The Long Term Plan – addressing health inequality

Following the announcement of NHS England's Long Term Plan earlier this month, the RCP has engaged in a week-long discussion covering the plan's most important themes. Today, RCP academic vice president Professor Cheng-Hock Toh explains what it means for health inequality.

The RCP is encouraged that the second chapter of the NHS Long Term Plan lays out how it will take more action on prevention and health inequalities. As a coalition of royal colleges and health faculties said in a letter to the chancellor ahead of last year’s autumn budget, a healthier population is key to the long-term sustainability of all public services, including NHS and social care services.

The RCP has played a key role in shaping public health policy in terms of air pollution, alcohol, obesity and tobacco. So we welcome the extension of smoking cessation and tobacco treatment services, targeted weight management services and a doubling of the diabetes prevention programme, a greater place for nutrition in medical education and training, and a renewed commitment to reduce air pollution created by the NHS.

[...] a healthier population is key to the long-term sustainability of all public services, including NHS and social care services

Professor Cheng-Hock Toh, RCP academic vice president

There are also encouraging mentions of meeting the needs of rough sleepers, more support for carers, helping more people with serious gambling problems, and doing more to ‘ensure that all people with a learning disability, autism, or both can live happier, healthier, longer lives’.

The fact this is all presented in the context of inequality, with the NHS to target a higher share of funding towards areas with high health inequality, is of most importance. We therefore look forward to the specific, measurable goals for narrowing inequalities that the plan says are forthcoming.

One of our policy and campaigns priorities for 2019 is to make sure UK policy reduces health inequalities by focusing on prevention, which is always better than cure. In particular, we will highlight the impact of deprivation, age and ethnicity.

This is the first time we have approached our public health work in terms of inequalities. It reflects growing concern among our members that large swathes of the UK population are being left behind in terms of their health. That life expectancy has stopped improving for the first time since 1982 is a worry, but the fact it has decreased in some areas is highly concerning.

In March 2018 the Office for National Statistics reported statistically significant increases in the inequality in life expectancy in England between the most and least deprived. On average, the least deprived males can expect to live almost a decade longer than the most deprived, while for females the gap is over 7 years.

In its Health Profile for England: 2018, Public Health England said there was no evidence that inequalities in life expectancy had narrowed: they had remained the same for males, and widened for females. A third of the gap was due to higher mortality rates from heart disease, lung cancer, and chronic lower respiratory diseases.

[...] the starkest finding was that the gap in healthy life expectancy between the richest and poorest areas of England was around 19 years for both males and females

Professor Cheng-Hock Toh, RCP academic vice president

But the starkest finding was that the gap in healthy life expectancy between the richest and poorest areas of England was around 19 years for both males and females. This inequality begins early in life: low birthweight, tooth decay and obesity are more prevalent in the poorest areas.

When we register with the GMC, we individually commit to protecting and promoting the health of patients and the public, to making the care of our patients our first concern, and to take prompt action if we think that patient safety, dignity or comfort is being compromised. As a profession, we are collectively committed, as reflected in the RCP strategy, to caring for individual patients and the health of the whole population, both in the UK and across the globe.

We cannot therefore allow the inequalities in health to continue, which is why we are establishing a new advisory group. Over the next year, it will bring together our public health special advisers and others to develop a strategy for RCP work aimed at reducing health inequalities.

There is much we and others can, and will, do. But in the face of continuing reductions to public health funding, we do fear our efforts will be hampered by rising demand at the hospital front door.

Professor Cheng-Hock Toh is the RCP academic vice president and professor of haematology at the University of Liverpool.

This blog is part of a week-long series of discussions focusing on the NHS Long Term Plan. If you have any questions or feedback about the topics covered in these posts please contact policy@rcplondon.ac.uk