Joined-up government action lies at the heart of tackling health inequalities, but the health service must act too

I begin my role as the RCP’s special adviser on population health at a time when the NHS and its workforce are under immense pressure. Last year saw record A&E wait times and, as recently highlighted by the RCP, far too many patients receiving treatment in temporary care environments such as hospital corridors. Primary care services are also under huge pressure. These are clear signs of a health service and a workforce facing overwhelming demand. Behind this is a population, many of whom are in increasingly poor health, contributing to that pressure.

Much of what we have heard from government has focused on immediate challenges facing health systems but we must redouble our efforts to consider contributing factors outside of the health service itself. Population health looks beyond the individual to focus on the broader societal determinants of health, which contribute 80–90% to the quality of public health. Population health identifies patterns and trends and develops strategies that can positively impact entire communities, the individuals and higher risk groups within them. It uses well-established techniques, by quantifying the positive effects on health from all those influences, including healthcare. 

The government’s recently announced 10 Year Health Plan (read the RCP’s recent response to the government’s consultation on the plan) identifies three key shifts in the way we approach health and care in the UK: from hospital to community, analogue to digital, and sickness to prevention. For these shifts to be successful, all require serious consideration of how best to treat individual patients and how we can transform services more broadly to address patient needs. However, the shift from sickness to prevention requires a sea change in approach to tacking ill-health at a population level – a change that has been a long time coming. 

We know only too well that a child growing up in disadvantage is more likely to face chronic illnesses, mental health challenges and reduced life expectancy. Boys born in Blackpool, for example, have the lowest healthy life expectancy in the UK. Those born there between 2016 and 2018 are projected to have 53.3 years of their life in what would be considered good health. The same male age group born in Richmond-upon-Thames can expect 71.9 years of health life expectancy – an astonishing 18.6-year disparity.

At the heart of these kinds of disparities, which are pervasive and numerous, lie the social determinants of health – as well described by Sir Michael Marmot and others – such as housing, education, employment, poverty, early years effects, access to transport and greenspaces, and the quality of the air we breathe. These many factors influence health status and so place significant demands on the health system. We have known for 25 years that unless we maximise effective health prevention measures, the NHS as we know it will become unsustainable. 

In March last year, RCP polling found that 55% of consultant physicians had seen more patients with ill health in the prior 3 months due to social and economic factors, while almost a quarter (24%) said more than half or almost all of their workload is due to illnesses or conditions related to the social determinants of health. I have been a member of the RCP Health Inequalities Advisory Group since 2021 and have seen first-hand the work the college has done supporting approaches that help to address wider determinants of health. The RCP rightly says the responsibility for addressing these determinants of health falls to the Department for Health and Social Care and every government department.

The RCP has long called for a cross-government strategy to reduce health inequalities – one that considers the role of every government department and every policy lever. The government’s commitment to a mission delivery board for health was a welcome step to addressing the root causes of ill health through a pan-government approach. The board has significant potential to drive meaningful change across society. 

Yet we are still waiting for it to set out its plans for exactly how this government will tackle social determinants. To date the government has focused on immediate pressures, for example reducing elective wait times. We must now also see action to prevent ill health to put the NHS on firmer footing for the future. The board must be the vehicle to deliver a cross-government strategy to reduce health inequalities and also feed into the 10-year plan, ensuring that action is taken to support primary, secondary and tertiary prevention. The RCP has and will keep campaigning on this issue.

The health sector plays a vital role in this and it’s equally important to recognise that it is incumbent on physicians to do all we can in our own working lives too.

 In December 2024, the RCP published guidance for physicians focused on building a better understanding of health inequalities and embedding action to tackle these inequalities within and across NHS organisations.

This provides practical actions for clinicians, clinical leaders and NHS organisations to make health inequalities a strategic priority. It includes information on existing statutory duties and guidance to help organisations better understand their obligations and act so that healthcare can positively contribute to reducing health inequalities. Clinicians can use their experience to help overcome barriers and exploit enablers to help embed health equity into NHS systems. 

As I start my new role as population health adviser, I look forward to building further on the RCP’s good work, calling on the government to deliver a cross-government strategy and harnessing the internationally renowned expertise of many of our members on various aspects of the wider determinants of health. We are committed to providing physicians with the tools and opportunities to make real change for their patients and local populations.