May 2021
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This conference examined the key policy priorities for tackling health inequalities in the national recovery from COVID-19.
We are very pleased to have been able to include a keynote contribution from Professor Sir Michael Marmot, Professor of Epidemiology and Director, Institute of Health Equity, University College London.
Key areas for discussion also included:
- research and evidence - understanding the impact of the pandemic on inequalities and key challenges it has highlighted, as well as the use of data and population health approaches
- policy priorities - including for investment and cross-government coordination
- tackling variation - supporting vulnerable communities, addressing regional imbalances, and tackling digital exclusion
- initiatives at a local level - place-based working, healthy communities, and the role of health service networks, local authorities, the third sector, and community groups
The discussion brought together stakeholders with parliamentary pass-holders from the House of Commons and key policy officials who attended from DHSC; the ONS; the CQC; the DfE; Defra; the FCDO; the Home Office; the Joint Biosecurity Centre; the NAO; the Office for Statistics Regulation; the UK Statistics Authority and the Welsh Government.
The agenda:
- The way forward for tackling health inequalities in the recovery from the pandemic
- Priority actions - assessing the impact of COVID-19 on health inequalities, national policy and cross-government collaboration, funding and investment, and key steps for supporting vulnerable communities
- Addressing national variation in health inequalities in the wake of the pandemic
- Scaling up health and wellbeing initiatives and engaging with local communities in service delivery
- Working with the community to overcome digital and health inequality
- Tackling health inequalities at the local level - improving outcomes for ethnic minority groups, the role of primary care, community engagement, developing healthy places, and optimising system-wide collaboration
Key areas for discussion:
COVID-19
- impact and the response - examining key areas where this national crisis has shone a spotlight on health inequalities, and how the challenges of the pandemic and recovery are being tackled
- inequalities - assessing what has been done to identify and mitigate the impact that the virus poses to different groups, particularly those with increased risk of experiencing poor outcomes
- engagement - evaluating how well communication campaigns have worked in reaching vulnerable groups, and tailoring messages for specific local communities, including for tackling vaccine hesitancy
National policy
- priorities - how action on tackling inequalities should be embedded into the Government’s objectives and planning as it leads the nation’s recovery from the pandemic
- coordination and leadership:
- increasing collaborative approaches across Government for tackling health inequalities, and developing a more joined-up policy framework
- setting an example for the rest of the country to follow, and ways to increase national responsibility for health inequalities
- integration with wider policy:
- the importance of tackling health inequalities as part of the Government’s ‘levelling up’ programme
- opportunities for integrating the social determinants of health within the programme for successful delivery
- the NIHP - what the role of the new National Institute for Health Protection should be in the future of public health in England and tackling health inequalities
Funding and investment
- priorities - identifying the most important targets for urgent funding in the wake of the pandemic
- opportunities - using the Levelling Up Fund, as well as further strategies for long-term investment, to improve health inequalities and tackle identified areas of deprivation
- addressing national variation - looking at:
- investment and funding allocation to tackle the north-south divide in life expectancy and health inequalities
- how the pandemic has highlighted divisions, and ways that this can be addressed as the country moves through recovery from the pandemic
Opportunities
- place-based focus - the role of increased working at a local, person-centred level in national health policy, and of integrated care systems in delivering improvements in local health inequalities
- population health - use of data and local insight to identify and target health inequalities within communities, sharing best practice, and how to widen the use of population health approaches
- system collaboration:
- overcoming barriers to partnership working across the NHS, local government, the third sector, employment, education, and housing services
- best practice for developing ways of working efficiently as a system, and pooling resources
Local initiatives
- health services - priorities for commissioning, as well as the role of primary care networks in addressing health inequalities, and provision of the support they need
- local authorities:
- opportunities for building on the positive work identified in The Marmot Review 10 Years On, and how to scale up successful approaches
- delivering safe and accessible housing, and innovating health and wellbeing initiatives across local government
- local stakeholders - strategies for engaging with community groups, businesses and individuals to design and optimise the services they use
- the third sector:
- their role in in supporting efforts to address health inequalities
- opportunities for optimising collaboration
- lessons that can be learned from the response to providing community support during the pandemic of charities and voluntary groups
Technology
- where can it help most - priorities for innovation in services and kit to best support health and wellbeing, including wearable technology and ways of easing social exclusion and loneliness
- access - addressing digital exclusion, widening internet access and improving digital literacy, and what can be learned from tackling challenges in access to digital healthcare through the pandemic
Inequality affecting ethnic minority groups
- research and evidence - identifying and improving understanding of the social determinants of health affecting people from ethnic minority backgrounds and their communities
- the impact of the pandemic - changes in awareness of inequality in different groups within the population, and what has been learned for mitigating issues and improving outcomes going forward
Healthy and sustainable places
- priorities - addressing links between deprived areas and poor environmental health
- the wider policy agenda - looking at ways of harnessing developments seen around air pollution and active travel through the pandemic
- further action - what more needs to be done to mitigate the impact on deprived and vulnerable communities
A scan of relevant developments:
- Build Back Fairer: The COVID-19 Marmot Review - the UCL Institute of Health Equity assessing the impact of COVID-19 on health inequalities, with recommendations for action
- Commission on Race and Ethnic Disparities: The Report:
- recommending a new Office for Health Disparities, initially to focus on research, health campaigns and community contacts, and including race and health as an example where there is an ‘overly pessimistic narrative’
- response to the Commission’s report:
- the NHS Race and Health Observatory ‘disappointed’ at conclusions on the causes of ethnic inequalities
- a letter from 250 professionals and doctors saying that the report ‘omits’ evidence from Sage on structural racism
- reports that the Consortium of Black, Asian and minority ethnic Health Professional Networks have expressed concerns that ideas in the report could lead to the inappropriate allocation of resources, potentially putting some communities at risk
- the health and social care white paper - including work to tackle health inequalities, as well as proposals on calorie labelling and food advertising
- NHS Long Term Plan:
- establishing integrated care networks and a focus on working at a place-based level
- commitments including measurable goals to reduce health inequalities and the allocation of funding for areas with the greatest need
- Advancing Our Health: Prevention in the 2020s green paper - including measures to incentivise prevention across the health system, engage with industry partners and address inequalities
- Transforming the public health system - with recently released details on establishing the UK Health Security Agency, the new Office for Health Promotion, and building on the work and influence of the Regional Directors of Public Health
- Sage Ethnicity Subgroup report - stating that ‘multifaceted’ policy is needed, with the Subgroup’s examples relating to personal finances, healthcare, employment and stigma relating to COVID transmission
- Levelling Up Health - the report from the APPG for Longevity which includes calls for focused work such as a Health Improvement Fund for communities with the worst health, and emphasis on smoking, obesity, clean food, clean air, and healthy children
- the welfare system - comments from Professor Sir Michael Marmot on reforming the welfare system to potentially improve mental health outcomes
- The best start for life: a vision for the 1,001 critical days - from Government, as part of the Early Years Healthy Development Review, with the Review team due to focus on six areas in the coming months: coherent support, Family Hubs, information, workforce, improvement and leadership
- Inquiries by the Women and Equalities Committee:
- Unequal impact? Coronavirus and BAME people - looking into pre-existing inequalities facing ethnic minorities and the implications regarding COVID-19
- Take up of the COVID-19 vaccines in BAME communities and women - recently announced
- Unequal impact? Coronavirus, disability and access to services - as concerns are more widely shared regarding the higher risk of death for disabled people with regard to COVID-19
- COVID-19: understanding the impact on BAME communities report - from PHE, looking into why ethnic minority groups are at greater risk
- Second quarterly report on progress to address COVID-19 health inequalities - from the Minister for Equalities focusing on the impact on ethnic minorities, suggesting that:
- disparities may be due to risk of infection
- ethnic minorities should not be treated as one group in terms of varying risk factors
- the Government will focus on deprivation in the coming months, which has been shown to drive higher infection rates across all ethnic groups
- Government launches call for evidence to improve health and wellbeing of women in England:
- enquiring on themes around listening and engagement, information, employment, research, COVID-19 and meeting women’s health needs throughout their lives
- the consultation will form the basis of the new Women’s Health Strategy announced by the Government on International Women’s Day
- the Learning from deaths of people with a learning disability (LeDeR) programme - looking at the circumstances around deaths of those with learning disabilities and making changes and improvements to provision through CCGs, steering groups and health and social care professionals
- Saving and improving lives: the future of UK clinical research delivery - the vision from the UK administrations which includes work on access and participation in research
- Community Champions to give COVID-19 vaccine advice and boost take up - funding for 60 charities and voluntary groups to improve engagement, communication and the provision of correct information with at-risk groups, overcoming barriers and supporting vaccine take up
- Action required to tackle health inequalities in latest phase of COVID-19 response and recovery - from NHS England, on increasing preventative programmes, digital inclusion in care pathways, inclusivity in the re-opening of services, and improving leadership
- the Spending Review - including the £4bn Levelling Up Fund, £254m for reducing homelessness, as well as funding for housing safety and affordability and local government COVID-19 community response
- Air Quality and coronavirus: a glimpse of a different future or business as usual - recent air quality report from the EFRA Committee highlighting the negative impact of poor air quality on disadvantaged communities
- the Air Quality Strategy - including commitments around:
- local targeted action for areas with poor air pollution
- air quality messaging systems to improve communication to those vulnerable to air pollution
- guidance for local authorities to help them make air quality improvements
Policy officials attending:
Our forums are known for attracting strong interest from policymakers and stakeholders. Places were reserved by parliamentary pass-holders from the House of Commons, and officials from the Care Quality Commission; Defra; the Department for Education; the Department of Health and Social Care; the Foreign, Commonwealth & Development Office; the Home Office; the Joint Biosecurity Centre; the National Audit Office; the Office for National Statistics; the Office for Statistics Regulation; the UK Statistics Authority and the Welsh Government.
