Powerful stories make the case for a cross-government strategy to reduce health inequalities

Real life stories of how people’s health is damaged by social factors such as poor housing are being highlighted by nearly 200 organisations calling for a cross-government strategy to reduce health inequalities.

The stories appear in a paper from the Royal College of Physicians, which convenes the Inequalities in Health Alliance (IHA), and include:

• An extremely malnourished and dehydrated patient, eventually admitted to hospital with sepsis, regularly missing meals so that she was able to feed her teenage son and afraid to call her GP for fear that he would be ‘taken into care’.
• A clinic providing bus passes because otherwise patients’ health deteriorated because they could not afford to attend for regular monitoring or treatment.
• A patient whose asthma worsened when his landlord refused to fix mould in his private rented accommodation and instead evicted him.
• A patient with obesity and diabetes who ate all his meals in fried chicken shops because he and his family lived in a grossly overcrowded apartment with no kitchen.

Senior representatives of the IHA have today written to the Prime Minister calling for an explicit cross-government health inequalities strategy, with clear measurable goals, that considers the role of every department and every available policy lever in tackling health disparities.

The Alliance says it has been ‘encouraged’ by commitments such as the Office for Health Improvement & Disparities, Levelling Up agenda and the cross-government ministerial board on prevention which all hold ‘great potential to be the catalyst we need to tackle health inequalities’. In the letter, the IHA asks for this work to be underpinned and strengthened with a cross-government strategy to reduce health inequalities that is led by, and accountable to, the prime minister.

Formed in October 2020, members of the IHA represent patients, doctors, nurses, social care professionals, pharmacists, local authorities and others, who have heard countless stories about the impact of non-clinical factors on the health of people across the country.

Health inequalities - unfair and avoidable differences in health and access to healthcare across the population, and between different groups within society - were a problem before COVID-19, with the gap in healthy life expectancy between the richest and poorest areas around 19 years. However, the pandemic has tragically demonstrated how these inequalities can have an impact in just a matter of weeks. Many deaths could have been prevented if there had been better levels of general health before the pandemic.

Before COVID-19, health inequalities were estimated to cost the UK between £31 billion and £33 billion each year in lost productivity and £20 billion to £32 billion in lost tax revenue and higher benefit payments.[1] These costs to the public purse will continue to grow without action, whereas tackling the causes of health inequalities would not only enable more people to live longer and healthier lives but also reduce future pressures on the NHS. The IHA wants recovery from COVID-19 to be a turning point for the health of the nation.

The NHS Long Term Plan and the NHS recovery from COVID-19 are focussed on reducing health inequalities but the IHA believes that a cross-government strategy is the only way to address the underlying causes. Areas with highest need should be prioritised for action and funding, but a nationwide cross-government approach will identify the policy changes required on national issues - such as housing and employment - that will be relevant for all communities.

Andrew Goddard, president of the Royal College of Physicians, says: “COVID-19 acted as a flag to unite behind. Now that we are emerging from the worst phases of the pandemic, we need a new flag. Reducing health inequalities is that flag because they have never been as big in modern times and the need to reduce them never more apparent.”