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How good is the NHS at closing the gap?

How is the NHS tackling health inequalities? Find out what health inequalities are, why they matter, and how they affect access to heath care.
© The King’s Fund

As you learned in Week 1, there is a link between health, genetics, social class, diet, environment, education and employment. This means that health and wellbeing is about more than just access to high-quality health care. But understanding how the NHS plays its part in this is another way in which we can judge how well the NHS is doing.

What are health inequalities?

There are systematic and unjustifiable differences in the health of certain groups of people – for example, people living in different regions of England, or with different levels of income. Some groups of people:

  • live longer than others
  • are more prone to particular conditions
  • experience poorer health than others
  • have a better experience of care than others.

Health inequalities is the term that is used to describe this concept and Public Health England defines this as:

Avoidable and unfair differences in health status between groups of people or communities.

Why do health inequalities matter?

As you learned in Week 1, only a small proportion of a person’s wellbeing is linked to the health care they receive. Our health is determined by a complex mix of factors, our lifestyles, health-related behaviours and a set of wider factors including income, housing and employment status. These latter factors are often referred to as the wider determinants of health (or sometimes the ‘social determinants of health’ or ‘broader determinants of health’). The diagram below illustrates all the factors that influence your health.

Source: Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried?

Many experts agree that the wider determinants of health are more important than health care in ensuring a healthy population. This means that many services have an impact on health inequalities but the NHS can also play an important role.

How does the NHS measure inequalities?

In recognition of this, the Health and Social Care Act introduced a new requirement for the NHS to reduce health inequalities in England. The main measures of health inequality that the NHS uses are described in Public Health England’s health profiles dataset. The Department of Health and Social Care has a legal duty to set out every year how well the NHS is doing on contributing to tackling health inequalities, given its legal duty to do so.

How successful is the NHS at reducing health inequalities?

Currently, the NHS assesses its performance against several health inequalities indicators, published in the Department of Health and Social Care’s annual report. The data shows that between 2010 to 2011 and 2017, health inequalities have widened across six of these indicators, with four of these showing a significant increase in inequality:

Worsened Improved
Male life expectancy at birth Female healthy life expectancy at birth
Male healthy life expectancy at birth Under-75 mortality rate from cardiovascular disease
Male life expectancy at 75 Under-75 mortality rate from cancer
Female life expectancy at birth Health-related quality of life for people with long-term conditions
Female life expectancy at 75 Unplanned hospitalisation for conditions that can be managed effectively outside of hospital
Infant mortality Patient experience of GP services
Emergency admissions for urgent conditions that should not usually require hospital admission Access to GP services
Data taken from Annex D of the Department of Health and Social Care annual report and accounts 2017-18

Over the next decade, the NHS has committed to a “more concerted and systematic approach to reducing health inequalities”. To this end, areas with higher levels of health inequalities will receive a larger share of funding in order to help close the health inequalities gap. New “specific, measurable goals for narrowing inequalities” will also be set out to ensure that local health services take this into consideration when planning services.

There are significant inequalities in health across the UK and there are variations in life expectancy at birth, depending on where you live. The latest data tells us that between Westminster and Blackpool there is a 9 year gap in life expectancy for men. For women, the gap is 8 years, ranging from an average life expectancy of 87 years in Camden, London and 80 years in Blackpool. What are some of the factors that you think contribute to this difference in life expectancy across the UK?

© The King’s Fund
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The NHS Explained: How the Health System in England Really Works

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