9 - Health inequalities

Summary

Aim

This chapter discusses the importance of identifying avoidable health inequalities and methods of addressing them. This is increasingly a focus for strategy and policy at local and national levels, and rightly so. Understanding how inequalities can affect access to services and good health and wellbeing is crucial in a bid to reduce them and ensure good care is available to all.

Understanding health inequalities

Equality versus equity

Before I delve into commissioning for health inequalities, it is worth spending a few moments on the meaning of equality and equity. There is a distinct difference, and although the term health inequalities is routinely used, it is inequity between groups that is the issue.

The image in Figure 9.1 is a common one, and it does an excellent job of illustrating the differences between equality and equity. It shows that although we can treat people the same and offer them the same opportunities and access, due to multiple reasons, this is not equity. Some people need additional support to access the same opportunities or offers of care. This means that distribution of resources is required in a way that is not always equal, but offers equity, to take account of need. It is helpful to remember this approach as we consider health inequalities.

What are health inequalities?

The King's Fund define health inequalities as ‘avoidable, unfair and systematic differences in health between different groups of people’ (Williams et al, 2022). Health inequalities arise for a variety of reasons, including age, sex, race, and religion, but also where we live, where we work, and how financially well off we are. Three key factors that have an impact on health equity are discussed next.

Socioeconomic and deprivation factors

One of the largest impacts on health outcomes is level of deprivation – that is, lack of the material benefits considered to be of basic necessity in society. Figure 9.2, taken from the NHS Long Term Plan, demonstrates the impact that deprivation can have on mortality. Those in the lowest deprivation decile have a lower life expectation by nearly ten years compared to those in the least deprived decile.