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Noticing health inequalities and doing something about it

Making progress on tackling health inequalities is not just about getting the right evidence – it means challenging power, shifting culture and changing how we work. In order to do this we need a clear narrative – a story – that empowers champions, motivates the undecided and challenges the unconvinced.

We have struggled to do this – for example a decade ago it was a real success when we started to talk about differences in life expectancy between socio-economic groups by using examples that many people are now familiar with the such as the bus journey/bus stop analogy.

However, despite its success I think that life expectancy data was not sufficient to mobilise and sustain action at a local level. Some of the reasons for this might be that life expectancy:

Health Inequalities and Multi-Morbidity – a more powerful narrative

quote from Health Foundation Understanding the Health Care Needs  of People with Multiple Health Conditions

In recent times thanks in significant part to the Institute of Health Equity and other players such as the Health Foundation we are seeing a shift to focus more on the impact of health inequality on Disability Free Life Years and multimorbidity.

This useful table from a RCGP article on  the epidemiology of multimorbidity in primary care sets out the ten most prevalent morbidities and associated comorbidities

Table from Epidemiology of Primary Care (2018) by Anna Cassell, Duncan Edwards et al.

The graph below from the Institute of Health Equity shows how people who experience socio-economic inequality are likely to have a shorter period of disability free life expectancy than people who are wealthier and to already have poor health before they reach pension age.

Talking about the relationship between socio-economic inequality and Disability Free Life years (or the very similar multi-morbidity) is helpful because it:

Of course focussing on multi-morbidity does not in itself solve health inequalities – however it does challenge the NHS, make it clearer what it’s contribution can be and pushes health services to make stronger connections to agencies working to address the social determinants of health.

What do you think?

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