Mind the gap: The NHS cannot single-handedly eradicate health inequalities
A lot of money is invested into research about health inequalities. Millions. But, we know what the issues are, we’re aware of the barriers (structural and individual), and we’ve seen best practice.
The answers won’t always lie within the research and medical fields. Medical professionals and researchers need humility and openness to accept this. What we need is less talk and more action!
If there’s something Inclusion Health nursing and nursing in the community setting has taught me, it’s that it takes stepping out of a “business as usual” mindset to make change happen. Not going rogue and completely ignoring guidance, but being creative with it. This might look like:
Having the autonomy and flexibility to offer truly tailored services that are responsive instead of reactionary and overly bureaucratic.
Making in-the-moment, dynamic risk assessments. This means taking well-managed risks.
Finding new opportunities to collaborate with others. Rather than staying within the field of healthcare alone, it makes sense to work with housing specialists, outreach workers, case workers, job centre workers etc.
All of this allows healthcare workers to make mainstream services more easily accessible and available to people when they need them because it’s about going to where people are.
It has been suggested that only 15-20% of a person’s health is influenced by healthcare services. The rest is determined by everything outside the clinic walls.
The NHS alone does not have the levers to reduce health inequalities. Addressing the factors that cause poor health in the first place is where we need to focus our attention. It’s important to recognise that health outcomes are affected by a person’s wider life – living conditions, financial situation, stress, people they spend time with, national policies (example of banning smoking in public spaces) and much more.
Intuitively, we know this. But somehow, it lands differently when there’s a number attached to it. So, what we’re saying then is that 75-80% of a person’s health rests on factors beyond the healthcare system.
There are two points here:
How we define and describe healthcare services
Wider factors that impact our health
What makes a healthcare service?
I cannot overestimate the powerful impact that community groups have had on the quality of my client/patient’s lives and subsequently, their health. Whether it’s a formal referral to a social prescribing programme, or something less structured. In some cases, community groups provide a lifeline for individuals. For some, the day centre or temple where they go for their lunch may be the only time they get to speak with someone that day.
Traditional healthcare services are a vital part of society. However, the way healthcare is thought of, as something that exists only within the realms of a clinical setting, needs to pivot if we want to see a change in the state of our health as a nation. At the moment, we have:
Primary health care services (GP Practices)
Community health care services (district nursing; community childrens nursing teams; health visitors; community mental health services etc.)
Secondary care (hospital care)
But there’s a space before this. We need to get comfortable seeing these spaces as our primary care services:
Parks + green spaces
Local grocers
Massage therapists
Barbers/hairdressers
Personal trainers
Galleries
Allotments
Yoga teachers
Community leaders
Sports/dance classes
Craft/hobbies groups
What we see as everyday background activities and practices, and people embedded in our communities, are actually what make up our primary care. These are the people and spaces that nourish us. This is where we go to recharge.
Note: I’m not suggesting people go to their barber or yoga teacher in obvious physical or mental health crisis or replace their GP with either of these roles. What this highlights, though, is that health starts way before we enter the healthcare establishment.
Social determinants of health
Our health outcomes are shaped by many factors, not just medical. There are social, economic and environmental conditions that impact our health everyday. Addressing health inequalities will take everyone’s efforts in all areas of society including:
The food industry
Religious institutions
Advertising regulatory authorities
Local town planning services that decide on how many betting shops, fast food retailers etc. can set-up and where
Schools
Media outlets that decide what we are shown
Local environmental agencies responsible for air quality
When greater social responsibility is taken by these institutions, this creates spaces for people to thrive. Together with joined-up working between healthcare workers and local community groups, we can create a more level playing field for people to access health information that ultimately improves their wellbeing.