The causes are multiple and crucially they extend well beyond what the NHS can deliver. From the cradle to the grave our lives are influenced decisively by the three pillars of social injustice – unfair distribution of wealth, unequal opportunity, and a failure to recognise privilege. People experience them for no reason other than other people choosing not to act to prevent them.<\/p>\n
These injustices are institutionally baked into our lives from cradle to grave- in maternity, in early years, in school and college, in housing, in transport, justice, employment (and unemployment), environment and of course, access to care within the NHS. Scarcity reduces intellectual bandwidth https:\/\/www.theguardian.com\/books\/2013\/aug\/23\/scarcity-sendhil-mullainathan-eldar-shafir<\/a><\/p>\n The imperative to tackle health inequities is a powerful and well-evidenced one. The work of Marmot and the attention by others on the impact of inequalities on specific groups (e.g. BME populations, the poorest communities, disabled citizens for example) or arising from particular circumstances (e.g. Covid) provides the basis for a powerful narrative around the impact on individuals and the wider impact on our economy and society.<\/p>\n Despite this there are multiple obstacles to overcome:<\/p>\n Despite all these obstacles, there are some positive initiatives across the country, sometimes drawing on the NHS as an anchor institution, that signpost the art of the possible.<\/p>\n But how do we unpick and challenge the biases baked into our society that impede sustained equitable improvement in population health and<\/u> tackle workforce inequities in the NHS?<\/p>\n We suggest four key actions are needed:<\/p>\n <\/p>\n <\/p>\n We need a new approach to tackling health equity and social justice in the NHS, avoiding ineffective implementation that wastes scarce resources, disengages staff, and leads to distrust within minority communities \u2013 this is neither affordable nor sustainable. Interventions that are implemented poorly have unintended consequences that set us back on our collective goal to improve population health and promote health equity.<\/p>\n Therefore, we need to make sure that:<\/p>\n Health inequalities are intimately linked to social justice t.\u00a0 https:\/\/www.bmj.com\/content\/371\/bmj.m4049<\/a><\/p>\n We need to put back into the heart of the health and care system a deep sense of values (empathy, kindness, respect, care, meaning) so that everyone experiences this daily in all they do and we need to recognise and unlock the untapped potential that exists if we focus more attention on upstream initiatives in prevention and addressing the root causes of inequalities. https:\/\/centreforpopulationhealth.co.uk\/about-us<\/a><\/p>\n Authors<\/strong><\/p>\n Roger Kline <\/strong>is Research Fellow at Middlesex University Business School.<\/p>\n Dr MaryAnn Ferreux <\/strong>is Executive Medical Director, Health Innovation, Kent Surrey Sussex.<\/p>\n Prof Durka Dougall <\/strong>is Founder of the Centre for Population Health.<\/p>\n Randeep Kaur Kular <\/strong>is\u00a0 Director of Strategic Projects at University Hospitals Birmingham where she leads on the delivery of large-scale complex projects, programmes, and portfolios and is the tactical lead for Health Inequalities. She has previously worked at the Runnymede Trust, the Office of the Deputy Prime Minister, the Cabinet Office and the Department of Health.<\/p>\n Declaration of interests<\/strong><\/p>\n We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.<\/p>\n","protected":false},"excerpt":{"rendered":" Since 2010 there has been a steady stream of legislation, policy initiatives and reports, all intended (in some cases purporting) to tackle health inequalities – which are by definition unfair and avoidable, causing immense damage not only to many of our citizens but to the economy and social fabric of the country too.\u00a0 In the […]<\/p>\n\n
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