Government must take next step on health inequalities

Ninety senior representatives of the alliance, which is convened by the Royal College of Physicians (RCP) and includes other royal colleges and bodies such as the British Medical Association and the NHS Confederation, wrote to prime minister Boris Johnson this week.

The letter acknowledges recent government moves towards addressing health inequality including the creation of the Office for Health Improvement and Disparities. But it called on Mr Johnson to ‘strengthen and underpin this work’ with an explicit cross-government strategy, involving all government departments, and led by the prime minister.

‘Covid-19 acted as a flag to unite behind,’ said Andrew Goddard (pictured), RCP president. ‘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. 

Life expectancy differs by 10 years for men across council areas in England. And before the Covid-19 pandemic, the gap in healthy life expectancy between the richest and poorest in England was almost two decades. The Alliance said this had a toll on individuals, regions and the country as a whole. In the areas with the lowest life expectancy, more than a third of those aged 25 to 64 are economically inactive due to long-term sickness or disability.

‘If we want to level-up and build back better, we need an explicit 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 said. Such a strategy could reduce costs to the public purse and, in the long-term, reduce pressure on the NHS.

The RCP also published a position paper making its case for the proposed strategy. It acknowledged that local leaders were already undertaking a range of approaches to improve health. And the NHS long-term plan and NHS recovery from Covid-19 are focused on reducing health inequalities. ‘But trying to prevent ill-health locally will only go so far unless the overarching determinants of health are addressed at national policy level,’ it said.

Factors contributing to ill-health were often outside the remit of the Department of Health and Social Care – hence the need for a more joined-up approach across government. It added that the 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 that will be relevant for all communities.’

Matthew Taylor, chief executive of the NHS Confederation, one of the signatories to the letter, said health leaders had seen the huge impact Covid-19 has had on people living in deprived areas and those from ethnic minority backgrounds. But they also knew that systemic inequality existed long before the pandemic hit.

‘If we are to have any hope of tackling health inequalities once and for all, there needs to be focused action across government coupled with a concrete, real-world strategy that sets out clear ambitions for the role we can all play in driving down the chronic disparities in health and well-being that persist across the country,’ he said.