Published: 26 October 2018
Everyone should have the same opportunities to lead a healthy life, no matter where they live or who they are. Health inequalities mean poorer health, reduced quality of life and early death for many people.
The North West Coast region faces stark health inequalities. Average life expectancy can vary across Local Authority areas by up to 12 years; for average healthy life expectancy this can be up to 27 years.
Between 1997 and 2010, the UK government implemented a comprehensive programme to reduce health inequalities in England, one of the most ambitious strategies of its kind. The target was to reduce by at least 10% the gap in life expectancy between the fifth of local authorities with the worst levels of poor health and deprivation and the population as a whole.
Research, supported by CLAHRC NWC and published last year, found that the English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. However, inequalities have started to increase again since the strategy ended. The concerns are that current policies are reversing the achievements of the strategy and future approaches should learn from this experience. Therefore it is no surprise to see the NIHR released the Health Inequalities Research Initiative to support policy makers in the Department of Health and Social Care (DHSC).
As the Due North Health Equity Report reminded us “much of the responsibility for reducing health inequalities and their socio-economic causes lies with central government. However, a lot can be done locally”. To have real impact at population level, interventions not only need to be sustainable and systematically delivered at a scale to reach large sections of the population. They need approaches that have collaborations at their heart.
CLAHRC NWC strives to tackle health inequalities and the socio-economic drivers of these inequalities by enabling critical conversations and collaborations between a range of local and national organisations.
An example is the CLAHRC NWC Improving Public Health Theme Neighbourhood Resilience Programme (NRP), which brings together partners in several local authorities to focus on health improvement barriers in 10 relatively disadvantaged neighbourhoods. Increasing a community's ability to access resources and respond to global economic challenges requires action at the national level. However, local actions and local partnerships involving anyone working or living in those neighbourhoods (including residents, schools, healthcare providers, businesses, public transport and council services) have an important contribution to make too and their impact should not be underestimated. There are significant benefits to collaborating in this way, as shared experience, knowledge and resources offer greater opportunities to see long-lasting change. A full case study of the initiative has been published in the “Health 2020 priority area four: creating supportive environments and resilient communities A compendium of inspirational examples”, compiled by the World Health Organization Regional Office for Europe.
Together with academic staff and representatives from our partners, the Health Inequalities Assessment Toolkit (HIAT) was developed to support organisations to routinely incorporate an equity dimension into all their activities. The uniqueness of the tool is that it is relevant to applied research, evidence synthesis, capacity building, knowledge exchange, implementation and evaluation.
With the HIAT and supporting policies and processes, CLAHRC NWC has been at the forefront of mainstreaming health inequalities across its portfolio of research and related activities. It has challenged individualised “lifestyle-centric” approaches to reducing health inequalities that often focus on modifying people’s behaviours without consideration of the wider politico and socio-economic forces that shape those behaviours.
It has infused partners and staff with greater awareness of the structural determinants of health, and stimulated more imaginative thinking about what action on inequalities is possible in their day-to-day practice as researchers, service providers, managers and/or commissioners.
I sincerely hope the legacy of CLAHRC NWC’s research and practical applications to embed health inequalities in research, including the proven benefit of collaboration, makes a continued impact on reducing health inequalities as longer term, we are doing this work to improve the health of future generations.