The case for tackling\u00a0health inequalities\u00a0<\/a>is clear and overwhelming, and yet attempts to do so in recent decades have had mixed success. Crucially, none of these efforts have translated into the enduring focus on addressing health inequalities that is needed.<\/p>\n While inequalities in health have always been a problem, the Covid-19 pandemic has shone a spotlight on inequalities, and created an opportunity for change. In this long read we make the case for developing a long-term approach to tackling health inequalities that will endure and consider past attempts, highlighting learnings for the renewed effort. Concurrent action is needed at multiple levels: an enduring national mission to tackle inequality; a new local and national partnership to create the conditions for system success; and local leadership to nurture the disruption needed to sustain success.<\/p>\n<\/div><\/div><\/div><\/div><\/div> Health inequalities<\/a>\u00a0are\u00a0avoidable, unfair and systematic differences<\/a>\u00a0in health between different groups of people. They are rooted deep within our society, and they are widening, leading to disparate outcomes,\u00a0varied access to services<\/a>, and poor experiences of care. This results in earlier deaths,\u00a0lost years of healthy life<\/a>,\u00a0intergenerational effects<\/a>\u00a0from\u00a0traumatic<\/a>\u00a0experiences, and has\u00a0significant economic costs<\/a>\u00a0for society.\u00a0Yet, health inequalities are often preventable.<\/p>\n Life expectancy<\/a>\u00a0is one way to measure the health of a population or particular group. Since 2010,\u00a0improvements in life expectancy have\u00a0stalled<\/a>\u00a0for the population as a whole, and for the poorest 10 per cent of women they have declined. Before the pandemic, the gap in life expectancy between the most and least deprived areas in England had grown to 10.3 years for men and 8.3 years for women.\u00a0Narrowing this gap<\/a>\u00a0demands a more preventive approach to health and a focus on the broader determinants of health.<\/p>\n Why is now a moment for change? Unfortunately, such changed context is not enough to inspire a different outcome in addressing inequalities.\u00a0Opportunity needs to be matched by action.<\/p>\n The problem: how to deliver enduring change The similarity of these reports\u2019 recommendations and the limited progress made illustrate the challenge still faced: how to implement change across a complex system so that it endures over time.<\/p>\nThe worst health outcomes<\/h3><\/a><\/li>
What can we learn from past attempts?<\/h3><\/a><\/li>
What does history tell us about the best route forward?<\/h3><\/a><\/li>
Conclusion<\/h3><\/a><\/li><\/ul><\/div>
The worst health outcomes<\/h3><\/a><\/li><\/ul><\/div>
\n<\/strong>The pandemic has turned a spotlight on the\u00a0impact of health inequalities<\/a>.\u00a0Alongside the continued moral and economic case for acting, the pandemic has brought new factors into play that can be harnessed to drive improvements.<\/p>\n\n
\n<\/strong>The urgent call to address health inequalities has been made before.\u00a0Reports led by\u00a0Douglas Black<\/a>\u00a0in 1980\u00a0and\u00a0Donald Acheson<\/a>\u00a0in 1998 made the case for sustained intervention to address health inequalities and address the wider determinants of health. In 2002, a review chaired by\u00a0Derek Wanless<\/a>\u00a0looked at the level of long-term health funding that would be required under a \u2018fully engaged\u2019 scenario, where a well-informed public takes control of their own health.\u00a0Michael\u00a0Marmot\u2019s<\/a>\u00a0review team assessed progress in 2010\u00a0and outlined a renewed plan of action, which was\u00a0updated in 2020<\/a>.<\/p>\n