Concepts
Understand concepts such as health inequalities
Health inequalities
There are systematic, avoidable, and unfair differences in health outcomes for different groups of people. Health inequalities can manifest in various ways, such as differences in health status (e.g., life expectancy), access to care (e.g., vaccination uptake), quality and experience of care, behavioural risks to health (e.g., smoking rates), and wider determinants of health (e.g., quality of housing).
Health inequalities can be experienced by people grouped by socio-economic factors (e.g., income), geography (e.g., urban or rural), specific characteristics (e.g., sex, ethnicity, disability), and socially excluded groups (e.g., people experiencing homelessness). These factors often intersect, leading to unique health risks and needs for different population groups. They are often underpinned by the the wider determinants of health.
Because health inequalities are so prevalent and affect different groups in different ways it is important to be precise when working to reduce them. Refer to the planning services and interventions section to find out more.
The wider determinants of health
Whilst individual and clinical factors play an important role in an individuals health, the broader physical, social, and economic environment play a determining role in the health of the population. For example, those living in poor quality housing are more likely to be affected by damp and cold, increasing their risk of respiratory conditions, while those on low incomes are less likely to afford or have time for high quality food, increasing propensity for obesity and conditions such as diabetes.
Given the breadth of the wider determinates of health it is important for all policies and services to systematically consider their impacts on health, including identifying opportunities to improve health outcomes and reduce inequalities through partnership working. Beyond organisational, resourcing and cultural barriers to working in this way, it can also be difficult to understand how a service affects health and account for this in the design of policy. There are however a number of relatively simple measures that can be used to provide a relatively quick assessment of this, though where possible a more thorough analysis should be undertaken.
For example, to identify which individuals or places are more likely to be adversely impacted by the wider determinants the Index of Multiple Deprivation (IMD). IMD encapsulates many of the determinants and is a granular measure used as the basis for many policies. IMD is divided into seven domains (Income, Employment, Education, Health, Crime, Barriers to housing and services, and Living environment) and has two accompanying indices for low income for children and older people (IDACI and IDAOPI respectively). While for specific projects more precise and appropriate measures will exist, IMD provides a robust minimal basis for action. Similarly using processes such as Theories of Change and Equality Impact Assessments can help identifying the mechanisms that may impact on health and wellbeing, including a policies affect on equity.
Further resources
The following sections and resources may also be of interest: