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Reducing health inequalities: system, scale and sustainability

Everyone should have the same opportunity to lead a healthy life, no matter where they live or who they are. Health inequalities mean poorer health, reduced quality of life and early death for many people. Reducing these inequalities is at the heart of PHE’s mission to improve the nation’s health but it is challenging because they are often deep-rooted with multiple causes.

The Health and Social Care Act 2012(3) introduced a new system for public health in England. Public Health England was established and local authorities once again took a lead role in public health. Whilst there were no longer specific targets to reduce health inequalities as there had been previously, the Act placed a new legal duty on PHE and NHS England to have due regard to reducing health inequalities. Although other non-health partners may not be covered by this legal duty, all have critical relevant duties under. For example, the Social Value Act 2012(9) and the Public Sector Equality Duty 2010(10) to those with protected characteristics.

In 2013-15, average life expectancy at birth in England was 79.5 years for males and 83.1 years for females. However, health inequalities as measured by the slope index of inequality show that in 2012-14, the gap in life expectancy between people living in the most and least deprived areas was 9.2 years for males and 7.0 years for females. The gap in healthy life expectancy is even greater. In 2013-15, average healthy life expectancy at birth in England was 63.4 years for males and 64.1 years for females and the gap between people living in the most and least deprived areas in 2013-15 was 18.9 years for males and 19.6 years for females (2012-14).

The Public Health Outcomes Framework (PHOF)(11) was developed in 2013 to enable measurement of progress on reducing health inequalities. The PHOF sets out a vision for public health, desired outcomes and the indicators to help us measure how well public health is being improved and protected. Ultimately, we aim to achieve positive progress on two headline indicators set out in both the Shared Delivery Plan(12) for the health system and the PHOF: inequalities in life expectancy and inequalities in healthy life expectancy as measured by the slope index of inequalities. To make steady progress on these two indicators, action needs to be taken on the multiple causes of inequalities, in ways that are structured, systematic and sustained.

This briefing updates the work of the former Health Inequalities National Support Team (HINST)(6) which in its time focused on systematically analysing and reducing health inequalities at scale in areas of greatest deprivation. The principles and conceptual frameworks that evolved with the HINST are still relevant and useful when applied to today’s system. This system pulls these together recent developments, and tools knowledge to create a resource that can be used by public health teams locally to plan their approach to reducing health inequalities effectively at scale.