Health Inequalities and Health Equity
Achieving ‘health equality’ is about removing ‘health inequalities’ which are the unfair and avoidable differences in health found across our community, and between different groups. We know that people living in Suffolk and North East Essex have different and inconsistent experiences of health and care based on a broad range of factors.
Health inequalities exist in all areas, including unequal experiences of health services, education, work and housing opportunities, and are also affected by individual differences including where you live. Key areas include:
- protected characteristics – such as ethnicity and sex, as outlined in The Equality Act (2010) – an actionable framework to target those who frequently suffer worse health outcomes.
- wider determinants of health – the ubiquitous social, economic, and environmental factors that shape mental and physical health and create a health gradient across society.
- social exclusion – associated with the poorest health outcomes, putting those affected beyond the extreme end of the gradient of health inequalities. This typically encompasses homeless people, Gypsy, Roma, and Traveller communities, people in contact with the justice system, vulnerable migrants and sex workers, but other groups can be included.
These are some common features about health inequalities that most people agree on:
- Health inequalities are unjust, unfair and avoidable
- They do not occur by chance. They go against the principles of social justice, and they are largely out of an individual’s control.
- These socially determined circumstances disadvantage people and limit their chances of living longer, healthier lives.
In 2010, Professor Sir Michael Marmot published Fair Society, Healthy Lives. The report showed that the worse off someone is socially and economically, the more likely they are to experience poor health and live a shorter life, compared to those who are better-off.
In the 10 years since the first Marmot report there has been a growing understanding that many complex and overlapping factors contribute to good health. However, outcomes have not improved. The Marmot Review: 10 Years On showed that life expectancy had stopped increasing in the UK, and for some communities it has started to fall.
The COVID-19 global pandemic has increased awareness of health inequalities because the virus had an unequal impact on different social, ethnic, and economic groups. This was a key finding in our own System Learning from Covid-19 in Suffolk and North East Essex ICS – see report HERE.
There is also growing concern that the post-pandemic economic upheaval, including the highest inflation rates seen in the UK for 40 years, and the ongoing disruption to education, and physical and mental health services, will deepen pre-existing health inequalities, and potentially create new ones.
Why is health equity also important?
The route to achieving health equality is by both mitigating health inequalities and promoting health equity. Health equality and health equity do not mean the same thing. Equality means giving everyone the same thing, whereas equity means giving people what they need to reach their best health. So a key aspect of achieving health equality is by introducing measures that promote health equity recognising that some people will require additional support and resources in order to achieve the same outcomes.
Health equality and health equity as ‘must dos’ – not ‘nice to dos’ in health and care. We recognise that it is our legal duty to prevent discrimination based on protected characteristics. We also have a public health commitment to improving the health of everyone across the population, with a focus on those whose health can benefit more.
Equality Act 2010
s149 of the Equality Act 2010 – Public Sector Equality Duty specifies the duty to:
- remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic;
- take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it; and
- encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low.
NHS Equality Delivery System (EDS2)
The NHS Equality Delivery System (EDS2) includes the following standards:
- Services are commissioned, procured, designed and delivered to meet the health needs of local communities.
- Screening, vaccination and other health promotion services reach and benefit all local communities.
- People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds.
The journey towards achieving health equality for our population will mean ‘Thinking Differently’ about health and care in many different ways. This includes recognising where inequalities exist and being accountable for driving health equity and addressing or mitigating issues that drive inequality for any part of our communities.
Relevant plans and strategies
NHS Suffolk and North East Essex Integrated Care Board – Coming soon
Ipswich and East Suffolk
North East Essex