What is health equity?
The World Health Organization defines health equity as “the absence of unjust and avoidable or remediable differences in health between socially, economically, demographically or geographically defined population groups”.
Important to this definition are differences that are unfair and avoidable. This means that we can do something to achieve health equity by addressing health disparities within individuals, communities and populations.
Why should we aim to achieve health equity?
The mission of the UK Health Security Agency (UKHSA) is to prepare for, prevent and respond to external threats that may affect our health and achieve more equitable outcomes. These hazards include infectious diseases and epidemics, the health effects of climate change and poor air quality, and radiological, chemical and nuclear exposures.
Not everyone experiences external health risks equally. Substantial differences exist between communities and population groups in external health risks, susceptibility to adverse outcomes, and the ability of an individual or community to recover.
For example, women living in the most deprived areas of England spend 19 years longer in poor health than women living in the least deprived areas.
Homeless people have a life expectancy more than 30 years shorter than the general population with a disproportionate burden of infectious diseases such as tuberculosis, hepatitis C and HIV. And during the first wave of the COVID-19 pandemic, men and women of Bangladeshi background were twice as likely to die of Covid-19 than people of white British background—even after accounting for differences in age, gender, deprivation and pre-existing health status.
Reducing these unfair and avoidable differences is essential to realizing the UKHSA’s ambition to tackle the ill-health burden caused by infectious diseases and environmental risks.
At UKHSA, achieving more equitable outcomes is one of our priorities. One of the first steps is to ensure that those working in the organization and our external health partners understand their role in addressing health inequities. We’re adding health equity to everything we do to help us protect every individual, every community.
Addressing the specific health security needs of disproportionately affected communities will help protect the rest of our population. For example, improving childhood immunization rates in underserved communities will reduce the likelihood of local outbreaks of measles and mumps.
Our legal obligations
At UKHSA we also have a legal responsibility to tackle health inequalities. The Equality Act 2010 requires all public sector organizations to tackle discrimination in relation to nine protected characteristics – age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, gender and sexual orientation.
This is known as Public Sector Equality Duty (PSED). Our specific PSED objectives reflect our goal of embedding health equity across our work, and we are monitoring our progress to ensure we meet our legal responsibilities.
What are we doing now about health equity?
We have a dedicated health equity team who are currently looking across our programs, policies and processes to develop our health equity strategy.
This includes adopting a ‘people and pathogens’ approach. This means not only preparing for and responding to external threats like the flu, but also focusing on how best to meet the needs of individuals and communities most at risk among multiple health threats. For example, vulnerable migrants or people exposed to the justice system.
To help with this, we have adopted the Core20PLUS framework originally developed by NHS England. The framework defines the populations and communities that we routinely consider throughout our work to address health disparities.
The Core20 refers to people living in the 20% most deprived areas of the country, as defined by the National Index of Multiple Deprivation – an index made up of seven domains in which people are born, grow up, work, live and age (broad determinants of health) across a range of conditions. ).
PLUS refers to communities and populations defined by protected characteristics such as race, sexuality, and disability; geographic disparities (for example, people living in coastal communities); and inclusion health groups. Inclusion health groups are socially excluded populations that are particularly vulnerable to external health threats.
These groups are also less likely to be represented in routine datasets meaning that inequalities are often hidden. Inclusive health groups include vulnerable migrants, people experiencing homelessness and Gypsy, Roma and Traveler communities.
Our work with Core20PLUS communities and populations includes partnering with relevant community groups to develop culturally sensitive and language-appropriate communication materials in response to disease outbreaks. This ensures that we are more effective in delivering our public health messages to individuals and populations that are often underserved. Another example is providing specific heatstroke advice for vulnerable people living in settings such as care homes and places of detention.
Embedding health equity in our practice means ensuring our broader organizational activities support health equity and inclusion through our hiring policies, how we procure goods and services, and where we build new offices and laboratories.
In addition to considering health equity across our programs, we are focusing on three areas of work:
The first is how we can work with partners and stakeholders to maximize opportunities to improve health equity. This includes national government colleagues such as the NHS and the Office for Health Improvement and Disparities, local and regional stakeholders such as local government and NHS integrated care systems, and voluntary and community organisations.
The second is to improve our data and surveillance – working with the public to better understand the needs of the most disadvantaged and vulnerable populations.
And the third is ensuring that our science strategy informs how we work across society, aiming to improve outcomes for those who need it most. We will ensure that our evaluation helps us understand the impact of our work on tackling health inequalities.
In the coming months, we’ll share some of this work with you through more blogs that look at our health equity data. They will focus on specific hazards and populations to explore health disparities, explain what we do and don’t know from the data, and highlight what can be done to provide more equitable health protection outcomes for our entire population.