To address the root cause of health inequalities, and close the gap between communities, we must see a shift in approach outside the traditional healthcare model. Within the Marmot Review, 2010, there were two final policy objectives: to ensure a healthy standard living for all, and create and develop healthy and sustainable places and communities.
Barriers and obstacles that many people face need to be broken down by the government so that individuals are empowered to seek and develop healthy lifestyles. As seen in previous articles, changes need to be made within both education and employment systems.
Health equality within communities
Firstly, we must look to expand the role of Public Health in developing healthier communities and preventing ill-health. It was found that 4 percent of the NHS budget was used in prevention. Policy should see a bold shift towards prevention methods as a tool in healthcare delivery. This would inevitably reduce the cost and burden on acute and chronic healthcare services, and therefore, the burden on individuals to engage with services.
In building a healthier and more sustainable society, government policy should look to tackle wider determinants of health that drives health inequalities. ‘Rethink Healthcare’ policy workshops have highlighted certain elements that could improve health:
- Access to local green spaces
- Access to NHS services – in regards with distance to travel, waiting times and accessibility to translators
- Access to sporting facilities – many clubs and facilities are not widely established to support everyone of all abilities. Sport can be expensive which acts as a disincentive
- Accessibility to eat healthy diets – examples include healthier options are more expensive and chocolates/sweets are found closer to the tills.
- Housing – with a rise in people living in rented accommodation, we have seen further cases of tenants exploited in regard to access to hot water, good standard of living, rent prices, maintenance of property etc.
Integration of health systems into communities
In tackling a fragmented system, we need to see further integration of planning, housing, transport, health, and environmental systems to address the root causes of health inequalities.
Social capital is the network between individuals within a community; it allows individuals to cooperate and achieve something together, leading to a more harmonious society. The Marmot Review, 2010 highlights evidence of communities with stronger social capital to have better health outcomes.
Through social networks, individuals are given help to seek employment, support physical and mental well-being, and protect against material disturbances. But there is a risk with social capital, that communities with stronger links can often lead to isolation of excluded groups. Therefore, government strategy for lifting standards of living should co-exist with targeted policy in supporting excluded groups.
Local charity groups and benefits on health
Integrating and incorporating the work of local charity groups as part of the healthcare team in supporting patients within the community, also has significant benefits. Charities are excellent in providing locally driven services to specific excluded groups, such as through coffee groups, sports for beginners, arts and craft sessions etc. By expanding the role of charities, this extra workforce can support those with additional needs, within the community.
An organised, central government response is needed
Over the last decade, we have seen the stagnation of life expectancy, with a drop in the most deprived 10 percent of communities. The amount of time spent in poor health has increased. The starkest finding from the Institute of Health Equity in England: the Marmot Review 10 Years On was there has been no national government strategy in addressing health inequalities.
This needs to be the centre of policy strategy in the national recovery plan following the Covid-19 pandemic. In the rebuilding of an aspirational society, we must see inequalities driven out and the opening of opportunities for everyone regardless of background.
This article concluding the series, ‘Addressing Health Inequalities’, in which strategies have been proposed to build healthier communities and ill-health prevention at all levels of society, from cradle to grave. With the proposed restructure of public and private bodies in addressing health inequalities, it aims to reduce the burden on health and social care services, and therefore, rescale our GDP funding of health and social care.
Final part of a series by Hasnain Khan looking at addressing health inequalities. Part one was entitled ‘empowering young people to be healthy’ and part two ‘creating aspiration and healthy working conditions’.