Taking your approach to population health and tackling health inequalities to the next level

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Tackling health inequalities is one key aspect of population health and an increasingly important priority for health and care. Health inequalities existed long before the seminal Black report (1980) or subsequent reports by Acheson (1998) and Marmot (2010), and they continue to persist today. The Covid-19 pandemic has served as a stark signal, highlighting and exacerbating inequalities, and stressing the urgent need for effective population health efforts that strongly focus on tackling them. It is therefore welcome that emerging health and care reforms are increasingly describing ambitions for improving population health and tackling health inequalities. However, history has shown that turning these policy aspirations into meaningful action that genuinely improves outcomes is often the bigger challenge (Marmot 2020).

'The Covid-19 pandemic has served as a stark signal, highlighting and exacerbating inequalities, and stressing the urgent need for effective population health efforts that strongly focus on tackling them.'

Since the publication of our Vision for population health, we have been working with individuals, organisations and local areas across UK to support them to develop their plans and workforce for population health, including addressing health inequalities, helping them to turn their aspirations into meaningful change. We have been delighted to see the leaders in these areas making progress. When asked by leaders at all levels about the best approach people can use to improve population health in their area, we often refer to three levels of practice that we come across.

The starting point is to recognise that whatever role you are in, you can make a difference. So, take time to consider your role, organisation or sector: what are you doing well already? What else is needed? Given that population health has a dual focus on improving health and reducing health inequalities, consider also: who are the vulnerable people and communities you are reaching and not reaching in your efforts? Remember that many other people (including non-paid carers and others) play a part in caring for the people you serve. Based on this, also think about: who else can contribute to your efforts to improve the health of your population and reduce health inequalities? Think broadly, as some of the most important people for this may not be the people you are used to working with.

'Those leading deep-reaching and meaningful change efforts often report that it is the relationship with the communities themselves that matter for population health and tackling health inequalities'

The next level of working is often to gain better understanding about your population, including the inequalities that exist, and about the numerous resources you can use to support this work. Public health teams have detailed information to help you, and many people across a range of organisations will also hold valuable insights, expertise and data about the local population. At this stage, leaders often focus on connecting datasets across partner organisations to create a more data-informed approach. For example, in Surrey Heartlands and Devon partners have been working to build datasets across organisations and have started using this data to identify vulnerable communities to focus their efforts. By doing this painstaking work, they have created a valuable resource to help them identify priority groups and areas, develop health interventions, monitor impact and further optimise efforts. Kaiser Permanente used a similar data-driven approach to reduce cardiovascular mortality in the United States, and similar efforts for population health management are emerging across the United Kingdom. It’s important to remember that the data is not an endpoint in itself, but an enabler. Pay attention to how you approach data collection and ensure it is done in a way that builds partnerships and engagement rather than focusing on just the numbers. Indeed, this can often be more important than the data itself! The data alone does not necessarily show the whole picture, as it is often based on measures chosen by organisations, rather than what may really matter to people in the local community or population. See it instead as a helpful tool to guide conversation and build partnership.

Beyond this, those leading deep-reaching and meaningful change efforts often report that it is the relationship with the communities themselves that matter for population health and tackling health inequalities – the notion of not ‘doing to’ but ‘leading with’ and being ‘led by’ staff and communities. For example, in Wigan the council and partners co-created solutions with local people, using a co-production approach seeking to truly understand local issues and priorities and create solutions to bring about meaningful change. In New York, the Montefiore health system tackled health inequalities by reaching into and working closely with communities based on what works for them. In Southcentral Alaska, the population helps to lead and guide the Nuka system of care. For Covid-19 vaccination in UK, Community Voices in north-west London worked with communities to understand concerns from minority ethnic groups and help work through these for positive outcomes. Other examples also mobilise the community as the driving force for meaningful change in a more advanced population health approach – for example the Poverty Commission in Morecambe Bay.

Through our work with teams in Oldham, north-east England, mid and north-east Essex, Northern Ireland and others we have seen that, at any level, these approaches can make the difference between another set of well-meaning aspirations and efforts that really make a meaningful difference for improving population health and tackling health inequalities. So, consider – what is your approach for population health and health inequalities? Which level are you currently working at? Is it time for you to move to the next level?

Leadership for population health

Our Leadership for population health programme is designed to support you to work strategically with partners from across the health and care system to improve the health of your local population.

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Comments

Ian R Lawson (MD)

Position
Retired consultant geriatric physician,
Organisation
NE Scotland Hosp. Board, Ex-U.Connecticut Med.School, etc
Comment date
24 March 2021

Disability and sickness, whether chronic or acute, brings inconvenience, unpredictability of daily functioning in the home or at work; such that, in the long run, there is unemployability (and income loss), retirement, and eventual dependency upon older others - inevitably so in societies of progressive wealth. In prior, former days, the majority, accustomed to "healthy functioning," could stigmatize a large minority of "failures," by designing "work-houses" or other penalizing and depriving contexts of permanent LTC.
So, beware those who advocate that the NHS should, from over-concentration upon sickness, divert itself to maintaining "health" for the relatively healthy.
As a consultant physician in charge of geriatric beds, on home visits one saw care providers of elderly, willing to the last. I was, like many of my specialty, revived by these socio-biologic scenes of illness and followed the example of a London lady in re-arranging hospital care.
What now, for me? The dreadful creep of "for-profits" may be secondary to a NHS that has a prime incentive to keep, many times more employed, the degreed and licensed products of colleges for the middle and upper classes; which can, moreover, concentrate upon prestigious "health" and fractionate ("socially related") illness by ancient terms of discrimination: including 'eligibility' & 'means-testing;' for what services may be 'administered' within faux-modern furnitured motels. It is near a century ago - old time - when all such were examined and 'rehabilitated,' irrespective without incurring stigma - or direct costs!
Here's me, at 93 years old, still somewhat independent, wondering whether there is now any difference, East or West of the Atlantic Ocean's shore, of services for elderly at increasing price?

rshepard

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
12 March 2021

Hi Keith,

Thank you for your comment. I don't know if you've contacted a specific person at the King's Fund and are awaiting a response from them, but we haven't received any other messages from you. If you'd like to get in touch, please email us at website@kingsfund.org.uk and we'll be able to direct your query to the best person.

Best wishes,

Becca

Keith Sharp

Position
Grade A Instructor,
Organisation
Tai Chi and Qigong Union for GB
Comment date
12 March 2021

I have written on a number of times as we move toward having Tai Chi and Qigong formally approved by the Health and Social Care Directorate.

I look forward to hearing from you.

Keith

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