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Unprecedented action to reduce health inequalities

It is indeed rare these days that I write something 'good' about the coalition government. Today's post is one of those rare moments. One of the major determinants of poor health is inequality. We cannot expect to break the cycle of poverty and disease unless we address this.  This is why joining up the dots between socio-economic circumstances and health care is essential. To treat poor health without regard to such circumstances is to ignore a substantial primary cause of ill-health. It is also one of the reasons I have been critical of the indiscriminate nature of the effects of the governments policies that are likely to increase poverty and inequalities. But today there is at least some good news.

Health professionals from a wide range of royal colleges and professional organisations have joined forces to improve patients’ health and reduce health inequalities by considering patients’ social and economic circumstances as well as their medical history. It is estimated that this 'unprecedented' commitment to act by more than 20 health organisations could save the NHS well in excess of £5.5 billion every year.

The action, which includes making ‘social’ referrals more important, is detailed in a landmark report ‘Working for Health Equity: The Role of Health Professionals’. The Report, which is supported by the Health Secretary Jeremy Hunt, will be launched at a global conference at BMA House in London today, Monday 18th March.

There are numerous examples up and down the country where health professionals are already taking action to tackle the social and economic causes of ill health   The country-wide action is being documented, assessed and driven by the Institute of Health Equity, based at University College London, and led by the global expert on reducing health inequalities, Professor Sir Michael Marmot:

‘We have the most equitable health service in the world. Of that we should be extremely proud. But it is inequalities in social and living conditions that are driving inequalities in health. Even among health professionals who have this insight, there has been a sense that it is for others to respond, there is not much we can do. But the response we have had from the many organisations and individuals that have helped us with this report is not only SHOULD we be taking action but there is ample evidence that we CAN.

The report and statements from health professional organisations make clear that action on the social determinants of health should be a core part of health professionals’ business – it improves clinical outcomes, and saves money and time in the longer term. In partnership with others in the wider society, health professionals can help reduce socially unjust and avoidable inequalities to ensure everyone has the same opportunity to live as healthy a life as the very best off.’

The Marmot Review of health inequalities ‘Fair Society, Healthy Lives’ highlighted that inequality in illness, in addition to health care costs, accounts for approximately £31-33 billion annually in productivity losses and lost taxes, and in higher welfare payments in the range of £20-32 billion . The government-commissioned review of health inequalities stated health could only be improved by considering an individual’s social circumstances and taking action on the ‘causes of the causes’ or the ‘social determinants’ of health.

Health inequalities feature across all of society, apart from those at the very top (around 1% of the population) – there is a social ladder, or gradient, for ill health and life expectancy, with the most deprived suffering the most and everyone below the very top experiencing worse outcomes than the best-off.

The gap in life expectancy across England between the best and worst-off is seven years  (this figure is substantially more within local areas, for example, 17 years in some areas of London  and 28 years in Glasgow). Disability free life expectancy (how long someone can expect to live free of life limiting illness) has an even steeper gradient and wider gap – there’s a 17-year difference between the best and worst off .

Every minute 463 people are seen by one of the 1.4 million people who work for the NHS – that’s eight people every second. They see and understand how patients’ socio-economic circumstances affect their health. Health professionals are highly trusted by the general public and therefore have a unique opportunity to support and improve their patients’ social and economic situations. The NHS is therefore well placed to coordinate action on the social determinants of health to reduce health inequalities.

The Coalition Government has placed a number of legal duties on health professionals to reduce health inequalities through the Health and Social Care Act. The Report’s six main recommendations are designed to help satisfy these duties:

Summary of ‘Working for Health Equity’ Recommendations:

1. Workforce education and training – mandatory social determinants of health (SDH) training within under and post graduate education as well as continued professional development (CPD). Education should include practice-based skills such as taking a social history and referring to non-medical services, students placement within non-health organisations and widening access to health care careers to all socio-economic groups.

2. Working with individuals and communities – prioritise social history alongside medical information to understand root causes of ill health and provide best care including referral to range of medical, social services and other agencies.

3. NHS organisations – ensure good quality work for all employees, including minimum income for healthy living (MIHL), occupational health and other services, and use purchasing power to assess health equity rigorously within contracted services.

4. Working in partnership – make tackling health inequalities a priority within the health sector and with external bodies by supporting joint commissioning, data-sharing and delivery and measuring progress.

5. Working as advocates – individual health professionals, students and health care organisations should act as advocates for patients, their families and local communities to improve the social and economic conditions and reduce inequalities; and advocate for change within the health workforce and to national policy.

6. The health system – maximise the opportunities offered by legal duties under the Health and Social Care Act 2012 and through the Public Health Outcomes Framework to act on the social determinants of health to reduce inequalities. Twenty-one health organisations have drawn up their own statements for and commitments to action.

It seems a pity that, whilst this initiative is welcome, the governments reforms of the benefits system and their indiscriminate effects will more likely than not drive more people  into poverty and increase the very social and economic inequalities this approach seeks to address.


  1. I just wanted to tell you how much posture now I enjoy your honest, heartfelt writing. I did IVF twice (major sperm issues) and was blessed with two boys. You've been dealt a lousy hand and have come to terms with it--I admire your fortitude greatly!


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