Finding a solution to healthcare inequality

There are a mul­ti­tude of rea­sons for the wide vari­a­tion in health­care diag­no­sis and treat­ment across the UK, rang­ing from where some­one lives or works to their gen­der, race and age. 

The inequal­i­ties have been high­light­ed by the coro­n­avirus pan­dem­ic, call­ing for redis­tri­b­u­tion of the lat­est med­ical tech­nol­o­gy and inno­va­tions nation­wide to address such an urgent prob­lem.

But can health­care inequal­i­ty be tack­led effec­tive­ly when fall­out from COVID will see NHS fund­ing stretched as wait­ing lists con­tin­ue to grow? 

Some dis­par­i­ties were already increas­ing before the pan­dem­ic hit, as Impe­r­i­al Col­lege Lon­don’s Dr Jonathan Clarke, co-author of Reduc­ing health­care inequal­i­ties and enhanc­ing the NHS, explains: “In the last decade, life expectan­cy had fall­en for some women in the poor­est parts of the UK. Many improve­ments in pop­u­la­tion health of recent decades have stalled.”

To counter this, and to build on the suc­cess of localised vac­ci­na­tion pro­grammes, one option tout­ed as a poten­tial way for­ward is com­mu­ni­ty diag­nos­tic hubs, sit­ed on high streets or in shop­ping cen­tres. 

Neil Mesh­er, chief exec­u­tive of Philips UK and Ire­land, says: “The will­ing­ness of peo­ple to engage with health ser­vices in non-tra­di­tion­al set­tings, includ­ing super­mar­ket car parks and ded­i­cat­ed vac­ci­na­tion cen­tres, is one les­son we must­n’t over­look. 

“By embed­ding diag­nos­tic capa­bil­i­ties deep­er into the com­mu­ni­ty cen­tres, where so many peo­ple already spend their time and trans­port links are well estab­lished, we can improve the NHS’s abil­i­ty to dis­cov­er and treat health issues more rapid­ly.”

Ex-NHS radi­og­ra­ph­er Jane Ren­dall, man­ag­ing direc­tor of Sec­tra, a diag­nos­tics imag­ing com­pa­ny, adds: “This could alle­vi­ate pres­sures on pathol­o­gy, radi­ol­o­gy and oth­er spe­cial­i­ties in acute envi­ron­ments. The right tech­nol­o­gy needs to be in place to make this hap­pen, for exam­ple the cloud com­put­ing required to allow imag­ing and oth­er dig­i­tal diag­nos­tic data to flow, poten­tial­ly nation­al­ly.” 

At the local lev­el, com­mu­ni­ty phar­ma­cies have also been her­ald­ed as hav­ing a poten­tial­ly big­ger role. But research by Med­i­cine Direct shows this could prove tricky as it found, among near­ly 17,000 of them, there were big dis­par­i­ties in the num­ber of peo­ple they serve. In Lon­don this was 1,131 patients per phar­ma­cy while, for exam­ple, in Sal­is­bury it was almost 6,000. 

Bridging the digital inequality gap

Many tech­no­log­i­cal solu­tions have been offered to solve this inequal­i­ty cri­sis, includ­ing the dig­i­tal­i­sa­tion of records for more effec­tive data analy­sis using advances in arti­fi­cial intel­li­gence, plus more apps to aid diag­no­sis, treat­ment and care. But a sur­vey from dia­betes man­age­ment app Quin showed just one in ten of those ques­tioned had used an app to mon­i­tor their own health con­di­tions, despite 87 per cent agree­ing with their pos­i­tive ben­e­fits. 

To change this, Quin co-founder Cyn­di Williams wants more sup­port and part­ner­ships with the health­care indus­try. She says: “The onus can­not fall sole­ly on the patient to find the right app for them. You would­n’t expect a patient to find the right drug on their own, so it is unrea­son­able and unre­al­is­tic to expect the major­i­ty to find med­ical apps inde­pen­dent­ly.

“The more effec­tive­ly we can inte­grate tech­nol­o­gy with health­care, max­imis­ing access and con­ve­nience and offer­ing guid­ance to suit a patien­t’s indi­vid­ual lifestyle, behav­iours and pref­er­ences, the more we can democ­ra­tise health­care and improve peo­ple’s lives.”

Nicholas Kel­ly, chief exec­u­tive of care tech­nol­o­gy provider Axela, cau­tions on “try­ing to run before we’ve learnt to walk”.

“We’re active­ly talk­ing about video con­sul­tan­cies, remote patient mon­i­tor­ing and elec­tron­ic health records. I think this is amaz­ing and def­i­nite­ly the way for­ward, but in doing that we for­get a large major­i­ty of the coun­try don’t have access to stan­dard broad­band speeds or even have access to tech­nol­o­gy that would facil­i­tate this. So I would like to see more mon­ey spent in bridg­ing the dig­i­tal gap in terms of the use of tech­nol­o­gy,” he says.

Changing attitudes and perception

Such inequal­i­ties are not just phys­i­cal, they exist in men­tal health­care too. Dr Stephani Hatch, pro­fes­sor of soci­ol­o­gy and epi­demi­ol­o­gy at King’s Col­lege Lon­don and lead for its health­care inequal­i­ties research group, will dis­cuss such issues at May’s inter­na­tion­al MQ Sci­ence Sum­mit.

“To tack­le racial and eth­nic inequal­i­ties in men­tal health we need wider recog­ni­tion of racism and dis­crim­i­na­tion as per­va­sive sources of adver­si­ty and in some cas­es trau­ma, which are wit­nessed and expe­ri­enced across insti­tu­tions and over the life course,” she says. 

“We need to see insti­tu­tions demon­strat­ing racial inclu­sion as a prac­tice and an expec­ta­tion in edu­ca­tion and train­ing pipelines and lead­er­ship. Invest­ment is need­ed too in improv­ing racial and eth­nic minor­i­ty rep­re­sen­ta­tion in those con­duct­ing and par­tic­i­pat­ing in men­tal health research.”

Lord Vic­tor Ade­bowale, chair­man of video-col­lab­o­ra­tion plat­form Vision­able, has a sim­i­lar view on inclu­sion. He says to get the most from dig­i­tal adop­tion to advance equi­ty, we must ensure those com­mis­sion­ing ser­vices design them with a fuller under­stand­ing of the needs of the indi­vid­u­als and com­mu­ni­ties they are intend­ed for.

“Pro­cure­ment could oth­er­wise present a clear and present dan­ger to ensur­ing that dig­i­tal tech in health sup­ports increased equi­ty and equal­i­ty in health­care,” he warns.

Empow­er­ment is anoth­er impor­tant fac­tor, with a recent report by Pub­lic Pol­i­cy Projects includ­ing as one of its twelve pol­i­cy rec­om­men­da­tions the need to empow­er patients to become informed co-cre­ators of their own health.

A solu­tion could sim­ply be lis­ten­ing and talk­ing more, says Peter Tay­lor, direc­tor of research at the Insti­tute of Devel­op­ment Stud­ies. “It is rare for the views of those who expe­ri­ence the worst effects of health­care issues to be includ­ed in deci­sion-mak­ing around inter­ven­tions,” he says.

“Lis­ten­ing and engag­ing is essen­tial to rebuild­ing trust and con­fi­dence in health­care providers and inter­ven­tions, which in turn deter­mines take-up and effec­tive­ness. With­out con­sul­ta­tion with the com­mu­ni­ties affect­ed at local, nation­al or glob­al lev­el, there is a huge risk those already left behind will fall even fur­ther behind.”