Health inequalities

“Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society” (NHS England, 2022).

Health inequalities are defined by variations in health outcomes - health status, life expectancy, and the prevalence of diseases - among different socioeconomic groups, demographic groups, and geographic locations.

Certain population groups are known to have particularly poor health outcomes as a result of multiple overlapping risk factors for poor health. These groups are known as ‘inclusion groups’ and include Gypsy, Roma and Traveller communities, sex workers and vulnerable migrants among others.

Health inequalities in detail

Individuals within a population can be grouped according to shared characteristics and circumstances. Inequalities between these groups can be linked to inequality in health outcomes.

Shared characteristics and circumstances can be grouped into four broad categories:

• Socioeconomic groups and deprivation
• Inclusion health groups
• Geography
• Protected characteristics

These categories may overlap and intersect which means that individuals may experience multiple inequalities at once, and this contributes considerably to increasing health inequalities.

Socioeconomic groups and deprivation

The conditions in which we are born, grow, live and work have a profound effect on health and wellbeing throughout life. Deprivation refers to generally worse conditions due to a relative lack or low quality of resources that contribute to quality of life, including health outcomes.

The Index of Multiple Deprivation (IMD) 2019 is the UK government's official measure of relative deprivation in England. IMD 2019 measures deprivation across the UK according to income, employment, education, health, crime, housing, and environment.

In communities where deprivation is higher, health outcomes are generally worse.

Inclusion health groups

Inclusion health describes population groups who are socially excluded, who typically experience multiple overlapping risk factors for poor health and are often not accounted for in electronic records. These groups include the homeless and rough sleepers, vulnerable migrants, sex workers, Gypsy, Roma, and Traveller communities, victims of modern slavery, people who are in prison or in contact with the criminal justice system, and people with drug and alcohol dependence.

People belonging to inclusion groups tend to have worse health outcomes than the general population and a lower average age of death. Poor access to health and care services and negative experiences can be contributing factors to poor health outcomes.

Geography

The area in which we live determines the  environmental conditions, and socioeconomic opportunities that we are exposed to, as well as access to healthcare.

People in rural or remote areas often face limited healthcare facilities, longer travel times, and fewer specialists. Urban areas may offer better services but also expose residents to pollution, overcrowding, and stress. Additionally, regional economic differences can impact employment, education, and income.

A significant proportion of the Kent population lives and works in coastal areas. In comparison to inland areas, coastal communities may experience particular inequalities due to the coastal location. To address these inequalities, Kent will become the UK’s first Marmot Coastal Region. This will be a proactive approach to health inequalities using the Marmot Principles (Fair Society, Healthy Lives (The Marmot Review),  and resulting in a long-term plan for sustained change in coastal areas in Kent. The work is still at a very early stage and has not yet officially launched.

Protected characteristics

There are fixed biological processes related to personal characteristics that contribute to health outcomes. For example, bone-density decreases with age meaning older people are more likely to suffer fractures. However, personal characteristics can act as a source of discrimination, stigma and systematic bias, while also determining behaviours which are rooted in social, cultural and institutional norms.

Ethnic minorities may face language barriers or cultural insensitivity, while disabled individuals might encounter physical or communication obstacles. LGBTQ+ people may avoid seeking care due to fear of prejudice.