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Inequalities in health: What do we know and what can we do?

25 Oct 2023

The UK’s National Health Service was designed in response to visible health inequalities, pushed forward by collectivist attitudes in the post-war era. Widening access to healthcare for all people removed the fear of ill-health, which had plagued low-income communities. As a nation, we became healthier thanks to its interventions.

In the latest edition of our membership magazine VOICE, we look at inequalities in health and preview this year’s President’s Conference. You can read this below and our members can read the full edition of VOICE by logging into your online dashboard.

The UK’s National Health Service was designed in response to visible health inequalities, pushed forward by collectivist attitudes in the post-war era. Widening access to healthcare for all people removed the fear of ill-health, which had plagued low-income communities. As a nation, we became healthier thanks to its interventions.

But despite the best intentions, 75 years after the NHS was established, we have not yet been able to eradicate health inequalities. At the beginning of his medical degree in 1980, College President Mike McKirdy encountered the Black Report. It uncovered a mortality gap across the UK, which revealed that health outcomes were significantly worse and lifespans much shorter for people living in the most underserved communities. (1)

Findings from the Black Report stuck with him throughout his career. However, over 40 years later, health inequalities continue to persist. In his native Glasgow, healthy life expectancy at birth is only 54.6 years for men and 57.6 years for women (2), compared to the national average of 76.6 (men) and 80.8 (women) years (3).

Faced with the lack of change, this year’s President’s Conference is dedicated to addressing health inequalities, focusing on unpacking its complexities and spotlighting effective interventions which empower clinicians to take action.

Spotlight on economics

On the frontline, healthcare professionals deal with the impact of health inequalities in their daily practice. Instances of chronic disease are rising among those in the most deprived areas of the UK, and in turn, the demand for health service is greater than ever before. However, this problem extends beyond the NHS. Key experts Sir Michael Marmot, Dr David Walsh, Marion Devaux and Professor Gerry McCartney will join the discussions at the conference, assessing what we know about health inequalities and what is preventing change. In their view, economics and social policy holds the key to understanding why this remains a problem for public health.

In 2010, Sir Michael Marmot published his landmark report ‘Fair Society, Healthy Lives’. It revealed the social gradient of health in which the most affluent in England were living on average seven years longer and 17 years more in good health than those in the poorest communities. Further, it estimated the public cost of health inequalities to be between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS. (4)

Although these findings made a concrete case for urgent action, Dr David Walsh argues that the lack of political will to implement policies are preventing change. He notes: “Health inequalities are an extension of broader societal inequalities: to narrow them, therefore, you need government policies which fundamentally make society more equal. In the UK, we don’t have those policies – indeed in recent years we have had the opposite in place, and as a consequence, health inequalities have widened dramatically.”

Although the economic policies introduced alongside the launch of Marmot’s report have had a lasting impact on health today, at the conference Dr David Walsh will discuss how similar polices have taken effect over the last one hundred years in Scotland. Coupled with this, Marion Devaux will look at the economic map of health inequalities in Europe, to assess how they are tackled in various different health systems.

Rethinking our delivery

Healthcare professionals and by extension, Royal Colleges, also have their part to play in reducing health inequalities. Within the NHS, service design and clinical intervention has introduced successful mechanisms to improve public health in local communities. In November, President Mike McKirdy will welcome leading practitioners Professor Kiran Patel, Professor David Conway, Dr Camilla Kingdon and Professor Andrea Williamson who are all rethinking the delivery of care to achieve health equity.

This starts with understanding how people access healthcare and Professor Andrea Williamson joins us to discuss ‘missingness’ in the system through appointment uptake. She argues ensuring people don’t fall through the cracks is one step to addressing health inequalities. Additionally, she believes in empowering doctors in their ability to deliver care and using this to advocate for patients, adding: “Personally, my key one would be a trauma informed practice approach to care – when that is enacted at all levels of the system from managers to frontline clinicians then many of the barriers to care that currently drive inequalities will vanish.

Also, importantly the advocacy role that doctors can have for patient groups. Doctors have power and are listened to – use it to achieve health equity!” In striving for equality in health, service design works in the context of wider determinants of health which requires intervention from both those on the ground and at the top.

Professor Kevin Fenton joins us to highlight how racism plays an intrinsic role in health outcomes and access to health. We will also be hearing from Medics Against Violence navigator Alan Gilmour to explore violence prevention in a health care context, particularly among youth, and Sir Harry Burns will further emphasise the importance of early interventions to reduce health inequalities.

Both Professor Tom Lloyd Goodwin and Professor Gerry McCartney will look at how we reshape our thinking on economics through community wealth building. We will also hear from the Directors of all four health systems, including Professor Bola Owolabi, Director of Healthcare Inequalities, NHS England, on the actions governments in the UK are currently taking to build a national response to health inequalities.

Notes and acknowledgements

We’d like to thank Dr David Walsh and Professor Andrea Williamson for their contributions to this article. The annual President’s Conference is a hybrid event taking place on 16 November 2023. We’d like to further thank all of our speakers for their participation in this event.

(1) Gray A. M. (1982). Inequalities in health. The Black Report: a summary and comment. International journal of health services : planning, administration, evaluation, 12(3), 349–380.
(2) ONS Geography Open Data, ONS, Health state life expectancies, UK: 2017 to 2019. Available at
(3) National Records of Scotland, 2022, Life Expectancy in Scotland 2019-2021. Available at
(4) Marmot, M. (2010) Fair society, healthy lives : the Marmot Review : strategic review of health inequalities in England post-2010. ISBN 9780956487001

Category: Health Inequalities

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