What we think
Health inequalities mean that some population groups experience significantly worse health outcomes than others. These inequalities are widening by some measures. Men living in the most disadvantaged communities can now expect to live for 9.5 years less than those living in the wealthiest areas, while for women, the difference is 7.5 years.
These inequalities have been starkly exposed by the Covid-19 pandemic which has taken a disproportionate toll on groups already facing the worst health outcomes, including some ethnic minority communities and people living in the most deprived areas. The economic and social consequences of measures to contain the virus risk worsening these inequalities further.
Health inequalities are not inevitable. Evidence shows that a concerted approach to tackling them can make a difference and the last national health inequalities strategy, which ran under the last Labour government, was associated with reduced inequalities, including in closing the life expectancy gap between the most and least deprived communities. In contrast, the most recent analysis shows that by some measures, namely life-expectancy, health inequalities have grown since the strategy was scrapped in 2010.
The NHS has a vital role to play, by investing more in prevention, reducing inequalities in access to services and leveraging its assets, spending power and role as an employer to support local economies and communities. Reducing inequalities should also be a key priority for integrated care systems, working in partnership with NHS organisations, local government and voluntary sector organisations.
However, these inequalities cannot be addressed by the NHS alone. To reverse this trend, a national, cross-government strategy that recognises the complex and wide ranging causes of the problem is needed. This should include binding, ambitious targets and seek to address the inequalities in the socio-economic drivers of health such as housing, education and employment.
Health inequalities are systematic differences in health between different groups of people.
These inequalities are understood and analysed across four, often interrelated, factors: socio-economic factors such as income, geographic factors like the area where people live, specific characteristics including LGBT+ and ethnic minority groups and finally, excluded groups like people experiencing homelessness.
There are interactions between these four factors, for example groups with particular protected characteristics, such as disability, gender and ethnic minority groups, can experience health inequalities over and above the general and pervasive relationship between socio-economic status and health. One of the core inequalities, the relationship between deprivation and life-expectancy is systemic. It means that the more deprived an area a person is from, the shorter their life expectancy on average. This relationship holds true across the whole population and is known as the social gradient in health. Much of this inequality is caused by higher mortality from heart and respiratory disease, and lung cancer, in deprived areas. The gap in healthy life expectancy, the length of time people spend in ‘good’ health, is even greater – about 19 years for both males and females.
Following a period where health inequalities were narrowing, gaps in life expectancy have been widening for several years. While overall life expectancy continues to increase, the rate of increase has slowed down since 2010, which masks significant disparities. While life expectancy in the most affluent communities has continued to rise, albeit much more slowly, it has stalled in the most deprived areas. For females in the most deprived communities, life expectancy has actually fallen in recent years.
Covid-19 has exacerbated and highlighted these long-standing inequalities. The mortality rate from the virus in the most deprived areas has been more than double that of the least deprived. In addition, some ethnic minority communities have seen significantly higher Covid-19 mortality rates than those seen in the white population. For example, mortality among Black African and Black Caribbean groups is approximately double, while for Pakistani and Indian groups the mortality rate is 1.3 times that of the white population.
Inequalities can also be observed in people’s ability to access care and their experience of using services. The most deprived parts of England have the fewest number of GPs per head and lower rates of admission for elective care.
Health and care services can be designed so that they meet the specific needs of marginalised groups. For example, evidence shows that health service outreach programmes for people who sleep rough can increase their access to health and care.
In 2019, The NHS Long-Term Plan set out the health service’s ambition to reduce health inequalities and increase its focus on prevention. The plan committed to targeting funding to those areas with the worst levels of inequalities and it set an expectation for local NHS systems, working closely with local government, to develop plans to reduce inequalities in their area over the coming years.