Positive Health Online

Health inequalities are not inevitable; they are the consequence of deliberate choices made by society, healthcare systems, and policymakers. This is the resounding message from an expert panel of public health and medical professionals.

Despite decades of advocacy for reform, they argued insufficient action has been taken to empower individuals, build and uplift communities, and dismantle entrenched structural biases. As alarming revelations from inquiries into Grenfell, the Covid-19 pandemic, and Lord Darzi’s investigation into the NHS emerge, the urgency for people’s needs-driven, long-term solutions is clear.

Brought together by Strasys, a leading analytics and innovation agency, during its latest "Thinking Differently" webinar, the panel emphasised that addressing disparities within the healthcare workforce is crucial to effect change – if we get it right for staff, we get it right for patients.

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What We Do: The Art of the Possible

“We Choose Not to Act."

Opening discussions, Dr Nadeem Moghal, Chief Medical and Innovation Officer at Strasys, laid bare the stark reality of health inequity in the UK, as a by-product of how resources, opportunities, and healthcare services are distributed: "How we organise society is a choice with consequences, including the acceptance of structural inequalities that contribute to health disparities.” He added, “If we ignore the consequences of inequalities, society faces serious risks.

“To narrow health inequalities, we must question the role of everyone in the system from employers, economic enablers, and service providers.”

Community Voices: Lessons from Grenfell and Covid

Drawing on her 23 years of experience in the NHS and public sector, Samira Ben Omar said navigating the space between the system and community has been like walking a tightrope. She stated not enough focus has been placed on collaboration between healthcare systems and communities to tackle health inequalities.

Disasters such as Grenfell and Covid-19, Samira argues, have exposed us to the reality: how deep-rooted issues such as racism impact health, and how some communities are ignored by the systems supposedly designed to care for them. But, she adds, they have also brought valuable lessons – that we can choose local action, we can choose to listen to what people truly value, and we can choose to listen to the whole community.

She says: “The challenge is bridging two different structures: the hierarchical, transactional public sector, and the relational, emergent community sector. The goal is to create a space where both can collaborate, leading to the "community voices" approach, born from crises like Covid and the Grenfell fire.

“It's about fostering meaningful conversations between patients and frontline staff, ensuring power belongs to the voices that we hear, and being ethically accountable to prevent system bias.

“The focus is on transparency, trust, and shared purpose, pushing both system and community to work together…Trust takes a long time, but trust worthiness can start from the beginning.”

“Life Expectancy Drops with Each Tube Stop Heading East.”

Mr Ajit Abraham, Group Executive Director for Inclusion & Equity at Barts Health NHS Trust, spoke from his experience as a consultant trauma and Hepato-pancreato-biliary surgeon in East London, an area where deprivation and reduced life expectancy are common. As an organization he explains they are seeing success because they choose to challenge inequalities and embed that challenge as a core value in their work.

He cites “We Belong”, a post-Covid strategy, born from Rawls’s ‘difference principle’*, as having practical impact on health outcomes. For example; wait times for individuals with learning disabilities have reduced, inclusion goals are part of quarterly performance reviews, and equity reporting is regularly scrutinised at board level to ensure progress.

Working at one of the largest hospital groups in the country, employing 25,000 people and serving millions of people, according to Mr Abraham, leadership choices play a pivotal role in perpetuating or dismantling health inequalities. He believes improving care quality requires enhanced population health, staff wellbeing, and crucially health equality – and this must be key to organizational thinking.

He explains: “When you love your job, care about your patients, and do it well, you can't ignore how the social determinants of health inequalities affect them every day.

“I work in Whitechapel, at the heart of deprivation in East London, where life expectancy drops with each tube stop heading east.

“What unites us in addressing health inequalities and inclusion is the belief that fairness matters.

“In a liberal democracy, we value freedom and equal opportunity, yet structural injustices can create unequal opportunities.”

A Lesson in Self-Reflection from Blackpool

The realities of health inequalities and the impact they are having on the people we both work with and serve are often staring us in the face, according to Maggie Oldham, Chief Executive of Blackpool Teaching Hospitals NHS Foundation Trust.

She described how the health challenges facing Blackpool and its surrounding areas are amongst the worst in England, particularly for women and young people.

She argued that the key to addressing health inequalities and unlocking solutions lie in understanding and investing in the local NHS workforce – because they reflect what is happening out there in the wider population. And that by choosing to be open about the realities, you can start to combat them.

“Blackpool faces troubling statistics: life expectancy is 79.5 years, the lowest in England, and it ranks among the most deprived areas. We see high rates of chronic illnesses like diabetes and cardiovascular diseases, especially among women. Socioeconomic factors like unemployment, poor mental health, high smoking rates, and teenage pregnancies further impact women's health. Blackpool is the second hardest place in the country to grow up female.” Yet, she adds, ”77% of our workforce is local and female.”

“Our people work in a challenging environment but also live in and are a product of that challenged local geography, but we still manage to provide a huge amount of care.

“The pandemic highlighted health inequalities, affecting both our patients and staff. Some patients in our ICU were also our staff members. We’re examining the impact of sickness among bands 2-5, noting certainly that some sickness rates and work-related illnesses were linked to smoking.

“I’ve learned that our staff are both our greatest challenge and our greatest asset. The organisations that get it right for staff also get it right for patients”.

“We Have to Do Things at Place Level”

Dr Arif Rajpura, Director of Public Health for Blackpool Council, added that a multi-faceted approach is required, to make quick impact in the community – such as increasing uptake of screenings and vaccinations - as well as long term change.

The benefits of addressing the root cause of inequality in an area where the population grapples with entrenched deprivation (unemployment, poor housing, poverty) may only be seen 15 or 20 years into the future. He argues that everyone in the system has to choose this path for it to work: “Ultimately what we are trying to do is improve life expectancy, improve healthy life expectancy and improve health inequalities.

“Tackling health inequalities requires time and investment, with benefits seen over time. Effective action happens at the community level, where the NHS, local government, and national government must collaborate.

“We must do things at place level. The focus should shift from merely saving money to investing in preventive, person-centred care, rather than just treating diseases.”

Notes

*This states ‘Social and economic inequalities are to be arranged so that they are to the greatest benefit of the least advantaged’

Further Information

Strasys, a leading analytics and innovation agency, has developed a new webinar series entitled “Thinking Differently”. In collaboration with our NHS partners, we are bringing the best thinking and insight to tackle the problems that need to be solved urgently. Our webinars provide a laser sharp focus on solutions, through short, powerful and practical presentations and debate. Watch back the ‘Narrowing health inequalities’ webinar now and to find out more and sign up for future events visit: https://www.strasys.uk/events/  

Get in touch if you would like to learn more about the innovative Strasys tools and methods to help your organisation address health inequalities events@strasys.uk

Our most recent webinar was “Revolutionising Healthcare Decision-Making through Data Innovation” Tuesday 3 December 12.30-13.45. Follow other events here