ethnic minority groups are more likely to live in deprived areas.
Mortality rates signal the extent to which poor health can cut lives short. Men living in the most deprived areas of England are expected to live nine years less, on average, than those in the least deprived areas – and 18 years in poorer health. Covid-19 highlighted stark inequalities by ethnicity, with the mortality rate for black men being 3.3 times higher than for white men in the early phases of the pandemic.
The Office for National Statistics recently published data on inequalities in mortality rates involving common physical health conditions. They show that people living in deprived areas were more likely to die from lung cancer or asthma, and mortality from diabetes and cardiovascular illness was higher for some ethnic minority groups. Deaths from these conditions can, and should, be prevented.
However, interpreting inequalities data can be complex, as differences exist between ethnic minority groups as well as between different health conditions. To reduce health inequalities, efforts must focus on the prevention of ill health and addressing the wider determinants of health. Half of health outcomes are attributable to the social, economic and physical factors in our environment – including in housing, employment and education.
Preventing the onset of serious illness would reduce pressure and ensure a more sustainable long-term provision of NHS services. Research suggests that total NHS treatment would be 15% lower if health inequalities were removed. Trusts play a significant role here and some have made notable progress, but preventative actions within the NHS have so far been variable, dispersed and largely under-funded.
Trusts can take action at each level of primary, secondary and tertiary prevention. Primary prevention aims to stop illness or disease before it occurs. As anchor institutions, trusts can use their influence within local economies. Trusts can widen access to employment opportunities for groups that traditionally face barriers entering the labour market and improve working conditions for staff. They can also consider their procurement and contracting processes, their housing estate/green spaces and their broader environmental impact.
Healthcare providers are also encouraged to consider prevention within clinical interactions. Making Every Contact Count expands the scope of conversations with patients to cover their wider health and wellbeing needs, such as smoking cessation or physical activity. Boosting health literacy enables patients to access relevant information and effectively navigate health services through improved communication. Trusts can also build trust with communities through collaboration with the Voluntary, Community or Social Enterprise sector.
Secondary prevention focuses on identifying illnesses early, minimising the impact and avoiding re-occurrence. One way that trusts do this is via screening programmes. Tertiary prevention acknowledges that some long-term conditions cannot be reversed and aims to manage the condition and improve quality of life. By ensuring services are accessible, trusts are improving the experience of individuals with long-term conditions.
Effective prevention programmes rely on partnerships between system partners and communities. They also benefit from innovations in digital and technology. Despite high commitment to tackling health inequalities, our survey of trust leaders identified barriers to making progress around operational pressures, availability and accuracy of data, and unclear lines of accountability. Health inequalities are not routinely seen as "core business", or focused on by regulators and other national organisations, which can mean that they are not always prioritised by boards.
For trusts to focus on prevention, there must be dedicated funding and resource. Without this, preventative efforts will largely be piecemeal and small scale. Action within the NHS must also be accompanied by a broader national focus on addressing health inequalities, such as a cross-government strategy to address the wider determinants of health. Greater investment in public health services, which have been cut considerably in recent years, is also required.
The Major Conditions Strategy outlines the government’s commitment to the prevention and management of long-term conditions where the biggest inequalities are seen. NHS Providers welcomes these policy commitments and we hope the full strategy (expected in 2024) will provide integrated, person-centred care to best meet patient's needs. NHS England’s Core20PLUS5 also prioritises action on addressing key clinical conditions. We hope this attention reduces the rates of avoidable mortality and inequalities for deprived groups and ethnic minorities in the coming years, while acknowledging more needs to be done outside of a specific focus on conditions and towards addressing the wider determinants of health.
NHS Providers is dedicated to supporting trusts in their efforts to reduce health inequalities and achieve race equality.
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