The RCP convenes the Inequalities in Health Alliance, a coalition of organisations who have come together to campaign for a cross-government strategy to reduce health inequalities.
The IHA was launched in October 2020, when it wrote to the prime minister to ask government to do three things:
- develop a cross-government strategy to reduce health inequalities
- commence the socio-economic duty, section 1 of the Equality Act 2010
- adopt a ‘child health in all policies’ approach.
Membership of the IHA is open to registered charities, NHS and social care organisations, public bodies, community groups and campaigning organisations that have an interest in reducing health inequality. Members of the IHA contribute to its ongoing campaign by promoting the ask for a cross-government strategy to reduce health inequalities to government, their memberships and networks.
What are health inequalities?
Health inequalities are the avoidable differences in health across the population. People's health is shaped by many factors, which often are beyond the remit of the NHS or the Department of Health and Social Care. That is why the IHA is calling for a cross-government strategy that considers the role of every government department and every available policy lever in tackling the factors that make people ill in the first place.
Why we need a cross-government strategy
A cross-government strategy is needed because health inequality is the result of many and varied factors. While it may seem that health inequality is a matter for the Department of Health and Social Care or the NHS, health and social care services can only try and cure the ailments created by the environments people live in. If we are to prevent ill health in the first place, we need to take action on the social determinants of ill health such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. All parts of government and public services need to adopt reducing health inequality as a priority.
A healthy population and a healthy economy are two sides of the same coin. Before COVID-19, health inequalities were estimated to cost the UK £31bn to £33bn each year in lost productivity, £20bn to £32bn in lost tax revenue and higher benefits payments, and almost a fifth (£4.8bn) of the NHS budget. The Office for National Statistics estimates that 2.5 million working age adults are unable to work due to long-term sickness, with 500,000 people having left the jobs market since 2019 due to long-term health problems.
Tackling health inequalities and acting on the social determinants of ill health requires coordinated action from across government. The IHA is calling for a cross-government strategy that considers the role of every government department, using every available policy lever to tackle the factors that make people ill in the first place.
What has the IHA done so far?
Following the publication of Health Equity in England: the Marmot review 10 years on, the RCP wrote to the prime minister along with other Medical Royal Colleges and the Royal Colleges of Midwifery and Nursing urging the government to adopt the recommendations of the report and go further. The RCP then brought the IHA together in October 2020 to campaign for a cross-government strategy. Since then, the IHA has worked with its members to raise the call for a cross-government strategy to reduce health inequalities with decision makers and in the media, including:
- The IHA first wrote to the Prime Minister asking him to develop a cross-government strategy to reduce health inequalities.
- 92 senior leaders of IHA members wrote publicly to Boris Johnson as prime minister to reiterate the call for a cross-government strategy to reduce health inequalities.
- This letter was sent alongside a new policy paper from the RCP, ‘the case for a cross-government strategy’, which included real life stories of how people’s health is damaged by social factors such as poor housing conditions and being unable to afford public transport.
- The IHA issued a briefing to MPs on its calls for a cross-government strategy to reduce health inequalities ahead of a Westminster Hall debate about the Office for Health Improvement and Disparities and health inequalities.
- The government published their flagship Levelling Up White Paper which committed to a Health Disparities White Paper which assured that the DHSC would work with the ‘whole of government to consider health disparities at each stage at which they arise…[including]…the wider determinants of health’.
- The rising cost of living throughout 2022 has had a considerable impact on people’s health. The RCP commissioned a nationwide public poll on behalf of the IHA to look at how the cost of living crisis was affecting people’s health. The poll found that over half of the population (55%) feel their health has been negatively affected by the rising cost of living. Of those who reported their health getting worse, 84% said it was due to increased heating costs, over three quarters (78%) a result of the rising cost of food and almost half (46%) down to transport costs rising.
- Boris Johnson resigned as prime minister in July 2022. The RCP was one of several medical royal colleges calling on the new prime minister to commit to reducing health inequalities by tackling the causes of ill health.
- Rising energy bills are having an adverse effect on people’s health. The RCP commissioned more nationwide polling on behalf of the IHA that found that over two thirds of people (69%) feel more worried about their ability to stay warm and healthy at home that winter (2022) compared to last winter (2021). When asked what they would do if a member of their household needed to use more heating than usual this winter to avoid ill health, only 22% said they would heat their home as necessary because they could afford the cost. The findings were covered by ITV News.
- The RCP published another policy paper, ‘the continued case for a cross-government strategy’.
- Over 155 members of the Inequalities in Health Alliance (IHA) signed a letter to the then secretary of state for health and social care, Dr Thérèse Coffey urging the government to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year.
- After much delay, we learnt that the Health Disparities White Paper had been scrapped.
- The RCP and members of the IHA submitted evidence to the Health and Social Care’s inquiry on prevention calling for it to consider health inequalities and the social determinants of ill health including poor housing, air quality and the marketing of food and alcohol or the availability of tobacco, to employment (including how much money you have), racism and discrimination and transport.
- The IHA issued a briefing for MPs and Peers on the current state of health inequalities, continuing the call for a cross-government strategy.
- The RCP and other members of the IHA submitted to the Labour Party’s National Policy Forum’s Prevention, early intervention and better public services for all Consultation. The RCP called for the Labour Party to adopt a cross-government strategy to reduce health inequalities ahead of the next general election.
- The Labour Party announced that it would establish a ‘mission delivery board’ to ‘bring together all departments with an influence over the social determinants of health’ in its ‘Health Mission’. The RCP welcomed this along with the commitment to halve the gap in healthy life expectancy between different regions in England.
- The RCP and other members of the IHA submitted to the government’s call for evidence on the Major Conditions Strategy (MCS). The RCP said in its response that many factors driving the conditions the MCS is seeking to cover, and health inequalities more widely, sit beyond the NHS and Department of Health and Social Care’s remit.
- 'A Covenant for Health - Policies and partnerships to improve our national health in 5 to 10 years' report was published. The RCP welcomed the report’s recommendation that action be led by the prime minister and chancellor, and that government assesses the health impact of all its policies.
- The government published the interim Major conditions strategy report, the ‘case for change and our strategic framework’. The RCP said it its response that it was reassuring that the interim report recognised that wider social determinants contribute to serious health conditions and called for the full report of the Major Conditions Strategy, due to be published in 2024, to include a cross-government strategy to reduce health inequalities.
- The Liberal Democrats passed a motion at their Autumn Party Conference to prevent ill health, tackle health inequalities and create a ‘health creation’ unit in the Cabinet Office. The RCP welcomed this as well as the commitments to restore the Public Health Grant to at least 2015 levels and wider public health measures.
- The IHA marked its third anniversary, with now over 250 members campaigning for a cross-government strategy to reduce health inequalities.
- The RCP published an updated policy paper reiterating our calls for a cross-government strategy to reduce health inequalities: RCP view on health inequalities: A call to action for a cross-government strategy.
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